
1: Int J Circumpolar Health. 2008 Dec;67(5):452-60.

Hearing outcomes after mobile ear surgery for chronic otitis media in Greenland.

Homøe P, Nikoghosyan G, Siim C, Bretlau P.

Department of Otolaryngology, Head & Neck Surgery, Rigshospitalet, University of 
Copenhagen, Denmark. phom@rh.regionh.dk

OBJECTIVES: Chronic otitis media (COM) with hearing loss (HL) occurs frequently
in many populations with limited access to specialized treatment. This article
reports on the hearing outcomes following mobile ear surgery in Greenland. STUDY 
DESIGN: The study was longitudinal and prospective with pre- and post-operative
followup data compiled at 1- and 2-year intervals. METHODS: Selection criterion
included individuals with COM with or without suppuration (CSOM) and with
associated HL. Hearing tests were obtained by using a simple air-conduction (AC) 
audiometry. The median age of the 274 participants was 27 years (8-60 years), and
45% were males. Sixty-one percent had COM and 34% had CSOM. Myringoplasty or
tympanoplasty type I was performed in 88% of the cases. RESULTS: The median
pre-operative AC pure-tone average was 38 dB. The follow-up rate was 75% and 61% 
at 1- and 2-years. Hearing gain was found in 78% at both follow-ups and was > or 
= 10 dB in 62% and 56%, respectively. The median hearing gain was 15 dB and 12
dB, respectively. Independent predictors of hearing gain were pre-operative
tympanic membrane atrophy and closure of perforations. CONCLUSIONS: Long-term
hearing gain can be achieved with mobile ear surgery and this, in addition to
tympanic membrane closure, is important for hearing rehabilitation in populations
with poor access to health care.

PMID: 19186766 [PubMed - indexed for MEDLINE]

2: In Vivo. 2008 Nov-Dec;22(6):763-5.

Antibacterial effect of octylcyanoacrylate against methicillin-resistant
Staphylococcus aureus isolates from patients with chronic suppurative otitis
media.

Jang CH, Park H, Choi CH, Cho YB, Park IY.

Department of Otolaryngology, Chonnam National University Medical School,
Gwangju, South Korea. chulsavio@hanmail.net

There has been a steady increase in the number of cases of methicillin-resistant 
Staphylococcus aureus (MRSA) otorrhea; this is a growing medical concern. For
otological surgery in children, octylcyanoacrylate can be an alternative method
of closure for surgical incisions. Recent in vitro studies have shown that
octylcyanoacrylate is effective as an antimicrobical barrier. To date, there have
been only rare reports on the antibacterial effect of octylcyanoacrylate against 
MRSA. The purpose of this study is to determine the antimicrobial effects of
octylcyanoacrylate against the MRSA that was isolated from patients with chronic 
suppurative otitis media. MATERIALS AND METHODS: Clinical MRSA (n=20) bacteria
and methicillin-sensitive SA (MSSA) (n=20) were obtained from patients. The
susceptibilities to various antibiotics were determined by disk diffusion method.
RESULTS: MSSA was sensitive to octylcyanoacrylate. The antibacterial activity of 
octylcyanoacrylate was weak against MRSA. CONCLUSION: Our results demonstrated
that octylcyanoacrylate has slight antibacterial activity against MRSA.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 19181004 [PubMed - indexed for MEDLINE]

3: Arch Otolaryngol Head Neck Surg. 2009 Jan;135(1):33-9.

Gene expression differences in infected and noninfected middle ear complementary 
DNA libraries.

Kerschner JE, Horsey E, Ahmed A, Erbe C, Khampang P, Cioffi J, Hu FZ, Post JC,
Ehrlich GD.

Department of Otolaryngology and Communications Disorders, Children's Hospital of
Wisconsin, 9000 W Wisconsin Ave, Milwaukee, WI 53226, USA. kersch@mcw.edu

OBJECTIVES: To investigate genetic differences in middle ear mucosa (MEM) with
nontypeable Haemophilus influenzae (NTHi) infection. Genetic upregulation and
downregulation occurs in MEM during otitis media (OM) pathogenesis. A
comprehensive assessment of these genetic differences using the techniques of
complementary DNA (cDNA) library creation has not been performed. DESIGN: The
cDNA libraries were constructed from NTHi-infected and noninfected chinchilla
MEM. Random clones were picked, sequenced bidirectionally, and submitted to the
National Center for Biotechnology Information (NCBI) Expressed Sequence Tags
database, where they were assigned accession numbers. These numbers were used
with the basic local alignment search tool (BLAST) to align clones against the
nonredundant nucleotide database at NCBI. RESULTS: Analysis with the Web-based
statistical program FatiGO identified several biological processes with
significant differences in numbers of represented genes. Processes involved in
immune, stress, and wound responses were more prevalent in the NTHi-infected
library. S100 calcium-binding protein A9 (S100A9); secretory leukoprotease
inhibitor (SLPI); beta(2)-microglobulin (B2M); ferritin, heavy-chain polypeptide 
1 (FTH1); and S100 calcium-binding protein A8 (S100A8) were expressed at
significantly higher levels in the NTHi-infected library. Calcium-binding
proteins S100A9 and S100A8 serve as markers for inflammation and have
antibacterial effects. Secretory leukoprotease inhibitor is an antibacterial
protein that inhibits stimuli-induced MUC1, MUC2, and MUC5AC production.
CONCLUSIONS: A number of genes demonstrate changes during the pathogenesis of OM,
including SLPI, which has an impact on mucin gene expression; this expression is 
known to be an important regulator in OM. The techniques described herein provide
a framework for future investigations to more thoroughly understand molecular
changes in the middle ear, which will likely be important in developing new
therapeutic and intervention strategies.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 19153305 [PubMed - indexed for MEDLINE]

4: Arch Otolaryngol Head Neck Surg. 2009 Jan;135(1):28-32.

Existence of important variations in the United States in the treatment of
pediatric mastoiditis.

Acevedo JL, Lander L, Shah UK, Shah RK.

Department of Otolaryngology-Head and Neck Surgery, National Capitol
Consortium,Washington, DC, USA.

OBJECTIVE: To determine national variations in resource utilization in the
treatment of pediatric mastoiditis. DESIGN: Retrospective review. SETTING:
National pediatric inpatient database. PATIENTS: The Kids' Inpatient Database for
2003 was used to extract data for admissions for mastoiditis. RESULTS: A total of
1049 patients (57% were male, and the mean age was 6.3 years) were identified.
Median total charges for an admission were $9600; total charges were less than
$28,604 in 90% of admissions. The mean length of stay (LOS) was 4.3 days (range, 
0-87 days). A total of 792 procedures were performed; 50.0% of patients underwent
tympanostomy tube placement and/or myringocentesis, and 21.6% underwent
mastoidectomy. The LOS for nonsurgical patients was 3.7 days. The LOS for
children undergoing tube placement was 4.6 days, with mean total charges of
$15,713; for mastoidectomy, the LOS was 5.5 days, with mean total charges of
$23,185. The primary payer was private insurance in 51.5% and Medicaid in 39.4%. 
Predictors of increased charges were treatment at teaching hospitals (P = .005), 
treatment at children's hospitals (P < .001), LOS (P < .001), the number of
procedures (P < .001), and hospital region (P = .003). Wide geographic variation 
was noted with respect to the mean total charges per admission, which ranged from
$5016 to $35,898. CONCLUSIONS: In 2003, the median charge for a pediatric
mastoiditis admission was $9600; 50% of patients underwent tympanostomy tube
placement, and about 21.6% underwent a mastoidectomy. There was wide variation in
total charges for admissions. Resource utilization was higher in teaching
hospitals and in children's' hospitals.

PMID: 19153304 [PubMed - indexed for MEDLINE]

5: Arch Otolaryngol Head Neck Surg. 2009 Jan;135(1):17-21.

Rate of concurrent otitis media in upper respiratory tract infections with
specific viruses.

Alper CM, Winther B, Mandel EM, Hendley JO, Doyle WJ.

Department of Otolaryngology, Children's Hospital of Pittsburgh and University of
Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. Cuneyt.Alper@chp.edu

OBJECTIVE: To estimate the coincidence of new otitis media (OM) for first
nasopharyngeal detections of the more common viruses by polymerase chain reaction
(PCR). New OM episodes are usually coincident with a viral upper respiratory
tract infection (vURTI), but there are conflicting data regarding the association
between specific viruses and OM. DESIGN: Longitudinal (October-March),
prospective follow-up of children for coldlike illness (CLI) by diary, middle ear
status by pneumatic otoscopy, and vURTI by PCR. SETTING: Academic medical
centers. PARTICIPANTS: A total of 102 families with at least 2 children aged
between 1 and 5 years (213 children; mean [SD] age, 3.7 [1.5] years; 110 male;
and 176 white) were recruited from the local communities at 2 study sites by
advertisement. MAIN OUTCOME MEASURES: New OM and CLI episodes and nasopharyngeal 
virus detections. RESULTS: A total of 176 children (81%) had isolated PCR
detection of at least 1 virus. The OM coincidence rates were 62 of 144 (44%) for 
rhinovirus, 15 of 27 (56%) for respiratory syncytial virus, 8 of 11 (73%) and 1
of 5 (20%) for influenza A and B, respectively, 6 of 12 (50%) for adenovirus, 7
of 18 (39%) for coronavirus, and 4 of 11 (36%) for parainfluenza virus detections
(P = .37). For rhinovirus, new OM occurred in 50% of children with and 32%
without a concurrent CLI (P = .15), and OM risk was predicted by OM and
breastfeeding histories and by daily environment outside the home. CONCLUSIONS:
New OM was associated with nasopharyngeal detection of all assayed viruses
irrespective of the presence or absence of a concurrent CLI. Differences among
viruses were noted, but statistical significance was not achieved, possibly
because of the low power associated with the small number of nonrhinovirus
detections.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 19153302 [PubMed - indexed for MEDLINE]

6: Ann Allergy Asthma Immunol. 2008 Dec;101(6):559-67; quiz 567-9, 636.

Antibiotics for the allergist: part 1.

La Shell MS, Tankersley MS.

Department of Allergy and Immunology, Wilford Hall Medical Center, Lackland Air
Force Base, San Antonio, Texas 78236, USA. mark.lashell@lackland.af.mil

OBJECTIVE: To review antibiotic use and selection for disorders commonly seen in 
allergy practice. DATA SOURCES: MEDLINE searches were performed cross-referencing
the keywords antibiotic, antimicrobial, management, and treatment with multiple
disorders commonly seen in allergy practice. References of the chosen articles
were also examined. STUDY SELECTION: Articles were selected based on their
relevance to the subject matter. RESULTS: A large body of research is available
that is relevant to both conventional and novel uses of antibiotics. The use of
antibiotics is in question for some disorders, whereas novel approaches to
therapy with macrolide antibiotics are areas of active investigation. Meanwhile, 
patterns of microbial resistance continue to evolve. CONCLUSION: For decades,
antibiotics have been traditional first-line treatments for many disorders.
Recently, this paradigm appears to be shifting as periods of observation come
into favor and nonbacterial causes of inflammation are under greater scrutiny.
Nonetheless, appropriate antibiotic selection often remains a key element in the 
treatment of these disorders. Knowledge of the relevant microbiology is an
inherent requirement in selecting antibiotic therapies and necessitates awareness
of current trends in bacterial resistance.

Publication Types: 
    Review

PMID: 19119699 [PubMed - indexed for MEDLINE]

7: J Zoo Wildl Med. 2008 Dec;39(4):667-70.

Magnetic resonance imaging findings in a red kangaroo (Macropus rufus) with
otitis.

Okeson DM, Coke RL, Kochunov P, Davis MD.

San Antonio Zoo, 3903 North Saint Mary's Street, San Antonio, Texas 78212, USA.
dmodvm@sbcglobal.net

Magnetic resonance imaging (MRI) was performed on an adult, male Red kangaroo
(Macropus rufus) with a history of nonspecific neurologic signs and acute
discharge from the left ear. MRI revealed findings consistent with otitis and
possible osteomyelitis of the temporal and mastoid bones. To the authors'
knowledge, this is the first report of otitis and MRI findings in a kangaroo.

Publication Types: 
    Case Reports

PMID: 19110716 [PubMed - indexed for MEDLINE]

8: J Int Med Res. 2008 Nov-Dec;36(6):1255-60.

Decline in pneumonia and acute otitis media after the introduction of childhood
pneumococcal vaccination in Liguria, Italy.

Ansaldi F, Sticchi L, Durando P, Carloni R, Oreste P, Vercelli M, Crovari P,
Icardi G.

Department of Health Sciences, University of Genoa, Italy.

The effect of the pneumococcal conjugate vaccine immunization programme on
pneumococcal-associated or potentially pneumococcal-associated hospital
admissions in the Italian region of Liguria was assessed. Hospital admission
rates were compared in subjects belonging to birth cohorts before and after the
introduction of widespread immunization for 0 - 2-year old children with a
seven-valent conjugate vaccine (PCV7). Significant reductions in hospitalization 
rates for all-cause and pneumococcal pneumonia and for acute otitis media were
observed in subjects born after widespread uptake of the vaccine. The preventive 
fraction (a measure of vaccine effectiveness) ranged from 15.2% for all cause
pneumonia to 70.5% for pneumococcal pneumonia. This study contributes to the
growing body of information that supports the beneficial effect of PCV7
vaccination.

PMID: 19094434 [PubMed - indexed for MEDLINE]

9: Expert Rev Vaccines. 2009 Jan;8(1):77-90.

Current progress with Moraxella catarrhalis antigens as vaccine candidates.

Mawas F, Ho MM, Corbel MJ.

Division of Bacteriology, National Institute for Biological Standards and
Control, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN63QG, UK.
fmawas@nibsc.ac.uk

The success of the immunization programs against Haemophilus influenzae type b
and, more recently, Streptococcus pneumoniae in developed and some developing
countries has demonstrated that invasive disease caused by these bacteria can be 
very effectively controlled by vaccination. There is also evidence that
pneumococcal vaccines can reduce the incidence of acute otitis media in children.
More complete control of this disease would be achieved if infections caused by
Moraxella catarrhalis and nontypeable H. influenzae, the other common agents of
otitis media in children and of a number of respiratory-associated infections in 
both children and adults, could also be controlled. Since these bacteria do not
possess capsules and are not known to secrete exotoxins, the search for vaccine
candidates has focused on the conserved epitopes exposed on the bacterial outer
membrane. In this article, we review the contribution of M. catarrhalis to
disease and recent advances in the development and testing of various vaccine
candidates against this bacterium, including those still in the development stage
and those approaching clinical trials. Recommendations are proposed for
approaches needed for the standardization of assays and use of appropriate animal
models for quality-control testing of these vaccine candidates. Regulatory issues
surrounding vaccines of this type are also discussed.

Publication Types: 
    Review

PMID: 19093775 [PubMed - indexed for MEDLINE]

10: Orbit. 2008;27(6):462-5.

Acute suppurative otitis media: an unusual cause of orbital apex syndrome.

Sethi A, Sareen D, Mrig S, Agarwal AK, Khera PS.

Department of ENT, Maulana Azad Medical College and Associated L. N. Hospital,
New Delhi, India.

We report the case of a 40-year-old female who presented to us with earache and a
rapidly progressive painful ophthalmoplegia involving the right eye with right
temporal swelling. A clinical and radiological assessment revealed it to be
temporal cellulitis with orbital apex syndrome secondary to acute otitis media.
In spite of prompt initiation of treatment, the patient died within 30 hr of
presentation. The case is discussed in detail with a brief review of medical
literature.

Publication Types: 
    Case Reports

PMID: 19085305 [PubMed - indexed for MEDLINE]

11: Otol Neurotol. 2009 Jan;30(1):64-9.

Modified Bondy's technique: refinements of the surgical technique and long-term
results.

Sanna M, Facharzt AA, Russo A, Lauda L, Pasanisi E, Bacciu A.

Gruppo Otologico, Piacenza, Rome, Italy. mario.sanna@gruppootologico.it

OBJECTIVE: To evaluate the short- (6 mo) and long-term (5 yr) outcomes of
modified Bondy technique, with particular reference to hearing results. STUDY
DESIGN: Retrospective study. SETTING: Quaternary referral otology and cranial
base center. PATIENTS: Two hundred thirty ears of 222 patients were operated on, 
using a modified Bondy technique between 1983 and 2005. All patients had primary 
acquired epitympanic cholesteatomas with intact pars tensa and intact ossicular
chain in normal or good-hearing ear. Preoperative audiometric results revealed a 
mean air conduction pure-tone average of 27.7 +/- 9.6 dB (range, 10-65 dB) and a 
mean bone conduction pure-tone average of 14.2 +/- 6.4 dB (range, 5-50 dB). The
mean preoperative air-bone gap was 13.5 +/- 6.7 dB (range, 0-25 dB). The average 
length of follow-up was 7.8 years (range, 5-16 yr). RESULTS: There was no
recurrent cholesteatoma in the present series. A pearl-like residual
cholesteatoma was found in the cavity in 7.4% of ears. Two patients (0.8%)
developed stenosis of meatoplasty. Three ears (1.3%) exhibited retraction pockets
extending to the attic. Postoperative discharging ear was observed in 3% of cases
and was successfully treated with topical drops. At the long-term follow-up, the 
air-bone gap was unchanged or improved from the preoperative level in 88% of
cases. The mean postoperative short- and long-term air-bone gaps were 14.6 +/-
8.5 dB (range, 0-55 dB) and 14.1 +/- 8.2 dB (range, 0-50 dB), respectively.
Postoperative high-frequency sensorineural hearing loss with bone conduction
worsening between 20 and 30 dB at 4 kHz was observed in 4 cases (1.7%). No dead
ears were encountered postoperatively. CONCLUSION: A modified Bondy operation is 
recommended in selected cases of epitympanic cholesteatoma in normal or
good-hearing ear with an intact pars tensa and ossicular chain. Modified Bondy
technique ensures complete eradication of disease while preserving a good
preoperative hearing in 1-stage operation.

PMID: 19034202 [PubMed - indexed for MEDLINE]

12: APMIS. 2008 Sep;116(9):785-90.

Alloiococcus otitidis--otitis media pathogen or normal bacterial flora?

Tano K, von Essen R, Eriksson PO, Sjöstedt A.

Department of Clinical Science, Otorhinolaryngology, Sunderby Hospital, Luleå,
Sweden. krister.tano@nll.se

During the last decade a new potential otitis media pathogen, Alloiococcus
otitidis, has been studied. It is still not clear whether this bacterium really
is a pathogen, although it has been found in a high percentage of middle ear
effusions in children. The present study aimed to investigate the presence of A. 
otitidis in the nasopharynx and outer ear canals, and to develop a culture method
that would make it possible to isolate A. otitidis from these locations.
Nasopharyngeal samples (n = 129) from children below 6 years were investigated by
conventional culture on blood agar plates with 6% saline and rabbit antisera
against A. otitidis, and by a PCR method. In the same way, we investigated 10
samples from vestibulum nasi of healthy persons, 68 samples from outer ear canals
of patients with acute or chronic ear problems, and 24 samples from outer ear
canals of healthy persons. In a rat model of acute otitis media, we instilled
living A. otitidis into rat middle ears through the tympanic bulla and evaluated 
the outcome clinically by otomicroscopy at days 3, 6 and 14. Of the 129
nasopharyngeal cultures, 9 were positive for A. otitidis by PCR, but none by the 
culture method. Of the 68 samples from patients with running ears, 4 were
positive for A. otitidis by PCR, but none by the culture method. Of the 24
healthy ear canals, 7 were positive for A. otitidis by PCR and 3 of them also by 
the culture method. No A. otitidis could be found from the vestibulum nasi. The
rat experiment showed that the reactions in the middle ears were mild; we could
not provoke a purulent acute otitis media in any of the rats. There was a 7%
prevalence of A. otitidis in children below 6 years. The highest prevalence (29%)
was found in outer ear canals of healthy persons, which strongly suggests that A.
otitidis is part of the normal bacterial flora of the outer ear canal. The
doubtful pathogenicity is also confirmed by the fact that--in the rat model--A.
otitidis elicited only a mild response in the middle ear. It was possible to
isolate A. otitidis using a blood agar plate with 6% saline.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 19024598 [PubMed - indexed for MEDLINE]

13: Curr Opin Otolaryngol Head Neck Surg. 2008 Dec;16(6):543-7.

Bench and bedside advances in otitis media.

Kerschner JE.

Division of Pediatric Otolaryngology, Department of Otolaryngology and
Communication Sciences, MedicalCollege of Wisconsin, Children's Hospital of
Wisconsin, Milwaukee, Wisconsin 53226, USA. kersch@mcw.edu

PURPOSE OF REVIEW: Otitis media continues to be an important pediatric illness
and requires significant expenditures in management and treatment. Despite its
prevalence and importance, clinicians often have significant knowledge deficits
regarding the most up-to-date research or clinical thinking regarding this
disease. The present review aims to discuss recent and important publications
related to otitis media and present an analysis of some of these findings. RECENT
FINDINGS: Major basic science and clinical themes related to otitis media are
discussed and include the importance of biofilms in otitis media pathogenesis,
the evidence that otitis media with effusion impacts development, the impact of
otitis media treatment on quality of life, risk factors associated with otitis
media and current concepts with respect to vaccine strategies and otitis media.
SUMMARY: Important basic and clinical research in the field of otitis media
continues to clarify our understanding of the pathogenesis of this disease and
drive new paradigms in treatment and clinical management.

PMID: 19023908 [PubMed - indexed for MEDLINE]

14: Arch Otolaryngol Head Neck Surg. 2008 Nov;134(11):1155-8.

Efficacy of tympanoplasty without mastoidectomy for chronic suppurative otitis
media.

Webb BD, Chang CY.

Department of Otolaryngology, University of Texas at Houston, Houston, Texas,
USA.

OBJECTIVE: To compare the efficacy of tympanoplasty without mastoidectomy in
patients with chronic suppurative otitis media (CSOM) vs efficacy in those with
dry tympanic membrane (TM) perforations. DESIGN: Retrospective controlled study
based on a prospective database. SETTING: Academic tertiary referral center.
PATIENTS: A total of 150 consecutive patients without cholesteatoma with CSOM or 
dry perforations alone who underwent tympanoplasty without mastoidectomy from
January 2000 through December 2005. INTERVENTION: Tympanoplasty without
mastoidectomy. MAIN OUTCOME MEASURE: Perforation recurrence. Independent
variables were age, surgical approach, perforation size, and revision surgery.
RESULTS: The TM graft failure rate was not significantly worse in the CSOM group 
compared with the dry perforation group (P = .48). The independent variables
studied were not statistically related to the success of tympanoplasty except
that revision surgery was associated with a slightly reduced success rate (P =
.03). CONCLUSIONS: The success rate of tympanoplasty without mastoidectomy is at 
least as good for patients with CSOM as it is for patients with perforation
without prior otorrhea. Age (P = .28), perforation size (P = .11), and surgical
approach (P = .82) were not significantly related to success rate. Revision
surgery was associated with a slightly lower success rate.

Publication Types: 
    Comparative Study

PMID: 19015443 [PubMed - indexed for MEDLINE]

15: Transpl Infect Dis. 2009 Feb;11(1):72-4. Epub 2008 Oct 30.

Unusual presentation of Ramsay Hunt syndrome in renal transplant patients: case
report and literature review.

Mortada RA, El Fakih RO, Assi M.

Department of Medicine, Internal Medicine, University of Kansas School of
Medicine-Wichita, Wichita, Kansas, USA. ramimortada@hotmail.com

Ramsay Hunt syndrome (RHS) is a rare manifestation of varicella zoster virus
(VZV) infection that accounts for around 12% of all cases of facial paralysis.
Although it is more common in immunosuppressed individuals, it has not been yet
reported in kidney transplant recipients. We describe the case of a 41-year-old
man with a history of renal transplant for whom the diagnosis and treatment of
RHS were delayed owing to an unusual presentation. We also review the literature 
on VZV infection in renal transplant patients.

Publication Types: 
    Case Reports
    Review

PMID: 19000154 [PubMed - indexed for MEDLINE]

16: Ann Otol Rhinol Laryngol. 2008 Oct;117(10):727-30.

Recovery of potential pathogens in the nasopharynx of healthy and otitis
media-prone children and their smoking and nonsmoking parents.

Brook I, Gober AE.

Department of Pediatrics, Georgetown University School of Medicine, Washington,
DC, USA.

OBJECTIVES: Exposure to smoking is associated with colonization with pathogenic
bacteria. This study investigated the frequency of isolation of potential
pathogens in the nasopharynx of healthy and otitis media-prone (OMP) children and
their smoking or nonsmoking parents. METHODS: Posterior nasopharynx cultures were
taken from 40 healthy and 40 OMP children and one of their parents. Twenty
parents in each group were smokers. Potential pathogenic organisms were
identified. RESULTS: In the healthy children whose parents smoked, 15 potential
pathogens were isolated from the parents and 13 were recovered from their
children. Among the healthy children whose parents were nonsmokers, 3 potential
pathogens were isolated from 2 parents (p < 0.005, compared to the parents and
children in the smoking group) and 7 were recovered from their children. In the
OMP children whose parents smoked, 16 potential pathogens were isolated from the 
parents and 19 were found in their children. Among the OMP children with
nonsmoking parents, 3 potential pathogens were isolated from the parents (p <
0.001, compared to the parents and children in the OMP smoking group and the
healthy children in the nonsmoking parents group) and 17 were recovered from
their children. CONCLUSIONS: Parents who smoke are more often colonized with
pathogens than those who do not smoke. The nasopharynx of healthy children of
smokers harbors a high number of pathogens that are similar to the flora found in
their parents and OMP children. Pathogenic organisms were found more often in OMP
children of both smoking and nonsmoking parents, as compared to healthy children 
whose parents were nonsmokers. Concordance with pathogens in the parent was high 
among the OMP children of smoking parents, but this was not observed in the OMP
children of nonsmokers.

Publication Types: 
    Comparative Study

PMID: 18998498 [PubMed - indexed for MEDLINE]

17: J Infect Dis. 2008 Dec 15;198(12):1862-9.

Myeloid differentiation primary response gene 88 is required for the resolution
of otitis media.

Hernandez M, Leichtle A, Pak K, Ebmeyer J, Euteneuer S, Obonyo M, Guiney DG,
Webster NJ, Broide DH, Ryan AF, Wasserman SI.

Department of Pediatrics, Division of Allergy, Immunology, Rheumatology, and
Infectious Diseases, University of North Carolina at Chapel Hill School of
Medicine, Chapel Hill, NC, USA.

BACKGROUND: Signaling defects in the Toll-like receptor (TLR) pathway, such as
interleukin-1 receptor-associated kinase 4 deficiency, highlight the prominence
of TLR signaling in the defense against bacterial disease. Because myeloid
differentiation primary response gene 88 (MyD88) can transduce signals from
almost all TLRs, we studied its role in otitis media (OM), the most common upper 
respiratory tract bacterial infectious disease in young children. METHODS: The
middle ears (MEs) of wild-type (WT) and MyD88(-/-) mice were inoculated with
nontypeable Haemophilus influenzae (NTHi). ME infection and inflammation were
monitored for 21 days after surgery. Bone marrow-derived macrophages from WT and 
MyD88(-/-) mice were infected with NTHi in vitro to assess their interaction with
bacteria. RESULTS: In WT mice, MyD88 expression was detected in the ME stroma at 
baseline. MyD88(-/-) mice displayed prolonged ME mucosal thickening and delayed
recruitment of neutrophils and macrophages. Although WT mice cleared NTHi within 
5 days, viable NTHi were isolated for up to 21 days in MyD88(-/-) mice. The
interaction between macrophages and NTHi was significantly altered in MyD88(-/-) 
mice. CONCLUSIONS: In this mouse model, MyD88-mediated signaling was important
for clearance of infection and resolution of inflammation in acute OM due to
NTHi. The role played by innate signaling in children susceptible to chronic or
recurrent OM deserves further study.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18986247 [PubMed - indexed for MEDLINE]

18: ORL J Otorhinolaryngol Relat Spec. 2008;70(6):389-92. Epub 2008 Nov 4.

Serum and middle ear immunoglobulins in suppurative otitis media.

Lasisi AO, Arinola OG, Bakare RA.

Department of Otorhinolaryngology, College of Medicine, University of Ibadan,
Ibadan, Nigeria. akeemlasisi@gmail.com

BACKGROUND AND PURPOSE: Despite the increasing occurrence of suppurative otitis
media (SOM), the content of immunoglobulin fractions in the middle ear secretion 
(MES) has still not been determined. METHOD: The serum and MESwere analyzed for
IgG and M using enzyme-linked immunoassay. RESULT: The subjects and controls were
30 males and 22 females, between 6 months and 9 years old, with a mean age of 6
years (SD = 3.26). The patient group included 20 chronic SOM (CSOM) and 17 acute 
SOM (ASOM) cases, and sera of 15 subjects made the control group. The mean serum 
IgG levels were for controls 1,051 mg/dl, ASOM 666.1 mg/dl and CSOM 1,321.1
mg/dl; the MES levels were for ASOM 203.4 mg/dl and CSOM 511.5 mg/dl. The mean
serum IgM levels were for controls 35 mg/dl, ASOM 64.1 mg/dl and CSOM 40 mg/dl;
the MES levels were for ASOM 22.59 mg/dl and CSOM 3.44 mg/dl. The mean MES:serum 
ratios for IgG and IgM were between 0.1 and 0.4 in ASOM and CSOM. The ratio of
serum IgG levels of controls to ASOM cases was 0.66 while that of controls to
CSOM was 1.3. The corresponding ratios of IgM were 1.6 and 0.88. Multivariate
analysis revealed a significant correlation between serum IgG levels of ASOM and 
CSOM (p = 0.043) and MES IgG (p = 0.02) in ASOM and CSOM but no correlation
between serum IgG levels in controls and ASOM (p = 0.25), serum IgM levels in
controls and CSOM (p = 0.62) and serum IgM levels in controls and ASOM (p =
0.73), ASOM and CSOM (p = 0.064) and MES IgM levels of ASOM and CSOM (p = 0.06). 
CONCLUSIONS: Monitoring of the serum and MES IgG in ASOM may provide a useful
index to assess the possibility of progression to chronicity. This forms a
database for the immunological status of SOM patients. Copyright 2008 S. Karger
AG, Basel.

Publication Types: 
    Comparative Study

PMID: 18984975 [PubMed - indexed for MEDLINE]

19: Otolaryngol Head Neck Surg. 2008 Nov;139(5):665-70.

The relationship between chronic otitis media-induced hearing loss and the
acquisition of social skills.

Bidadi S, Nejadkazem M, Naderpour M.

Student Research Committee, Faculty of Medicine, Tabriz University of Medical
Sciences, Tabriz, Iran. bidadi@tabrizu.ac.ir

OBJECTIVE: To investigate the effects of hearing loss caused by chronic otitis
media (COM) on acquiring social skills. SUBJECTS AND METHODS: A case-control
study of 90 patients, including patients with COM, age range 15-30 years, was
conducted in the otorhinolaryngology ward of Tabriz University Hospital. Social
skills were assessed with a social skills questionnaire. RESULTS: Social skill
scores were found to be lower in hearing-impaired COM patients compared with the 
control group (P < 0.001). Social skill disabilities in patients with bilateral
COM were more severe than in patients with unilateral COM and the controls (P <
0.001). Correlation between social skills score and degree of hearing loss was
significantly negative (P = 0.014, rho = -0.314). These data indicate an inverse 
relationship between hearing loss and social skills. CONCLUSION: Social skills
and educational level of COM patients are affected because of hearing impairment.
This study suggests that COM has effects on social development and education.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18984261 [PubMed - indexed for MEDLINE]

20: Otolaryngol Head Neck Surg. 2008 Nov;139(5):646-53.

Control of chronic otitis media and sensorineural hearing loss in C3H/HeJ mice:
glucocorticoids vs mineralocorticoids.

MacArthur CJ, Kempton JB, DeGagne J, Trune DR.

Oregon Hearing Research Center, Department of Otolaryngology-Head and Neck
Surgery, Oregon Health and Science University, Portland, OR, USA.
macarthc@ohsu.edu

OBJECTIVE: The impact of glucocorticoids and mineralocorticoids on chronic otitis
media (COM) in toll-like receptor 4-deficient C3H/HeJ mice was investigated.
STUDY DESIGN: To evaluate control of COM by steroids with differences in their
anti-inflammatory (prednisolone, dexamethasone), and fluid absorption functions
(fludrocortisone, aldosterone). A minimum sample size of five animals for each
group was required based on power analysis calculations. Sample sizes ranged from
7 to 17 mice per treatment group. SUBJECTS AND METHODS: Auditory brain stem
response (ABR) thresholds were performed at baseline, 2 weeks and 4 weeks.
Histopathologic test results were evaluated on all mice ears at the end of the
study. RESULTS: Analysis of variance (ANOVA) of ABR threshold change showed
significant treatment effects (P < 0.05) by both steroid types at all time
intervals and ABR frequencies except 4 weeks/8 kHz. Histologic assessment showed 
prednisolone-treated mice (62%) had a higher rate of clearance of middle and
inner ear inflammation than control mice (4%). CONCLUSION: It was concluded that 
steroid treatments can improve the physiology of chronic middle and inner ear
disease seen with COM.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural

PMID: 18984258 [PubMed - indexed for MEDLINE]

21: Can Vet J. 2008 Aug;49(8):785-8.

Comparative study of the microbial profile from bilateral canine otitis externa.

Oliveira LC, Leite CA, Brilhante RS, Carvalho CB.

Department of Pathology and Legal Medicine, Federal University of Ceará, DPML/UFC
60441-750 Fortaleza-CE, Brazil. lisveterinaria@yahoo.com.br

Fifty dogs with bilateral otitis externa were studied over a 10-month period. The
exudates of both external ears were obtained, using sterile swabs, and
microorganisms were isolated according to standard microbiological techniques.
Antimicrobial susceptibility testing of Staphylococcus intermedius was done by
the agar diffusion method. There was bacterial and/or fungal growth in all of the
samples. These were all polymicrobial infections. Anaerobic bacteria were not
isolated in any sample. The most common pathogens isolated were S. intermedius
and Malassezia pachydermatis. A statistically significant difference (P < 0.05)
was observed in the isolation pattern between the right and left ears in 34 of
the 50 animals (68%). High resistance rates of S. intermedius strains to
penicillin, ampicillin, erythromycin, tetracycline, and clindamycin were found.
The results suggest that in bilateral canine otitis externa, each ear should be
cultured separately and considered as separate units.

PMID: 18978972 [PubMed - indexed for MEDLINE]

22: Biochem Biophys Res Commun. 2008 Dec 19;377(3):763-8. Epub 2008 Oct 26.

Glucocorticoids inhibit nontypeable Haemophilus influenzae-induced MUC5AC mucin
expression via MAPK phosphatase-1-dependent inhibition of p38 MAPK.

Komatsu K, Jono H, Lim JH, Imasato A, Xu H, Kai H, Yan C, Li JD.

Department of Microbiology & Immunology, University of Rochester Medical Center, 
601 Elmwood Avenue, Rochester, NY 14642, USA.

Glucocorticoids are highly effective in the control of many inflammatory and
immune diseases. Despite the importance of glucocorticoids in suppressing immune 
and inflammatory responses, the molecular basis for the inhibitory effect of
glucocorticoids on mucin overproduction, a hallmark of chronic respiratory
diseases, still remains unclear. Here we show that glucocorticoids markedly
inhibit up-regulation of MUC5AC induced by NTHi, a major human bacterial pathogen
causing chronic obstructive pulmonary disease and otitis media. Inhibition of
NTHi-induced MUC5AC expression by dexamethasone occurs at the level of p38 MAPK
via glucocorticoid receptor. Moreover, glucocorticoids up-regulate MKP-1
expression, which in turn leads to p38 dephosphorylation and the subsequent
inhibition of NTHi-induced MUC5AC expression. These studies provide new insight
into the molecular mechanism underlying glucocorticoid therapy and may lead to
novel therapeutic intervention for inhibiting mucin overproduction in patients
with NTHi infections.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18957283 [PubMed - indexed for MEDLINE]

23: J Korean Med Sci. 2008 Oct;23(5):762-6.

Epidemiological and genetic characterization of methicillin-resistant
Staphylococcus aureus isolates from the ear discharge of outpatients with chronic
otitis media.

Yang JA, Kim JY, Yoon YK, Kim S, Park DW, Sohn JW, Sim HS, Kim MJ.

Department of Internal Medicine, College of Medicine, Research Institute of
Emerging Infectious Diseases, Korea University, Seoul, Korea.

The origin of methicillin-resistant Staphylococcus aureus (MRSA) strains from
otolaryngology outpatients has not been evaluated yet in Korea. We analyzed
epidemiologic and genetic characteristics of MRSA isolates from the ear discharge
of 64 outpatients with chronic otitis media in a Korean University Hospital
during 2004. MRSA strains were grouped as either from the initial visit (n=33) or
the follow-up visit (n=31) based on the timing of isolation.
Healthcare-associated risk factors were frequently present among patients of the 
initial visit group, especially prior visit to primary clinic (79%) and
antibiotic use (73%). SCCmec typing and multilocus sequence typing results showed
that two genotypes, ST5-MRSA-II and ST239-MRSAIII, were prevalent in both the
initial visit (73% vs. 24%) and the follow-up visit (55% vs. 42%). Pulsed-field
gel electrophoresis identified eight types, including two major types shared by
both groups. We conclude that majority of MRSA strains from ear discharge of
chronic otitis media belonged to nosocomial clones that might be circulating in
the community. This is the first report of the genetic analysis of MRSA strains
from otolaryngology practices in Korea.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18955778 [PubMed - indexed for MEDLINE]

24: Curr Allergy Asthma Rep. 2008 Nov;8(6):525-30.

Eosinophilic otitis media: a new middle ear disease entity.

Iino Y.

Department of Otolaryngology, Jichi Medical University Saitama Medical Center,
1-847, Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan. yiino@omiya.jichi.ac.jp

Eosinophilic otitis media (EOM) is intractable otitis media characterized by the 
presence of a highly viscous yellow effusion containing eosinophils. It occurs
mainly in patients with bronchial asthma and is resistant to conventional
treatments for otitis media. Here we discuss the clinical features, pathogenesis,
and management of EOM. EOM predominantly affects women and presents most often in
patients in their 50s. The clinical features of the middle ear in EOM are roughly
divided into the otitis media with effusion type and chronic otitis media type.
The latter is further divided into two subtypes: simple perforation and
granulation tissue formation. EOM is often complicated by rhinosinusitis
(eosinophilic sinusitis). High-tone loss is more frequently found and more severe
in EOM patients than in chronic otitis media control patients, and EOM patients
sometimes become deaf suddenly. Systemic or topical steroid administration is the
most effective treatment for patients with EOM. The instillation of triamcinolone
acetonide, a suspension of steroids, into the middle ear is very effective for
controlling eosinophilic inflammation. It is very important to explain to
patients with EOM that the disease may last for a long period and that
progressive and sudden hearing loss may occur.

Publication Types: 
    Review

PMID: 18940145 [PubMed - indexed for MEDLINE]

25: Curr Allergy Asthma Rep. 2008 Nov;8(6):519-24.

Otitis media as a presenting complaint in childhood immunodeficiency diseases.

Wilson NW, Hogan MB.

Department of Pediatrics, Section of Allergy, Immunology, and Pulmonology,
University of Nevada School of Medicine, 343 Elm Street, Suite 201, Reno, NV
89503, USA. nwilson@medicine.nevada.edu

Otitis media is one of the most common childhood infections and may result from a
variety of underlying problems. Suspicion of immunodeficiency should increase
when ear infections are frequent; suppurative; unresponsive to antibiotics;
caused by unusual organisms; or seen in the context of other frequent infections,
severe eczema, or failure to thrive. Humoral immune deficiencies, particularly
with an inability to make antibody to encapsulated organisms, are the
immunodeficiencies most likely to cause increased otitis media. Immune system
evaluation should concentrate on humoral immunodeficiency disorders, but the
presenting history and physical findings also should be considered when designing
the work-up. Treating the underlying immune deficiency is usually necessary to
adequately control the ear infections.

Publication Types: 
    Review

PMID: 18940144 [PubMed - indexed for MEDLINE]

26: Curr Allergy Asthma Rep. 2008 Nov;8(6):513-8.

Gastric pepsin in middle ear fluid of children with otitis media: clinical
implications.

He Z, O'Reilly RC, Mehta D.

Division of Pediatric Otolaryngology, Alfred I. duPont Hospital for Children,
Wilmington, DE 19899, USA.

Gastroesophageal reflux and extraesophageal reflux have been postulated to be
involved in the pathogenesis of otitis media. This is supported by recent studies
revealing the presence of gastric pepsin in the middle ear space of children with
otitis media but not in control patients without otitis media. Reflux's role in
otitis media appears to be most pronounced in younger children and those with
purulent effusions.

Publication Types: 
    Review

PMID: 18940143 [PubMed - indexed for MEDLINE]

27: Curr Allergy Asthma Rep. 2008 Nov;8(6):508-12.

Immune modulatory oligonucleotides in the prevention and treatment of
allergen-induced eustachian tube dysfunction in the animal model.

Blanks DA, Ebert CS Jr.

Department of Otolaryngology-Head and Neck Surgery, University of North Carolina 
at Chapel Hill, CB# 7070, G0412 Neurosciences Hospital, Chapel Hill, NC
27599-7070, USA. dblanks@med.unc.edu

This article reviews the current literature investigating the applications and
success of immune modulatory oligonucleotides as immunotherapy to treat and
prevent allergen-induced eustachian tube dysfunction in animal models. Synthetic 
DNA-based immunotherapy agents composed of unmethylated cytosine-guanine
dinucleotides (CpG ODNs) that bind to Toll-like receptors have been found to have
tremendous potential as therapeutic agents and adjuvants. CpG ODNs can induce a
shift in the cytokine profile and immune response that favors the T-helper type 1
pathway and suppresses the T-helper type 2 pathway. This makes CpG ODNs promising
candidates for treating allergic diseases. Current CpG ODN studies have
demonstrated prevention and treatment of acute allergen inflammation of the
eustachian tube in an animal model of otitis media. Immune modulatory
oligonucleotides in immunotherapy, administered systemically or topically, have
been shown to be safe and effective in the animal model.

Publication Types: 
    Review

PMID: 18940142 [PubMed - indexed for MEDLINE]

28: Arch Otolaryngol Head Neck Surg. 2008 Oct;134(10):1085-9.

The effect of the palatoplasty method on the frequency of ear tube placement.

Smith LK, Gubbels SP, MacArthur CJ, Milczuk HA.

Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science
University, 3181 Sam Jackson Park Rd, Portland, OR 97239-3098, USA.

OBJECTIVE: To determine whether the type of palate repair affects the frequency
of subsequent ventilation tube placement. DESIGN: Combined retrospective and
prospective cohort with more than 2 years clinical follow-up after palatoplasty. 
SETTING: Tertiary care children's hospital and clinic. PATIENTS: A total of 170
patients with cleft palate (with or without cleft lip) underwent palatoplasty
between 1995 and 2003. Sixty-nine patients with less than 2 years of follow-up
visits and 1 patient who did not require ear tubes were excluded from this
analysis. INTERVENTIONS: Either traditional 2-flap palatoplasty (group A) or
double-opposing Z-plasty (group B) was performed. The type of palatoplasty
performed was based on the reconstructive surgeon's clinical decision.
Ventilation tubes were placed for otitis media, conductive hearing loss, or
eustachian tube dysfunction. Patients received routine follow-up care every 6
months or whenever acute problems arose. Data were analyzed with independent t
tests, chi(2) tests, and Fisher exact tests. MAIN OUTCOME MEASURES: Number of ear
tubes placed after palatoplasty in each group. RESULTS: Group A had a mean (SE)
of 2.9 (0.2) sets of tubes placed, while group B had a mean (SE) of 1.8 (0.2)
sets of tubes. Group A had significantly more sets of ventilation tubes placed (P
< .001) than group B. Subgroup analysis based on type of cleft was performed.
CONCLUSION: Children with cleft palate who underwent double-opposing Z-plasty had
fewer sets of ear tubes placed postoperatively than patients who had traditional 
repair.

Publication Types: 
    Comparative Study

PMID: 18936356 [PubMed - indexed for MEDLINE]

29: Otolaryngol Head Neck Surg. 2008 Oct;139(4):490-494.

Assessment of acute otitis externa and otitis media with effusion performance
measures in otolaryngology practices.

Patel MM, Eisenberg L, Witsell D, Schulz KA.

American Academy of Otolaryngology-Head and Neck Surgery Foundation, 1650
Diagonal Road, Alexandria, VA 22314, USA. mpatel@entnet.org

OBJECTIVE: To evaluate the acute otitis externa and otitis media with effusion
performance measure sets in a clinical setting and provide preliminary data on
measure compliance. STUDY DESIGN AND SETTING: Quality improvement study. SUBJECTS
AND METHODS: Convenience sampling (N = 84) was performed at five sites of ENT and
Allergy Associates, LLC. RESULTS: Physicians reported prescribing topical
antibiotic preparations and assessing for auricular or periauricular pain in 98% 
of acute otitis externa cases (N = 55). In addition, 87% did not prescribe
systemic antimicrobials. Pneumatic otoscopy was used by 76% of physicians as a
method for otitis media with effusion diagnosis and 10% administered a hearing
test within 6 months before tympanostomy tube placement (N = 29). Furthermore, as
recommended, 86% did not prescribe decongestants or antihistamines whereas 93%
and 90% did not prescribe antimicrobials or systemic steroids, respectively.
CONCLUSION: Although compliance in this study was generally high across both
measure sets, actual use of the face sheet forms for appropriate patients was
lower than the 80% reporting mandate by the Centers for Medicare and Medicaid
Services that allows physicians to receive the monetary bonus. Incentive-based
reporting should be continuously investigated to assess challenges for evaluating
current measures.

Publication Types: 
    Multicenter Study

PMID: 18922333 [PubMed - indexed for MEDLINE]

30: J Cardiovasc Med (Hagerstown). 2008 Nov;9(11):1152-5.

An uncommon case of right-sided throat pain and swallow syncope.

Favaretto E, Schenal N, Russo N, Buja G, Iliceto S, Bilato C.

Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences,
University of Padova, Padova, Italy.

A 63-year-old man presented with recurrent syncopal attacks associated with
swallowing and right-sided throat pain. Immediately after admission, he presented
a 16-s asystolia. The patient's clinical history was unremarkable except for
previous postimplant periodontitis. Several episodes of severe bradycardia and
sinus pauses, always associated with painful deglutition, were recorded
subsequently. X-ray orthopanthomography and magnetic resonance imaging of the
neck confirmed several areas of periodontitis around the previous dental implants
and right mastoid inflammation. A barium swallow and fibre-optic endoscopy also
revealed a small sliding hiatus hernia and distal chronic oesophageal
inflammation. Despite complete dental curettage, antibiotics and
antigastro-oesophageal reflux therapy, only partial relief of the pain and
incomplete resolution of the arrhythmic disorder were obtained after 3 weeks, and
the patient underwent pacemaker implantation. At 1-month follow-up, however, he
reported the complete relief of the throat pain; subsequent Holter monitoring
showed normal sinus rhythm, without pacemaker-induced electrical activity.

Publication Types: 
    Case Reports

PMID: 18852592 [PubMed - indexed for MEDLINE]

31: Pediatr Infect Dis J. 2008 Nov;27(11):958-62.

Diagnostic inaccuracy and subject exclusions render placebo and observational
studies of acute otitis media inconclusive.

Pichichero ME, Casey JR.

Department of Microbiology and Immunology, University of Rochester Medical
Center, Rochester, NY 14642, USA. michael_pichichero@urmc.rochester.edu

BACKGROUND: Diagnostic accuracy and appropriate inclusion/exclusion criteria
representative of children at greatest risk is of paramount importance in trials 
to evaluate placebo or observation as an option for acute otitis media (AOM)
management. METHODS: Twelve observational studies spanning the time frame
1958-2005 and 13 natural history studies spanning the time frame 1968-2006 were
evaluated for the diagnostic criteria, inclusion criteria, and exclusion criteria
applied within the study design. RESULTS: Although a bulging or full tympanic
membrane (TM) with effusion is the best indication of a diagnosis of bacterial
AOM based on tympanocentesis findings, few observational and natural history
studies required a bulging TM. Examination of subject inclusion criteria showed
that many subjects did not have AOM but rather had no middle ear disease at all
or they had otitis media with effusion. Exclusion criteria of subjects were also 
remarkable. Frequently children <2 years old were excluded; mean age among the
studies reflected an older age group, unlike the true epidemiology of AOM. Otitis
prone children, those with severe disease, with a bulging TM, with fever, with a 
definite need for antibiotics, with recent antibiotic treatment, with recent AOM,
or with perforation of the TM were often excluded. CONCLUSIONS: Guidelines and
some authorities have overlooked or discounted the importance of the issues of
inaccurate diagnosis on study entry, broad inclusion criteria, and the creation
of bias in exclusion criteria among placebo/natural history trials in AOM. The
current data favoring observation of children with AOM should be reconsidered
until better studies are conducted.

PMID: 18845985 [PubMed - indexed for MEDLINE]

32: Cochrane Database Syst Rev. 2008 Oct 8;(4):CD004975.

Once or twice daily versus three times daily amoxicillin with or without
clavulanate for the treatment of acute otitis media.

Thanaviratananich S, Laopaiboon M, Vatanasapt P.

Department of Otolaryngology, Faculty of Medicine, Khon Kaen University, 123
Friendship Road, Khon Kaen, Thailand, 40002. sthanaviratananich@gmail.com

BACKGROUND: Acute otitis media (AOM) is a common problem in children, for which
the antibiotic amoxicillin, with or without clavulanate, is frequently
prescribed. OBJECTIVES: To compare the effectiveness of one or two daily doses
with three or four daily doses of amoxicillin, with or without clavulanate, for
the treatment of AOM in children. SEARCH STRATEGY: We searched the Cochrane
Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, issue
1), which contains the Acute Respiratory Infections (ARI) Group's Specialized
Register; MEDLINE (January 1950 to March 2008); EMBASE (1974 to March 2008); the 
Science Citation Index (2001 to March 2008); and NLM Gateway (HSRProj) (March
2008). SELECTION CRITERIA: We included studies if they met the following
criteria: randomized controlled trials (RCTs) of children aged 12 years or
younger with AOM, diagnosed by the following explicit criteria: acute ear pain
(otalgia) and inflamed ear drum (confirmed by positive tympanocentesis or
tympanogram of type B or C). DATA COLLECTION AND ANALYSIS: We extracted data on
treatment outcomes from individual trials. We assessed quality based on selection
bias, performance bias, attrition bias and sample size calculation. The quality
grading was defined as low risk of bias, moderate risk of bias or high risk of
bias. The results were summarized as risk ratio (RR) and 95% confidence intervals
(CI). MAIN RESULTS: We included six studies with 1601 children in the review.
Although the clinical cure rates at the end of therapy and at the follow-up
periods of each study were shown to be comparable between the two groups, we did 
not perform pooled data analysis because of moderate to high risk of biases in
the included studies. Most of the children were aged 2 months to 12 years. None
of the studies had any consistently significant results either for benefit or
harm. The outcomes were assessed at the end of therapy (often 10 days) and this
may have been too late to measure any differences. AUTHORS' CONCLUSIONS: This
review showed insufficient evidence to judge whether once or twice daily doses of
amoxicillin, with or without clavulanate, were comparable with three or four
daily doses for the treatment of AOM. The evidence appears to be biased and
therefore no firm conclusions can be drawn.

Publication Types: 
    Meta-Analysis
    Review

PMID: 18843673 [PubMed - indexed for MEDLINE]

33: Cochrane Database Syst Rev. 2008 Oct 8;(4):CD004741.

Grommets (ventilation tubes) for recurrent acute otitis media in children.

McDonald S, Langton Hewer CD, Nunez DA.

ENT Department, St Michael's Hospital, University Hospitals Bristol NHS Trust,
Southwell Street, Bristol, UK, BS2 8EG. stevemcdonald001@hotmail.com

BACKGROUND: Acute suppurative otitis media is one of the most common infectious
diseases in childhood. Recurrent acute otitis media is defined for the purposes
of this review as either three or more acute infections of the middle ear cleft
in a six-month period, or at least four episodes in a year. Strategies for
managing the condition include the assessment and modification of risk factors
where possible, repeated courses of antibiotics for each new infection,
antibiotic prophylaxis and the insertion of ventilation tubes (grommets).
OBJECTIVES: To establish whether ventilation tube insertion reduces the frequency
of episodes of recurrent acute otitis media and the proportion of children with
symptoms of ear disease. SEARCH STRATEGY: We searched the Cochrane Ear, Nose and 
Throat Disorders Group Trials Register, the Cochrane Central Register of
Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1 2008), MEDLINE (1950
to 2008), EMBASE (1974 to 2008), CINAHL, mRCT (the metaRegister of Controlled
Trials for ongoing/unpublished trials), NRR (National Research Register), LILACs,
KoreaMed, IndMed, PakMediNet, Zetoc, ISI Proceedings and Cambridge Scientific
Abstracts. Reference lists of articles retrieved from the electronic searches
were scanned for further trials. Systematic reviews and other meta-analyses were 
also searched for and their reference lists scanned. Contact was sought with
authors of published trials and other experts in the field. The date of the last 
search was March 2008. SELECTION CRITERIA: No trials that included a treatment
and a control group that met the inclusion criteria were excluded. Abstracts were
screened and full text articles of studies that met our inclusion criteria
obtained. Two authors independently applied the inclusion criteria. Studies
included in the review underwent quality assessment performed independently by
all authors adapting the methods outlined in the Cochrane Handbook for Systematic
Reviews of Interventions. DATA COLLECTION AND ANALYSIS: Data were extracted
independently by the authors and synthesised descriptively. Five randomised
controlled trials were identified, of which two fulfilled the inclusion criteria.
MAIN RESULTS: Two studies involving 148 children were included in the review. One
of these studies, involving 95 children, showed that ventilation tube insertion
leads to a mean reduction of 1.5 episodes of acute otitis media in the first six 
months after treatment. This study also showed a significant increase in the
proportion of children with no episodes of AOM (p < 0.001) in the ventilation
tube group. The other included study also found a higher proportion of patients
in the ventilation tube group had no episodes of AOM in the six months after
intervention, but the difference did not reach statistical significance (p =
0.16). AUTHORS' CONCLUSIONS: Ventilation tubes have a significant role in
maintaining a 'disease-free' state in the first six months after insertion.
Further research is required to investigate the effect beyond six months.
Clinicians should consider the possible adverse effects of grommet insertion
before surgery is undertaken.

Publication Types: 
    Review

PMID: 18843668 [PubMed - indexed for MEDLINE]

34: BMC Infect Dis. 2008 Oct 8;8:134.

Lysozyme M deficiency leads to an increased susceptibility to Streptococcus
pneumoniae-induced otitis media.

Shimada J, Moon SK, Lee HY, Takeshita T, Pan H, Woo JI, Gellibolian R, Yamanaka
N, Lim DJ.

Gonda Department of Cell and Molecular Biology, House Ear Institute, Los Angeles,
CA, USA. Jasmd513@aol.com

BACKGROUND: Lysozyme is an antimicrobial innate immune molecule degrading
peptidoglycan of the bacterial cell wall. Lysozyme shows the ubiquitous
expression in wide varieties of species and tissues including the tubotympanum of
mammals. We aim to investigate the effects of lysozyme depletion on pneumococcal 
clearance from the middle ear cavity. METHODS: Immunohistochemistry was performed
to localize lysozyme in the Eustachian tube. Lysozyme expression was compared
between the wild type and the lysozyme M-/- mice using real time quantitative
RT-PCR and western blotting. Muramidase activity and bactericidal activity of
lysozyme was measured using a lysoplate radial diffusion assay and a liquid broth
assay, respectively. To determine if depletion of lysozyme M increases a
susceptibility to pneumococal otitis media, 50 CFU of S. pneumoniae 6B were
transtympanically inoculated to the middle ear and viable bacteria were counted
at day 3 and 7 with clinical grading of middle ear inflammation. RESULTS:
Immunolabeling revealed that localization of lysozyme M and lysozyme P is
specific to some/particular cell types of the Eustachian tube. Lysozyme P of
lysozyme M-/- mice was mainly expressed in the submucosal gland but not in the
tubal epithelium. Although lysozyme M-/- mice showed compensatory up-regulation
of lysozyme P, lysozyme M depletion resulted in a decrease in both muramidase and
antimicrobial activities. Deficiency in lysozyme M led to an increased
susceptibility to middle ear infection with S. pneumoniae 6B and resulted in
severe middle ear inflammation, compared to wild type mice. CONCLUSION: The
results suggest that lysozyme M plays an important role in protecting the middle 
ear from invading pathogens, particularly in the early phase. We suggest a
possibility of the exogenous lysozyme as an adjuvant therapeutic agent for otitis
media, but further studies are necessary.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18842154 [PubMed - indexed for MEDLINE]

35: Methods Mol Biol. 2009;493:179-90.

Multilocus sequence typing and pulsed field gel electrophoresis of otitis media
causing pathogens.

Thomas JC, Pettigrew MM.

Yale University School of Public Health, New Haven, CT, USA.

Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are
the three leading bacteria species associated with otitis media. Defining the
molecular epidemiology of bacteria known to cause otitis media is of great
importance, in both clinical and research settings. PFGE and MLST provide data
for the characterization of isolates' genetic relatedness, yet they differ in the
types of studies for which they are most useful. Consequently, knowledge of both 
techniques is important for laboratories intending to study the molecular
epidemiology of otitis media-associated bacterial pathogens.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18839348 [PubMed - indexed for MEDLINE]

36: BMJ. 2008 Oct 3;337:a1607. doi: 10.1136/bmj.a1607.

Overuse of tympanostomy tubes in New York metropolitan area: evidence from five
hospital cohort.

Keyhani S, Kleinman LC, Rothschild M, Bernstein JM, Anderson R, Chassin M.

Department of Health Policy, Mount Sinai School of Medicine, One Gustave L Levy
Place, Box 1077, New York, NY 10029, USA. Salomeh.Keyhani@mountsinai.org

OBJECTIVES: To compare tympanostomy tube insertion for children with otitis media
in 2002 with the recommendations of two sets of expert guidelines. DESIGN:
Retrospective cohort study. SETTING: New York metropolitan area practices
associated with five diverse hospitals. PARTICIPANTS: 682 of 1046 children who
received tympanostomy tubes in the five hospitals for whom charts from the
hospital, primary care physician, and otolaryngologist could be accessed.
RESULTS: The mean age was 3.8 years. On average, children with acute otitis media
had fewer than four infections in the year before surgery. Children with otitis
media with effusion had less than 30 consecutive days of effusion at the time of 
surgery. Concordance with recommendations was very low: 30.3% (n=207) of all
tympanostomies were concordant with the explicit criteria developed for this
study and 7.5% (n=13) with the 1994 guideline from the American Academy of
Pediatrics, American Academy of Family Medicine, and American Academy of
Otolaryngology-Head and Neck Surgery. Children who had previously had
tympanostomy tube surgery, who were having a concomitant procedure, or who had
"at risk conditions" were more likely to be discordant. CONCLUSIONS: A
significant majority of tympanostomy tube insertions in the largest and most
populous metropolitan area in the United States were inappropriate according to
the explicit criteria and not recommended according to both guidelines.
Regardless of whether current practice represents a substantial overuse of
surgery or the guidelines are overly restrictive, the persistent discrepancy
between guidelines and practice cannot be good for children or for people
interested in improving their health care.

Publication Types: 
    Comparative Study
    Multicenter Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 18835846 [PubMed - indexed for MEDLINE]

37: Otol Neurotol. 2008 Dec;29(8):1056-60.

Role of pneumococcal proteins in sensorineural hearing loss due to otitis media.

Tsuprun V, Cureoglu S, Schachern PA, Ferrieri P, Briles DE, Paparella MM, Juhn
SK.

Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota,
55455, USA. tsupr001@umn.edu

HYPOTHESIS: Two Streptococcus pneumoniae proteins, pneumococcal surface protein A
(PspA) and pneumolysin (Ply), have functional and histopathologic effects on the 
inner ear. BACKGROUND: Temporary or permanent sensorineural hearing loss is known
to be a sequela of pneumococcal otitis media. Several pneumococcal proteins such 
as PspA and Ply have been shown to contribute to the pathogenesis of the middle
ear; however, effects of these proteins on the inner ear and hearing loss are
unknown. METHODS: Middle ears of chinchillas were inoculated with either
wild-type S. pneumoniae or its mutants, deficient in PspA or Ply proteins. After 
28 days, auditory brainstem response of animals was tested, and their bullae were
processed for histopathologic analysis by light microscopy. RESULTS: Twenty-eight
days after instillation of 20 colony-forming units of wild-type pneumococci,
auditory brainstem response test showed threshold changes of 10 to 15 dB for 4 to
32 kHz and more than 20 dB for 1 to 2 kHz. No significant hearing loss was
observed after instillation of the same or even higher doses of isogenic S.
pneumoniae mutants of PspA or Ply proteins, or saline injection, after the same
period. Histologic analysis showed no fluid, inflammatory cells, or bacteria in
the middle ear, indicating that hearing loss was sensorineural. Inner ear
morphology showed pathologic changes in the stria vascularis, suggesting it as
the target of otitis media-induced damage, which may lead to sensorineural
hearing loss. CONCLUSION: The virulence PspA and Ply proteins of S. pneumoniae
affect the inner ear and auditory function.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18833010 [PubMed - indexed for MEDLINE]

38: J Clin Microbiol. 2008 Nov;46(11):3808-10. Epub 2008 Oct 1.

Serotype distribution and penicillin resistance of Streptococcus pneumoniae
isolates from middle ear fluids of pediatric patients with acute otitis media in 
Japan.

Hotomi M, Billal DS, Kamide Y, Kanesada K, Uno Y, Kudo F, Ito M, Kakehata S,
Sugita R, Ogami M, Yamanaka N; Advanced Treatment for Otitis Media Study Group
(ATOMS).

Department of Otolaryngology, Head and Neck Surgery, Wakayama Medical University,
811-1 Kimiidera, Wakayama-shi, Wakayama 640-8501, Japan.

Out of 175 pneumococcal isolates from middle ear fluids, 26.3% were
penicillin-resistant S. pneumoniae (PRSP). Serotypes 19F and 23F occurred most
frequently among PRSP strains. The 7-valent pneumococcal conjugate vaccine (PCV) 
showed better coverage of PRSP strains (87.0%). The 7-valent PCV may reduce the
prevalence of PRSP in Japan.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18832131 [PubMed - indexed for MEDLINE]

39: BMC Complement Altern Med. 2008 Oct 2;8:56.

Echinacea purpurea and osteopathic manipulative treatment in children with
recurrent otitis media: a randomized controlled trial.

Wahl RA, Aldous MB, Worden KA, Grant KL.

Department of Pediatrics, University of Arizona, Tucson, Arizona, USA.
rwahl@u.arizona.edu

BACKGROUND: Recurrent otitis media is a common problem in young children.
Echinacea and osteopathic manipulative treatment have been proposed as preventive
measures, but have been inadequately studied. This study was designed to assess
the efficacy of Echinacea purpurea and/or osteopathic manipulative treatment
(OMT) for prevention of acute otitis media in otitis-prone children. METHODS: A
randomized, placebo-controlled, two-by-two factorial trial with 6-month
follow-up, conducted 1999 - 2002 in Tucson, Arizona. Patients were aged 12-60
months with recurrent otitis media, defined as three or more separate episodes of
acute otitis media within six months, or at least four episodes in one year.
Ninety children (44% white non-Hispanic, 39% Hispanic, 57% male) were enrolled,
of which 84 had follow-up for at least 3 months. Children were randomly assigned 
to one of four protocol groups: double placebo, echinacea plus sham OMT, true OMT
(including cranial manipulation) plus placebo echinacea, or true echinacea plus
OMT. An alcohol extract of Echinacea purpurea roots and seeds (or placebo) was
administered for 10 days at the first sign of each common cold. Five OMT visits
(or sham treatments) were offered over 3 months. RESULTS: No interaction was
found between echinacea and OMT. Echinacea was associated with a borderline
increased risk of having at least one episode of acute otitis media during
6-month follow-up compared to placebo (65% versus 41%; relative risk, 1.59, 95%
CI 1.04, 2.42). OMT did not significantly affect risk compared to sham (44%
versus 61%; relative risk, 0.72, 95% CI 0.48, 1.10). CONCLUSION: In otitis-prone 
young children, treating colds with this form of echinacea does not decrease the 
risk of acute otitis media, and may in fact increase risk. A regimen of up to
five osteopathic manipulative treatments does not significantly decrease the risk
of acute otitis media. TRIAL REGISTRATION: ClinicalTrials.gov Identifier:
NCT00010465.

Publication Types: 
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural

PMID: 18831749 [PubMed - indexed for MEDLINE]

40: Int J Audiol. 2008 Sep;47(9):584-9.

Balance and otitis media with effusion.

Casselbrant ML, Villardo RJ, Mandel EM.

Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, 
Pittsburgh, PA 15213, USA. Margaretha.Casselbrant@chp.edu

Dizziness can be caused by a variety of peripheral vestibular, central, and
systemic disease processes. Eustachian tube dysfunction with and without
middle-ear effusion has been considered one of the most common causes of balance 
disturbances in young children. Several studies have indicated that during an
episode of otitis media the child's balance deteriorates and the child may become
clumsy and fall more often. Thus, not only the adverse effect on hearing should
be considered in the management of a child with otitis media, but also the
child's balance.

Publication Types: 
    Review

PMID: 18821228 [PubMed - indexed for MEDLINE]

41: Laryngoscope. 2008 Nov;118(11):2040-3.

The treatment for postirradiation otitis media with effusion: a study of three
methods.

Xu YD, Ou YK, Zheng YQ, Chen Y, Ji SF.

Department of Otolaryngology, Second Affiliated Hospital of Sun Yat-Sen
University, Guangzhou, China.

OBJECTIVE: To explore treatments for postirradiation otitis media with effusion
(OME) in patients with nasopharyngeal carcinoma. STUDY DESIGN: This study is a
prospective quasi-randomized clinical trial. METHODS: Ninety-six patients (135
ears) with OME after the first course of radiotherapy for nasopharyngeal
carcinoma were divided into three groups: simple auripuncture plus aspiration,
tympanic membrane fenestration with cauterization, and myringotomy plus grommet
insertion. Cure rates and incidences of complications were compared. RESULTS: Two
deaths occurred. The other 94 patients (132 ears) finished a 2-year follow-up. In
group 1, four ears (8.9%) were cured after the first treatment and 17 ears
overall (37.8%) were cured by the end of the follow-up. Twenty ears (44.4%) had
persistent fluid, two ears (4.4%) developed chronic suppurative otitis media, and
five ears (11.1%) developed dry eardrum perforation. In group 2, seven ears
(15.6%) were cured after the first treatment and 21 ears overall (46.7%) were
cured by the end of the follow-up. Fourteen ears (31.1%) had persistent fluid,
three ears (6.7%) developed chronic suppurative otitis media, and seven ears
(15.6%) developed dry eardrum perforation. In group 3, eight ears (17.8%) were
cured after the first treatment and 23 ears overall (51.1%) were cured by the end
of the follow-up. Seven ears (15.6%) had persistent fluid, five ears (11.1%)
developed chronic suppurative otitis media, three ears (6.7%) developed eardrum
perforation with effusion, and five ears (11.1%) developed dry eardrum
perforation. CONCLUSION: The methods each have advantages and disadvantages. We
believe that a step by step approach should be used when choosing the treatment
method for postirradiation OME. That is, first apply auripuncture plus
aspiration, and then the other methods if this approach is inadequate. Enhanced
local care after grommet insertion can effectively reduce the incidence of
complications.

Publication Types: 
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial

PMID: 18818551 [PubMed - indexed for MEDLINE]

42: Otol Neurotol. 2008 Oct;29(7):965-71.

TORP-vibroplasty: a new alternative for the chronically disabled middle ear.

Hüttenbrink KB, Zahnert T, Bornitz M, Beutner D.

Department of Otorhinolaryngology-Head and Neck Surgery, University Clinic,
Cologne, Germany. huettenbrink.k-b@uni-koeln.de

OBJECTIVE: Surgery can often eradicate chronic middle ear disease in patients
with recurrent cholesteatoma, tubal dysfunction, and others; however, in many
cases, social hearing cannot be restored even after multiple revision
tympanoplasties. A hearing aid is then recommended. Placement of an implantable
hearing aid with its advantage of an unoccluded ear canal, irrespective of middle
ear function, seems to be a promising alternative. STUDY DESIGN: After
establishing the biomechanics of the ear in our temporal bone laboratory, various
locations and attachments of a Vibrant transducer were investigated. These
experiments resulted in the development of a new titanium clip holder for a
Vibrant integrated total ossicular replacement prosthesis assembly with placement
on the footplate. Four patients with permanent severe combined hearing loss were 
implanted with this device after multiple revision tympanoplasties. The first
case is described in detail. RESULTS: Placing a transducer directly on the
footplate via a rod transmission gave a better gain for the high frequencies than
in the round window location. The acoustic results of the patients showed an
improved gain in speech understanding, unobtainable by a conventional hearing
aid. CONCLUSION: The concept of a total ossicular replacement
prosthesis-vibroplasty establishes a straightforward procedure in the tympanic
cavity similar to a normal tympanoplasty. The open ear canal and its superior
acoustic performance offer a promising perspective for revision operations in
cases of incurable middle ear dysfunction.

PMID: 18818544 [PubMed - indexed for MEDLINE]

43: Vaccine. 2008 Jun 16;26 Suppl 2:B16-8.

The impact of pneumococcal conjugate vaccines on otitis media-can we extrapolate 
to pneumonia?

Dagan R.

Ben Gurion University of the Negev, Soroka University Medical Center, Beer-Sheva 
84101, Israel. rdagan@bgu.ac.il

Pneumococcal conjugate vaccines (PCVs) have significant efficacy in preventing
acute otitis media caused by vaccine-type pneumococcal serotypes. This article
questions whether experiences with pneumococcal otitis can be applied to
pneumococcal pneumonia, and examines whether PCVs have a class effect, meaning do
different PCVs offer equivalent protection against the same outcome of
pneumococcal disease. While PCVs appear to have a class effect in general,
variability in serotype-specific antibody concentrations makes extrapolation from
one vaccine to another difficult. Antibody concentrations or measurements of
antibody functionality may provide a means to anticipate a predicted outcome in
pneumococcal pneumonia for certain emergent vaccine candidates.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18793601 [PubMed - indexed for MEDLINE]

44: Ear Nose Throat J. 2008 Sep;87(9):514-8.

Mastoiditis on MRI: fact or artifact?

Meredith JR, Boyev KP.

Division of Otology/Neurotology, Department of Otolaryngology-Head and Neck
Surgery, University of South Florida College of Medicine, Tampa, FL 33612, USA.

Fluid signal in the mastoid can be an incidental finding on T2-weighted magnetic 
resonance imaging and often is interpreted as mastoiditis by radiologists. This
study examines 28 consecutive cases of such erroneously diagnosed "mastoiditis"
and documents the presence or absence of otologic symptoms and clinical signs. We
found a very low prevalence of otologic symptoms or pathology and no cases of
mastoiditis in these patients, and we determined that magnetic resonance imaging 
is not an effective screening modality for mastoiditis. We also reviewed the
literature on current diagnostic criteria for mastoiditis and propose alternative
terminology to replace the use of excessively alarming terms such as
"mastoiditis" unless they apply to that specific clinical diagnosis.

Publication Types: 
    Comparative Study

PMID: 18800323 [PubMed - indexed for MEDLINE]

45: Curr Opin Otolaryngol Head Neck Surg. 2008 Oct;16(5):406-11.

Contemporary indications for ventilation tube placement.

Schraff SA.

Arizona Otolaryngology Consultants, Phoenix, Arizona 85004, USA.
schraffs@hotmail.com

PURPOSE OF REVIEW: To discuss the current indications for ventilation tube
placement RECENT FINDINGS: In the past year, several studies have challenged the 
current guidelines for ventilation tube placement and antibiotic use for otitis
media in children. Critics argue that some of these studies have poor scientific 
validity, yet these studies are being referenced, and sometimes misinterpreted,
by the media. Fueled by these media reports, many concerned parents are now
questioning otolaryngologists as to the efficacy and safety of ventilation tube
placement. Whereas the indications for tube placement in children may be in a
state of flux, the indications for tube placement in adults has (and is) fairly
static. I will discuss the current published guidelines and the potential for
changing trends in tube placement rates. I will also review the literature for
the past year regarding postoperative management and adjuvant therapies. SUMMARY:
Although there have been no radical changes in the indications for ventilation
tube placement, recent studies have challenged the current clinical indicators
and the ramifications of these studies may be more evident in the years to come.

Publication Types: 
    Review

PMID: 18797280 [PubMed - indexed for MEDLINE]

46: J Am Acad Audiol. 2008 Apr;19(4):309-24.

Wideband middle ear power measurement in infants and children.

Hunter LL, Tubaugh L, Jackson A, Propes S.

Division of Audiology, ML 2002, Cincinnati Children's Medical Center, 3333 Burnet
Avenue, Cincinnati, OH 45229-3039, USA. lisa.hunter@cchmc.org

Wideband middle ear power (WMEP) measurement is a method of middle ear analysis
that may provide improved diagnostic capability over single-frequency
tympanometry. However, normative data, information about test-retest reliability,
and results in clinical disorders are needed for clinical application. Normative 
and reliability data on WMEP in children three days to 47 months of age were
obtained using a prototype commercial instrument. A prospective study was
conducted in children enrolled from a well-child pediatric clinic (n = 97), with 
comparisons of age, gender, and middle ear status and stimulus type (broadband
chirp and sine wave). No significant age effect for power reflectance across the 
age range of this study was found, except at 6000 Hz. Significantly higher-power 
reflectance was found for ears with poor ear status, specifically otitis media
with effusion. Smaller but nonsignificant differences in power reflectance were
found for ears with positive and negative tympanometric peak pressure. Intraclass
correlation coefficients showed significant correlations of 0.68 to 0.97 at
various test frequencies using the chirp stimulus. Multivariate analysis of
variance showed no significant effect of stimulus type (sine wave vs broadband
chirp), ear, or gender. These results provide normative data for wideband middle 
ear power analysis for infants and children from birth to age four years.

Publication Types: 
    Clinical Trial
    Research Support, N.I.H., Extramural
    Validation Studies

PMID: 18795470 [PubMed - indexed for MEDLINE]

47: Int J Audiol. 2008;47 Suppl 1:S57-61.

Wideband reflectance associated with otitis media in infants and children with
cleft palate.

Hunter LL, Bagger-Sjoback D, Lundberg M.

Department of Communication Sciences and Disorders, Division of Otolaryngology,
University of Cincinnati, Cincinnati, Ohio, USA. Lisa.hunter@cchmc.org

Wideband reflectance (WBR) is a method of middle-ear analysis that may provide
more information and provide a more detailed look at the middle-ear system than
tympanometry. WBR has the potential to improve efficiency of newborn hearing
screening programs by reducing time needed to accurately diagnose middle-ear
status. This prospective study compares wideband reflectance results with 226-Hz 
and 1000-Hz tympanometry and distortion product otoacoustic emissions in a group 
of infants and children with cleft lip and palate, who have not been treated with
myringotomy or tubes. Results are also compared to normative data in children of 
similar ages using the same instrument and methods. Results demonstrate that
wideband reflectance showed the highest level of agreement (88%) with DPOAE
results.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 18781515 [PubMed - indexed for MEDLINE]

48: Pediatr Crit Care Med. 2008 Sep;9(5):e35-7.

Lemierre syndrome in a 5-month-old male infant: Case report and review of the
pediatric literature.

Aspesberro F, Siebler T, Van Nieuwenhuyse JP, Panosetti E, Berthet F.

Divisions of Neonatal and Pediatric Intensive Care Unit (FA), Pediatric Radiology
(JPVN), Otorhinolaryngology, Head and Neck Surgery (EP), and Pediatrics (FB),
Clinique Pédiatrique, Centre Hospitalier de Luxembourg, Luxembourg, USA.
faspes@hotmail.com

OBJECTIVES: To report, to the best of our knowledge, the youngest patient with
Lemierre syndrome. DESIGN: Descriptive case report with review of the pediatric
literature. SETTING: Pediatric intensive care unit in a tertiary referral
hospital. DATA SOURCE: Systemic review of the literature, including PubMed
(English-only journals) and major textbooks. PATIENT: We report a 5-month-old boy
who presented with fever and a perforated left-sided otitis media. He developed
left-sided complicated otitis media with retroauricular fluid collection,
mastoiditis, and temporomandibular joint effusion. The clinical picture was
complicated by a left internal jugular vein and left lateral sinus thrombosis.
Fusobacterium necrophorum grew in the pus culture. INTERVENTIONS: Low molecular
weight heparin. MEASUREMENTS AND MAIN RESULTS: No immunodeficiency and no
thrombophilia were identified as predisposing conditions for Lemierre syndrome.
Surgical drainage, early and adequate antibiotic treatment, and anticoagulation
were followed by complete recovery. CONCLUSIONS: This case report illustrates
that Lemierre syndrome can occur in infants without underlying risk factors for
severe infections or thrombotic complications.

Publication Types: 
    Case Reports
    Review

PMID: 18779698 [PubMed - indexed for MEDLINE]

49: Ann Otol Rhinol Laryngol. 2008 Aug;117(8):630-6.

Interleukin-10 is an essential modulator of mucoid metaplasia in a mouse otitis
media model.

Tsuchiya K, Komori M, Zheng QY, Ferrieri P, Lin J.

University of Minnesota Otitis Media Research Center, Department of
Otolaryngology, University of Minnesota Medical School, Minneapolis, Minnesota,
USA.

OBJECTIVES: Inflammatory cytokines are involved in the development of mucous cell
metaplasia and hyperplasia (MCM) in otitis media (OM). However, which cytokines
play an essential role in the MCM of OM is not clear at the moment. METHODS: In
this study, we hypothesized that interleukin-10 (IL-10) played an indispensable
role in the MCM of bacterial OM, and we used IL-10 knockout mice to test this
hypothesis. RESULTS: In wild-type mice, both Streptococcus pneumoniae and
Haemophilus influenzae triggered the development of MCM in the middle ear mucosa.
In IL-10 knockout mice, the number of goblet cells and mucin-producing cells in
the middle ear was significantly reduced after bacterial middle ear infection
compared with that in wild-type mice. CONCLUSIONS: We conclude that IL-10 plays
an essential role in the MCM of bacterial OM. Interleukin-10 is a potential
target for the treatment of MCM in OM.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18771082 [PubMed - indexed for MEDLINE]

50: J Neuroophthalmol. 2008 Sep;28(3):182-5.

Postganglionic horner syndrome in three patients with coincident middle ear
infection.

Spector RH.

Private Practice, 980 Johnson Ferry Road, Suite 550, Atlanta, GA 30342, USA.
fstop007@bellsouth.net

Three patients developed a postganglionic Horner syndrome during the course of an
ipsilateral uncomplicated middle ear infection. The mechanism may be an effect on
the middle ear caroticotympanic sympathetic plexus, for which there is
considerable anatomic and physiologic evidence. Why Horner syndrome does not
occur more often after middle ear infection is a mystery.

Publication Types: 
    Case Reports

PMID: 18769280 [PubMed - indexed for MEDLINE]

51: Ear Hear. 2008 Oct;29(5):718-24.

The development of frequency weighting for speech in children with a history of
otitis media with effusion.

Eapen RJ, Buss E, Grose JH, Drake AF, Dev M, Hall JW.

Department of Otolaryngology, Head and Neck Surgery, The University of North
Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
rpayyapi@unch.unc.edu

OBJECTIVES: To determine the effect of chronic (recurrent) otitis media with
effusion (OME) on frequency weighting in the perception of speech in noise. It
was hypothesized that children with a history of OME weight speech information in
the mid frequency region higher than control children. DESIGN: This is a matched 
cohort study looking at differences in frequency weighting in 12 children with a 
history of OME 1 to 2 wks after placement of tympanostomy tubes compared with 21 
control children. Children were tested on their ability to identify key words in 
sentences presented in speech-shaped noise. The frequency content of the
sentences was manipulated to determine the relative importance of frequencies in 
the regions of 1, 2, and 4 kHz. The frequency bands selected were 798 to 1212 Hz 
(low band), 1575 to 2425 Hz (mid band), and 3000 to 5000 Hz (high band). Initial 
testing involved adaptive runs where a speech-shaped masker was held at a
constant level and the level of the speech with all three bands present varied.
Once a level corresponding to 85% to 90% correct was identified, novel sentences 
were then presented at this signal-to-noise ratio in fixed block runs, with all
bands present, or with one of the three bands omitted. RESULTS: The children in
the OME group achieved 85% to 90% correct at a lower signal-to-noise ratio than
controls in the adaptive testing, where all three speech bands were present.
Fixed block testing indicated that children with OME history gave more weight to 
speech frequencies in the region of 2000 Hz compared with the age-matched control
group. CONCLUSIONS: The results are consistent with an interpretation that the
development of frequency weighting in the perception of speech can be affected by
a history of OME.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18769271 [PubMed - indexed for MEDLINE]

52: Int J Pediatr Otorhinolaryngol. 2008 Nov;72(11):1609-18. Epub 2008 Sep 2.

Effect of paranasal sinusitis on the development of otitis media with effusion:
influence of eustachian tube function and adenoid immunity.

Hong CK, Park DC, Kim SW, Cha CI, Cha SH, Yeo SG.

Department of Otolaryngology, School of Medicine, Kyung Hee University, Seoul,
Republic of Korea.

OBJECTIVES: Concordance between sinusitis and otitis media with effusion (OME)
has been reported in 5-60% of patients. Since nasal diseases induce edema and
lymphoid tissue hyperplasia in the nasopharyngeal mucosa, especially the
adenoids, chronic infection of the adenoids has been reported to induce otitis
media. In addition, deterioration in the mucosal barrier of the adenoids makes
the latter vulnerable to bacterial infections, resulting in OME or sinusitis. We 
therefore evaluated adenoid local immunity and Eustachian tube function by
sinusitis and the concordance between sinusitis and OME. MATERIALS AND METHODS:
We examined PNS series and tympanometry of 520 patients who had undergone
adenotonsillectomies. In addition, local adenoidal immunity was evaluated in 10
children with OME and sinusitis, 11 with only sinusitis, 10 with only OME and 12 
with no history of OME or sinusitis. Adenoid size, squamous metaplasia, IgA,
BCL-6, and mucosal barrier were also determined. RESULTS: Of 520 patients, 80
(15.4%) had both OME and sinusitis. The incidence of Eustachian tube dysfunction 
differed significantly between patients with and without sinusitis (p=0.03). The 
incidence of squamous metaplasia differed significantly between patients with
sinusitis plus OME and patients with sinusitis alone (p=0.01), and between
patients with OME alone and those without both conditions (p=0.005). Patients
with both sinusitis and OME differed significantly in IgA secretion (p=0.01) and 
Bcl-6 expression (p=0.02) from those with sinusitis alone, as did patients with
OME alone and those without both conditions (p=0.02 and p=0.03, respectively).
CONCLUSIONS: Sinusitis plus OME were present in 15.4% of patients. Eustachian
tube dysfunction was present in 37.9% of sinusitis patients and in 28.4% of those
without sinusitis. IgA, BCL-6 and squamous metaplasia were important in local
adenoidal immunity.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18768224 [PubMed - indexed for MEDLINE]

53: Early Hum Dev. 2008 Oct;84(10):667-71. Epub 2008 Aug 29.

Recurrent otitis media with effusion in preterm infants with histologic
chorioamnionitis--a 3 years follow-up study.

De Felice C, De Capua B, Costantini D, Martufi C, Toti P, Tonni G, Laurini R,
Giannuzzi A, Latini G.

Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Senese Siena,
Italy. defelice.claudio@libero.it

BACKGROUND: Recurrent otitis media with effusion (OME) is a leading cause of
acquired hearing loss in childhood. Histological chorioamnionitis (HCA) is an
important cause of preterm delivery and neonatal morbidity and mortality. Here,
we tested the hypothesis of an association between recurrent OME during the first
3 years of life and HCA in very low birth weight (VLBW) infants. METHODS: A total
of 110 randomly selected VLBW preterm newborns with HCA and 135 gestational age
and gender-matched, HCA-negative VLBW infants were evaluated prospectively during
the first 3 years of life for the presence of OME, as diagnosed on the basis of
otoscopy, type B or C tympanogram, ipsilateral absence of transient evoked
otoacoustic emissions responses, and ipsilaterally increased threshold at
diagnostic auditory brain responses evaluation. Potential risk factors for OME
were also examined in the two groups. RESULTS: The HCA-positive infants showed a 
approximately six times higher frequency of recurrent OME (P<0.0001), increased
frequency (>5/yr) of clinical otitis media episodes (P=0.000020), approximately
five times higher frequency of adenoid hypertrophy (P<0.00001), a significant
seasonal pattern of birth with autumn predominance (P<0.00001), and the first OME
occurred earlier (P<0.0001), as compared to the HCA-negative counterparts.
Recurrent OME was significantly associated with HCA (O.R.=17.76, 95% CI:
8.98-35.13, P<0.00001), adenoid hypertrophy (O.R.=9.96, 95% CI: 5.17-19.18,
P<0.00001), frequency of acute otitis episodes >5/yr (O.R.=8.91, 95% CI:
1.96-40.41, P=0.0005), and birth in autumn (O.R.=5.58, 95% CI: 2.79-11.12,
P<0.00001). CONCLUSIONS: These findings indicate that HCA is a previously
unrecognized risk factor for the development of recurrent bilateral OME in VLBW
preterm infants during the first 3 years of life.

PMID: 18760552 [PubMed - indexed for MEDLINE]

54: Otol Neurotol. 2008 Oct;29(7):949-52.

Bone conduction hearing level in patients with eosinophilic otitis media
associated with bronchial asthma.

Iino Y, Usubuchi H, Kodama K, Takizawa K, Kanazawa T, Ohta Y.

Department of Otolaryngology, Jichi Medical University Saitama Medical Center,
Saitama, Japan. yiino@omiya.jichi.ac.jp

OBJECTIVE: Eosinophilic otitis media (EOM) is characterized by the extensive
accumulation of eosinophils in the middle ear mucosa and middle ear effusion and 
is usually associated with bronchial asthma. EOM patients show gradual
deterioration of hearing and sometimes become deaf suddenly. However, there have 
been no systemic studies of bone conduction hearing level (BCHL) of patients with
EOM. PATIENTS: Seventy-one ears of 38 patients with EOM associated with bronchial
asthma were included in this study. For controls, 65 ears of age-matched 60
patients with chronic otitis media (COM), who underwent tympanoplasty, were
similarly studied. The BCHLs at 250, 500, 1,000, 2,000 and 4,000 Hz of EOM
patients were compared with those of COM patients, and the clinical risk factors 
for the deterioration of BCHL in EOM were analyzed. RESULTS: Two patients became 
profoundly deaf unilaterally after the onset of EOM. High-tone loss was more
frequently found and more severe in EOM patients than in COM patients. The
clinical risk factors for high-tone loss were older age, male sex, presence of
pathogens, and condition of the middle ear mucosa. CONCLUSION: High-tone hearing 
loss and profound hearing loss were frequently associated with EOM, suggesting
that inflammatory products of the middle ear invade the inner ear via the round
window to cause inner ear damage. To prevent the deterioration of BCHL, the
control of eosinophilic inflammation and bacterial infection is mandatory.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18758390 [PubMed - indexed for MEDLINE]

55: Otol Neurotol. 2008 Oct;29(7):961-4.

Trimethoprim-sulfamethoxazole in children with chronic otitis media: a randomized
comparison of costs and effects.

Boonacker CW, van der Veen EL, van der Wilt GJ, Schilder AG, Rovers MM.

Julius Center for Health Sciences and Primary Care, Wilhelmina Children's
Hospital, University Medical Center Utrecht, The Netherlands.
c.w.b.boonacker@umcutrecht.nl

OBJECTIVE: To study the cost-effectiveness of a 6- to 12-week course of high-dose
oral trimethoprim-sulfamethoxazole in children with chronic active otitis media
(COM). STUDY DESIGN: Cost-effectiveness study including both direct and indirect 
costs alongside a randomized placebo-controlled trial. SETTING: Tertiary care
university hospital in the Netherlands. PATIENTS: One hundred one children aged 1
to 12 years with a documented history of COM for at least 3 months. INTERVENTION:
Six to 12 weeks of oral trimethoprim-sulfamethoxazole 18 mg/kg twice daily versus
placebo. MAIN OUTCOME MEASURES: Incremental cost-effectiveness in terms of costs 
per number needed to treat (NNT) to cure 1 patient (incremental
cost-effectiveness ratio [ICER]). Curation was defined as no otomicroscopic signs
of otorrhea in either ear. RESULTS: After 6 weeks of follow-up, the difference in
mean cost per patient between the trimethoprim-sulfamethoxazole and placebo
groups was Euro100 (US $126). The NNT was 4 (clinical effect), and the
corresponding ICER was Euro400 (US $504), that is, the average extra costs to
cure 1 child from otorrhea is Euro400 (US $504). After 12 weeks of follow-up, the
difference in mean costs between both groups was Euro159 (US $201), the NNT was
7, and the corresponding ICER was Euro1,113 (US $1,407).The mean costs after 1
year of follow-up were Euro1,601 (US $2,021) in the trimethoprim-sulfamethoxazole
group and Euro1,164 (US $1,469) in the placebo group. Because the clinical effect
of trimethoprim-sulfamethoxazole disappeared after its discontinuation, we did
not calculate an ICER at 1 year of follow-up. CONCLUSION: In children with active
COM, direct and indirect costs of a 6- to 12-week course of high-dose oral
trimethoprim-sulfamethoxazole are modest in the light of its short-term clinical 
benefit.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 18758386 [PubMed - indexed for MEDLINE]

56: BMC Pediatr. 2008 Aug 28;8:32.

Absent otoacoustic emissions predict otitis media in young Aboriginal children: a
birth cohort study in Aboriginal and non-Aboriginal children in an arid zone of
Western Australia.

Lehmann D, Weeks S, Jacoby P, Elsbury D, Finucane J, Stokes A, Monck R, Coates H;
Kalgoorlie Otitis Media Research Project Team.

Collaborators: Aalberse J, Alpers K, Arumugaswamy A, Beissbarth J, Bonney P,
Bonney R, Bowman J, Carter J, Carville K, Coleman S, Cripps A, Dorizzi L, Dunn D,
Edwards E, Forrest A, Foxwell R, Gordon C, Harrington B, Harnett G,
Jeffries-Stokes C, Johnston J, Jones G, de Klerk NH, Kyd J, Kyaw-Myint SM,
Lannigan F, Leach AJ, Lewis T, McAullay D, McIntosh P, Meiklejohn K, Murphy D,
Nichols F, Pingault N, Richmond P, Riley TV, Sivwright K, Smith D, Sorian S,
Spencer J, Stanley FJ, Tamwoy J, Taylo A, Watson K, Wood K.

Telethon Institute for Child Health Research, Centre for Child Health Research,
University of Western Australia, Australia. deborahl@ichr.uwa.edu.au

BACKGROUND: Otitis media (OM) is the most common paediatric illness for which
antibiotics are prescribed. In Australian Aboriginal children OM is frequently
asymptomatic and starts at a younger age, is more common and more likely to
result in hearing loss than in non-Aboriginal children. Absent transient evoked
otoacoustic emissions (TEOAEs) may predict subsequent risk of OM. METHODS: 100
Aboriginal and 180 non-Aboriginal children in a semi-arid zone of Western
Australia were followed regularly from birth to age 2 years. Tympanometry was
conducted at routine field follow-up from age 3 months. Routine clinical
examination by an ENT specialist was to be done 3 times and hearing assessment by
an audiologist twice. TEOAEs were measured at ages <1 and 1-2 months. Cox
proportional hazards model was used to investigate the association between absent
TEOAEs and subsequent risk of OM. RESULTS: At routine ENT specialist clinics, OM 
was detected in 55% of 184 examinations in Aboriginal children and 26% of 392
examinations in non-Aboriginal children; peak prevalence was 72% at age 5-9
months in Aboriginal children and 40% at 10-14 months in non-Aboriginal children.
Moderate-severe hearing loss was present in 32% of 47 Aboriginal children and 7% 
of 120 non-Aboriginal children aged 12 months or more. TEOAE responses were
present in 90% (46/51) of Aboriginal children and 99% (120/121) of non-Aboriginal
children aged <1 month and in 62% (21/34) and 93% (108/116), respectively, in
Aboriginal and non-Aboriginal children at age 1-2 months. Aboriginal children who
failed TEOAE at age 1-2 months were 2.6 times more likely to develop OM
subsequently than those who passed. Overall prevalence of type B tympanograms at 
field follow-up was 50% (n = 78) in Aboriginal children and 20% (n = 95) in
non-Aboriginal children. CONCLUSION: The burden of middle ear disease is high in 
all children, but particularly in Aboriginal children, one-third of whom suffer
from moderate-severe hearing loss. In view of the frequently silent nature of OM,
every opportunity must be taken to screen for OM. Measurement of TEOAEs at age
1-2 months to identify children at risk of developing OM should be evaluated in a
routine health service setting.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18755038 [PubMed - indexed for MEDLINE]

57: Paediatr Drugs. 2008;10(5):329-35.

Pharmacodynamic target attainment of oral beta-lactams for the empiric treatment 
of acute otitis media in children.

Fallon RM, Kuti JL, Doern GV, Girotto JE, Nicolau DP.

Department of Pharmacy Services, Maine Medical Center, Portland, Maine, USA.

OBJECTIVE: To determine the probability of oral beta-lactam regimens achieving
bactericidal pharmacodynamic exposure against pathogens causing acute otitis
media (AOM) given contemporary prevalence and resistance rates. METHODS: A
5000-patient Monte Carlo simulation was used to recreate steady-state
concentration-time profiles for oral drug administration regimens of amoxicillin,
amoxicillin/clavulanic acid, cefpodoxime, cefprozil, ceftibuten, and cefuroxime
in a population of 12.5-month-old children. The percent of simulated children in 
whom free drug concentrations above the minimum inhibitory concentration (MIC)
for 50% of the drug administration interval (50% fT>MIC) were achieved was
determined; 180 middle ear fluid isolates (56 Haemophilus influenzae and 124
Streptococcus pneumoniae) collected during the 2004 Global Respiratory
Antimicrobial Surveillance Project (GRASP) were used. The cumulative fraction of 
response (CFR) was calculated and weighted against the prevalence of organisms
causing AOM extrapolated from the literature. The contribution of a 'Pollyanna
phenomenon' for each organism was also incorporated to estimate clinical
effectiveness. RESULTS: Against S. pneumoniae isolates, amoxicillin 30 mg/kg
every 8 hours (84.7%) achieved the greatest CFR followed by
amoxicillin/clavulanic acid and the other amoxicillin-based regimens. Against H. 
influenzae isolates, cefpodoxime, ceftibuten, and amoxicillin/clavulanic acid
each achieved a CFR of >90%. When weighted by the prevalence of AOM-causing
pathogens, CFR was highest for cefpodoxime (87.5%), amoxicillin/clavulanic acid
(85.7%), and amoxicillin 30 mg/kg every 8 hours (70.8%). The contribution of a
'Pollyanna phenomenon' increased the probability of clinical effectiveness for
all agents, with amoxicillin/clavulanic acid (90.2%) and cefpodoxime (90.1%)
having the highest weighted CFR. CONCLUSIONS: Based on the recent epidemiologic
and resistance profiles of S. pneumoniae and H. influenzae,
amoxicillin/clavulanic acid (45 mg/kg every 12 hours) and cefpodoxime (5 mg/kg
every 12 hours) provide the greatest likelihood of achieving optimal
pharmacodynamic exposures empirically in children with AOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18754699 [PubMed - indexed for MEDLINE]

58: Clin Vaccine Immunol. 2008 Oct;15(10):1555-63. Epub 2008 Aug 27.

Distribution of pneumococcal surface protein A families 1 and 2 among
Streptococcus pneumoniae isolates from children in finland who had acute otitis
media or were nasopharyngeal carriers.

Melin MM, Hollingshead SK, Briles DE, Hanage WP, Lahdenkari M, Kaijalainen T,
Kilpi TM, Käyhty HM.

National Public Health Institute (KTL), Department of Vaccines, Mannerheimintie
166, 00300 Helsinki, Finland. merit.melin@ktl.fi

PspA is a structurally variable surface protein important to the virulence of
pneumococci. PspAs are serologically cross-reactive and exist as two major
families. In this study, we determined the distribution of PspA families 1 and 2 
among pneumococcal strains isolated from the middle ear fluid (MEF) of children
with acute otitis media and from nasopharyngeal specimens of children with
pneumococcal carriage. We characterized the association between the two PspA
families, capsular serotypes, and multilocus sequence types (STs) of the
pneumococcal isolates. MEF isolates (n = 201) of 109 patients and nasopharyngeal 
isolates (n = 173) of 49 children were PspA family typed by whole-cell enzyme
immunoassay (EIA). Genetic typing (PCR) of PspA family was done for 60 isolates
to confirm EIA typing results. The prevalences of PspA families 1 and 2 were
similar among pneumococci isolated from MEF (51% and 45%, respectively) and
nasopharyngeal specimens (48% each). Isolates of certain capsule types as well as
isolates of certain STs showed statistical associations with either family 1 or
family 2 PspA. Pneumococci from seven children with multiple pneumococcal
isolates appeared to express serologically different PspA families in different
isolates of the same serotype; in three of the children the STs of the isolates
were the same, suggesting that antigenic changes in the PspA expressed may have
taken place. The majority of the isolates (97%) belonged to either PspA family 1 
or family 2, suggesting that a combination including the two main PspA families
would make a good vaccine candidate.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18753340 [PubMed - indexed for MEDLINE]

59: Clin Exp Immunol. 2008 Oct;154(1):134-40. Epub 2008 Aug 22.

Erratum in:
    Clin Exp Immunol. 2008 Dec;154(3):432.

Expression of inflammatory mediators in the otitis media induced by Helicobacter 
pylori antigen in mice.

Kariya S, Okano M, Fukushima K, Nomiya S, Kataoka Y, Nomiya R, Akagi H, Nishizaki
K.

Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate
School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
skariya@cc.okayama-u.ac.jp

Helicobacter pylori is a Gram-negative bacterium that is recognized as one of the
key factors in gastric diseases such as gastritis, peptic ulcer and gastric
cancer. Recent studies have shown relationships between H. pylori and
extra-digestive diseases, and the presence of H. pylori in the middle ear and
upper respiratory tract has been reported. However, the role of H. pylori in
middle ear disease remains unclear. The present study demonstrated that H. pylori
whole-cell protein directly induces macrophage migration inhibitory factor,
macrophage inflammatory protein 2, interleukin 1 beta and tumor necrosis factor
alpha in middle ear epithelium in mice, and severe proliferation of inflammatory 
cells was observed in middle ear cavity inoculated with H. pylori whole-cell
protein. In addition, trans-tympanic injection of macrophage migration inhibitory
factor up-regulated expression of macrophage inflammatory protein 2 in the middle
ear. These findings indicate that H. pylori infection causes immunological
inflammation in middle ear epithelium, and H. pylori may play a significant role 
in otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18727622 [PubMed - indexed for MEDLINE]

60: Pediatr Infect Dis J. 2008 Oct;27(10):929-33.

Host's response in otitis media: understanding genetic susceptibility.

Ilia S, Goulielmos GN, Samonis G, Galanakis E.

Department of Pediatrics, University of Crete, Heraklion, Greece.

Increasing evidence is emerging on genetic factors affecting host's response to
infection in the middle ear. This review summarizes current knowledge on the
field and on the contribution of nonspecific barriers, innate, and adaptive
immunity. Better understanding of susceptibility to this very common disease will
facilitate identification of high-risk individuals and optimization of prevention
and treatment.

Publication Types: 
    Review

PMID: 18724267 [PubMed - indexed for MEDLINE]

61: Otolaryngol Head Neck Surg. 2008 Sep;139(3):395-8.

The changes of MRSA infections in chronic suppurative otitis media.

Park MK, Jung MH, Kang HJ, Woo JS, Lee HM, Jung HH, Hwang SJ, Chae SW.

Department of Otolaryngology-Head and Neck Surgery, Korea University College of
Medicine, Guro-gu, Seoul, Korea.

OBJECTIVES: To investigate the epidemiologic and microbiological characteristics 
of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) and
hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA)
infections in the otorrhea of chronic suppurative otitis media (COM) patients.
DESIGN: Retrospective study of patients with newly identified MRSA infections
from January 1998 through December 2006. A total of 2773 patients with a
diagnosis of COM were included in this study. An antibiotic sensitivity test was 
performed for each isolate. RESULTS: The prevalence of MRSA in COM was 4.9
percent (137 of 2773 patients). The proportion of CA-MRSA rose from 0.7 percent
in 1998 to 11.4 percent in 2006. However, the proportion of HA-MRSA did not
change significantly, from 0.7 percent in 1999 to 1.3 percent in 2006. All of the
CA-MRSA strains identified in our study were susceptible to
trimethoprim/sulfamethoxazole (TMP/SMX). Rifampin susceptibility was also noted
in 90 percent of the cases. CONCLUSIONS: CA-MRSA infections have risen
dramatically in the past decade. CA-MRSA and HA-MRSA in COM differed in both
clinical and microbiological aspects.

PMID: 18722220 [PubMed - indexed for MEDLINE]

62: Otolaryngol Head Neck Surg. 2008 Sep;139(3):333-9.

Randomized controlled studies and the treatment of middle-ear effusions and
tonsillar pharyngitis: how random are the studies and what are their limitations?

Ruben RJ.

Department of Otolaryngology-Head and Neck Surgery, Albert Einstein College of
Medicine, 3400 Bainbridge Avenue, 3rd Floor, Bronx, NY 10467-2490, USA.
ruben@aecom.yu.edu

OBJECTIVE: To determine the applicability and external validity of randomized
control studies (RCTs) in the light of patient susceptibilities and
vulnerabilities to the sequelae of otitis media with effusion (OME) and tonsillar
pharyngitis (T&A) and the composition of their cohorts. STUDY DESIGN: RCTs for
OME and T&A were analyzed to determine which intrinsic and extrinsic
susceptibilities to the otolaryngic disease and its sequelae were included or
excluded and the composition of the cohort. METHODS: A Medline and a Science
Direct search were performed for all RCTs concerning OME and T&A through 2007.
The articles selected to be included in this study are the OME RCTs that reported
language and/or hearing outcomes and the T&A RCT studies in which the outcome
measure was infection, alleviation of airway obstruction, and/or quality of life.
These were analyzed for their inclusion or exclusion of intrinsic and extrinsic
susceptibilities to the otolaryngic disease and their sequelae and the
composition of the cohort. The pertinent otolaryngologic literature was assessed 
to determine applicable risk factors. RESULTS: The analysis of the inclusion or
exclusion of risk factors showed that for OME 0 percent were included and 16
percent were excluded, and there were no data for 84 percent. The T&A findings
were similar in that 1 percent of risk factors were included, 8 percent excluded,
and there were no data for 92 percent. Both the OME and the T&A cohorts data were
similar in that approximately half of the suitable candidates completed the
study; 25 percent of the OME and 13 percent of the T&A enrolled subjects were
either withdrawn or placed into a different experimental group. On the average,
with data available, it took 4.6 years to recruit the OME sample and 5.5 years to
recruit the T&A sample. CONCLUSION: The results of RCTs for these conditions are 
only applicable to narrowly defined and highly circumscribed populations. They
cannot be generalized to the entire patient population because of their limited
external validity. Future RCT protocols should be designed to control for the
intrinsic and extrinsic susceptibilities that result in a propensity to acquire
the disease and/or an exacerbation of the disease's sequelae. These studies would
determine the most effective strategies for preventing disorders and/or their
deleterious sequelae.

Publication Types: 
    Evaluation Studies

PMID: 18722208 [PubMed - indexed for MEDLINE]

63: Arch Dis Child. 2009 Feb;94(2):92-8. Epub 2008 Aug 19.

Spray bacteriotherapy decreases middle ear fluid in children with secretory
otitis media.

Skovbjerg S, Roos K, Holm SE, Grahn Håkansson E, Nowrouzian F, Ivarsson M,
Adlerberth I, Wold AE.

Department of Clinical Bacteriology, University of Gothenburg, Guldhedsgatan 10A,
SE-413 46 Gothenburg, Sweden. susann.skovbjerg@vgregion.se

OBJECTIVE: Secretory otitis media (SOM) is characterised by persistent fluid in
the middle ear cavity, but the cause is unknown. We investigated the clinical,
bacteriological and immunological effects of treatment with probiotic bacteria on
SOM. DESIGN: In this double-blind pilot/preliminary study, 60 children with
long-standing SOM (median 6 months) who were scheduled for insertion of
tympanostomy tubes were randomised to nasal spray treatment with Streptococcus
sanguinis, Lactobacillus rhamnosus or placebo for 10 days before surgery.
Clinical evaluation was carried out after 10 days of treatment. Middle ear fluid 
(MEF) was collected during surgery for quantification of cytokines and detection 
of bacteria by culture and polymerase chain reaction (PCR). Nasopharyngeal swabs 
were obtained before treatment and at surgery. RESULTS: Complete or significant
clinical recovery occurred in 7/19 patients treated with S sanguinis compared to 
1/17 patients in the placebo group (p<0.05). In the L rhamnosus treatment group, 
3/18 patients were cured or much better (p = 0.60 compared with placebo). Spray
treatment did not alter the composition of the nasopharyngeal flora or the
cytokine pattern observed in the nasopharynx or MEF, except for a higher level of
IL-8 found in the nasopharynx of L rhamnosus treated children. CONCLUSIONS: This 
study shows that spray treatment with S sanguinis may be effective against SOM.
The mechanism for the effect remains to be investigated.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 18713796 [PubMed - indexed for MEDLINE]

64: Stat Med. 2008 Nov 29;27(27):5640-63.

Regaining power lost by non-compliance via full probability modelling.

Becque T, White IR.

MRC Biostatistics Unit, Institute of Public Health, Forvie Site, Robinson Way,
Cambridge CB2 0SR, U.K. Taeko.Becque@gmail.com

Non-compliance, or non-receipt of randomized intervention, is a common problem in
randomized controlled trials. An intention-to-treat (ITT) analysis, which
compares individuals as randomized, under-estimates the efficacy of the
intervention and leads to a loss of power. We explore the possibility of
regaining some of this power in a setting with all-or-nothing compliance, without
making any assumptions about the comparability of compliers and non-compliers.
Efficacy may be specified as the complier average causal effect (CACE), which is 
the difference in mean outcome among compliers. Compliance is only partially
observed, but under an exclusion restriction assumption, the CACE may be
estimated using maximum likelihood. In order to quantify the possible gain in
power, we derive an expression for the asymptotic relative efficiency (ARE) of
the CACE relative to the ITT effect with a Normally distributed outcome. Under
the assumption of a common CACE across covariate strata, the CACE estimate is at 
least as powerful as ITT analysis. The inclusion of covariates that predict
compliance enables an additional gain in power, which is investigated
algebraically. Using data from three clinical trials, we obtain values of the ARE
ranging up to 1.05 due to covariates alone, and 1.13 due to CACE modelling alone,
corresponding to gains in power of up to 5 per cent. This implies that a large
gain in power obtained using as-treated or per-protocol analyses is likely to be 
due to the strong and often implausible assumptions such analyses require to be
valid. Copyright (c) 2008 John Wiley & Sons, Ltd.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 18712776 [PubMed - indexed for MEDLINE]

65: Can Fam Physician. 2008 Aug;54(8):1123-7.

Comment in:
    Can Fam Physician. 2008 Oct;54(10):1377-8; discussion 1378.

Acute otitis media in children with tympanostomy tubes.

Schmelzle J, Birtwhistle RV, Tan AK.

Department of Family Medicine, Queen's University, Kingston, ON, Canada.

OBJECTIVE: To review evidence regarding antibiotic treatment of acute otitis
media in children with tympanostomy tubes and to discuss antibiotic resistance
and ototoxicity.QUALITY OF EVIDENCE: MEDLINE, EMBASE, the Cochrane Database of
Systematic Reviews, and the Cochrane Central Register of Controlled Trials were
searched for relevant articles. Articles providing level I evidence(randomized
controlled trials) for treatment were used. Key words used in the search included
otitis media(MeSH), middle ear ventilation (MeSH), tympanostomy tubes, and
otorrhea.MAIN MESSAGE: Tympanostomy tube insertion is a common procedure; acute
otitis media is a frequent sequela.Treatment options include systemic or topical 
antibiotics with or without corticosteroids. The development of bacterial
resistance to antibiotics and ototoxicity related to treatment are important
considerations. There have been well-conducted randomized controlled trials of
topical versus systemic antibiotic agents. Combined with proper ear cleaning and 
tragal pumping, topical fluoroquinolone agents offer the most effective
treatment.CONCLUSION: Current evidence suggests that a topical fluoroquinolone,
with or without a corticosteroid, is the treatment of choice for acute otitis
media with tympanostomy tubes.

Publication Types: 
    Review

PMID: 18697973 [PubMed - indexed for MEDLINE]

66: Parassitologia. 2008 Jun;50(1-2):85-8.

Management of Malassezia-related diseases in the dog.

Peano A, Gallo MG.

Dipartimento Produzioni Animali, Epidemiologia ed Ecologia, Università degli
Studi di Torino, Italy. andrea.peano@unito.it

Most cases of Malassezia dermatitis/otitis in the dog are associated with
concurrent dermatoses or systemic diseases and recurrences are not uncommon.
Recognition and control of the predisposing factors are therefore key factors for
successful therapy and prevention of recurrent infections. Currently, Malassezia 
dermatitis/otitis is managed by the use of antifungal drugs. Systemic therapy is 
often necessary, in particular when clinical signs are severe and widespread.
Ketoconazole and Itraconazole are the most commonly used drugs. Topical therapy
is an alternative in case of localized lesions and external ear localizations.
Different commercial formulations, available in clinical practice in form of
creams, gels, lotions, sprays and ear drops are often used as adiuvants to
systemic therapy. Topicals more frequently used are represented by imidazolic
antifungals, chlorhexydine and lime sulphur. The presentation deals with more
recent advances about the protocols for treatment of Malassezia-related diseases 
in the dog. New perspectives, as the use of natural compounds, immunotherapy and 
inhibitors of yeast adherence factors, are also discussed.

Publication Types: 
    Review

PMID: 18693565 [PubMed - indexed for MEDLINE]

67: Parassitologia. 2008 Jun;50(1-2):81-3.

Diagnostic and clinical features of animal malasseziosis.

Nardoni S, Corazza M, Mancianti F.

Dipartimento di Patologia Animale, Profilassi ed Igiene degli Alimenti,
Università di Pisa. Viale delle Piagge, 2 56124 Pisa, Italy.
snardoni@vet.unipi.it

Malassezia yeasts infection represents a common clinical concern with a special
regard to canine dermatology. The Authors review the main clinical features of
malasseziosis in canine and feline medicine, summarizing predisposing factors and
aetiopathogenesis of the yeasts' infection. A special reference was given to
clinical and microscopical diagnosis.

Publication Types: 
    Review

PMID: 18693564 [PubMed - indexed for MEDLINE]

68: Pediatrics. 2008 Aug;122(2):267-72.

Morbidity of overweight (>or=85th percentile) in the first 2 years of life.

Shibli R, Rubin L, Akons H, Shaoul R.

Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel.

OBJECTIVES: Our hypothesis was that morbidity related to overweight/obesity is
already evident in infants and young toddlers. The major objectives of this study
were (1) to assess the prevalence of overweight in a sample of hospitalized
infants and (2) to assess the prevalence of morbidity in overweight infants in a 
community-based sample. METHODS: The hospital admission study population included
2139 infants, <or=24 months of age, who were admitted for any reason to the
pediatric department at the Bnai Zion Medical Center in 2004-2005. For the
community-based sample, we identified overweight infants (>or=85th
weight-for-height percentile in >or=2 measurements, >or=3 months apart), <or=24
months of age, in 8 mother and child health care facilities in the Haifa
subdistrict of Israel. Parents of infants were interviewed by using a structured 
questionnaire. RESULTS: We found that overweight infants (85th to 94th
percentiles) had fewer admissions and fewer repeated admissions than expected.
Infants of >or=95th percentile had more admissions than expected, as well as a
larger number of repeated admissions. In the second part of the study, we found
that rates of developmental delays (mainly delayed gross motor skills) and
snoring were significantly higher in infants of >or=85th percentile. In addition,
although the results were not statistically significant, infants with overweight 
suffered more frequently from breathing problems, such as asthma and stridor.
When the mothers were asked to assess whether their child was overweight, only
31.6% of mothers of overweight children thought that the child was overweight.
CONCLUSIONS: The high admission rates for infants of >or=95th percentile and the 
high incidence rates of respiratory morbidity, snoring, and delayed gross motor
skills in overweight infants support our hypothesis regarding early morbidity
associated with overweight.

Publication Types: 
    Comparative Study

PMID: 18676542 [PubMed - indexed for MEDLINE]

69: PLoS ONE. 2007 Aug 13;3(8):e2950.

Genetic requirement for pneumococcal ear infection.

Chen H, Ma Y, Yang J, O'Brien CJ, Lee SL, Mazurkiewicz JE, Haataja S, Yan JH, Gao
GF, Zhang JR.

Center for Immunology and Microbial Disease, Albany Medical College, Albany, New 
York, USA.

BACKGROUND: Ear infection or otitis media (OM) accounts for most bacterial
respiratory infections in children in both developed and developing nations.
Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella
catarrhalis are the major OM pathogens. However, little is known about the
genetic basis of bacterial OM largely due to practical difficulties in conducting
research in ear infection models and genetically manipulating clinical isolates. 
Here, we report the first genome-scale in vivo screen for bacterial genes
required for ear infection in a chinchilla model by signature tagged mutagenesis 
(STM), a high throughput mutant screen technique. METHODOLOGY/PRINCIPAL FINDINGS:
STM strains were constructed with a multi-drug resistant OM isolate ST556
(serotype 19F) and screened in a chinchilla OM model. Out of 5,280 mutants
tested, 248 mutants were substantially underrepresented in the mutant pools
recovered from the middle ear fluids of the infected chinchillas, indicating the 
impaired ability to survive and replicate in the middle ears due to genetic
disruptions in the chromosome of strain ST556. Further DNA sequencing analysis
mapped the mutations to 169 pneumococcal genes. Surprisingly, only 52 of these
genes were required for pneumococcal nasopharyngeal colonization in a murine
model. This infection site-specific gene requirement was verified by targeted
mutagenesis in the selected genes. CONCLUSIONS/SIGNIFICANCE: These findings
suggest that there are a subset of pneumococcal genes required for ear infection 
and that these may be distinct from those required for nasal colonization. Our
data thus provide comprehensive gene targets for mechanistic understanding of
pneumococcal ear infection. Finally, this study has also developed a model for
future genome-scale search for virulence determinants in other pathogens
associated with ear infections.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18670623 [PubMed - indexed for MEDLINE]

70: Pediatr Infect Dis J. 2008 Aug;27(8):692-8.

Topical ciprofloxin versus topical framycetin-gramicidin-dexamethasone in
Australian aboriginal children with recently treated chronic suppurative otitis
media: a randomized controlled trial.

Leach A, Wood Y, Gadil E, Stubbs E, Morris P.

Menzies School of Health Research, Darwin, Australia.

BACKGROUND: Chronic suppurative otitis media (CSOM) affects many children in
disadvantaged populations. The most appropriate topical antibiotic treatment in
children with persistent disease is unclear. METHODS: Children with CSOM despite 
standard topical treatment were randomized to 6-8 weeks of topical ciprofloxacin 
(CIP) versus topical framycetin-gramicidin-dexamethasone (FGD). Otoscopic,
audiologic, and microbiologic outcomes were measured using standardized
assessments and blinding. RESULTS: Ninety-seven children were randomized. Ear
discharge failed to resolve at the end of therapy in 70% children regardless of
allocation [risk difference = -2%; (95% CI: -20 to 16)]. Healing of the tympanic 
membrane occurred in one of 50 children in the CIP group and none of 47 children 
in the FGD group. Severity of discharge failed to improve in more than 50%
children in each group, and mean hearing threshold (38 dB and 35 dB) and
proportion of children with greater than 25 dB hearing loss (98% and 88%) were
not significantly different between the CIP and FGD groups. Side effects were
rare. CONCLUSIONS: This study showed a similarly low rate of improvement or cure 
in children with persistent CSOM for both CIP and FGD topical therapies.
Complications and side effects were insufficient to cease therapy or inform
prescribing of either therapy.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 18664984 [PubMed - indexed for MEDLINE]

71: Wiad Parazytol. 2008;54(1):37-41.

Otitis externa: the analysis of relationship between particular signs/symptoms
and species and genera of identified microorganisms.

Kurnatowski P, Filipiak J.

Department of Biology and Medical Parasitology, Medical University of Łódź, Łódź,
Poland. pkurnatowski@yahoo.com

OBJECTIVE: To investigate a relationship between the etiological factor of
external otitis and occurrence of particular signs/symptoms. DESIGN: A special
questionnaire was designed and completed by all patients covering personal
details, medical history, results of otolaryngological examination and
bacteriological and mycological investigations. SUBJECTS: 249 patients of the
Outpatient Department of Laryngology at the Regional Hospital in Bełchatów with
symptoms of external otitis. For analysis of relationships between particular
signs/symptoms and species/genera of microorganisms, statistical tests were used:
chi2 test, chi2 test with Yate's modification, C-Pearson index, and Fisher exact 
test for very small samples. RESULTS: There is a statistical dependence between
discharge, hearing loss, swelling of skin, scant, dried discharge with fetid
odour and bacteria isolated from the external ear canal. Similar dependence
exists between pain, hearing loss, no smelly discharge or wet, black plug of
fetid odour and fungi. Also there is a statistical dependence between pruritus,
red skin and grey, fetid discharge and mixed flora. CONCLUSIONS: Some of symptoms
and signs are connected with definite etiological factors which is important not 
only for correct diagnosis but also for institution of appropriate and effective 
treatment. On the basis of some characteristic symptoms and signs it is possible 
to make a tentative diagnosis as to the etiological pathogen responsible for
external otitis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18664104 [PubMed - indexed for MEDLINE]

72: Ann Otol Rhinol Laryngol. 2008 Jun;117(6):470-6.

Effect of infliximab on experimentally induced otitis media in rats.

Lee DH, Yeo SW, Chang KH, Park SY, Oh JH, Seo JH.

Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The
Catholic University of Korea, Seoul, South Korea.

OBJECTIVES: We performed a prospective randomized and controlled animal study to 
investigate the effects of infliximab on experimental otitis media in rats.
METHODS: Seventy-two Sprague-Dawley rats were randomly allocated to 3 study
groups and 1 control group. Infliximab was injected intravenously.
Histopathologic changes were determined by hematoxylin-eosin staining.
Fluorescence microscopy was performed to examine the leakage of the exudates.
Vascular permeability was measured by the Evans blue dye technique. RESULTS: In
comparison with the control group, we found significant differences in the extent
of middle ear mucosa without active inflammation and the presence of reparable
lesions in all study groups treated with infliximab. A significant reduction of
extravasated Evans blue dye in all study group animals was found as compared with
the control group animals. CONCLUSIONS: This study suggests that the monoclonal
tumor necrosis factor alpha antibody, infliximab, can reduce inflammatory
activity in experimental otitis media in rats.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18646445 [PubMed - indexed for MEDLINE]

73: Cochrane Database Syst Rev. 2008 Jul 16;(3):CD001727.

Update of:
    Cochrane Database Syst Rev. 2004;(3):CD001727.

Decongestants and antihistamines for acute otitis media in children.

Coleman C, Moore M.

Department of Paediatrics, Wycombe Hospital, The Walled Garden, High Street,
Maidenhead, Berkshire, UK, SL6 5NB. cass81@doctors.org.uk

BACKGROUND: Acute otitis media (AOM) is a common and important source of
morbidity in children, although the majority of cases resolve spontaneously.
While frequently recommended, decongestant and antihistamine therapy is of
unclear benefit. OBJECTIVES: To determine the efficacy of decongestant and
antihistamine therapy in children with AOM on outcomes of AOM resolution, symptom
resolution, medication side effects, and complications of AOM. SEARCH STRATEGY:
In this updated review, we searched the Cochrane Central Register of Controlled
Trials (CENTRAL) (The Cochrane Library 2007, Issue 2); MEDLINE (January 2004 to
May 2007); and EMBASE (July 2003 to May 2007). SELECTION CRITERIA: Randomized
controlled trials (RCTs) evaluating decongestant or antihistamine treatment for
children with AOM were included. Patient-oriented outcomes were considered most
relevant. DATA COLLECTION AND ANALYSIS: The review authors independently
evaluated studies for inclusion, performed validity assessments and completed
data extraction. Dichotomous data were pooled to generate relative risks;
homogeneity was assessed using approximate chi-square tests. MAIN RESULTS: No new
studies were included following this updated search. Fifteen trials involving
2695 people were included. Only the combined decongestant-antihistamine group
demonstrated statistically lower rates of persistent AOM at the two week period
(fixed relative risk (RR) 0.76; 95% confidence interval (CI) 0.60 to 0.96; number
needed to treat (NNT) 10). No benefit was found for early cure rates, symptom
resolution, prevention of surgery or other complications. There was a five to
eight -fold increased risk of side effects for those receiving an intervention,
which reached statistical significance for all decongestant groupings. Validity
sub analyses demonstrated that lower quality studies found benefit, while
analysis of those studies with higher validity scores found no benefit of
treatment. AUTHORS' CONCLUSIONS: Given lack of benefit and increased risk of side
effects, these data do not support the use of decongestant treatment in children 
with AOM. There was a small statistical benefit from combination medication use
but the clinical significance is minimal and study design may be biasing the
results. Thus, the routine use of antihistamines for treating AOM in children
cannot be recommended.

Publication Types: 
    Meta-Analysis
    Review

PMID: 18646076 [PubMed - indexed for MEDLINE]

74: Bratisl Lek Listy. 2008;109(5):204-9.

Severe acute otitis media in children.

Pavlovcinova G, Jakubikova J, Hromadkova P, Mohammed E.

Children's ENT Department, Children's University Hospital, Bratislava, Slovakia. 
gabikad@yahoo.com

Acute otitis media (AOM) is one of the most common infections in children.
Recently it was noticed that there is a marked increase in relapse of severe
acute otitis media in children. There is also an increase in number of
hospitalized children due to severe AOM, with etiological agent resistant to
antibiotics. There is a rise of infections, caused by highly resistant
Streptococcus pneumoniae, too. Authors retrospectively reviewed children
hospitalized at the Children's ENT Department in Children's University Hospital
in Bratislava, from January 2005 to December 2006, due to severe acute otitis
media. They mainly focused on etiological agent, antibiotics resistance as well
as alternatives of treatment and prevention of severe AOM. During 2 years, there 
were 76 children aged from 4 months to 14 years hospitalized with severe AOM. The
most frequent etiological agent was Streptococcus pneumoniae in 37 cases; this
was almost in 70% of cases resistant to routine antibiotics. In 7 cases there was
mastoiditis, and mastoidectomy or antrotomy had to be done in 6 cases. To
establish a diagnosis and start appropriate treatment it is necessary to identify
etiological agent and its sensitivity. An increasing bacterial resistance is
forcing us to prescribe antibiotics rationally. When severe AOM occurs,
tympanotomy and insertion of ventilation tubes, exceptionally mastoidectomy, is
often required (Fig. 13, Tab. 3, Ref. 18). Full Text (Free, PDF) www.bmj.sk.

PMID: 18630803 [PubMed - indexed for MEDLINE]

75: Laryngoscope. 2008 Jul;118(7 Part 2 Suppl 116):1-9.

The role of extraesophageal reflux in otitis media in infants and children.

O'Reilly RC, He Z, Bloedon E, Papsin B, Lundy L, Bolling L, Soundar S, Cook S,
Reilly JS, Schmidt R, Deutsch ES, Barth P, Mehta DI.

Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.
roreilly@nemours.org

OBJECTIVES/HYPOTHESIS: Gastroesophageal reflux disease (GERD) is common in
children, and extraesophageal reflux disease (EORD) has been implicated in the
pathophysiology of otitis media (OM). We sought to 1) determine the incidence of 
pepsin/pepsinogen presence in the middle ear cleft of a large sample of pediatric
patients undergoing myringotomy with tube placement for OM; 2) compare this with 
a control population of pediatric patients undergoing middle ear surgery
(cochlear implantation) with no documented history of OM; 3) analyze potential
risk factors for OM in children with EORD demonstrated by the presence of pepsin 
in the middle ear cleft; and 4) determine if pepsin positivity at the time of
myringotomy with tube placement predisposes to posttympanostomy tube otorrhea.
STUDY DESIGN AND METHODS: Study Group: prospective samples of 509 pediatric
patients (n = 893 ear samples) undergoing myringotomy with tube placement for
recurrent acute OM and/or otitis media with effusion in a tertiary care pediatric
hospital with longitudinal follow-up of posttympanostomy tube otorrhea. Control
Group: prospective samples of 64 pediatric patients (n = 74 ears) with negative
history of OM undergoing cochlear implantation at one of the three tertiary care 
pediatric hospitals. A previously validated, highly sensitive and specific
modified enzymatic assay was used to detect the presence of pepsin in the middle 
ear aspirates of study and control patients. Risk factors for OM and potentially 
associated conditions, including GERD, allergy, and asthma were analyzed for the 
study group through review of the electronic medical record and correlated
topresence of pepsin in the middle ear space. Study patients were followed
longitudinally postoperatively to determine the incidence of posttympanostomy
tube otorrhea. RESULTS: The incidence of pepsin in the middle ear cleft of the
study group was 20% of patients and 14% of ears, which is significantly higher
than 1.4% of control patients and 1.5% of control ears (P < .05). Study patients 
younger than 1 year had a higher rate of purulent effusions and pepsin in the
middle ear cleft (P < .05). Patients with pepsin in the middle ear cleft were
more likely to have an effusion at the time of surgery than patients without
pepsin in the middle ear cleft (P < .05). There was no statistical association
found between the presence of pepsin and clinical history of GERD, allergy,
asthma, or posttympanostomy tube otorrhea. CONCLUSIONS: Pepsin is detectable in
the middle ear cleft of 20% of pediatric patients with OM undergoing tympanostomy
tube placement, compared with 1.4% of controls; recovery of pepsin in the middle 
ear space of pediatric patients with OM is an independent risk factor for OM.
Patients under 1 year of age have a higher incidence of purulent effusions and
pepsin-positive effusions. Clinical history of GERD, allergy, and asthma do not
seem to correlate with evidence of EORD reaching the middle ear cleft. The
presence of pepsin in the middle ear space at the time of tube placement does not
seem to predispose to posttympanostomy tube otorrhea.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18594333 [PubMed - indexed for MEDLINE]

76: J Pediatr. 2008 Dec;153(6):764-70. Epub 2008 Jul 14.

Effects of influenza plus pneumococcal conjugate vaccination versus influenza
vaccination alone in preventing respiratory tract infections in children: a
randomized, double-blind, placebo-controlled trial.

Jansen AG, Sanders EA, Hoes AW, van Loon AM, Hak E.

Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.

OBJECTIVE: To evaluate the effects of influenza vaccination with or without
heptavalent pneumococcal conjugate vaccination on respiratory tract infections
(RTIs) in children. STUDY DESIGN: This was a randomized, double-blind,
placebo-controlled trial comprising 579 children age 18 to 72 months with a
previous history of physician-diagnosed RTI, recruited between 2003 and 2005. The
children were assigned to 2 doses of parenteral inactivated trivalent subunit
influenza plus heptavalent pneumococcal conjugate vaccination (TIV+PCV7),
influenza plus placebo vaccination (TIV+plac), or control hepatitis B virus
vaccination plus placebo (HBV+plac). Main outcome measures were febrile RTI and
related polymerase chain reaction (PCR)-confirmed influenza, primary care visits,
antibiotic prescriptions, and acute otitis media (AOM) episodes. RESULTS: During 
influenza seasons, febrile RTI were reduced by 24% (95% confidence interval [CI] 
= 1% to 42%) in the TIV+PCV7 group and by 13% (95% CI = -12% to 32%) in the
TIV+plac group compared with the control group. The occurrence of PCR-confirmed
influenza was reduced by 52% (95% CI = 7% to 75%) in the TIV+PCV7 group and by
51% (95% CI = 3% to 75%) in the TIV+plac group. Episodes of AOM were reduced by
57% (95% CI = 6% to 80%) in the TIV+PCV7 group and by 71% (95% CI = 30% to 88%)
in the TIV+plac group. Outside of the influenza seasons, no significant effects
of vaccinations were demonstrated on the studied outcomes. CONCLUSIONS: During
influenza seasons, influenza vaccination with or without pneumococcal conjugate
vaccination substantially reduced cases of confirmed influenza and AOM episodes.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 18621393 [PubMed - indexed for MEDLINE]

77: Microb Pathog. 2008 Sep;45(3):201-6. Epub 2008 Jun 3.

Interaction of pneumococcal phase variation and middle ear pressure/gas
composition: an in vitro model of simulated otitis media.

Li-Korotky HS, Banks JM, Lo CY, Zeng FR, Stolz DB, Swarts JD, Doyle WJ.

Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 8100
Rangos Research Center, 3460 Fifth Avenue, Pittsburgh, PA 15213, USA.
Ha-Sheng.Li@chp.edu

Streptococcus pneumoniae, a leading cause of otitis media (OM), undergoes
spontaneous intra-strain variations in colony morphology. Transparent (T) variant
is more efficient in colonizing the nasopharynx while the opaque (O) variant
exhibits greater virulence during systemic infections. We hypothesized that
changes in middle ear (ME) gas pressure/composition during Eustachian tube (ET)
dysfunction and the treatment of that dysfunction, e.g., tympanostomy tube (TT)
insertion, play a role in selecting the S. pneumoniae variant that can
efficiently colonize/infect the ME mucosa. Human ME epithelial cells were
preconditioned for 24h under one of three conditions that simulated (1) normal
ME, (2) ME with ET obstruction (ETO) and (3) ME with TT; subsequently exposed to 
a dose (approximately 10(7)CFU/ml) of either T or O variant of S. pneumoniae, and
then incubated for 1h and 3h. Under the simulated ETO and TT conditions, T
variant exhibited a higher growth rate and greater epithelial adherence and
killing than did O variants. Attachment of T variant to epithelial cells was
documented by scanning electron microscopy. These results suggest that the T
variant is more highly adapted to various ME environments than the O variants.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18619763 [PubMed - indexed for MEDLINE]

78: Acta Otolaryngol. 2008;128(12):1303-7.

Inhibitory effect of caffeic acid phenethyl ester (CAPE) on LPS-induced
inflammation of human middle ear epithelial cells.

Song JJ, Cho JG, Hwang SJ, Cho CG, Park SW, Chae SW.

Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University
International Hospital, Gyeonggi, Korea.

CONCLUSIONS: The results suggest that the anti-inflammatory effect of caffeic
acid phenethyl ester (CAPE) is due to its inhibition of tumor necrosis factor
(TNF)-alpha expression and interleukin (IL)-8 production. The anti-inflammatory
effect of CAPE is possibly through the inhibition of nuclear factor (NF)-kappaB
via the suppression of inhibitor-kappaB-alpha (IkappaB-alpha) degradation.
OBJECTIVES: CAPE is a biologically active component of propolis, a resinous
material obtained from bee hives, which originates from conifer bark. The effect 
of CAPE on lipopolysaccharide (LPS)-induced inflammatory reactions is not known. 
The aim of this study was to evaluate the anti-inflammatory effect of CAPE on
cultured human middle ear epithelial cells (HMEECs). MATERIALS AND METHODS: The
effect of CAPE on LPS-induced TNF-alpha expression was evaluated in HMEECs by
real-time reverse transcription polymerase chain reaction (RT-PCR). LPS-induced
IL-8 production was determined by enzyme-linked immunosorbent assay (ELISA), and 
LPS-induced IkappaB-alpha degradation was followed by Western blot analysis.
RESULTS: CAPE significantly inhibited LPS-induced up-regulation of TNF-alpha in a
dose-dependent manner. IL-8 production by LPS was significantly suppressed by the
CAPE pretreatment. Furthermore, LPS-induced IkappaB-alpha degradation was
suppressed by the CAPE pretreatment.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18607954 [PubMed - indexed for MEDLINE]

79: Curr Med Res Opin. 2008 Aug;24(8):2339-47. Epub 2008 Jul 4.

Dexamethasone phosphate in antibiotic ear drops for the treatment of acute
bacterial otitis externa.

Mösges R, Schröder T, Baues CM, Sahin K.

Institute of Medical Statistics, Informatics and Epidemiology, Faculty of
Medicine, University of Cologne, Germany. Ralph@Moesges.de

OBJECTIVES: To compare the efficacy and safety of polymyxin sulfate 7500
IU/neomycin sulfate 3500 IU/dexamethasone phosphate 0.1% (PN+Dx) otic solution
with polymyxin sulfate 7500 IU/neomycin sulfate 3500 IU (PN-Dx) in patients with 
acute bacterial otitis externa (AOE), in order to determine the possible benefit 
of the addition of dexamethasone. RESEARCH DESIGN AND METHODS: Active controlled,
double-blind, randomized, parallel group, multi-center clinical trial in ear,
nose, and throat (ENT) specialist practices with a planned interim analysis for
sample size adaptation. In total, 338 patients aged 18-76 who had a previous
episode of otitis externa within the last year were randomized to receive 10 +/- 
2 days of treatment with two drops, three times daily, of either PN+Dx or PN-Dx. 
MAIN OUTCOME MEASURES: Change in the clinical symptom score (consisting of the
subscores redness, swelling, pain, and secretion) and of the visual analogue
scale (VAS) rating for pain from Visit 1 (Day 1) to Visit 2 (Day 4 +/- 1),
patient's assessment of efficacy at Visit 3 (Day 10 +/- 2), and the frequency and
type of adverse events. RESULTS: There was a significantly greater reduction of
swelling from Visit 1 to Visit 2 with PN+Dx, and more patients rated the efficacy
of PN+Dx as 'very good' or 'good' at Visit 3 (p = 0.03). There was also a
significantly greater decrease in the clinical symptom score from Visit 1 to
Visit 2 in the PN+Dx group in patients who had at least a moderately severe
symptom score with more than seven points at Visit 1 (p = 0.01) and in patients
suffering from their current episode of otitis externa for more than 2 days (p = 
0.02). In total, 14 adverse events were reported during the study period with no 
related adverse drug reactions for PN+Dx. CONCLUSIONS: The addition of
dexamethasone phosphate to polymyxin B/neomycin significantly reduces swelling in
patients with AOE and leads to significantly higher patient's ratings of
treatment efficacy. It especially leads to an overall reduction of symptoms in
cases of moderately or more severe otitis externa and cases lasting for more than
2 days.

Publication Types: 
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 18606053 [PubMed - indexed for MEDLINE]

80: Kathmandu Univ Med J (KUMJ). 2006 Oct-Dec;4(4):479-82.

Prevalence of otitis media in school going children in Eastern Nepal.

Maharjan M, Bhandari S, Singh I, Mishra SC.

Department of ENT, Kathmandu Medical College, Nepal. puntoo@hotmail.com

OBJECTIVES: To find out the prevalence of otitis media in school going children
from lower socio-economic strata. MATERIAL AND METHODS: This study was carried
out in a government school, Shree Naragram Secondary School in Morang district,
eastern Nepal, and included 1050 children aged between 5-15 years. RESULTS: Of
the 1050 school children, 346 children were found to have various ENT related
problems. Hearing assessment revealed a conductive hearing loss on one or both
sides in 114 cases (87%). Various middle ear pathologies were detected in these
children, out of which chronic suppurative otitis media "Tubotympanic type" was
the most common, followed by otitis media with effusion. The prevalence of otitis
media in these children was found to be13.2% and those with hearing loss
comprised 12.47%. Prevalence of otitis media is found to be much higher in school
going children as compared to adults, and is even higher amongst children
belonging to the lower socio-economic strata. Conditions complicating otitis
media are more common and severe in children as compared to adults. CONCLUSION:
Primary ear care education to teachers, students and guardians can prevent these 
vulnerable children from developing hearing impairment. School based study could 
be one of the useful and cost-effective modality aimed at community oriented
program.

PMID: 18603958 [PubMed - indexed for MEDLINE]

81: Kathmandu Univ Med J (KUMJ). 2006 Oct-Dec;4(4):455-9.

Hearing results after myringoplasty.

Shrestha S, Sinha BK.

Kathmandu Medical College Teaching Hospital, Nepal. sangitadr@yahoo.com

BACKGROUND: Myringoplasty is one of the various surgical techniques for the
management of chronic supurative otitis media of tubotympanic type (CSOM-TT). The
presence of a perforation of tympanic membrane with intermittent discharge and
hearing loss of conductive nature are the indications of myringoplasty. It is a
beneficial procedure done for closing tympanic membrane perforation and improving
hearing. OBJECTIVE: The aim of this study was to assess hearing improvement after
myringoplasty within ten weeks following surgery. MATERIAL AND METHODS: The study
population consisted of 50 patients who were suffering from CSOM-TT. Preoperative
and postoperative examinations of the patients were conducted clinically as well 
as audiologically. Pre and postoperative air-bone (A-B) gap were calculated by
taking the averages of bone conduction and air conduction at the frequencies of
500, 1000 and 2000 Hz. Myringoplasty was performed with underlay technique under 
local anaesthesia by either permeatal or endaural approach. Temporal muscle
fascia was used as grafting material for reconstruction of the tympanic membrane.
RESULTS: Preoperatively, air-bone gap of 30 db or more was observed in 39 (76%)
patients whereas post operatively A-B gap of 30 db or more was observed in only
one patient. Using hearings gain exceeding 15 dB as the criterion, thirty-nine
(78%) patients had their hearing gain exceeding 15 dB. Using postoperative A-B
gap within 20 dB as the criterion, 42 (84%) patients had their A-B gap within 20 
dB. CONCLUSION: Myringoplasty is a beneficial procedure for hearing improvement. 
Using the proportion of patients with a postoperative A-B gap of 30 dB as the
criterion, in this study, 98% of patients achieved their A-B gap closer within 30
dB. Using hearing gain exceeding 15 dB as the criterion, 78% patient had their
hearing gain exceeding 15 dB.

PMID: 18603953 [PubMed - indexed for MEDLINE]

82: Am J Otolaryngol. 2008 Jul-Aug;29(4):255-61. Epub 2008 Mar 19.

A single topical agent is clinically equivalent to the combination of topical and
oral antibiotic treatment for otitis externa.

Roland PS, Belcher BP, Bettis R, Makabale RL, Conroy PJ, Wall GM, Dupre S, Potts 
S, Hogg G, Weber K; Cipro HC Study Group.

Collaborators: Marbury T, Nielsen RW, Chanin L, Ruoff G, Bock BT, Latiolais T,
Bettis R, Aoki JE, Bolz EA, Cutler ML, Turner MA, Klein TC, Spiegel CA, Zastrow
J, Wright W 3rd, Walter EB Jr, Belcher B, Bruschetta HR, Christi C, Makabali R,
Goldstein GM, White A.

Department of Otolaryngology Head-Neck Surgery, University of Texas, Southwestern
Medical School, Dallas TX 75235-9035, USA.

OBJECTIVE: To demonstrate clinical equivalence (statistical noninferiority) of
topical ciprofloxacin and hydrocortisone (CHC, Cipro HC) and topical
neomycin/polymyxin b/hydrocortisone (NPH, Cortisporin) with systemic amoxicillin 
(AMX, Amoxil), for treatment of acute otitis externa (AOE). DESIGN: Randomized,
active-control, observer-blind, multicenter trial. PATIENTS: Altogether, 206
patients were enrolled (CHC, 106; NPH + AMX, 100). Patients were > or =1 year of 
age, had AOE >2 days with at least mild symptoms, and gave informed consent. All 
were evaluable for safety, and 151 were evaluable for efficacy. INTERVENTIONS:
Ciprofloxacin and hydrocortisone 3 drops twice daily for 7 days (adults and
children) or NPH 4 drops (adults) or 2 drops (children) with AMX 250 mg (adults
and children) 3 times daily for 10 days, as directed in approved product
labeling. MAIN OUTCOME MEASURES: The primary efficacy variable was response to
therapy 7 days after treatment ended (test of cure). Secondary variables included
time to end of pain, symptom scores (otalgia and tenderness) and microbiological 
eradication. Noninferiority was declared if the lower confidence limit around the
measurement difference was above -10 (nearer zero). RESULTS: Response to therapy 
was higher for CHC (95.71% vs 89.83%) but was statistically noninferior (lower
confidence limit, -4.98) to NPH + AMX. Median time to end of pain was 6 days for 
both groups. Noninferiority was declared for symptom scores at all measurement
periods and for microbiological eradication. No serious adverse events related to
treatment were reported. CONCLUSIONS: Ciprofloxacin and hydrocortisone is
clinically equivalent to NPH + AMX for the treatment of AOE in adults and
children. However, low systemic exposure, absence of ototoxicity, and less
frequent dosing clearly favor Cipro HC.

Publication Types: 
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 18598837 [PubMed - indexed for MEDLINE]

83: Vet Ther. 2008 Summer;9(2):111-21.

Comparative adrenocortical suppression in dogs with otitis externa following
topical otic administration of four different glucocorticoid-containing
medications.

Reeder CJ, Griffin CE, Polissar NL, Neradilek B, Armstrong RD.

Animal Dermitology Clinic, Louisville, KY 40299, USA.

The safety of using otic formulations is often of concern for practitioners and
pet owners alike, with "safe" in this context meaning no adrenocortical
suppression. This study evaluated the effect of four glucocorticoid-containing
otic formulations on plasma cortisol concentrations, measured by corticotropin
stimulation testing (plasma cortisol concentrations before and after
corticotropin injection), in dogs presented with otitis externa. Dexamethasone
tended to have larger adrenocortical suppression compared with the other three
formulations (betamethasone, triamcinolone, and mometasone), but the difference
was not statistically significant. The largest difference among the four drugs
was observed between dexamethasone and betamethasone (P=.09).

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 18597249 [PubMed - indexed for MEDLINE]

84: Pediatrics. 2008 Jul;122(1):34-9.

Pneumococcal mastoiditis in children and the emergence of multidrug-resistant
serotype 19A isolates.

Ongkasuwan J, Valdez TA, Hulten KG, Mason EO Jr, Kaplan SL.

Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor
College of Medicine, Houston, Texas, USA.

OBJECTIVE: We review the impact of pneumococcal conjugate vaccine on pneumococcal
mastoiditis in children at Texas Children's Hospital. METHODS: The medical charts
(including the number of pneumococcal conjugate vaccine doses) for children with 
pneumococcal mastoiditis treated at Texas Children's Hospital between January
1995 and June 2007 were reviewed retrospectively. Isolates were serotyped with
the capsular swelling method. Pulsed-field gel electrophoresis was performed on
the 19A isolates and multilocus sequence typing on selected 19A clones. RESULTS: 
Forty-one pneumococcal mastoiditis cases were identified, and 19A (n = 19) was
the most common serotype. Before the introduction of pneumococcal conjugate
vaccine (from 1995 to December 1999), 0 of 12 cases were 19A. Between April 2000 
and October 2006, 15 cases of pneumococcal mastoiditis occurred, and 5 were 19A. 
Fourteen cases of pneumococcal mastoiditis occurred between November 2006 and
June 2007, all of which were 19A. Mastoiditis caused by 19A isolates was more
likely to present with subperiosteal abscess and was more likely to need
intraoperative mastoidectomy than was mastoiditis caused by non-19A isolates.
Multidrug resistance was also common among the 19A isolates; 13 (68%) of the 19A 
isolates were resistant to all antibiotics tested routinely. Pulsed-field gel
electrophoresis analysis placed 14 (74%) of the 19 serotype 19A isolates into a
highly related group; 12 isolates were classified as closely related, and 2 were 
possibly related. Multilocus sequence typing analysis placed the pulsed-field gel
electrophoresis cluster isolates into clonal complex 271 (sequence types 320 and 
1451). CONCLUSIONS: At Texas Children's Hospital, 19A has become the predominant 
serotype causing pneumococcal mastoiditis, partly related to the emergence of
multidrug-resistant clonal complex 271 strains. Subperiosteal abscesses and the
need for mastoidectomy were more common in children with mastoiditis caused by
serotype 19A isolates, compared with isolates of other serotypes.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18595984 [PubMed - indexed for MEDLINE]

85: Hear Res. 2008 Sep;243(1-2):78-86. Epub 2008 Jun 13.

Change of middle ear transfer function in otitis media with effusion model of
guinea pigs.

Dai C, Gan RZ.

School of Aerospace and Mechanical Engineering and Bioengineering Center,
University of Oklahoma, Norman, OK 73019, USA.

Otitis media with effusion (OME) is an inflammatory disease of the middle ear
that causes most cases of conductive hearing loss observed in the pediatric
population. With the long term goal of evaluating middle ear function with OME,
the aim of the current study was to create an animal model of OME in which middle
ear transfer functions could be measured. In guinea pigs, OME was created by
injecting lipopolysaccharide (LPS) into the middle ear. Evidence of OME was
assessed by otoscopy, tympanometry, histology, and by measuring the volume of
fluid in the middle ear. Vibrations of the umbo and round window membrane were
measured with a laser Doppler vibrometer at frequency range of 200-40 kHz in
three groups of 3, 7, and 14 days after injection of LPS. Changes in displacement
of the umbo and round window membrane in response to 80 dB SPL sound in the ear
canal were measured across the frequency range. Displacement of both the umbo and
round window membrane was reduced at all time points following LPS injections.
Further, the change of the displacement transmission ratio (DTR) from the
tympanic membrane to the round window occurred mainly in chronic (e.g. 14 days
post-LPS injection) OME ears. This study provides useful data for analyzing the
change of middle ear transfer function in OME ears.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18586077 [PubMed - indexed for MEDLINE]

86: Otolaryngol Head Neck Surg. 2008 Jul;139(1):55-61.

Outcome of mobile ear surgery for chronic otitis media in remote areas.

Homøe P, Siim C, Bretlau P.

Department of Otolaryngology-Head and Neck Surgery, Rigshospitalet, University of
Copenhagen, Denmark. phom@rh.regionh.dk

OBJECTIVES: The Inuit of Greenland, Canada and Alaska suffer from chronic otitis 
media (COM). In Greenland these patients used to be referred to Denmark for ear
surgery. This was expensive and unsatisfactory, and the results were poor. A
mobile ear surgery project was developed. DESIGN: The study is longitudinal and
prospective with follow-up. SUBJECTS AND METHODS: The 274 patients were selected 
according to severity of COM and hearing loss. Only air conduction (AC)
audiometry was obtained. Median age was 27 years and 55% were females. RESULTS:
Closure rates at three weeks, one year, and two years were 67 percent, 72
percent, and 76 percent, respectively. Median AC pure tone average improvement
was 15 dB and 12 dB after one year and two years, and 73 percent and 67 percent
were satisfied. Outcome was associated with quality of the surgical skills (P <
0.002). We found marked spontaneous fluctuations between the follow-ups.
CONCLUSION: The results of mobile ear surgery in Greenland are acceptable. Mobile
ear surgery may be implemented in areas with limited access to health care, eg,
in developing countries.

PMID: 18585562 [PubMed - indexed for MEDLINE]

87: J Infect Chemother. 2008 Jun;14(3):180-7. Epub 2008 Jun 24.

Clinical bacteriology and immunology in acute otitis media in children.

Yamanaka N, Hotomi M, Billal DS.

Department of Otolaryngology - Head and Neck Surgery, Wakayama Medical
University, 811-1 Kimiidera, Wakayama 641-8509, Japan.

Acute otitis media (AOM) is the most common disease seen in childhood.
Streptococcus pneumoniae, non-typeable Haemophilus influenzae (NTHi), and
Moraxella catarrhalis are the most frequent pathogens of all AOM episodes. The
high prevalence of drug-resistant pathogens such as penicillin-resistant S.
pneumoniae (PRSP) and betalactamase producing or nonproducing
ampicillin-resistant H. influenzae (BLPAR or BLNAR) is causing serious clinical
problems worldwide. PRSP and BLNAR have become important risk factors for
intractable clinical outcome of AOM. PRSP causes a three times higher incidence
of intractable AOM than susceptible strains. BLNAR strains show
penicillin-binding protein gene mutation and are not only resistant to
ampicillin, but also have reduced susceptibility to cephalosporin. The resistant 
H. influenzae pathogen has shown clonal dissemination in Japan in ways different 
from those of penicillin-resistant S. pneumoniae. Protection against AOM due to
these pathogens may depend on pathogen-specific antibodies. Pneumococcal capsular
polysaccharides (PCPs) are type specific and poorly immunogenic in children
younger than 2 years old. Approximately 50% of otitis-prone children showed
subnormal levels of anti-PCP IgG2 antibody. In our immunological study in
children with otitis media, however, otitis-prone children were not unusually
vulnerable to infections except those resulting in otitis media. This fact seems 
to refute the presence of a broad immunological deficit in these children. Some
pathogen-specific antibodies may be directed against protein immunogens such as
pneumococcal surface protein A (PspA) of S. pneumoniae, P6 of NTHi, and UspA of
M. catarrhalis. The levels of antibody to P6 of NTHi in healthy children were
significantly higher than those in the otitis-prone children after the age of 18 
months. In general, individual antibody levels in otitis-prone individuals did
not have an age-dependent rise. The failure to develop a good antibody response
to common antigens such as PspA and P6 may enable the pathogen to cause
persistent or recurrent disease.

Publication Types: 
    Review

PMID: 18574652 [PubMed - indexed for MEDLINE]

88: Ear Nose Throat J. 2008 May;87(5):271-2, 279.

Multiple simultaneous complications of acute otitis media in a child diagnosed
with chronic granulomatous disease: a case report.

Wilson R, Bhuta T, Haydon R.

Department of Surgery, Division of Otolaryngology, University of Kentucky College
of Medicine, 800 Rose St., Lexington, KY 40536-0298, USA.
robertwilson44@insightbb.com

While the prevalence of acute otitis media complications in pediatric patients
has decreased over the past 30 years because of effective antibiotic therapy, the
incidence has begun to rise again recently, possibly because of increased
antibiotic resistance. Patients who simultaneously manifest multiple
complications may require a more thorough evaluation, including an immunologic
work-up. The presented case should encourage physicians to investigate the
possibility of an underlying immunodeficiency when treating patients with
multiple simultaneous complications of acute otitis media.

Publication Types: 
    Case Reports

PMID: 18572782 [PubMed - indexed for MEDLINE]

89: Acta Otolaryngol. 2008 Jul;128(7):750-5.

Up-regulation of macrophage migration inhibitory factor induced by endotoxin in
experimental otitis media with effusion in mice.

Kariya S, Schachern PA, Cureoglu S, Tsuprun V, Okano M, Nishizaki K, Juhn SK.

Otitis Media Research Center, Department of Otolaryngology-Head and Neck Surgery,
University of Minnesota, Minneapolis, MN 55455, USA.

CONCLUSION: Injection of endotoxin into the middle ear causes production of
macrophage migration inhibitory factor (MIF) in an experimental mouse model of
otitis media with effusion (OME). Down-regulation of MIF may become a new
approach for the management of OME. OBJECTIVE: To determine the role of MIF in
OME. MATERIALS AND METHODS: Mice were divided into two groups and their middle
ears were injected with either endotoxin or phosphate-buffered saline (PBS). Mice
were sacrificed at 6 h, 12 h, or 1, 3, 7, or 14 days after injection and
concentrations of MIF, interleukin-1 beta (IL-1beta) and tumor necrosis
factor-alpha (TNF-alpha) in middle ear effusions were measured by enzyme-linked
immunosorbent assay. RESULTS: Concentrations of MIF in the endotoxin group at 1
day and 3 days were significantly higher than in the PBS control group.
Concentrations of IL-1beta in the endotoxin group at 6 h, 12 h, 1 day, and 3 days
were significantly higher than in controls. Concentrations of TNF-alpha in the
endotoxin group at 1 day and 3 days were significantly higher than in controls.
Concentration of MIF in the endotoxin group was positively correlated with that
of IL-1beta and TNF-alpha.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18568516 [PubMed - indexed for MEDLINE]

90: Trends Amplif. 2008 Jun;12(2):76-9.

Stuart Gatehouse: a personal appreciation.

Haggard M.

MRC Multi-Centre Otitis Media Study Group, Addenbrooke's Hospital, Cambridge,
United Kingdom. mark.haggard@mrc-cbu.cam.ac.uk

Stuart Gatehouse worked in the MRC Institute of Hearing Research Scottish Section
for 29 years until his untimely death in 2007. The former director records a
personal appreciation but also an explanation, for those who did not know him
well, of the mixture of qualities that made him an outstanding applied scientist.

Publication Types: 
    Biography
    Historical Article

Personal Name as Subject: 
    Gatehouse S

PMID: 18567588 [PubMed - indexed for MEDLINE]

91: Int J Pediatr Otorhinolaryngol. 2008 Aug;72(8):1225-33. Epub 2008 Jun 20.

Tube associated otorrhea in children with recurrent acute otitis media; results
of a prospective randomized study on bacteriology and topical treatment with or
without systemic antibiotics.

Granath A, Rynnel-Dagöö B, Backheden M, Lindberg K.

Karolinska Institutet, Department of Clinical Science, Intervention and
Technology and Ear-, Nose-, Throat- and Cochlear Department at Karolinska
University Hospital Huddinge, Stockholm, Sweden. anna.granath@karolinska.se

OBJECTIVE: To establish if otorrhea associated to tympanostomy tubes in infants
suffering from recurrent acute otitis media is similar to acute otitis media, and
if topical treatment alone is sufficient or if addition of systemic antibiotics
is required. METHODS: Children under 3 years of age with tympanostomy tubes due
to recurrent acute otitis media were recruited to the study. The study design was
open label randomized and prospective. Fifty patients were allocated to either of
two treatment groups and were monitored for 6 months. Group I received only
topical treatment (commercially available ear drops and saline solution) in case 
of otorrhea. Group II was treated with topical treatment together with systemic
antibiotics. All episodes of acute otorrhea were registered. Main outcome measure
was duration of otorrhea in days. Bacterial samples from the ear discharge were
taken. RESULTS: Forty-one episodes were treated according to protocol. The
bacteriological testing mainly showed bacteria typical of acute otitis media. A
majority of episodes were cured within 7 days in both groups, and statistical
analysis showed no significant difference between the treatment groups in
duration of otorrhea. In Group I systemic antibiotics were added in one-third
(7/21) of the episodes due to signs of affected general condition such as high
fever and severe earache. CONCLUSIONS: The otorrhea episodes in the study were
similar to acute otitis media based on the bacteriological results. Topical
treatment alone might be used as first treatment of choice. Although systemic
antibiotics were added in several cases in the topical treatment group, the
findings of the study do not support use of systemic antibiotics for tube
associated otorrhea in RAOM children in general.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 18565598 [PubMed - indexed for MEDLINE]

92: Fam Pract. 2008 Aug;25(4):233-6. Epub 2008 Jun 17.

Is pacifier use a risk factor for acute otitis media? A dynamic cohort study.

Rovers MM, Numans ME, Langenbach E, Grobbee DE, Verheij TJ, Schilder AG.

Julius Center for Health Science and Primary Care, University Medical Center
Utrecht, Stratenum 6.131, PO Box 85060, 3508 AB Utrecht, The Netherlands.
m.rovers@umcutrecht.nl

BACKGROUND: Recently, the use of a pacifier has been identified as a risk factor 
for acute otitis media (AOM). The studies performed so far, however, suffer from 
methodological limitations. OBJECTIVE: To study whether pacifier use increases
the risk of AOM. METHODS: Four hundred and ninety-five children between the ages 
of 0 and 4 years followed from 2000 to 2005 in a dynamic population study in the 
Leidsche Rijn residential area in Utrecht, The Netherlands. At baseline, the
parents of these children filled out a questionnaire regarding pacifier use and
potential confounders. AOM was diagnosed by GPs according to the International
Classification of Primary Care coding system. Odds ratios (ORs) and 95%
confidence intervals (CIs) were calculated. RESULTS: Of the 216 children that
used a pacifier at baseline, 76 (35%) developed at least one episode of AOM, and 
of the 260 children that did not use a pacifier, 82 (32%) developed at least one 
AOM episode; for recurrent AOM, these figures were 33 (16%) versus 27 (11%),
respectively. The adjusted ORs for pacifier use and AOM and recurrent AOM were
1.3 (95% CI 0.9-1.9) and 1.9 (95% CI 1.1-3.2), respectively. CONCLUSION: Pacifier
use appears to be a risk factor for recurrent AOM. Parents should be informed
about the possible negative effects of using a pacifier once their child has been
diagnosed with AOM to avoid recurrent episodes.

PMID: 18562333 [PubMed - indexed for MEDLINE]

93: Clin Pediatr (Phila). 2008 Nov;47(9):901-6. Epub 2008 Jun 16.

Pathogens causing recurrent and difficult-to-treat acute otitis media, 2003-2006.

Pichichero ME, Casey JR, Hoberman A, Schwartz R.

University of Rochester Medical Center and Legacy Pediatrics, Rochester, New York
14642, USA. michael_pichichero@urmc.rochester.edu

This study sought to determine the microbiology of recurrent acute otitis media
(AOM) and AOM treatment failure (AOMTF) in the context of widespread use of
heptavalent pneumococcal conjugate vaccine (PCV7). In this retrospective cohort
study, 244 AOM isolates obtained by tympanocentesis during 3 respiratory
seasons--2003-2004 (n = 126), 2004-2005 (n = 52), 2005-2006 (n = 66)--from three 
geographically diverse pediatric populations were compared. Most isolates were
from children less than 2 years old, who had received PCV7. For the 3 seasons the
proportion of Streptococcus pneumoniae isolates was 35%, 35%, and 46% and for
Haemophilus influenzae was 55%, 58%, and 39%, respectively (change in trend, P = 
.09). A total of 37%, 39%, and 50% of S. pneumoniae were penicillin
nonsusceptible (PNSP) and 48%, 67%, and 50% of H. influenzae produced
beta-lactamase, respectively. Although H. influenzae remains the most frequently 
isolated pathogen in children with AOMTF or recurrent AOM, S. pneumoniae that are
PNSP are reemerging as important organisms.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18559884 [PubMed - indexed for MEDLINE]

94: Clin Otolaryngol. 2008 Jun;33(3):265-8.

The long-term effect of unilateral t-tube insertion in patients undergoing cleft 
palate repair: 20-year follow-up of a randomised controlled trial.

Hornigold R, Morley A, Glore RJ, Boorman J, Sergeant R.

OBJECTIVES: Between July 1984 and March 1987, all children that underwent repair 
for primary cleft palate at the Queen Victoria Hospital were enrolled in a
clinical trial. Those found to have otitis media with effusion at time of surgery
had a t-tube inserted into one randomised ear, whilst the other ear received no
treatment. The object of the study was to reassess the patients from the original
trial to discover the impact of the unilateral t-tube, twenty years later
analysed on an intention to treat basis. DESIGN: Children that underwent primary 
palatal closure during the study dates were identified from the cleft palate
database. Patients that were involved in the original trial were identified,
contacted and invited to take part in the follow-up study. SETTING: Tertiary
referral Specialist unit. PARTICIPANTS: Twenty-two patients were identified as
potential study participants. Of this group, fourteen were contactable and seven 
participants agreed to take part in our follow-up study. MAIN OUTCOME MEASURES:
Persistent symptomatology, otoscopy, pure tone audiometry and tympanometry.
RESULTS: Follow-up results were compared within the original treatment groups
from the primary study, on an intention to treat basis. Otoscopically the ears
were normal in 2 of the 7 treated ears compared with four of the seven
non-treated ears. All the other ear ears had various types of chronic otitis
media. Four of the seven had hearing of >10 dB in the treated ear compared with
the non-treated ear. CONCLUSIONS: These findings would indicate need for caution 
in the use of t-tubes in the cleft population and raises the question of
long-term follow-up to assess for secondary cholesteatoma.

Publication Types: 
    Letter
    Randomized Controlled Trial

PMID: 18559037 [PubMed - indexed for MEDLINE]

95: Ir Med J. 2008 Apr;101(4):123-4.

One to make the diagnosis. A case of non tuberculous mycobacterial mastoiditis in
a nine year old female.

Molloy J, Shandilya M, Mahesh B, McShane D, El Nazir B.

Department of Paediatrics, AMNCH, Tallaght, Dublin 24.

Some members of the Non-Tuberculous Mycobacteria family are free living organisms
in the environment. They may be pathogenic in the immunocomprimised or in chronic
lung disease. We describe a case of a nine year old of Asian descent who
presented with clinical mastoiditis where the pathogenic organism was
Mycobacterium Gordonae. The decision was made to give the patient full
antimycobacterial treatment and subsequently the patient made a full recovery.

Publication Types: 
    Case Reports

PMID: 18557517 [PubMed - indexed for MEDLINE]

96: Int J Pediatr Otorhinolaryngol. 2008 Aug;72(8):1207-13. Epub 2008 Jun 11.

Trends in otitis media surgery: a decrease in adenoidectomy.

Haapkylä J, Karevold G, Kvaerner KJ, Pitkäranta A.

Department of Otorhinolaryngology, Helsinki University Central Hospital, PL 220, 
00029 HUS, Finland. johanna.haapkyla@Helsinki.fi

OBJECTIVE: Large variability in adenoidectomies and tympanostomy tube insertions 
between Norway and Finland has been suggested, but not yet confirmed. Objective
is to compare trends in paediatric adenoidectomies and tympanostomy tube
insertions for Norway and Finland from 1999 to 2005. METHODS: National Finnish
and Norwegian databases (STAKES and NPR) provided information on children between
0 and 7 years operated in the years 1999-2005. Surgical rates were viewed in the 
light of child density, age and gender, and compared bi-nationally. RESULTS:
Adenoidectomies were more common in Finland throughout the study period.
Adenoidectomies in both countries decreased markedly from 1999 to 2005. The
Finnish adenoidectomy rates were reduced from 212 to 133 per 10,000 children,
equivalent Norwegian figures were 84 and 44 per 10,000 children. Tympanostomy
tube insertions increased from 97 to 147 per 10,000 children in Finland in the
same study period. In Norway the rates were more stable, 119 and 123 per 10,000
in 1999 and 2005, respectively. Peak-age for otitis media surgery was the second 
year of life in Finland, sixth in Norway. Boys were more frequently operated on
in both countries. CONCLUSION: Our study confirmed differences in the approach to
otitis media surgery and revealed a decreasing trend in adenoidectomies in both
countries. Similar data from other countries is needed to confirm the latter.

Publication Types: 
    Comparative Study

PMID: 18550182 [PubMed - indexed for MEDLINE]

97: J Antimicrob Chemother. 2008 Sep;62(3):587-92. Epub 2008 Jun 10.

Antibiotics for respiratory, ear and urinary tract disorders and consistency
among GPs.

Ong DS, Kuyvenhoven MM, van Dijk L, Verheij TJ.

Julius Center for Health Sciences and Primary Care, University Medical Center
(UMC) Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
davidsyong@gmail.com

OBJECTIVES: To describe specific diagnoses for which systemic antibiotics are
prescribed, to assess adherence of antibiotic choice to national guidelines and
to assess consistency among general practitioners (GPs) in prescribed volumes of 
antibiotics for respiratory, ear and urinary tract disorders. METHODS: The
cross-sectional study included 174 GPs from 89 general practices. Data were
derived from the Second Dutch National Survey of General Practice (DNSGP-2) in
2001. Outcome measures were the antibiotic prescriptions for respiratory, ear and
urinary tract disorders defined according to the International Classification of 
Primary Care codes, the percentage of first-choice antibiotics complying with
national guidelines and the number of antibiotic prescriptions per 1000 patients 
per GP per year. RESULTS: The most antibiotics for respiratory tract infection
(RTI) were prescribed for acute bronchitis (25%), sinusitis (22%) and acute upper
RTI (14%). The most antibiotics were prescribed for acute otitis media (77% of
ear disorders) and cystitis (95% of urinary tract disorders). First-choice
antibiotics were prescribed in approximately 75% of the cases, whereas macrolides
and amoxicillin/clavulanate (second-choice antibiotics) were prescribed in
approximately 25%, especially in lower RTIs. The correlations (Spearman rho)
between prescribed volumes for the three main groups of disorders varied from
0.39 to 0.67. CONCLUSIONS: GPs were consistent in prescribing antibiotics for the
three groups of diseases. Improvement strategies should focus on the management
of acute upper RTIs and acute bronchitis and also on the use of
amoxicillin/clavulanate and macrolides, these being mostly second-choice
antibiotics in national guidelines.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18544602 [PubMed - indexed for MEDLINE]

98: Int J Pediatr Otorhinolaryngol. 2008 Aug;72(8):1215-23. Epub 2008 Jun 9.

Efficacy of allergy immunotherapy as a treatment for patients with chronic otitis
media with effusion.

Hurst DS.

Tufts University, Boston, MA, United States. meear43@gmail.com

OBJECTIVE: Controversy persists over the significance of allergy as it might
relate to chronic middle-ear disease as no controlled study of the efficacy of
allergy immunotherapy has been published. The aim of this study was (1) to
evaluate the atopic status of patients with intractable chronic otitis media with
effusion or drainage from their middle ear and (2) to determine in this select
population the efficacy of specific allergy immunotherapy in preventing or
limiting the duration of their chronic middle-ear disease. METHODS: This was a
prospective, cohort study of patients cared for in a private community practice. 
History, examination, audiogram, tympanometry and recurrence of
effusion/infection were recorded on 89 patients (52 children <15 years old, 37
adults) referred with (1) effusion found to warrant myringotomy and ventilation
tubes, or (2) chronic drainage from a perforation or tube. All were evaluated for
allergy by intradermal skin testing according to criteria of the American Academy
of Otolaryngic Allergy. A control cohort of 21 patients who refused therapy was
included. Intervention consisted of immunotherapy for dust, pollen, and molds.
Recurrence or persistence of fluid or drainage following 2-8 years of therapy was
compared to the patient's pretreatment status. RESULTS: All 89 OME patients
proved to be atopic. Most were allergic to dust (94%), animals (44%) and molds
(88%) while 9% were allergic only to seasonal pollens. Associated allergic
diseases included asthma (21%) and allergic rhinitis/sinusitis (63%). Otitis was 
the sole symptom among 37%. Immunotherapy provided complete resolution of
effusion or drainage in 85% of 127 ears. CONCLUSION: Intradermal testing proved
all 89 patients with intractable middle-ear disease in this study who presented
with chronic effusion or chronic draining perforations or tubes to be atopic.
Specific allergy immunotherapy significantly improved 5.5% and completely
resolved 85% of chronic otitis media with effusion in these ears. None of the
controls resolved spontaneously (p<0.001). This supports the hypothesis that in
many, otitis media with effusion is an immune mediated allergic disease and
suggests that these patients deserve consideration for aggressive evaluation and 
allergy treatment, as most respond to immunotherapy.

PMID: 18541312 [PubMed - indexed for MEDLINE]

99: Pediatr Int. 2008 Jun;50(3):315-8.

Acute abdomen in children due to extra-abdominal causes.

Tsalkidis A, Gardikis S, Cassimos D, Kambouri K, Tsalkidou E, Deftereos S,
Chatzimichael A.

Department of Pediatrics, University Hospital of Alexandroupolis, Democritus
University of Thrace-Medical School, Alexandroupolis, Greece.
atsalkid@med.duth.gr

BACKGROUND: Acute abdominal pain in children is a common cause for referral to
the emergency room and for subsequent hospitalization to pediatric medical or
surgical departments. There are rare occasions when the abdominal pain is derived
from extra-abdominal organs or systems. The aim of the present study was to
establish the most common extra-abdominal causes of acute abdominal pain.
METHODS: The notes of all children (1 month-14 years of age) examined for acute
abdominal pain in the Accident and Emergency (A&E) Department of Alexandroupolis 
District University Hospital in January 2001-December 2005 were analyzed
retrospectively. Demographic data, clinical signs and symptoms, and laboratory
findings were recorded, as well as the final diagnosis and outcome. RESULTS: Of a
total number of 28 124 children who were brought to the A&E department, in 1731
the main complaint was acute abdominal pain. In 51 children their symptoms had an
extra-abdominal cause, the most frequent being pneumonia (n = 15), tonsillitis (n
= 10), otitis media (n = 9), and acute leukemia (n = 5). CONCLUSION: Both
abdominal and extra-abdominal causes should be considered by a pediatrician who
is confronted with a child with acute abdominal pain.

Publication Types: 
    Comparative Study

PMID: 18533944 [PubMed - indexed for MEDLINE]

100: Acta Otorhinolaryngol Ital. 2008 Feb;28(1):30-3.

Lateral sinus thrombosis as a complication of acute mastoiditis.

Bianchini C, Aimoni C, Ceruti S, Grasso DL, Martini A.

Department of Medical and Surgical Specialities, Audiological Unit, University of
Ferrara, Italy.

Lateral sinus thrombosis is a rare complication of middle ear diseases: in
children, it is usually related to acute otitis media, but it is also found in
adults with chronic otitis. It was more frequent in the pre-antibiotic era and
mortality was high. The Authors present a paediatric case of lateral sinus
thrombosis in which they describe the clinical approach and related literature.

Publication Types: 
    Case Reports

PMID: 18533553 [PubMed - indexed for MEDLINE]

101: Int J Pediatr Otorhinolaryngol. 2008 Jul;72(7):1085-9. Epub 2008 Jun 3.

Intranasal phenylephrine-surfactant treatment is not beneficial in otitis media
with effusion.

Johnson D, Chandrasekhar SS, Mautone AJ.

UMDNJ-New Jersey Medical School Department of Pediatrics, NJ, USA.

BACKGROUND: Otitis media is the most common reason for non-well-child visits to
the primary care physician. Various treatments are in use to try to ameliorate
the pain arising from Eustachian tube (ET) dysfunction. One such treatment is
topical phenylephrine spray, despite clinical evidence disputing its use.
Previous research by this laboratory has demonstrated the beneficial effect of
topical surfactant treatment in reducing ET opening pressure, allowing the tube
to open. This study is designed to test the effectiveness of topical
phenylephrine, delivered with surfactant, in reducing days of effusion in OME, in
an animal model. METHODS: OME was generated by injecting Klebsiella pneumoniae
lipopolysaccharide into the right bullae of 28 gerbils. After frank OME resulted,
the animals were divided into four groups. Group 1 received no treatment or
propellant spray alone (placebo). Group 2 received intranasal surfactant spray
once daily. Group 3 received intranasal surfactant-phenylephrine spray once
daily. Group 4 received intranasal surfactant-phenylephrine spray twice daily.
All animals were evaluated on a daily basis by both otomicroscopy and
tympanometry, and treatment was ceased when the ear returned to normal
appearance. Evaluations were continued for a total of 30 days. Chi-squared
analysis with significance set at .05 was performed. RESULTS: In the untreated
and placebo groups, middle ear effusion resolved at 16.25 days by otomicroscopy
and 28.26 days by tympanometry. In Group 2 (surfactant alone), effusion resolved 
at 10.57 days and 15.71 days, respectively. In Group 3 (surfactant-phenylephrine 
once daily), effusion resolved at 15.67 days and 28.33 days. In Group 4
(surfactant-phenylephrine twice daily), effusion resolved at 18.67 days and 28.33
days. These results were statistically significant. CONCLUSIONS: Intranasal
phenylephrine-surfactant treatment is shown to be at least ineffective, and
possibly detrimental, in the resolution of OME, in this animal model. The
hypothesis is that surfactant potentiates the drying effect of phenylephrine at
the ET by allowing it to get to the ET more easily; in addition, the drying
effect of phenylephrine prevents full surfactant action. We believe that these
results can be extrapolated to humans and that phenylephrine should be avoided in
these cases.

PMID: 18524392 [PubMed - indexed for MEDLINE]

102: Int J Pediatr Otorhinolaryngol. 2008 Aug;72(8):1183-91. Epub 2008 Jun 3.

Differential expression of cytokine genes and iNOS induced by nonviable
nontypeable Haemophilus influenzae or its LOS mutants during acute otitis media
in the rat.

Tong HH, Chen Y, Liu X, DeMaria TF.

Department of Otolaryngology, College of Medicine and Public health, The Ohio
State University, Room 4024B, Cramblett Hall, 456 West 10th Avenue, Columbus, OH 
43210, USA. tong.1@osu.edu

OBJECTIVE: We have previously demonstrated that the disruptions of nontypeable
Haemophilus influenzae (NTHi) lipooligosaccharide (LOS) htrB and rfaD genes may
play a role in the pathogenesis of otitis media (OM). The purpose of this study
was to determine whether NTHi LOS gene disruptions influence the induction of
gene expression for proinflammatory mediators in vivo using the rat model of
acute OM. METHODS: At 3, 6, 12, 24, 48 and 72 h after transbullar inoculation
with nonviable NTHi, expression of genes for the cytokines and chemolines; tumor 
necrosis factor alpha (TNF-alpha), interleukin-lbeta (IL-1beta), and IL-6,
IL-1alpha, IL-8, IL-10, and inducible nitric oxide synthase (iNOS) were
quantitated by real-time PCR. Enzyme-linked immunosorbent assay was performed to 
confirm the gene expression data as determined by real-time PCR. The middle ear
inflammatory responses were also evaluated. RESULTS: The NTHi 2019 parent and its
isogenic LOS htrB (B29) and rfaD (DK-1) mutant strains induced a significant
up-regulation in gene expression for the cytokines examined compared to the
sham-inoculated controls at 3, 6 and 12 h post-inoculation (P<0.05 in all cases).
However, the NTHi 2019 cohort demonstrated a significant increase in gene
expression for TNF-alpha (up to 6 h), IL-1alpha and IL-8 (up to 24 h), IL-1beta
and IL-6 (up to 48 h), and IL-10 and iNOS (up to 72 h) relative to the animals
inoculated with NTHi B29 (P<0.05, in all cases), Moreover, the concentrations of 
inflammatory cells in the middle ear lavage fluid samples from the NTHi 2019
cohort were 2.8-5.3-fold higher than those of the B29 cohort. There were no
significant differences in mRNA expression of the cytokines between the NTHi 2019
and the DK-1-treated groups. CONCLUSIONS: Data from this study indicate that the 
disruption of the NTHi htrB gene may impact the temporal mRNA expression of
inflammatory mediators and inflammation within the middle ear.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18524391 [PubMed - indexed for MEDLINE]

103: Pediatr Infect Dis J. 2008 Jul;27(7):613-7.

Comment in:
    Pediatr Infect Dis J. 2008 Dec;27(12):1121-2.

Fusobacterium necrophorum middle ear infections in children and related
complications: report of 25 cases and literature review.

Le Monnier A, Jamet A, Carbonnelle E, Barthod G, Moumile K, Lesage F, Zahar JR,
Mannach Y, Berche P, Couloigner V.

Laboratoire de Microbiologie, Assistance Publique Hôpitaux de Paris, Paris,
France.

BACKGROUND: Fusobacterium necrophorum is associated with Lemierre syndrome
(pharyngitis with septic thrombosis of the internal jugular veins) but it can
also be involved in other head and neck infections, including sinusitis,
parotitis, dental infections, and otitis media. METHODS: This retrospective study
analyzes a series of 25 pediatric cases of acute otitis media caused by F.
necrophorum and treated in our institution between 1995 and 2006. RESULTS: We
observed 3 clinical presentations: (1) uncomplicated otitis media (44%; n = 11); 
(2) acute mastoiditis (40%; n = 10); and (3) otogenic variant of Lemierre
syndrome (16%; n = 4) associating acute mastoiditis, suppurative thrombophlebitis
of the lateral and/or cavernous sinuses, meningitis syndrome, and sometimes
distant septic metastasis or extensive osteolysis of the temporal bone. Sixty
percent of these cases were diagnosed during the last 4 years of the study.
Children less than 1 year of age were at increased risk for Lemierre syndrome.
Broad range 16S rDNA polymerase chain reaction and sequencing were used to
confirm the identification of F. necrophroum and to detect secondary sites of
infection. All patients had favorable clinical outcome, but complicated cases
(mastoiditis and otogenic variant of Lemierre syndrome) required prolonged
hospital stays and duration of treatment. CONCLUSIONS: Based on bacteriologic
investigation, we recommend systematic culture for anaerobes and that antibiotic 
treatment of F. necrophorum middle ear infections and subsequent complications
includes coverage for anaerobic bacteria.

Publication Types: 
    Case Reports
    Review

PMID: 18520974 [PubMed - indexed for MEDLINE]

104: Otol Neurotol. 2008 Aug;29(5):649-57.

Myringotomy versus ventilation tubes in secretory otitis media: eardrum
pathology, hearing, and eustachian tube function 25 years after treatment.

Cayé-Thomasen P, Stangerup SE, Jørgensen G, Drozdziewic D, Bonding P, Tos M.

Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Gentofte University
Hospital of Copenhagen, Copenhagen, Denmark. peca@geh.regionh.dk

OBJECTIVE: This report documents the dynamics of eardrum pathology, hearing
acuity, and eustachian tube function during 25 years after treatment of bilateral
secretory otitis media. The included children were treated by myringotomy on the 
left ear and ventilation tube insertion on the right ear. MATERIALS AND METHODS: 
Two hundred twenty-four children with bilateral secretory otitis media were
treated by bilateral myringotomy and insertion of a ventilation tube on the right
side only. The children were reexamined by otomicroscopy, tympanometry, and pure 
tone audiometry after 3, 7, and 25 years. At the last evaluation, the eustachian 
tube function was evaluated by the 9-step test. RESULTS: 1) Myringosclerosis and 
late atrophy were more prevalent in tube ears. 2) Prevalence of eardrum
retraction decreased over time, whereas that of sclerosis remained unchanged in
tube ears and increased in myringotomy ears. 3) Prevalence of atrophy increased
over time in tube ears. 4) Extension of myringosclerosis increased, whereas that 
of atrophy and tensa retraction decreased over time, regardless of treatment. 5) 
Hearing was better in the tube ear during, but not after treatment. 6)
Tympanometric findings were not related to treatment. 7) Eustachian tube function
at 25 years was not related to treatment. CONCLUSION: The insertion of a
ventilation tube after myringotomy leads not only to better hearing until
extrusion but also to an increased prevalence of long-term pathologic changes of 
the eardrum, that is, myringosclerosis and late atrophy. The temporary hearing
improvement may reduce the risk of detrimental effects on speech and language
development. The prevalence and extension of the various subtypes of pathology
change over the years after treatment, which implies the existence of intrinsic
repair mechanisms, but also continuing progression of disease and/or treatment
sequelae many years after treatment. However, these changes do not seem to affect
the hearing acuity in the long term. The treatment modality has no impact on late
eustachian tube function.

PMID: 18520632 [PubMed - indexed for MEDLINE]

105: Otol Neurotol. 2008 Aug;29(5):666-72.

Otogenic cranial base osteomyelitis: a proposed prognosis-based system for
disease classification.

Lee S, Hooper R, Fuller A, Turlakow A, Cousins V, Nouraei R.

Department of Otolaryngology, The Alfred Hospital, Prahran, Victoria, Australia. 
stewartbjplee@hotmail.com

OBJECTIVES: To review the presentation, microbiology, and long-term results of
treating otogenic cranial base osteomyelitis to develop a prognosis-based disease
classification system. PATIENTS AND METHODS: Thirty-eight patients with otogenic 
cranial base osteomyelitis treated between 1989 and 2002 were studied. Patient
demographics, presentation, pathogens, details of therapy, and disease-specific
survival were recorded. Patients were stratified using Technetium-99
single-photon emission computerized tomography (SPECT) at presentation into 4
grades: I, mild uptake; II, focal mastoid/temporal bone uptake not reaching
midline; III, petrous temporal bone uptake reaching midline; and IV, uptake
crossing midline, involving the contralateral temporal bone. Actuarial analysis
was used to identify prognostic factors. RESULTS: There were 27 men. The average 
age at presentation was 65 +/- 16 years (range, 19-95 yr). The median
age-adjusted Charlson comorbidity score was 5, and 63% of patients were diabetic.
The most common presenting symptoms were pain and otorrhea, and 8 patients had
cranial nerve neuropathy. Pseudomonas aeruginosa was the most common bacterial
pathogen (n = 28; 74%), and 9 patients had fungal or mixed infections. On
average, antibiotics were administered for 161 days, and 6 patients had
concomitant surgery. The average follow-up was 33 months, and 3-year
disease-specific survival was 76%. Univariate predictors of survival were the
SPECT grade, fungal/mixed infections, Charlson score, immune compromise, and
cranial nerve neuropathy. The only independent predictor of survival on
multivariate Cox regression was the SPECT stage at presentation. CONCLUSION:
Cranial base osteomyelitis is associated with significant morbidity and mortality
and requires prolonged treatment. Long-term outcome can be predicted from the
initial SPECT scan.

PMID: 18520626 [PubMed - indexed for MEDLINE]

106: Otol Neurotol. 2008 Jun;29(4):499-501.

Cochlear implantation in atelectasis and chronic otitis media: long-term
follow-up.

Xenellis J, Nikolopoulos TP, Marangoudakis P, Vlastarakos PV, Tsangaroulakis A,
Ferekidis E.

ENT Department, Athens University, Ippokratio, Greece.

OBJECTIVE: To report the long-term results of cochlear implantation in cases with
chronic otitis media or atelectasis using a single surgical technique performed
in a single cochlear implant center. PATIENTS: Nine patients who were implanted
using the blind-pit closure of the external ear canal technique (4 patients with 
adhesive otitis media and 5 with radical mastoid cavities). Follow-up ranged from
18 months to 12 years (mean, 7.05 yr). INTERVENTION: The surgical procedure was
performed in 2 stages. The first stage included canal wall down or lowering any
high facial ridge in previous mastoidectomies, removal of all skin, and blind-pit
closure of the external ear canal without mastoid cavity obliteration or
eustachian tube obliteration. Cochlear implantation was performed 6 months after 
the first surgical procedure. RESULTS: All operations were uneventful, and during
cochlear implantation, as a second stage, no epithelia or other problems were
encountered. No serious complications were encountered during the follow-up
period. One case had a minor disruption of the external canal closure that was
reclosed successfully under local anesthesia. All patients were using the device 
at the last follow-up interval with no device problems. CONCLUSION: Blind-sac
closure of the external ear canal without obliteration is a rather safe surgical 
procedure in cases with chronic otitis media or atelectasis. Meticulous surgical 
technique and proper patient selection are of paramount importance. However, a
2-stage procedure may not always be necessary and might best be confined to those
patients who have active inflammatory disease at the primary procedure.

PMID: 18520585 [PubMed - indexed for MEDLINE]

107: Int J Pediatr Otorhinolaryngol. 2008 Aug;72(8):1151-8. Epub 2008 Jun 2.

Craniofacial morphology and otitis media with effusion in children.

Di Francesco R, Paulucci B, Nery C, Bento RF.

Otolaryngology Department, University of São Paulo, School of Medicine, Sao
Paula, Brazil. renatadifran@uol.com.br

Otitis media with effusion (OME) affects 28-38% of pre-school children, and it
occurs due to the dysfunction of the auditory tube. Anatomical development of the
auditory tube depends on the craniofacial growth and development. Deviations of
normal craniofacial morphology and growth using cephalometric studies, may
predict the evolution of otitis. Our goal in this paper is to determine if there 
are differences in craniofacial morphology between children with adenoid
enlargement, with and without otitis media with effusion. This is a prospective
study in which the sample consisted of 67 children (male and female) from 5 to 10
years old. All patients presented chronic upper airway obstruction due to tonsil 
and adenoid enlargement (>80% degree of obstruction). Thirty-three patients
presented otitis media with effusion, for more than 3 months and 34 did not. The 
latter composed the control group. Standardized lateral head radiographs were
obtained for all subjects. Radiographs were taken with patient positioned by a
cephalostat and stayed with mandibles in centric occlusion and lips at rest.
Radiographs were digitalized and specific landmarks were identified using a
computer program Radiocef 2003, 5th edition. Measurements, angles and lines were 
taken of the basicranium, maxilla and mandible according to the modified Ricketts
analysis. In addition, facial height and facial axis were determined. Children
with otitis media with effusion present differences in the morphology of the
face, regarding these measures: N-S (anterior cranial base length), N-ANS (upper 
facial height), ANS-PNS (size of the hard palate), Po-Or.N-Pog (facial depth),
Ba-N.Ptm-Gn (facial axis), Go-Me (mandibular length) and Vaia--Vaip (inferior
pharyngeal airway).

PMID: 18514333 [PubMed - indexed for MEDLINE]

108: BMC Pediatr. 2008 Jun 2;8:23.

Compared to placebo, long-term antibiotics resolve otitis media with effusion
(OME) and prevent acute otitis media with perforation (AOMwiP) in a high-risk
population: a randomized controlled trial.

Leach AJ, Morris PS, Mathews JD; Chronic Otitis Media Intervention Trial - One
(COMIT1) group.

Collaborators: Hayhurst B, Koops H, Melder A, Pulakui M, Stubbs L, Hare K,
Beissbarth J, Smith-Vaughan H, Stubbs L, Leach S, Liddle R, Donath S, Jacklyn S, 
McDonnell J, Bex J, Hutton S, Lukitch A.

Menzies School of Health Research, Charles Darwin University, Darwin, Northern
Territory, Australia. amanda@menzies.edu.au

BACKGROUND: For children at high risk of chronic suppurative otitis media (CSOM),
strategies to prevent acute otitis media with perforation (AOMwiP) may reduce
progression to CSOM. METHODS: In a double blind study in northern Australia, 103 
Aboriginal infants with first detection of OME were randomised to receive either 
amoxicillin (50 mg/kg/d BD) or placebo for 24 weeks, or until bilateral aerated
middle ears were diagnosed at two successive monthly examinations (success).
Standardised clinical assessments and international standards for microbiology
were used. RESULTS: Five of 52 infants in the amoxicillin group and none of 51
infants in the placebo group achieved success at the end of therapy (Risk
Difference = 9.6% [95% confidence interval 1.6,17.6]). Amoxicillin significantly 
reduced the proportion of children with i) perforation at the end of therapy (27%
to 12% RD = -16% [-31,-1]), ii) recurrent perforation during therapy (18% to 4%
RD = -14% [-25,-2]), and iii) reduced the proportion of examinations with a
diagnosis of perforation during therapy (20% to 8% adjusted risk ratio 0.36
[0.15,0.83] p = 0.017). During therapy, the proportion of examinations with
penicillin non-susceptible (MIC > 0.1 microg/ml) pneumococci was not
significantly different between the amoxicillin group (34%) and the placebo group
(40%). Beta-lactamase positive non-capsular H. influenzae (NCHi) were uncommon
during therapy but more frequent in the amoxicillin group (10%) than placebo
(5%). CONCLUSION: Aboriginal infants receiving continuous amoxicillin had more
normal ears, fewer perforations, and less pneumococcal carriage. There was no
statistically significant increase in resistant pneumococci or NCHi in
amoxicillin children compared to placebo children who received regular paediatric
care and antibiotic treatment for symptomatic illnesses.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 18513453 [PubMed - indexed for MEDLINE]

109: Ann Trop Paediatr. 2008 Jun;28(2):123-7.

Role of elevated immunoglobulin E levels in suppurative otitis media.

Lasisi AO, Arinola OG, Olayemi O.

Department of Otorhinolaryngology, College of Medicine, University of Ibadan,
Nigeria. akeemlasisi@gmail.com

BACKGROUND AND OBJECTIVES: An association between suppurative otitis media (SOM) 
and allergy has been reported in about 80% of patients with allergy. However,
there is controversy regarding their relationship and the concept of middle-ear
allergic response. We test the hypothesis that increased secretion of IgE in the 
middle ear is higher in chronic than in acute SOM. METHODS: Allergy skin testing 
and enzyme-linked immunoassay of specimens of middle-ear secretions and sera were
analysed. RESULTS: Paired sera and middle-ear secretions (MES) from 37 subjects
with SOM, 20 chronic (CSOM) and 17 acute (ASOM), and sera of 15 controls selected
from children without otitis media were analysed. There were 30 males and 27
females aged between 6 months and 9 years, mean (SD) 6 years (3.26). A history of
allergy and skin test positive to one or more of dust, house dust mite, mould,
cockroach and poultry feathers were found in 80% of CSOM, 47% ASOM and 33%
controls. The mean IgE levels in sera were: controls 52.1 mg/dL, ASOM 63.9 mg/dL 
and CSOM 79.2 mg/dL; the MES levels were: AOM 60.4 mg/dL and CSOM 102.0 mg/dL.
The MES to serum IgE ratios were 0.75 for ASOM and 1.4 for CSOM. The serum IgE
ratio of controls to ASOM was 1.22 and to CSOM was 1.5. Multivariate analysis of 
the mean showed significant correlation between IgE level of MES in ASOM and CSOM
(p=0.04) but no correlation between IgE levels in control and ASOM sera (p=0.10),
control and CSOM sera (p=0.7) or AOM and CSOM sera (p=0.3). CONCLUSION: Allergy
appears to play a contributory role in CSOM and elevated IgE in the MES suggests 
a likely mucosal response.

PMID: 18510822 [PubMed - indexed for MEDLINE]

110: Int J Infect Dis. 2008 Sep;12(5):550-2. Epub 2008 May 27.

Fungal malignant otitis externa treated with hyperbaric oxygen.

Ling SS, Sader C.

Otolaryngology Department, Royal Perth Hospital, Wellington St, Perth, Western
Australia 6009, Australia. shanus@iinet.net.au

OBJECTIVE: To report a case of Aspergillus flavus malignant otitis externa,
successfully treated with antifungal agents, surgical debridement, and hyperbaric
oxygen treatment. PATIENT: The case was a 77-year-old man with non-insulin
dependent diabetes mellitus, who presented with otalgia and purulent otorrhea.
Intervention was with surgical debridement, antifungal agents, and hyperbaric
oxygen treatment. The main outcome measures were radiological and histological
findings. CONCLUSIONS: A. flavus is a rare cause of malignant otitis externa.
Aggressive treatment should include surgical debridement, with appropriate
antifungal agents and hyperbaric oxygen therapy.

Publication Types: 
    Case Reports

PMID: 18508401 [PubMed - indexed for MEDLINE]

111: Eur Arch Otorhinolaryngol. 2008 Aug;265(8):907-10. Epub 2008 May 28.

Necrotizing otitis externa: a painless reminder.

Thio D, Reece P, Herdman R.

Department of Otolaryngology, Royal Berkshire Hospital, Reading RG1 5AN, UK.
daniel.thio@yahoo.co.uk

Necrotizing otitis externa is a necrotizing osteomyelitis of the skull base that 
predominantly affects diabetic and immunocompromised patients. Pseudomonas
aeruginosa is the most frequently implicated organism. Patients present with
severe otalgia, otorrhoea with or without facial palsy, or rarely, facial pain as
a symptomatic feature. We report a case of necrotizing otitis externa presenting 
with totally painless otorrhoea and highlight the need for a high index of
suspicion when treating patients with otitis externa.

Publication Types: 
    Case Reports

PMID: 18506468 [PubMed - indexed for MEDLINE]

112: Otolaryngol Head Neck Surg. 2008 Jun;138(6):778-81.

The role of chronic infection in children with otitis media with effusion:
evidence for intracellular persistence of bacteria.

Coates H, Thornton R, Langlands J, Filion P, Keil AD, Vijayasekaran S, Richmond
P.

Department of ENT Surgery, Princess Margaret Hospital for Children, Perth,
Western Australia. harveyc@cyllene.uwa.edu.au

OBJECTIVE: Demonstrate mucosal bacterial infection in children with otitis media 
with effusion (OME). STUDY DESIGN AND SETTING: Middle ear mucosal biopsies from
11 children with OME were examined for bacteria utilizing transmission electron
microscopy. This was correlated with standard culture and polymerase chain
reaction (PCR) of middle ear effusions. RESULTS: Gram-positive coccal bacteria
were demonstrated in middle ear mucosal epithelial cells of 4 of 11 (36%)
children. Morphological appearance of bacteria and detection of pneumolysin DNA
by PCR in middle ear fluid suggests a role for persistent intracellular infection
with Streptococcus pneumoniae and other gram-positive cocci in some cases of OME.
CONCLUSION: Intracellular bacterial infection of middle ear mucosal epithelial
cells in children with OME may be an important mechanism for bacterial
persistence, and contribute to inflammation and mucus production in the
pathogenesis of this condition. SIGNIFICANCE: Persistent intracellular infection 
is a novel paradigm for OME pathogenesis in children and may influence antibiotic
effectiveness in treatment of this condition.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18503854 [PubMed - indexed for MEDLINE]

113: B-ENT. 2008;4(1):39-43.

Erratum in:
    B-ENT. 2008;4(2):2 p preceding 77. Radhouane, M [corrected to Mani, R]; Malek, B 
[corrected to Belcadhi, M]; Moncef, B S [corrected to Ben Said, M]; Kamel, B
[corrected to Bouzouita, K].

Aspergillus mastoiditis with intact tympanic membrane in immunocompetent host.

Mani R, Belcadhi M, Ben Said M, Bouzouita K.

*Department of Otolaryngology, Head and Neck Surgery, Farhat Hached University
Hospital, Sousse, Tunisia. mani_radhouane@yahoo.fr

Aspergillus mastoiditis is a very rare condition usually observed in
immunocompromised patients. Masked mastoiditis is defined as a subclinical
infectious inflammatory process of the mucosal lining and bony structures of the 
mastoid air cells with intact tympanic membranes. To our knowledge, our report of
a masked Aspergillus mastoiditis occurring in a 71-year-old diabetic woman is
only the second case of masked mastoiditis in the literature. Aggressive medical 
and surgical management are necessary to avoid a fatal outcome from this invasive
infection.

Publication Types: 
    Case Reports
    Review

PMID: 18500021 [PubMed - indexed for MEDLINE]

114: Am J Surg Pathol. 2008 Jul;32(7):1038-43.

Otic pneumocystosis in acquired immune deficiency syndrome.

Mahlakwane MS, Ramdial PK, Sing Y, Calonje E, Biyana S.

Department of Anatomical Pathology, National Health Laboratory Services, Durban, 
KwaZulu Natal, South Africa.

AIDS-associated otic pneumocystosis is rare. Of 14 cases documented mainly as
case reports up to now, only 1 has been reported in the surgical pathology
literature. We report 6 males, mean age of 32.3 years, with external auditory
canal masses and otorrhea. Two biopsies contained a predominance of granulation
tissue with a mixed inflammatory cell infiltrate and elusive foci of foamy
exudate. In contrast, 4 biopsies demonstrated conspicuous angiocentric mantles of
stippled, foamy exudate. Fibrin was noted in intravascular, perivascular, and
intervascular locations. One biopsy demonstrated bordering of the foamy exudate
by a palisaded granulomatous reaction, with adjacent discrete giant
cell-containing granulomas. Special stains confirmed trophozoites and cysts
within the foamy exudate. Review of 2 initial "nondiagnostic" biopsies confirmed 
granulation tissue and necrotic debris in which Pneumocystis jiroveci was
identified in focal foamy exudate. After the diagnosis of otic pneumocystosis,
all patients were initiated on trimethoprim-sulfamethoxazole. One patient also
had dapsone. Two patients succumbed to pulmonary tuberculosis and 2 were lost to 
follow-up. One patient with pneumocystis pneumonia did not return for follow-up
after 6 weeks. One patient experienced complete resolution of the mass on medical
therapy, and is disease free for 4 years. Heightened recognition of the
characteristic foamy exudate in an unconventional location remains the gold
standard in the timely diagnosis of this eminently treatable disease. In all
patients, otic pneumocystosis served as the sentinel of underlying HIV infection 
and AIDS.

Publication Types: 
    Case Reports

PMID: 18496145 [PubMed - indexed for MEDLINE]

115: J Laryngol Otol. 2008 Jul;122(7):687-90. Epub 2008 May 19.

Expansile properties of otowicks: an in vitro study.

Clamp PJ.

Department of ENT, Royal United Hospital Bath NHS Trust, Bath, UK.
philip.clamp@nhs.net

OBJECTIVE: To determine the expansile and absorptive properties of the expandable
ear wick when tested with commonly prescribed ear drop preparations. DESIGN: This
in vitro study assessed wick expansion and absorption of drops when different ear
drop preparations were applied. Nine commonly used ear drop preparations were
tested (Gentisone HC, Sofradex, Otomize, Betnesol, Exocin, Canesten,
Locorten-Vioform, EarCalm and ichthammol glycerin) with a standard expandable ear
wick. MAIN OUTCOME MEASURES: Weight, length and width of otowick following
exposure to ear drops. RESULTS: There was a marked difference in the absorption
and expansion of the otowick when different drops were used. This corresponded to
the aqueous or oil base of each preparation. All aqueous ear drop preparations
(i.e. Gentisone HC, Sofradex, Otomize, Betnesol, Exocin and EarCalm) produced
similar rates of absorption into, and expansion of, the otowick. The oil-based
ear drop preparations (i.e. Canesten, Locorten-Vioform and ichthammol glycerin)
failed to expand the wick and showed poor rates of absorption into the wick.
CONCLUSION: Expandable ear wicks should only be used in conjunction with aqueous 
ear drops. When using expandable otowicks as an adjunct to treating fungal otitis
externa, acetic acid ear drops should be prescribed, as all other anti-fungal
drops are oil-based.

Publication Types: 
    Evaluation Studies

PMID: 18485255 [PubMed - indexed for MEDLINE]

116: Med J Aust. 2008 May 19;188(10):599-603.

The effect of passive smoking on the risk of otitis media in Aboriginal and
non-Aboriginal children in the Kalgoorlie-Boulder region of Western Australia.

Jacoby PA, Coates HL, Arumugaswamy A, Elsbury D, Stokes A, Monck R, Finucane JM, 
Weeks SA, Lehmann D.

Telethon Institute for Child Health Research, Centre for Child Health Research,
University of Western Australia, Perth, WA, Australia.

OBJECTIVES: To determine the risk of otitis media (OM) associated with passive
smoking in young children, and any competing effect between passive smoking and
childcare attendance. DESIGN, PARTICIPANTS AND SETTING: Prospective cohort study 
of 100 Aboriginal and 180 non-Aboriginal children born in Kalgoorlie Regional
Hospital between 1 April 1999 and 31 January 2003. These children underwent
routine clinical examinations by an ear, nose and throat specialist up to three
times before the age of 2 years, and tympanometry at routine field follow-up
visits from the age of 4 months. Childrens' mothers were interviewed at 1-3 weeks
postpartum to provide sociodemographic data. MAIN OUTCOME MEASURES: Associations 
between OM and exposure to environmental tobacco smoke (ETS) and childcare
attendance. RESULTS: 82 Aboriginal and 157 non-Aboriginal children attended for
routine clinical examinations. OM was diagnosed at least once in 74% of
Aboriginal children and 45% of non-Aboriginal children; 64% of Aboriginal
children and 40% of non-Aboriginal children were exposed to ETS. Exposure to ETS 
increased the risk of specialist-diagnosed OM in Aboriginal children (OR, 3.54;
95% CI, 1.68-7.47); few attended childcare. Non-Aboriginal children exposed to
ETS but not attending childcare were at increased risk of OM (OR, 1.91; 95% CI,
1.07-3.42) while those attending childcare had no increased smoking-related risk.
Tympanometry was performed on 87 Aboriginal and 168 non-Aboriginal children; a
type B tympanogram (suggesting fluid in the middle ear) was also associated with 
passive smoking in Aboriginal children. CONCLUSIONS: Reducing the exposure of
children to ETS is a public health priority, especially for the Aboriginal
population. A smoke-free environment will help reduce the burden of OM.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 18484936 [PubMed - indexed for MEDLINE]

117: Pediatr Dent. 2008 Mar-Apr;30(2):105-10.

Middle ear and respiratory infections in early childhood and their association
with early childhood caries.

Alaki SM, Burt BA, Garetz SL.

Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
sumeralaki@msn.com

PURPOSE: The purpose of this study was to examine the risk of early childhood
caries (ECC) in children who had middle ear infections (MEI) or respiratory tract
infections (RTI) during early childhood. METHODS: Medicaid data from Michigan
were analyzed for all continuously enrolled children born in 2001 for whom
enrollment, medical, and dental claims were filed during 2001-2004. Proportional 
hazards survival models were used to assess the risk of ECC in children who had
MEl or RTI during the first year of life. RESULTS: Included in the study were
29,485 children (51% males and 49% females). By first year of life, 47% and 69%
of children had a claim for MEI and RTI, respectively. Children with at least one
claim for MEI or RTI were at 29% higher risk for developing ECC compared to those
with no claims (P < .001). Hispanic children with 8 or more claims showed 91%
greater risk for developing ECC than those with less than 8 claims (P = .01).
CONCLUSIONS: The occurrence of middle ear infections or respiratory tract
infections during the first year of life is associated with a significantly
increased risk for developing early childhood caries during subsequent years.
Race and ethnicity are possible predictors for ECC in the studied models.

PMID: 18481574 [PubMed - indexed for MEDLINE]

118: J Otolaryngol Head Neck Surg. 2008 Feb;37(1):130-6.

Effects of various densities of middle ear fluids on acoustic immittance:
experimental study.

Yilmaz I, Cagici CA, Ozluoglu LN, Akkuzu B, Ozgirgin N, Sener M, Atas A.

Department of Otolaryngology, Baskent University School of Medicine, Ankara,
Turkey. iy38@yahoo.com

OBJECTIVE: To study the effects of various densities of middle ear fluids on
acoustic immittance and elucidate the characteristics of this study that might be
beneficial for clinical use in otitis media with effusion. STUDY DESIGN:
Experimental, in vivo model. MATERIALS AND METHODS: The study was performed on 12
ears of six white Vienna rabbits. Rabbits were placed in six positions: normal
resting position (group 1); after drilling a hole into the tympanic bulla (group 
2); filling the bulla with distilled water (group 3; density = 1000 g/cm(3));
filling the bulla with 8.4% bicarbonate solution (group 4; density = 1005
g/cm(3)); filling the bulla with Tonimer gel (group 5; density = 1035 g/cm(3));
and filling the bulla with glycerine (group 6; density > 1050 g/cm(3)). Acoustic 
immittance measurements were then made in vivo. During each measurement, volume, 
compliance, pressure, and gradient values were recorded. Analysis of variance,
Student t-test, and Pearson correlation coefficient and multiple regression
analyses were used for statistical evaluations of the data. RESULTS: Volume,
compliance, and pressure values were obtained in all of the six measurements. A
significant difference in volume was found between groups 1 and 2 (p < .001) and 
between the other four groups in this study (p < .001). With regard to
compliance, group 2 was significantly different from groups 3, 4, 5, and 6 (p <
.001). With regard to pressure, there was no intergroup (1 and 2) difference (p =
.639); however, a significant difference (p < .001) was found between groups 1
and 2 and the other four groups. A significant difference was found between
groups 3 and 6 (p = .006). A gradient value was obtained in all of the six
measurements only for groups 1 and 2. In group 2, a significant rise in gradient 
was observed (p = .001). CONCLUSION: Generally, volume, compliance, and pressure 
values declined significantly in rabbits in which the bulla had been filled with 
fluid when compared with rabbits with empty bullae. Drilling a hole into the
bulla increased volumetric values under normal conditions but had no effect on
compliance and pressure values. The significant difference between groups 3 and 6
regarding pressure demonstrates that the density of fluid in the middle ear plays
a role in pressure values when measured with tympanometry. We conclude that the
correlation between density and pressure values of middle ear fluids may be
useful in the clinical decision-making process when treating disorders such as
otitis media.

PMID: 18479640 [PubMed - indexed for MEDLINE]

119: Eur Arch Otorhinolaryngol. 2008 Sep;265(9):1021-5. Epub 2008 May 14.

Multifrequency tympanometry in adults with otitis media with effusion.

Lai D, Li W, Xian J, Liu S.

Department of Otolaryngology-Head and Neck Surgery, The affiliated hospital of
Luzhou Medical College, Luzhou, People's Republic of China.

We compared the diagnostic values of multifrequency tympanometry (MFT) and
conventional 226-Hz tympanometry in adults with otitis media with effusion (OME) 
and discuss whether the resonant frequency (RF) can be used as a reliable method 
in adults with OME. Prospective study was designed to compare the normal hearing 
group and the group with OME. In the OME group (n = 85), conductive or mixed
hearing loss was found, air-bone gap was more than 10 dBHL, and acoustic reflex
was not elicited. In the normal hearing group (n = 36), pure tone threshold was
less than or equal to 15 dBHL and air-bone gap was less than 10 dBHL. Levene's
test was used to compare the difference between the OME group and the normal
hearing group on day 1, day 15, day 30, day 90, respectively. The relationship
among multifrequency tympanometry, 226-Hz tympanometry and acoustic reflex test
in ears recovering from OME was also investigated. A statistically significant
decrease in RF value was found in ears with OME compared to normative data. In
follow-up visits, both the RF values and the percentage of type A tympanograms
increased while the percentage of type B and C tympanograms decreased. A high
agreement between middle ear resonant frequency test and acoustic reflex test in 
ears recovering from OME was found. The resonant frequency test provides more
detailed information than the 226-Hz tympanometry. Multifrequency tympanometry
may be a more sensitive and objective diagnostic tool in adults with OME.

Publication Types: 
    Comparative Study

PMID: 18478243 [PubMed - indexed for MEDLINE]

120: Lab Invest. 2008 Jul;88(7):722-30. Epub 2008 May 12.

Induction of cytomegalovirus-infected labyrinthitis in newborn mice by
lipopolysaccharide: a model for hearing loss in congenital CMV infection.

Li L, Kosugi I, Han GP, Kawasaki H, Arai Y, Takeshita T, Tsutsui Y.

Department of Pathology, Hamamatsu University School of Medicine, Hamamatsu,
Japan.

Congenital cytomegalovirus (CMV) infection is the most common infectious cause of
sensorineural hearing loss in children. Here, we established an experimental
model of hearing loss after systemic infection with murine CMV (MCMV) in newborn 
mice. Although almost no viral infection was observed in the inner ears and
brains by intraperitoneal (i.p.) infection with MCMV in newborn mice, infection
in these regions was induced in combination with intracerebral (i.c.) injection
of bacterial lipopolysaccharide (LPS). The susceptibility of the inner ears was
higher than that of the brains in terms of viral titer per unit weight. In the
labyrinths, the viral infection was associated with the mesenchymal vessels and
accompanied by inflammatory cells induced by LPS, causing hematogenous targets of
infection in the labyrinths. Viral infection also spread in the perilymph regions
such as the scala tympani and scala vestibuli, probably from infected brains via 
meningogenic and cochlear nerve routes. Viral infection was not observed in the
scala media in the endolymph, including the Corti organ. However, viral infection
was observed in the spiral limbus, including the stria vascularis. These results 
suggest that hearing loss caused by labyrinthitis after congenital CMV infection 
may be enhanced by inflammation caused by systemic bacterial infection in the
neonatal period.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18475257 [PubMed - indexed for MEDLINE]

121: J Coll Physicians Surg Pak. 2008 Apr;18(4):226-9.

Frequency of Otitis Media with Effusion in recurrent upper respiratory tract
infection in children.

Raza M, Jalil J, Shafique M, Ghafoor T.

Department of Otolaryngology, Combined Military Hospital, Rawalpindi.

OBJECTIVE: To determine the frequency of Otitis Media with Effusion (OME) in
children with recurrent upper respiratory tract infections. STUDY DESIGN: A
descriptive study. PLACE AND DURATION OF STUDY: Combined Military Hospital,
Gujranwala, from September 2003 to September 2005. PATIENTS AND METHODS: Children
of either gender suffering from more than 2 episodes of upper respiratory tract
infection in the last 12 weeks were studied. The inclusion criteria were mild
intermittent ear pain, fullness or "popping" of the ear drum; poor response to
normal speech, inattentiveness, behavioural changes; irritability, sleep
disturbances; balance problems and poor school performance. Diagnosis of OME was 
confirmed by pneumatic otoscopy while tuning-fork tests, tympanometry, pure tone 
audiometry were used as adjunct investigations. Results were described in
percentage and 95% confidence interval was determined. RESULTS: Out of the 350
referred cases, pneumatic otoscopy by otolaryngologists diagnosed OME in 147
(42%, 95% CI=37.9-47.1). Out of these, 112 (76%) had retracted tympanic membrane,
25 (17%) had bulging of tympanic membrane and 10/147 (6.08%) cases showed
dullness of tympanic membrane with no additional features. Tympanometry confirmed
fluid behind the tympanic membrane in 145/147 (98.6%) cases. Tuning-fork tests
showed negative Rinne's test in 122 (83%). Pure tone audiometry diagnosed
deafness in 138/147 (93.8%) cases. CONCLUSION: OME with hearing loss is common in
children having recurrent upper respiratory tract infection and nonspecific
ear-related symptoms.

PMID: 18474156 [PubMed - indexed for MEDLINE]

122: Int J Pediatr Otorhinolaryngol. 2008 Jul;72(7):945-51. Epub 2008 May 9.

MRSA with progression from otitis media and sphenoid sinusitis to clival
osteomyelitis, pachymeningitis and abducens nerve palsy in an immunocompetent
10-year-old patient.

Laurens MB, Becker RM, Johnson JK, Wolf JS, Kotloff KL.

Department of Pediatrics, Division of Infectious Disease and Tropical Pediatrics,
University of Maryland School of Medicine, Baltimore, MD 21201, USA.
mlaurens@medicine.umaryland.edu

A previously healthy 10-year-old patient with headache, otalgia, and hearing loss
was diagnosed with pachymeningitis and methicillin-resistant Staphylococcus
aureus otitis media and bacteremia. Despite antimicrobial therapy, intracranial
extension progressed, including clival osteomyelitis, sphenoid sinusitis,
cavernous sinus inflammation and cranial nerve palsies, until the sphenoid sinus 
was drained. This case exemplifies an aggressive MRSA intracranial infection that
advanced despite antibiotic therapy.

Publication Types: 
    Case Reports

PMID: 18472169 [PubMed - indexed for MEDLINE]

123: Medicina (Kaunas). 2008;44(4):313-21.

Tympanic membrane changes in experimental acute otitis media and myringotomy.

Alzbutiene G, Hermansson A, Cayè-Thomasen P, Kinduris V.

Department of Otorhinolaryngology, Kaunas University of Medicine, Eiveniu 2,
50009 Kaunas, Lithuania. giedre.alzbutiene@gmail.com

OBJECTIVE: The present experimental study explored pathomorphological changes and
calcium depositions in the tympanic membrane during experimental acute otitis
media caused by nontypeable Haemophilus influenzae in myringotomized and
nonmyringotomized ears. MATERIAL AND METHODS: A rat model of experimental acute
otitis media caused by nontypeable Haemophilus influenzae was employed. Sixteen
Sprague-Dawley rats were used. Four days following middle ear inoculation, a
bilateral myringotomy was performed in six randomly selected animals. Another
group of 10 animals was inoculated only. On days 4, 7, 14, and 28 after
inoculation, two animals from each group were sacrificed. The temporal bones were
removed and the tympanic membranes were dissected, followed by paraffin
embedding. Adjacent sections were stained with PAS-alcian blue for basic
histopathological observations and by von Kossa method for determination of
calcium phosphate depositions. RESULTS: Particularly intense invasion of
polymorphonuclear neutrophil leukocytes was seen on day 4 after inoculation. The 
highest infiltration of macrophages was observed on day 7. The peak number of
lymphocytes was seen on day 14. No difference occurred in the number of
polymorphonuclear leukocytes in myringotomized and nonmyringotomized tympanic
membranes. The infiltration with lymphocytes and activated macrophages in all
parts of the myringotomized tympanic membranes was statistically significantly
higher than in the nonmyringotomized animals. The total amount of interstitial
calcium phosphate depositions during days 7, 14, and 28 of study was
statistically higher in the sections of pars tensa from myringotomized membranes 
compared to the nonmyringotomized membranes. CONCLUSION: Nontypeable Haemophilus 
influenzae-induced acute otitis media and myringotomy provoke more extensive
inflammatory reaction with microcalcification in the tympanic membranes.

Publication Types: 
    Comparative Study

PMID: 18469509 [PubMed - indexed for MEDLINE]

124: Chem Senses. 2008 Jul;33(6):503-7. Epub 2008 May 6.

Olfactory function in Australian aboriginal children and chronic otitis media.

Armstrong JE, Laing DG, Wilkes FJ, Laing ON.

School of Women and Children's Health, Faculty of Medicine, University of New
South Wales, Level 3, Sydney Children's Hospital, High Street, Randwick, New
South Wales 2031, Australia.

Chronic suppurative otitis media (CSOM), a severe form of middle ear infection,
affects most Australian Aboriginal children with up to 50% in some communities
suffering hearing loss as a consequence. To date, there is no information on
whether repeated exposure to the pathogens that characterize CSOM and that are
present in the upper respiratory airway affect olfactory function. Accordingly,
this study aimed to determine whether 1) there was a high prevalence of olfactory
loss in Aboriginal children and 2) hearing loss is a predictor of olfactory loss.
Two hundred and sixty one 9- to 12-year-old Aboriginal children from 16 rural
communities reported to have high prevalences of CSOM and hearing loss were
assessed for olfactory loss using a 16-odor identification test and hearing loss.
One child was found to be anosmic, 4 were slightly hyposmic, and 42 had hearing
loss. No relationship was found between olfactory loss and hearing loss. The
test-retest reliability of the 16-odor identification test was 0.98. It was
concluded that CSOM does not appear to affect olfactory function in the long term
and that hearing loss in Aboriginal children is not a predictor of olfactory
loss.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18463088 [PubMed - indexed for MEDLINE]

125: J Infect Dis. 2008 Jul 1;198(1):35-40.

Temporal relationship between human parechovirus 1 infection and otitis media in 
young children.

Tauriainen S, Oikarinen S, Taimen K, Laranne J, Sipilä M, Lönnrot M, Ilonen J,
Simell O, Knip M, Hyöty H.

Dept. of Virology, University of Tampere Medical School, 33014 University of
Tampere, Tampere, Finland. Sisko.Tauriainen@uta.fi

BACKGROUND: Human parechovirus (HPeV) 1 is a common virus that infects almost
everyone during childhood. Because clinical symptoms are poorly documented, we
evaluated the symptoms associated with HPeV1 infection in a cohort of children
followed prospectively from birth at 3-month intervals. METHODS: Symptoms such as
fever, cough, those of the common cold, otitis media, and gastroenteritis were
determined from hospital records and from questionnaires administered to the
parents of 59 children during regular study visits. HPeV1 infections were
diagnosed by measuring neutralizing antibodies in follow-up serum samples.
Additionally, HPeV RNA was analyzed in middle ear fluid (MEF) and nasopharyngeal 
aspirate samples from 33 patients with otitis media by reverse-transcription
polymerase chain reaction. RESULTS: Otitis media showed a clear association with 
HPeV1 infection-it developed in 50% of the 3-month follow-up periods that yielded
evidence for HPeV1 infection but in only 14% of the HPeV1-negative periods (odds 
ratio [OR], 6.14 [95% confidence interval {CI}, 2.75-13.77]). In children with
recurring otitis media, MEF samples were positive for HPeV in 15% of episodes.
Cough was also associated with HPeV1 infection, but this association was weaker
(OR, 3.67 [95% CI, 1.66-8.09]). Other symptoms were not linked to HPeV1
infection. Conclusions: HPeV1 infections are common in childhood and may cause
otitis media and cough.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18462136 [PubMed - indexed for MEDLINE]

126: Infect Immun. 2008 Jul;76(7):3255-67. Epub 2008 May 5.

Application of capillary electrophoresis mass spectrometry and liquid
chromatography multiple-step tandem electrospray mass spectrometry to profile
glycoform expression during Haemophilus influenzae pathogenesis in the chinchilla
model of experimental otitis media.

Lundström SL, Li J, Månsson M, Figueira M, Leroy M, Goldstein R, Hood DW, Moxon
ER, Richards JC, Schweda EK.

Karolinska Institutet and University College of South Stockholm, Clinical
Research Center, NOVUM, S-141 86 Huddinge, Sweden.

Otitis media caused by nontypeable Haemophilus influenzae (NTHi) is a common and 
recurrent bacterial infection of childhood. The structural variability and
diversity of H. influenzae lipopolysaccharide (LPS) glycoforms are known to play 
a significant role in the commensal and disease-causing behavior of this
pathogen. In this study, we determined LPS glycoform populations from NTHi strain
1003 during the course of experimental otitis media in the chinchilla model of
infection by mass spectrometric techniques. Building on an established structural
model of the major LPS glycoforms expressed by this NTHi strain in vitro (M.
Månsson, W. Hood, J. Li, J. C. Richards, E. R. Moxon, and E. K. Schweda, Eur. J. 
Biochem. 269:808-818, 2002), minor isomeric glycoform populations were determined
by liquid chromatography multiple-step tandem electrospray mass spectrometry
(LC-ESI-MS(n)). Using capillary electrophoresis ESI-MS (CE-ESI-MS), we determined
glycoform profiles for bacteria from direct middle ear fluid (MEF) samples. The
LPS glycan profiles were essentially the same when the MEF samples of 7 of 10
animals were passaged on solid medium (chocolate agar). LC-ESI-MS(n) provided a
sensitive method for determining the isomeric distribution of LPS glycoforms in
MEF and passaged specimens. To investigate changes in LPS glycoform distribution 
during the course of infection, MEF samples were analyzed at 2, 5, and 9 days
postinfection by CE-ESI-MS following minimal passage on chocolate agar. As
previously observed, sialic acid-containing glycoforms were detected during the
early stages of infection, but a trend toward more-truncated and less-complex LPS
glycoforms that lacked sialic acid was found as disease progressed.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18458064 [PubMed - indexed for MEDLINE]

127: Pediatrics. 2008 May;121(5):e1352-6.

Comparison of two approaches to observation therapy for acute otitis media in the
emergency department.

Chao JH, Kunkov S, Reyes LB, Lichten S, Crain EF.

Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of
Medicine, Bronx, New York, USA. jenniferhchao@hotmail.com

OBJECTIVE: This study compared parental adherence to delayed antibiotic therapy
for acute otitis media with and without a written prescription in a pediatric
emergency department. PATIENTS AND METHODS: Children aged 2 to 12 years who met
criteria for delayed antibiotic treatment were randomly assigned to observation
therapy with or without a prescription. Patients randomly assigned to observation
therapy without prescription were instructed to seek follow-up care if symptoms
persisted for 2 to 3 days. Patients assigned to observation therapy with a
prescription were discharged with an antibiotic prescription, and instructed to
fill it if their child's symptoms persisted 2 to 3 days. A research assistant who
was blinded to group assignment called parents 7 to 10 days after the visit to
assess adherence to observation therapy. RESULTS: Of 117 children assigned to the
observation therapy group, 100 completed follow-up; of 115 assigned to the
observation therapy with a prescription group, 106 completed follow-up. In the
observation therapy group, 87 parents reported no antibiotic use within the 3-day
observation period compared with 66 parents in the prescription group. During the
entire study period, 81% of the observation therapy group reported no use of
antibiotics compared with 53% in the prescription group. These groups did not
differ in satisfaction with the visit; 91% and 95% were very or extremely
satisfied, respectively. No complications were reported. CONCLUSIONS: Observation
therapy with and without a prescription were both well accepted by parents of
children diagnosed with acute otitis media in an urban pediatric emergency
department. Adherence to delayed antibiotic therapy was better for those not
offered a prescription. These data suggest that, in the pediatric emergency
department setting, observation therapy reduces antibiotic use without
compromising satisfaction with the visit.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 18450878 [PubMed - indexed for MEDLINE]

128: Pediatr Infect Dis J. 2008 Jun;27(6):490-3.

Rates of tympanic membrane closure in double-tympanocentesis studies.

Slovik Y, Raiz S, Leiberman A, Puterman M, Dagan R, Leibovitz E.

Department of Otolaryngology, Soroka University Medical Center, Israel.

BACKGROUND: Data on the outcome of tympanic membrane (TM) closure after
tympanocentesis in acute otitis media (AOM) patients is limited. OBJECTIVES: To
analyze the dynamics of TM perforation closure after 1 or 2 tympanocentesis
procedures performed at diagnosis and during AOM treatment. PATIENTS AND METHODS:
Study population included 113 children enrolled in 4 double-tympanocentesis
studies. Only the files of patients whose first and second examination were
performed by the same 2 otorhinolaryngologists were analyzed. Middle ear fluid
(MEF) was cultured on day 1 and days 4-6, the latter only in initially
culture-positive patients. Patients were also examined on days 11-14 and followed
until days 22-28. RESULTS: Ninety-three (82%) patients underwent tympanocentesis 
on days 4-6; 103 (91%) and 95 (84%) were evaluable on days 11-14 and 22-28,
respectively. One hundred seventy-three ears underwent tympanocentesis on day 1
and 139 on days 4-6. Ninety-seven (86%) patients had positive MEF cultures. One
hundred fifty-three (88%) tympanocentesis procedures performed at enrollment were
closed on days 4-6. No differences were recorded in the closure rates as function
of patient age, previous AOM history, MEF culture positivity, pathogens isolated 
at enrollment, and pathogen eradication on days 4-6. The 20 eardrums still open
on days 4-6 were closed on days 11-14. Eleven (9%) of the evaluable ears tapped
on days 4-6 were not closed on days 11-14 and 9 of 10 were closed on days 22-28. 
CONCLUSIONS: TM perforation closed in most cases within a few days regardless of 
patient and disease characteristics, and 2 consecutive tympanocentesis procedures
performed at short-time intervals are associated with good TM closure rates.

PMID: 18449065 [PubMed - indexed for MEDLINE]

129: Pediatr Infect Dis J. 2008 Jun;27(6):483-9.

A randomized comparative study of levofloxacin versus amoxicillin/clavulanate for
treatment of infants and young children with recurrent or persistent acute otitis
media.

Noel GJ, Blumer JL, Pichichero ME, Hedrick JA, Schwartz RH, Balis DA, Melkote R, 
Bagchi P, Arguedas A.

Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Raritan, NJ
08869, USA. gnoel1@prdus.jnj.com

BACKGROUND: The need for alternative antimicrobial therapy for recurrent and
persistent acute otitis media (AOM) in children has raised interest in assessing 
the efficacy and safety of fluoroquinolones for treatment of these infections.
METHODS: In an evaluator-blinded, active-comparator, noninferiority, multicenter 
study, children (6 months to <5 years) were randomized 1:1 to receive
levofloxacin (10 mg/kg twice daily) or amoxicillin/clavulanate (14:1; amoxicillin
45 mg/kg twice daily) for 10 days, with evaluations 4-6 days of therapy (visit
2), 2-5 days after completing therapy (visit 3), and 10-17 days after last dose
(visit 4). Primary outcome was clinical cure at visit 3 based on resolution of
clinical signs and symptoms of AOM. RESULTS: A total of 1650 children were
randomized and 1305 were clinically evaluable at visit 3 (630 levofloxacin, 675
comparator). Clinical cure rates were 72.4% (456 of 630) in levofloxacin-treated 
and 69.9% (472 of 675) in amoxicillin/clavulanate-treated children. Cure rates
were also similar for levofloxacin and comparator for each age group (< or =24
months: 68.9% versus 66.2%; >24 months: 76.9% versus 75.1%; respectively). Cure
rates at visit 4 were 74.9% and 73.8% in levofloxacin and amoxicillin/clavulanate
groups, respectively. The upper limits of the confidence intervals were less than
the noninferiority margin of 10% indicating that levofloxacin treatment is
noninferior to comparator treatment overall and in both infants (6 months to 2
years) and children 2-5 years. No differences between treatment groups regarding 
the frequency or type of adverse events were apparent. CONCLUSIONS: Levofloxacin 
was not inferior to amoxicillin/clavulanate for the treatment of recurrent and/or
persistent AOM in infants and children.

Publication Types: 
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial

PMID: 18449063 [PubMed - indexed for MEDLINE]

130: Pharmacotherapy. 2008 May;28(5):678-81.

Nonbloody, red stools from coadministration of cefdinir and iron-supplemented
infant formulas.

Lancaster J, Sylvia LM, Schainker E.

Northeastern University School of Pharmacy, Tufts Medical Center, Boston,
Massachusetts, USA.

Cefdinir is an extended-spectrum, third-generation cephalosporin that may be used
for treatment of acute otitis media in patients allergic to penicillin. When
administered with iron-containing products, including infant formulas, cefdinir
or one of its metabolites may bind to ferric ions, forming a nonabsorbable
complex that imparts a reddish color to the stool. We describe a 9-month-old
infant with failure to thrive and acute otitis media who developed an
erythematous maculopapular rash during treatment with amoxicillin-clavulanate.
His antibiotic therapy was changed to cefdinir. Five days into a 10-day course of
therapy, the infant's mother brought him to the pediatric clinic and reported the
appearance of red stools. He had no associated gastrointestinal symptoms
(vomiting, abdominal pain, or diarrhea). His hematocrit and hemoglobin level were
normal, and Clostridium difficile antigen studies and tests for species of
Shigella, Salmonella, and Camphylobacter as well as ova and parasites were all
negative. Cefdinir was discontinued, and his stools returned to normal within 48 
hours. Three weeks later, he again received cefdinir for recurrent otitis media. 
Red stools reappeared 48 hours later, were determined to be guaiac negative, and 
resolved within hours of drug discontinuation. During both occurrences of red
stools, the infant had been breastfed and was receiving supplemental feedings
with an iron-containing infant formula. In the product labeling of cefdinir, this
adverse event is described as a consequence of the drug-drug interaction;
however, it is not listed in the adverse drug reaction section of the labeling.
As such, one may miss the association between cefdinir and reddish stools when
investigating this event as a potential adverse reaction to cefdinir. When using 
the Naranjo adverse drug reaction probability scale to assess causality in our
patient's case, this adverse drug reaction was determined as highly probable. As 
this infant had been breastfed, the use of a supplemental iron-containing infant 
formula was not identified as a potential contributing factor until the second
occurrence of red stools. Health care professionals should review the entire
product labeling, including the drug-drug interaction section, when investigating
a potential adverse drug reaction. With the recent approval of generic
formulations of cefdinir, clinicians should be aware of this drug-drug
interaction with iron-containing products to prevent unnecessary alarm by parents
and caregivers, as well as costly medical evaluations for gastrointestinal
bleeding.

Publication Types: 
    Case Reports

PMID: 18447664 [PubMed - indexed for MEDLINE]

131: Kulak Burun Bogaz Ihtis Derg. 2008;18(1):14-8.

The effect of naproxen sodium on experimental otitis media.

Kayhan FT, Algün Z.

Department of Otolaryngology, Bakirköy Dr. Sadi Konuk Training and Research
Hospital, Istanbul, Turkey. ftulinkayhan@hotmail.com

OBJECTIVES: We evaluated the effect of naproxen sodium on propylene
glycol-induced otitis media in guinea pig ears. MATERIALS AND METHODS: Twenty
adult guinea pigs were randomized to the study and control groups equal in
number. A single dose of propylene glycol (0.2 ml, 60%) was applied to the left
ears of the control group and to both ears of the study group. Saline solution
was applied to the right ears of the control group. After propylene glycol
application, the study group received naproxen sodium (oral, 10 mg/kg daily) for 
15 days, whereas the control ears were left untreated. At the end of four weeks, 
the animals were decapitated under anesthesia. Otoscopic examination was
performed and temporal bones were removed for histologic examination under light 
microscopy. RESULTS: Nine animals were alive in each group at the end of four
weeks. In the control group, all the right ears receiving saline solution were
normal, whereas otitis media and inflammatory changes were observed in six of the
left ears receiving propylene glycol. In the study animals treated with naproxen 
sodium, otitis media and tympanic membrane perforation were seen in 14 ears. Of
these, three ears had purulent, 11 ears had serous effusion. Epithelial
hyperplasia (n=10), keratinizing epithelium and cholesteatoma formation (n=4)
were also observed. CONCLUSION: Our results suggest that the administered dose of
systemic naproxen sodium has no inhibitory effect on the development of
inflammation and otitis media.

PMID: 18443397 [PubMed - indexed for MEDLINE]

132: Homeopathy. 2008 Apr;97(2):83-8.

Petroleum: a series of 25 cases.

Gnaiger-Rathmanner J, Schneider A, Loader B, Böhler M, Frass M, Singer SR,
Oberbaum M.

Austrian Society for Homeopathic Medicine, Vienna, Austria.

This study is based on 25 well documented reports of cases which responded well
to treatment with Petroleum. Materia medica data were compared with results in
contemporary clinical practice. Many patients had characteristic skin problems;
children often had recurrent or chronic upper respiratory tract problems. The
most prominent mental feature is a quiet, withdrawn or stubborn disposition. The 
mental symptoms may be difficult to recognise. Detailed documentation in daily
practice can be helpful for preserving data of the effect of a medicine;
confirmation of statements given in materia medica; improving understanding of
homeopathic medicines and differentiating the indications for medicines.

Publication Types: 
    Case Reports
    Review

PMID: 18439969 [PubMed - indexed for MEDLINE]

133: Otolaryngol Head Neck Surg. 2008 May;138(5):637-40.

Chronic otitis media and immunoglobulin E-mediated hypersensitivity in adults: is
it a contributor of cholesteatoma?

Hong SD, Cho YS, Hong SH, Chung WH, Chung KW.

Department of Otorhinolaryngology, Head and Neck Surgery, Samsung Medical Center,
Sungkyunkwan University School of Medicine, Gangnam-Gu, Seoul, Korea.

OBJECTIVES: The aim of this study was to determine the relationship between
chronic otitis media (COM) and immunoglobulin E (IgE)-mediated hypersensitivity
in adults. STUDY DESIGN: A prospective comparative study. SUBJECTS AND METHODS:
One hundred seventeen patients with COM from July 2005 to April 2007 were
enrolled. All subjects had a questionnaire on allergic rhinitis symptoms and
performed allergy tests that included a total IgE and the multiple
radioallergosorbent chemiluminescence assay to check the presence of IgE-mediated
hypersensitivity. RESULTS: The prevalence of IgE-mediated hypersensitivity and
allergic rhinitis were 22.2% and 7.7% in patients with COM, respectively. The
mean total IgE was 157.2 ranging from 3 to 1833. The prevalence of IgE-mediated
hypersensitivity was similar with regard to the recurrence or bilaterality.
However, patients with cholesteatoma had a higher prevalence of IgE-mediated
hypersensitivity than patients without that condition. CONCLUSION: The prevalence
of IgE-mediated hypersensitivity and allergic rhinitis in adults with COM
appeared to be higher than in the general population. Allergy might contribute to
COM especially in cases with a cholesteatoma.

Publication Types: 
    Comparative Study

PMID: 18439471 [PubMed - indexed for MEDLINE]

134: Otolaryngol Head Neck Surg. 2008 May;138(5):572-5.

Increased risk of otitis media with effusion in allergic children presenting with
adenoiditis.

Marseglia GL, Pagella F, Caimmi D, Caimmi S, Castellazzi AM, Poddighe D, Klersy
C, Ciprandi G.

Dipartimento di Scienze Pediatriche, Università di Pavia, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy. gl.marseglia@smatteo.pv.it

OBJECTIVE: Otitis media with effusion (OME) is a common disorder in childhood.
The aim of the study was to assess the association of atopy and endoscopic
features with the presence of OME. SUBJECTS AND METHODS: This cross-sectional
study evaluated 287 children presenting with acute upper-airway infections
persistent for at least ten days and tested through nasal endoscopy and
skin-prick test. RESULTS: Fifty-three patients had a diagnosis of OME; out of
them, 23 showed acute rhinosinusitis, ten adenoiditis, and 20 both features. OME 
was diagnosed in 26 atopic children and in 27 nonatopic ones. On a multivariable 
analysis, allergic rhinitis, endoscopic pattern of adenoiditis, and younger age
were all shown to be independently associated with a diagnosis of OME.
CONCLUSIONS: This study suggests that allergic rhinitis and adenoiditis are
significant risk factors to OME development and that the risk becomes higher when
these two conditions are concomitantly present.

PMID: 18439460 [PubMed - indexed for MEDLINE]

135: Ear Nose Throat J. 2008 Feb;87(2):79-80.

Spontaneous cerebrospinal fluid leak presenting as unilateral (left-sided) middle
ear effusion.

Rajkumar KT, Orabi AA, Timms MS.

Department of Otorhinolaryngology, Blackburn Royal Infirmary, Blackburn, UK.
ktrajkumar2000@yahoo.com

Spontaneous leak of cerebrospinal fluid (CSF) into the middle ear occurs rarely
and can easily be missed, especially in adults. Although the presenting symptoms 
can be subtle, early suspicion and confirmatory imaging can establish the
diagnosis. Most previously reported cases of spontaneous CSF leak into the middle
ear occurred on the right side. We report a case of left-sided single-defect
spontaneous leak.

Publication Types: 
    Case Reports

PMID: 18437926 [PubMed - indexed for MEDLINE]

136: Otolaryngol Clin North Am. 2008 Jun;41(3):537-49, viii-ix.

Malignant otitis externa.

Carfrae MJ, Kesser BW.

Department of Otolaryngology - Head and Neck Surgery, Division of
Otology-Neurotology, University of Virginia Health System, Box 800713, 1 Hospital
Drive, Old Medical School, 2nd Floor, Charlottesville, VA 22908, USA.

Malignant otitis externa is an invasive, potentially life-threatening infection
of the external ear and skull base that requires urgent diagnosis and treatment. 
It affects immunocompromised individuals, particularly those who have diabetes.
The most common causative agent remains Pseudomonas aeruginosa. Definitive
diagnosis is frequently elusive, requiring a high index of suspicion, various
laboratory and imaging modalities, and histologic exclusion of malignancy.
Long-term oral antipseudomonal agents have proven effective; however, pseudomonal
antibiotic resistance patterns have emerged and therefore other bacterial and
fungal causative agents must be considered. Adjunctive therapies, such as
aggressive debridement and hyperbaric oxygen therapy, are reserved for extensive 
or unresponsive cases.

Publication Types: 
    Review

PMID: 18435997 [PubMed - indexed for MEDLINE]

137: J Laryngol Otol. 2008 Dec;122(12):1299-304. Epub 2008 Apr 21.

Screening for hearing loss and middle-ear effusion in school-age children, using 
transient evoked otoacoustic emissions: a feasibility study.

Georgalas C, Xenellis J, Davilis D, Tzangaroulakis A, Ferekidis E.

Department of Otolaryngology, Academic Medical Centre, Amsterdam, The
Netherlands. cgeorgalas@amc.uva.nl

INTRODUCTION: The characteristics of otoacoustic emissions that make them ideally
suited for universal newborn hearing loss screening could potentially be useful
for the screening of older children. This study was performed in order to assess 
the role of otoacoustic emissions in a screening programme for middle-ear
disorders and hearing loss in school-age children. METHODS: Cross-sectional,
preliminary screening study. SETTING: Primary schools of Argolida municipality,
south-east Greece, between December 2004 and March 2005. PATIENT SELECTION AND
RECRUITMENT: All the primary school students of Argolida were invited, by press
releases and individually by their teachers, to attend a session of otological
and audiological screening. RESULTS: One hundred and ninety-six children were
evaluated using transient evoked otoacoustic emissions. Twenty per cent failed in
both ears, while in 32 per cent otoacoustic emissions could not be produced in at
least one ear. Younger children had higher rates of absent transient evoked
otoacoustic emissions. The absence of otoacoustic emissions was highly correlated
with tympanic membrane changes seen on otoscopy and the presence of a type B
tympanogram. As a single screening modality, otoacoustic emissions had a 100 per 
cent sensitivity in diagnosing hearing loss worse than 30 dB, and a 90 per cent
sensitivity and 64 per cent specificity in diagnosing hearing loss worse than 25 
dB, which did not improve by adding tympanometry to the screening protocol.
CONCLUSION: These results strongly suggest the potential usefulness of
otoacoustic emission testing in screening school-age children for hearing loss.
Further studies, taking into account cost-effectiveness issues, are indicated.

Publication Types: 
    Evaluation Studies

PMID: 18423079 [PubMed - indexed for MEDLINE]

138: Vaccine. 2008 May 12;26(20):2466-70. Epub 2008 Mar 31.

Impact of different case definitions for acute otitis media on the efficacy
estimates of a pneumococcal conjugate vaccine.

Palmu A, Jokinen J, Kilpi T; Finnish Otitis Media Study Group.

National Public Health Institute, Helsinki, Finland; Tampere School of Public
Health, Tampere, Finland. arto.palmu@ktl.fi

Considerably higher vaccine efficacy estimate for clinical acute otitis media
(AOM) has been obtained for the 11-valent pneumococcal conjugate vaccine with
protein D of Haemophilus influenzae as a carrier (PncPD11) in the POET study than
for the 7-valent pneumococcal conjugate vaccine (PncCRM7) in the Finnish Otitis
Media (FinOM) Vaccine Trial. We recalculated PncCRM7 efficacy from the FinOM data
using a case definition for AOM very close to the POET definition and a
definition giving an incidence for AOM in the control group comparable to that
obtained in the POET study. The different case definitions had only a slight
impact on the vaccine efficacy estimates compared to the original case
definitions. We were not able to show that the differences between the study
results would be due to the case definitions used.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18420315 [PubMed - indexed for MEDLINE]

139: J Infect Dis. 2008 Apr 15;197(8):1094-102.

Comment in:
    J Infect Dis. 2008 Apr 15;197(8):1079-81.    J Infect Dis. 2008 Apr 15;197(8):1082-3.    J Infect Dis. 2008 Apr 15;197(8):1087-93.    J Infect Dis. 2008 Oct 1;198(7):1093-4.

Seasonality of antibiotic-resistant streptococcus pneumoniae that causes acute
otitis media: a clue for an antibiotic-restriction policy?

Dagan R, Barkai G, Givon-Lavi N, Sharf AZ, Vardy D, Cohen T, Lipsitch M,
Greenberg D.

Pediatric Infectious Disease Unit, Soroka University Medical Center, Israel.
rdagan@bgu.ac.il

BACKGROUND: It is unclear whether reducing antibiotic prescriptions can reduce
rates of resistance once resistance becomes prevalent. We attempted to determine 
whether reduced antibiotic consumption, which is observed yearly in children
during the warm season, is associated with a reduction in antibiotic resistance
in pneumococcal acute otitis media (AOM). METHODS: Antibiotic prescriptions and
resistance were measured prospectively during 1999-2003 in 2 demographically
distinct populations: Jewish and Bedouin children (aged <5 years) in southern
Israel. Associations were assessed using seasonally clustered logistic regression
models. RESULTS: The study included 236,466 prescriptions and 3609 pneumococcal
isolates. Prescription rates decreased during the warm months by 36% and 15% in
Jewish and Bedouin children, respectively (P < .001 for the season). Among Jewish
children, higher resistance rates were observed during the cold than the warm
months (P < .001 for each antibiotic). This difference remained significant after
adjustment for age, ethnic group, study year, history of antibiotic use, and
serotype. The difference was not observed in Bedouin children. CONCLUSIONS: Rapid
seasonal decline in resistant AOM-causing pneumococci occurred only in Jewish
children, among whom a marked prescribing seasonality was noted, and not in
Bedouin children, among whom prescription was less seasonal. The rapid seasonal
decrease in resistance associated with markedly reduced antibiotic use suggests
that drug-resistant pneumococci may pay a fitness cost.

PMID: 18419528 [PubMed - indexed for MEDLINE]

140: Otol Neurotol. 2008 Jun;29(4):526-30.

Serous otitis media in children: implication of Alloiococcus otitidis.

de Miguel Martinez I, Macias AR.

Department of Microbiology, University and Children's Hospital Insular of Las
Palmas, Gran Canaria, Spain.

OBJECTIVE: Otitis media with effusion (OME) has long been considered to be a
noninfective disease resulting from a eustachian tube dysfunction. However,
several microbiological techniques have shown bacteria in the middle ear fluids
from patients with OME. Alloiococcus otitidis has been detected in the middle ear
fluid from patients with OME. The exact role of this infectious agent in the
pathogenesis of OME has yet to be elucidated. STUDY DESIGN: A prospective
clinical trial. SETTING: A tertiary university-based referral center. PATIENTS:
The inclusion criteria included 110 patients aged between 1 and 12 years. The
control group included samples obtained from 30 healthy children undergoing a
cochlear implantation. The second group included 40 middle ear effusions (MEEs)
that were collected from 40 pediatric OME patients during the placement of the
ventilation tube. As for the third group, they were 40 children with acute otitis
media. Intervention: The bacterial analysis of the MEE was performed by means of 
microbiological culture-specific techniques. MAIN OUTCOME MEASURE: Positive
cultures for A. otitidis as analyzed by bacteriological analysis of samples from 
the middle ear mucosa and MEE. RESULTS: Bacteria were present in the culture of
72.5% (29) of the patients with OME. Alloiococcus otitidis was the most frequent 
bacterium in OME (48.27%) as well as Haemophilus influenzae nonserotype B
(17.24%). Streptococcus pneumoniae was the most commonly detected pathogen in
acute otitis media (37.5%), and then H. influenzae nonserotype B (25%). For most 
of the OME cases, only A. otitidis bacteria were isolated. CONCLUSION: We
observed a high rate of culture positivity for A. otitidis in patients with
clinical OME without suppuration. Further studies are needed to confirm whether
the association of A. otitidis with OME represents causality. Antibiotic therapy 
aimed at A. otitidis is complicated by reported resistance, thus emphasizing the 
importance of our understanding of the pathogenetic role played by this organism

PMID: 18418283 [PubMed - indexed for MEDLINE]

141: J Health Popul Nutr. 2007 Dec;25(4):414-21.

Acute otitis media during the first two years of life in a rural community in
Bangladesh: a prospective cohort study.

Roy E, Hasan KhZ, Haque F, Siddique AK, Sack RB.

Child Health Unit, Public Health Sciences Division, ICDDR,B, GPO Box 128, Dhaka
1000, Bangladesh. eliza@icddrb.org

The study investigated the burden of acute otitis media (AOM) during the first
two years of life in a cohort of 252 newborns in rural Bangladesh using data
collected on occurrences of AOM. Trained community health workers (CHWs)
conducted household surveillance and picked up cases of AOM using the study
algorithm. The incidence rate was 0.9 episodes per child-year observed. Forty-six
percent (n=115) of the 252 subjects developed AOM: 36% (n=91) during the first
year of life and 10% (n=24) during the second year of life (p<0.001). The
age-specific incidence rates of AOM varied; peaks occurred in the 6-12-month
age-group and the lowest in the first three months of life. In total, 20% (n=49) 
of the study subjects had single, 26% (n=66) recurrent, and 54% (n=137) no
episode of AOM. Perforation with discharge developed in 85% (n=322) of 375
episodes. The duration of discharge from the ears was < or =6 weeks in 95% of the
episodes, but in 5% of the episodes, discharge from the ears continued for >6
weeks. The incidence of AOM was higher in the monsoon season compared to the
summer season (p<0.003). The study documented AOM as an important cause of
morbidity among rural children up to two years of age in Bangladesh and should be
addressed with strategies to overcome the burden of disease.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18402184 [PubMed - indexed for MEDLINE]

142: Pediatr Dent. 2008 Jan-Feb;30(1):9-14.

The relationship between acute otitis media and the anatomic form of the hard
palate.

Kim SJ, Donovan DM, Blanchard SB, Kowolik JE, Eckert GJ.

Department of Periodontics and Allied Dental Programs, Indiana University School 
of Dentistry, Indianapolis, IN, USA. skim1@iupui.edu

PURPOSE: Acute otitis media (AOM) is a serious health concern for millions of
children. This study was conducted to determine the relationship between AOM and 
the shape of the hard palate. METHODS: Intraoral examinations were performed on
175 pediatric dental patients ages 4-6. The palatal height was classified as
high, medium or low. The accompanying parent completed a survey regarding their
child's age, gender, overall health, history of AOM and presence of known risk
factors for AOM. RESULTS: Eighty five percent of the total sample had a positive 
history for AOM, with 76% experiencing AOM prior to age 1. High palatal vault was
a significant finding in children that experienced AOM before age 1 (odds ratio
3.49). Logistic regression analysis revealed that children with high palatal
vaults underwent tube placement more often than the rest of the study population 
(odds ratio 2.49). CONCLUSIONS: Our study revealed a relationship between the
presence of high palatal vaults and early, recurrent acute otitis media in young 
children. Recognition of high palatal vault in children suffering from AOM, in
the presence of other known risk factors, may guide health care professionals to 
identify an otitis media prone patient and aid in prevention of recurrence.

Publication Types: 
    Comparative Study

PMID: 18402092 [PubMed - indexed for MEDLINE]

143: Acta Otolaryngol Suppl. 2007 Dec;(559):61-4.

Does acute dysfunction of the saccular afferents affect the subjective visual
horizontal in patients with vestibular neurolabyrinthitis?

Murofushi T, Ushio M, Takai Y, Iwasaki S, Sugasawa K.

Department of Otolaryngology, Tokyo Postal Services Agency Hospital, 2-14-23
Fujimi, Chiyoda-ku, Tokyo, Japan.

CONCLUSIONS: The results of a series of studies including the present study
suggest that acute dysfunction of the utricular afferents accompanied by acute
dysfunction of the saccular afferents might require more time for the
compensation of the otolith-ocular system than acute utricular dysfunction that
was not accompanied by acute saccular dysfunction. Perhaps the inputs from the
saccule also have some contribution to the subjective visual horizontal (SVH).
OBJECTIVE: To clarify if acute dysfunction of the saccular afferents affects the 
SVH. PATIENTS AND METHODS: Twenty-six patients with vestibular neurolabyrinthitis
(20 men and 6 women, 23-67 years of age) were enrolled in this study. They had
undergone measurement of SVH at the early stage (within 1 month after the attack)
and 3 months after the attack. For the measurement of SVH, we used a device that 
has a red bar of light-emitting diodes with a head fixing frame. They also
underwent vestibular evoked myogenic potentials (VEMPs) testing. For the
recording of VEMPs, 95 dBnHL clicks were presented. RESULTS: Patients with
vestibular neurolabyrinthitis showed deviation of SVH toward the affected
side-down at the early stage after the attack, irrespective of VEMP results.
However, 3 months after the attack SVH was significantly more deviated toward the
affected side-down in patients who showed absent VEMPs than those with VEMPs
present (p<0.01 Mann-Whitney U test).

PMID: 18340573 [PubMed - indexed for MEDLINE]

144: Acta Otolaryngol Suppl. 2007 Dec;(559):5-8.

Factors associated with the presence of drug-resistant bacteria and recurrent
acute otitis media in children--a study in a private clinic.

Kikuta S, Ushio M, Fujimaki Y, Kaga K.

Department of Otolaryngology, Graduate School of Medicine, University of Tokyo,
7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.

CONCLUSIONS: The proportion of drug-resistant bacteria was lower than previous
reports. In children with acute otitis media (AOM), lower age, presence of
multiple bacteria, and otitis media with effusion (OME) represented significant
factors for recurrent AOM and the presence of drug-resistant bacteria. OBJECTIVE:
Recently, the proportion of drug-resistant bacteria has been increasing in
children with AOM. We studied the proportion of drug-resistant bacteria and
background factors for detection of drug-resistant bacteria and recurrent AOM in 
a private clinic. SUBJECTS AND METHODS: Subjects comprised 170 patients <12 years
old with AOM. Middle ear fluid was collected and pathogenic bacteria were
identified. The following factors were considered: age, sex, use of antibiotics
in the past 1 month, past history of recurrent AOM, presence of OME, and multiple
bacteria of the three main strains (Streptococcus pneumoniae, Haemophilus
influenzae, and Moraxella catarrhalis). RESULTS: A total of 169 strains were
detected in 77% of children with AOM. Drug-resistant bacteria comprised 44 of the
169 strains (26%). Lower age (p=0.001) and presence of multiple bacteria
(p<0.001) represented significant factors for the presence of drug-resistant
bacteria. OME was a significant factor for recurrent AOM (p<0.001).

PMID: 18340553 [PubMed - indexed for MEDLINE]

145: Int J Pediatr Otorhinolaryngol. 2008 Jun;72(6):737-50. Epub 2008 Apr 8.

Comparison of study designs for acute otitis media trials.

Pichichero ME, Casey JR.

University of Rochester, School of Medicine, Department of
Microbiology/Immunology, 601 Elmwood Avenue, Box 672, Rochester, NY 14642, United
States. Michael_pichichero@urmc.rochester.edu

BACKGROUND: A framework for evaluating the efficacy of antibiotics in development
as well as those currently approved for acute otitis media (AOM) is needed.
OBJECTIVE: Review strengths and limitations of various antibiotic trial designs
and their outcome measures. METHODS: A review of 157 published trials involving
36,710 subjects for the treatment of AOM. RESULTS: AOM trials have three designs:
(1) clinical, clinical diagnosis and assessment of outcomes; (2) single
tympanocentesis, microbiologic diagnosis (by middle ear fluid culture) and
clinical assessment of outcomes; and (3) double tympanocentesis, microbiologic
diagnosis and microbiologic outcome assessment. Identifiable strengths and
limitations of each design are reviewed. Case definitions for entry of children
in trials of AOM vary widely. The lack of stringent diagnostic criteria in a
clinical design allows for inclusion of a significant proportion of children with
a non-bacterial etiology (i.e., viral AOM or otitis media with effusion).
Tympanocentesis increases diagnostic accuracy at study entry; however, the
procedure is confounding because of its potentially therapeutic benefit and the
procedure is not performed in a uniform manner. A second tympanocentesis allows a
high sensitivity to detect microbiologic eradication, but it does not correlate
with clinical outcomes in half of the cases. The timing of outcome assessment
also varies widely among trials. CONCLUSIONS: Improved clinical diagnosis
criteria for AOM are needed to enhance specificity; emphasis on a bulging
tympanic membrane has the best evidence base. Tympanocentesis within study
designs has merits. At study entry it assures diagnostic accuracy but may alter
outcomes and it is useful to document microbiologic outcomes but lacks
specificity for clinical outcomes. For all designs, test of cure assessment 2-7
days after completion of therapy seems most appropriate.

Publication Types: 
    Review

PMID: 18400312 [PubMed - indexed for MEDLINE]

146: PLoS ONE. 2008 Apr 9;3(4):e1969.

Strain-specific virulence phenotypes of Streptococcus pneumoniae assessed using
the Chinchilla laniger model of otitis media.

Forbes ML, Horsey E, Hiller NL, Buchinsky FJ, Hayes JD, Compliment JM, Hillman T,
Ezzo S, Shen K, Keefe R, Barbadora K, Post JC, Hu FZ, Ehrlich GD.

Department of Pediatrics, Allegheny General Hospital, Pittsburgh, Pennsylvania,
United States of America.

BACKGROUND: Streptococcus pneumoniae [Sp] infection is associated with local and 
systemic disease. Our current understanding of the differential contributions of 
genetic strain variation, serotype, and host response to disease phenotype is
incomplete. Using the chinchilla model of otitis media [OM] we investigated the
disease phenotype generated by the laboratory strain TIGR4 and each of thirteen
clinical strains (BS68-75, BS290, BS291, BS293, BS436 and BS437); eleven of the
thirteen strains have been genomically sequenced. METHODOLOGY/PRINCIPAL FINDINGS:
For each strain 100 colony forming units were injected bilaterally into the
tympanic bullae of 6 young adult chinchillas under general anesthesia. All
animals were examined daily for local and systemic disease by a blinded observer.
Pneumatic otoscopy was used to evaluate local disease, and behavioral assessments
served as the measure of systemic disease. Virulence scoring was performed using 
a 4-point scale to assess four clinical parameters [severity and rapidity of
local disease onset; and severity and rapidity of systemic disease onset] during 
a 10-day evaluation period. Highly significant variation was observed among the
strains in their ability to cause disease and moribundity.
CONCLUSIONS/SIGNIFICANCE: As expected, there was a significant correlation
between the rapidity of systemic disease onset and severity of systemic disease; 
however, there was little correlation between the severity of otoscopic changes
and severity of systemic disease. Importantly, it was observed that different
strains of the same serotype produced as broad an array of disease phenotypes as 
did strains of different serotypes. We attribute these phenotypic differences
among the strains to the high degree of genomic plasticity that we have
previously documented.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 18398481 [PubMed - indexed for MEDLINE]

147: Acta Paediatr. 2008 May;97(5):657-62.

Baby swimming and respiratory health.

Nystad W, Håberg SE, London SJ, Nafstad P, Magnus P.

Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
wenche.nystad@fhi.no

AIM: To estimate the effect of baby swimming in the first 6 months of life on
respiratory diseases from 6 to 18 months. METHODS: We used data from The
Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian
Institute of Public Health in children born between 1999 and 2005 followed from
birth to the age of 18 months (n = 30,870). Health outcomes: lower respiratory
tract infections (LRTI), wheeze and otitis media between 6 and 18 months of age. 
Exposure: baby swimming at the age of 6 months. The effect of baby swimming was
estimated by logistic regression analysis adjusting for potential confounders.
RESULTS: About 25% of the children participated in baby swimming. The prevalence 
of LRTI was 13.3%, wheeze 40.0% and otitis media 30.4%. Children who were baby
swimming were not more likely to have LRTI, to wheeze or to have otitis media.
However, children with atopic mothers who attended baby swimming had an increased
risk of wheeze, adjusted odds ratios (aOR) 1.24 (95% CI 1.11, 1.39), but not LRTI
or otitis media. This was also the case for children without respiratory diseases
before 6 months aOR 1.08 (95%CI 1.02-1.15). CONCLUSION: Baby swimming may be
related to later wheeze. However, these findings warrant further investigation.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, N.I.H., Intramural
    Research Support, Non-U.S. Gov't

PMID: 18394113 [PubMed - indexed for MEDLINE]

148: Braz J Otorhinolaryngol. 2008 Jan-Feb;74(1):118-24.

In vitro antimicrobial activity of plants in Acute Otitis Externa.

Nogueira JC, Diniz Mde F, Lima EO.

Centro de ciências de saúde, UFPB, PB, Brazil.

Acute Otitis Externa is an inflammation of the outer auditory meatus, and
according to popular saying, medicinal plant extracts can be used in its
treatment. AIM: to assess the in vitro antimicrobial activity of the following
plants: Aleolanthus suaveolens; Caryophyllus aromaticus; Cymbopogon citratus;
Matricaria chamomila; Pithecellobium avaremotemo; Plectranthus amboinicus and
Ruta graveolens on the germs that cause otitis externa. MATERIALS AND METHODS:
the minimum inhibitory concentration of extracts and oils from these plants was
obtained from otitis externa samples. RESULTS: Staphylococcus aureus in 10
cultures, Pseudomonas aeruginosa in 8, Pseudomonas aeruginosa and Staphylococcus 
aureus together in 5 cultures and Candida albicans and Candida krusei in 4
cultures. P. aeruginosa was resistant to all oils and extracts tested; extracts
from A. suaveolens, P. avaremotemo and R. graveolens were inactive; the essential
oil from C. aromaticus and M. chamomila were active against 3 strains of S.
aureus and the Candida strains; seven of the S. aureus strains were sensitive to 
the P. amboinicus extract; however, the oil was inactive against 4 S. aureus
strains and the Candida strains were sensitive to the R. graveolens essential
oil. CONCLUSION: depending on the etiological agent, some plants presented
satisfactory results, however we still need more detailed studies in order to
better use these plants.

PMID: 18392512 [PubMed - indexed for MEDLINE]

149: Niger J Med. 2008 Jan-Mar;17(1):20-4.

Managing chronic otitis media with cholesteatoma report of 223 patients seen in a
5-year period.

Mustafa A, Hysenaj Q, Latifi X, Ukimeraj L, Thaçi H, Heta A, Behramaj A.

ENT/Head and Neck Surgery Clinic, University Clinical Center, Prishtina, Kosovo. 
aziz_mustafa2000@yahoo.com

BACKGROUND: To assess the clinical features, diagnosis, and treatment of patients
having chronic otitis media (COM) with cholesteatoma seen in the ENT/Head and
Neck Surgery Clinic at the University Clinical Center, Prishtina, Kosovo. METHOD:
A systematic review of the medical records of all patients admitted to the ENT
clinic having COM with cholesteatoma between January 1999 and December 2003.
RESULTS: During this period, 223 patients suffering from COM with cholesteatoma
underwent surgical treatment. There were 123 (55%) male and 100 (45%) female
patients. Their mean age was 30.7 years, ranging from youngest patient
(7-year-old girl) to oldest (73-year-old lady). Thirty-three patients developed
complications: 17 patients extracranial complications (EC) and 16 intracranial
complications (IC). Leading pathogens in this series were Proteus mirabilis in
52% of cases, Proteus vulgaris in 14% and Staphylococcus aureus in 12%. All
patients underwent surgical treatment: 10 patients (4.5%) a canal-wall up (CWU)
procedure and 213 (95.5%) a canal-wall down (CWD) procedure. No deaths occurred
in this series. CONCLUSION: Because of possibility of developing life-threatening
complications, patients with COM with cholestatoma must diagnosed in time and
followed as soon as possible to the center that performs ear surgery, as only
adequate treatment option for these patients.

PMID: 18390126 [PubMed - indexed for MEDLINE]

150: Pediatrics. 2008 Apr;121(4):674-9.

Trends in otitis media treatment failure and relapse.

Sox CM, Finkelstein JA, Yin R, Kleinman K, Lieu TA.

Center for Child Health Care Studies, Department of Ambulatory Care and
Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston,
Massachusetts, USA. colin.sox@bmc.org

OBJECTIVES: The goals were to describe trends in acute otitis media, treatment
failure, and relapse and in high-dose amoxicillin use and to determine whether
treatment of acute otitis media with high-dose amoxicillin was associated with
treatment failure or relapse. METHODS: We conducted a retrospective study of
acute otitis media visits made between 1996 and 2004 by children 2 months to 12
years of age in a large group practice, using computerized data. We defined acute
otitis media as an otitis media visit with antibiotics dispensed (preceded by 30 
days without otitis media visits), treatment failure as initiation of treatment
with a second antibiotic before the first prescription was finished, and relapse 
as initiation of antibiotic treatment after the first prescription was finished
but within 30 days after the index acute otitis media episode. The primary
independent measure was high-dose amoxicillin (>70 mg/kg per day). We evaluated
changes over time and determined whether high-dose amoxicillin use was associated
with otitis media treatment failure or relapse. RESULTS: We identified 111,335
acute otitis media visits over a 9-year period. The incidence of acute otitis
media decreased from 385.1 visits per 1000 enrollees in 1996 to 188.8 visits per 
1000 enrollees in 2004. The proportion of acute otitis media visits treated with 
high-dose amoxicillin increased from 1.7% in 1996 to 41.9% in 2004. Both otitis
media treatment failure and relapse rates decreased from 1996 to 2004 (from 3.9% 
to 2.6% and from 9.2% to 8.9%, respectively). The odds of treatment failure or
relapse did not differ between acute otitis media episodes treated with high-dose
and low-dose amoxicillin. CONCLUSIONS: During the past decade, acute otitis
media, treatment failure, and relapse became less common and high-dose
amoxicillin use increased. However, high-dose amoxicillin treatment did not
reduce the risk of individual infections resulting in adverse outcomes.

Publication Types: 
    Comparative Study

PMID: 18381530 [PubMed - indexed for MEDLINE]

151: Pediatrics. 2008 Apr;121(4):669-73.

Valuing reduced antibiotic use for pediatric acute otitis media.

Meropol SB.

University of Pennsylvania School of Medicine, Center for Clinical Epidemiology
and Biostatistics, Room 108, Blockley Hall, 423 Guardian Dr, Philadelphia, PA
19104, USA. meropols@mail.med.upenn.edu

OBJECTIVE: The 2004 American Academy of Pediatrics acute otitis media guidelines 
urge parents to weigh the benefits of reduced antibiotic use, adverse drug
events, and future resistance versus risks of extra costs and sick days resulting
from guideline use. The value of decreased antibiotic resistance has not been
quantified. The objective was to perform cost-utility analysis, estimating the
resistance value of implementing the guidelines for acute otitis media treatment 
for children <2 years of age. Outcomes were described with a common denominator
and the value of avoiding resistance was estimated using a parental perspective. 
METHODS: Decision analysis results were used for outcome probabilities. Published
utilities were used to describe outcomes in quality-adjusted life-day units. The 
minimum resistance benefit value, where the benefits of the American Academy of
Pediatrics guidelines would at least balance their costs, was defined as the
guidelines' incremental costs minus their other benefits. RESULTS: For a child 2 
to <6 months of age presenting to a primary care physician with possible otitis
media, parents would need to value the resistance benefit at 0.77
quality-adjusted life-days per antibiotic prescription avoided for the
guidelines' benefits to balance their costs. For the 6- to <24-month-old group,
results were 0.67 quality-adjusted life-days per prescription avoided. Results
were sensitive to the dollar cost utility; when willingness to pay ranged from
$20,000 to $200,000 per quality-adjusted life-year, results ranged from 0.36 and 
0.30 quality-adjusted life-days up to 4.10 and 3.57 quality-adjusted life-days
for the 2- to <6-month-old and 6- to <24-month-old groups, respectively. Costs
were driven by missed parent work days. CONCLUSIONS: From a societal perspective,
trading 0.30 to 4 quality-adjusted life-days to avoid 1 antibiotic course might
be desirable; from a parental perspective, this may not be as desirable. Parent
demand for antibiotics may be rational when driven by the value of parent time.
Other approaches that have the potential to reduce antibiotic use, such as wider 
use of influenza vaccine and improved rapid viral diagnostic techniques, might be
more successful.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 18381529 [PubMed - indexed for MEDLINE]

152: Pediatrics. 2008 Apr;121(4):657-68.

Age inconsistency in the American Academy of Pediatrics guidelines for acute
otitis media.

Meropol SB, Glick HA, Asch DA.

Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
School of Medicine, 108 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104,
USA. meropols@mail.med.upenn.edu

OBJECTIVE: The American Academy of Pediatrics acute otitis media guidelines could
reduce antibiotic use. The objective was to compare strategies for diagnosing and
treating otitis: (1) a commonly used, 2-criteria strategy, (2) the guidelines'
3-criteria algorithm, and (3) initially watching without antibiotics. METHODS: A 
decision analysis was performed with literature-based parameter. The target
population was children presenting to primary care physicians with possible
otitis media. Main outcomes were antibiotic use, sick days, mild adverse drug
events, and number needed to treat/avoided sick day. RESULTS: For children 2 to
<6 months of age, compared with the 2-criteria strategy, guideline use predicted 
21% less antibiotic use, 13% more sick days, and 23% fewer adverse drug events;
the number needed to treat for the 2-criteria strategy versus the American
Academy of Pediatrics strategy was 1.2 children per avoided sick day. For
children 6 to <24 months of age, guideline use, compared with the 2-criteria
strategy, predicted 26% less antibiotic use, 14% more sick days, and 28% fewer
adverse drug events; the number needed to treat for the 2-criteria strategy
versus the American Academy of Pediatrics strategy was 1.4 children per avoided
sick day. For children >2 years of age, guideline use, compared with the
2-criteria strategy, predicted 67% less antibiotic use, 4% more sick days, and
68% fewer adverse drug events. The number needed to treat for the guideline
strategy versus the watch strategy was 6.3 children per avoided sick day; that
for the 2-criteria strategy versus the guideline strategy was 12.3. Guideline use
for children <2 years implies that our number needed to treat to avoid a sick day
is <1.4; for children >2, guideline use implies we are willing to treat at least 
6.3 children to avoid a sick day. Thus, the guidelines imply a greater
willingness to treat older children, compared with younger children. CONCLUSIONS:
The American Academy of Pediatrics guidelines are inconsistent in their outcomes 
across age groups. Guideline implementation under age 2 reduces antibiotic use
but at a relatively heavy cost of sick days and parental missed work days. This
trade-off may be particularly unfavorable for working parents, who might
reasonably prefer greater antibiotic use.

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 18381528 [PubMed - indexed for MEDLINE]

153: Value Health. 2008 Mar-Apr;11(2):304-14.

Estimating the effect of treatment rate changes when treatment benefits are
heterogeneous: antibiotics and otitis media.

Park TR, Brooks JM, Chrischilles EA, Bergus G.

Health Research Consultant, Health Dialog Analytic Solutions, Portland, ME, USA.

OBJECTIVE: Contrast methods to assess the health effects of a treatment rate
change when treatment benefits are heterogeneous across patients. Antibiotic
prescribing for children with otitis media (OM) in Iowa Medicaid is the empirical
example. METHODS: Instrumental variable (IV) and linear probability model (LPM)
are used to estimate the effect of antibiotic treatments on cure probabilities
for children with OM in Iowa Medicaid. Local area physician supply per capita is 
the instrument in the IV models. Estimates are contrasted in terms of their
ability to make inferences for patients whose treatment choices may be affected
by a change in population treatment rates. RESULTS: The instrument was positively
related to the probability of being prescribed an antibiotic. LPM estimates
showed a positive effect of antibiotics on OM patient cure probability while IV
estimates showed no relationship between antibiotics and patient cure
probability. CONCLUSIONS: Linear probability model estimation yields the average 
effects of the treatment on patients that were treated. IV estimation yields the 
average effects for patients whose treatment choices were affected by the
instrument. As antibiotic treatment effects are heterogeneous across OM patients,
our estimates from these approaches are aligned with clinical evidence and
theory. The average estimate for treated patients (higher severity) from the LPM 
model is greater than estimates for patients whose treatment choices are affected
by the instrument (lower severity) from the IV models. Based on our IV estimates 
it appears that lowering antibiotic use in OM patients in Iowa Medicaid did not
result in lost cures.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18380643 [PubMed - indexed for MEDLINE]

154: Pediatr Infect Dis J. 2008 Apr;27(4):296-301.

Persistence of pathogens despite clinical improvement in antibiotic-treated acute
otitis media is associated with clinical and bacteriologic relapse.

Asher E, Dagan R, Greenberg D, Givon-Lavi N, Libson S, Porat N, Leiberman A,
Leibovitz E.

Pediatric Infectious Disease Unit, Soroka University Medical Center and the
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,
Israel.

BACKGROUND: Pathogen eradication in patients with acute otitis media (AOM) is
associated with a reduced risk of clinical failures, but most children in whom
middle ear fluid (MEF) culture remains positive show clinical improvement or
clinical cure. We investigated the relationship between MEF culture-positivity
during treatment in patients with clinical improvement/cure, and the occurrence
of subsequent AOM. METHODS: A total of 673 patients with culture-positive MEF
were enrolled in double-tympanocentesis studies and followed for 3 weeks after
completion of treatment. RESULTS: On day 4-6, 189/673 (28%) patients had
culture-positive MEFs. Patients with clinical improvement/cure on day 11-14 (end 
of treatment) despite having culture-positive MEF on day 4-6 more often had
recurrent AOM episodes (53/151, 35%) than those with culture-negative MEF
(114/476, 24%; P = 0.007). 41/53 (77%) culture-positive patients with clinical
improvement/cure on day 11-14 underwent tympanocentesis when AOM recurred and
29/41 (71%) were culture-positive. Pulsed field gel electrophoresis identity
between pathogens at recurrence and those persisting on day 4-6 was found in
19/29 (66%) compared with 31/86 (36%) of the evaluable patients with recurrence
and culture-negative MEF on day 4-6 (P = 0.005). CONCLUSIONS: (1) Failure to
eradicate MEF pathogens during antibiotic treatment is associated with clinical
recurrences, even in patients showing clinical improvement/cure at end of
treatment; (2) these recurrences are mostly caused by pathogens initially present
in MEF and persisting during treatment.

PMID: 18379372 [PubMed - indexed for MEDLINE]

155: Int J Pediatr Otorhinolaryngol. 2008 Jun;72(6):787-92. Epub 2008 Apr 2.

Otitis media as a cause of significant hearing loss among Nigerians.

Olusesi AD.

Hearing Loss Clinic, Department of Ear, Nose & Throat, National Hospital, Room H.
1/04, Central Area (Phase II), Garki, Abuja 90000, Nigeria.
biodun@nanootology.org

Mild or worse hearing loss, defined as pure tone average >25 decibel, is seen
commonly with preventable etiologies. SETTINGS: A tertiary care, urban referral
hospital. METHODS: Retrospective analysis of prospectively collected data of
individuals attending the hearing loss clinic of National Hospital, Abuja,
between May 2005 and April 2007. Data matching the diagnosis of acute otitis
media (AOM), otitis media with effusion (OME) and chronic suppurative otitis
media (CSOM) were extracted from the database and analyzed. RESULT: A total of
298 cases with primary presenting complaints of hard of hearing were seen. A
total of 77 cases had hearing loss due to otitis media. 44 (57.1%) had OME, 26
(33.8%) had CSOM, while 7 (9.1%) had AOM. The observed distribution of the OME
was left OME (18.1%, n=14), right OME (9.1%, n=7) and bilateral OME (29.9%,
n=23), while the CSOM is distributed into left CSOM (15.5%, n=12), bilateral CSOM
(11.7%, n=9) and right CSOM (6.4%, n=5), and AOM is distributed into right AOM
(2.6%, n=2), left AOM (3.9%, n=3), and bilateral AOM (2.6%, n=2). The mean pure
tone averages for the three groups are AOM (30.5dB), OME (41.5dB) and CSOM
(56.9dB). CONCLUSION: Otitis media is an important cause of preventable hearing
loss in developing countries, and the predominance of unilateral otitis media in 
the left ear observed in this study deserves further studies.

PMID: 18378007 [PubMed - indexed for MEDLINE]

156: Turk J Pediatr. 2008 Jan-Feb;50(1):70-3.

Langerhans cell histiocytosis presented as bilateral otitis media and
mastoiditis.

Skoulakis CE, Drivas EI, Papadakis CE, Bizaki AJ, Stavroulaki P, Helidonis ES.

Departments of Otolaryngology, General Hospital of Volos, Volos, Greece.

Langerhans cell histiocytosis (LCH) is a rare disease that may affect multiple
organs. The etiology of LCH remains unclear to date. It is currently believed
that clonal accumulation and proliferation of CD1a-positive Langerhans cells are 
causative. The term LCH or histiocytosis X refers to three separate illnesses
(listed in order of increasing severity): eosinophilic granuloma,
Hand-Schüller-Christian disease and Letterer-Siwe disease. A seven-month-old boy 
presented with history of recurrent bilateral otitis media and rash and
seborrheic areas on his scalp. Two days prior, his mother noticed a small lump
over the right mastoid. Lateral skull X-ray (Schüller) was evidence for lytic
lesion on right temporal bone. The computerized tomography scan showed
inflammatory changes with bone erosion. During surgical exploration, fragile
slightly yellowish tissue with necrotic areas was found that was determined as
LCH on histology. Chemotherapy was subsequently initiated. The initial
presentation of LCH with bilateral ear and skull involvement is a very rare
condition. The signs and symptoms of otologic histiocytosis can mimic those of
acute and chronic infectious ear disease. Only a surgically obtained biopsy leads
to definitive diagnosis and appropriate therapy.

Publication Types: 
    Case Reports

PMID: 18365596 [PubMed - indexed for MEDLINE]

157: Laryngoscope. 2008 Jun;118(6):1066-71.

Daily tympanometry for high-resolution measurement of the time between onset of
cold-like illness and middle ear effusion.

Doyle WJ, Winther B, Alper CM.

Department of Otolaryngology, Children's Hospital of Pittsburgh, University of
Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.

BACKGROUND: Tympanometry is a simple method to assess middle ear pressure (MEP)
and the presence of middle ear effusion (MEE), a marker of otitis media (OM).
OBJECTIVES: To determine whether daily parental tympanometry and illness sign
recording in their children can be used to define the time between onsets of
cold-like illness (CLI) and MEE at high resolution. STUDY DESIGN: Prospective,
longitudinal, 7 month, daily follow-up on 169 children aged 1 through 8.6 years. 
METHODS: Tympanograms and illness were recorded daily by a parent. Tympanograms
were examined, rejected if artifactual, and MEP data were entered into a
database, with "flat tympanograms" coded as -400 mm H2O = MEE. The incidence and 
burden of CLIs (>2 days) were calculated, and for each CLI, the presence/absence 
of concurrent MEE (>2 days) was determined. For each child, the average MEP for
CLI and nonCLI days was calculated. Paired CLI and tympanometric results were
aligned and the days between event onsets determined. Stepwise regression was
used to assign risk predictors for the measured outcomes. RESULTS: A total of 566
CLIs were recorded, and the average CLI burden/child was 16%. Age was a
significant predictor of CLI incidence/child, and age, history of colds, and
daily environment were predictors of CLI-burden/child. Of the 433 evaluable CLI
episodes, MEE was a complication in 37%, and MEE with a CLI was predicted by age,
OM history, and environment. MEP was significantly more negative during CLI
episodes, and the magnitude was predicted by age, race, and OM history. The
average difference in MEE-CLI onsets was 1.2 +/- 4.0 days; approximately 32% of
MEEs occurred prior to CLI onset and 17% on the same day as CLI onset.
CONCLUSIONS: CLIs adversely affect the middle ear-ambient pressure balance and
are frequently associated with MEE episodes. The distribution in onsets between
those events suggests that chemoprophylaxis of a child with a newly identified
CLI to prevent MEE would have a low expected efficiency.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18354338 [PubMed - indexed for MEDLINE]

158: J Laryngol Otol. 2008 Aug;122(8):854-7. Epub 2008 Mar 20.

'Over-under' myringoplasty with umbus-anchored graft.

Fiorino F, Barbieri F.

Department of Otolaryngology, Civile Maggiore Hospital, Verona, Italy.
franco.fiorino@virgilio.it

INTRODUCTION: 'Over-under' myringoplasty is a versatile and effective surgical
technique for tympanic membrane repair. The main drawbacks are possible trauma to
the inner ear, due to manipulation of the malleus, and graft detachment from the 
apical portion of the malleus during the healing process, with consequent
reduction of sound transfer function. To obviate these disadvantages, we have
modified the over-under myringoplasty by maintaining anchorage of the tympanic
membrane to the umbus. MATERIAL AND METHODS: A total of 78 umbus-anchored
over-under myringoplasties were performed from 2004 to 2006 in 63 patients. After
elevation of the tympanomeatal flap, the malleus was freed from the tympanic
membrane in a superior to inferior direction, up to the region immediately
superior to the umbus. A large graft with a radial slit was distended under the
tympanic remnants and annulus, and the two tongues were positioned to surround
the umbus area and overlapped under a non-perforated portion of the tympanic
membrane. RESULTS: Graft take was obtained in 71 ears (91 per cent). The auditory
results showed an average residual air-bone gap of 6.7 dB, which was
significantly better (p = 0.04) in comparison to that obtained in ears undergoing
traditional over-under myringoplasty (11.9 dB). CONCLUSION: Modification of the
over-under myringoplasty by anchoring the graft to the umbus preserves both lever
and catenary effects of the tympano-ossicular system, reduces traumatising
manoeuvres during dissection of the tympanic membrane from the malleus, and
yields excellent results in terms of graft take and auditory outcome.

PMID: 18353198 [PubMed - indexed for MEDLINE]

159: Eur Arch Otorhinolaryngol. 2008 Jul;265(7):739-42. Epub 2008 Mar 20.

Cartilage graft in type I tympanoplasty: audiological and otological outcome.

Gamra OB, Mbarek C, Khammassi K, Methlouthi N, Ouni H, Hariga I, Zribi S, Koubâa 
J, El Khedim A.

Department of Otorhinolaryngology-Head and Neck Surgery, Habib Thameur Hospital, 
8 Rue Ali Ben Ayed, Montfleury, 1008, Tunis, Tunisia. olfabengamra@yahoo.fr

The aim of this study is to evaluate anatomical and audiological results of
cartilage tympanoplasty compared to fascia tympanoplasty in the reconstruction of
tympanic membrane perforations. We carry a retrospective study about 380 patients
operated in our department between 1998 and 2005. Patients were classified into
two groups: 90 (23.6%) undergo cartilage tympanoplasty and 290 (76.4%) fascia
tympanoplasty. In each group, we calculated the average of pre and postoperative 
air bone gap (ABG) and the average air conduction gain (ACG) at 250-4,000 Hz. The
surgical technique is explained in detail. We detail and analyze the audiological
and anatomical results in each group. Successful closure of the tympanic membrane
perforation was achieved in 97% of the cartilage group as compared to 94% of the 
fascia group. The average ACG was 21 +/- 11 dB in cartilage group and 20 +/- 22
dB in fascia group. With an average follow-up of 2 years, residual perforation
was observed in 2.2% in cartilage group. Reperforation of fascia graft and
retraction were noted in 2.1 and 1%, respectively. The authors show the great
reliability of cartilage tympanoplasty to close tympanic membrane perforations.
We recommend using cartilage as a first choice, especially in stable or evolutive
chronic otitis media, and in recurrent perforation of the tympanic membrane.

PMID: 18351372 [PubMed - indexed for MEDLINE]

160: Arch Otolaryngol Head Neck Surg. 2008 Mar;134(3):290-3.

The contralateral ear in chronic otitis media: a series of 500 patients.

Selaimen da Costa S, Rosito LP, Dornelles C, Sperling N.

Department of Otolaryngology-Head and Neck Surgery, Universidade Federal do Rio
Grande do Sul, Porto Alegre, Brazil.

OBJECTIVE: To study the contralateral ear of patients with chronic otitis media
(COM). DESIGN: Transversal. SETTING: Tertiary referral center. PATIENTS: A total 
of 500 consecutive patients who had been diagnosed as having COM with or without 
cholesteatoma. INTERVENTIONS: Digital otoendoscopy was performed on both ears.
MAIN OUTCOME MEASURE: Pathologic alterations in the contralateral ear. RESULTS:
In 75.2% of the patients, the contralateral ear was found to have some structural
abnormalities; 60.4% of the patients presented with COM without cholesteatoma,
and in this group, 69.9% had an abnormal contralateral ear. In those with
cholesteatoma, the contralateral ear was found to be abnormal in 83.3%. The most 
frequent finding in both groups was retraction of the tympanic membrane.
CONCLUSIONS: Patients with COM in 1 ear have a high chance of presenting with
some degree of disease in the contralateral side. We believe that our findings
suggest that COM should be ideally approached not as a static pathological
incident affecting 1 ear but rather as an on-going process that may affect both
ears.

PMID: 18347255 [PubMed - indexed for MEDLINE]

161: J Laryngol Otol. 2008 Nov;122(11):1168-74. Epub 2008 Mar 17.

Management of temporal bone meningo-encephalocoele.

Ramalingam KK, Ramalingam R, SreenivasaMurthy TM, Chandrakala GR.

Institute of ENT and Head and Neck, KKR ENT Hospital and Research Institute,
Chennai, India. kkrenthospital@gmail.com

Meningo-encephalocoele of the temporal bone, also known as fungus cerebri, is a
rare occurrence in clinical practice. We present a series of 13 patients with
chronic otitis media who suffered brain herniation into the mastoid cavity. We
also discuss the presentation and management of brain herniation with or without 
cerebrospinal fluid leak. STUDY DESIGN: Retrospective. METHODS: Among 963 cases
undergoing revision mastoid surgery, 13 patients suffered brain herniation. These
cases were identified and analysed. RESULTS: All 13 patients' initial diagnosis
was chronic suppurative otitis media with cholesteatoma, and all had undergone
previous mastoid surgery resulting in a defect in the tegmen and weakening of the
dura mater. The revision procedures performed included 10 (76.9 per cent)
modified radical mastoidectomies without ossicular chain reconstruction and one
(7.6 per cent) modified radical mastoidectomy with ossicular chain
reconstruction; two (15.3 per cent) patients required a blind sac closure. Brain 
herniation and/or cerebrospinal fluid leak were repaired by a transmastoid +/-
minicraniotomy procedure. CONCLUSIONS: Injury to the tegmen and dura should be
avoided during surgery for chronic middle-ear disease. Cerebrospinal fluid leaks,
if encountered, should be managed in the same surgical session. The transmastoid 
approach is helpful in repairing defects smaller than 1 cm in diameter, whereas
the combined transmastoid-minicraniotomy approach provides good access when
closing defects larger than 1 cm in diameter and also enables auto-calvarial
grafting.

PMID: 18346291 [PubMed - indexed for MEDLINE]

162: J Laryngol Otol. 2008 Jul;122(7):735-6. Epub 2008 Mar 17.

Grommet insertion using a branula.

Raman R, Rahmat O.

Department of Otolaryngology, Faculty of Medicine, University Malaya, Kuala
Lumpur, Malaysia. ramanr_99@yahoo.com

OBJECTIVE: To develop an easy method of performing myringotomy and grommet
insertion, using minimal instruments. METHODS: An ear speculum and a branula were
used. RESULTS: This method was found to be useful. CONCLUSION: An easy method of 
performing myringotomy and grommet insertion is proposed.

PMID: 18346289 [PubMed - indexed for MEDLINE]

163: Paediatr Drugs. 2008;10(2):75-83.

Acute otitis media in children: association with day care centers--antibacterial 
resistance, treatment, and prevention.

Greenberg D, Hoffman S, Leibovitz E, Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of
Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
dudi@bgu.ac.il

Children attending day care centers (DCCs) frequently carry
antibacterial-resistant organisms in their nasopharynx, leading to acute otitis
media (AOM) that may be refractory to antibacterial treatment. The development
and spread of resistant organisms are facilitated in DCCs as a result of the
following: (i) large numbers of children; (ii) frequent close person-to-person
contact; and (iii) a wide use of antimicrobial medications. Intensive
antimicrobial usage provides the selection pressure that favors the emergence of 
resistant organisms, while DCCs provide an ideal environment for transmission of 
these organisms.The American Academy of Pediatrics and American Academy of Family
Physicians' guidelines recommend high-dose amoxicillin/clavulanic acid (rather
than amoxicillin alone) as the first therapeutic choice in the treatment of AOM
in children attending DCCs. The introduction of the 7-valent pneumococcal
conjugated vaccine (PCV7) had a major role in decreasing the number of episodes
of Streptococccus pneumoniae AOM secondary to the serotypes included in the
vaccine. It also had a major role in reducing the nasopharyngeal carriage of
vaccine-type S. pneumoniae (and in particular of antibacterial-resistant
organisms), preventing, in this way, its spread to contacts in the community.
However, the recent observation of increased rates of antibacterial-resistant
non-vaccine serotype S. pneumoniae may erode the success of PCV7.

Publication Types: 
    Review

PMID: 18345717 [PubMed - indexed for MEDLINE]

164: Arch Dis Child. 2008 Aug;93(8):690-4. Epub 2008 Mar 12.

Acute otitis media in the first two months of life: characteristics and
diagnostic difficulties.

Berkun Y, Nir-Paz R, Ami AB, Klar A, Deutsch E, Hurvitz H.

Department of Pediatrics, Bikur Cholim Hospital, Jerusalem, Israel.
berkun@post.tau.ac.il

OBJECTIVE: To assess the clinical and laboratory features of acute otitis media
(AOM) in infants younger than 2 months, to look for factors predicting bacterial 
otitis, and to evaluate the accuracy of AOM diagnosis among paediatricians.
METHODS: The study population comprised a cohort of 277 hospitalised infants up
to 61 days old that were treated for the first episode of AOM in a paediatric
department. We reviewed their medical records and analysed the demographic,
clinical and laboratory data, and the diagnosis made by both paediatricians and
otolaryngologists. RESULTS: Presenting symptoms were mainly respiratory (70.0%)
and fever (62.5%). The most common pathogens were Streptococcus pneumoniae and
Haemophilus influenzae. Gram-negative bacilli grew in 10.5% of the infants.
Multivariate analysis revealed that AOM in the second month of life was
associated with male gender, concurrent bronchiolitis and diarrhea. Although high
leukocyte count was associated with bacterial pathogen, more than 70% of the
patients with positive culture had normal white blood cell counts. The
paediatrician diagnosed only 45% of the patients subsequently diagnosed with AOM 
by an otolaryngologist. CONCLUSIONS: The absence of predictors for bacterial
infection in more than 70% of bacterial AOM suggests that empirical antibiotic
treatment should be advised for the young infants with AOM even when afebrile and
with normal laboratory profile. A low diagnostic rate of AOM by the paediatrician
emphasizes the need for improvement in examination skills and instrumentation to 
allow a thorough ear evaluation in children of a very young age.

Publication Types: 
    Evaluation Studies

PMID: 18337275 [PubMed - indexed for MEDLINE]

165: Int J Pediatr Otorhinolaryngol. 2008 Jun;72(6):731-6. Epub 2008 Mar 11.

Which children would benefit most from tympanostomy tubes (grommets)? A personal 
evidence-based review.

Lous J.

Department of General Practice, Institute of Public Health, University of
Southern, J.B.Winsløws Vej 9A, 5000 Odense C, Denmark. jlous@health.sdu.dk

Otitis media with effusion (OME) is a common condition in young children. OME
causes some hearing loss, and can cause permanent changes in the tympanic
membrane as well as other symptoms. In most cases OME is of short duration. As
long-lasting bilateral OME for decades has been associated with delayed cognitive
and language development, parents and ENT specialists have a positive attitude
towards treatment with tympanostomy tubes (TT). METHOD: This personal
evidence-based review is build on own observations and research combined with
newer studies and guidelines. RESULTS: The review argues for a relatively
restrictive treatment policy concerning the use of TT in children with OME
without signs or symptoms of impaired social or linguistic function. CONCLUSION: 
Six months with bilateral OME and significant hearing loss should be present
before treatment with TT in otherwise healthy children. At the moment we have no 
evidence for the subgroups of children excluded from the RCTs, i.e. children with
speech/language delays, behaviour and learning problems, or syndromes. Clinicians
will need to make their own decisions regarding treatment of such children. The
situation just now is that some children are over-treated and some are
under-treated. There is an urgent need for prospective cohort studies and
randomised studies on children with long-lasting OME in an attempt to
characterise the children who would benefit most from TT.

Publication Types: 
    Review

PMID: 18336921 [PubMed - indexed for MEDLINE]

166: Carbohydr Res. 2008 May 5;343(6):1079-90. Epub 2007 Dec 23.

A polysaccharide of Alloiococcus otitidis, a new pathogen of otitis media:
chemical structure and synthesis of a neoglycoconjugate thereof.

Arar S, Vinogradov E, Shewmaker PL, Monteiro MA.

Department of Chemistry, University of Guelph, Guelph, ON, Canada N1G 2W1.

Alloiococcus otitidis is a recently discovered Gram-positive bacterium that has
been linked with otitis media (middle ear infections). In this study, we describe
the structure of a novel capsular polysaccharide (PS) expressed by the
type-strain of A. otitidis, ATCC 51267, and the synthesis of a glycoconjugate
composed of the capsule PS and bovine serum albumin (BSA). The capsule PS of A.
otitidis type-strain was determined to be a repeating trisaccharide composed of
3-substituted N-acetyl-D-glucosamine (GlcpNAc), 6-substituted
N-acetyl-D-galactosamine (GalpNAc), and 4-substituted D-glucuronic acid (GlcpA), 
of which the majority was amidically decorated with L-glutamic acid (Glu):
{-->6)-beta-GalpNAc-(1-->4)-[Glup-->6]-beta-GlcpA-(1-->3)-beta-GlcpNAc-(1}n.
Monomeric analysis performed on other A. otitidis strains revealed that similar
components were variably expressed, but Glu appeared to be a regular constituent 
in all the strains examined. Due to the suitable presence of GlcpA and Glu, our
approach for glycoconjugate synthesis employed a carbodiimide-based strategy with
activation of available carboxyl groups by
1-ethyl-3-(3-dimethylaminopropyl)carbodiimide hydrochloride (EDC), which afforded
direct coupling between the capsule PS and BSA. Analysis by mass spectrometry
indicated that this A. otitidis capsule PS-BSA conjugate was composed of BSA
units that carried up to seven capsule PSs. This work represents the first report
in the literature describing an A. otitidis cell-surface carbohydrate and the
synthesis of a glycoconjugate preparation thereof. Presently, we are formulating 
plans to immunologically evaluate this A. otitidis glycoconjugate vaccine in
animals.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18336800 [PubMed - indexed for MEDLINE]

167: Vet Dermatol. 2008 Apr;19(2):95-100.

Investigation of aural bacterial and fungal flora following otitis in captive
okapi (Okapia johnstoni).

Allender MC, Langan J, Citino S.

College of Veterinary Medicine, University of Illinois, Urbana, IL 61802, USA.
mattallender@utk.edu

Ten cases of otitis in nine captive okapi were observed at a captive zoological
institution. Duration of clinical signs ranged from 3 days to 7 months. Two
individuals each had a recurrence. A variety of fungi and bacteria were isolated 
from the aural canals of healthy okapi and their environments. Numerous different
bacterial and fungal pathogens were cultured. Surveys investigating the
occurrence of ear disease and related environmental factors from 15 other
institutions that house okapi revealed otitis was only seen at one institution.
While it appears that many bacterial and fungal pathogens are found in the okapi 
ear canal, it is suspected that environmental conditions, such as fungal load,
air and hay quality, humidity, and temperature may be predisposing factors
leading to ear infections in this species.

PMID: 18336426 [PubMed - indexed for MEDLINE]

168: Otolaryngol Clin North Am. 2008 Apr;41(2):311-23, vi.

The link between allergic rhinitis and chronic otitis media with effusion in
atopic patients.

Luong A, Roland PS.

Section of Nasal and Sinus Disorders, Head and Neck Institute, Cleveland Clinic
Foundation, 9500 Euclid Avenue, A71, Cleveland, OH 44195, USA.

The significant incidence of atopy associated with otitis media with effusion
(OME) has suggested a role of allergy in the pathogenesis of OME. Analysis of
inflammatory mediators indicates that the mucosa of the middle ear can respond to
antigen in the same way as does the mucosa of the lower respiratory tract. Recent
characterization of the mucosa and effusion from atopic patients with OME reveals
a Th2 cytokine and cellular profiles consistent with an allergic response,
supporting the role of allergy in OME. In addition, animal studies demonstrate
that inhibiting characteristic allergy cytokines can prevent the production of
middle ear effusion. As the understanding of allergy and its role in the
inflammation of OME continues to deepen, this will introduce focused treatments
of OME in the atopic population.

Publication Types: 
    Review

PMID: 18328370 [PubMed - indexed for MEDLINE]

169: Eur Arch Otorhinolaryngol. 2008 Oct;265(10):1199-203. Epub 2008 Mar 7.

The management of otitis externa: a randomised controlled trial of a glycerol and
icthammol ribbon gauze versus topical antibiotic and steroid drops.

Hornigold R, Gillett D, Kiverniti E, Harries M.

Department of Otorhinolaryngology, Brighton and Sussex University Hospitals NHS
Trust, Eastern Road, Brighton BN2 5BE, UK. r_hornigold@yahoo.com

We compared the use of glycerol and icthammol (G&I) ribbon gauze versus topical
antibiotic and steroid drops in the management of otitis externa. Patients
presenting with acute otitis externa were systematically recruited from
attendance in the ENT emergency clinic. Exclusion criteria were age <18 years,
diabetic patients, and those who had been previously treated for otitis externa
by the department within the last month. A total of 43 patients were recruited
with 48 infected ears, the mean patient age was 47 years, (range 18-80 years).
Patients were randomised to either insertion of a G&I ribbon gauze or topical ear
drops by means of a ballot with no stratification. All patients were reviewed 5
days later. Patients were asked to comment on their pain using the ten point
visual analogue pain score. Oedema of the canal wall, presence of debris and
visibility of the tympanic membrane were graded on microscopy. Patient
satisfaction and return to work were assessed. There was a statistically
significant decrease in the pain score between each visit for the entire group of
patients and decrease in canal wall swelling (P < 0.001). There was no
significant difference between drops and ribbon gauze in terms of pain relief,
canal wall oedema, or aural discharge. Following microbiological analysis, 27.8% 
of bacteria were resistant to neomycin. The cost of treatment with G&I is less
than a third of that for topical antibiotic-steroid drops and requires less
patient compliance. Patient concerns with the ribbon gauze included its cosmetic 
appearance and loss of hearing and with drops included frequency of application. 
We recommend the use of G&I ribbon gauze as first-line treatment, particularly
for those who have had allergies to carriers of drops, those that are poorly
compliant or with poor manual dexterity, for example patients with rheumatic
hands.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 18324410 [PubMed - indexed for MEDLINE]

170: Laryngoscope. 2007 Dec;117(12):2174-82.

AM-111 reduces hearing loss in a guinea pig model of acute labyrinthitis.

Barkdull GC, Hondarrague Y, Meyer T, Harris JP, Keithley EM.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery,
University of California San Diego, San Diego, CA 92103-8895, USA.
gbarkdul@ucsd.edu

OBJECTIVES/HYPOTHESIS: This study investigated the otoprotective properties of
AM-111, an inhibitor of c-Jun N-terminal kinase-mediated apoptosis and
inflammation. STUDY DESIGN: A controlled, prospective animal study using a guinea
pig model of acute labyrinthitis. METHODS: Acute labyrinthitis was generated by
injection of antigen into the scala tympani of sensitized guinea pigs. Treatment 
groups received 100 microL of AM-111 at concentrations of 100 micromol/L, 10
micromol/L, and 1 micromol/L in a hyaluronic acid gel formulation delivered over 
the round window niche within 1 hour of antigen challenge. Cochlear function was 
monitored over 21 days with serial auditory brainstem response (ABR) and
distortion product otoacoustic emission (DPOAE) measurements followed by
histologic analysis. RESULTS: The ABR results on day 21 demonstrated that
untreated control ears for acute labyrinthitis had a mean hearing loss (HL) of 68
+/- 12 dB. In contrast, ears treated with AM-111 (100 micromol/L) had a mean HL
of 39 +/- 31 dB. These two groups were statistically different (one-way analysis 
of variance, P = .03). Secondary outcomes, including DPOAE shift, inner hair cell
survival, inflammatory cell counts, and spiral ganglion density, were also
statistically significant in favor of an otoprotective effect of AM-111. Lower
doses of AM-111 did not produce a statistically significant reduction in HL over 
controls. CONCLUSION: AM-111 delivered over the round window membrane in a 100
microL hyaluronic acid formulation at a 100 micromol/L concentration immediately 
after induction of acute labyrinthitis in the guinea pig cochlea protects
hearing, reduces hair cell loss, and reduces the number of inflammatory cells at 
21 days after treatment.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18322422 [PubMed - indexed for MEDLINE]

171: Int J Pediatr Otorhinolaryngol. 2008 May;72(5):647-51. Epub 2008 Mar 5.

Linezolid for tympanostomy tube otorrhea caused by methicillin-resistant
Staphylococcus aureus and multiple drug-resistant Streptococcus pneumoniae.

Isaacson G, Aronoff SC.

Departments of Otolaryngology-Head & Neck Surgery, Temple University School of
Medicine, Philadelphia, PA 19140, United States. glenn.isaacson@temple.edu

OBJECTIVE: To describe a consecutive series of children with refractory
tympanostomy tube otorrhea treated with linezolid and document its clinical
effectiveness and adverse effects. DESIGN: Retrospective, single institution case
series. METHODS: The records of children treated with linezolid for refractory
gram-positive otorrhea from 2003 to 2007 were analyzed for causative organisms,
antimicrobial sensitivities, history of prior medical treatments, time to
cessation of otorrhea, adverse effects of linezolid and recurrence of infection. 
RESULTS: Ten episodes of refractory gram-positive otorrhea treated with linezolid
were documented among eight children during the study period. Seven were caused
by methicillin-resistant Staphylococcus aureus and three by multiple-drug
resistant Streptococcus pneumoniae. Prior treatment regimes included clindamycin,
trimethoprim-sulfamethoxazole/rifampin, amoxicillin-clavulanate, and/or a
third-generation cephalosporin. Seven of eight children had failed extended
courses of fluoroquinolone ear drops. All children were free of otorrhea by the
14th day of twice-daily treatment with oral linezolid at 20mg/kg/day. One child
developed two additional episodes of S. aureus otorrhea three and 10 months after
initial treatment. Each was successfully controlled with linezolid. There were no
adverse effects from linezolid treatment. CONCLUSION: Oral linezolid is highly
effective in the treatment of refractory otorrhea caused by methicillin-resistant
S. aureus and multiple drug-resistant S. pneumoniae. It has a low risk of serious
side effects. It is one of only a few oral agents with activity against these
organisms and is very expensive. Linezolid should be used only when otorrhea
cannot be treated with conventional agents or when complications of otitis media 
pose a risk to life or function.

PMID: 18321598 [PubMed - indexed for MEDLINE]

172: Eur Arch Otorhinolaryngol. 2008 Nov;265(11):1301-8. Epub 2008 Mar 5.

Temporal breach management in chronic otitis media.

Bodénez C, Bernat I, Vitte E, Lamas G, Tankéré F.

Otolaryngology, Head and Neck Surgery Department, Pitié-Salpêtrière Hospital,
47-83 Bd. de l'Hôpital, 75651, Paris Cédex 13, France.
camille.bodenez@psl.aphp.fr

In a retrospective study performed at the Otolaryngology, Head and Neck Surgery
Department, Pitié-Salpêtrière Hospital, Paris from 1991 to March 2007, we
determined surgical procedures for the treatment of tegmen breaches in chronic
otitis media. Forty-two cases were examined: 76% corresponded to chronic otitis
media with cholesteatoma, and 24% to chronic otitis media without cholesteatoma. 
Twenty-eight cases were operated using a combined approach, eight cases using a
single suprapetrous approach, and six cases using a transmastoid approach. A
total of 33% of the cases showed a meningocele or a meningoencephalocele treated 
through either a combined or a suprapetrous approach. No recurrence or
neural/meningeal infectious involvement was found after a mean time of 43 months 
in the 36 long-term follow-up cases operated through the combined or suprapetrous
approaches. Two cases included in the study were a loss to follow-up. Three of
the former cases had already been operated for supracentimetric fissure using
lower approach. Two out of the six patients operated using lower approach
presented post surgery cerebrospinal fluid otorrhea. Combined or suprapetrous
approaches seem to be best adapted to the treatment of supracentimetric or
recurrent tegmen breaches, as well as to the precise examination and repair of
meningeal lesions. Treatment for tegmen breach can be achieved in a single
intervention, even when there is an ongoing infection of the middle ear. The
mastoid approach should be used only for infracentimetric defects when there is
no neural/meningeal lesion.

PMID: 18320200 [PubMed - indexed for MEDLINE]

173: Sao Paulo Med J. 2007 Nov 1;125(6):309-14.

Phonological performance measured by speech severity indices compared with
correlated factors.

Wertzner HF, Amaro L, Galea DE.

Department of Physiotherapy, Language-Speech-Hearing Sciences and Occupational
Therapy, Universidade de São Paulo, Brazil. hfwertzn@usp.br

CONTEXT AND OBJECTIVE: Some factors seem to influence speech impairment among
phonologically disordered children. The aim was to compare severity indices with 
some correlated factors. DESIGN AND SETTING: Observational, analytical and
cross-sectional study conducted within the Language-Speech-Hearing Sciences
Course, Universidade de São Paulo. METHOD: Fifty phonologically disordered
children with ages ranging from 4 to 11 years took part. The indices were
calculated from phonology tests and were correlated with anamnesis and
audiological data. Students t test and Spearmans correlation were used to compare
percentages of consonants correct (PCC) and process density index (PDI) for
children with and without otitis, upper respiratory histories and audiological
abnormalities, with regard to whether or not they were comprehended during
assessment, their ages when they started to speak and their ages at the
assessment. RESULTS: The higher the age at the assessment was, the higher the PCC
(imitation: 0.468; naming: 0.431; Spearmans correlation) and the lower the PDI
(imitation: 0.459; naming: 0.431); the later the child started to speak, the
lower the PCC (imitation p = 0.064; naming p = 0.050) and the higher the PDI
(imitation p = 0.067; naming p = 0.042). There were differences between groups
with and without upper respiratory history (PCC: imitation p = 0.016, naming p = 
0.005; PDI: imitation p = 0.014, naming p = 0.008). There was no difference
between the groups regarding otitis, comprehension during the assessment and
audiological data. CONCLUSIONS: Children with upper respiratory histories who
began to speak later presented more severe speech impairment indices.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 18317599 [PubMed - indexed for MEDLINE]

174: Otol Neurotol. 2008 Apr;29(3):339-43.

Predicting outcome of malignant external otitis.

Joshua BZ, Sulkes J, Raveh E, Bishara J, Nageris BI.

Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center,
Beilinson Campus, Petah Tiqwa, Israel.

OBJECTIVE: Malignant external otitis (MEO) continues to pose a diagnostic and
therapeutic challenge. The lack of a diagnostic study since 1987 combined with
recent findings of quinolone-resistant MEO prompted the present analysis of MEO
outcome in a major tertiary medical center. METHODS: Seventy-five consecutive
patients hospitalized for suspected MEO between 1990 and 2003 were divided into 2
diagnostic groups: MEO Type 1, presence of all obligatory clinical and radiologic
criteria and most of the occasional criteria of Cohen and Friedman or absence of 
1 obligatory criterion with failure of intensive treatment, and MEO Type 2,
absence of one of the obligatory criteria with treatment response within 1 week. 
The groups were compared for demographic data, underlying diseases, ear
parameters, culture findings, length of hospitalization, and treatment before
hospitalization, obtained from the charts. RESULTS: Both types of MEO affected
mostly diabetic patients and were characterized by granulations and discharge in 
the external ear, severe prolonged pain, soft tissue involvement and bone
destruction on computed tomographic scan, and growth of Pseudomonas aeruginosa in
culture. However, Type 1 MEO was associated with a significantly older patient
age at presentation, higher rate of oral antidiabetic treatment, history of
diabetic (vascular) complications, computed tomographic findings of
nasopharyngeal involvement (soft tissue swelling, soft tissue asymmetry, or
abscess formation), bone destruction, and temporomandibular joint involvement-all
of which led to significantly longer treatment and shorter survival. CONCLUSION: 
The worse prognosis of Type 1 MEO compared with Type 2 should alert clinicians to
establish earlier diagnosis and treatment.

PMID: 18317396 [PubMed - indexed for MEDLINE]

175: Pediatr Infect Dis J. 2008 Apr;27(4):292-5.

Tympanometric findings in young children during upper respiratory tract
infections with and without acute otitis media.

Revai K, Patel JA, Grady JJ, Chonmaitree T.

Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA.

BACKGROUND: Upper respiratory tract infections (URI) likely lead to acute otitis 
media (AOM) by causing Eustachian tube dysfunction which creates negative middle 
ear pressure. Children younger than 2 years of age are at highest risk for AOM
compared with older children and adults. There has been no published study
comparing the middle ear status during URI in infants and young children by age
group. METHODS: We analyzed data from a prospective, longitudinal study of
virus-induced AOM. Healthy children 6-35 months of age were enrolled in a study
designed to capture all AOM after URI during a 1-year follow-up period.
Tympanometry was used to address the middle ear status; tympanometric findings
during the first week of URI were compared among different age groups.
Tympanograms were classified into type A (normal), type B (middle ear effusion), 
and type C (negative middle ear pressure). RESULTS: Children 6-11 months of age
with URI experienced abnormal tympanograms more frequently than older children (P
< 0.001). The peak day for an abnormal tympanogram was day 2 of the URI. Abnormal
tympanogram tended to be type B in children age 6-23 months and type C in
children age 24-47 months (P < 0.001). One-third of children older than 24 months
of age had type C tympanogram during the first week of URI. CONCLUSIONS:
Eustachian tube dysfunction and middle ear abnormality during URI are more severe
in children younger than 2 years of age, compared with older children. These
findings could help explain the higher incidence of AOM after URI in younger
children.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural

PMID: 18316989 [PubMed - indexed for MEDLINE]

176: Auris Nasus Larynx. 2008 Dec;35(4):480-4. Epub 2008 Mar 7.

Microbiology of otitis externa in the secondary care in United Kingdom and
antimicrobial sensitivity.

Ninkovic G, Dullo V, Saunders NC.

Department of Otolaryngology, Royal Sussex County Hospital, Brighton, UK.
g.ninkovic@doctors.org.uk

INTRODUCTION: Otitis externa is one of the most common conditions seen in the
otolaryngology clinics. There are no recently published studies that have looked 
at the causative pathogens of the otitis externa seen in secondary care in the
United Kingdom and their antimicrobial sensitivities. We present results of a
prospective study to determine the current bacteriology of the condition.
METHODS: Swabs were taken from the external auditory canals of the patients who
presented to the otolaryngology emergency clinic with symptoms of otitis externa.
These were analysed using microscopy, culture and sensitivity testing in one
laboratory. The samples were cultured on blood agar, chocolate agar, Sabouraud
agar, fastidious anaerobes agar with neomycin and staph/strep agar. Antimicrobial
sensitivities of isolated pathogens were tested on iso-sensitest and blood agars 
using the BSAC disc diffusion template program. RESULTS: The most commonly
identified pathogen was Pseudomonas aeruginosa (45.1%), followed by
Staphylococcus aureus (9%), anaerobes (6.3%), beta haemolytic Streptococcus group
G (2.8%), beta haemolytic Streptococcus group A (1.4%), Streptococcus pneumoniae 
(0.7%), methicillin resistant S. aureus (0.7%), Candida species (9.7%),
Aspergillus species (4.2%) and Absidia corymbifera (0.7%). One hundred percent
resistance of Pseudomonas isolates to neomycin, chloramphenicol, trimethoprim and
amoxicillin was observed while most were sensitive to ciprofloxacin (100%),
polymixin B (100%) and gentamicin (98.5%). S. aureus isolates were sensitive to
gentamicin and flucloxacillin (100%). 92.3% were sensitive to neomycin and
chloramphenicol. Resistance to penicillin and amoxicillin is observed. All
isolates anaerobes were sensitive to metronidazole. CONCLUSION: Polymixin B,
gentamicin or ciprofloxacin topical preparations should be used as first line
treatment of otitis externa. If the infection does not settle swab results should
be used to guide further treatment.

PMID: 18314283 [PubMed - indexed for MEDLINE]

177: Otolaryngol Head Neck Surg. 2008 Mar;138(3):274-8.

Acute bacterial rhinosinusitis and otitis media: changes in pathogenicity
following widespread use of pneumococcal conjugate vaccine.

Benninger MS.

Head and Neck Institute, The Cleveland Clinic, Cleveland, OH 44195, USA.
benninm@ccf.org

OBJECTIVE: Acute bacterial rhinosinusitis and acute otitis media are two of the
most common respiratory tract infections. The common pathogenic bacteria
associated with these infections are Streptococcus pneumoniae, Haemophilus
influenzae, Moraxella catarrhalis, and Staphylococcus aureus. With the recent
widespread use of pneumococcal conjugate vaccine, there is evidence that there is
a shift of both the pneumococcal serotypes and the distribution of pathogenic
bacteria. The purpose of this article was to investigate whether the literature
supports changes in pathogenicity of acute bacterial rhinosinusitis and otitis
media after widespread use of conjugate pneumococcal vaccine. DATA SOURCES:
MEDLINE search of the literature was performed between 1995 and 2007. REVIEW
METHODS: Literature review of changes in distribution of pathogens, resistance
rates, and pneumococcal serotype changes before and after widespread use of
conjugate pneumococcal vaccine. RESULTS: There is evidence that the distribution 
of pneumococcal serotypes has changed after the widespread use of conjugate
pneumococcal vaccine. There appears to be both less invasive and noninvasive
pneumococcal disease and with childhood immunization there also appears to be a
protective effect on adults (herd immunity). Increases in nonvaccine serotypes,
some with high levels of resistance are being identified in some communities.
There is also growing evidence that there may be an increasing prevalence of
Haemophilus influenzae in these infections. CONCLUSIONS: Widespread use of
conjugate pneumococcal vaccine has led to decreasing incidence of pneumococcal
otitis media and likely also acute bacterial rhinosinusitis, which may have
implications for treatment recommendations for these infections.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 18312870 [PubMed - indexed for MEDLINE]

178: Clin Pediatr (Phila). 2008 Jun;47(5):452-6. Epub 2008 Feb 29.

Appropriate antibiotic use for acute otitis media: what consumers find using Web 
searches.

Holland ML, Fagnano M.

Department of Community and Preventive Medicine, University of Rochester,
Rochester, NY 14642, USA. margaret_holland@urmc.rochester.edu

The use of the Internet for health information is growing, but there is little
control over the timeliness of updates or the accuracy of the information. Recent
changes in recommendations for the treatment of acute otitis media were made in
an effort to decrease the unnecessary use of antibiotics. We conducted a
systematic review of Web sites to determine if consumers are likely to find
appropriate information. Only 31% of relevant Web sites found explain the new
"watch and wait" recommendation, and 41% include a recommendation to finish the
full course of prescribed antibiotics. Web sites that include an update date, are
reviewed by a physician, provide references, and have a nonprofit-type domain are
more likely to contain updated information. Physicians should be aware that their
patients might visit the office with expectations based on outdated information
found on the Web. Organizations making recommendations should consider how to
disseminate new information through the Web.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 18310526 [PubMed - indexed for MEDLINE]

179: Orbit. 2008;27(1):51-4.

Morbid complications of otitic hydrocephalus.

Durairaj VD, Andrews B, Rao RR, Chan KH.

Department of Ophthalmology, University of Colorado Health Sciences Center,
Denver, Colorado 80045-0510, USA. vikram.durairaj@uchsc.edu

PURPOSE: To report two cases of otitic hydrocephalus with long-term
complications. DESIGN: Retrospective case reports. PARTICIPANTS: Two patients
with otitic hydrocephalus with previously diagnosed otitis media. METHODS: Review
of clinical history, radiographic findings, medical and surgical management, and 
follow-up. RESULTS: Two patients with previously diagnosed otitis media presented
with otitic hydrocephalus. Both were found to have elevated opening pressures
with lumbar puncture and radiographic evidence of sinus thrombosis. Although the 
patients received appropriate medical and surgical management, they both suffered
long-term complications. Patient 1 is dependent on a ventriculoperitoneal shunt
to control headaches and has required multiple shunt revisions. Patient 2 is
dependent on a ventriculoperitoneal shunt to control headaches and has permanent 
decreased visual acuity and bilateral optic neuropathy. During her clinical
course, she required an optic nerve sheath fenestration. CONCLUSIONS: Otitic
hydrocephalus can result in permanent vision loss and chronic headaches requiring
spinal fluid diversion. We report two cases with morbid complications. A
collaborative effort from ophthalmologists, otolaryngologists, and neurosurgeons 
is recommended to achieve the best clinical outcome.

PMID: 18307148 [PubMed - indexed for MEDLINE]

180: Int J Pediatr Otorhinolaryngol. 2008 May;72(5):629-34. Epub 2008 Mar 4.

Conservative management of acute mastoiditis in children.

Geva A, Oestreicher-Kedem Y, Fishman G, Landsberg R, DeRowe A.

Family Medicine Program, Maccabi Health Services, Israel.

OBJECTIVE: To review the current management of acute mastoiditis with critical
emphasis on the role of myringotomy. DESIGN: A retrospective chart review.
SETTING: Tertiary-care, university affiliated children's hospital. PATIENTS: One 
hundred and forty-four consecutive children hospitalized for acute mastoiditis
between the years 1991 and 2002. INTERVENTIONS: All children were treated with
parenteral antibiotics (conservative management). Myringotomy was performed at
the discretion of the otolaryngologist on-call. MAIN OUTCOME MEASURES: Comparing 
outcomes of children with or without myringotomy regarding hospital stay,
complications and the need for surgical interventions. RESULTS: Myringotomy was
performed in 34.6% of episodes. The children who underwent myringotomy were found
to be significantly younger (22.4 compared to 28.8 months, p=0.028) and had more 
complications (n=17 vs. n=8, p<0.001). Complications overall occurred in 16.3% of
episodes. Performing myringotomy had no significant effect on the duration of
hospital stay. Children pretreated with antibiotics underwent significantly less 
myringotomies p=0.027. There were no significant differences between children who
underwent myringotomy and those who did not with regard to WBC count, or ESR.
CONCLUSIONS: These findings suggest that myringotomy may not be required in all
cases of acute mastoiditis. Parenteral antibiotics is sufficient in most cases.
Criteria for myringotomy may include a younger age. Conservative management
resulted in good outcomes in this series.

PMID: 18304656 [PubMed - indexed for MEDLINE]

181: Aust Vet J. 2008 Mar;86(3):88-94.

The method of application and short term results of tympanostomy tubes for the
treatment of primary secretory otitis media in three Cavalier King Charles
Spaniel dogs.

Corfield GS, Burrows AK, Imani P, Bryden SL.

School of Veterinary and Biomedical Sciences, Murdoch University, Perth, Western 
Australia, Australia.

Primary secretory otitis media is an uncommon disease affecting predominantly
Cavalier King Charles Spaniel dogs. Current treatment recommendations include
repeated manual removal of the mucoid effusion from the tympanic cavity through a
myringotomy incision and topical or systemic corticosteroids. The aim of this
study was to assess the efficacy of tympanostomy tubes to provide continual
tympanic cavity ventilation and drainage for the treatment of primary secretory
otitis media in three dogs. Tympanostomy tubes were placed within a myringotomy
incision in the pars tensa with the aid of an operating microscope. Clinical
signs resolved rapidly in all cases following the procedure and all cases were
asymptomatic at the time of follow-up, 8, 6 and 4 months later. Results of this
study indicate that tympanostomy tubes provide continual tympanic cavity
ventilation and drainage and may be an acceptable alternative to repeated
myringotomy for the treatment of primary secretory otitis media.

Publication Types: 
    Case Reports

PMID: 18304044 [PubMed - indexed for MEDLINE]

182: Eur J Clin Microbiol Infect Dis. 2008 Jul;27(7):571-7. Epub 2008 Feb 26.

Antimicrobial resistance of Staphylococcus from otorrhea in chronic suppurative
otitis media and comparison with results of all isolated Staphylococci.

Park DC, Lee SK, Cha CI, Lee SO, Lee MS, Yeo SG.

Department of Obstetrics and Gynecology, College of Medicine, Catholic
University, Suwon, South Korea.

Staphylococcus is one of the most important pathogenic bacteria in chronic
suppurative otitis media (CSOM). The prevalence of pathogenic bacteria in
patients with CSOM has not been compared with the prevalence rates in patients
from other fields of medicine. We investigated the pathogenic bacteria in CSOM
throughout Korea and annual isolation rates of methicillin-resistant
Staphylococcus aureus (MRSA) over 6 years. Routine culture results and
susceptibility data of CSOM isolated from 2000 to 2005 were collected from six
general hospitals in Korea, along with the results of all clinically isolated
Staphylococci from one tertiary care teaching hospital. Of the 1,162 bacteria
identified in 1,360 CSOM patients, 628 (54.0%) were Staphylococci in CSOM. Of the
latter, 288 (45.9%) were MRSA, which accounted for 24.8% of identified bacteria. 
Of the 5,988 clinically isolated Staphylococci from one tertiary care hospital,
3,712 (61.9%) were MRSA. All MRSA isolated from CSOM patients were sensitive to
vancomycin and teicoplanin, and 88.2% were sensitive to
sulfamethoxazole/trimethoprim. In contrast, these strains showed little or no
sensitivity to oxacillin, clindamycin, penicillin, and erythromycin. Annual MRSA 
isolation rates showed no tendencies to increase or decrease. MRSA was the most
frequently identified Staphylococcus in patients with otorrhea. The isolation
rate of MRSA has not changed over 6 years. Continuous and periodic surveillance
of MRSA is necessary to reduce the spread of antibiotic-resistant pathogens and
to guide appropriate antibacterial therapy.

Publication Types: 
    Comparative Study

PMID: 18299908 [PubMed - indexed for MEDLINE]

183: Arch Iran Med. 2008 Mar;11(2):196-9.

Intraoperative findings in revision chronic otitis media surgery.

Faramarzi A, Motasaddi-Zarandy M, Khorsandi MT.

Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz,
Iran.

In this study, we reviewed the surgical findings in a series of revision
tympanomastoidectomy to determine the most common causes of failure in chronic
otitis media surgery. The intraoperative findings at revision mastoidectomy with 
tympanoplasty of 116 patients were analyzed. The most common sites of pathologic 
tissue at revision surgery (with cholesteatoma and/ or granulation tissue) were
unexenterated cells of the sinodural angle. The most common mechanical cause of
retention of debris in canal wall down procedures was facial ridge.

PMID: 18298298 [PubMed - indexed for MEDLINE]

184: Nepal Med Coll J. 2007 Dec;9(4):239-44.

The morphology of central tympanic membrane perforations.

Nepal A, Bhandary S, Mishra SC, Singh I, Kumar P.

Department of Otolaryngology and Head and Neck Surgery, B.P.Koirala Institute of 
Health Sciences, Dharan, Nepal. ajitnepal2001@yahoo.com

The objective of this study was to assess the extent of conductive hearing loss
in relation to different sizes and sites of simple central tympanic membrane
perforations. Total 100 cases attending ENT OPD, BPKIHS during period of April
2003 to Mar 2004 without any discrimination of sex, race and religion were taken 
for the cross sectional prospective study. Dry, clean central tympanic membrane
perforations due to various causes like chronic suppurative otitis
media-tubotympanic, post acute suppurative otitis media residual perforations or 
simple traumatic perforations with conductive hearing loss and without
preexisting hearing loss were clinicoaudiologically evaluated and analyzed.
Hearing loss was found to be directly proportional to the size of perforation
irrespective of their cause, which was statistically significant. Hearing loss in
the study was found to range from negligible to 53dB. Overall, perforations
involving posterioinferior quadrant were found to have maximum hearing loss.

PMID: 18298012 [PubMed - indexed for MEDLINE]

185: Ir J Med Sci. 2008 Sep;177(3):221-3. Epub 2008 Feb 23.

Otitis externa: quality of life assessment.

Ali R, Burns P, Donnelly M.

Department of Otolaryngology, Waterford Regional Hospital, Dunmore Road,
Waterford, Ireland.

INTRODUCTION: Otitis externa (OE) is an extremely common dermatological condition
that can affect social life and employment, but formal studies of its general
health impact are lacking. OBJECTIVE: The aims of this study were two-folded,
first to assess the impact of OE on various health determinants as measured by
the Finlay's dermatological quality of life index (DLQI) and second to see if
there was any difference on quality of life (QoL) of patients with acute and
chronic OE. METHODS: A prospective questionnaire study was carried out. The study
included 85 consecutive adult patients with both acute and chronic OE attending
the casualty department of a regional otolaryngology unit. RESULTS: Both groups
of patients reported a significantly poor QoL, particularly patients with acute
OE, whom were significantly affected by the condition. CONCLUSION: We concluded
that OE has a significant impact on the QoL particularly in patients with acute
and chronic OE.

PMID: 18297370 [PubMed - indexed for MEDLINE]

186: J Pediatr Psychol. 2008 Aug;33(7):789-96. Epub 2008 Feb 21.

A meta-analysis of interventions to increase adherence to medication regimens for
pediatric otitis media and streptococcal pharyngitis.

Wu YP, Roberts MC.

Clinical Child Psychology Program, 2011 Dole Human Development Center, University
of Kansas, 1000 Sunnyside Avenue, Lawrence, KS 66045-7555, USA. yelenawu@ku.edu

OBJECTIVE: The current study quantitatively synthesized the adherence
intervention literature for two common acute childhood illnesses and examined the
magnitude of change in adherence as indicated by different outcome measures and
the relationship between type of intervention and adherence outcome. METHODS:
Meta-analysis was used to synthesize the results of 12 interventions to increase 
medication adherence in pediatric otitis media and streptococcal pharyngitis.
Effect sizes were analyzed using homogeneity tests and an analog to the analysis 
of variance. RESULTS: Combination interventions were more effective than single
strategy interventions. However, families receiving educational interventions
alone did not demonstrate better adherence than control groups. Indirect measures
of adherence showed more change in adherence than direct measures. CONCLUSIONS:
Further work is needed to develop effective interventions for improving adherence
for the medication regimens required for short-term illness and for optimizing
health outcomes.

Publication Types: 
    Comparative Study
    Meta-Analysis
    Review

PMID: 18296457 [PubMed - indexed for MEDLINE]

187: Vaccine. 2008 Mar 17;26(12):1501-24. Epub 2008 Feb 4.

Mouse models for the study of mucosal vaccination against otitis media.

Sabirov A, Metzger DW.

Department of Microbiology and Immunology, University of Rochester Medical
Center, Rochester, NY, United States.

Otitis media (OM) is one of the most common infectious diseases in humans. The
pathogenesis of OM involves nasopharyngeal (NP) colonization and retrograde
ascension of the pathogen up the Eustachian tube into the middle ear (ME). Due to
increasing rates of antibiotic resistance, there is an urgent need for vaccines
to prevent infections caused by the most common causes of bacterial OM, including
nontypeable Haemophilus influenzae, Streptococcus pneumoniae and Moraxella
catarrhalis. Current vaccine strategies aim to diminish bacterial NP carriage,
thereby reducing the likelihood of developing acute OM. To be effective,
vaccination should induce local mucosal immunity both in the ME and in the NP.
Studies in animal models have demonstrated that the intranasal route of
vaccination is particularly effective at inducing immune responses in the nasal
passage and ME for protection against OM. The mouse is increasingly used in these
models, because of the availability of murine reagents and the existence of
technology to manipulate murine models of disease immunologically and
genetically. Previous studies confirmed the suitability of the mouse as a model
for inflammatory processes in acute OM. Here, we discuss various murine models of
OM and review the applicability of these models to assess the efficacy of mucosal
vaccination and the mechanisms responsible for protection. In addition, we
discuss various mucosal vaccine antigens, mucosal adjuvants and mucosal delivery 
systems.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 18295938 [PubMed - indexed for MEDLINE]

188: Eur Arch Otorhinolaryngol. 2008 Sep;265(9):1047-56. Epub 2008 Feb 21.

Psychometric evaluation of the OM8-30 questionnaire in Dutch children with otitis
media.

Timmerman AA, Meesters CM, Anteunis LJ, Chenault MN, Haggard MP.

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of 
Maastricht, Maastricht, The Netherlands. ATI@skno.azm.nl

The Dutch translation of the OM8-30 questionnaire, originally developed in the UK
on a large clinical sample, has been applied for validation in an ENT sample,
with the aim of assessing otitis media impact and identifying treatment needs in 
children suffering from chronic otitis media (OM) and/or upper respiratory tract 
infections (URTI). Caregivers of 246 children completed the OM8-30 and also the
generic Strengths and Difficulties Questionnaire (SDQ), prior to otolaryngologist
consultation. Factor analysis confirmed the hypothesized six-factor structure,
accounting for 55.5% of the variance. The internal consistency was satisfactory
to good for all of the physical and developmental facets (alpha-values > or =
0.68). The correlation matrix with the SDQ scales and total difficulties score
showed significant relationships for almost all of the OM8-30 developmental
facets and sub-aggregate (Ps < 0.01), supporting the concurrent validity of the
OM8-30 as a measure of impact in otitis media. This first examination of the
Dutch OM8-30 shows that the psychometric characteristics are sufficiently good
for the assessment of disease impact, and that this can be subdivided into impact
on physical health and on developmental aspects. Recommendations for further
research include the study of confounders such as hearing, age and previous
operations so that these can be adjusted out, and the determination of which
subgroup of children may benefit from tympanostomy tubes.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Validation Studies

PMID: 18288479 [PubMed - indexed for MEDLINE]

189: Arch Otolaryngol Head Neck Surg. 2008 Feb;134(2):128-32.

Antibiotic therapy to prevent the development of asymptomatic middle ear effusion
in children with acute otitis media: a meta-analysis of individual patient data.

Koopman L, Hoes AW, Glasziou PP, Appelman CL, Burke P, McCormick DP, Damoiseaux
RA, Le Saux N, Rovers MM.

Julius Center for Health Sciences and Primary Care, University Medical Center
Utrecht, Stratenum 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands.
l.koopman@umcutrecht.nl

OBJECTIVES: To determine predictors of the development of asymptomatic middle ear
effusion (MEE) in children with acute otitis media (AOM) and to assess the effect
of antibiotic therapy in preventing the development of MEE in these children.
DATA SOURCES: A systematic literature search was performed using PubMed, EMBASE, 
the Cochrane databases, and the proceedings of international otitis media
symposia. STUDY SELECTION: A trial was selected if the allocation of participants
to treatment was randomized, children aged 0 to 12 years with AOM were included, 
the comparison was between antibiotic therapy and placebo or no (antibiotic)
treatment, and MEE at 1 month was measured. DATA EXTRACTION: Data from 5
randomized controlled trials were included in the meta-analysis of individual
patient data (1328 children aged 6 months to 12 years). We identified independent
predictors of the development of asymptomatic MEE and studied whether these
children benefited more from antibiotic therapy than children with a lower risk. 
The primary outcome was MEE (defined as a type B tympanogram) at 1 month. DATA
SYNTHESIS: The overall relative risk of antibiotic therapy in preventing the
development of asymptomatic MEE after 1 month was 0.9 (95% confidence interval,
0.8-1.0; P =.19). Independent predictors of the development of asymptomatic MEE
were age younger than 2 years and recurrent AOM. No statistically significant
interaction effects with treatment were found. CONCLUSION: Because of a marginal 
effect of antibiotic therapy on the development of asymptomatic MEE and the known
negative effects of prescribing antibiotics, including the development of
antibiotic resistance and adverse effects, we do not recommend prescribing
antibiotics to prevent MEE.

Publication Types: 
    Meta-Analysis
    Research Support, Non-U.S. Gov't

PMID: 18283152 [PubMed - indexed for MEDLINE]

190: Clin Infect Dis. 2008 Mar 15;46(6):815-23.

Comment in:
    Clin Infect Dis. 2008 Jul 1;47(1):146-7.    Clin Infect Dis. 2008 Mar 15;46(6):824.

Viral upper respiratory tract infection and otitis media complication in young
children.

Chonmaitree T, Revai K, Grady JJ, Clos A, Patel JA, Nair S, Fan J, Henrickson KJ.

Department of Pediatrics, University of Texas Medical Branch, Galveston, TX
77555-0371, USA. tchonmai@utmb.edu

BACKGROUND: The common cold or upper respiratory infection (URI) is highly
prevalent among young children and often results in otitis media (OM). The
incidence and characteristics of OM complicating URI due to specific viruses have
not been well studied. METHODS: We performed a prospective, longitudinal cohort
study of 294 healthy children (age range, 6 months to 3 years). Each child was
observed for 1 year to assess the occurrence of URI, acute OM (AOM), and OM with 
effusion (OME) complicating URI due to specific viruses. RESULTS: We documented
1295 URI episodes (5.06 episodes per child-year) and 440 AOM episodes (1.72
episodes per child-year). Virus studies were performed for 864 URI episodes; 63% 
were virus positive. Rhinovirus and adenovirus were most frequently detected
during URI. The overall incidence of OM that complicated URI was 61%, including a
37% incidence of AOM and a 24% incidence of OME. Young age was the most important
predictor of AOM that complicated URI. AOM occurred in approximately one-half of 
children with URI due to adenovirus, respiratory syncytial virus, or coronavirus 
and in approximately one-third of those with URI due to influenza virus,
parainfluenza virus, enterovirus, or rhinovirus. CONCLUSIONS: More than 60% of
episodes of symptomatic URI among young children were complicated by AOM and/or
OME. Young age and specific virus types were predictors of URI complicated by
AOM. For young children, the strategy to prevent OM should involve prevention of 
viral URI. The strategy may be more effective if the priority is given to
development of means to prevent URI associated with adenovirus and respiratory
syncytial virus.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18279042 [PubMed - indexed for MEDLINE]

191: Braz J Otorhinolaryngol. 2007 Nov-Dec;73(6):738-43.

Hystology findings' correlation between the ossicular chain in the transoperative
and cholesteatomas.

Dornelles C, Rosito LP, Meurer L, Costa SS, Argenta A, Alves SL.

Brazilian Center for Otitis Media.

Chronic otitis media is hystopathologycaly defined as the presence of
irreversible inflammatory tissue changes in the middle ear. Ossicular lesions
represent the most prevalent change. AIM: to correlate the degree of ossicular
chain changes seen during surgery with the inflammatory histological degree and
the thickness of the cholesteatoma perimatrix. STUDY DESIGN: Cross-sectional
study. METHODS: Seventy-one descriptions of surgeries done in patients submitted 
to tympanomastoydectomy were reviewed. Cholesteatoma were collected and fixed in 
10% formaldehyde. Two slides were made for each cholesteatoma, one stained with
HE and another with picrossirius. Images were obtained from light microscopy and 
digitally processed and "blindly" analyzed using Image Pro-Plus Software. For
statistical analysis we used Spearman's coefficient. Differences were considered 
statistically significant if P< or =0.05. RESULTS: the ossicular chain was
involved in 65 cases. The incus was the most frequently affected bone, followed
by the stapes and the malleus. When the Spearman's coefficient was employed
considering ossicular chain change degree with patient's age by the time of
surgery, perimatrix thickness and histological degree of inflammation,
correlations were not established. CONCLUSION: Our findings indicate that
ossicular chain changes are practically universal when a cholesteatoma is
present. We didn't find correlations related with bone erosion and
cholesteatoma's histological findings.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18278219 [PubMed - indexed for MEDLINE]

192: Pediatr Infect Dis J. 2008 Mar;27(3):200-6.

Failure to achieve early bacterial eradication increases clinical failure rate in
acute otitis media in young children.

Dagan R, Schneider S, Givon-Lavi N, Greenberg D, Leiberman A, Jacobs MR,
Leibovitz E.

Pediatric Infectious Disease Unit, Soroka University Medical Center and the
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,
Israel. rdagan@bgu.ac.il

BACKGROUND: The objective of this study was to determine the association between 
early bacteriologic failure and clinical failure in acute otitis media (AOM).
METHODS: Children with AOM aged 3-35 months enrolled in studies documenting both 
bacteriologic outcomes by tympanocentesis on day 4-6 and clinical outcomes on day
11-16 (immediate posttreatment visit) constituted our study group. Bacteriologic 
outcomes were studied for children with AOM caused by Streptococcus pneumoniae,
nontypeable Haemophilus influenzae or both. The relative risk (RR) for clinical
failure of children with bacteriologic failure compared with children with
bacteriologic eradication was the main outcome measure. RESULTS: Nine hundred
seven episodes were analyzed. Clinical failure occurred in 7.3% of 660 patients
with bacterial eradication versus 32.8% of 247 patients with bacteriologic
failures. The overall RR (95% confidence interval) for clinical failure was 4.41 
(95% CI: 3.19-6.11), with little variation between pathogens. After correction
for age, gender, ethnic origin, previous otitis history, and previous antibiotic 
treatment, the rate was 6.52 (95% CI: 4.26-9.99). Across clinical studies with 8 
antibiotic drug regimens for AOM, the rate of clinical failure correlated with
bacteriologic failure (r = 0.8967; P = 0.003). CONCLUSIONS: In young children
with culture-positive AOM, failure to eradicate the pathogen from middle ear
fluid within the first few days of treatment leads to a significant risk for
clinical failure.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18277926 [PubMed - indexed for MEDLINE]

193: Acta Vet Hung. 2007 Dec;55(4):471-7.

Isolation of Malassezia pachydermatis and M. sympodialis from the external ear
canal of cats with and without otitis externa.

Dizotti CE, Coutinho SD.

Veterinary Medicine Faculty, Paulista University, São Paulo, Brazil.

The objective of this study was to determine the presence of Malassezia spp. in
the external ear canal of cats with and without otitis. Forty-five animals were
studied, 20 with and 25 without otitis externa (OE). Cerumen or secretion from
external ear canal samples was cultured on modified Mycosel agar and sterile
olive oil was added to the surface of the medium before specimen seeding. The
isolates were analysed for macro- and micromorphology and identified by catalase 
tests and on the basis of growth on Tween 20, 40, 60 and 80. Malassezia spp. were
isolated from 15 out of 20 (75%) animals with otitis and from 7 out of 25 (28%)
cats without OE; the difference between the two groups was statistically
significant (P < or = 0.05). Malassezia pachydermatis and M. sympodialis were
isolated from 60% (12/20) and 40% (8/20) of cats with otitis, respectively, with 
no significant difference in the frequency of isolation between the two species. 
In the microflora of the healthy ear canal M. pachydermatis was significantly
more common (6/25, 24%) than M sympodialis (1/25, 4%). The present investigation 
confirms that M. sympodialis can also act as an aetiological agent of feline OE, 
and if commercial veterinary laboratories do not use media with added lipids for 
the isolation of Malassezia spp., this might lead to false-negative results.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18277706 [PubMed - indexed for MEDLINE]

194: Int J Pediatr Otorhinolaryngol. 2008 Apr;72(4):491-9. Epub 2008 Feb 12.

The incidence, prevalence and burden of OM in unselected children aged 1-8 years 
followed by weekly otoscopy through the "common cold" season.

Mandel EM, Doyle WJ, Winther B, Alper CM.

Department of Otolaryngology, Children's Hospital of Pittsburgh and the
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

BACKGROUND: There is a continuing interest in defining the incidence, prevalence 
and burden of otitis media (OM) in the individual and population for purposes of 
assigning "risk factors". Often overlooked in past studies are the contributions 
of cold-like illnesses (CLIs) and sampling interval to those estimates.
OBJECTIVE: Describe the incidence of symptomatic (AOM) and asymptomatic (OME) OM,
the prevalence of OM, the contribution of CLI incidence, burden and other OM
"risk factors" to the incidence and burden of OM, and the effect of sampling
interval on those measures in children. METHODS: 148 children (74 male; 131
white, aged 1.0-8.6 years) were followed from November 1 to April 30 by weekly
pneumatic otoscopy to diagnose OM presence/absence and by daily parental diary to
assign CLI episodes. Data for previously identified OM "risk factors" were
collected on 127. Results were summarized using standard measures of incidence,
prevalence and burden, and multiple regression techniques were used to identify
OM "risk factors". RESULTS: The basal OM prevalence was 20% with peaks in
December and March and the temporal pattern was correlated with CLI prevalence.
The incidence of OME (per 27,232 child-days) was 317, AOM was 74 and CLI was 456.
The seasonal pattern of AOM and OME incidences tracked and was correlated with
that for CLIs. New OM episodes were usually of short duration (<or=7 days in 40%,
<or=4 weeks in 75-90%) and the usual OM burden was low (median=12%). OM and
breastfeeding histories and CLI incidence/prevalence were significant predictors 
of OME and AOM incidence and OM burden. Longer sampling intervals were less
efficient in capturing AOM and OME durations and incidences, but not OM burden.
CONCLUSIONS: These results demonstrate a high incidence and prevalence of OM,
most OM episodes were of short duration and longer sampling intervals introduced 
biases into some parameter estimates. There was a significant relationship
between OM and CLI incidence, prevalence and burden suggesting that CLI
experience should be controlled for in assessing independent "risk factors" for
AOM and OME.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18272237 [PubMed - indexed for MEDLINE]

195: B-ENT. 2007;3(4):195-9.

Ceruminous gland carcinoma of the external auditory canal presenting as chronic
otitis media.

Selcuk A, Ensari S, Cetin MA, Sak SD, Dere H.

Ankara Numune Educational and Research Hospital, 4th ENT Clinic, Turkey.
sadin27@yahoo.com

OBJECTIVE: Ceruminous neoplasms of the external ear canal are rare.
Classification, clinical behavior, and management of these tumours are
controversial. We report a case of carcinoma originating from the ceruminous
glands of the external ear canal (EAC), operated based on a diagnosis of chronic 
otitis media with polyp. CASE REPORT: A 48-year-old man presented with left ear
discharge and hearing loss. Clinical examination showed a well-circumscribed
polypoid mass limited to the EAC. There was no history of bloody ear discharge or
radiological findings of bony erosion suggestive of malignancy. Our preliminary
diagnosis was chronic otitis media with polyp formation. Tympanoplasty was
performed. Histopathology revealed a ceruminous carcinoma, and an additional
operation involving lateral temporal bone dissection was performed, followed by
60 Gy radiation therapy. CONCLUSION: Ceruminous carcinomas should be considered
in the differentialdiagnosis of middle and external ear pathologies in cases of
soft tissue mass in the EAC.

Publication Types: 
    Case Reports

PMID: 18265725 [PubMed - indexed for MEDLINE]

196: Cent Eur J Public Health. 2007 Dec;15(4):143-6.

The effect of breastfeeding and its duration on acute otitis media in children in
Brno, Czech Republic.

Vogazianos E, Vogazianos P, Fiala J, Janecek D, Slapák I.

Department of Paediatric Otorhinolaryngology, University Hospital, Brno, Czech
Republic.

AIM: We designed this study to assess the effect of breastfeeding and its
duration on acute otitis media (AOM) in children of our geographical region. Our 
main aim was to determine the period of breastfeeding, necessary to achieve
optimal preventive results against AOM. METHODS: The children that, according to 
the questionnaire, had suffered AOM infections in the past were used as the study
group with the rest of the children used as control. The duration of
breastfeeding was divided into months and the odds ratios for the occurrence of
AOM were calculated for the children breastfed for more than or equal to a
certain period, compared to the children breastfed for less than that period.
This was repeated for each month separately and the results plotted on a graph of
the confidence interval (CI) for the odds ratio values, against months of
breastfeeding. RESULTS: The results of our study show that breastfeeding for a
period of up to 11 months can play a significant preventive role against AOM
(odds ratio and lower 90% CI > 1). Breastfeeding for longer periods of time is
also beneficial, with breastfeeding up to 18 months being associated with some
preventive effect against the disease (odds ratio > 1), but the reduction in the 
incidence of AOM is not statistically significant after the 11th month.
Furthermore, there are marked differences in the importance of breastfeeding
during the first 11 months, with a vital protective effect during the first 4
months of life which, however, drops by the 5th month and then rises again from
the beginning of the 6th to the end of the 8th month. The protective effect then 
drops once more, although it remains positive and statistically significant until
the 11th month of life and positive, but not statistically significant, until the
18th. CONCLUSION: Our study has revealed that for an optimal preventive effect to
be achieved, the child should be breastfed for at least the first 11 months of
its life. Continuing after this for up to the 18th month shows some preventive
effect, which however is not statistically significant. Our results support the
hypothesis that the importance of breastfeeding varies with the development of
the child, its changing environment and to the new immunological challenges this 
brings.

PMID: 18251228 [PubMed - indexed for MEDLINE]

197: Arch Pediatr Adolesc Med. 2008 Feb;162(2):151-6.

Comment in:
    Arch Pediatr Adolesc Med. 2008 Feb;162(2):186-8.    J Pediatr. 2008 Jul;153(1):144-5.

A program of anticipatory guidance for the prevention of emergency department
visits for ear pain.

McWilliams DB, Jacobson RM, Van Houten HK, Naessens JM, Ytterberg KL.

Division of Community Pediatric and Adolescent Medicine, Department of Pediatric 
and Adolescent Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905-0001, 
USA. mcwilliams.deborah@mayo.edu

OBJECTIVE: To test whether well-child care visit anticipatory guidance can safely
reduce emergency department (ED) visits. DESIGN: Retrospective analysis comparing
an intervention site with control sites using a "difference-in-differences"
regression model. SETTING: Primary care practices at the Mayo Clinic.
PARTICIPANTS: Children who attended a 15-month well-child care visit.
INTERVENTIONS: Nurses provided standardized education and prescribed
antipyrine-benzocaine otic drops at the 15-month well-child care visit. Education
focused on controlling otalgia, recognizing signs of more serious illness, and
decreasing the sense of medical urgency for uncomplicated ear pain. MAIN OUTCOME 
MEASURES: Visit rates for ear pain during the ensuing year were compared in 4
retrospective cohorts: the intervention cohort (n = 191), a cohort from the same 
practice the preceding year (n = 168), and as controls, cohorts from these same
years at other primary care sites not adopting this intervention (n = 133 and
126). RESULTS: After the intervention, ED visits for ear pain decreased 80%;
urgent care visits, 40%; and primary care visits, 28%, with no significant change
in the control sites' visit use during this time. Regression models incorporating
patient characteristics and comparing the changes between sites across time
supported the belief that the decline in ED use was significant (P = .009), with 
no significant change in urgent care (P = .33) or primary care (P = .14) use. On 
questionnaires, more than 80% of parents whose children had experienced
subsequent ear pain responded that the program helped them avoid an ED or
after-hours visit and strongly recommended continuing the education program.
CONCLUSION: Nurse-administered anticipatory guidance reduced ED visits for ear
pain in toddlers and was well appreciated by parents.

PMID: 18250240 [PubMed - indexed for MEDLINE]

198: Int J Pediatr Otorhinolaryngol. 2008 Apr;72(4):461-7. Epub 2008 Feb 4.

A visual analog scale can assess the effect of surgical treatment in children
with chronic otitis media with effusion.

Datema FR, Vemer-van den Hoek JG, Wieringa MH, Mulder PM, Baatenburg de Jong RJ, 
Blom HM.

Department of Otolaryngology, HagaZiekenhuis, Location Juliana Children's
Hospital, The Hague, The Netherlands. f.datema@erasmusmc.nl

BACKGROUND: The OM-6 survey is a validated and multinationally accepted
instrument to measure the treatment effect of otitis media in children. Routine
use of the OM-6 in a busy general practice is not always possible and can lead to
incomplete returned surveys. A simplified method is favoured when the aim is a
continuous process of complete treatment-outcome-data collection. This study
tests if a VAS can quantify how much a child suffers from chronic otitis media
and how much this changes due to surgical treatment. The change in overall OM-6
scores due to surgical treatment, functions as the gold reference standard.
Furthermore, this study tests if the VAS is faster to use than the OM-6 and if it
leads to an improvement in complete data collection. METHODS: Prospective cohort 
follow-up study of 175 consecutive children with chronic otitis media in a
paediatric otolaryngology practice in a metropolitan area. Data collected
included patient's age, gender, clinical presentation, type of surgical procedure
performed, overall OM-6 score and VAS score (at initial presentation and at
follow-up), time needed to complete an OM-6 survey and VAS separately and number 
of incorrect OM-6 surveys and VAS questions returned. RESULTS: The VAS scores and
overall OM-6 scores show a good, positive correlation at baseline (Spearman's
rho=0.71). This correlation improves at follow-up, one and 6 months after
intervention (rho=0.73 and rho=0.80, respectively). The change in VAS scores and 
overall OM-6 scores, interpreted as change due to surgical intervention, show a
good positive correlation at follow-up (rho=0.70 and rho=0.77, respectively). The
VAS is almost three times faster than the OM-6 (28s versus 81s). More than 13% of
OM-6 surveys were returned incomplete. All VAS questions were returned correct.
CONCLUSIONS: The VAS can be used as a simplified method for routine surgical
treatment effect analysis in children with chronic otitis media.

PMID: 18249447 [PubMed - indexed for MEDLINE]

199: J Acoust Soc Am. 2007 Dec;122(6):3527-38.

Multifield coupled finite element analysis for sound transmission in otitis media
with effusion.

Gan RZ, Wang X.

School of Aerospace and Mechanical Engineering, University of Oklahoma, Norman,
Oklahoma 73019, USA. rgan@ou.edu

In this paper, a newly constructed three-dimensional finite element (FE) model of
the human ear based on histological sections of a left ear temporal bone is
reported. The otitis media with effusion was simulated in the model with variable
fluid levels in the middle ear. The interfaces among the air, structure, and
fluid in the ear canal and middle ear cavity were identified and the
acoustic-structure-fluid coupled FE analysis was conducted when the middle ear
fluid level was varied from zero to full fill of the cavity. The results show how
the displacements of the tympanic membrane and stapes footplate or the middle ear
transfer function is affected by fluid in the cavity across the auditory
frequencies. Comparison of model results with measured data in temporal bones
indicates that this model has the capability to extend FE analysis into
pathological ears such as otitis media with visualized fluid-air interfaces
inside the middle ear structures.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18247761 [PubMed - indexed for MEDLINE]

200: Turk J Pediatr. 2007 Oct-Dec;49(4):390-6.

Comment in:
    Turk J Pediatr. 2008 Sep-Oct;50(5):513.

The comparison of single-dose ceftriaxone, five-day azithromycin, and ten-day
amoxicillin/clavulanate for the treatment of children with acute otitis media.

Biner B, Celtik C, Oner N, Küçükuğurluoğlu Y, Güzel A, Yildirim C, Adali MK.

Department of Pediatrics, Trakya University Faculty of Medicine, Edirne, Turkey.

The aim of the study was to evaluate the efficacy of short-course antimicrobial
therapies [single intramuscular dose of ceftriaxone (50 mg/kg, not exceeding 1
g), 5 days of azithromycin (10 mg/kg on day 1, then 5 mg/kg daily on days 2-5)
and the traditional 10-day course of amoxicillin/clavulanate (90/6.4 mg/kg/day in
2 doses)] in children with acute otitis media (AOM). The study was conducted as a
prospective, comparative, open randomized trial between February 2001 and April
2003, and 104 children were enrolled, with a mean age of 3.8 (2.3) years. The
clinical and otoscopic assessments of the children were made on days 0, 3, 11 and
30 after admission, and tympanometry was performed on day 30. The patients were
diagnosed and followed with a scoring system. Clinical success was achieved in
29/34 patients (85.3%) in the ceftriaxone group, 27/31 patients (87.1%) in the
azithromycin group and 34/39 children (87.2%) in the amoxicillin/clavulanate
group. The rate of persistence of middle-ear fluid did not differ between the
three groups (p>0.05). During the one-month period, no recurrent case was
observed. The most common drug-related adverse effects were associated with the
gastrointestinal system. In conclusion, for the treatment of children with AOM,
the clinical success of single-dose intramuscular ceftriaxone and of five-day
azithromycin treatments was comparable to that of the traditional 10-day therapy 
with high-dose amoxicillin/clavulanate.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 18246740 [PubMed - indexed for MEDLINE]

201: Cochlear Implants Int. 2008 Jun;9(2):90-6.

Meningitis resulting in hearing loss and labyrinthitis ossificans - does the
causative organism matter?

Douglas SA, Sanli H, Gibson WP.

The Sydney Cochlear Implant Centre, University of Sydney, Sydney Australia.
SusanADouglas@gmail.com

Our aim was to demonstrate whether one causative agent of meningitis is more
likely to cause profound hearing loss and labyrinthitis ossificans. We obtained
data from the New South Wales health department for cases of meningitis between
1995 and 2005 (1568 cases) and the Sydney Cochlear Implant Centre for cochlear
implant patients with hearing loss secondary to meningitis from 1984 to 2005 (70 
ears in 59 patients). The aetiological agents were compared with regard to their 
ability to cause profound hearing loss and cochlear ossification. Neisseria
meningitidis resulted in 56.9% of cases of meningitis and 11.4% of the cases of
profound hearing loss resulting in cochlear implantation (incidence of profound
hearing loss of 0.4%). Streptococcus pneumoniae, however, caused 41.1% of
meningitis but 85.7% of cochlear implantation (incidence of 4.6%). Labyrinthitis 
ossificans was more common after infection with Streptococcus pneumoniae but
there was no statistically significant difference between Streptococcus
pneumoniae, Haemophilus influenzae or Neisseria meningitidis for labyrinthitis
ossificans (p = 0.45, chi-squared test). In conclusion Neisseria meningitidis
meningitis carries a very low risk of profound hearing loss but Streptococcus
pneumoniae meningitis a significantly higher risk.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18246540 [PubMed - indexed for MEDLINE]

202: Surg Radiol Anat. 2008 May;30(3):221-7. Epub 2008 Feb 2.

Analysis of unilateral sclerotic temporal bone: how does the sclerosis change the
mastoid pneumatization morphologically in the temporal bone?

Lee DH, Jung MK, Yoo YH, Seo JH.

Department of Otolaryngology-Head and Neck Surgery, Uijeongbu St. Mary's
Hospital, The Catholic University of Korea, 65-1 Gumoh-Dong, Uijeongbu,
Gyeonggi-Do 480-717, South Korea. leedh0814@catholic.ac.kr

BACKGROUNDS: Some disorders, such as otitis media and Eustachian tube
dysfunction, may cause the temporal bone to become sclerotic. A sclerotic
temporal bone has the tendency to shrink. The aim of this study was to evaluate
the morphologic changes that result from sclerosis of the temporal bone. METHODS:
We measured 9 variables on 2 axial images, and 8 variables on 2 coronal images in
healthy ears and diseased ears in 37 patients with unilateral chronic otitis
media. We also measured the volume of mastoid pneumatization. RESULTS: The
distance from sigmoid sinus to Henle's spine was correlated to the degree of
volume reduction, and it accounted for about 17.7% of the total variation in
volume reduction. There was no difference in the sigmoid sinus type in
comparisons between sclerotic and pneumatic mastoids. CONCLUSIONS: The sclerosis 
of the temporal bone was observed to reduce the volume of the mastoid
pneumatization. However, a large portion of the volume reduction may result from 
the sclerotic change in the air cell system, rather than from shrinkage of the
mastoid bone. Therefore, the location of surgically-important structures, in the 
middle and inner ear, is only rarely changed in sclerotic temporal bone.

PMID: 18246294 [PubMed - indexed for MEDLINE]

203: Pediatrics. 2008 Feb;121(2):253-60.

Trends in acute otitis media-related health care utilization by privately insured
young children in the United States, 1997-2004.

Zhou F, Shefer A, Kong Y, Nuorti JP.

National Center for Immunization and Respiratory Diseases, Centers for Disease
Control and Prevention, 1600 Clifton Rd NE, Mail Stop E-52, Atlanta, GA 30333,
USA. faz1@cdc.gov

OBJECTIVE: The goal was to estimate the population effect of 7-valent
pneumococcal conjugate vaccine on rates of acute otitis media-related ambulatory 
visits and antibiotic prescriptions for <2-year-old children enrolled in private 
insurance plans. METHODS: We performed a retrospective analysis of a defined
population by using the 1997-2004 MarketScan databases, which included an average
of >500,000 person-years of observations for children <2 years of age. Trends in 
rates of International Classification of Diseases, Ninth Revision-coded
ambulatory visits and antibiotic prescriptions attributable to acute otitis media
were evaluated, and the national direct medical expenditures for these outcomes
were estimated. RESULTS: In a comparison of 2004 with 1997-1999 (baseline
period), rates of ambulatory visits and antibiotic prescriptions attributable to 
acute otitis media decreased from 2173 to 1244 visits per 1000 person-years
(42.7% reduction) and from 1244 to 722 prescriptions per 1000 person-years (41.9%
reduction), respectively. Total, estimated, national direct medical expenditures 
for acute otitis media-related ambulatory visits and antibiotic prescriptions for
children <2 years of age decreased from an average of $1.41 billion during 1997
to 1999 to $0.95 billion in 2004 (32.3% reduction). CONCLUSIONS: Acute otitis
media-related health care utilization and associated antibiotic prescriptions for
privately insured young children decreased more than expected (on the basis of
efficacy estimates in prelicensure clinical trials) after the introduction of
routine 7-valent pneumococcal conjugate vaccine immunization. Although other
factors, such as clinical practice guidelines to reduce antibiotic use, might
have contributed to the observed trend, 7-valent pneumococcal conjugate vaccine
may play an important role in reducing the burden of acute otitis media,
resulting in substantial savings in medical care costs.

Publication Types: 
    Comparative Study

PMID: 18245415 [PubMed - indexed for MEDLINE]

204: Int J Pediatr Otorhinolaryngol. 2008 Mar;72(3):337-42. Epub 2008 Feb 1.

Relationship between effusion bacteria and concentrations of immunoglobulin in
serum and effusion fluid in otitis media with effusion patients.

Yeo SG, Park DC, Lee SK, Cha CI.

Department of Otolaryngology, College of Medicine, Kyung Hee University, #1
Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Republic of Korea.

OBJECTIVE: Bacterial infection and immunity are important in the development of
otitis media with effusion (OME) in children who have not developed Eustachian
tube function. We evaluated the relationship between the presence of bacteria in 
effusion fluid and immunoglobulin (Ig) concentrations in effusion fluid and
serum. METHODS: Middle ear effusion and blood samples were collected from 58 OME 
patients who had undergone ventilation tube insertion. Bacteria in effusion fluid
were detected by standard bacterial culture and polymerase chain reaction (PCR). 
Serum and middle ear fluid Ig concentrations in OME patients and serum Ig
concentrations in 64 control children were evaluated. RESULTS: Bacteria were
detected in 24/58 (41.4%) effusion fluid samples by PCR and in 12/58 (20.6%) by
standard culture. There was no correlation between effusion Ig concentration and 
the presence of bacteria or between serum and effusion Ig concentrations, but
serum Ig concentration was related to the presence of effusion bacteria (p<0.05).
Serum IgG, IgA and IgM in patients with OME were lower than in control patients
(p<0.05). CONCLUSIONS: These results suggest that the presence of effusion
bacteria in OME may be related to systemic immunity, but that the concentration
of Ig in effusion fluid may not be affected by the presence of effusion bacteria.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18242717 [PubMed - indexed for MEDLINE]

205: Auris Nasus Larynx. 2008 Sep;35(3):353-6. Epub 2008 Jan 31.

Facial canal dehiscence in the initial operation for chronic otitis media without
cholesteatoma.

Kim CW, Rho YS, Ahn HY, Oh SJ.

Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine,
Hallym University, 445 Gil-Dong, Gangdong-gu, Seoul, Republic of Korea.
kcw5088@dreamwiz.com

OBJECTIVE: To evaluate the risk of the facial nerve injury during operations for 
chronic otitis media without cholesteatoma by analysis of the intraoperative
findings of the facial canal dehiscence. METHODS: We retrospectively reviewed
operative findings of 152 patients who underwent tympanoplasty with mastoidectomy
for chronic otitis media. We examined every segment of the facial canal from the 
geniculate ganglion to the mastoid segment. Facial canal dehiscence was confirmed
by palpation with a Rosen pick after inspection with a surgical microscope.
RESULTS: The rate of facial canal dehiscence was 8.6% (13 of 152 cases), and the 
tympanic segment was the most commonly found region at 84.6% (11 of 13 cases). Of
the 11 cases of tympanic segment dehiscence, 9 cases were involved the lateral
aspect of the facial canal in the oval window area. There was one case each of
facial canal dehiscence in the geniculate ganglion and the mastoid segment,
respectively. CONCLUSION: The rate of facial canal dehiscence of 8.6% is not a
low incidence rate, so even though performing a routine chronic ear operation,
surgeons may encounter facial canal dehiscence at any time and should be prepared
for the emergence of such a situation.

PMID: 18242032 [PubMed - indexed for MEDLINE]

206: Auris Nasus Larynx. 2008 Dec;35(4):552-5. Epub 2008 Feb 1.

Surgical treatment of chronic otitis media with temporomandibular joint
involvement.

Aarnisalo AA, Tervahartiala P, Jero J, Törnwall J.

Department of Otorhinolaryngology, University of Helsinki, HUCH, Helsinki,
Finland. antti.aarnisalo@hus.fi

We report a case of chronic otitis media with spread of the infection into the
temporomandibular joint (TMJ), causing displacement of the joint and
malocclusion. Chemotherapy of the malignant disease caused activation of the
chronic ear infection with a temporomandibular joint involvement. The patient was
operated twice to eradicate the infection from the mastoid, middle ear and
temporomandibular joint. A radical cavity with musculoperiosteal flap
obliteration was created. The joint was isolated from the radical cavity with a
thin vascularized temporomyofascial flap. No restriction in the movements of the 
temporomandibular joint could be noted in the follow-up. After the surgeries
chemotherapy could continue without signs of inflammation in the
temporomandibular joint or mastoid region. Prompt surgical intervention is
indicated when temporomandibular joint symptoms arise in cases of chronic otitis 
media.

Publication Types: 
    Case Reports

PMID: 18242031 [PubMed - indexed for MEDLINE]

207: Ear Nose Throat J. 2007 Nov;86(11):672-4, 681.

Is i.v. access necessary for myringotomy with tubes?

Allen AH.

Georgia ENT & Facial Plastics, PC, Valdosta, GA 31602, USA.
georgiaent@bellsouth.net

A retrospective chart review was conducted at a community-based hospital to
determine whether intravenous access is necessary during the performance of
myringotomy with tube insertion. The study included 50 pediatric patients divided
equally into 2 groups: group 1, who did not have intravenous access established
before the procedure, and group 2, who did have intravenous access established.
To be enrolled, patients in both groups had to be < or =12 years of age, have an 
American Society of Anesthesiologists physical status classification of P1 or P2,
and had to have undergone no adjunctive procedure with the myringotomy. Induction
time was significantly shorter in group 1 (average: 6.96 +/- 2.72 minutes) than
in group 2 (average: 9.80 +/- 3.82 minutes; p = 0.004). Operating time and total 
operating room time were not significantly different between the two groups.
Additionally, 24 of 25 patients in group 1 had their pain managed with
acetaminophen or no medication at all, while 9 of 25 group 2 patients received
acetaminophen and 13 received intravenous pain medication. Interestingly, no
patients in group 1 required antiemetics, whereas 4 patients in group 2, who were
given intravenous orintramuscularnarcotics, received antiemetic medications.
These findings indicate that myringotomy with tube insertion can be safely
accomplished without establishing intravenous access. Induction times and time
under general anesthesia were significantly increased when intravenous access was
obtained. The findings also suggest that acetaminophen provides adequate
postoperative pain control in this patient population and that the use of
intravenous or intramuscular narcotics increases the risk of postoperative
nausea.

PMID: 18225626 [PubMed - indexed for MEDLINE]

208: B-ENT. 2007;3 Suppl 7:61-3.

Tinnitus in children and adolescents.

Gordts F, Decreton S.

ENT Department, Universitair Ziekenhuis Brussel, Brussels.
Frans.gordts@uzbrussel.be

ENT practitioners are rarely confronted with tinnitus complaints from children.
The present paper describes a literature review conducted in an attempt to
identify possible reasons for this. Rather than applying the vast amount of
information about tinnitus among adults, it seeks to highlight those domains
where differences between children and adults are of importance.

Publication Types: 
    Review

PMID: 18225609 [PubMed - indexed for MEDLINE]

209: J Clin Invest. 2008 Feb;118(2):651-8.

Comment in:
    J Clin Invest. 2008 Feb;118(2):471-4.

Eya4-deficient mice are a model for heritable otitis media.

Depreux FF, Darrow K, Conner DA, Eavey RD, Liberman MC, Seidman CE, Seidman JG.

Department of Genetics, Harvard Medical School, Boston, Massachusetts 02115, USA.

Otitis media is an extremely common pediatric inflammation of the middle ear that
often causes pain and diminishes hearing. Vulnerability to otitis media is due to
eustachian tube dysfunction as well as other poorly understood factors, including
genetic susceptibility. As EYA4 mutations cause sensorineural hearing loss in
humans, we produced and characterized Eya4-deficient (Eya4(-/-)) mice, which had 
severe hearing deficits. In addition, all Eya4(-/-) mice developed otitis media
with effusion. Anatomic studies revealed abnormal middle ear cavity and
eustachian tube dysmorphology; thus, Eya4 regulation is critical for the
development and function of these structures. We suggest that some human otitis
media susceptibility reflects underlying genetic predisposition in genes like
EYA4 that regulate middle ear and eustachian tube anatomy.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18219393 [PubMed - indexed for MEDLINE]

210: J Clin Invest. 2008 Feb;118(2):471-4.

Comment on:
    J Clin Invest. 2008 Feb;118(2):651-8.

Can you hear me now? A genetic model of otitis media with effusion.

Lazaridis E, Saunders JC.

Department of Otorhinolaryngology, Head and Neck Surgery, University of
Pennsylvania, Philadelphia, Pennsylvania 19104, USA. elaz@mail.med.upenn.edu

Otitis media with effusion (OME) is characterized by the occurrence of fluid in
the middle-ear cavity in the absence of any signs of acute ear infection and
occurs most frequently in children with auditory or eustachian tube dysfunction. 
Its chronic form is an important clinical issue for pediatricians and otologists 
alike. The study by Depreux et al. in this issue of the JCI shows that absence of
the transcriptional activator Eya4 in knockout mice results in abnormal
structuring of the eustachian tube, thus predisposing these animals to OME (see
the related article beginning on page 651). The development of this
genetics-based animal model is an important advance for understanding OME and for
exploring new avenues of treatment.

Publication Types: 
    Comment
    Research Support, N.I.H., Extramural

PMID: 18219392 [PubMed - indexed for MEDLINE]

211: Ear Nose Throat J. 2007 Dec;86(12):738-43.

Correlation between otitis media and craniofacial morphology in adults.

Di Francesco RC, Sampaio PL, Bento RF.

Department of Otolaryngology, University of São Paulo School of Medicine, São
Paulo, Brazil. renatadifran@uol.com.br

We conducted a comparison study to determine if the development of otitis media
in adults is correlated with craniofacial morphology. Our study population was
made up of 66 adults, aged 18 to 40 years; 32 of these patients had otitis media 
and 34 did not. All subjects underwent a complete otolaryngologic examination,
video-otoscopy, fiberoptic nasal endoscopy, and lateral cephalometry. Statistical
analysis of the cephalometric measurements in the otitis media group and the
control group revealed significant differences in the angle between the anterior 
skull base and medial skull base, upper facial height, and anterior facial
height. Also, some significant differences were seen between the measurements in 
the otitis media group and the normal dimensions of the harmonic face as reported
in the literature; these differences were seen in the length of the anterior
skull base, the angle of cranial deflection, the depth of the maxilla, the angle 
of the mandibular plane, the angle of facial depth, the angle of the facial cone,
and lower facial height. Not all of these significant differences, however were
predictive of the evolution of otitis media. Based on our analysis, we conclude
that four cephalometric measurements are predictive of the evolution of otitis
media: (1) the length of the anterior skull base, (2) the angle between the
anterior skull base and medial skull base, (3) maxillary depth, and (4) upper
facial height. No correlations were found between otitis media and nasal blockage
or between otitis media and facial type.

PMID: 18217377 [PubMed - indexed for MEDLINE]

212: In Vivo. 2007 Nov-Dec;21(6):1043-7.

Effect of topical dexamethasone on sensorineural hearing loss in
endotoxin-induced otitis media.

Jang CH, Cho YB, Choi CH, Park SY, Pak SC.

Department of Otolaryngology, Chonnam National University Medical School,
Gwangju, Dong-ku, South Korea. chulsavio@hanmail.net

Sensorineural hearing loss, which is limited to the cochlear basal turn, due to
acute or chronic otitis media has been reported in clinical and experimental
studies. In the present study, the effect of intratympanic dexamethasone on
endotoxin-induced cochlear damage was investigated by measuring the cochlear
blood flow and hearing. MATERIALS AND METHODS: Ten male Sprague-Dawley rats were 
inoculated with lipopolysaccharide (LPS), and divided into 2 groups of five rats 
each. One hour after intratympanic inoculation, the group A received 40 microl of
phosphate-buffered saline (PBS) in the right middle ear cavity, group B received 
40 microl of dexamethasone. The treated animals were examined 24 h after
inoculation using auditory brainstem response (ABR) and cochlear blood flow
(CBF). RESULTS: The elevated threshold decreased significantly after
intratympanic dexamethasone administration compared to the PBS-treated group.
Intratympanic dexamethasone administration to the round window of rats led to a
statistically significant increase in CBF compared to the PBS-treated group (p
<0.05). The response to round window application of prostaglandin E1 (PGE1) in
the dexamethasone-treated group was better than in the PBS-treated group.
CONCLUSION: Our results showed that intratympanic dexamethasone treatment was
effective in protecting the function of the cochlea against endotoxin-induced
otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18210753 [PubMed - indexed for MEDLINE]

213: Arch Otolaryngol Head Neck Surg. 2008 Jan;134(1):45-8.

Comment in:
    Arch Otolaryngol Head Neck Surg. 2008 Jan;134(1):49.

The relationship between acute mastoiditis and antibiotic use for acute otitis
media in children.

Ho D, Rotenberg BW, Berkowitz RG.

Department of Otolaryngology, Royal Children's Hospital, Victoria 3052,
Australia.

OBJECTIVE: To determine the relationship between prior antibiotic use and the
development of acute mastoiditis (AM) in children. DESIGN: Retrospective review. 
SETTING: Tertiary pediatric center. PATIENTS: We identified 129 patients with AM 
who were admitted to our center between 1996 and 2005. MAIN OUTCOME MEASURE:
Proportion of children who developed AM. RESULTS: A total of only 67 patients
(51.9%) had undergone any antimicrobial treatment prior to hospital admission. In
1996, 64% of patients with AM had received antibiotics for acute otitis media
(AOM) prior to admission (n = 7 of 11), but this percentage had steadily
decreased to 27% by 2005 (n = 4 of 15). The yearly number of cases of AM treated 
in our institution has remained stable over this period. A subperiosteal abscess 
was identified in 45 patients (34.9%), while the remainder (n = 84) had
postauricular inflammation only (65.1%). Nineteen patients with a subperiosteal
abscess (42%) and 48 patients without a subperiosteal abscess (57%) had undergone
prehospitalization antimicrobial therapy for suppurative AOM. There was no
significant difference in antibiotic use between the numbers of patients with or 
without a subperiosteal abscess. Regarding the sensitivity of bacteria isolated
from patients with a subperiosteal abscess, only 1 patient was infected with an
organism that was not sensitive to the prehospitalization antibiotic prescribed. 
CONCLUSION: Use of antibiotics to treat suppurative AOM in children might not
influence the subsequent development of AM.

PMID: 18209135 [PubMed - indexed for MEDLINE]

214: Arch Otolaryngol Head Neck Surg. 2008 Jan;134(1):39-44.

MUC2 expression in human middle ear epithelium of patients with otitis media.

Ubell ML, Kerschner JE, Wackym PA, Burrows A.

Division of Pediatric Otolaryngology, Department of Otolaryngology and
Communication Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA.

OBJECTIVE: To compare levels of expression of mucin gene 2 (MUC2), a major
secretory mucin, in the middle ear of patients with otitis media (OM) and control
patients. DESIGN: Case-control study. SETTING: Children's Hospital of Wisconsin, 
Milwaukee. PATIENTS: Nineteen patients aged 6 months to 15 years undergoing
routine ventilation tube insertion for recurrent OM or chronic OM with effusion
and 8 controls with no history of OM undergoing cochlear implantation.
INTERVENTIONS: Biopsy of middle ear epithelium for RNA extraction. MAIN OUTCOME
MEASURE: Expression of MUC2 by real-time reverse transcription-polymerase chain
reaction. RESULTS: Twenty-seven OM samples (17 recurrent and 10 with effusion)
from 19 patients were analyzed and compared with 9 control samples from 8
patients. The mean MUC2 expression was 6.12 (95% confidence interval, 3.32-8.89) 
times that of the controls in the OM samples overall, 5.00 (95% confidence
interval, 2.79-7.21) times that of controls in the recurrent OM samples, and 7.98
(95% confidence interval, 1.58-14.38) times that of controls in the OM with
effusion samples. CONCLUSIONS: Levels of MUC2 expression in human middle ear
epithelium are significantly increased in patients with OM overall, patients with
recurrent OM, and patients with OM with effusion compared with controls. Mucins
are fundamentally important in the middle ear, controlling viscoelastic
properties of secretions and providing mucosal protection and bacterial
clearance. Demonstration of these differences between patient groups highlights
the need for greater understanding of molecular responses in OM, which may
provide novel interventions for this common problem.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18209134 [PubMed - indexed for MEDLINE]

215: Clin Infect Dis. 2008 Feb 15;46(4):e34-7.

Association of nasopharyngeal bacterial colonization during upper respiratory
tract infection and the development of acute otitis media.

Revai K, Mamidi D, Chonmaitree T.

Department of Pediatrics, University of Texas, Medical Branch at Galveston,
Galveston, TX 7555-0371, USA. kfrevai@utmb.edu

Acute otitis media occurs mostly after upper respiratory tract infection; the
causative bacteria are those colonized in the nasopharynx. We studied 709
episodes of upper respiratory tract infection and found that children with no
bacteria in the nasopharynx were at low risk for acute otitis media, whereas
children with 3 pathogenic bacteria were at the greatest risk.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18205533 [PubMed - indexed for MEDLINE]

216: Am J Med Genet A. 2008 Feb 15;146A(4):426-32.

Otitis media with effusion and hearing loss in children with Cornelia de Lange
syndrome.

Marchisio P, Selicorni A, Pignataro L, Milani D, Baggi E, Lambertini L, Dusi E,
Villa L, Capaccio P, Cerutti M, Esposito S, Principi N.

Institute of Pediatrics, University of Milan, Fondazione IRCCS Ospedale Maggiore 
Policlinico, Mangiagalli e Regina Elena, Milan, Italy.

The development of children who have syndromes with mental retardation and/or
language delay can be worsened by sensorineural or conductive hearing loss (HL). 
Given the existing scarcity of data, we investigated the prevalence of otitis
media with effusion and/or HL in 50 children with Cornelia de Lange syndrome
(CdLS) aged 1-18 years, and its impact on the children's performance. The
children underwent otological and audiological examinations in order to ascertain
the relative frequencies of otitis media with effusion and/or hearing impairment;
their demographic and clinical data were obtained by questionnaires and from
information in their medical charts. Otitis media with effusion was diagnosed in 
94%, and its prevalence was similar in all age groups; HL was detected in 40
children (80%). Conductive HL due to middle ear effusion was the main cause of
hearing impairment alone (60%) or in combination with sensorineural deficit
(20%). HL had a negative impact on performance regardless of the type. A history 
of routine audiological and/or otological assessments was reported by a minority 
of parents. Our findings indicate that otitis media with effusion and/or HL is an
important feature of children with CdLS and may negatively affect their
performance. Careful follow-up throughout childhood is necessary to detect and
treat any hearing loss in children with CdLS in order to minimize its impact on
performance.

PMID: 18203151 [PubMed - indexed for MEDLINE]

217: Otol Neurotol. 2008 Jan;29(1):19-22.

Management of chronic otitis by middle ear obliteration with blind sac closure of
the external auditory canal.

Sanna M, Dispenza F, Flanagan S, De Stefano A, Falcioni M.

Gruppo Otologico Piacenza, Rome, Italy.

OBJECTIVE: Description of a technique of middle ear obliteration (MEO) with blind
sac closure of the external auditory canal with discussion of the indications for
its use in cases of recalcitrant chronic otitis and in far advanced disease.
PATIENTS: All patients underwent otologic examination and audiologic and
radiologic assessments in a quaternary center. RESULTS: Fifty-three cases of MEO 
were analyzed. For 9 patients, primary surgery was performed. One case of
residual disease was identified. The minimum follow-up was 2 years. CONCLUSION:
The decision to perform a MEO is one that is made only rarely. However, this is a
technique that should be part of every otologist's armamentarium. Whereas the
indications for its use are more straightforward in an ear with unserviceable
hearing, a MEO is occasionally required in an ear with good cochlear reserve due 
the severity of disease. All of our patients managed by MEO have had an
improvement in their quality of life and a high rate of successful eradication of
disease.

PMID: 18199953 [PubMed - indexed for MEDLINE]

218: Curr Opin Pediatr. 2008 Feb;20(1):72-8.

The concept and practice of a wait-and-see approach to acute otitis media.

Spiro DM, Arnold DH.

Department of Emergency Medicine, Oregon Health and Science University, Portland,
Oregon 97239, USA. spirod@ohsu.edu

PURPOSE OF REVIEW: We review the contemporary management of acute otitis media,
including symptomatic care, the rationale and literature for utilizing the
wait-and-see approach, and the indications for immediate therapy with
antibiotics. RECENT FINDINGS: Current guidelines recommend selective use of
observation in children diagnosed with acute otitis media. Recent evidence
suggests that a wait-and-see approach will reduce the use of antibiotics and
decrease adverse events associated with their use. Earlier studies found that
antimicrobials reduce pain and discomfort in the acute phase of illness compared 
with placebo. A recently published trial, however, suggests that when analgesics 
are utilized there may be minimal or no difference in otalgia whether antibiotics
are prescribed or withheld. SUMMARY: Treatment of acute otitis media is the most 
frequent indication for prescribing antibiotics in the pediatric population.
Evidence suggests there is marginal benefit from antibiotics for most children
diagnosed with AOM. Based on current data, we propose an algorithm for the
management of children with AOM that includes a wait-and-see approach with
specific indications for immediate treatment with antibiotics. A wait-and-see
approach to acute otitis media that empowers families by using a shared
decision-making model will reduce the use of antibiotics and will decrease
resistance to antimicrobials.

Publication Types: 
    Review

PMID: 18197043 [PubMed - indexed for MEDLINE]

219: Clin Infect Dis. 2007 Dec 15;45(12):1583-7.

Erratum in:
    Clin Infect Dis. 2008 Feb 1;46(3):489.

Comment in:
    Clin Infect Dis. 2008 Jul 15;47(2):289-91; author reply 291-2.

Pneumococcal conjugate vaccine does not influence Staphylococcus aureus carriage 
in young children with acute otitis media.

Cohen R, Levy C, Thollot F, de La Rocque F, Koskas M, Bonnet E, Fritzell B, Varon
E.

Service de Microbiologie, Centre Hospitalier Intercommunal de Creteil, Creteil,
France. robert.cohen@wanadoo.fr

We investigated nasopharyngeal carriage of Streptococcus pneumoniae and
Staphylococcus aureus among infants and young children with acute otitis media in
a country where use of 7-valent pneumococcal conjugate vaccine (PCV7) has been
progressively implemented. Among 1783 children enrolled, 60.8% carried S.
pneumoniae, and 9% carried S. aureus. Among S. pneumoniae carriers, the rate of
S. aureus carriage was 8.4%, compared with 9.9% among S. pneumoniae noncarriers. 
The rate of S. pneumoniae carriage in the PCV7-vaccinated population was lower
(59.8%) than that observed in the nonvaccinated population (66.2%; P<.04). In
contrast, in young children (age, <2 years) with acute otitis media, our study
suggests that the S. aureus carriage rate is not affected by PCV7 immunization
(9.0% in vaccinated children vs. 8.7% in nonvaccinated children). Furthermore, in
children aged >1 year, the booster dose induces a sharp reduction in the carriage
of vaccine serotypes of S. pneumoniae, without any change in S. aureus carriage.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18190319 [PubMed - indexed for MEDLINE]

220: Kulak Burun Bogaz Ihtis Derg. 2007;17(4):224-7.

The effects of radiofrequency and incisional myringotomy on the duration of
patency.

Eken M, Evren C, Sanli A, Aydin S, Paksoy M.

Department of Otolaryngology, Dr. Lütfi Kirdar Kartal Training and Research
Hospital, Istanbul, Turkey. memedeken@yahoo.com

OBJECTIVES: We investigated whether radiofrequency could prolong the patency of
myringotomy. MATERIALS AND METHODS: Eighteen guinea pigs were enrolled in this
study. Myringotomies were created by radiofrequency in the right ears in the
study group using the ENTec coblator plasma surgery system, while the left ears
had incisional myringotomies as the control group. After myringotomies, the
tympanic membranes were examined with otomicroscopy on the 5th, 7th, 10th, and
14th days. Closure times of the two groups were compared by the Mann-Whitney
U-test. RESULTS: All the myringotomies were closed up to the tenth postoperative 
day. There was no significant difference between the two groups with respect to
closure times. CONCLUSION: Radiofrequency is a safe and minimally destructive
method to perform a myringotomy, but it does not provide long-time patency.

PMID: 18187975 [PubMed - indexed for MEDLINE]

221: Am J Epidemiol. 2008 Mar 1;167(5):540-5. Epub 2008 Jan 9.

Comparison of methods of handling missing data in individual patient data
meta-analyses: an empirical example on antibiotics in children with acute otitis 
media.

Koopman L, van der Heijden GJ, Grobbee DE, Rovers MM.

Julius Center for Health Sciences and Primary Care, University Medical Center
Utrecht, Utrecht, the Netherlands. l.koopman@umcutrecht.nl

What is the influence of various methods of handling missing data (complete case 
analyses, single imputation within and over trials, and multiple imputations
within and over trials) on the subgroup effects of individual patient data
meta-analyses? An empirical data set was used to compare these five methods
regarding the subgroup results. Logistic regression analyses were used to
determine interaction effects (regression coefficients, standard errors, and p
values) between subgrouping variables and treatment. Stratified analyses were
performed to determine the effects in subgroups (rate ratios, rate differences,
and their 95% confidence intervals). Imputation over trials resulted in different
regression coefficients and standard errors of the interaction term as compared
with imputation within trials and complete case analyses. Significant interaction
effects were found for complete case analyses and imputation within trials,
whereas imputation over trials often showed no significant interaction effect.
Imputation of missing data over trials might lead to bias, because association of
covariates might differ across the included studies. Therefore, despite the gain 
in statistical power, imputation over trials is not recommended. In the authors' 
empirical example, imputation within trials appears to be the most appropriate
approach of handling missing data in individual patient data meta-analyses.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 18184640 [PubMed - indexed for MEDLINE]

222: Eur Arch Otorhinolaryngol. 2008 Aug;265(8):899-905. Epub 2008 Jan 4.

Antihistamine effects on experimental middle ear inflammatory model.

Chimona TS, Panayiotides JG, Papadakis CE, Helidonis ES, Velegrakis GA.

Department of Otolaryngology, University of Crete School of Medicine, Crete,
Greece. chimonath@yahoo.gr

Allergy is thought to be one of the etiologic factors in otitis media. The
purpose of this study was to determine the histopathologic effects of H1
histamine receptor antagonists in an experimental histamine-induced middle ear
inflammation model. In group A (20 rabbits), histamine challenge followed a 3-day
intramuscular pretreatment with a single dose of 0.1 ml hydroxyzine hydrochloride
(50 mg/ml) per day. In group B (20 rabbits), histamine challenge followed a 3-day
pretreatment with a single dose 1.2 mg desloratadine per day orally. In group C
(20 rabbits), histamine challenge followed a 3-day pretreatment with a single
dose 1.2 mg levocetirizine per day orally. On the fourth day after baseline
otomicroscopy 0.5 ml histamine 20 mg/ml was injected transtympanically on the
right. Middle ear mucosa was removed and the following parameters were assessed: 
edema, vascular dilatation and congestion, inflammation, acute inflammatory
component, presence of eosinophils, activity of the inflammation and fibrosis. A 
semi-quantitative grading system of 0-3 was used for grading of all parameters
and statistical analysis performed by using the Mann-Whitney non-parametric test.
Group A mucosae showed lower grades of all the parameters evaluated compared with
those of group B. Histopathology of the mucosae of group C showed lower grade of 
inflammation compared with group B with significant statistical difference for
the seven parameters tested. Our data validate the use of antihistamines in the
treatment of refractory OME of allergic origin. Oldest H1 antagonists can be
replaced by the newest agents who counteract successfully histamine effects,
without any interactions or adverse effects from central nervous system.

PMID: 18175139 [PubMed - indexed for MEDLINE]

223: Paediatr Perinat Epidemiol. 2008 Jan;22(1):60-71.

The Kalgoorlie Otitis Media Research Project: rationale, methods, population
characteristics and ethical considerations.

Lehmann D, Arumugaswamy A, Elsbury D, Finucane J, Stokes A, Monck R,
Jeffries-Stokes C, McAullay D, Coates H, Stanley FJ.

Telethon Institute for Child Health Research, Centre for Child Health Research,
the University of Western Australia, West Perth, WA, Australia.
deborahl@ichr.uwa.edu.au

Otitis media (OM) is one of the most common paediatric illnesses for which
medical advice is sought in developed countries. Australian Aboriginal children
suffer high rates of OM from early infancy. The resultant hearing loss can affect
education and quality of life. As numerous factors contribute to the burden of
OM, interventions aimed at reducing the impact of single risk factors are likely 
to fail. To identify key risk factors and understand how they interact in complex
causal pathways, we followed 100 Aboriginal and 180 non-Aboriginal children from 
birth to age 2 years in a semi-arid zone of Western Australia. We collected
demographic, obstetric, socio-economic and environmental data, breast milk once, 
and nasopharyngeal samples and saliva on seven occasions. Ear health was assessed
by clinical examination, tympanometry, transient evoked otoacoustic emissions and
audiometry. We considered the conduct of our study in relation to national
ethical guidelines for research in Aboriginal and Torres Strait Islander health. 
After 1 year of community consultation, the study was endorsed by local
committees and ethical approval granted. Fieldwork was tailored to minimise
disruption to people's lives and we provided regular feedback to the community.
We saw 81% of non-Aboriginal and 65% of Aboriginal children at age 12 months. OM 
was diagnosed on 55% and 26% of routine clinical examinations in Aboriginal and
non-Aboriginal children respectively. Aboriginal mothers were younger and less
educated, fewer were employed and they lived in more crowded conditions than
non-Aboriginal mothers. Sixty-four per cent of Aboriginal and 40% of
non-Aboriginal babies were exposed to environmental tobacco smoke. Early
consultation, provision of a service while undertaking research, inclusion of
Aboriginal people as active members of a research team and appropriate
acknowledgement will assist in ensuring successful completion of the research.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18173785 [PubMed - indexed for MEDLINE]

224: Eur Arch Otorhinolaryngol. 2008 Jul;265(7):843-6. Epub 2008 Jan 3.

Primary temporal bone secretory meningioma presenting as chronic otitis media.

Marcelissen TA, de Bondt RB, Lammens M, Manni JJ.

Department of Otolaryngology and Head and Neck Surgery, University Hospital
Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
t.marcelissen@home.nl

We report an extremely rare case of a secretory meningioma primarily involving
the temporal bone. A 56-year old female patient presented to us with a history of
a chronic otitis media and unilateral hearing loss. Diagnostic investigations
revealed a tumor arising from the temporal bone without signs of intracranial
involvement. Histopathological examination showed a meningioma of the secretory
type. The tumor was partially resected and serial imaging at follow-up revealed
no extension of the tumor. No new symptoms developed 1 year after surgery.
Secretory meningioma is a rare meningioma subtype and extracranial presentation
in the temporal bone is very unusual. We present the first case of a primary
temporal bone secretory meningioma in the otorhinolaryngological literature. As
radical as possible surgical excision with serial imaging at follow-up is
recommended.

PMID: 18172659 [PubMed - indexed for MEDLINE]

225: Pediatrics. 2008 Jan;121(1):e24-33.

Clinical characteristics of New York City children who received tympanostomy
tubes in 2002.

Keyhani S, Kleinman LC, Rothschild M, Bernstein JM, Anderson R, Simon M, Chassin 
M.

Department of Health Policy, Mount Sinai School of Medicine, One Gustave L. Levy 
Pl, Box 1077, New York, NY 10029, USA. salomeh.keyhani@mountsinai.org

OBJECTIVE: Tympanostomy tube insertion is the most common procedure that requires
general anesthesia for children in the United States. We report on the clinical
characteristics of a cohort of New York City children who received tympanostomy
tubes in 2002. METHODS: This retrospective cohort study included all 1046
children who received tubes in 2002 in any of 5 New York City area hospitals. We 
analyzed clinical data for all 682 (65%) children for whom we were able to
abstract data for the preceding year from all of 3 sources: hospital,
pediatrician, and otolaryngologist medical charts. RESULTS: Mean age was 3.8
years, 57% were male, and 74% had private insurance. More than 25% of children
had received tubes previously. The stated reason for surgery was otitis media
with effusion for 60.4% of children, recurrent acute otitis media for 20.7%, and 
eustachian tube dysfunction for 10.6%. Children with recurrent acute otitis media
averaged 3.1 +/- 0.2 episodes (median: 3.0) in the previous year; those with
otitis media with effusion averaged effusions that were 29 +/- 1.7 days long
(median: 16 days) at surgery. Twenty-five percent of children had bilateral
effusions of >42 days' duration at surgery. Despite a clinical practice guideline
for otitis media with effusion that recommends withholding tympanostomy tubes for
otherwise healthy children until a bilateral effusion is at least 3 to 4 months
old, 50% of children had surgery without having had 3 months of effusion
cumulatively during the year before surgery. CONCLUSIONS: The clinical
characteristics of children who received tympanostomy tubes varied widely. Many
children with otitis media with effusion had shorter durations of effusions than 
are generally recommended before surgery. The extent of variation in treating
this familiar condition with limited treatment options suggests both the
importance and the difficulty of managing common practice in accordance with
clinical practice guidelines.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 18166541 [PubMed - indexed for MEDLINE]

226: Otolaryngol Head Neck Surg. 2008 Jan;138(1):50-6.

Medical decision analysis: indications for tympanostomy tubes in RAOM by age at
first episode.

Higgins TS, McCabe SJ, Bumpous JM, Martinez S.

Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical
School, Norfolk, VA 23507, USA. higgints@evms.edu

OBJECTIVE: To compare utility estimates between tympanostomy tubes (TT) and
short-courses of antibiotics in children with recurrent acute otitis media (RAOM)
stratified by age at first episode. STUDY DESIGN AND SETTING: Formal decision
analysis. RESULTS: The model recommended TT sooner in children with a history of 
a first episode of AOM occurring early in life. In children over 12 months old at
onset, TT were recommended with seven episodes in 24 months, five episodes in 12 
months, and three episodes in six months. In children under six months old at
onset, TT were recommended with three episodes in 24 months and two episodes in a
six-month or 12-month time span. CONCLUSIONS: Earlier TT may be indicated in
children who developed a first episode of AOM at a very young age because of the 
higher risk of AOM recurrence. SIGNIFICANCE: This study is the first formal
decision analysis to compare tympanostomy tubes and short-courses of antibiotics 
stratified by age at onset of the first AOM episode.

Publication Types: 
    Comparative Study

PMID: 18164993 [PubMed - indexed for MEDLINE]

227: Pediatr Infect Dis J. 2008 Jan;27(1):71-3.

Randomized, controlled trial efficacy of pneumococcal conjugate vaccine against
otitis media among Navajo and White Mountain Apache infants.

O'Brien KL, David AB, Chandran A, Moulton LH, Reid R, Weatherholtz R, Santosham
M.

Center for American Indian Health, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA. klobrien@jhsph.edu

We report the phase III trial efficacy of 7-valent pneumococcal conjugate vaccine
against clinical and culture proven otitis media (OM) among Navajo and White
Mountain Apache infants. Efficacy was -0.4% (95% CI: -19.4 to 15.6) for
clinically-diagnosed OM, 5.1% (95% CI: -51.5 to 40.6) for severe OM, and 64% (95%
CI: -34% to 90%) for vaccine serotype pneumococcal OM suggesting that this
vaccine is efficacious for pneumococcal OM in this high risk population.

Publication Types: 
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 18162944 [PubMed - indexed for MEDLINE]

228: Pediatr Infect Dis J. 2008 Jan;27(1):12-6.

Seasonal distribution of otitis media pathogens among Costa Rican children.

Guevara S, Soley C, Arguedas A, Porat N, Dagan R.

Instituto de Atención Pediátrica, San José, Costa Rica.

BACKGROUND: Otitis media is an important cause of pediatric consultation, and
knowledge of yearly pathogen distribution might improve antimicrobial selection. 
OBJECTIVES: To determine the seasonal pathogen and antimicrobial resistance
distribution among Costa Rican children with otitis media. METHODS: Between 1999 
and 2004, 952 children with otitis media, aged 3-144 months who participated in
various clinical trials, were analyzed. Data obtained from this period were
compared against historical data collected between 1992 and 1997. RESULTS: Five
hundred sixteen (52%) children had a baseline middle ear fluid pathogen isolated.
The most common pathogens were Streptococcus pneumoniae 252 (49%), Haemophilus
influenzae 190 (37%), S. pyogenes 38 (7%), and Moraxella catarrhalis 36 (7%). The
overall proportion of H. influenzae (24-37%; P = 0.01) and the production of
beta-lactamase producing H. influenzae (2.6-7%; P = 0.02) increased from
1992-1997 to 1999-2004. There was a nonstatistically significant trend for a
higher frequency of S. pneumoniae and H. influenzae isolates detected during the 
rainy season than during the dry season: S. pneumoniae 58% versus 42% but not
significant (P = 0.1) and H. influenzae 68% versus 32% (P = 0.06), respectively. 
During the rainy season, penicillin-nonsusceptible S. pneumoniae was identified
more frequently (38.5%) than during the dry season (18%) (P = 0.003; odds ratio: 
2.94; 95% confidence interval: 1.4-6.45). Penicillin-nonsusceptible S. pneumoniae
decreased from 46.5% (1999-2001) to 16% (2002-2003) and this was associated with 
a significant decline of a circulating 19F penicillin-resistant S. pneumoniae
serotype (from 89% to 26%), respectively. CONCLUSIONS: S. pneumoniae and H.
influenzae are the 2 most common pathogens producing otitis media in Costa Rican 
children. An increase in the number of H. influenzae and M. catarrhalis was
observed in recent years. Penicillin-nonsusceptible S. pneumoniae isolates were
more commonly observed during the rainy season, in which increased morbidity with
respiratory pathogens is observed.

PMID: 18162931 [PubMed - indexed for MEDLINE]

229: Hear Res. 2008 Feb;236(1-2):22-32. Epub 2007 Nov 24.

Combined effect of fluid and pressure on middle ear function.

Dai C, Wood MW, Gan RZ.

School of Aerospace and Mechanical Engineering and Bioengineering Center,
University of Oklahoma, 865 Asp Avenue, Room 200, Norman, OK 73019, United
States.

In our previous studies, the effects of effusion and pressure on sound
transmission were investigated separately. The aim of this study is to
investigate the combined effect of fluid and pressure on middle ear function. An 
otitis media with effusion model was created by injecting saline solution and air
pressure simultaneously into the middle ear of human temporal bones. Tympanic
membrane displacement in response to 90 dB SPL sound input was measured by a
laser vibrometer and the compliance of the middle ear was measured by a
tympanometer. The movement of the tympanic membrane at the umbo was reduced up to
17 dB by the combination of fluid and pressure in the middle ear over the
auditory frequency range. The fluid and pressure effects on the umbo movement in 
the fluid-pressure combination are not additive. The combined effect of fluid and
pressure on the umbo movement is different compared with that of only fluid or
pressure change in the middle ear. Negative pressure in fluid-pressure
combination had more effect on middle ear function than positive pressure.
Tympanometry can detect the middle ear pressure of the fluid-pressure
combination. This study provides quantitative information for analysis of the
combined effect of fluid and pressure on tympanic membrane movement.

Publication Types: 
    In Vitro
    Research Support, N.I.H., Extramural

PMID: 18162348 [PubMed - indexed for MEDLINE]

230: J Med Food. 2007 Dec;10(4):636-42.

Topical anti-inflammatory activities of Vitis rotundifolia (muscadine grape)
extracts in the tetradecanoylphorbol acetate model of ear inflammation.

Bralley EE, Hargrove JL, Greenspan P, Hartle DK.

Nutraceutical Research Laboratories, Department of Pharmaceutical and Biomedical 
Sciences, University of Georgia, Athens, GA 30602, USA.

The ability of muscadine grape skin, seed, or combined skin and seed extracts to 
inhibit mouse ear inflammation, edema, and polymorphonuclear leukocyte
infiltration was tested following topical application of
12-O-tetradecanoylphorbol 13-acetate (TPA). Ethanolic extracts of skins, seeds,
or a combination of these from purple (Ison) cultivars were applied to both ears 
of female Swiss mice 30 minutes after TPA (2 microg per ear) administration.
Control mice were treated with indomethacin or 50% ethanol vehicle 30 minutes
after TPA. Ear thickness was measured before TPA and at 4 and 24 hours post-TPA
administration to assess ear edema. Ear punch biopsies were collected at 24 hours
and weighed as a second marker of edema. Myeloperoxidase (MPO) (EC 1.11.1.7)
activity was measured in each ear punch biopsy as an index of neutrophil
infiltration. Extracts of muscadine skin, seed, and combination treatments
significantly reduced ear edema, ear biopsy weight, and MPO activity compared to 
TPA vehicle control. There was no significant difference in anti-inflammatory
activity of the skin and seed extracts. However, an additive effect was observed 
with the combination treatment that was statistically similar to the
anti-inflammatory activity of indomethacin treatment. It can be concluded that
muscadine skin, seed, and combination skin/seed extracts exhibit significant
topical anti-inflammatory properties.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18158834 [PubMed - indexed for MEDLINE]

231: Arch Dis Child. 2008 Jan;93(1):40-4.

Comment in:
    Arch Dis Child. 2008 Aug;93(8):714.    Evid Based Nurs. 2008 Oct;11(4):107.    J Fam Pract. 2008 Jun;57(6):370-3.

Topical lignocaine for pain relief in acute otitis media: results of a
double-blind placebo-controlled randomised trial.

Bolt P, Barnett P, Babl FE, Sharwood LN.

Emergency Department, Royal Children's Hospital, Murdoch Children's Research
Institute and University of Melbourne, Melbourne, Australia.

OBJECTIVE: Acute otitis media (AOM) is common in children, yet the optimal
management of ear pain associated with AOM has not been well studied. We set out 
to determine the efficacy of topical aqueous 2% lignocaine eardrops compared with
a placebo (saline) for pain relief of AOM in children. DESIGN: Double-blind,
randomised, placebo-controlled trial. SETTING: Tertiary children's hospital
emergency department. PATIENTS AND INTERVENTIONS: Children aged between 3 and 17 
years with earache and AOM without evidence of perforation were eligible.
Patients were randomised to receive either 2% lignocaine or saline eardrops
(placebo). MAIN OUTCOME MEASURES: Pain scores were measured before and after
ear-drop administration. Patient and physician-interpreted pain scores were
measured by using the Bieri faces pain scale and visual analogue scale at 10, 20 
and 30 minutes. The primary outcome measure was reduction in patient-measured
pain scores by 50% from the baseline. Secondary outcome measures were reduction
in patient-measured pain scores by 25% or by at least two points. Telephone
follow-up occurred after 1 day and 1 week. Analysis was by intention to treat.
RESULTS: 63 children (31 were treated with lignocaine, 32 with placebo) aged 3 to
12 years were enrolled. The groups were demographically and clinically similar,
with similar proportions having received analgesia in the preceding 4 hours.
Children receiving lignocaine showed significantly lower patient-measured pain
scores with a reduction by 50% from baseline at 10 minutes (RR 2.06, 95% CI
1.03-4.11, p = 0.03) and 30 minutes (RR 1.44, 95% CI 1.07-1.93, p = 0.009) but
not at 20 minutes (RR 1.35 95% CI 0.88-2.06). The response to lignocaine
treatment showed significantly lower patient-measured pain scores for 25%
reduction at all time points and for two-point reduction at 10 minutes and
favoured lignocaine at 20 minutes and 30 minutes without reaching statistical
significance. There were no serious adverse events during the 30 minute follow-up
period. CONCLUSION: This study suggests that topical aqueous 2% lignocaine
eardrops provide rapid relief for many young children presenting with ear pain
attributed to AOM. The concurrent use of simple oral analgesia is a likely
contributor to effective management of this painful childhood condition.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 18156478 [PubMed - indexed for MEDLINE]

232: Int J Antimicrob Agents. 2008 Mar;31(3):228-34. Epub 2007 Dec 26.

A class IIa peptide from Enterococcus mundtii inhibits bacteria associated with
otitis media.

Knoetze H, Todorov SD, Dicks LM.

Department of Microbiology, University of Stellenbosch, Stellenbosch 7600, South 
Africa.

Peptide ST4SA, produced by Enterococcus mundtii ST4SA, inhibits the growth of
Acinetobacter baumannii, Enterococcus faecalis, Enterococcus faecium,
Staphylococcus aureus, Streptococcus pneumoniae and Gram-positive bacteria
isolated from patients diagnosed with middle ear infections. The peptide adsorbed
at a level of 94% to S. pneumoniae 40, Pseudomonas aeruginosa 25 and E. faecium
HKLHS. Low concentrations of peptide ST4SA (51200 arbitrary units (AU)/mL) caused
DNA and enzyme leakage from target cells, whilst 1638400AU/mL caused cell lysis. 
No decrease in antimicrobial activity was observed when tested on solid medium
with human blood as base. Peptide ST4SA revealed a similar level of activity
compared with tetracycline (30 microg), but much higher activity compared with
nasal sprays, aminoglycosides, cephalosporins, fluoroquinolones, lincosamides,
macrolides, nitroimidazole, penicillin, quinolones, sulphonamides,
chloramphenicol, furazolidone, fusidic acid, rifampicin, trimethoprim,
trimethoprim/sulfamethoxazole and vancomycin when tested in vitro. Peptide ST4SA 
dissipates the proton-motive force and may be used in the treatment of
multidrug-resistant strains where antibiotics are excluded from cells by efflux
pumps dependent on the membrane proton gradient.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 18155886 [PubMed - indexed for MEDLINE]

233: Eur Arch Otorhinolaryngol. 2008 Aug;265(8):887-91. Epub 2007 Dec 20.

Analysis of axial temporal bone computed tomography scans for performing a safe
posterior tympanotomy.

Kim CW, Oh SJ, Kim HS, Ha SH, Rho YS.

Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University
College of Medicine, 445 Gil-Dong, Gangdong-gu, Seoul 134-701, South Korea.
kcw5088@dreamwiz.com

A posterior tympanotomy is a procedure performed to access the posterior
mesotympanum to remove pathologic lesions through a mastoid exposure. In this
study, we aimed to evaluate and classify the anatomical relationships between the
vertical segment of the facial nerve and the mastoid antrum in an axial temporal 
bone CT to prevent facial nerve injury when performing a posterior tympanotomy.
We performed retrospective analysis of temporal bone CT scans. A cohort of 102
patients who underwent tympanomastoidectomy for chronic otitis media, and 43
patients with sensorineural hearing loss with normal temporal bone, were
included. All patients had preoperative and diagnostic computed tomography of the
temporal bone from January to December 2006. Anatomical relationships were
evaluated according to several parameters: protrusion of the facial nerve into
the mastoid antrum, status of the facial canal, new bone formation over the
facial canal, and size of the mastoid antrum. Anatomical relationships between
the vertical segment and the mastoid antrum were classified into six types. Type 
1 has no protrusion of the facial nerve with a regular facial canal, and Type 2
has no protrusion with a partly thin facial canal. Type 3 has protrusion into the
antrum with a regular facial canal, and Type 4 has protrusion with a partly thin 
facial canal. Type 5 has new bone formation around the facial canal, and Type 6
has new bone formation with a small or contracted antrum. These results may
enable preoperative assessment of the facial nerve's status, and provide
background knowledge to prevent facial nerve injury when performing a posterior
tympanotomy.

PMID: 18097676 [PubMed - indexed for MEDLINE]

234: Otol Neurotol. 2008 Apr;29(3):350-2.

Idiopathic inflammatory medial meatal fibrotizing otitis presenting in children.

Hopsu E, Pitkäranta A.

Department of Otorhinolaryngology, Kymenlaakso Central Hospital, Korka, Finland. 
erkki.hopsu@kymshp.fi

OBJECTIVE: Acquired atresia of the ear canal presents rarely in children.
Idiopathic inflammatory medial meatal fibrotizing otitis (IMFO) evidently has its
own distinct etiopathologic findings causing acquired ear canal atresia.
PATIENTS: Two IMFO children treated and followed-up at the Department of
Otorhinolaryngology of Helsinki University Hospital. INTERVENTIONS: Clinical and 
radiologic evaluation of 2 children with IMFO solely affecting the glabrous skin 
over the osseous part of the ear canal and the tympanic membrane. MAIN OUTCOME
MEASURE: Review of identical cases of the acquired postinflammatory or
inflammatory medial meatal atresia in children reported in association with
literature. RESULT: Idiopathic inflammatory medial meatal fibrotizing otitis,
affecting solely the glabrous skin on the tympanic membrane and the osseous part 
of the external ear canals, is manifesting in 2 children without ongoing chronic 
middle ear infection. CONCLUSION: The etiopathologic findings or pathophysiology 
of IMFO is speculative. The success of surgical correction of the already-formed 
fibrous atresia has not been established.

Publication Types: 
    Case Reports

PMID: 18097334 [PubMed - indexed for MEDLINE]

235: Braz J Otorhinolaryngol. 2007 Sep-Oct;73(5):671-4.

Sensorineural hearing loss in chronic suppurative otitis media with and without
cholesteatoma.

de Azevedo AF, Pinto DC, de Souza NJ, Greco DB, Gonçalves DU.

Santa Casa de Misericórdia, Belo Horizonte.

Sensorineural hearing loss (SNHL) related to chronic suppurative otitis media
(CSOM) was studied to clarify the involvement of cholesteatomas in this context. 
AIM: to evaluate SNHL related to CSOM and its association with cholesteatomas,
disease duration and patients ages. METHODS: Retrospective analysis of 115
patients with CSOM with and without cholesteatoma submitted to surgical
treatment. Inclusion criteria were active unilateral disease, normal
contralateral ear and age below 60 years. RESULTS: The average age was 26.3
years, 58 males and 57 females. The duration of ear disease was, in average, 12.4
years. The average threshold of hearing was 40 dB in CSOM ear and 22 dB in the
normal contralateral ear (P=0.002). CSOM with cholesteatoma occurred in 78 of 115
cases. In the abnormal ear, SNHL was seen in 15 cases, being 6 cases of profound 
loss, that correlated with adjusted-age (P=0.003) and absence of cholesteatoma
(P=0.01), but not with disease duration (P=0.458). CONCLUSION: SNHL occurred in
13% of the patients with CSOM, and was correlated with older age, but not with
the presence of cholesteatoma or longer duration of ear disease.

PMID: 18094809 [PubMed - indexed for MEDLINE]

236: Am Fam Physician. 2007 Dec 1;76(11):1650-8.

Erratum in:
    Am Fam Physician. 2008 Jul 1;78(1):30. dosage error in text.

Comment in:
    Am Fam Physician. 2008 Jul 1;78(1):28; discussion 30.

Summary for patients in:
    Am Fam Physician. 2007 Dec 1;76(11):1659-60.

Diagnosis and treatment of otitis media.

Ramakrishnan K, Sparks RA, Berryhill WE.

University of Oklahoma Health Sciences Center, Oklahoma City 73104, USA.
kramakrishnan@ouhsc.edu

Diagnostic criteria for acute otitis media include rapid onset of symptoms,
middle ear effusion, and signs and symptoms of middle ear inflammation.
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are
the most common bacterial isolates from the middle ear fluid of children with
acute otitis media. Fever, otalgia, headache, irritability, cough, rhinitis,
listlessness, anorexia, vomiting, diarrhea, and pulling at the ears are common,
but nonspecific symptoms. Detection of middle ear effusion by pneumatic otoscopy 
is key in establishing the diagnosis. Observation is an acceptable option in
healthy children with mild symptoms. Antibiotics are recommended in all children 
younger than six months, in those between six months and two years if the
diagnosis is certain, and in children with severe infection. High-dosage
amoxicillin (80 to 90 mg per kg per day) is recommended as first-line therapy.
Macrolide antibiotics, clindamycin, and cephalosporins are alternatives in
penicillin-sensitive children and in those with resistant infections. Patients
who do not respond to treatment should be reassessed. Hearing and language
testing is recommended in children with suspected hearing loss or persistent
effusion for at least three months, and in those with developmental problems.

Publication Types: 
    Review

PMID: 18092706 [PubMed - indexed for MEDLINE]

237: Nepal Med Coll J. 2007 Sep;9(3):196-8.

Microorganisms present in discharging otitis media in a group of patients in
Kathmandu.

Jha AK, Singh JB, Dutta D.

Department of Otolaryngology and Head and Neck Surgery, Nepal Medical College and
Teaching Hospital, Jorpati. drakjha@gmail.com

Discharge from the ear is one of the commonest symptoms of infections of the ear.
To study the major strains of bacteria encountered in ear discharges, this study 
was conducted from July 1999, to June 2001 in the microbiology laboratory of Om
Hospital. A total of 115 patients, of 6-35 years of age clinically diagnosed as
discharging otitis media were studied. In 60.9% single organism and in 26.08% two
organisms were isolated. Results revealed that, Staphylococcus aureus (34.3%),
Klebsiella pneumoniae (24.3%), Pseudomons aeruginosa (22.8%), Enterobacter sps
(7.1%), Esch coli (4.3%), Citrobacter sps (1.4%), Proteus sps (1.4%),
Acinetobacter sps (1.4%) and Pneumococci (1.4%) were the common organisms in the 
discharge. Candida albicans (2.8%) was the pathogen in two cases. In 27.8% of
cases the causative agent was not demonstrated. About sixty percent (65.9%),
64.8% and 56.0% of the isolates were sensitive to amikacin, ciprofloxacin and
gentamycin respectively.

PMID: 18092440 [PubMed - indexed for MEDLINE]

238: Otol Neurotol. 2007 Dec;28(8):1072-5.

Mechanical obstruction of the eustachian tube by the benign tumor of the
parapharyngeal space does not cause otitis media with effusion.

Sumi T, Tsunoda A, Shirakura S, Kishimoto S.

Department of Otolaryngology, Tokyo Medical and Dental University, Bunkyo-ku,
Yushima 1-5-45, Tokyo 113-8519, Japan.

OBJECTIVE: We are reporting on eustachian tube and middle ear pathologic findings
in patients with parapharyngeal tumors. PATIENTS: Eleven cases of eustachian tube
involvement as indicated by obstruction due to compression of the tumor were
assessed in this study. MAIN OUTCOME MEASURES: Each patient underwent otoscopy,
nasopharyngoscopy, a pure-tone hearing test, impedance audiometry, and
sonotubometry. RESULTS: All of the tumors were diagnosed benign according to the 
histologic examination. In 9 of the 11 patients, the pharyngeal opening of the
eustachian tube narrowed or was blocked by the tumor. None of the patients showed
any response on the tumor side in the sonotubometry. Therefore, gas exchange was 
prevented through the eustachian tube by the tumor; however, they also showed an 
intact tympanic membrane and normal hearing tests. CONCLUSION: According to our
data, if there is drainage of middle ear fluid through the eustachian tube and
the exchange of gas in the middle ear is preserved, otitis media with effusion
will not occur even in cases such as these.

Publication Types: 
    Case Reports

PMID: 18084819 [PubMed - indexed for MEDLINE]

239: Infection. 2008 Feb;36(1):2-14. Epub 2007 Dec 14.

Nitrogen and oxygen molecules in meningitis-associated labyrinthitis and hearing 
impairment.

Klein M, Koedel U, Kastenbauer S, Pfister HW.

Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-University,
Marchioninistr. 15, 81377, Munich, Germany.

Pneumococcal meningitis remains a serious disease with a case fatality rate of
15%-25%. Furthermore, long-term residues affect up to 50% of survivors. One of
the most frequent sequelae is sensorineural hearing loss, which occurs in 26% of 
survivors of pneumococcal meningitis. Unfortunately, sufficient treatment
regimens are still missing. New insights into the pathology and pathophysiology
of meningitis-associated hearing loss have come from animal models of bacterial
meningitis. Most likely, bacteria reach the cochlea through the cochlear
aquaeduct. Once arrived in the perilymphatic spaces, they induce a severe
suppurative labyrinthitis. The blood-labyrinth barrier breaks, hair cells are
damaged, and neurons in the spiral ganglion undergo cell death, leading to
meningitis-associated hearing loss. Reactive oxygen and nitrogen species, in
particular peroxynitrite, seem to be among the crucial mediators of cochlear
damage and hearing loss during meningitis. In our rat model of pneumococcal
meningitis, adjunctive therapy with the antioxidants and peroxynitrite scavengers
Mn(III)tetrakis(4-bencoic acid)-porphyrin (MnTBAP) and N-Acetyl-L-Cystein (NAC)
significantly attenuated acute and long-term hearing loss. In several other
animal studies of pneumococcal meningitis, adjunctive antioxidant therapy also
protected infected animals from intracranial complications. Therefore, the use of
antioxidants seems to be a promising future treatment option in pneumococcal
meningitis.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 18084715 [PubMed - indexed for MEDLINE]

240: Clin Otolaryngol. 2007 Dec;32(6):429-39.

Psychometric qualities of questionnaires for the assessment of otitis media
impact.

Timmerman AA, Meesters CM, Speyer R, Anteunis LJ.

Department of Otorhinolaryngology - Head & Neck Surgery, University Hospital of
Maastricht, Maastricht, The Netherlands. ati@skno.azm.nl

BACKGROUND: The assessment of impact and evaluation of treatment effects in
chronic otitis media (OM) calls for a much broader approach than just examining
the presence of middle ear effusion or hearing loss. It is increasingly
recognised that this condition may result in a comprised quality of life. Several
studies have used proxy completed questionnaires to objectify the illness
experience associated with chronic OM. OBJECTIVE OF REVIEW: To review
questionnaires which have been developed to describe the effects of chronic OM on
the daily functioning of children. Psychometric properties have been evaluated,
in addition to discriminative and evaluative qualities. TYPE OF REVIEW: A
systematic review of publications pertaining to developed questionnaires related 
with chronic OM. SEARCH STRATEGY: Systematic literature searches of PubMed
(1966-January 2007) and EMBASE (1989-January 2007) were conducted, supplemented
by using free text words to identify publications after January 2005. RESULTS:
The included 15 questionnaires were developed for children with recurrent or
persistent OM, describing functional health status (FHS), while two
questionnaires also evaluate the effect of tympanostomy tubes insertion. The
questionnaires generally cover six impact areas (physical symptoms, child
development, educational performance, emotional/practical burden and general
health status) with physical symptoms being the most prominant. CONCLUSIONS: The 
OM8-30, OMO-22 and OM-6 adequately reflect the multidimensional aspects of FHS in
chronic OM. The OMO-22 and OM8-30 show the best psychometric properties for the
discrimination of impact severity between children, while the OM-6 was found to
have the best qualities for the evaluation of clinical change. Clinical
applicability is crucial for the assessment of FHS in chronic OM, but requires a 
trade-off with necessary psychometric properties.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 18076428 [PubMed - indexed for MEDLINE]

241: Audiol Neurootol. 2008;13(3):161-71. Epub 2007 Dec 13.

Electrically evoked auditory steady-state responses in a guinea pig model:
latency estimates and effects of stimulus parameters.

Jeng FC, Abbas PJ, Brown CJ, Miller CA, Nourski KV, Robinson BK.

Department of Speech Pathology and Audiology, University of Iowa, Iowa City,
Iowa, USA. jeng@ohio.edu

Cochlear implant speech processors typically extract envelope information of
speech signals for presentation to the auditory nerve as modulated trains of
electric pulses. Recent studies showed the feasibility of recording, at the
scalp, the electrically evoked auditory steady-state response using
amplitude-modulated electric stimuli. Sinusoidally amplitude-modulated electric
stimuli were used to elicit such responses from guinea pigs in order to
characterize this response. Response latencies were derived to provide insight
regarding neural generator sites. Two distinct sites, one cortical and another
more peripheral, were indicated by latency estimates of 22 and 2 ms,
respectively, with the former evoked by lower (13-49 Hz) and the latter by higher
(55-320 Hz) modulation frequencies. Furthermore, response amplitudes declined
with increasing carrier frequency, exhibited a compressive growth with increasing
modulation depths, and were sensitive to modulation depths to as low as 5%. (c)
2007 S. Karger AG, Basel

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18075245 [PubMed - indexed for MEDLINE]

242: Georgian Med News. 2007 Oct;(151):40-4.

Systemic inflammatory responses in patients with acute otitis media and the
impact of treatment with sinupret.

Chkhaidze I, Nemsadze K, Gotsadze K, Nikoleishvili E, Gordeladze G.

Tbilisi State Medical University, Tbilisi.

The systemic inflammatory responses and the impact of sinupret therapy have been 
investigated in 14 patients with acute otitis media, AOM. The age of inspected
individuals covered a range of 29.0+/-12.3 years. The blood samples were taken at
the admission and after ten days treatment with sinupret. The dosage of sinupret 
application was two tablets or 50 drops three times per day. Utilizing the
technique of enzymelinked immunoassays, the concentrations of two cytokines,
TNF-alpha and IL-6, were measured in the blood serum. The minimum detectable
amount of cytokines was less then 2.5 pg/ml. Age-matched five healthy subjects
without significant medical history served for controls. The study proved an
existence of systemic inflammatory responses under the AOM. In AOM patients as
compared with healthy individuals the concentrations of both cytokines were
elevated, although the difference reached the statistically significant level
with respect to TNF-alpha but not to IL-6. After treatment with sinupret, the
TNF-alpha level dropped noticeably, proving a recovery from the pathology. IL-6
displayed a similar pattern, although the difference between pre- and
post-treatment samples was statistically nonsignificant. Assessment of varies
cytokines and proper establishment of their profiles could detect more specific
marker(s) of AOM of both bacterial or viral etiology and could promote thus a
precise prediction of the outcome of the pathology. Generally, the estimation of 
cytokines under AOM could offer a powerful tool for the objective evaluation of
efficacy of treatment and for the avoidance of the ineffective drug therapy.

PMID: 18071211 [PubMed - indexed for MEDLINE]

243: Pediatr Infect Dis J. 2007 Oct;26(10 Suppl):S4-7.

The burden and outcome of respiratory tract infection in Australian and
aboriginal children.

Leach AJ, Morris PS.

Ear and Respiratory Unit, Child Health Division, Menzies School of Health
Research, and Charles Darwin University, Darwin, Northern Territory, Australia.
Amanda.leach@menzies.edu.au

The burden of otitis media in developing and disadvantaged populations is
substantial. This article looks at that burden in developed affluent and
indigenous populations (in Australia). A model is presented to explain the high
prevalence of chronic suppurative otitis media in indigenous populations, and an 
assessment of efforts to improve these outcomes if not prevent these infections
is provided. Lastly, various international guidelines for managing acute otitis
media are compared.

PMID: 18049380 [PubMed - indexed for MEDLINE]

244: Pediatr Infect Dis J. 2007 Oct;26(10 Suppl):S17-9.

Bacterial biofilms in otitis media: evidence and relevance.

Bakaletz LO.

College of Medicine, The Ohio State University, Center for Microbial
Pathogenesis, Columbus Children's Research Institute, Columbus, Ohio, USA.
BakaletL@pediatrics.ohio-state.edu

A biofilm is a highly organized, multicellular network of bacteria encased in a
matrix and found in close association with a surface. Substantial effort in
understanding the biologic and biochemical nature of biofilms has resulted in
evidence supporting their importance in otitis media (OM), both from the
perspective how pathogens develop viable communities in the middle ear as well as
how this structure impedes successful antibiotic therapy. This new understanding 
may explain the recurrent nature of OM, and the persistence of middle ear fluid
after infection. This article looks closely at biofilms in OM and suggests that
an improved understanding of the unique properties of bacteria resident within a 
biofilm and the proteins they express while part of this organized community has 
the potential to identify novel and perhaps biofilm-specific molecular targets
for the design of vaccine candidates for the prevention of OM.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 18049376 [PubMed - indexed for MEDLINE]

245: Pediatr Infect Dis J. 2007 Oct;26(10 Suppl):S12-6.

Evolving microbiology and molecular epidemiology of acute otitis media in the
pneumococcal conjugate vaccine era.

Pichichero ME, Casey JR.

Department of Microbiology and Immunology, University of Rochester, Rochester,
New York 14642, USA. urmc.rochester.edu

The addition of the 7-valent pneumococcal conjugate vaccine (PCV7) to the routine
immunization schedule in the United States for infants has produced a much more
favorable impact on the incidence of acute otitis media (AOM) than anticipated.
Because the serotypes included in PCV7 were those most frequently expressing
antibiotic resistance in 2001, predictions were made that up to 98% of
pneumococcal AOM episodes would be caused by penicillin susceptible strains.
However, recent studies have shown that the benefits of PCV7 are becoming eroded.
Replacement serotypes of pneumococci have emerged, expressing polysaccharide
capsules different from those included in PCV7, with increasing frequency. These 
replacement strains are coming to dominate in the nasopharynx and in AOM isolates
(and in invasive disease). Expansion in the isolation of serotypes 3, 7F,
15B/C/F, 19A, 22F, 33F, and 38 has been described in various surveillance
systems. Pneumococcal strains expressing non-PCV7 capsular serotypes also appear 
to be rapidly acquiring resistance to penicillin and other antibiotics. Emergence
of strains of pneumococci expressing non-PCV7 capsular serotypes is occurring by 
multiple mechanisms including capsular switching as suggested by molecular
epidemiology studies. Expansion of the number of serotypes included in
pneumococcal conjugate vaccines is needed to sustain a long-term benefit from
immunization against these bacteria.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18049375 [PubMed - indexed for MEDLINE]

246: Am J Otolaryngol. 2008 Jan-Feb;29(1):1-6.

Complications in primary and secondary acquired cholesteatoma: a prospective
comparative study of 62 ears.

Vikram BK, Udayashankar SG, Naseeruddin K, Venkatesha BK, Manjunath D,
Savantrewwa IR.

Department of Otolaryngology, Head and Neck Surgery, Karnataka Institute of
Medical Sciences, Hubli, India. entvikram@rediffmail.com

OBJECTIVES: This study aimed to compare the clinicopathologic behavior of
complications in primary and secondary acquired cholesteatoma and figure out the 
differences between them. DESIGN: This was a prospective cross-sectional study.
METHODS: This was a study conducted in a tertiary referral medical college
hospital comprising of 62 ears, of which 32 were in the primary acquired
cholesteatoma group (PACG) and 30 were in the secondary acquired cholesteatoma
group (SACG). We compared the 2 groups with respect to 7 prognostic variables, as
follows: age distribution, sex, duration of ear discharge, pathology in the ear, 
predisposing disease focus in nose and throat, pattern of complications, and
microbiology of ear. OBSERVATION AND RESULTS: The presence of cholesteatoma
increased the risk for complications by more than 2 times in PACG, but the
presence of granulation tissue did not show the same risk. More than half of the 
ears with complication contained some or the other predisposing disease focus in 
the nose or throat. The PACG was 3 times more prone to complications than the
SACG in the presence of these foci. They showed a similar pattern of
complications. Brain abscess and mastoid infections were the commonest
complications. CONCLUSIONS: The PACG was more prone to complications than the
SACG in the presence of cholesteatoma and focus in the nose and throat.
Irrespective of the different pathologic origin of the 2 types, the patterns of
complications remained the same with no major differences, indicating a common
final pathway in the natural course of the disease.

Publication Types: 
    Comparative Study

PMID: 18061824 [PubMed - indexed for MEDLINE]

247: Int J Pediatr Otorhinolaryngol. 2008 Feb;72(2):209-14. Epub 2007 Dec 4.

Presence of otitis media with effusion and its risk factors affect serum cytokine
profile in children.

Johnston BN, Preciado DA, Ondrey FG, Daly KA.

Department of Otolaryngology-Head and Neck Surgery, University of Minnesota,
Minneapolis, MN, United States.

Otitis media with effusion (OME) is a condition that has significant impact on
the quality of life of children. Although the etiology is multi-factorial,
certain risk factors such as an allergic predisposition, daycare, and cigarette
smoke exposure contribute to its pathogenesis. OBJECTIVE: (1) To determine
whether there is a tendency for children with chronic or recurrent OME (cases) to
have higher serum levels of the T-helper 2 cell (Th-2) allergenic-type cytokines,
interleukin-4 (IL-4), and IL-5, or the T-helper 1(Th-1) infectious-type
cytokines, interferon-gamma (IFN-gamma), and tumor necrosis factor-alpha
(TNF-alpha), compared to children without a history of recurrent OME (controls)
and (2) to determine any possible correlations between the cytokine levels and
risk factors associated with OME. METHODS: We analyzed serum levels of these four
cytokines by enzyme-linked immunosorbent assays of 19 cases and 17 controls.
RESULTS: Cases, independent of age, had increased levels of serum IL-5 compared
to controls (p=0.014). While a significant difference in serum IL-4 levels did
not exist between cases and controls, children exposed to cigarette smoke had
significantly higher levels of serum IL-4 (p=0.003). While serum levels of
IFN-gamma were statistically significantly higher in cases than controls with
univariate analysis (p=0.011), when controlling for age and smoke exposure with
multivariate analyses, the difference did not reach significance (p=0.086).
CONCLUSION: These results suggest that patients with chronic or recurrent OME and
those exposed to cigarette smoke mount a Th-2 allergic-like response, as
demonstrated by their serum cytokines.

PMID: 18055023 [PubMed - indexed for MEDLINE]

248: Ann Trop Paediatr. 2007 Dec;27(4):291-6.

Socio-economic status and hearing loss in chronic suppurative otitis media in
Nigeria.

Lasisi AO, Sulaiman OA, Afolabi OA.

Department of Otorhinolaryngology, College of Medicine, University of Ibadan,
Ibadan, Nigeria. sakeemng@yahoo.com

BACKGROUND: Hearing loss is reported in about 50% of cases of chronic suppurative
otitis media (CSOM). AIM: To report the prevalence, type and severity of hearing 
loss in CSOM and identify risk factors. METHODS: A prospective study of hearing
loss in CSOM was undertaken in University College Hospital, Ibadan, two general
hospitals and two primary health care centres, all in densely populated,
semi-urban areas in south-west Nigeria. Controls were selected from school
children, hospital workers' children and children whose parents were visiting the
hospitals, all of whom claimed that there had been no episode of otitis media in 
the past. An oral questionnaire was administered to all, followed by audiometry
and examination of the ear, nose and throat in study children. RESULTS: There
were 189 CSOM subjects and 100 controls aged between 4 and 150 months [mean (SD) 
59.25 (44.55), 173 girls and 116 boys, M:F 1.5:1]. The prevalence of hearing loss
in CSOM was 89/189 (47%) and was conductive in 73/89 (82%) and sensorineural
(SHL) in 16/89 (18%). Of the subjects with hearing loss, 72% had had otitis media
during the 1st year of life. Of the 89, 61 (69%) were of low social class, 13/37 
(35%) were middle class and 15/63 (24%) upper class. The duration of CSOM ranged 
from 4 weeks to 12 years [mean (SD) 4 yrs (2.04)] and from 5 to 12 years in those
with SHL [mean (SD) 9 yrs (6.21)]. There was significant correlation between
socio-economic status and hearing loss (r=0.138, p=0.02) while no correlation was
found with upper respiratory infection (r=0.054, p=0.36), age of onset (r=0.037, 
p=0.62) or frequency of attacks (r=-0.068, p=0.35). CONCLUSION: About one fifth
of patients with CSOM have SHL. Early diagnosis and management of CSOM is
imperative to improve outcome. CSOM is strongly associated with low
socio-economic status.

Publication Types: 
    Multicenter Study

PMID: 18053346 [PubMed - indexed for MEDLINE]

249: Ann Allergy Asthma Immunol. 2007 Nov;99(5):401-7.

The role of nasal allergy in chronic secretory otitis media.

Pelikan Z.

Allergy Research Foundation, Breda, The Netherlands. zpelikan@casema.nl

BACKGROUND: Chronic secretory otitis media (SOM) has multifactorial causes, and
nasal allergy is suspected as one of these causative factors. OBJECTIVES: To
investigate the possible role of nasal allergy in SOM in adults and to determine 
the diagnostic value of nasal challenges with allergens (nasal provocation tests)
combined with tympanometry for the diagnosis of this disorder. METHODS: In 69
young adults with chronic or recurrent SOM, 173 nasal challenges with allergens
were performed by anterior rhinomanometry combined with tympanometry (pure-tone
air conduction tympanometry). In 42 control subjects with only allergic rhinitis 
and no history of middle ear disease, 42 nasal challenges with allergens were
repeated and combined with tympanometry. The study design was a
placebo-controlled comparison. RESULTS: Of the 69 patients, 54 developed 129
positive nasal responses of various types (P < .01), 117 of which were
accompanied by significant changes in middle ear pressure (P < .01). No
significant tympanometric changes (P > .10) were recorded during the 42 positive 
nasal responses in control subjects. CONCLUSIONS: These results may confirm the
occurrence of chronic SOM in some adult patients and the possible involvement of 
nasal allergy in chronic SOM. The nasal challenges with allergen performed by
rhinomanometry, combined with tympanometry, seem to be a valuable supplementary
tool for the diagnosis of this disorder.

PMID: 18051208 [PubMed - indexed for MEDLINE]

250: Pediatr Infect Dis J. 2007 Oct;26(10 Suppl):S8-S11.

The challenge of recalcitrant acute otitis media: pathogens, resistance, and
treatment strategy.

Leibovitz E.

Department of Pediatrics, Pediatric Infectious Disease Unit, Soroka Medical
Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev,
Beer-Sheva, Israel. eugenel@bgumail.bgu.ac.il

Recalcitrant acute otitis media (AOM), including 2 well-defined and sometimes
related entities (persistent AOM and recurrent AOM), is a common pediatric
problem. Episodes of AOM in children with either persistent or recurrent AOM were
shown to be associated with recovery of middle ear fluid bacterial pathogens
(particularly Streptococcus pneumoniae) with higher resistance to antibiotics
compared with children with AOM not recently treated with antibiotics. The
relationships between nasopharyngeal carriage of Streptococcus pneumoniae and
persistence of middle ear fluid pathogens despite clinical improvement or cure
and subsequent recurrence are discussed in depth. The findings emphasize the
importance of bacteriologic eradication in the prevention of recurrent AOM
episodes.

Publication Types: 
    Review

PMID: 18049381 [PubMed - indexed for MEDLINE]

251: Pediatr Infect Dis J. 2007 Oct;26(10 Suppl):S20-2.

Prospects for prevention of otitis media.

Pelton SI.

Boston University Schools of Medicine and Public Health, Pediatric Infectious
Disease, Boston Medical Center, Boston, MA, USA. spelton@bu.edu

ABSTRACT:: Understanding the pathogenesis of acute otitis media provides insight 
into strategies for immunoprophylaxis. This article evaluates the interactions
between pathogen and host defense, and identifies potential bacterial and viral
vaccine targets. Discussed in detail are the attributes for a candidate antigen
necessary to achieve a greater reduction in the burden of middle ear disease.
These include: (1) the need to target a broad spectrum of otopathogens; (2)
antigens need to be shared across all (or most) isolates within a bacterial
species; (3) antigens need to be surface exposed during middle ear infection; and
(4) preferred antigens have an essential function such that nonexpressing
bacterial mutants have reduced virulence. A vaccine candidate (Pnc-PD) that
encompasses these "attributes" is discussed from the perspective of how it may
provide additional protection from middle ear disease if further studies confirm 
initial data on efficacy.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18049377 [PubMed - indexed for MEDLINE]

252: Pediatr Allergy Immunol. 2007 Nov;18 Suppl 18:31-4.

Paranasal sinuses and middle ear infections: what do they have in common?

Marchisio P, Ghisalberti E, Fusi M, Baggi E, Ragazzi M, Dusi E.

Institute of Paediatrics, University of Milan, Fondazione IRCCS Ospedale Maggiore
Policlinico, Mangiagalli e Regina Elena, Milan, Italy. paola.marchisio@unimi.it

Otitis media and sinusitis are among the most common pediatric diseases and they 
share common features. Although the anatomy, physiology and disease processes are
not identical, knowledge of the pathophysiology of middle ear disorders often
provides to the pediatrician a useful understanding of sinus diseases. The same
risk factors identified for otitis media may play a pivotal role in the
development of sinusitis. Moreover, as both paranasal sinuses and middle ear
acquire respiratory pathogens from nasopharynx, acute sinusitis is usually caused
by the same bacterial pathogens that cause acute otitis media, with a major role 
for Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis,
while anaerobes may predominate in chronic disease. A responsibility of bacterial
biofilms in chronic sinusitis, similarly to otitis media, has been recently
suggested. Biofilms, three-dimensional aggregates of bacteria, are refractory to 
antibiotics and thus might explain why some patients improve while on antibiotics
but relapse after completion of therapy.

Publication Types: 
    Review

PMID: 17767605 [PubMed - indexed for MEDLINE]

253: J Laryngol Otol. 2008 Jun;122(6):580-3. Epub 2007 Nov 30.

Follow up after middle-ear ventilation tube insertion: what is needed and when?

Spielmann PM, McKee H, Adamson RM, Thiel G, Schenk D, Hussain SS.

Department of Otolaryngology, Raigmore Hospital, Inverness, Aberdeen, Scotland,
UK. patrickspielmann@nhs.net

INTRODUCTION: There is a paucity of evidence to guide the post-operative follow
up of patients undergoing middle-ear ventilation tube insertion for the first
time. This study was conceived to identify current practice at our institution
(Ninewells Hospital, Dundee) and to inform subsequent change in our follow-up
procedure. METHODS: Two cycles of data collection and analysis were performed.
All paediatric patients undergoing ventilation tube insertion for the first time 
were identified. Patients who had previously undergone ventilation tube insertion
or additional procedures such as adenoidectomy or tonsillectomy were excluded.
The first data collection period comprised all of the year 2000, and the second
18 months over 2003-2004. A minimum of 20 months' follow up was allowed for. Data
regarding clinical findings and audiometry were recorded at each follow-up
appointment. RESULTS: We identified a total of 50 patients meeting our criteria
for inclusion in the first cohort. There were a total of 156 appointments between
surgery and data collection (a mean of 3.12 per child). A total of 113 (72 per
cent) appointments lead to no medical intervention. The only statistically
significant difference between patients requiring further ventilation tube
insertion (n = 10) and those not requiring further treatment during the study
period (n = 40) was the average hearing threshold (p < 0.01). These findings
prompted a change in the post-operative regime; all patients undergoing
ventilation tube insertion were subsequently seen at three months for a pure tone
audiogram, and further review depended on clinical and audiometric findings.
Records for 84 children were identified and collected for the second cohort,
there were a total of 154 appointments (a mean of 1.83 per child). In only 18
appointments (12 per cent) were normal findings and hearing recorded and children
given a further review appointment. Sixteen of 29 (55 per cent) children with
abnormal clinical findings (otorrhoea, tube blockage or extrusion) required some 
form of intervention (p < 0.05). Twenty-six had a mean hearing threshold worse
than 20 dB at first review. Nineteen (73 per cent) required further intervention 
of some sort (p < 0.01). CONCLUSIONS: Our study demonstrated that the vast
majority of review appointments resulted in no clinical intervention. We
therefore question the need for regular follow up in this patient group. Twenty
per cent (10 of 50 and 18 of 84) of our patients required further ventilation
tube insertion within the study periods. This is consistent with rates reported
in the literature. Children with abnormal clinical findings or a mean hearing
threshold greater than 20 dB were significantly more likely to require further
intervention. We would recommend one post-operative review with audiometry, three
months after surgery. At this initial appointment, further review should be
offered to those children with poor hearing, early extrusion, blockage or
infection, as they are more likely to require further ventilation tube insertion.
This strategy is dependent on good links with community primary care providers
and easy access to secondary care for further management, should this be
required.

PMID: 18047760 [PubMed - indexed for MEDLINE]

254: Eur Arch Otorhinolaryngol. 2008 Jul;265(7):765-8. Epub 2007 Nov 29.

Early onset otitis media: risk factors and effects on the outcome of chronic
suppurative otitis media.

Lasisi AO, Olayemi O, Irabor AE.

Department of Otorhinolaryngology, College of Medicine, University of Ibadan,
Ibadan, Nigeria. akeemlasisi@gmail.com

The onset of early otitis media (EOM), in the first few months of life has been
reported to predict later chronic otitis media (CSOM), although the prevalence
rates are increasing little is known about specific risk factors. In this survey 
we examined the hypothesis that higher risk factors is associated with the
development of OM within 1 year compared to later onset and early onset otitis
media (OM) has potential for negative outcome of CSOM. This is a survey of the
age at onset of otorrhoea and associated risk factors in children with CSOM, in
five sites spread in two sub-urban cities in two states in Nigeria.
Questionnaires were administered on the informants followed by examination of the
children. EOM was seen in 136/189 (70%) with CSOM, the age range was 1-150
months, mean of 59.25 (SD = 44.55). Of the 85 CSOM subjects with hearing loss,
EOM accounted for 49 (57.7%) while 36 (42.4%) was later onset, On multivariate
analysis (OR = 0.276, CI = 0.133-0.572, P = 0.001) revealing EOM was significant 
in the development of hearing loss however there was no correlation with the
frequency of attack of otorrhoea (OR = 1.025, CI = 0.88-1.19, P = 0.75). Low
socioeconomic status seen in 110/136 EOM (P = 0.000), allergy (P = 0.030) and
number of people >10 in household (OR = 4.13, CI = 1.81-9.39, P = 0.001)
constituted the significant risk for EOM compared to later onset. Bottlefeeding, 
adenoiditis/adenoid hypertrophy, indoor cooking and upper respiratory infection
were not found to have statistical significance in early onset OM compared to
later onset OM. This study found correlation between EOM and hearing loss and
identified allergy, low social status and chronic exposure to overcrowding
through increased number of children in the household significant risk factors
for future research focus. This may help in controlling the prevalence of hearing
loss accompanying CSOM.

PMID: 18046567 [PubMed - indexed for MEDLINE]

255: Otol Neurotol. 2008 Jan;29(1):13-5.

Chronic suppurative otitis media, caloric testing, and rotational chair testing.

Gianoli GJ, Soileau JS.

The Ear and Balance Institute, Baton Rouge, Louisiana 70816, USA.
ggianoli@gmail.com

OBJECTIVE: To determine the incidence of caloric and rotational chair testing
(ROT) abnormalities in a group of patients with chronic suppurative otitis media 
(CSOM) and to correlate caloric test results with ROT. PATIENTS: Twenty-five
patients with CSOM with or without cholesteatoma who were to undergo
tympanomastoid surgery. INTERVENTIONS: Caloric and ROT. MAIN OUTCOME MEASURES:
History of dizziness. Vestibular test abnormalities defined by caloric weakness
(CW), reduced gain, abnormal phase, or asymmetry on ROT. RESULTS: Among the 25
patients, 13 had bilateral CSOM-most with long-standing disease and history of
previous surgical intervention. Of the 25 patients, 19 (76%) demonstrated either 
unilateral or bilateral CW. Eighteen (72%) demonstrated abnormalities on ROT.
Eleven patients (44%) had complaints of vertigo/dizziness, although 2 of these
patients had both normal caloric testing and ROT. Unilateral or bilateral CW was 
80% accurate in predicting an ROT abnormality, whereas the symptom of
vertigo/dizziness was only 48% accurate in predicting an ROT abnormality.
CONCLUSION: The incidence of CW among CSOM patients in this study was high and
correlated well with abnormalities on ROT. Interestingly, ROT results correlated 
better with CW than symptoms of dizziness/vertigo. Although CW findings can be
the result of technical limitations in testing patients with CSOM, ROT
corroboration of these results suggest that they are valid findings.

Publication Types: 
    Comparative Study

PMID: 18046261 [PubMed - indexed for MEDLINE]

256: Acad Emerg Med. 2007 Dec;14(12):1172-5.

National trends in emergency department antibiotic prescribing for children with 
acute otitis media, 1996 2005.

Fischer T, Singer AJ, Lee C, Thode HC Jr.

Department of Emergency Medicine, Stony Brook University Medical Center, Stony
Brook, NY, USA.

OBJECTIVES: Withholding antibiotics in nontoxic children with acute otitis media 
(AOM) is now recommended to reduce bacterial resistance rates. Using the National
Hospital Ambulatory Medical Care Survey (NHAMCS), the authors describe the
national trends for prescribing antibiotics in children with AOM presenting to
emergency departments (EDs) in the United States over the past decade. The
authors hypothesized that the rates of prescribing antibiotics would decline over
time. METHODS: This was a retrospective study of NHAMCS databases. A national
sampling of ED visits for 1996-2005 was used to identify trends in ED
prescription of antibiotics to patients with AOM. The National Drug Code
Directory Drug Classes were used to identify type of antibiotic prescribed.
Frequency and type of antibiotic prescription patterns over time were evaluated. 
RESULTS: There were 2.6 million and 2.1 million ED visits for AOM during the
first and last years of the study. Children ages 2-12 years accounted for about
40% of all ED visits for AOM, with another 40% in the younger than 2 years age
group and 20% in the older than 12 years of age group. During the first and last 
year of the study, 79.2% and 91.3% of the patients with AOM were prescribed
antibiotics, respectively. There was a slight increasing trend in the proportion 
prescribed antibiotics over time (p = 0.02). The rates of use of antibiotics for 
AOM were similar in all three age groups. CONCLUSIONS: There was a slight
increase in the percentage of children with AOM who were prescribed antibiotics
in the ED between 1996 and 2005. There was also no change in the patterns of
prescribing antibiotics.

PMID: 18045893 [PubMed - indexed for MEDLINE]

257: Int J Pediatr Otorhinolaryngol. 2008 Feb;72(2):215-22. Epub 2007 Nov 28.

No association between hearing loss due to bilateral otitis media with effusion
and Denver-II test results in preschool children.

Serbetcioglu B, Ugurtay O, Kirkim G, Mutlu B.

Dokuz Eylul Medical School, Department of Otolaryngology, Inciralti-Izmir 35340, 
Turkey. serbetcioglu@gmail.com

OBJECTIVE: Otitis media with effusion (OME) is the most common cause of acquired 
hearing loss in childhood and has been associated with delayed language
development and behavioral problems. In this study, children with an evidently
recurrent otitis media were investigated. The present study examines the
association between hearing loss versus developmental screening test parameters
of preschool children. METHODS: Sixteen children with bilateral otitis media were
compared with age-matched same number of children with normal hearing (controls).
RESULTS: Language and verbal cognitive abilities were not affected significantly 
as a result of the presence of hearing loss because of OME. Using internationally
standardized Denver-II test to evaluate the language development and other
developmental screening parameters, no significant difference was found between
the patient and control groups. CONCLUSIONS: This study failed to find any
association between the hearing loss due to otitis media with effusion and speech
and language parameters in preschool children.

PMID: 18045700 [PubMed - indexed for MEDLINE]

258: J Vet Med A Physiol Pathol Clin Med. 2007 Dec;54(10):559-63.

Identification and antimicrobial susceptibility of bacteria and yeasts isolated
from healthy dogs and dogs with otitis externa.

Lyskova P, Vydrzalova M, Mazurova J.

Department of Biology and Biochemistry, Faculty of Chemical Technology,
University of Pardubice, Strossova 239, 530 03 Pardubice, Czech Republic.
petra.lyskova@upce.cz

The bacterial and fungal flora of the external ear canal of dogs with otitis
externa and of healthy dogs were studied. The most frequently isolated
microorganism from otitic ears was Staphylococcus intermedius (58.8%), followed
by Malassezia pachydermatis (30.9%), Streptococcus canis (29.9%), Proteus spp.
(14.4%) and Escherichia coli (10.3%). A statistical analysis of our results
showed that the prevalence of these microorganisms is significant in dogs with
otitis externa. Furthermore, the antimicrobial susceptibility patterns of
isolated strains were determined. Majority of all bacterial isolates were most
susceptible to gentamicin. Malassezia pachydermatis, the most prevalent yeast in 
this study, showed an excellent level of susceptibility to all antifungal agents 
tested.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18045339 [PubMed - indexed for MEDLINE]

259: Expert Rev Anti Infect Ther. 2007 Dec;5(6):939-50.

Cephalosporins in overcoming beta-lactamase-producing bacteria and preservation
of the interfering bacteria in the treatment of otitis, sinusitis and
tonsillitis.

Brook I.

Georgetown University School of Medicine, Department of Pediatrics, 4431
Albemarle Street NW, Washington, DC 20016, USA. ib6@georgetown.edu

The treatment of upper respiratory tract infections (URTIs) is complicated by the
resurgence of beta-lactamase-producing bacteria (BLPB) and the absence of
interfering bacteria. BLPB can have a direct pathogenic impact in causing the
infection as well as an indirect impact through their ability to produce the
enzyme beta-lactamase. BLPB may not only survive penicillin therapy but can also 
protect other penicillin-susceptible bacteria from penicillin. In this review,
the clinical in vitro and in vivo evidence supporting the role of these organisms
in the increased failure rate of penicillin in eradication of otitis, sinusitis
and pharyngo-tonsillitis is outlined and the implication of that increased rate
on the management of infections is discussed. Bacteria with interference
capability of potential respiratory pathogens can prevent colonization and
subsequent invasion by these organisms. These include alpha-hemolytic
streptococci, nonhemolytic streptococci and Prevotella and Peptostreptococcus
spp. Treatment with antimicrobials can affect the balance between the interfering
organisms and potential pathogens. The role of bacterial interference in URTIs
and its effect on their treatment is discussed. The use of some of the
cephalosporins that are able to overcome the effect of BLPB and preserve the
beneficial interfering bacteria can overcome and modulate these phenomena and
achieve better cure of URTIs.

Publication Types: 
    Review

PMID: 18039079 [PubMed - indexed for MEDLINE]

260: J Laryngol Otol. 2008 Jun;122(6):635. Epub 2007 Nov 26.

Branula used as T-tube introducer for middle-ear effusion.

Raman R, Rahmat O.

Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya,
Kuala Lumpur, Malaysia. ramanr_99@yahoo.com

OBJECTIVE: We report a method of inserting a T-tube. METHOD: A 14-G branula and a
T-tube are used. RESULTS: This method was found to be simple and required few
instruments. CONCLUSIONS: To the best of our knowledge, this method has not
previously been reported.

Publication Types: 
    Technical Report

PMID: 18036281 [PubMed - indexed for MEDLINE]

261: J Laryngol Otol. 2008 Sep;122(9):905-11. Epub 2007 Nov 26.

A critical evaluation of the evidence on a causal relationship between
Helicobacter pylori and otitis media with effusion.

Sudhoff H, Rajagopal S, Baguley DM, Ebmeyer J, Schmelzer A, Schreiber S, Moffat
DA.

Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK.
Holger.Sudhoff@rub.de

OBJECTIVE: There is growing interest in the presence of Helicobacter pylori in
the upper aerodigestive tract, and in the middle ear in patients with otitis
media with effusion. Some studies have reported detecting H pylori in the middle 
ear, although reports to the contrary exist. In this study, we critically
evaluate the evidence for the theory that H pylori in the middle ear plays a role
in otitis media with effusion. MATERIAL: We undertook a systematic review of all 
available studies investigating the presence of H pylori in the middle ear of
patients with otitis media with effusion. The current literature was critically
analysed using the key words and phrases 'Helicobacter pylori' 'otitis media with
effusion', 'serous otitis media', 'glue ear' and 'middle ear'. Six original
research papers were identified, studying a total of 203 patients and 27
controls; two of these papers were randomised, controlled studies and four were
prospective, cohort studies. RESULTS: At present, there is poor evidence for the 
existence of H pylori-associated otitis media with effusion. CONCLUSIONS: Further
research in the field is needed in order to delineate the presence of H pylori
and its role in the pathogenesis of otitis media with effusion.

Publication Types: 
    Review

PMID: 18036278 [PubMed - indexed for MEDLINE]

262: Clin Ther. 2007 Sep;29(9):1950-6.

Pooled analysis of two clinical trials comparing the clinical outcomes of topical
ciprofloxacin/dexamethasone otic suspension and polymyxin
B/neomycin/hydrocortisone otic suspension for the treatment of acute otitis
externa in adults and children.

Rahman A, Rizwan S, Waycaster C, Wall GM.

School of Pharmacy, Shenandoah University, Winchester, Virginia 22601, USA.
arahman@su.edu

OBJECTIVE: This study aimed to compare the clinical outcome of patients receiving
topical ciprofloxacin 0.3%/dexamethasone 0.1% (CD) otic suspension with that of
those receiving polymyxin B/neomycin/ hydrocortisone (PNH) otic suspension for
the treatment of acute otitis externa (AOE). METHODS: Data from 2 institutional
review board-approved, multicenter, observer-masked, parallel-group, randomized, 
noninferiority clinical trials conducted at 76 institutions across the United
States between April 1998 and July 1999 were pooled together for this analysis.
Patients > or =1 year of age diagnosed with AOE were considered for inclusion in 
the studies. Patients with AOE >4 weeks' duration, a perforated tympanic
membrane, chronic suppurative otitis media, or use of either antibiotics or
steroids within the previous 7 days were excluded from the studies. Patients were
randomly assigned to receive CD or PNH for 7 days. CD was administered as 3 drops
in children and 4 drops in patients > or =12 years of age BID. PNH was
administered as 3 drops in children and 4 drops in patients > or =12 years of age
TID. The clinical investigators were blinded to treatment assignment. Due to the 
different dosing regimens, patients were not blinded, but they also were not
directly informed of their treatment assignments. Otic inflammation, tenderness, 
edema, and discharge were clinically assessed on days 3, 8, and 18 of the
studies. Otic inflammation and edema were evaluated using a 4-point scale (none =
0; mild = 1; moderate = 2; and severe = 3). Otic tenderness and discharge were
rated on a binomial scale (absent = 0 and present = 1). The clinical assessments 
were aggregated into a 9-point composite clinical scale (range, 0-8) to compare
baseline severity between groups. For the final outcomes assessment in this
study, the aggregated clinical scores were dichotomized into cured (0) versus
noncured (>0) and analyzed using a Kaplan-Meier survival technique. A log-rank
test was used to compare the cure curves between treatment groups. Kaplan-Meier
summary statistics provide the mean and median times to cure, and the mean times 
to cure for the 25th and 75th patient quartiles. Tolerability was assessed by
monitoring patients for adverse events at each visit. RESULTS: Data from 1072
patients (1242 ears) were included in the analysis (CD, 537 patients; PNH, 535
patients). Baseline AOE severity and demographic characteristics were similar
between the 2 treatment groups. The mean patient age was 21.7 and 22.0 years in
the CD and PNH groups, respectively. Both groups were similar with respect to
sex, with 50.7% and 53.5% females in the CD and PNH groups, respectively. The
racial composition was predominately white (88.6% vs 84.9% in the CD and PNH
groups, respectively). The log-rank test revealed a significant difference in the
AOE cure curves between the CD and PNH groups (P = 0.038). The proportions cured 
in the AOE at-risk groups at the day-3, -8, and -18 assessments in the CD and PNH
treatment groups were 0.14 and 0.10, 0.75 and 0.72, and 0.98 and 0.97,
respectively. The Kaplan-Meier summary statistics indicated that the mean time to
cure was 0.6 day less with CD compared with PNH (9.7 vs 10.3 days).
Treatment-related adverse event rates were similar between the 2 groups and
occurred in 3.8% of the patients. The most common adverse events included otic
pruritus (2.1%), otic congestion (0.6%), otic debris (0.5%), otic pain (0.3%),
superimposed ear infection (0.3%), and erythema (0.1%). CONCLUSION: These data
from 2 previous studies suggest that time to cure was significantly less with CD 
compared with PNH in patients with AOE.

Publication Types: 
    Comparative Study
    Meta-Analysis

PMID: 18035194 [PubMed - indexed for MEDLINE]

263: Eur Arch Otorhinolaryngol. 2008 Feb;265(2):139-45. Epub 2007 Nov 23.

Treating common ear problems in pregnancy: what is safe?

Vlastarakos PV, Nikolopoulos TP, Manolopoulos L, Ferekidis E, Kreatsas G.

ENT Department, Hippokrateion General Hospital of Athens, 114 Vas. Sofias Av.,
Athens, Greece. pevlast@hotmail.com

In everyday practise, more than 80% of pregnant women receive one at least
medication, often for ENT causes. The aim of the present paper is to review the
literature on safety and administration of medical treatment for ear diseases, in
pregnant women. The literature review includes Medline and database sources.
Electronic links, related books and written guidelines were also included. The
study selection was as follows: controlled clinical trials, prospective trials,
case-control studies, laboratory studies, clinical reviews, systematic reviews,
metanalyses, and case reports. The following drugs are considered relatively
safe: beta-lactam antibiotics (with dose adjustment), macrolides (although the
use of erythromycin and clarithromycin carries a certain risk), and acyclovir.
Non-selective NSAIDs (until the 32nd week), nasal decongestants (with caution and
up to 7 days), intranasal corticosteroids, with budesonide as the treatment of
choice, first generation antihistamines, or cetirizine (third trimester) and
loratadine (second and third trimester) from the second generation, H2 receptor
antagonists (except nizatidine) and proton pump inhibitors (except omeprazole),
can be used to relieve patients from the related symptoms. Meclizine and
dimenhydrinate, as antiemetics in vertigo attacks; metoclopramide, vitamin B6 and
ginger rhizome, alternatively. Low-dose diazepam and diuretics in severe cases of
Meniere's disease (with caution). Systemic administration of prednisone and
prednisolone can be considered in selected cases. By contrast, selective COX-2
inhibitors, betahistine and vasodilating agents are contraindicated in pregnancy.
Since otologic and neurotologic manifestations during pregnancy tend to seriously
affect the quality of life of the expectant mothers, ENT surgeons should
familiarise themselves with the basic guidelines and safety precautions for any
related medication, in order to provide appropriate treatment.

Publication Types: 
    Review

PMID: 18034353 [PubMed - indexed for MEDLINE]

264: Neuro Endocrinol Lett. 2007 Nov;28 Suppl 3:14-5.

Bacterial meningitis after sinusitis and otitis media: ear, nose, throat
infections are still the commonest risk factors for the community acquired
meningitis.

Lesnakova A, Holeckova K, Kolenova A, Streharova A, Kisac P, Beno P, Kalavsky E, 
Sramka M, Ondrusova A, Benca J, Seckova S, Sladeckova V, Bartkovjak M, Bukovinova
P, Hvizdak F, Lengyel P, Sabo I, Rudinsky B, Bauer F, Luzica R, Bielova M, Karvaj
M, Huttova M, Wiczmandyova O, Svabova V, Findova L, Kutna K, Deadline J, Diana E,
Kiwou M.

St. Elizabeth University College, Tropical Projects, Slovakia.

We investigated how many cases of bacterial meningitis in our national survey
were associated with sinusitis or otitis media. Among 372 cases of bacterial
meningitis within our nationwide 17 years survey, 201 cases were community
acquired (CBM) and in 40 (20%) otitis media or sinusitis acuta/chronica were
reported 1-5 weeks before onset of CBM. Diabetes mellitus (20% vs. 7.5%, p=0.01),
alcohol abuse (35% vs. 15.4%, p=0.003) and trauma (30% vs. 14.9%, p=0.02) were
significantly associated with CBM after ENT infections. Concerning etiology, CBM 
after sinusitis/otitis was insignificantly associated with pneumococcal etiology 
(50% vs. 33.8 %, NS) and significantly associated with other (L. monocytogenes,
Str. agalactiae) bacterial agents (9.9 % vs. 25 %, p=0.008) . However those
significant differences for new ENT related CBM had no impact on mortality (12.4 
% vs. 5%, NS), failure after initial antibiotics (10 % vs. 9.5%, NS) and
neurologic sequellae (12.5 % vs. 15.4 %, NS).

PMID: 18030266 [PubMed - indexed for MEDLINE]

265: Laryngoscope. 2008 Feb;118(2):283-7.

Effects of ototopical antihistamine on otitis media in an allergic rat.

Cutler JL, Labadie RF.

Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, Walter
Reed Army Medical Center, Washington, DC 20307, USA. Jeffrey.cutler@hotmail.com

OBJECTIVES/HYPOTHESIS: A reliable model of allergy has been created in the Brown 
Norway rat. In this model, allergen presentation to the middle ear causes
functional disruption of the eustachian tube, predisposing to the development of 
otitis media with effusion. The purpose of this study was to study the effects of
ototopical antihistamine on lipopolysaccharide (LPS)-induced otitis media in the 
allergic rat model. STUDY DESIGN: Prospective animal-based research study.
METHODS: Fifteen (n = 15) rats were made allergic via sensitization to ovalbumin 
(OVA) by subcutaneous injection and randomized into three groups: saline (SAL) + 
LPS, olopatadine (OLO) + LPS, and azelastine (AZE) + LPS. Allergic rats were
transtympanically injected with OVA 24 hours prior to challenge, creating a
subclinical inflammatory response in which there is no visible middle ear
effusion. Thirty-five microliters of test substance (SAL + LPS, OLO + LPS, or AZE
+ LPS) were injected into the middle ear at 0, 2, and 4 hours. Effusion was
collected at 2, 4, and 6 hours. Statistical analysis was performed on effusion
volume and albumin concentration. RESULTS: Significant increase in effusion
volume with respect to time was noted for the SAL + LPS group, whereas the AZE + 
LPS group demonstrated a decrease. Intergroup comparison revealed a significant
decrease in effusion volume at hour 6, with both AZE and OLO less than LPS alone.
A significant decrease in albumin concentration over time was noted in the AZE
group. Intergroup comparison revealed a significant difference inalbumin
concentration at hour 6, with OLO significantly lower than LPS. CONCLUSIONS:
Ototopical antihistamines are effective in reducing effusion volume and albumin
concentration in LPS-induced otitis media in an allergic rat model. This finding 
supports the hypothesis that ototopic antihistamines may prove effective in
treating patients with allergy-induced eustachian tube dysfunction.

Publication Types: 
    Evaluation Studies

PMID: 18025947 [PubMed - indexed for MEDLINE]

266: Int J Pediatr Otorhinolaryngol. 2008 Feb;72(2):167-71. Epub 2007 Nov 19.

Staged tympanostomy tube placement facilitates pediatric cholesteatoma
management.

Mueller DT, Isaacson G.

Department of Otolaryngology-Head & Neck Surgery, Temple University School of
Medicine, 3400 North Broad Street, Kresge West Building, Suite 102, Philadelphia,
PA 19140, United States. darrylmueller1@yahoo.com

OBJECTIVES: Evaluate results of middle ear ventilation with or without
adenoidectomy prior to definitive cholesteatoma surgery in children with
concomitant middle ear effusion. METHODS: Charts of 40 children seen in follow-up
for acquired or congenital cholesteatoma were reviewed. Nine children underwent
staged tympanostomy tube placement for concomitant middle ear effusion. Computed 
tomography was obtained after placement of tubes in all patients. Extent of
disease by tomography was compared to disease extent at definitive surgery.
Details of cholesteatoma surgeries, most recent disease status, and length of
follow-up were recorded. RESULTS: Three children had extensive congenital
cholesteatoma, while six had acquired disease. All nine children underwent tube
placement (four with adenoidectomy) prior to definitive surgery. Computed
tomography obtained after middle ear ventilation accurately predicted extent of
cholesteatoma involvement. Seven atticotomies, two tympanomastoidectomies, and
one revision mastoidectomy were performed. Follow-up ranged from 9 to 99 months
with a median of 54 months. All were free of cholesteatoma at latest assessment. 
CONCLUSIONS: Staged tympanostomy tube placement with or without adenoidectomy
prior to tympanomastoidectomy allows superior delineation of cholesteatoma extent
pre-operatively and facilitates surgery in children with concomitant middle ear
effusion. Adenoidectomy may improve eustachian tube function and decrease the
risk of recurrent disease.

PMID: 18023884 [PubMed - indexed for MEDLINE]

267: Acta Otolaryngol Suppl. 2007 Oct;(558):44-8.

Tympanoplasty, with or without mastoidectomy, is highly effective for treatment
of chronic otitis media in children.

Yoon TH, Park SK, Kim JY, Pae KH, Ahn JH.

Department of Otolaryngology, University of Ulsan College of Medicine, Asan
Medical Center, Seoul, Korea. thyoon@amc.seoul.kr

CONCLUSION: The overall success rate of tympanoplasty, with or without
mastoidectomy, in the treatment of chronic pediatric otitis media, was high and
did not depend on patient age, the status of the contralateral ear, the inclusion
or absence of surgical mastoidectomy, or the method of mastoidectomy (when this
procedure was employed). Tympanoplasty may be expected to improve hearing in
cases of chronic otitis media accompanied by perforation, but not in cases of
cholesteatoma. OBJECTIVES: This study analyzed the clinical features of pediatric
patents with chronic otitis media undergoing tympanoplasty, with or without
mastoidectomy. Follow-up data were examined to determine the effectiveness of
these procedures on the course of the patients' conditions. SUBJECTS AND METHODS:
We retrospectively reviewed the medical records of 111 children (a total of 119
ears were treated from this group) aged 15 years or less, who underwent surgical 
treatment for pediatric chronic otitis media. The subjects were composed of
children suffering from chronic otitis media with perforation (COMP) (63 ears),
and patients presenting chronic otitis media with cholesteatoma (COMC) (56 ears).
The mean follow-up period was 40 months. Preoperative and postoperative (at the
final follow-up) audiometry and otologic examinations were performed. Data from
postoperative otologic examinations and audiometric measurements were accompanied
by examination of both the operative ear and the contralateral ear. Surgical
success was defined as the presence of an intact tympanic membrane without
perforation, retraction, or evidence of recurring cholesteatoma. RESULTS: The
mean ages at the time of operation were 11.1+/-3.3 years for COMP patients and
9.7+/-3.0 years for COMC subjects. Surgical treatments for pediatric COMP and
COMC patients included tympanoplasty only in 45 ears (38% of ears treated) and
tympanoplasty with mastoidectomy in 74 ears (62%). Most of patients with COMC
received tympanoplasty with mastoidectomy. No patient with COMP underwent canal
wall-down mastoidectomy. Mean pre-operative air-bone gaps (ABGs) and
post-operative ABGs were compared. Significant improvement in ABG was evident in 
the COMP group, but not in the COMC group. Surgical success rates at follow-up
after 6 months and 12 months were 97% and 95%, respectively, in the COMP group.
In the COMC patients, surgical success rates at follow-up after 6 months and 12
months were 98% and 93%. There were no significant relationships between surgical
success rate and patient age, the status of the contralateral ear, or the extent 
of surgery.

PMID: 17882569 [PubMed - indexed for MEDLINE]

268: J Infect Dis. 2007 Nov 15;196(10):1528-36. Epub 2007 Oct 31.

Erratum in:
    J Infect Dis. 2008 Mar 1;197(5):779-80.

Antibodies to pneumococcal surface protein A families 1 and 2 in serum and saliva
of children and the risk of pneumococcal acute otitis media.

Simell B, Melin M, Lahdenkari M, Briles DE, Hollingshead SK, Kilpi TM, Kayhty H.

Department of Vaccines, National Public Health Institute, Mannerheimintie 166,
Helsinki, Finland. birgit.simell@ktl.fi

BACKGROUND: Pneumococcal surface protein A (PspA) is a highly variable yet
cross-reactive protein that exists as 2 major families. We assessed the
development of human serum and salivary antibodies against the PspA families 1
(PspA1) and 2 (PspA2) in early childhood and their role in the prevention of
pneumococcal acute otitis media (AOM). METHODS: Serum levels of IgG and salivary 
levels of IgA antibodies to PspA1 and PspA2 were measured by use of enzyme
immunoassay from the samples from the Finnish Otitis Media Cohort Study obtained 
at the ages of 12 months (287 and 160 samples, respectively) and 18 months (258
and 131 samples, respectively). The Cox proportional hazard model was used to
evaluate the relative risk (RR) of pneumococcal AOM during the 6 months after
sampling relative to concentration of serum or presence of salivary anti-PspA in 
the samples. RESULTS: Anti-PspA1 and anti-PspA2 concentrations at 12 and 18
months were related to prior culture-confirmed pneumococcal exposure. The
concentrations of serum anti-PspA were not significantly associated with the risk
of pneumococcal AOM. At 18 months, the presence of salivary anti-PspA was
significantly associated with a lower risk of pneumococcal AOM during the 6
months after sampling (RR, 0.27 [95% confidence interval, 0.11-0.69]).
CONCLUSIONS: The lowered risk of pneumococcal AOM associated with the presence of
salivary anti-PspA at 18 months suggests that mucosal anti-PspA antibodies have a
role in the prevention of pneumococcal AOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18008233 [PubMed - indexed for MEDLINE]

269: Pediatr Emerg Care. 2007 Nov;23(11):779-84.

Pediatric mastoiditis in the pneumococcal conjugate vaccine era: symptom duration
guides empiric antimicrobial therapy.

Roddy MG, Glazier SS, Agrawal D.

Division of Emergency Medicine, Children's National Medical Center, Washington,
DC 20010, USA.

BACKGROUND: The microbiology of acute otitis media has changed in the heptavalent
pneumococcal conjugate vaccine (PCV) era. We hypothesize similar changes with
pediatric mastoiditis. OBJECTIVES: To compare the etiology of mastoiditis in the 
pre-PCV (January 1995-December 2000) and post-PCV (January 2001- April 2005) eras
to guide empiric antimicrobial therapy in the pediatric emergency department.
METHODS: Retrospective chart review of all patients admitted with a diagnosis of 
mastoiditis from January 1995 to April 2005. RESULTS:: One hundred twenty-two
charts were reviewed, 68 pre-PCV and 54 post-PCV. Etiological agents were
determined by culture results in 60 patients. The most common bacterial isolates 
were Streptococcus pneumoniae (24), Pseudomonas aeruginosa (12), Staphylococcus
aureus (12), Streptococcus pyogenes (8), and Haemophilus influenzae (2). There
was no reduction in mastoiditis due to S. pneumoniae from the pre-PCV to the
post-PCV eras (odds ratio [OR], 0.9; 95% confidence interval [CI], 0.4-2.1; P =
0.77). Ceftriaxone nonsusceptibility was seen in 30% of post-PCV S. pneumoniae
isolates compared with 7% of pre-PCV isolates. Acute mastoiditis was diagnosed in
93 patients, and chronic mastoiditis (defined as >or=3 wk of symptoms) was
diagnosed in 29 patients. Streptococcus pneumoniae was more likely to be
implicated in acute versus chronic mastoiditis (OR, 9.2; 95% CI, 1.2-52.2; P =
0.01). Pseudomonas aeruginosa was more frequently implicated in chronic versus
acute mastoiditis (OR, 16.4; 95% CI, 2.1-75.8; P = 0.0003). CONCLUSIONS: There
was no difference in the proportion of pediatric mastoiditis cases caused by S.
pneumoniae in the pre-PCV versus post-PCV eras. Empiric antimicrobial therapy
with ceftriaxone alone is not sufficient in the post-PCV era.

PMID: 18007207 [PubMed - indexed for MEDLINE]

270: Radiother Oncol. 2007 Dec;85(3):463-8. Epub 2007 Nov 19.

Analysis of anatomical factors controlling the morbidity of radiation-induced
otitis media with effusion.

Wang SZ, Wang WF, Zhang HY, Guo M, Hoffman MR, Jiang JJ.

Department of Radiotherapy and Oncology, Eye Ear Nose and Throat Hospital of
Fudan University, Shanghai, PR China. shengziwang@yahoo.com

PURPOSE: To analyze the anatomical factors controlling the morbidity of
radiation-induced otitis media with effusion (OME) and determine how to best
preserve middle ear function when treating nasopharyngeal carcinoma (NPC).
MATERIALS AND METHODS: Forty patients with nasopharyngeal carcinoma undergoing
3-D radiotherapy (RT) planning and curative RT were analyzed retrospectively. The
difference in dosage over the middle ear cavity and the isthmus of the Eustachian
tube (ET) was evaluated. Pure tone audiometry and impedance audiometry tests were
performed before and after RT. RESULTS: Mean dosages over the isthmus of the ET
for acoustic impedance and pure tone audiometry were recorded. Differences in
dosage among the three classifications of unchanged, improved, and worsened ears 
were statistically significant. CONCLUSION: There was a correlation between the
morbidity of radiation-induced OME and the radiation dosage over the middle ear
cavities. Decreased OME morbidity was observed when the dosage over the isthmus
of the ET was below 52 Gy and the dosage over middle ear cavity was below 46 Gy.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18006095 [PubMed - indexed for MEDLINE]

271: Int J Pediatr Otorhinolaryngol. 2008 Jan;72(1):57-61. Epub 2007 Nov 19.

Interventions for prevention of otitis media may be most effective if implemented
in the first weeks of life.

Smith-Vaughan H, Byun R, Halpin S, Nadkarni MA, Jacques NA, Hunter N, Morris PS, 
Leach AJ.

Menzies School of Health Research, Darwin, Australia. heidi@menzies.edu.au

OBJECTIVE: For Indigenous Australian children living in remote communities, onset
of otitis media commences within weeks of birth and is associated with early
nasopharyngeal colonisation with multiple respiratory bacterial pathogens:
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. The 
high prevalence of eardrum perforation and the failure of standard therapies to
cure or prevent OM in this population require urgent attention. The objective of 
this study was to measure the changes in nasopharyngeal bacterial flora between
birth and first episode of otitis media. METHODS: For 10 randomly selected
Indigenous children with early onset otitis media, S. pneumoniae, H. influenzae, 
M. catarrhalis, S. aureus, and total bacterial load were enumerated in serial
nasopharyngeal swabs using real-time quantitative PCR. RESULTS: Between 0 and 3
weeks of age, all 10 infants had bilaterally normal ears. At 3-6 weeks of age,
seven of eight infants examined had otitis media. By 6-13 weeks of age, all 10
infants had otitis media. The relative density of respiratory pathogens among
total nasopharyngeal flora increased significantly with onset of otitis media,
and the majority of children became colonised with the three respiratory
pathogens. There was no association between OM onset and S. aureus load.
CONCLUSIONS: Onset of otitis media between 3 and 6 weeks of life was associated
with a significant increase in all major bacterial OM pathogens (S. pneumoniae,
H. influenzae, M. catarrhalis), as well as total bacterial load in the
nasopharynx. Interventions to prevent acquisition of multiple OM pathogens in the
first weeks of life are needed.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18006084 [PubMed - indexed for MEDLINE]

272: Eur Arch Otorhinolaryngol. 2008 May;265(5):587-91. Epub 2007 Nov 15.

Temporal bone central giant-cell granuloma presenting as a serous otitis media.

Rudic M, Grayeli AB, Cazals-Hatem D, Cyna-Gorse F, Bouccara D, Sterkers O.

Department of Otorhinolaryngology Head and Neck Surgery, AP-HP, Hospital Beaujon,
100, Boulevard. du General Leclerc, 92118 Clichy Cedex, France.

Central giant cell granuloma is a benign intraosseous lesion that most commonly
occurs in the facial bones. Its location in the temporal bone is extremely rare
and only 20 cases have been reported in the literature. We report a case of an
adult female patient presenting with a right serous otitis media and mastoiditis 
associated with a mixed hearing loss during 6 months. CT-scan and MRI revealed a 
temporal bone tumor involving the mastoid, and surrounding the right
temporo-mandibular joint. Tumor was totally removed after a canal-wall-down
mastoidectomy and middle ear exclusion. Pathology revealed a central giant cell
granuloma. Seven months following the surgery there was no evidence of
recurrence. Central giant cell granuloma is a rare temporal bone lesion, with non
specific clinical and imaging signs but characteristic pathological features.
Today, a total surgical removal and regular MRI follow-up is the best management 
option.

Publication Types: 
    Case Reports

PMID: 18004584 [PubMed - indexed for MEDLINE]

273: Antimicrob Agents Chemother. 2008 Jan;52(1):378-81. Epub 2007 Nov 12.

Characterization and dynamics of middle ear fluid and nasopharyngeal isolates of 
Streptococcus pneumoniae from 12 children treated with levofloxacin.

Davies TA, Leibovitz E, Noel GJ, McNeeley DF, Bush K, Dagan R.

Johnson & Johnson Pharmaceutical Research and Development, LLC, Room B225, 1000
Route 202, Raritan, NJ 08869, USA. tdavies@prdus.jnj.com

Children who had acute otitis media and were treated with levofloxacin were
assessed for the emergence of fluoroquinolone-resistant Streptococcus pneumoniae.
Nasopharynx cultures were obtained from patients at the entry to and during
levofloxacin therapy. All nasopharynx isolates (n = 59) from 12 children were
levofloxacin susceptible without parC/E or gyrA/B mutations. Pneumococcal
nasopharynx persistence was not associated with levofloxacin resistance.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17999965 [PubMed - indexed for MEDLINE]

274: Auris Nasus Larynx. 2008 Sep;35(3):338-43. Epub 2007 Nov 13.

Platelet-activating factor (PAF) induced cytokine production and otitis media
with effusion (OME) in the rat middle ear.

Ogura M, Furukawa M, Tada N, Ikeda H, Yamashita T.

Department of Otolaryngology, Kansai Medical University, 2-3-1 Shinmachi,
Hirakata, Osaka, Japan.

OBJECTIVES: We examined the effect of platelet-activating factor (PAF) on IL-8
production in cultured rat middle ear epithelial cells (RMECs), and the
concentrations of cytokine, PAF, and PAF-acetylhydrolase (PAF-AH) were also
examined in the PAF-induced experimental OME (otitis media with effusion) of
rats. METHODS: Using an enzyme-linked immunospecific assay, we measured the
levels of cytokines in the cultured RMECs and the PAF-induced OME of rats. The
PAF was quantitated by the platelet-aggregating activity and the PAF-AH was
measured by radioimmunoassay. RESULTS: Both PAF and C-PAF, which is a stable
analogue of PAF, significantly induced production of IL-8 in the RMECs in a
dose-dependent manner. The PAF-induced IL-8 production was abolished by
co-incubation with WEB2170, a specific PAF receptor antagonist. The
concentrations of the cytokines and PAF in the PAF-induced OME of rats were
higher on day 1 and the PAF and cytokine levels seemed to correspond well with
the persistence of OME. CONCLUSION: PAF may stimulate the local production of
cytokines and may induce OME in the middle ear.

Publication Types: 
    In Vitro
    Research Support, Non-U.S. Gov't

PMID: 17997066 [PubMed - indexed for MEDLINE]

275: Ann Otol Rhinol Laryngol. 2007 Oct;116(10):779-84.

Morphological sequence of Plastipore extrusion in experimental otitis media.

Trinidad A, Vicente J, Verdaguer JM, Daza R, García-Berrocal JR, Ramírez-Camacho 
R.

Ear Research Group, Department of Otorhinolaryngology, University Hospital Puerta
de Hierro, Autonomous University of Madrid, Madrid, Spain.

OBJECTIVES: Plastipore prostheses are still used by many surgeons, although the
functional results are controversial. The aim of this study was the morphological
analysis of Plastipore material performance in the middle ear of rats, with
special attention to extrusion. METHODS: Twenty-four Wistar rats were given
implants made of commercially available Plastipore and assigned to 3 groups:
group A, with implantation in a healthy middle ear; group B, with implantation
and cauterization of the nasopharyngeal orifice of the eustachian tube
(hypoventilation); and group C, with implantation, cauterization of the
eustachian tube, and bacterial inoculation with Pseudomonas aeruginosa. RESULTS: 
The pathological study showed in nearly all cases the disintegration of the
biomaterial. Adhesion between the biomaterial and bone could be seen in 1 rat
from group C (hypoventilation and infection). In group C, the Plastipore was in
contact with the tympanic membrane in 1 case and was extruding in 2 animals.
Different phases of extrusion were defined. No extrusion was observed in the
other groups. CONCLUSIONS: The sequential stages of Plastipore extrusion are
demonstrated. Infection seems to be the most important factor in Plastipore
extrusion in our model.

PMID: 17987784 [PubMed - indexed for MEDLINE]

276: Curr Allergy Asthma Rep. 2007 Nov;7(6):444-50.

Inner ear and facial nerve complications of acute otitis media, including
vertigo.

Kitsko DJ, Dohar JE.

Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh,
University of Pittsburgh School of Medicine, 3705 Fifth Avenue, Pittsburgh, PA
15213, USA. dennis.kitsko@chp.edu

Acute otitis media is one of the most common diagnoses made in children in the
United States. Intracranial and extracranial (intratemporal) complications have
greatly decreased in the antibiotic era, but still remain a challenge when they
arise. This article addresses two intratemporal complications with significant
associated morbidity: facial nerve paralysis/paresis, and labyrinthitis.
Epidemiology, pathology, clinical diagnosis, and treatment options are discussed,
focusing on an evidence-based approach to diagnosis and management. In addition, 
the future of treatment and current questions regarding otitis media are briefly 
discussed.

Publication Types: 
    Review

PMID: 17986375 [PubMed - indexed for MEDLINE]

277: Curr Allergy Asthma Rep. 2007 Nov;7(6):436-43.

Soluble CD14: role in atopic disease and recurrent infections, including otitis
media.

Lødrup Carlsen KC, Granum B.

Department of Pediatrics, Division of Woman and Child, Ullevål University
Hospital, NO-0407 Oslo, Norway. k.c.l.carlsen@medisin.uio.no

Soluble CD14 (sCD14) is a part of innate immunity that has been implicated in
many diseases, including allergic diseases. However, many influencing factors and
confounders, including gender-gene-environment interactions, may complicate
interpretations of the observed associations to allergic diseases. In this paper,
we review current literature describing the functions of sCD14 and its
associations with common (recurrent) infections and with allergic diseases.
Because sCD14 is involved with immunologic responses to infections, and exposure 
to microbial compounds is debated as a protective or a trigger factor for allergy
development, these factors-which include genotypes, gender, age, microbial agents
(from the environment and infection), and tobacco smoke-cannot be assessed
independently. We conclude that confounding effects are important and must be
considered to understand the role of sCD14 in allergic development.

Publication Types: 
    Review

PMID: 17986374 [PubMed - indexed for MEDLINE]

278: Int J Antimicrob Agents. 2007 Dec;30 Suppl 2:S127-30. Epub 2007 Nov 5.

The use of pharmacokinetic/pharmacodynamic principles to predict clinical outcome
in paediatric acute otitis media.

Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center and Faculty
of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel. rdagan@bgu.ac.il

Double tympanocentesis studies of children with acute otitis media, carried out
over an 11-year period, were used to confirm that pharmacokinetic (PK) and
pharmacodynamic (PD) parameters can be used as predictors of the bacteriological 
and clinical efficacy of antimicrobial agents. Predicted susceptibilities of
common respiratory pathogens, such as Streptococcus pneumoniae and Haemophilus
influenzae, were compared with the bacteriological outcome of treatment in which 
the high-dose formulation of amoxicillin/clavulanate (90mg/kg/day) given twice
daily achieved the greatest bacteriological eradication rates for an oral agent. 
Further analysis of the data has indicated that failure to eradicate bacteria
from the middle ear fluid is strongly correlated with clinical failure.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 17980558 [PubMed - indexed for MEDLINE]

279: Int J Pediatr Otorhinolaryngol. 2008 Jan;72(1):23-30. Epub 2007 Oct 31.

Clinical qualitative evaluation of the diagnosis of acute otitis media in general
practice.

Legros JM, Hitoto H, Garnier F, Dagorne C, Parot-Schinkel E, Fanello S.

Département universitaire de santé publique-CHU Angers, 49933 Cedex 9, France.

OBJECTIVES: Assess the quality of the diagnosis of acute otitis media (AOM) given
by general practitioners (GPs) on a daily basis and compare it with the diagnosis
of ear, nose and throat specialist (ENTS) which is considered as the gold
standard. METHODOLOGY: Every GP had to include six children aged 1-4 years for
whom he suspected or diagnosed that they were suffering from AOM. Parents had to 
accept to see the ENTS participating in the survey within 48 h. RESULTS:
Twenty-four GPs took part in the survey and included at least one child, which
amounts to a final 57% acceptability rate. Two hundred and eight eardrums were
included in the survey. 21.9% of assumptions or diagnosis's of AOM (30/137) were 
declared null by the ENTS. GPs diagnose AOM without any doubt only in 54% of all 
cases. The diagnosis and the assumption of AOM were respectively confirmed in
83.8% of all cases and 71.4% by the ENTS. The combination of redness and bulge,
and isolated redness accounted for respectively 44.3% and 26.2% of the main
otoscopical factors reminiscent of the AOM according to GPs. In the case of
redness and bulge, the diagnosis was confirmed in 83% of all cases by the ENTS as
opposed to 75% regarding the isolated redness. An AOM was suspected in 57.1% of
the eardrums barely or not visible or without any sign of infection and not
confirmed in 25% of all cases. CONCLUSION: The global over diagnosis is 21.9% and
25% when the otoscopy is hindered by the presence of cerumen or when the eardrums
are only inflammatory. Even though the over diagnosis is inferior to the one
mentioned in published writings, post-graduate teaching on the various cerumen
removal techniques and the use of pneumatic otoscopy could contribute to
improving the quality of diagnosing AOM.

Publication Types: 
    Comparative Study

PMID: 17976829 [PubMed - indexed for MEDLINE]

280: Int J Pediatr Otorhinolaryngol. 2008 Jan;72(1):13-7. Epub 2007 Oct 31.

Proinflammatory and immunoregulatory cytokines in the middle ear effusions.

Skotnicka B, Hassmann E.

Department of Pediatric Otolaryngology, Medical Academy of Białystok, Poland.
pedorl@amb.edu.pl

OBJECTIVE: The recognition of inflammatory mediators in middle ear effusions and 
their correlation with clinical parameters may allow better understanding of many
complex events leading to development of permanent sequelae of otitis media and
hopefully help to develop future interventions. The aim of the study was to
evaluate the presence and level of proinflammatory interleukin (IL) 1beta, IL-6
and immunoregulatory IL-10 in the middle ear effusions, their mutual correlation 
and relationship with age, duration of the illness, number of episodes of acute
otitis media, and presence of retraction pockets. METHODS: The study included 25 
children (41 ears), who had been scheduled for myringotomy with the insertion of 
tympanostomy tubes due to otitis media with effusion. The interview (duration of 
the illness, number of episodes of acute otitis media), clinical and audiological
examination was conducted according to the developed examination check list.
Middle ear effusions (MEE) were collected aseptically, the samples centrifuged
and supernatant frozen at a temperature of -80 degrees C. The IL-1beta, IL-6 and 
IL-10 were assayed using enzyme-linked immunosorbent assay (ELISA) kits
incorporating monoclonal antibodies and the ETI system reader. The nonparametric 
Mann-Whitney U test was used for statistical analysis and Pearson's linear
correlation coefficient was calculated. RESULTS: IL-1beta was detected in 80% of 
examined effusions, IL-6 in 78%, and IL-10 in 88%. There was a strong statistical
correlation between IL-1beta and IL-6 concentrations (r=0.627, P=0.000), as well 
as IL-6 and IL-10 (r=0.66, P=0.000) No statistically significant correlation was 
found between levels of cytokines and clinical parameters. CONCLUSIONS:
Proinflammatory and immunoregulatory cytokines participate in middle ear
inflammatory response. The lack of direct correlation between IL-1beta and IL-10 
may be responsible for chronic character of the disease. As no correlation
between the levels of cytokines and clinical parameters was found it seems that
the time of duration of inflammation rather than its intensity measured by levels
of cytokines is the main factor in development of middle ear mucosa pathology.

PMID: 17976828 [PubMed - indexed for MEDLINE]

281: J Am Anim Hosp Assoc. 2007 Nov-Dec;43(6):307-12.

Antimicrobial testing of selected fluoroquinolones against Pseudomonas aeruginosa
isolated from canine otitis.

McKay L, Rose CD, Matousek JL, Schmeitzel LS, Gibson NM, Gaskin JM.

Department of Dermatology, VCA-Aurora Animal Hospital, 2600 West Galena
Boulevard, Aurora, Illinois 60506, USA.

A total of 100 Pseudomonas aeruginosa (P. aeruginosa) isolates were collected
over a 1.5-year period from cases of canine otitis. Sensitivities to
enrofloxacin, marbofloxacin, and orbifloxacin were determined using minimum
inhibitory concentration testing (MICT). Isolates were also tested for
sensitivities to enrofloxacin and marbofloxacin using disk-diffusion
susceptibility testing (DDST). Isolates were significantly more sensitive to
marbofloxacin than to enrofloxacin (z = -4.57; P<0.05) or orbifloxacin (z =
-5.02; P<0.05). Agreement was 87% between MICT and DDST for marbofloxacin, with
approximately equal numbers of overestimation and underestimation errors.
Agreement was 74% between MICT and DDST for enrofloxacin, but DDST tended to
overestimate the number of enrofloxacin-susceptible strains. These results
suggest that marbofloxacin is more effective against P. aeruginosa than either
enrofloxacin or orbifloxacin and that relying on DDST may lead to ineffective
enrofloxacin treatment.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17975212 [PubMed - indexed for MEDLINE]

282: Ear Nose Throat J. 2007 Sep;86(9):552-4.

A comparison of outcomes following tympanostomy tube placement or conservative
measures for management of otitis media with effusion.

Diacova S, McDonald TJ.

Department of Otorhinolaryngology--Head and Neck Surgery, State Medical and
Pharmaceutical University N. Testemitanu, Chisinau, Moldova.

We obtained the charts of 183 patients (197 ears) who had undergone surgery for
chronic otitis media (COM), and we reviewed their otic histories to analyze the
series of events that ultimately culminated in surgery. All ears had originally
been treated for otitis media with effusion (OME); 125 ears had been treated with
tympanostomy tube placement, and 72 ears had been treated with conservative
measures. Our goal was to compare the influence that these two strategies had on 
the subsequent development of COM and its sequelae (i.e., retraction pockets,
tympanic membrane perforations, and cholesteatomas) and thereby determine which
strategy is preferable. We found that although retraction pockets developed in a 
significantly higher proportion of the tympanostomy-treated ears than the
conservatively treated ears (58 vs. 35%; p < 0.01), a significantly greater
percentage of retractions in the tympanostomy-treated ears were mild and situated
in the anterior part of the tympanic membrane (52 vs. 32%; p < 0.05). Moreover,
severe retractions were significantly more common in the conservatively treated
ears (40 vs. 16%; p < 0.02); the incidence of complete retractions in the two
groups of ears was similar (tympanostomy: 32%; conservative treatment: 28%).
Cholesteatomas developed in a significantly lower percentage of
tympanostomy-treated ears (67 vs. 81%; p < 0.05), and the incidence of large
cholesteatomas that involved the tympanic and mastoid cavities was likewise
significantly lower in these ears (44 vs. 69%; p < 0.05). There was no
significant difference in the incidence of tympanic membrane perforations.
Finally, even though all of these ears eventually required surgery for COM, the
tympanostomy-treated ears required significantly fewer repeat surgeries (16 vs.
28%; p < 0.05) and significantly fewer radical modified tympanomastoidectomies
(30 vs. 44%; p < 0.05). Therefore, we conclude that myringotomy with insertion of
tympanostomy tubes to treat OME is superior to conservative treatment.

Publication Types: 
    Comparative Study

PMID: 17970145 [PubMed - indexed for MEDLINE]

283: Otolaryngol Head Neck Surg. 2007 Nov;137(5):766-71.

External auditory canal closure: an alternative management for the refractory
chronically draining ear.

Yoshida N, Cunningham CD 3rd, McElveen JT Jr.

Department of Otolaryngology, Tohoku University, School of Medicine, Sendai,
Japan.

OBJECTIVE: To discuss the surgical technique and evaluate the effectiveness of
external auditory canal (EAC) closure in patients with refractory chronically
draining ears. STUDY DESIGN AND SETTING: A retrospective case review of seven
patients who underwent EAC closure for chronically draining ears at a private
tertiary otologic referral center between 2001 and 2004. Three patients underwent
concomitant placement of a BAHA implant, and one patient underwent cochlear
implantation during a second-stage procedure. RESULTS: All seven patients had
successful closure of the external auditory canal with elimination of chronic
drainage. The follow-up interval ranged from 10 to 35 months. There were no cases
of iatrogenic cholesteatoma formation or breakdown of the ear canal closure.
CONCLUSION AND SIGNIFICANCE: In patients with refractory chronically draining
ears, EAC closure, alone or in conjunction with a bone-anchored implant, may be a
treatment option. A BAHA implant can be placed during the initial procedure or
staged.

PMID: 17967643 [PubMed - indexed for MEDLINE]

284: Rev Cubana Med Trop. 2005 May-Aug;57(2):154-5.

Severe otitis due to Vibrio fluvialis in a patient with AIDs: first report in the
world.

Cabrera Rodríguez LE, Monroy SP, Morier L, Ramírez Alvarez MM, Fernández Abreu A,
Castro Escarpulli G, Longa Briceño A, Bravo Fariñas L.

Instituto de Medicina Tropical Pedro Kourí, Ciudad de La Habana.

A case of waterborne otitis in a patient with AIDS was reported, who got infected
with Yibrio fluvialis by swimming in a pool of sea water. This is the first case 
reported in Cuba and as far as we know in the world. We describe the clinical
features associated with this an unusual case and discuss its significance.

Publication Types: 
    Case Reports

PMID: 17966587 [PubMed - indexed for MEDLINE]

285: J Med Microbiol. 2007 Nov;56(Pt 11):1558-60.

Cerebellar abscess and meningitis, caused by Shewanella putrefaciens and
Klebsiella pneumoniae, associated with chronic otitis media.

Yilmaz G, Aydin K, Bektas D, Caylan R, Caylan R, Koksal I.

Department of Infectious Disease and Clinical Microbiology, Karadeniz Technical
University School of Medicine, Trabzon, Turkey.

Shewanella putrefaciens is a facultatively anaerobic, non-motile, Gram-negative, 
non-fermentative bacterium. It is found in various environments and has been
isolated worldwide. S. putrefaciens is a rare cause of brain abscesses and
meningitis. This is a case report of a cerebellar abscess and meningitis caused
by Shewanella putrefaciens and Klebsiella pneumoniae in a river trap fisherman.

Publication Types: 
    Case Reports

PMID: 17965359 [PubMed - indexed for MEDLINE]

286: J Med Assoc Thai. 2007 Sep;90(9):1866-71.

Outcome of myringotomy with ventilation tube for otitis media with effusion in
Thai children: Ramathibodi experiences.

Tanpowpong K, Saisukul I, Kittimanont H, Rattanasiri S.

Department of Otolaryngology, Faculty of Medicine Ramathibodi Hospital, Mahidol
University, 270 Rama VI Rd, Ratchathevi, Bangkok 10400, Thailand.
raktp@mahidol.ac.th

OBJECTIVE: Study the otologic and audiologic outcome when using a ventilation
tube (VT) for the treatment of otitis media with effusion (OME) in Thai children.
MATERIAL AND METHOD: The medical records of twenty-three pediatric patients, 17
male and 6 female, aged 4 to 11 (mean age of 6.8 years), with the diagnosis of
OME who attended the Department of Otolaryngology, Faculty of Medicine
Ramathibodi Hospital, between January 2001 and December 2006 were reviewed.
Seventeen (73.9%) patients had associated diseases, 26% with allergic rhinitis
(AR), 21.7% with obstructive sleep apnea from chronic hypertrophic tonsillitis
and adenoid hypertrophy (OSA), and 26% with cleft palate (CP). The audiometric
with tympanometric assessment were done pre- and post-operative with mean of 47.3
and 294.2 days respectively. All children were treated with myringotomy and
insertion of VT. Oto-microscopic examinations for tympanic membrane pathologic
abnormalities were confirmed Post operative otorrhea cases were identified. The
extrusion rates of VT were also recorded after the insertion. RESULTS:
Twenty-three patients were enrolled in the present study. Mean air-bone gap was
18.24 (SD = 13.04) and 10.83 (SD = 8.26) before and after the operation
respectively, and the difference was statistically significant (p = 0.0013). This
could be interpreted that myringotomy with insertion VT could improve hearing by 
decreasing the air-bone gap dB. Having assessed the effect of associated diseases
(i.e., AR, OSA, and CP) on differences of air-bone gap between before and after
operation, the authors found that having AR, OSA, and CP did not statistically
affect the results of the operation. However the mean differences of air-bone gap
between before and after operation were quite different for AR versus non-AR
(-11.58 vs. -5.78), and OSA versus the non-OSA group (-12.10 vs. -5.95). This
might have the effects of the two factors but with this small sample size and
thus low power could not detect the effect. Tympanometric pattern was mainly type
B in the pre-operative (79.3%) and post operative (62.5%) period after tympanic
membrane closure in both ears. Mucoid fluid in the middle ear cavity of both ears
was detected during the operation in all patients. Post operative otorrhoea
occurred in 16.7%. The mean of extrusion rate of VT was 307.2 +/- 204.7 days with
maximum of 760 days. The mean duration of OME before surgery was 384.1 days.
CONCLUSION: The effects of conventional VT in Thai children with OME could
improve statistical significant hearing by decreasing the air-bone gap. The
associated diseases (i.e., AR, OSA, and CP) did not statistically affect the
results of the operation.

PMID: 17957932 [PubMed - indexed for MEDLINE]

287: Acta Paediatr. 2007 Dec;96(12):1814-8. Epub 2007 Oct 22.

Clinical/otologic score before and during treatment of acute otitis media.

Satran R, Leibovitz E, Raiz S, Piglansky L, Press J, Leiberman A, Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center and the
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,
Israel.

OBJECTIVES: To determine clinical characteristics of AOM at presentation and
during therapy according to specific etiologies. PATIENTS AND METHODS: 1003
patients studied during 1996-2001 in antibiotic efficacy studies underwent
tympanocentesis and middle ear fluid culture at enrollment and on Day 4-6 (in
initially culture-positive patients only). We used a clinical/otologic (CO) score
for evaluating severity of fever, irritability and tympanic membrane redness and 
bulging (0-3 each parameter, maximal score=12). RESULTS: Seven hundred
sixty-three patients had positive cultures with 392 (39%) Haemophilus influenzae,
198 (20%) Streptococcus pneumoniae and 173 (17%) mixed H. influenzae and S.
pneumoniae infection. Mean CO score was higher in culture-positive versus
culture-negative patients (8.21+/-2.17 vs. 7.73+/-2.32, p=0.003) regardless of
isolated organism. A marked improvement in CO score was observed on Day 4-6 in
all patients: 1.83+/-2.18 in children initially culture-positive and 0.9+/-1.67
in those initially culture-negative (p<0.001). The improvement was greater in
patients with eradication versus those with bacteriological failure (CO score
1.52+/-1.82 vs. 2.77+/-2.85, p<0.001). CONCLUSIONS: CO score before treatment,
after bacterial eradication or in bacteriologic failures are similar in bacterial
AOM and are not predictive of the etiology of the disease.

PMID: 17953728 [PubMed - indexed for MEDLINE]

288: BMJ. 2007 Nov 10;335(7627):982. Epub 2007 Oct 18.

Comment in:
    BMJ. 2007 Nov 10;335(7627):946-7.    J Fam Pract. 2008 Feb;57(2):85.

Protective effect of antibiotics against serious complications of common
respiratory tract infections: retrospective cohort study with the UK General
Practice Research Database.

Petersen I, Johnson AM, Islam A, Duckworth G, Livermore DM, Hayward AC.

UCL Centre for Infectious Disease Epidemiology, Department of Primary Care and
Population Sciences, University College London, London NW3 2PQ.

OBJECTIVE: To determine the extent to which antibiotics reduce the risk of
serious complications after common respiratory tract infections. DESIGN:
Retrospective cohort study. SETTING: UK primary care practices contributing to
the general practice research database. DATA SOURCE: 3.36 million episodes of
respiratory tract infection. MAIN OUTCOME MEASURES: Risk of serious complications
in treated and untreated patients in the month after diagnosis: mastoiditis after
otitis media, quinsy after sore throat, and pneumonia after upper respiratory
tract infection and chest infection. Number of patients needed to treat to
prevent one complication. RESULTS: Serious complications were rare after upper
respiratory tract infections, sore throat, and otitis media, and the number
needed to treat was over 4000. The risk of pneumonia after chest infection was
high, particularly in elderly people, and was substantially reduced by antibiotic
use, with a number needed to treat of 39 for those aged > or =65 and 96-119 in
younger age groups. CONCLUSION: Antibiotics are not justified to reduce the risk 
of serious complications for upper respiratory tract infection, sore throat, or
otitis media. Antibiotics substantially reduce the risk of pneumonia after chest 
infection, particularly in elderly people in whom the risk is highest.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17947744 [PubMed - indexed for MEDLINE]

289: J Otolaryngol. 2007 Aug;36(4):197-202.

Accuracy of the Weber and Rinne tuning fork tests in evaluation of children with 
otitis media with effusion.

Behn A, Westerberg BD, Zhang H, Riding KH, Ludemann JP, Kozak FK.

Division of Pediatric Otolaryngology, British Columbia's Children's
Hospital,Vancouver, British Columbia, Canada.

OBJECTIVE: The purpose of this study was to determine the accuracy of the Rinne
and Weber tuning fork tests in predicting the degree of hearing loss secondary to
otitis media with effusion (OME) in children compared with pure-tone audiometry. 
DESIGN: A blinded prospective study was performed on cases of unilateral and
bilateral OME in children between ages 2 and 11 years. SETTING: Patients were
recruited from the tertiary Pediatric Otolaryngology Clinic at British Columbia's
Children's Hospital in Vancouver. METHODS: The subjects consisted of 58 children 
with unilateral or bilateral OME. The Rinne and Weber tests were performed using 
a 256 Hz and a 512 Hz tuning fork. Pure-tone audiometry was performed to
establish the presence and degree of an air-bone gap (ABG). MAIN OUTCOME
MEASURES: The tuning fork responses were correlated with the ABG to determine
their accuracy. RESULTS: The Weber test did not show an association between the
ABG and the lateralization response using either the 256 Hz (p = .484) or the 512
Hz tuning fork (p = .120). For the Rinne test, an increase in ABG was
significantly associated with a higher rate of response air conduction < bone
conduction using either the 256 Hz or the 512 Hz fork (p < .04). Age was not
associated with outcome for any of the tuning fork tests. CONCLUSIONS: The
overall accuracy of the Rinne and Weber tuning fork tests in predicting
conductive hearing loss associated with OME in children is poor.

Publication Types: 
    Clinical Trial

PMID: 17942032 [PubMed - indexed for MEDLINE]

290: JAMA. 2007 Oct 17;298(15):1772-8.

Comment in:
    JAMA. 2007 Oct 17;298(15):1803-4.

Emergence of a multiresistant serotype 19A pneumococcal strain not included in
the 7-valent conjugate vaccine as an otopathogen in children.

Pichichero ME, Casey JR.

University of Rochester and Legacy Pediatrics, Rochester, New York, USA.
michael_pichichero@urmc.rochester.edu

CONTEXT: Concern has been raised about the possible emergence of a bacterial
strain that is untreatable by US Food and Drug Administration (FDA)-approved
antibiotics and that causes acute otitis media (AOM) in children. OBJECTIVE: To
monitor continuing shifts in the strains of Streptococcus pneumoniae that cause
AOM, with particular attention to capsular serotypes and antibiotic
susceptibility, following the introduction of a pneumococcal 7-valent conjugate
vaccine (PCV7). DESIGN, SETTING, AND PATIENTS: Prospective cohort study using
tympanocentesis to identify S pneumoniae strains that caused AOM in children
receiving PCV7 between September 2003 and June 2006. All children were from a
Rochester, New York, pediatric practice. MAIN OUTCOME MEASURE: Determination of
serotypes and antibiotic susceptibility of S pneumoniae causing AOM. RESULTS:
Among 1816 children in whom AOM was diagnosed, tympanocentesis was performed in
212, yielding 59 cases of S pneumoniae infection. One strain of S pneumoniae
belonging to serotype 19A was a new genotype and was resistant to all antibiotics
approved by the FDA for use in children with AOM. This strain was identified in 9
cases (2 in 2003-2004, 2 in 2004-2005, and 5 in 2005-2006). Four children
infected with this strain had been unsuccessfully treated with 2 or more
antibiotics, including high-dose amoxicillin or amoxicillin-clavulanate and 3
injections of ceftriaxone; 3 had recurrent AOM; and for 2 others, the infection
was their first in life. The first 4 cases required tympanostomy tube insertion
after additional unsuccessful antibiotic therapies. Levofloxacin was used in the 
subsequent 5 cases, with resolution of infection without surgery. CONCLUSION: In 
the years following introduction of PCV7, a strain of S pneumoniae has emerged in
the United States as an otopathogen that is resistant to all FDA-approved
antibiotics for treatment of AOM in children.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17940232 [PubMed - indexed for MEDLINE]

291: Curr Med Res Opin. 2007 Dec;23(12):2961-70.

Impact of oseltamivir on the incidence of secondary complications of influenza in
adolescent and adult patients: results from a retrospective population-based
study.

Blumentals WA, Schulman KL.

Roche, Nutley, NJ, USA. william.blumentals@roche.com

OBJECTIVE: To assess the effectiveness of oseltamivir in reducing the risks of
influenza-related secondary complications in otherwise healthy adolescent and
adult patients aged > or = 13 years. RESEARCH DESIGN AND METHODS: Retrospective
cohort analysis utilizing health insurance claims data in the USA (Thomson
MarketScan Research Database) from six influenza seasons (October-March) between 
2000 and 2006 to identify adults and adolescents (> or = 13 years) with
influenza. Patients who received a prescription for oseltamivir within +/-1 day
of diagnosis were compared with a propensity-matched control group receiving no
antiviral treatment. The first claim evidence of influenza was used to establish 
the study index date. Differences in outcomes were determined using Cox
proportional hazards regression and expressed in terms of hazard ratios (HR) with
95% confidence intervals (CI). MAIN OUTCOME MEASURES: Diagnosis of pneumonia, any
respiratory condition, otitis media and its complications, hospitalizations due
to pneumonia, and hospitalization for any reason within 14 days of the index
date. Healthcare expenditure within 30 days of the index date was also analyzed. 
RESULTS: The oseltamivir and untreated control groups each included 36 751
eligible patients. Oseltamivir use reduced the risks of otitis media and its
complications by 23% (HR=0.77; 95% CI: 0.65, 0.93), any respiratory disease by
18% (HR 0.82; 95% CI: 0.79, 0.86), and hospitalization for any reason by 22% (HR 
0.78; 95% CI: 0.67, 0.91). There were no differences in any other clinical
outcomes, including hospitalization for respiratory disease. Healthcare
expenditure did not differ between the two groups. LIMITATIONS: The retrospective
nature of the study meant that the findings may be susceptible to missing or lost
data. The results obtained here represent individuals enrolled in private
healthcare plans and may not, therefore, be representative of the entire US
population. The lack of a virologic diagnosis of influenza, and an index date
based on the first diagnosis of influenza rather than first exposure or symptom
onset, may have resulted in a conservative estimate of treatment effect.
CONCLUSIONS: Secondary complications of influenza, such as respiratory disease
and otitis media, were reduced in patients treated with oseltamivir. The risk of 
hospitalization for respiratory diseases was not reduced, although there was a
reduction in the risk of hospitalization for any reason. Clinical benefits
observed with oseltamivir were not associated with a change in healthcare costs.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17939881 [PubMed - indexed for MEDLINE]

292: Arch Otolaryngol Head Neck Surg. 2007 Oct;133(10):1002-4.

Characteristics and prognosis of malignant external otitis with facial paralysis.

Soudry E, Joshua BZ, Sulkes J, Nageris BI.

Department of Otolaryngology-Head and Neck Surgery, and Epidemiology Unit, Rabin 
Medical Center, Beilinson Campus, Petah Tiqwa 49100, and Sackler Faculty of
Medicine, Tel Aviv University, Israel.

OBJECTIVE: To compare the characteristics and prognosis of patients with
malignant (necrotizing) external otitis (MEO) with and without facial nerve palsy
in today's era of third-generation antibiotics. DESIGN: Comparative retrospective
case series. SETTING: Department of Otolaryngology-Head and Neck Surgery, Rabin
Medical Center, a tertiary care medical center. PATIENTS: Forty-eight patients
with MEO diagnosed and treated from 1990 to 2004. Eight had facial paralysis and 
40 had normal facial nerve function. MAIN OUTCOME MEASURES: Clinical, laboratory,
and imaging findings and survival. RESULTS: There was no statistically
significant difference between patients with and without facial nerve involvement
in terms of age, comorbidities, duration of complaints, physical findings,
erythrocyte sedimentation rate, and bone scan findings. Computed tomography
indicated a more progressive disease in patients with facial nerve involvement.
However, no statistically significant between-group difference was found in
overall survival. CONCLUSION: Although facial nerve involvement is a sign of
progression of MEO, it does not, by itself, worsen prognosis.

Publication Types: 
    Comparative Study

PMID: 17938323 [PubMed - indexed for MEDLINE]

293: Ann Otol Rhinol Laryngol. 2007 Sep;116(9):705-11.

Results, hearing rehabilitation, and follow-up with magnetic resonance imaging
after tympanomastoid exenteration, obliteration, and external canal overclosure
for severe chronic otitis media.

Ketelslagers K, Somers T, De Foer B, Zarowski A, Offeciers E.

University Department of Otorhinolaryngology, AZ Sint-Augustinus Hospital,
Wilrijk (Antwerp), Belgium.

OBJECTIVES: We sought to evaluate the results, auditory rehabilitation, and
follow-up with magnetic resonance imaging (MRI) after tympanomastoid exenteration
with obliteration of the mastoid cavity and overclosure of the external ear canal
in patients with severe chronic otitis media that was resistant to medical
therapy and conventional surgery and was associated with a profound sensorineural
or severe conductive hearing loss. METHODS: Twenty-nine patients were analyzed
and underwent this surgical technique. Twelve patients had, during the same or
later stage, either cochlear implantation, fixture implantation for a
bone-anchored hearing aid, or middle ear implantation. For follow-up control of
the obliterated cavity, delayed gadolinium-enhanced, T1-weighted MRI in
combination with non-echo planar imaging diffusion weighted sequences were used. 
RESULTS: No patient had recurrent otorrhea after an average follow-up period of
4.75 years. One patient had a residual cholesteatoma as shown by new MRI
techniques, and this was successfully resected. One patient developed
complications 6 months after 1-stage tympanomastoid exenteration and cochlear
implantation. CONCLUSIONS: This technique is very useful in selected patients
with severe chronic otitis media that is resistant to medical therapy and surgery
and is associated with a profound sensorineural or severe conductive hearing
loss. New sequences in MRI are used for postoperative follow-up of these
obliterated cavities and seem reliable for the detection of residual or recurrent
cholesteatoma. Middle ear implantation and cochlear implantation can be
relatively safely performed in these patients in a second stage.

PMID: 17926595 [PubMed - indexed for MEDLINE]

294: Aust Fam Physician. 2007 Oct;36(10):863-4.

Fighting disease with fruit.

Jones R, Smith F.

Bulgarr Ngaru Aboriginal Medical Service, Grafton, New South Wales.
drrayjones@bigpond.com

Otitis media and chronic suppurative otitis media are common conditions in
Aboriginal communities, and are associated with poor nutrition, overcrowding and 
passive smoking. This article reports on an extension of our nutrition program,
which was first reported in Australian Family Physician under the title 'Are
there health benefits from improving basic nutrition in a remote Aboriginal
community?'

PMID: 17925911 [PubMed - indexed for MEDLINE]

295: Eur Arch Otorhinolaryngol. 2008 Aug;265(8):881-5. Epub 2007 Oct 6.

A randomised controlled trial comparing Triadcortyl with 10% glycerine-ichthammol
in the initial treatment of severe acute otitis externa.

Masood A, Moumoulidis I, Ray S, Chawla O, Panesar J.

Department of Otolaryngology, Associated teaching hospital of the University of
London, Luton and Dunstable Hospital, Lewsey Road, Luton, LU4 0DZ, UK.
dramasood@yahoo.co.uk

Acute otitis externa is a common clinical condition accounting for a large
proportion of patients attending the otolaryngology department, although milder
cases are often managed in primary care. Treatment of the most severe forms of
otitis externa involves aural toilet, followed by the application of a topical
preparation, commonly in the form of an ear canal dressing. A prospective
single-blind randomized controlled trial was performed to compare the efficacy of
10% glycerine-ichthammol (GI) solution and Triadcortyl (TAC) ointment, both
applied as ear canal dressings, in the initial management of severe acute otitis 
externa. A total of 64 patients were studied. Both treatment modalities were
proven efficacious in the treatment of severe acute otitis externa. Although
there was a statistically significant improvement of pain parameters in the TAC
group, we found no significant differences in clinical findings between the two
groups. Therefore, it is recommended that GI dressing can be used instead of an
antibiotic dressing as an initial treatment of severe acute otitis externa on the
basis of cost, avoidance of resistance and toxicity.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 17922130 [PubMed - indexed for MEDLINE]

296: Otol Neurotol. 2007 Dec;28(8):1034-7.

Probabilities of ossicular discontinuity in chronic suppurative otitis media
using pure-tone audiometry.

Carrillo RJ, Yang NW, Abes GT.

Department of Anatomy, Philippine General Hospital, Ermita, Manila, Philippines. 
ryner_c@yahoo.com

OBJECTIVE: To analyze the likelihood ratios (LRs) and predictive values of
preoperative air-bone gap (ABG) levels on the presence of gross ossicular
discontinuity (OD) among chronic suppurative otitis media (CSOM) patients.
SETTING: Tertiary hospitals. METHODS: Records of 276 patients with CSOM 7 to 75
years old undergoing their first tympanomastoidectomy were reviewed. Association 
of preoperative audiogram on the presence of OD was analyzed using logistic
regression analysis and chi 2 tests. Frequency-specific ABG values were compared 
with the presence of OD. RESULTS: In CSOM without cholesteatoma, the ABG of 20 dB
or less at 500 Hz (LR [-], 0.119; 95% confidence interval [CI], 0.016-0.867) and 
30 dB or less at 1 kHz (LR [-], 0.276; 95% CI, 0.087-0.876) decreased probability
of OD from 33 to 5.6% and 15.5%, respectively. Air-bone gap levels of greater
than 30 dB at 2 kHz (LR [+], 2.8; 95% CI, 1.4-5.9) and greater than 40 dB at 4
kHz (LR [+], 2.2; 95% CI, 1.2-3.9) increased the probability of OD from 33 to 51 
to 89%. In the presence of cholesteatoma, the chance of OD was 88%. The ability
of ABG to alter probability of OD was not significant in the presence of
cholesteatoma. CONCLUSION: Narrow ABG at lower frequencies suggested absence of
OD. Wide ABG at higher frequencies suggested presence of OD. Simple tympanoplasty
can be done to patients with a small chance of OD as assessed by pure-tone
audiometry, whereas a mandatory exploration of the ossicular chain with possible 
reconstruction was suggested on subjects with a high chance of OD. The presence
of cholesteatoma warrants ossicular chain exploration.

PMID: 17921908 [PubMed - indexed for MEDLINE]

297: Laryngoscope. 2007 Dec;117(12):2213-7.

Role of albumin coating of tympanostomy tubes: long-term clinical evaluation.

Kinnari TJ, Rihkanen H, Laine T, Salonen EM, Jero J.

Department of Otolaryngology, Helsinki University Central Hospital and Haartman
Institute, Helsinki, Finland. teemu.j.kinnari@helsinki.fi

OBJECTIVE: Our previous work has shown that albumin coating of tympanostomy tubes
prevented adhesion of proteins or bacteria on the tube surface in vitro and in a 
9-month prospective follow-up study. This study was continued until all tubes
were extruded. STUDY DESIGN: A prospective, clinical trial. METHODS: The
randomized, double-blind clinical trial had 149 patients. The randomization was
revealed after the follow-up period of 9 months. The number of tube sequelae in
ears with human serum albumin (HSA)-coated titanium tympanostomy tubes was
compared with the contralateral ears with uncoated, otherwise identical titanium 
tubes. The follow-up continued until all tubes were extruded, followed by
evaluation of each tympanostomized patient. RESULTS: No significant difference
between the two tube types emerged after the 9-month follow-up. Among the
patients younger than 2 years, one of the three typical bacteria causing acute
otitis media (AOM), Streptococcus pneumoniae, Haemophilus influenzae, or
Moraxella catarrhalis, was found in 45% of all bacterial cultures taken during
AOM. However, among patients older than 2, one of these bacteria appeared in 17% 
of all the bacterial cultures and in 8% of cultures taken during the summer.
CONCLUSIONS: After the first 9 follow-up months, no difference was found in the
sequelae related to uncoated and HSA-coated tubes. The typical bacteria causing
AOM were found less frequently among patients older than 2 years. A profile of
tympanostomy patients in Finland will be given.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 17921900 [PubMed - indexed for MEDLINE]

298: Sleep Med. 2008 Jul;9(5):549-54. Epub 2007 Oct 24.

Prevalence of recurrent otitis media in habitually snoring school-aged children.

Gozal D, Kheirandish-Gozal L, Capdevila OS, Dayyat E, Kheirandish E.

Division of Pediatric Sleep Medicine and Kosair Children's Hospital Research
Institute, Department of Pediatrics, University of Louisville, 570 South Preston 
Street, Suite 204, Louisville, KY 40202, USA. david.gozal@louisville.edu

INTRODUCTION: The pathophysiology of obstructive sleep apnea (OSA) and recurrent 
otitis media (ROM) is intimately associated with the presence of adenotonsillar
hypertrophy in children. However, it remains unclear whether habitually snoring
children have a higher prevalence of ROM and whether they require tympanostomy
tube placement more frequently. METHODS: Questionnaires collected from parental
surveys of 5- to 7-year-old children attending the public schools in Louisville, 
KY were retrospectively reviewed for the presence of habitual snoring (HS), ROM, 
and the need for tympanostomy tube insertion. RESULTS: There were 16,321 surveys 
with complete datasets (51.2% boys; 18.6% African American (AA) with a mean age
of 6.2+/-0.7 years). Of these children, 1844 (11.3%) were HS (53% boys; 25.9%
AA); and, of these, 827 HS had also a positive history of ROM (44.8%) with a
slight predominance in males (55%). In addition, 636 of these children underwent 
placement of tympanostomy tubes (i.e., 34.4% of all HS and 76.9% of ROM). Among
the 14,477 non-snoring children (NS), ROM was reported in 4247 NS children
(29.3%; p<0.000001; odds ratio [OR]: 1.95; confidence interval [CI]: 1.77-2.16)
of which 57.6% were boys, and 1969 NS with ROM underwent tympanostomy tube
placement (i.e., 46.3% of those with ROM and 13.6% of all non-snoring children). 
Thus, the risk for tympanostomy tube placement was also greater among HS compared
to NS children (p<0.00001; OR: 2.19; CI: 1.98-2.43). CONCLUSIONS: Habitual
snoring is associated with a significant increase in the prevalence of recurrent 
otitis media and the need for tympanostomy tube placement. Further studies aiming
to assess the prevalence of obstructive sleep apnea among children with ROM are
needed.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17921061 [PubMed - indexed for MEDLINE]

299: Clin Radiol. 2007 Nov;62(11):1110-8. Epub 2007 Sep 5.

Classification of temporal bone pneumatization based on sigmoid sinus using
computed tomography.

Han SJ, Song MH, Kim J, Lee WS, Lee HK.

Department of Otorhinolaryngology, National Health Insurance Corporation Ilsan
Hospital, and Yonsei University College of Medicine, Seoul, Republic of Korea.

AIM: To analyse several reference structures using axial computed tomography (CT)
imaging of the temporal bone, which may reflect pneumatization of the entire
temporal bone by statistical correlation to the actual volume of the temporal
bone measured using three-dimensional reconstruction. MATERIALS AND METHODS: One 
hundred and sixteen temporal bones were studied, comprising 48 with normal
findings and 68 sides showing chronic otitis media or temporal bone fracture.
After measuring the volume of temporal bone air cells by the volume rendering
technique using three-dimensional reconstruction images, classification of
temporal bone pneumatization was performed using various reference structures on 
axial images to determine whether significant differences in the volume of
temporal bone air cells could be found between the groups. RESULTS: When the
sigmoid sinus at the level of the malleoincudal complex was used in the
classification, there were statistically significant differences between the
groups that correlated with the entire volume of the temporal bone. Grouping
based on the labyrinth and the ascending carotid artery showed insignificant
differences in volume. Furthermore, there was no significant correlation between 
the cross-sectional area of the antrum and the entire volume of the temporal
bone. CONCLUSION: The degree of pneumatization of temporal bone can be estimated 
easily by the evaluation of the air cells around the sigmoid sinus on axial CT
images.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17920872 [PubMed - indexed for MEDLINE]

300: Int J Pediatr Otorhinolaryngol. 2007 Dec;71(12):1889-95. Epub 2007 Oct 25.

Protective effect of pulmonary surfactant on cilia of Eustachian tube in otitis
media with effusion.

Ma Z, Dai C, Yang S, Li M, Qi L.

ENT Department Yueyang Hospital Traditional Chinese & Western Medicine, Shanghai 
University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai 200437,
China. Mzhx114@163.com

OBJECTIVE: The aim of this study was to evaluate the effect of pulmonary
surfactant (PS) on cilia of Eustachian tube (ET) in guinea pigs suffering from
otitis media with effusion (OME). METHODS: A nonviable heat-killed pneumococci
(HKP) solution was injected into the tympanum of guinea pig via a transtympanic
approach therefore establishing models of OME (effusion in tympanum and hearing
loss). After being injected with physiologic saline solution or pulmonary
surfactant transtympanically, the response threshold of each guinea pig was taken
by ABR. Changes of effusion and ciliary ultrastructure were observed. RESULTS:
Normal group (A), the response threshold is 14.00+/-3.08 dBHL. Abundant and
intact cilia were observed, ciliary morphology was normal, cilia regularly
arranged in concord, no goblet cells was observed. Model-control group (B0), 5
days following the inoculation of HKP, serous effusion was present in tympanum.
The response threshold is 45.00+/-5.67 dBHL. Cilia lost and arranged irregularly,
hyperplasia of the goblet cells was observed. Saline group, the previously
observed serous effusion of tympanum was increased or unchanged. The response
threshold is 65.50+/-6.85 dBHL. Cilia were coalescing and swelling. A lot of
cilia lost and arranged disorderly. A number of compound cilia of the bulging
type were formed by cytoplasmic protuberances of ciliated cells. Massive mucoid
secretions stuck on the surface of the ET. PS group, the previously observed
serous effusion of tympanum was reduced in amount or disappeared completely. The 
response threshold is 23.53+/-6.32 dBHL. Ciliary morphology was generally normal.
Cilia comparatively arrange in concord. A mucus deposits was adhering to the tips
of cilia. CONCLUSION: The findings of the study suggest that pulmonary surfactant
plays an important role in protecting of cilia of ET of guinea pigs suffering
from OME.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17913247 [PubMed - indexed for MEDLINE]

301: Pediatrics. 2007 Oct;120(4):814-23.

Genetic polymorphisms in immunoresponse genes TNFA, IL6, IL10, and TLR4 are
associated with recurrent acute otitis media.

Emonts M, Veenhoven RH, Wiertsema SP, Houwing-Duistermaat JJ, Walraven V, de
Groot R, Hermans PW, Sanders EA.

Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University
Medical Center, Dr Molewaterplein 50, Room Ee15-02, 3015 GE, Rotterdam, The
Netherlands. m.emonts@erasmusmc.nl

OBJECTIVE: Cytokines and other inflammatory mediators are involved in the
pathogenesis of otitis media. We hypothesized that polymorphisms in inflammatory 
response genes contribute to the increased susceptibility to acute otitis media
in otitis-prone children. PATIENTS AND METHODS: DNA samples from 348 children
with > or = 2 acute otitis media episodes, who were participating in a
randomized, controlled vaccination trial, and 463 healthy adult controls were
included. Polymorphisms in TNFA, IL1B, IL4, IL6, IL10, IL8, NOS2A, C1INH, PARP,
TLR2, and TLR4 were genotyped. Genotype distributions in children with recurrent 
acute otitis media were compared with those in controls. Within the patient
group, the number of acute otitis media episodes before vaccination and the
clinical and immunologic response to pneumococcal conjugate vaccinations were
analyzed. RESULTS: The IL6-174 G/G genotype was overrepresented in children with 
acute otitis media when compared with controls. In the patient group, TNFA
promoter genotypes -238 G/G and -376 G/G and the TLR4 299 A/A genotype were
associated with an otitis-prone condition. Furthermore, lower specific
anticapsular antibody production after complete vaccination was observed in
patients with the TNFA-238 G/G genotype or TNFA-863 A allele carriage. Finally,
the IL10-1082 A/A genotype contributed to protection from the recurrence of acute
otitis media after pneumococcal vaccination. CONCLUSIONS: Variation in innate
immunoresponse genes such as TNFA-863A, TNFA-376G, TNFA-238G, IL10-1082 A, and
IL6-174G alleles in the promoter sequences may result in altered cytokine
production that leads to altered inflammatory responses and, hence, contributes
to an otitis-prone condition.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 17908769 [PubMed - indexed for MEDLINE]

302: Acta Neurochir (Wien). 2007 Nov;149(11):1179-81; discussion 1181. Epub 2007 
Oct 1.

Abscess-a rare fourth ventricular mass.

Pruthi N, Devi BI, Shivshankar JJ, Pandey P.

Department of Neurosurgery, National Institute of Mental Health and
Neurosciences, Bangalore, India. pruthi_nupur@yahoo.co.in

Midline posterior fossa mass lesions in young adults are usually
medulloblastomas, pilocytic astrocytomas, haemangioblastomas or ependymomas. We
present clinical, imaging and intraoperative findings of an abscess occurring
within the fourth ventricle which was associated with right chronic suppurative
otitis media and right transverse sinus thrombosis. The possible pathogenesis is 
discussed.

Publication Types: 
    Case Reports

PMID: 17906968 [PubMed - indexed for MEDLINE]

303: Laryngoscope. 2007 Oct;117(10):1809-14.

Contralateral ear in chronic otitis media: a histologic study.

Rosito LP, da Costa SS, Schachern PA, Dornelles C, Cureoglu S, Paparella MM.

Division of Otolaryngology Head and Neck Surgery, Hospital de Clínicas de Porto
Alegre, Brasil. letischmidt@hotmail.com

OBJECTIVE: The objective of this study is to determine the prevalence of the
contralateral ear changes in human temporal bones of donors with chronic otitis
media. STUDY DESIGN: Transversal. MATERIAL AND METHODS: The temporal bones were
examined under light microscopy and then described. Chronic otitis media was
defined by the presence of irreversible inflammatory alterations in the middle
ear cleft. The contralateral ear was defined as the normal or the less affected
ear. To compare the qualitative variables, the chi test was used. Spearman's
nonparametric test was used for correlations. P values less than or equal to .05 
were considered significant. RESULTS: We studied 85 pairs of temporal bones.
Cholesteatoma was observed in 22.4% of the more damaged ears. The prevalence of
contralateral ears with alterations was 91.8%. The main alterations were
granulation tissue (81%), effusion (58%), and tympanic membrane retractions
(35%). There was a direct and moderately strong correlation between the extent of
granulation tissue in the more damaged ear and the contralateral ear (r(s) =
0.345, P = .004). A strong correlation was observed between the extent of
cholesteatoma in the more damaged ear and in the contralateral ear (rs = 0.617, P
< .001). CONCLUSION: We observed a high prevalence of changes in the
contralateral ear. There was a direct correlation between the extent of both
granulation tissue and cholesteatoma between the two ears, demonstrating that the
more extensive the manifestation of these pathologies in the more damaged ear,
the greater they will be in the contralateral ear.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17906499 [PubMed - indexed for MEDLINE]

304: Int J Pediatr Otorhinolaryngol. 2007 Dec;71(12):1865-72. Epub 2007 Sep 29.

Comparison of old, professional and consumer model acoustic reflectometers in the
detection of middle-ear fluid in children with recurrent acute otitis media or
glue ear.

Teppo H, Revonta M.

Department of Otorhinolaryngology, Kanta-Hame Central Hospital, FIN-13530
Hameenlinna, Finland. heikki.teppo@khshp.fi

OBJECTIVE: Acoustic reflectometry is an alternative method of determining the
probability of middle-ear fluid. Its sensitivity and specificity are comparable
to those of pneumatic otoscopy and tympanometry. The relative superiority between
the first-generation model and second-generation spectral gradient acoustic
reflectometers (introduced for both professional and consumer use) has not been
studied. This study aimed to assess the diagnostic performance of three different
acoustic reflectometry devices, and to evaluate the intercorrelation of the
results. METHODS: Fifty children (100 ears) aged <7 years undergoing ambulatory
otomicroscopic myringotomy in anesthesia were examined with three different
acoustic reflectometers, and the results were compared to the myringotomy
findings (gold standard method). Specificity, sensitivity and positive and
negative predictive values of each instrument in detecting middle-ear fluid were 
determined. The intercorrelations between the three devices were assessed
descriptively (percentage agreement) and statistically (kappa correlation).
RESULTS: Second-generation professional and consumer spectral gradient acoustic
reflectometers performed equally well in detecting middle-ear fluid
(specificities 84 and 85%, sensitivities 83 and 77%, respectively) and were
superior to the old model. Accordingly, the results obtained with professional
and consumer models correlated well with each other (kappa 0.60) but not with
those of the first-generation device. Acoustic reflectometry is not reliable when
performed in anesthesia with the patient lying down. CONCLUSIONS: Newer spectral 
gradient acoustic reflectometers perform better than the older first-generation
model. In this study, the consumer model gave the same information as
professional model, but its diagnostic validity in the hands of layman consumers 
needs to be confirmed.

Publication Types: 
    Comparative Study

PMID: 17904648 [PubMed - indexed for MEDLINE]

305: Otolaryngol Head Neck Surg. 2007 Oct;137(4):612-8.

Macrophage inflammatory proteins in cytomegalovirus-related inner ear injury.

Schraff SA, Schleiss MR, Brown DK, Meinzen-Derr J, Choi KY, Greinwald JH, Choo
DI.

Department of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati
Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
Scott.Schraff@CCHMC.org

OBJECTIVE: Inner ear inflammation triggered by CMV infection may play a role in
CMV-related auditory pathogenesis. The purpose of the study was to determine if a
virally encoded macrophage inflammatory protein played a role in CMV-related
hearing loss. DESIGN: Mutagenesis was performed with deletion of a guinea pig CMV
macrophage inflammatory protein. Intracochlear inoculations were performed on
three groups of animals (n = 18). Group 1 received sterile viral media, Group 2
received wild-type CMV virus, and Group 3 received "knockout" (KO) virus with a
deleted immunomodulation gene. Baseline and postinoculation ABRs were obtained.
ELISA and PCR were performed and temporal bones examined. SUBJECTS: Eighteen
guinea pigs. RESULTS: The KO group had significantly better hearing than the WT
group. There were no significant differences between the KO and sham groups. The 
WT group had significant hearing loss at all frequencies. Inflammation and
fibrosis were noted in the WT temporal bones only. CONCLUSIONS: Virally encoded
macrophage inflammatory proteins appear to play a significant role in CMV-related
hearing loss.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17903579 [PubMed - indexed for MEDLINE]

306: Niger J Clin Pract. 2007 Jun;10(2):130-6.

Pattern of pathogens in ear discharge of HIV-infected children in Nnewi,
Southeast Nigeria.

Ugochukwu EF, Ezechukwu CC, Undie N, Akujobi C.

Department of Paediatrics, Nnamdi, Azikiwe University Teaching Hospital, Nnewi,
Nigeria. efugochukwu@yahoo.com

OBJECTIVE: This is a descriptive, prospective, hospital-based study designed to
determine the prevalent organisms in ear infections and their antimicrobial
susceptibility patterns in HIV-infected children compared to age-and sex-matched 
HIV sero-negative patients. METHOD: Two hundred and fifty eight HIV-infected
children being followed up at the Paediatric HIV clinic had their ears examined
for middle ear infection. All those with discharging ears had swabs taken.
Culture and antimicrobial sensitivities were ascertained. The same was done for
another cohort of 57 age-and sex-matched HIV-negative patients with discharging
ears. RESULTS: Twenty eight (10.9%) of 258 HIV-infected children had discharging 
ears and were made up of 13 females and 15 males aged between 7 and 132 months.
Out of this number 85.7% had chronically discharging ears, 96.4% of the 28
children acquired the HIV infection vertically. 78.6% had been on antiretroviral 
drugs from one to twenty-one months. 67.9% of the patients had associated
opportunistic infections. Acute ear infections were predominant among the control
group. Klebsiella, Proteus, Staphylococcus and Pseudomonas were major pathogens
isolated among the HIV-infected group and Streptococcus, Klebsiella and
Pseudomonas for the HIV-negative group. A hundred percent sensitivity was
recorded among the quinolones for all bacterial organisms isolated. CONCLUSION:
HIV-infected children tend to have more of chronic than acute ear infections and 
this is reflected in the causative organisms. Similar antimicrobial sensitivity
patterns apply to HIV-infected and HIV-negative children. There is a need to
revisit the use of quinolones in children.

PMID: 17902505 [PubMed - indexed for MEDLINE]

307: Pediatr Infect Dis J. 2007 Oct;26(10):892-6.

The dynamics of bacteria in the middle ear during the course of acute otitis
media with tympanostomy tube otorrhea.

Ruohola A, Meurman O, Nikkari S, Skottman T, Heikkinen T, Ruuskanen O.

Department of Pediatrics, Turku University Hospital, Turku, Finland.
aino.ruohola@utu.fi

BACKGROUND: Dynamics of bacteria during acute otitis media (AOM) has not been
thoroughly studied because it requires repeated tympanocentesis. AOM with
tympanostomy tube otorrhea provides a unique opportunity to study the appearance 
and disappearance of pathogens during the course of the disease without stressing
the child. METHODS: Middle ear fluid (MEF) samples were taken before treatment
(amoxicillin clavulanate or placebo) and then daily during follow-up from 75
children having AOM with otorrhea through a tympanostomy tube. Bacteria were
identified by culture, and typical AOM pathogens also by polymerase chain
reaction. RESULTS: Bacteria were initially shown in 67 (89%) children. New
bacteria appeared in MEF more often in placebo than in amoxicillin clavulanate
recipients [9 of 38 (24%) versus 2 of 37 (5%); P = 0.032]. During the follow-up, 
new occurrences of Moraxella catarrhalis were detected in MEF more frequently
than those of Streptococcus pneumoniae or Haemophilus influenzae. Of the 28
patients with bilateral otorrhea, 11 (39%) had disparate bacteria at study entry 
and/or during the follow-up. CONCLUSIONS: Changes in bacterial findings during
the course of AOM are common in patients not receiving treatment, and even
possible despite adequate treatment. In bilateral otorrhea, disparate bacterial
findings are common.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 17901793 [PubMed - indexed for MEDLINE]

308: Eur Arch Otorhinolaryngol. 2008 Mar;265(3):293-8. Epub 2007 Sep 22.

Gel chromatographic characterization of proteins in mucous and serous middle ear 
effusions of patients with otitis media in comparison to serum proteins.

Yabe R, Higo R, Sugita K, Iwamori M.

Yabe ENT Clinic, 1-6-13 Ginza, Chuo-ku, Tokyo 104-0061, Japan.

Otitis media with effusion (OME) is an inflammatory disease of the middle ear
cavity that is associated with middle ear effusions (MEEs), which are frequently 
mucous and serous for pediatric and adult patients exhibiting low and high
responsiveness to medical treatment, respectively. To assess the pathological
outcomes in mucous and serous MEEs, their protein compositions were determined by
sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blotting in
comparison with those in the same patients' sera. A mucin, which is
immunochemically identical with nasal mucin, was a characteristic consituent of
mucous MEEs (n = 25), being present at the concentration of 59.4 mg/ml and
comprising about 60% of the total proteins, but it was not detected in serous
MEEs (n = 30) or sera. Serum proteins with molecular weights of less than 260 kDa
were detected in serous and mucous MEEs, in which albumin was the major protein. 
Albumin, IgM and alpha1-acid glycoprotein, and lysozyme, IgA and IgG in MEEs were
present at lower and higher concentrations than in sera, respectively. The ratios
of IgA, IgG, IgM and alpha1-acid glycoprotein to albumin in mucous MEEs were 4-, 
3-, 1.4- and 1.0-times higher than those in the respective pediatric sera, and
those in serous MEEs were 1.7-, 1.7-, 0.6- and 0.3-times higher than those in
adult sera. Also, the concentrations of lysozyme in mucous and serous MEEs were
19 and 3 microg/ml, but those in pediatric and adult sera were negligible. These 
results indicate that the contents of these proteins, in comparison to albumin,
might be useful criteria for assessing the inflammation level in MEEs.

Publication Types: 
    Comparative Study

PMID: 17891410 [PubMed - indexed for MEDLINE]

309: Int J Pediatr Otorhinolaryngol. 2007 Dec;71(12):1843-8. Epub 2007 Sep 24.

Level of psychosocial adaptation in young school children with otitis media.

Timmerman A, Meesters C, Anteunis L, Chenault M.

Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital of
Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. ATI@skno.azm.nl

OBJECTIVE: Assessment of the level of psychosocial adaptation in Dutch young
school children with persistent and/or recurrent otitis media compared to a U.S. 
community sample. The goal of this study was to determine the presence of
behavioural effects related to a history of hearing loss resulting from recurrent
or persistent otitis media. METHODS: Caregivers of 160 children, age range 4-7
years, suffering from either upper respiratory tract infections (URTI) and/or
otitis media with effusion (OME), completed the generic Strengths and
Difficulties Questionnaire (SDQ) and impact supplement before consulting the ENT 
physician. RESULTS: In the ENT sample significant differences were found for the 
SDQ subscales hyperactivity-inattention and emotional symptoms, as well as for
the total difficulties score and impact rating, compared to the U.S. community
sample (p<.0005). Classification of severity (low, medium, high difficulties) for
SDQ symptom scores, according to U.S. normative scoring bands, showed
significantly more children in higher severity bands for SDQ total difficulties
(p<.0005), emotional symptoms (p<.005), hyperactivity-inattention (p<.001) and
prosocial behaviour (p<.005). This is expressed in a larger percentage of scores 
in the high difficulties (>90% of scores) than in the medium difficulties (80-90%
of scores) band for most ENT SDQ scores, except for SDQ prosocial behaviour
(18.1%) and total difficulties (17.5%). CONCLUSION: The level of psychosocial
adaptation seems to be compromised in the Dutch ENT sample for both internalising
(emotional symptoms) and externalising (hyperactivity-inattention) behaviour
dimensions, which indirectly supports the cumulative effects of a disease history
with chronic otitis media, resulting in poorer attention skills and fewer social 
interactions present. The classification of SDQ symptom severity, indicates that 
any behavioural effect of otitis media and resulting hearing loss is within the
borderline score range, asking for vigilance regarding possible developmental and
educational sequelae during childhood.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17889940 [PubMed - indexed for MEDLINE]

310: Southeast Asian J Trop Med Public Health. 2007 Jul;38(4):749-53.

Suction clearance and 2% topical miconazole versus the same combination with
acidic drops in the treatment of otomycosis.

Kiakojuri K, Roushan MR, Sepidgar SA.

Department of Otolaryngology, Shahid Beheshti Teaching Hospital, Babol Medical
University, Babol, Iran. kia_ko13358@yahoo.com

From April 2003 to September 2004, 59 ears from 55 patients received suction
clearance and topical miconazole 2% (regimen 1) and in September 2004 to December
2005, 64 ears from 58 patients received the same combinations plus acidic drops
[acetic acid 3% (v/ v) in 97% ethanol]. The mean age of patients treated with
regimen 1 was 35.76+/-16 years and in regimen 2 was 37.98+/-15 years. Aspergilus 
sp and Candida sp were seen in 35 (59.3%) and 24 (40.7%) cases treated with
regimen 1 and in 43 (67.2%) and 21 (32.8%) cases treated in regimen 2,
respectively. Relapse occurred in 2 (3.4%) ears treated with regimen 1, but none 
in cases treated with regimen 2 (p=0.228). The findings reveal that there were no
statistically significant differences between the two regimens and both may be
used for the treatment of otomycosis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17883017 [PubMed - indexed for MEDLINE]

311: J Vet Med A Physiol Pathol Clin Med. 2007 Oct;54(8):424-7.

Malassezia otitis externa in the dog: the effect of heat-fixing otic exudate for 
cytological analysis.

Griffin JS, Scott DW, Erb HN.

Department of Clinical Sciences, College of Veterinary Medicine, Cornell
University, Ithaca, NY 14853, USA.

This study was conducted on 32 dogs with Malassezia otitis externa to determine
the effect of heat-fixing otic exudate on cytological analysis. Malassezia
infection was confirmed by cytological examination of otic exudate. Otic
discharge collected with cotton swabs was then rolled onto glass slides. One
slide per dog was heat-fixed prior to staining; the other slide was not
heat-fixed. The number of yeast in 10 oil-immersion fields (1000 x magnification)
was counted for both slides from each dog. Heat-fixing did not systematically
cause either increased or decreased numbers of Malassezia on cytology of otic
exudate.

PMID: 17877584 [PubMed - indexed for MEDLINE]

312: Diagn Microbiol Infect Dis. 2007 Sep;59(1):67-74.

Pharmacokinetics and pharmacodynamics of gatifloxacin in children with recurrent 
otitis media: application of sparse sampling in clinical development.

Rubino CM, Ambrose P, Cirincione B, Arguedas A, Sher L, Lopez E, Sáez-Llorens X, 
Grasela DM.

Institute for Clinical Pharmacodynamics, Ordway Research Institute, Albany, NY
12206, USA. crubino-icpd@ordwayresearch.org

Gatifloxacin is a 4th-generation fluoroquinolone previously under investigation
for the treatment of otitis media in infants and children. These analyses were
designed to evaluate the extent of drug exposure relative to adult populations
and to examine the relationship between drug exposure and response to therapy in 
children with recurrent otitis media or early treatment failures of acute otitis 
media. The patient population included 187 patients from an open-label,
multicenter, noncomparative study using gatifloxacin 10 mg/kg once daily.
Gatifloxacin exposure was estimated using a single steady-state blood sample in
conjunction with a pharmacostatistical model developed using a separate pediatric
data set. Gatifloxacin exposure was equivalent to that in adults given 400 mg
daily. Of the 41 patients who had Streptococcus pneumoniae from middle ear
culture, there were only 3 bacteriologic failures; there was no relationship
between plasma fu AUC(0-24):MIC ratio and outcome. In conclusion, population
pharmacokinetic/pharmacodynamic methods allowed estimation of drug exposure using
one sample per patient.

Publication Types: 
    Clinical Trial, Phase II
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 17875453 [PubMed - indexed for MEDLINE]

313: Kulak Burun Bogaz Ihtis Derg. 2007;17(3):183-6.

Incudostapedial rebridging ossiculoplasty with glass ionomer cement: a case
report.

Kubilay U, Sezen OS, Ozkiriş M, Haytoğlu S, Unver S.

Department of Otolaryngology, Dr. Lütfi Kirdar Kartal Training and Research
Hospital, Istanbul, Turkey. drutkukubilay@hotmail.com

A 31-year-old woman presented with a complaint of hearing loss of a two-year
history. Otoscopic examination revealed a central ear drum perforation without
discharge. The air-bone gap was 35 dB at 0.5, 1, 2, and 3 kHz. Under general
anesthesia, the patient underwent tympanoplasty for chronic otitis media. At
surgery, the ossicular chain was intact except for discontinuity by a 2-mm gap
between the long process of the incus and the head of the stapes. The gap was
reconstructed with the use of a fluoroplastic prosthesis. Myringoplasty was
successful, but the patient complained of hearing loss at the end of six months. 
Transcanal posterior tympanotomy was performed under local anesthesia for
decreased conductive hearing. The prosthesis was still in place, but was not
conducting the movements of the malleus to the stapes. It was removed and glass
ionomer cement (Ketac-Cem) was applied for rebridging. The average air-bone gap
measured in the postoperative sixth month was less than 10 dB.

Publication Types: 
    Case Reports

PMID: 17873512 [PubMed - indexed for MEDLINE]

314: Auris Nasus Larynx. 2008 Sep;35(3):401-3. Epub 2007 Sep 17.

A case of syryngocystadenoma papilliferum (SCAP) involving middle ear, presenting
with otomastoiditis and cerebral abscess.

Presutti L, Alicandri-Ciufelli M, Mattioli F, Marchioni D, Costantini M.

Policlinico di Modena, Università degli Studi di Modena e Reggio Emilia,
Department of Otolaryngology, Via del Pozzo 71, Modena, Italy.

Syryngocystadenoma papilliferum (SCAP) is an uncommon cutaneous adnexal neoplasm 
of apocrine gland origin. Until now, fewer than 200 cases have been reported in
international literature, of which 12 cases involved the external ear. No cases
of SCAP involving the middle ear have been reported. We describe a case of SCAP
of external and middle ear, presenting with otomastoiditis and cerebral abscess; 
this aggressive behavior, never reported for a benign adenoma of the external or 
middle ear, could lead to a differential diagnosis with cholesteatoma or
malignancies.

Publication Types: 
    Case Reports

PMID: 17870265 [PubMed - indexed for MEDLINE]

315: Acta Otolaryngol. 2008 Feb;128(2):144-50.

Activities of matrix metalloproteinases and tissue inhibitor of
metalloproteinase-2 in idiopathic hemotympanum and otitis media with effusion.

Moon SK, Linthicum FH Jr, Yang HD, Lee SJ, Park K.

Gonda Department of Cell and Molecular Biology, House Ear Institute, Los Angeles,
CA, USA. smoon@hei.org

CONCLUSION: The expression profile of matrix metalloproteinases (MMPs) and tissue
inhibitor of metalloproteinase-2 (TIMP-2) was specific to the type of middle ear 
effusion. Further studies are necessary for elucidating its correlation with the 
sequelae of otitis media with effusion (OME) and idiopathic hemotympanum.
OBJECTIVES: We aimed to investigate the relative activities of gelatinases (MMP-2
and -9), stromelysin-1 (MMP-3), and matrilysin-1 (MMP-7), as well as measuring
TIMP-2 levels in the serous and mucous effusions of OME and hemorrhagic effusion 
of the idiopathic hemotympanum. MATERIALS AND METHODS: Middle ear effusions were 
collected from patients with OME and idiopathic hemotympanum, and were classified
as mucoid, serous, or hemorrhagic. MMP activity in the effusion samples was
examined by gelatin and casein zymography. Levels of TIMP-2 were measured by
ELISA. Human temporal bone sections, with and without otitis media (OM), were
examined histologically. RESULTS: One case showed tympanic membrane thinning in
the OM group, but none in the control group. While MMP-2 was present in all
effusions, the active form of MMP-2 was found only in mucous effusions. MMP-3 and
MMP-7 activity was detected only in the mucous effusions. MMP-9 exhibited
activity in all effusions, with the highest levels in mucous effusions. TIMP-2
levels were markedly elevated in serous effusions.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17851959 [PubMed - indexed for MEDLINE]

316: Acta Otolaryngol. 2008 Feb;128(2):132-8.

Gram-negative pathogen Klebsiella oxytoca is associated with spontaneous chronic 
otitis media in Toll-like receptor 4-deficient C3H/HeJ mice.

MacArthur CJ, Pillers DA, Pang J, Degagne JM, Kempton JB, Trune DR.

Department of Otolaryngology Head & Neck Surgery, Oregon Health & Science
University, Portland, OR, USA. macarthc@ohsu.edu

CONCLUSION: This report confirms the presence of gram-negative Klebsiella
bacteria in the middle ear of the C3H/HeJ mouse by culture, polymerase chain
reaction (PCR), and electron microscopy. Identification of the bacterial pathogen
supports the C3H/HeJ mouse as an excellent model for spontaneous chronic otitis
media and its effects on the middle and inner ear. OBJECTIVES: The C3H/HeJ mouse 
has a single amino acid substitution in its Toll-like receptor 4, making it
insensitive to endotoxin and suppressing initiation of the innate immune system. 
This study explored the bacteriology of the resultant middle ear infection by
culture, PCR, histology, and electron microscopy. MATERIALS AND METHODS:
Twelve-month-old C3H/ HeJ mice were screened positive for spontaneous otitis
media. Tympanocentesis and blood cultures of mice were carried out under
sedation. Middle ear aspirate material and blood samples were then sent for
culture and PCR. Mice were then sacrificed for bright-field and electron
microscopy analysis. RESULTS: All tympanocentesis and blood specimens grew
gram-negative Klebsiella oxytoca, which was confirmed by PCR. Histopathology
confirmed an intense inflammatory reaction and gram-negative bacteria in the
middle and inner ears. Electron microscopy of the middle ears revealed abundant
rod-shaped Klebsiella bacteria, both free and being engulfed by neutrophils.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17851949 [PubMed - indexed for MEDLINE]

317: Acta Otolaryngol. 2007 Oct;127(10):1062-7.

Bacteriology of chronic suppurative otitis media--a multicenter study.

Yeo SG, Park DC, Hong SM, Cha CI, Kim MG.

Department of Otolaryngology, College of Medicine, Kyung Hee University, Seoul,
Korea. yeo2park@yahoo.co.kr

CONCLUSIONS: Bacterial predominance and antibiotic sensitivity have changed over 
time, making continuous and periodic surveillance necessary in guiding
appropriate antibacterial therapy. OBJECTIVES: With the development and
widespread use of antibiotics, the types of pathogenic microorganisms and their
resistance to antibiotics have changed. Knowledge of the species and resistance
rates of current pathogens is important for determining the appropriate
antibiotics for patients with chronic suppurative otitis media. We investigated
the current bacteriology of chronic suppurative otitis media. SUBJECTS AND
METHODS: This was a retrospective study of 1102 patients with chronic suppurative
otitis media seen at six hospitals in Korea from January 2001 to December 2005.
RESULTS: The most commonly identified pathogenic bacterial species was
Pseudomonas, with the next most prevalent being methicillin-resistant
Staphylococcus aureus (MRSA).

Publication Types: 
    Comparative Study
    Multicenter Study

PMID: 17851935 [PubMed - indexed for MEDLINE]

318: Acta Otolaryngol. 2007 Oct;127(10):1031-7.

Effects of inflammatory changes in the middle ear mucosa on middle ear total
pressure.

Uchimizu H.

Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo,
Japan. uchimizu@u01.gate01.com

CONCLUSIONS: Inflammation of the middle ear mucosa leads to inhibition of
transmucosal carbon dioxide (CO2) diffusion. Furthermore, CO2 diffusion is
inhibited more severely in ears with a histologically higher grade of
inflammation. OBJECTIVES: To investigate the effect of inflammatory changes in
the middle ear mucosa on transmucosal gas exchange, and the relationship between 
the histologic inflammation grade of the middle ear mucosa and the middle ear
total pressure (METP). MATERIALS AND METHODS: Twenty-six rabbits were used for
this study. Changes in the METP and the oxygen partial pressure in the middle ear
(PmO2) were measured in the otitis media group and the untreated group, and were 
compared between the two groups. Inflammatory changes in the middle ear mucosa
were classified into four grades histologically, and the relationship between the
histologic inflammatory grade and the maximum METP was examined. RESULTS: The
maximum METP in the otitis media group was significantly decreased compared with 
the untreated group (p < 0.05), but there was no difference between the two
groups in the rate of decrease of the PmO2. Furthermore, the maximum METP in
grade III inflammation was significantly decreased compared with that in grade II
inflammation (p < 0.05).

PMID: 17851893 [PubMed - indexed for MEDLINE]

319: J Investig Med. 2007 Jul;55(5):248-54.

Catabolism of glycoconjugates in chronic otitis media with cholesteatoma.

Olszewska E, Borzym-Kluczyk M, Olszewski S, Zwierz K.

Department od Otolaryngology, Medical University of Bialystok, Bialystok, Poland.
ewaolsz@yahoo.com

Chronic ear disease with cholesteatoma is characterized by an intrusion of
keratinizing stratified squamous epithelium into the middle ear manifesting bone 
resorption at the interface of the perimatrix. The aim of our study was to
investigate the markers of a catabolic process associated with several chronic
inflammatory states. We assessed the level of catabolism of glycoconjugates in
assays of cholesteatoma extracts, quantifying two lysosomal exoglycosidases:
alpha-mannosidase (alpha-MAN) and beta-galactosidase (beta-GAL). Cholesteatomas
(n = 15) and normal adult postauricular skin served as controls (n = 15) were
collected from the patients during surgery owing to chronic otitis media. To
assess exoglycosidase activity, release of p-nitrophenol from p-nitrophenol
derivatives of alpha-mannose and beta-galactose was used. In 13 of 15 specimens, 
we observed significantly higher activity of investigated enzymes in
cholesteatoma tissue compared with control tissue (postauricular skin). The mean 
activity of alpha-MAN from the cholesteatoma cells was 1.76 +/- 1.10 nkat/g wet
tissue and 0.61 +/- 0.21 nkat/g wet tissue in the control probes. The mean
activity of beta-GAL from the cholesteatoma cells was 1.77 +/- 1.07 nkat/g wet
tissue and 0.87 +/- 0.20 nkat/g wet tissue in the control probes. Catabolic
reactions involving glycoproteins, glycolipids, and proteoglycans may play a role
in cholesteatoma-related bone resorption. The present data indicating that the
lysosomal exoglycosidases alpha-MAN and beta-GAL are significantly and
consistently elevated suggest the need to further correlations assessment between
levels of alpha-MAN and beta-GAL and cholesteatoma behavior. Further research
should also evaluate the relative importance of these particular exoglycosidases 
in manifesting bone resorption in considering the spectrum of identified
inflammatory mediators.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17850736 [PubMed - indexed for MEDLINE]

320: J Appl Microbiol. 2007 Dec;103(6):2489-95.

A comparison of molecular typing methods for Moraxella catarrhalis.

Pingault NM, Lehmann D, Bowman J, Riley TV.

School of Biomedical, Biomolecular and Chemical Sciences, The University of
Western Australia, Perth, WA, Australia.

AIMS: Three molecular typing techniques were examined to determine which method
was the most discriminatory in order to perform epidemiological typing of
Moraxella catarrhalis. METHODS AND RESULTS: Twenty-five Mor. catarrhalis isolates
obtained from nasopharyngeal aspirates collected from Aboriginal and
non-Aboriginal children were subjected to random amplified polymorphic DNA (RAPD)
analysis, automated ribotyping and pulsed field gel electrophoresis (PFGE). RAPD 
analysis determined two Mor. catarrhalis types, automated ribotyping with PstI
determined four Mor. catarrhalis ribogroups and PFGE analysis with NotI
determined 21 pulse field groups within the 25 isolates examined. CONCLUSIONS:
Analysis of discrimination index and typeability demonstrated that PFGE is the
most discriminatory method for typing Mor. catarrhalis. SIGNIFICANCE AND IMPACT
OF THE STUDY: This study confirms that PFGE is the most appropriate molecular
tool for the epidemiological study of Mor. catarrhalis.

Publication Types: 
    Comparative Study

PMID: 17850316 [PubMed - indexed for MEDLINE]

321: J Am Acad Audiol. 2007 Jun;18(6):496-503.

Evaluation of the subjective effect of middle ear implantation in
hearing-impaired patients with severe external otitis.

Snik AF, van Duijnhoven NT, Mulder JJ, Cremers CW.

Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre,
The Netherlands. a.snik@kno.umcn.nl

The subjective benefit of middle ear implantation was studied in a group of 23
hearing-impaired patients who could not use conventional hearing aids owing to
severe chronic external otitis. Changes in hearing disability (Abbreviated
Profile of Hearing Aid Benefit [APHAB]) and changes in quality of life (Glasgow
Benefit Inventory [GBI]) were determined. Mean benefit value on the APHAB for the
subscale Ease of Communication was close to the mean reference value for
conventional hearing aids. For the subscales Reverberation and Background Noise, 
a poorer result was found. Individual analysis of the APHAB scores showed
significant benefit in 12 out of the 23 patients. According to the GBI, 16 out of
17 patients reported that middle ear implantation had made a positive impact on
their quality of life. It is concluded that middle ear implantation has a
positive effect on hearing difficulties and quality of life in hearing-impaired
subjects who cannot use conventional devices. The APHAB outcomes were not better 
than those reported for conventional devices.

Publication Types: 
    Evaluation Studies

PMID: 17849637 [PubMed - indexed for MEDLINE]

322: Pediatr Infect Dis J. 2007 Aug;26(8):689-92.

The spectrum and management of otitis media in Australian indigenous and
nonindigenous children: a national study.

Gunasekera H, Knox S, Morris P, Britt H, McIntyre P, Craig JC.

Centre for Kidney Research, The Children's Hospital, Westmead, Sydney, Australia.
hasanthg@chw.edu.au

BACKGROUND: Indigenous children have the highest reported prevalence and severity
of otitis media in the world, but whether their clinical management varies
accordingly is unknown. METHODS: Using a representative Australia-wide cluster
survey of consecutive primary healthcare consultations, we compared
practitioners' investigation, treatment, and referral practices for otitis media 
in indigenous and nonindigenous children (0-18 years), after adjusting for
clustering. RESULTS: Over 8 years (1998-2006), 7991 practitioners managed 141,693
problems during 119,503 consultations with children, including 2856 (2%) with
indigenous children. Ear problems were the fourth most common problems managed
overall, with otitis media seen more commonly in indigenous than in nonindigenous
children (10% versus 7% consultations, P < 0.001). Indigenous children were
significantly more likely to have severe otitis media (chronic and/or suppurative
and/or perforation, 8% versus 2%, P < 0.001); discharging ears (4% versus 0.1%, P
< 0.001); ear swabs [4%, 95% confidence interval (CI): 2%-6% versus 0.8%, 95% CI:
0.6%-0.9%]; and topical eardrops administered (11%, 95% CI: 7%-15% versus 5%, 95%
CI: 4%-5%); but not more likely to receive oral antibiotics (72% versus 76%);
have ear syringing (1% versus 0.2%); be referred to an otolaryngologist (6%
versus 3%) or audiologist (2% versus 1%); all P > 0.05. CONCLUSIONS: In the
Australian primary healthcare setting, indigenous children are 5 times more
likely to be diagnosed with severe otitis media than nonindigenous children, but 
reported management is not substantially different, which is inconsistent with
established national guidelines. This spectrum-management discordance may
contribute to continued worse outcomes for indigenous children with otitis media.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 17848879 [PubMed - indexed for MEDLINE]

323: Scand J Prim Health Care. 2007 Sep;25(3):166-71.

Evaluation of phenoxymethylpenicillin treatment of acute otitis media in children
aged 2-16.

Neumark T, Mölstad S, Rosén C, Persson LG, Törngren A, Brudin L, Eliasson I.

Lindsdal Primary Health Centre, Kalmar, Sweden. thomasn@ltkalmar.se

OBJECTIVE: To study the clinical recovery from acute otitis media (AOM) in
children, 2-16 years of age, managed with or without treatment with
phenoxymethylpenicillin (PcV). DESIGN: An open, prospective randomized trial.
Children aged between 2 and 16 years, presenting with one- or double-sided AOM
(without perforation) with symptom duration of less than four days, were
included. The children were randomized to PcV for five days or to no primary
antibiotic treatment. A health score and compliance were registered on a daily
basis for seven days. SETTING: A total of 32 health centres and 72 GPs in
south-east Sweden. Subjects. Children aged 2-16 presenting with earache. MAIN
OUTCOME MEASURES: Recovery time, symptom duration, frequency of complications (up
to three months) and consumption of healthcare services independent of treatment 
with or without antibiotics. RESULTS: A total of 179 patients carried out the
trial; 92 were randomized to PcV, 87 to no primary antibiotic treatment. The
median recovery time was four days in both groups. Patients who received PcV had 
less pain (p <0.001) and used fewer analgesics. There were no significant
differences in the number of middle-ear effusions or perforations at the final
control after three months. Children randomized to PcV treatment consulted less
(p <0.001) during the first seven days. CONCLUSIONS: Our investigation supports
that PcV treatment of AOM does not affect the recovery time or complication
rates. PcV provided some symptomatic benefit in the treatment of AOM in otherwise
healthy children, aged 2-16 years.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 17846935 [PubMed - indexed for MEDLINE]

324: Vet Dermatol. 2007 Oct;18(5):370-7.

Proliferative and necrotizing otitis externa in four cats.

Mauldin EA, Ness TA, Goldschmidt MH.

Department of Clinical Studies, School of Veterinary Medicine, University of
Pennsylvania, Philadelphia, Pennsylvania 19104-6051, USA. emauldin@vet.upenn.edu

Proliferative and necrotizing feline otitis externa is a rare disorder of unknown
aetiology. This condition was diagnosed by skin biopsy in three adult domestic
shorthair cats (3-5 years old) and one kitten (6 months old). The affected cats
had large tan to dark brown-black coalescing plaques covering the concave surface
of the pinnae and external ear canals. Friable material from the plaques and a
thick exudate occluded the ear canals. The cats had a secondary bacterial and/or 
yeast otitis. Prior to the histopathological diagnosis, all cats received
numerous otic preparations as well as oral antibiotics and corticosteroids
without resolution. Histologically, all cases had strikingly similar changes;
acanthosis with pronounced hair follicle outer root sheath hyperplasia and
neutrophilic luminal folliculitis, follicular keratosis and individually necrotic
keratinocytes in the outer root sheath of hair follicles. One case was documented
via skin biopsy to have persisted for 4 years. The adult cats were treated with
topical 0.1% tacrolimus and all showed marked improvement although one cat was
lost to follow up. The lesions completely resolved with topical tacrolimus alone 
in one cat and topical tacrolimus in addition to oral prednisolone in another
cat.

Publication Types: 
    Case Reports

PMID: 17845627 [PubMed - indexed for MEDLINE]

325: Vet Dermatol. 2007 Oct;18(5):341-7.

Aetiology of canine otitis externa: a retrospective study of 100 cases.

Saridomichelakis MN, Farmaki R, Leontides LS, Koutinas AF.

Clinic of Medicine, School of Veterinary Medicine, University of Thessaly,
Karditsa, Greece. msarido@vet.uth.gr

The objective of this retrospective study was to investigate in 100 dogs with
otitis externa (OE) the possible associations between signalment, history,
clinical and laboratory findings and the various primary, secondary and
perpetuating causative factors of ear canal inflammation. The age of the dogs
ranged from 3 months to 14 years (median: 4.75 years) and they included 45 males 
and 55 females. Cocker spaniels, Jura des Alpes and Brittany spaniels were
significantly overrepresented among dogs with OE when compared to the hospital
canine population. In the majority of the cases, OE was chronic-recurrent (63%)
or bilateral (93%). Allergic dermatitis (43/100 dogs), grass awns (12/100) and
otoacariasis (7/100) were the most common primary causative factors; no primary
factor could be incriminated in 32 cases and more than one was found in three
dogs. Malassezia spp. (66/100 dogs), cocci (38/100) and rods (22/100) were the
secondary causative factors, while ear canal stenosis (38/100) and tympanic
membrane perforation-otitis media (25/100) were the most important perpetuating
factors. Atopic dermatitis and adverse food reactions-associated OE was more
common in females and dogs with a history of pruritic skin disease, while grass
awn-induced OE occurred in cocker spaniels and acute cases. Tympanic membrane
perforation was less frequent in atopic dermatitis and adverse food
reactions-associated OE, but more common when otoscopic and ear canal cytological
examination revealed the presence of grass awns and rods, respectively. Finally, 
cocci overgrowth was positively associated with ear canal stenosis.

PMID: 17845622 [PubMed - indexed for MEDLINE]

326: Laryngoscope. 2007 Nov;117(11):2002.

The old-fashioned Politzer maneuver: a video clip demonstration.

Casale M, Rinaldi V, Setola R, Salvinelli F.

Department of Otolaryngology, Interdisciplinary Center for Biomedical Research
(CIR), University Campus Bio-Medico, Rome, Italy. m.casale@unicampus.it

Politzer maneuver causes retrograde inflation of the middle ear by forcing air
through the eustachian tube, and it has been proposed by many authors as the main
nonsurgical treatment of middle ear effusion. To our knowledge, this is the first
case in the literature in which air entering into a middle ear with effusion
through a Politzer maneuver has been captured on video (www.laryngoscope.com).

Publication Types: 
    Case Reports

PMID: 17828049 [PubMed - indexed for MEDLINE]

327: Acta Vet Scand. 2007 Sep 10;49:21.

A previously unidentified Chorioptes species infesting outer ear canals of moose 
(Alces alces): characterization of the mite and the pathology of infestation.

Hestvik G, Zahler-Rinder M, Gavier-Widén D, Lindberg R, Mattsson R, Morrison D,
Bornstein S.

Department of Biomedical Sciences and Veterinary Public Health, Swedish
University of Agricultural Sciences, Box 7028, 750 07 Uppsala, Sweden.
gete.hestvik@bvf.slu.se

BACKGROUND: During the past decade, Chorioptes mites occupying the outer ear
canals have been a common finding at routine necropsies of moose (Alces alces) in
Sweden, but neither the taxonomy of the mites nor lesions from the infestation
have been investigated. In this study, the mites are characterized by
morphological and molecular techniques, and the histopathology of the skin of the
outer ear canal is described. METHODS: External auditory meatuses from 53
necropsied moose were examined for the presence of Chorioptes, and samples from
outer ear canals were taken for histopathological and microbiological
examination. A proportion of the mites from each moose was identified to species.
The DNA was extracted from mites from three moose, and their ITS-2 sequences were
determined; these sequences were compared phylogenetically to sequences from
other Chorioptes taxa. RESULTS: Chorioptes mites were found in 43 (81%) of the 53
moose. The mites had morphological and genetic characteristics distinct from
those of C. texanus and C. bovis, the two species generally accepted within the
genus. Morphology also did not argue for a diagnosis as C. crewei, C. mydaus or
C. panda. On histopathology, lesions were characterized by a hyperplastic
perivascular to interstitial dermatitis with epidermal hyperkeratosis and crust
formation. Dermal inflammatory infiltrates were composed of mixed T- and
B-lymphocytes, plasma cells and macrophages, whereas eosinophils were notably
uncommon. Staphylococcus aureus was grown from the infested epidermis of five of 
14 examined moose. CONCLUSION: Chorioptes mite infestation was frequently
detected in the outer ear canals of moose in Sweden. The mites were evidently
pathogenic, being associated with inflammatory lesions of the external auditory
meatus. Our studies indicate infestations with a previously undescribed
Chorioptes species.

PMID: 17825115 [PubMed - indexed for MEDLINE]

328: Curr Opin Otolaryngol Head Neck Surg. 2007 Oct;15(5):347-51.

The role of biofilms in otolaryngologic infections: update 2007.

Post JC, Hiller NL, Nistico L, Stoodley P, Ehrlich GD.

Center for Genomic Sciences, Allegheny Singer Research Institute, Pittsburgh,
Pennsylvania, USA. cpost@wpahs.org

PURPOSE OF REVIEW: Biofilms have been shown to play a role in otitis media,
sinusitis, cholesteatoma, tonsillitis, adenoiditis, and device infections. This
article is written to review recent advances in the field. RECENT FINDINGS: The
role of biofilms in the persistence of chronic, mucosal-based ENT-related
infections was first recognized in otitis media. Definitive proof was lacking
until the demonstration of bacterial biofilms on the middle-ear mucosa of
children, not only with chronic otitis media with effusion, but also with
recurrent otitis media. Strains of Pseudomonas aeruginosa isolated from
cholesteatoma are avid biofilm formers. Biofilms have been reported in the
adenoids of children with chronic rhinosinusitis, helping to explain the clinical
observation that adenoidectomy can be beneficial to children with chronic otitis 
or chronic rhinosinusiti. Additional studies have confirmed the presence of
biofilms in chronic tonsillitis. Biofilms have also been shown to be involved in 
infected cochlear implants and tracheotomy tubes. SUMMARY: The recognition that
chronic otolaryngologic bacterial infections are biofilm related has been the
impetus for the development of new technologies for the study of biofilms and
their prevention and treatment. Understanding that chronic bacterial infections
are biofilm related is fundamental to developing rationale strategies for
treatment and prevention.

Publication Types: 
    Review

PMID: 17823552 [PubMed - indexed for MEDLINE]

329: J Clin Microbiol. 2007 Nov;45(11):3764-7. Epub 2007 Sep 5.

Genetic diversity of paired middle-ear and pharyngeal nontypeable Haemophilus
influenzae isolates from children with acute otitis media.

Berrens ZJ, Marrs CF, Pettigrew MM, Sandstedt SA, Patel M, Gilsdorf JR.

University of Michigan, Department of Pediatrics and Communicable Diseases, L2224
Women's Hospital, Ann Arbor, MI 48109-5244, USA.

Pulsed-field gel electrophoresis was used to determine genetic diversities of
multiple nontypeable Haemophilus influenzae isolates from throat and ear
specimens of eight children with otitis media. From five children, all ear and
throat isolates were identical. The bacterial populations in these specimens
showed less diversity than populations in throat isolates of healthy children.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17804648 [PubMed - indexed for MEDLINE]

330: Arch Pediatr Adolesc Med. 2007 Sep;161(9):884-8.

Spectral gradient acoustic reflectometry compared with tympanometry in diagnosing
middle ear effusion in children aged 6 to 24 months.

Chianese J, Hoberman A, Paradise JL, Colborn DK, Kearney D, Rockette HE,
Kurs-Lasky M.

Division of General Academic Pediatrics, Children's Hospital of Pittsburgh,
Pittsburgh, PA 15213-2583, USA. jennifer.chianese@chp.edu

OBJECTIVES: To evaluate the accuracy of spectral gradient acoustic reflectometry 
(SGAR) in children aged 6 to 24 months, and to compare SGAR with tympanometry.
DESIGN: Comparison of diagnostic tests. SETTING: Inner-city primary care center
in Pittsburgh, Pennsylvania. PARTICIPANTS: A total of 786 healthy children aged 6
to 24 months. MAIN OUTCOME MEASURES: Test characteristics of SGAR (sensitivity,
specificity, and positive and negative predictive values) and receiver operating 
characteristic curves from the SGAR and tympanometric data. RESULTS: The SGAR
results were available for 3096 otoscopic examinations in 647 children.
Tympanometric results were available for 2854 otoscopic examinations in 597
children. Using the recommended SGAR pass or fail cutoff, 53% of the ears in
which effusion was present would have been considered effusion free (sensitivity,
47%). Only 10% of the ears without effusion would have been considered to have
effusion (specificity, 90%). The area under the receiver operating characteristic
curve was 0.78 for SGAR and 0.83 for tympanometry. CONCLUSION: Spectral gradient 
acoustic reflectometry is slightly less discerning than tympanometry in
predicting the presence or absence of middle ear effusion in children younger
than 2 years.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 17768289 [PubMed - indexed for MEDLINE]

331: Laryngoscope. 2007 Nov;117(11):2026-9.

Gold laser versus curettage adenoidectomy: incidence of complications and
otorrhea after concurrent pressure-equalization tube placement.

Worley NK, Abdalkhani A, Hagmann MA, Belafsky PC, Amedee RG.

Department of Otolaryngology-Head and Neck Surgery, Tulane University School of
Medicine, New Orleans, LA, USA. okworley@cox.net

OBJECTIVES: To measure the incidence of postoperative complications and otorrhea 
in patients undergoing Gold laser or curettage adenoidectomy with
pressure-equalization (PE) tube placement. STUDY DESIGN: A prospective study of
100 patients, ages 8 to 48 months, undergoing Gold laser (n = 50) or curettage
adenoidectomy (n = 50) and PE tube placement in a pediatric outpatient setting.
METHODS: Pediatric patients with chronic otitis media with effusion and adenoid
hypertrophy after failure of medical management were included in the study.
Adenoid size and middle ear status were recorded at surgery. The total
adenoidectomy procedure time was recorded. All patients were evaluated at 1 week,
1 month, and 4 months postoperatively. The incidence of nasal complications and
otorrhea was recorded. RESULTS: There was no statistical difference in age, race,
sex, adenoid size, or middle ear status between groups. The laser group had a
shorter procedure time (P = .001) and a lower incidence of otorrhea (P = .024).
There was no difference in nasal complications between groups. CONCLUSIONS: The
Gold laser adenoidectomy technique can be safely performed with PE tube placement
and may offer advantages over the traditional curettage adenoidectomy technique.

Publication Types: 
    Comparative Study

PMID: 17767089 [PubMed - indexed for MEDLINE]

332: Otolaryngol Head Neck Surg. 2007 Sep;137(3):450-3.

Comparison of cytokine levels in bilateral ear effusions in patients with otitis 
media secretoria.

Matkovic S, Vojvodic D, Baljosevic I.

ORL Clinic, Belgrade, Serbia and Montenegro.

OBJECTIVE: The aim of this study was to clarify the site of primary pathology in 
otitis media with effusion. STUDY DESIGN AND SETTING: The levels of the
inflammatory mediators TNF-alpha, TNF-beta, IL-1beta, IL-8, IL-6, IL-4, IL-2,
IL-5, IL-10, and IFN-gamma were measured in 54 pairs (108 samples) using specific
enzyme-linked immunosorbent assays (ELISAs). RESULTS: The levels of
pro-inflammatory cytokines TNF-alpha, TNF-beta, IL-1beta, IL-8, anti-inflammatory
cytokines IL-5, IL-4, IL-10, IL-6, and cytokines with immunoregulatory potential 
IFN-gamma, IL-2 were different between both ears of the same patient. CONCLUSION:
The results suggest that in one individual both ears have different immunological
processes or rates and this has implications on using the opposite ear as a
control in clinical trials. SIGNIFICANCE: Profiles of interlink of examined
cytokines within the samples of both ear effusions were significantly different. 
A significant bilateral difference was found in the levels of IFN-gamma.

Publication Types: 
    Comparative Study

PMID: 17765774 [PubMed - indexed for MEDLINE]

333: Otolaryngol Head Neck Surg. 2007 Sep;137(3):433-8.

Obliteration of the persistently discharging mastoid cavity using the middle
temporal artery flap.

Singh V, Atlas M.

Department of Otolaryngology, St. Michaels Hospital, Bristol, United Kingdom.
viv_s@hotmail.com

OBJECTIVE: To evaluate the surgical outcome of patients undergoing obliteration
of a persistently discharging mastoid cavity with specific soft tissue vascular
flaps for chronic otitis media or cholesteatoma. STUDY DESIGN: A five-year
retrospective consecutive case review in a tertiary care referral center.
Following mastoidectomy obliteration with a superiorly based middle temporal
artery, axial periosteal flap and inferiorly based random pedicled
musculoperiosteal flap was performed. The primary outcome was control of
suppuration and the creation of a dry, low-maintenance cavity as assessed by a
semi-quantitative scale. RESULTS: A total of 51 consecutive patients undergoing
revision mastoidectomy with obliteration were identified with a minimum follow-up
of 12 months; 43 (84%) had a small dry healthy mastoid cavity; three ears (6%)
had occasional otorrhea that was relatively easily managed by topical therapy.
CONCLUSION: Obliteration using the middle temporal artery and inferior random
flaps is an effective method to manage patients with pre-existing cavities and
also those not previously operated upon.

PMID: 17765771 [PubMed - indexed for MEDLINE]

334: Acta Otolaryngol. 2007 Aug;127(8):821-4.

MRI findings of the middle ear in infants.

Sano M, Kaga K, Mima K.

Department of Otorhinolaryngology and Head & Neck Surgery, Graduate School of
Medicine and Faculty of Medicine, University of Tokyo, and Division of Radiology,
University of Tokyo Hospital, Tokyo, Japan. neurootolsano@ybb.ne.jp

CONCLUSIONS: While infants under the age of 1 year exhibited a high rate of
abnormal intensities in the middle ear and mastoid cavities, older infants showed
no abnormal intensities in these regions. From the signal intensity on T1- and
T2-weighted MRI, the abnormal intensities in the middle ear cavity were
considered to represent liquid effusion. Taken together with the findings of
temporal bone CT, the abnormal intensities in the mastoid cavity were considered 
to represent bone marrow. OBJECTIVE: Histopathological studies of the temporal
bone and tympanometry investigations have reported the presence of mesenchyme and
liquid effusion in the middle ear cavity of infants. However, very few CT or MRI 
middle ear cavity findings of newborns and infants have been published, and none 
have included the mastoid cavity. We therefore performed an MRI study of the
middle ear and mastoid cavities of infants under 2 years old (83 cases, 88
imaging series). SUBJECTS AND METHODS: MRI (1.5 T) was originally performed on
suspicion of brain disorders in infants aged under 2 years. All MRI slices were
studied and classified on the basis of the distribution of abnormal intensities
in the middle ear and mastoid cavities. RESULTS: All the abnormal imaging
appeared in infants under 1 year old, in particular, 74.24% (n=49) of abnormal
imaging appeared in the first 20 weeks after birth.

PMID: 17762991 [PubMed - indexed for MEDLINE]

335: Acta Otolaryngol. 2007 Aug;127(8):809-15.

Local application of CpG oligodeoxynucleotide enhances nontypeable Haemophilus
influenzae-specific mucosal IgA responses in the middle ear.

Kodama S, Hirano T, Abe N, Suzuki M.

Department of Otolaryngology, Oita University Faculty of Medicine, Oita, Japan.

CONCLUSIONS: Nasal vaccination with P6 protein of nontypeable Haemophilus
influenzae (NTHi) and CpG oligodeoxynucleotide (ODN) may be effective for the
induction of NTHi-specific protective immunity in the middle ear and middle ear
application of CpG ODN may possibly be a new treatment strategy for otitis media 
(OM). OBJECTIVES: Owing to the increased prevalence of antibiotic-resistant
bacteria in recent years, treatment for OM often fails. In the interest of
developing an alternative treatment that does not require antibiotics, the
efficacy of middle ear application of CpG ODN was examined. MATERIALS AND
METHODS: Mice were immunized intranasally with P6 and CpG ODN, and CpG ODN was
then inoculated into the middle ear. P6-specific antibody titers were determined 
by enzyme-linked immunosorbent assay (ELISA) and the numbers of P6-specific
antibody-producing cells were determined by enzyme-linked immunospot (ELISPOT)
assay. RESULTS: P6-specific IgA in ear wash and serum IgG titers were elevated
after nasal immunization. The number of specific IgA-producing cells was markedly
increased in the middle ear mucosa. Interestingly, middle ear application of CpG 
ODN enhanced IgA levels in the middle ear.

PMID: 17762989 [PubMed - indexed for MEDLINE]

336: Laryngoscope. 2007 Sep;117(9):1605-10.

Lemierre syndrome: two cases and a review.

Syed MI, Baring D, Addidle M, Murray C, Adams C.

Department of Otolaryngology, Royal Alexandra Hospital, Paisley, United Kingdom. 
iqbalms@hotmail.com

OBJECTIVES: Lemierre syndrome is usually caused by an acute oropharyngeal
infection in previously healthy young adults, resulting in thrombophlebitis of
the internal jugular vein, leading to metastatic septic embolization and
bacteraemia. The usual organism is Fusobacterium necrophorum. Lemierre syndrome, 
not so long ago labeled as the "forgotten disease," is on the rise. Today with
increasing antibiotic-resistant organisms, and decreasing awareness of the
syndrome, subsequent re-emergence of this "forgotten disease" is becoming more
common in clinical settings. Lemierre syndrome has significant morbidity. Cranial
nerve complications associated with the condition have been increasingly
diagnosed in the last few years. Looking back at literature on Lemierre syndrome,
there have been review articles in medical and microbiology journals but rarely
in otolaryngology journals. By presenting our cases we demonstrate the diverse
presentations and severity of the illness. METHODS: A review of the literature
and a case report on two cases seen in our institution in the last year are
presented. Each of these had varied presentations and neurologic
complications-one developed 9th to 12th cranial nerve palsies and Horner
syndrome, which have not been described in previous literature, and the other
developed polyneuropathy and a frontal lobe infarct among other multisystem
complications. CONCLUSIONS: Diagnosis of Lemierre syndrome is not always
straightforward as clinical features are variable and blood cultures are often
negative. Awareness of the syndrome and a high degree of suspicion are needed.

Publication Types: 
    Case Reports
    Review

PMID: 17762792 [PubMed - indexed for MEDLINE]

337: J Infect Chemother. 2007 Aug;13(4):235-54. Epub 2007 Aug 27.

Study of nasopharyngeal bacterial flora. Variations in nasopharyngeal bacterial
flora in schoolchildren and adults when administered antimicrobial agents.

Konno M, Baba S, Mikawa H, Hara K, Matsumoto F, Kaga K, Nishimura T, Kobayashi T,
Furuya N, Moriyama H, Okamoto Y, Furukawa M, Yamanaka N, Matsushima T, Yoshizawa 
Y, Kohno S, Kobayashi K, Morikawa A, Koizumi S, Sunakawa K, Inoue M, Ubukata K.

Teikyo University School of Medicine, Tokyo, Japan. mrsa@interlink.or.jp

Changes in nasopharyngeal bacterial flora in adults with acute upper respiratory 
tract infection on administration of antimicrobial agents were investigated, and 
how these changes contrasted with those in children. Many patients with acute
sinusitis due to allergies, and patients with malignancy and diabetes mellitus
were included in the investigation. The detection rates of Streptococcus
pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, the major bacteria
of acute otitis media (AOM), were 22%, 10%, and 7% respectively, which were
significantly lower than those for children. Gram stain examination of
nasopharyngeal swab samples showed a significant relation between leukocyte
infiltration and the detection amount of S. pneumoniae (P = 0.0086). A
significant relation (P = 0.0134) was also observed when H. influenzae was
simultaneously detected. No significant change in the three major AOM bacteria
present in nasopharyngeal bacterial flora after administration of antimicrobial
agents was observed. However, all S. pneumoniae and H. influenzae detected after 
antimicrobial agent administration had the beta-lactam-resistance gene. It was
observed that a significant improvement in leukocyte infiltration occurred 6 to
10 days after antimicrobial agent administration. In contrast, a significant
improvement in children was observed at 2 to 5 days. In the adult subjects, this 
improvement was probably due to spontaneous remission rather than the effect of
the antimicrobial agents. Although investigation of the long-term administration 
of antimicrobial agents was also conducted, its benefits for the patients were
not elucidated.

PMID: 17721687 [PubMed - indexed for MEDLINE]

338: Pediatr Infect Dis J. 2007 Sep;26(9):778-81.

Temporal relationships for cold-like illnesses and otitis media in sibling pairs.

Alper CM, Winther B, Mandel EM, Doyle WJ.

Department of Otolaryngology, Children's Hospital of Pittsburgh, University of
Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. alperc@pitt.edu

BACKGROUND: New otitis media (OM) episodes are most frequently a complication of 
cold-like illnesses (CLIs) which are often virus infections that can be exchanged
within the family unit. Interference with intrafamily CLI transmission may
present a strategy for OM prophylaxis in high risk children. This study estimated
factors relevant to strategy efficiency. METHODS: Two siblings (ages, 1.0-4.3 and
1.7-6.1 years) from 69 families were followed for 193 days beginning in October
using daily parental diaries focused on CLI signs and weekly pneumatic otoscopy
to diagnose OM presence/absence. An algorithm converted the signs to
presence/absence of a cold-day; cold-days were grouped into CLI episodes, and
episodes were examined for intersib transmission and OM complications. RESULTS:
We identified 267 CLIs in the younger siblings and 221 in the older siblings.
Twenty-seven percent of the CLI episodes in one sibling occurred after CLI onset 
in the other with a median interval of 3 days. Sixty-two percent of newly
diagnosed OM episodes occurred during a CLI and 27% of CLIs were complicated by
OM. Analysis of factors that could affect CLI incidence documented significant
contributions of gender, age, daily environment and the CLI burden in the sibling
with expected directionalities. CONCLUSION: The results document intrafamily
transmission of CLIs that is often associated with the development of OM as a
complication. These observations and the measured interval between primary and
secondary CLI onsets support the possibility of preventing OM by strategies that 
target intrafamily CLI transmission.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17721370 [PubMed - indexed for MEDLINE]

339: Otol Neurotol. 2007 Sep;28(6):771-3.

Necrotizing external otitis: a report of 46 cases.

Franco-Vidal V, Blanchet H, Bebear C, Dutronc H, Darrouzet V.

Otolaryngology and Skull Base Surgery Department, Pellegrin Hospital, France.
valerie.vidal@chu-bordeaux.fr

OBJECTIVES: To define germs involved, clinical presentation, treatment regimen,
and prognostic factors in necrotizing external otitis. PATIENTS AND METHODS:
Retrospective study reviewing a series of 46 patients treated during 10 years in 
a tertiary care center. Diagnosis was confirmed by using otomicroscopy, computed 
tomographic and/or magnetic resonance imaging scan and bone scintigraphy (Te 99
and Ga 26 bone scan). Patients were provided ceftazidime and ciprofloxacin
intravenously and monitored using a Ga-67 bone scan. The following were assessed:
presenting symptoms, general context, bacteriological analysis, imaging protocol 
sensitivity, complications, delay to healing, and cure rate. RESULTS: Sex ratio
was 2.29 (mean age, 73.6 yr). The most common presenting symptoms were otalgia
and otorrhea in 97.8 and 91.3%, respectively. Facial paralysis was present in
19.6% of cases. Thirty patients had diabetes mellitus (65.2%), and 8 were
immunocompromised (17.4%). Pseudomonas aeruginosa was isolated in 69.2% of cases 
and was resistant to ciprofloxacin in 18.5%, but was susceptible to ceftazidime
in all cases. Four patients died during the treatment (4.4%), but only 2 of
disease. The mean delay to healing was 14 weeks (SD, 9.7). Healing rate was
95.6%. No relapse was observed after a mean follow-up of 78.4 weeks (SD, 36.5
wks). Two factors significantly influenced the prognosis: facial paralysis and
existence of systemic factors for immune deficiency (p = 0.023 and 0.038,
respectively). CONCLUSION: The association of ciprofloxacin and ceftazidime was
efficient in countering the increasing resistance of P. aeruginosa to quinolones.
We propose a prognostic classification of necrotizing external otitis based on
the presence of facial paralysis and/or systemic factors.

PMID: 17721365 [PubMed - indexed for MEDLINE]

340: AIDS Read. 2007 Aug;17(8):402-4.

An unusual cause of mastoiditis that evolved into multiple ring-enhancing
intracerebral lesions in a person with HIV infection.

Casula S, Castro JG, Espinoza LA.

Jackson Memorial Hospital, Miami, Florida, USA.

Acute mastoiditis, an infectious inflammatory process in the temporal bone, is an
uncommon complication of otitis media. Here we describe a fatal case of
mastoiditis complicated by thrombosis of the sigmoid sinus and intracerebral
abscess caused by an unusual pathogen (Nocardia asteroides) in a person with HIV 
infection. Sulfonamides have remained the first-line agents for the management of
Nocardia infections, but mortality remains high in patients with intracerebral
infection.

Publication Types: 
    Case Reports

PMID: 17717884 [PubMed - indexed for MEDLINE]

341: Int J Pediatr Otorhinolaryngol. 2007 Nov;71(11):1693-7. Epub 2007 Aug 22.

Otologic findings in children with gastroesophageal reflux.

Serra A, Cocuzza S, Poli G, La Mantia I, Messina A, Pavone P.

Otolaryngology Section, Department of Medicine and Surgery, University of
Catania, Italy.

BACKGROUND: Nearly 90-95% of children with drool have physiologic
gastroesophageal reflux (GER) that usually resolves by 12-15 months of age;
however, 5-10% of children with drool have pathologic GER. Of these children,
most recover clinically by 18 months of age without therapy, yet 10% develop
chronic, recurrent gastroesophageal reflux disease (GERD) with sequelae. The
respiratory symptoms associated with GER consist mainly of bronchial asthma and
laryngospasm, but often include a persistent cough of unknown aetiology,
obstructive apnoea, and an obstructive respiratory syndrome confined to the
nasopharynx. Gastric acid reflux, enters the adenoids, causes oedema of the tubal
orifices, and later leads to relapsing diseases of the middle ear in children.
AIM AND SCOPE: To evaluate the incidence of otologic manifestations in children
with GER and the efficacy of treatment, comparing two different groups of
children (i.e., treated versus untreated). SUBJECTS AND METHODS: From January
2005 to November 2006, audiologic screening of newborns and suckling children
(0-24 months of age) at risk for auditory illnesses was held at the University
Department of Otolaryngology in Catania. Seventy-three children (average age, 13 
months) were selected after failing acoustic otoemissions for chronic bilateral
catarrhal pathology involving the middle ear (tympanometry type B) and were
positive for at least one of the different signs of GER at the time of
history-taking. The children were randomised and subdivided into two groups: (1) 
a group of 40 children (27 females and 13 males; average age, 12 months) who
received treatment; and (2) a group of 29 children (16 males and 13 females;
average age, 14 months) who did not receive treatment. Four children were lost to
follow-up after completing the study. All children enrolled in the study
underwent a rhinopharynxlaryngeal fibroscopy with flexible optics, a gastric
ultrasound scan after clinical observation, and a multi-channel pH-metry for
18-24h. RESULTS: Findings obtained by rhinopharynxlaryngeal fibroscopy showed
that 82% of cases had diffuse hyperaemia involving the entire rhinopharyngeal
mucosa and 13% of the cases had arytenoidal hyperaemia. Resolution and
improvement of the reflux occurred in 52.5 and 40% of the cases in the treated
group, respectively, versus complete resolution and an improvement in symptoms of
45 and 30% of cases, respectively, in the control group. CONCLUSIONS: The
hypothesis of a correlation between reflux and chronic middle otitis of the
serous-mucous type was confirmed in the present study. Adopting a preventive
treatment strategy may be useful in reducing the possibility of ear involvement.

Publication Types: 
    Randomized Controlled Trial

PMID: 17716750 [PubMed - indexed for MEDLINE]

342: Acta Otolaryngol. 2007 Sep;127(9):927-31.

Prediction of upper respiratory tract bacteria in acute otitis media.

Foglé-Hansson M, White P, Hermansson A.

Department of Otorhinolaryngology, Central Hospital, Skövde, Sweden.
margaretha.fogle-hansson@vgregion.se

CONCLUSIONS: Thorough otomicroscopical examination of the tympanic membrane in
acute otitis media (AOM) might distinguish AOM episodes caused by different
bacteria. It thus might be a way to select appropriate treatment for each patient
without raising the number of dangerous complications. OBJECTIVES: The aim of
this study was to see if it might be possible to predict the causative bacterium 
by judging the otomicroscopical appearance of the tympanic membrane in episodes
of AOM. PATIENTS AND METHODS: The study was prospective. Patients suffering from 
non-perforated AOM were included. The tympanic membrane was photographed. A
prediction of the causative bacterium was made and tympanocentesis was performed.
Effusion from the middle ear and a nasopharyngeal swab were obtained for
bacterial culturing. The causative bacteria were categorized into gram-positive
(Streptococcus pneumoniae and S. pyogenes) or gram-negative (non-typable
Haemophilus influenzae and Moraxella catarrhalis). RESULTS: A total of 82
patients were included in the study. A correct prediction was made in 47/63, a
false prediction in 16/63 (kappa 0.48, p<0.001).

PMID: 17712670 [PubMed - indexed for MEDLINE]

343: Int J Pediatr Otorhinolaryngol. 2007 Oct;71(10):1579-83. Epub 2007 Aug 20.

Acute mastoiditis in Norway: no evidence for an increase.

Kvaerner KJ, Bentdal Y, Karevold G.

Department of Special Needs Education, University of Oslo, Norway.
k.j.kvarner@medisin.uio.no

OBJECTIVE: In a large Norwegian newspaper in November 2005, an otolaryngologist
at Rikshospitalet claimed that the increasing number of children hospitalized for
acute mastoiditis was worrying and questioned the restrictive use of antibiotics 
in Norway. Based on latter he recommended that all children below age 2 with
symptoms of uncomplicated acute otitis media should receive antibiotics. Our
purpose was to incidence variation and characteristics of acute mastoiditis in
children. METHODS: Registry based study with complete data on hospitalization for
acute mastoiditis and cortical mastoidectomy in Norway during 1999-2005. RESULTS:
Three hundred and ninety-nine Norwegian children aged 0-16 years were included.
The incidence of acute mastoiditis in children below 2 ranged from 13.5 to 16.8
per 100,000 during the study period. Corresponding numbers for children 2-16
years were 4.3-7.1 per 100,000 children. No incidence increase was found during
the study period. Age-specific incidence revealed a peak during the second and
third year of life, and acute mastoiditis was most common in boys. Cortical
mastoidectomy was equally common in the young and older age group, 22% received
surgery. For children aged 2 and above, significantly fewer children were
hospitalized for acute mastoiditis media during the period July, August and
September. CONCLUSION: Despite the introduction of restrictive Norwegian
guidelines for antibiotic treatment of acute otitis media in children aged 1 year
and above, our data did not give evidence for an increase in acute mastoiditis.
Except for the high incidence of acute mastoiditis in young children,
hospitalization characteristics were remarkably similar in children below and
above 2 years.

PMID: 17707917 [PubMed - indexed for MEDLINE]

344: J Laryngol Otol. 2008 Sep;122(9):893-7. Epub 2007 Aug 17.

Relationship between tuberculous otomastoiditis and tuberculous meningitis.

Sonmez G, Turhan V, Senol MG, Ozturk E, Sildiroglu HO, Mutlu H.

Department of Radiology, Gulhane Military Medical Academy, Haydarpasa Teaching
Hospital, Istanbul, Turkey. gunersonmez@hotmail.com

OBJECTIVE: The aim of this study was to determine the correlation between
tuberculous meningitis and tuberculous otomastoiditis. MATERIALS AND METHODS:
Meningeal involvement sites were investigated by magnetic resonance imaging in 32
patients (21 males, 11 females) who had previously been diagnosed with
tuberculous meningitis. Clinical and laboratory findings and responses to
anti-tuberculous treatment were evaluated, and the presence of concomitant
tuberculous otomastoiditis was also investigated. RESULTS: The meningeal
involvement site was unilateral (in the sylvian fissure and the perimesencephalic
cistern) in 28 patients (87.5 per cent), and bilateral and widespread in four
patients (12.5 per cent). Tuberculous otomastoiditis was found in 11 of the
patients with tuberculous meningitis (34.3 per cent). Otomastoiditis was on the
same side as the meningeal involvement in nine of these 11 patients. Bilateral
otomastoiditis with meningeal involvement was observed in two patients.
CONCLUSIONS: Tuberculous meningitis is frequently accompanied by otomastoiditis, 
although the exact causal relationship between the two conditions is unclear.
Since meningitis is a serious clinical condition, concomitant otomastoiditis
generally remains unrecognised. Tuberculosis should be considered in the
differential diagnosis of patients with otitis or otomastoiditis who do not
respond to antibiotic therapy.

PMID: 17705895 [PubMed - indexed for MEDLINE]

345: J Laryngol Otol. 2007 Nov;121(11):1013-9. Epub 2007 Aug 15.

Evidence-based review of aetiopathogenic theories of congenital and acquired
cholesteatoma.

Persaud R, Hajioff D, Trinidade A, Khemani S, Bhattacharyya MN, Papadimitriou N, 
Kalan A, Bhattacharyya AK.

Department of Otolaryngology, Northwick Park Hospital, Harrow, UK.
ricardopersaud@yahoo.co.uk

Cholesteatoma is a non-neoplastic, keratinising lesion which has two forms:
congenital and acquired. Congenital cholesteatoma develops behind a normal,
intact tympanic membrane, whilst acquired cholesteatoma is associated with a
defect in the tympanic membrane. The pathological substrate of cholesteatoma is
keratinising stratified squamous epithelium, but the origin of this epidermal
tissue in the middle ear is controversial. Here, we review the most relevant and 
recent evidence for the principal aetiopathogenic theories of both forms of
cholesteatoma, in the light of recent otopathological findings. Congenital
cholesteatoma is most plausibly explained by the persistence of fetal epidermoid 
formation. Conclusive 'proof' awaits the unambiguous demonstration of the
metamorphosis of an epidermoid nidus into a lesion in vivo. Acquired
cholesteatoma may develop by various mechanisms: immigration, basal hyperplasia, 
retraction pocket and/or trauma (iatrogenic or non-iatrogenic). However, squamous
metaplasia of the normal cuboidal epithelium of the middle ear is a highly
unlikely explanation. Chronic inflammation seems to play a fundamental role in
multiple aetiopathogenic mechanisms of acquired cholesteatoma. Therefore early
treatment of inflammatory conditions might reduce their sequelae, perhaps by
preventing the development of hyperplastic papillary protrusions. Continued
otopathological, cellular and molecular research would enhance our limited
understanding of cholesteatoma and may lead to new therapeutic strategies for
this erosive disease, which often defies surgical treatment.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 17697435 [PubMed - indexed for MEDLINE]

346: Braz J Otorhinolaryngol. 2007 May-Jun;73(3):384-9.

The effect of timpanoplasty on tinnitus in patients with conductive hearing loss:
a six month follow-up.

Lima Ada S, Sanchez TG, Bonadia Moraes MF, Batezati Alves SC, Bento RF.

Otolaryngology, USP. draadrianalima@hotmail.com

Tympanoplasty is done to eradicate ear pathology and to restore the conductive
hearing mechanism (eardrum and ossicles). Some patients, however, do not tolerate
tinnitus and question physicians about the results of surgery when tinnitus
persists. AIM: to evaluate the progression of tinnitus in patients with
conductive hearing loss after tympanoplasty. STUDY DESIGN: a prospective cohort
study. Material and Methods: 23 consecutive patients with tinnitus due to chronic
otitis media underwent tympanoplasty. The patients underwent a medical and
audiological protocol for tinnitus before and after tympanoplasty. RESULTS: 82.6%
of patients had improvement or elimination of tinnitus after tympanoplasty The
mean score of postoperative intolerance to tinnitus (1.91 for 30 and 180 days)
was significantly different from preoperative scores (5.26). As to hearing loss, 
patients improved medically 30 and 180 days after surgery (3.65 and 2.91)
compared to the preoperative condition (6.56). Audiometry revealed improvement at
all frequencies from 0.25 to 6KHz, except at 8KHz. The air-bone gap was closed or
was within 10dB in 14 cases (61%). An intact tympanic membrane was achieved in
78% of the cases. CONCLUSION: Aside from the classical improvement of hearing
loss, tympanoplasty also offers good control of tinnitus.

PMID: 17684660 [PubMed - indexed for MEDLINE]

347: Braz J Otorhinolaryngol. 2007 May-Jun;73(3):331-6.

Latex biomembrane: a new method to coat the open cavity in
tympanomastoidectomies.

Alves de Sousa LC, Ribeiro de Toledo Piza M, Coutinho-Netto J, Ruiz DB, Schmidt
VB.

Department of Surgery, Medical School of Ribeirão Preto, University of São Paulo.
lcarlos@clinicapaparella.com.br

The new cavity created after an open cavity tympanomastoidectomy (OCTM) is filled
with an antibiotic impregnated cotton pack (cotton tape, umbilical tape, gauze). 
The removal of this pack usually causes some bleeding and discomfort for the
patient. We propose the use of a latex biomembrane to cover the cavity, which
will act as an interface between the raw bone surface and the packing. STUDY
DESIGN: clinical prospective. AIM: To study the performance of the latex
biomembrane as an interface between the raw bone surface and the pack, and to
analyze its role in cavity epithelization. MATERIAL AND METHODS: 64 ears of
patients submitted to OCTM were studied. The biomembrane was used in the packing 
of 54 ears and in the 10 remaining ears the regular cotton tape packing was used.
RESULTS: In the majority of the cases where the biomembrane was used the packing 
was removed much easier with no bleeding or pain for the patient and also showed 
an earlier cavity epithelization. CONCLUSION: The use of the latex biomembrane
has proven to be an effective method to cover the mastoid cavity facilitating
epithelization and removal of mastoid cavity packing.

PMID: 17684653 [PubMed - indexed for MEDLINE]

348: Int J Pediatr Otorhinolaryngol. 2007 Nov;71(11):1663-9. Epub 2007 Aug 2.

Acute mastoiditis in children: the "Ferrara" experience.

Palma S, Fiumana E, Borgonzoni M, Bovo R, Rosignoli M, Martini A.

Department of Audiology, University of Ferrara, Arcispedale sant'Anna-Corso della
Giovecca 203, 44100 Ferrara, Italy.

OBJECTIVE: This study aims to investigate the clinical features and outcomes of
acute mastoiditis in children referred to the ENT/Audiology Department of the
University of Ferrara from January 1994 to December 2005. It also aims to discuss
risk factors and to find predictors for surgery. METHODS: A retrospective study
on case sheets of children with an acute mastoiditis diagnosis was carried out.
Fifty-five cases fulfilled the inclusion criteria: they presented otoscopical
evidence of acute otitis media and inflammatory findings of the mastoid area such
as post-auricular swelling, redness or tenderness, protrusion of the auricle
and/or radiological findings. RESULTS: Twenty-six patients were only treated with
antibiotic therapy, tympanocentesis alone was performed in 11 cases; in 5, a
ventilation tube was positioned. Mastoidectomy was performed in 13 patients. The 
group who underwent mastoidectomy had a median hospital stay of 15 days (5-54),
in this group were found the following complications: 1 meningitis, 1
meningo-encephalitis, 1 lateral and sigmoid sinus thrombosis, 1 facial palsy.
CONCLUSION: the incidence of otomastoiditis does not seem to be decreasing, on
the contrary, in some countries, it seems to be on the increase. Our experience
cannot confirm a real increase of the incidence but we noted periodic variations 
during the time of observation. It is important, that careful attention is paid
to the clinical assessment of children who are 2-years old or under, as they seem
to be more exposed to the risk of clinical complications; therefore, it is highly
recommended that the otologist and the paediatrician collaborate closely.

PMID: 17681615 [PubMed - indexed for MEDLINE]

349: Eur Arch Otorhinolaryngol. 2008 Jan;265(1):53-6. Epub 2007 Aug 7.

Usefulness of CT scans in malignant external otitis: effective tool for the
diagnosis, but of limited value in predicting outcome.

Sudhoff H, Rajagopal S, Mani N, Moumoulidis I, Axon PR, Moffat D.

Department of Otolaryngology and Skull Base Surgery, Addenbrooke's Hospital,
Cambridge, UK. holger.sudhoff@rub.de

Computerized tomography (CT) scanning is a well recognised tool for the diagnosis
of malignant external otitis. To investigate the degree of correlation between CT
findings scan and the patients clinical status focusing on a subgroup of patients
with cranial nerve palsies. Diagnosis of malignant external otitis was confirmed 
in 23 patients (average age 71 years, age range 39-87) based on criteria of
severe pain, otitis externa refractory to conventional treatments and possibly
diabetes mellitus and pseudomonas detection. CT was performed on 23 of these
patients. Results from these scans were analysed and correlated with patient
clinical status. Retrospective analysis of CT images and medical notes were used 
for data analysis.The CT scans of all 23 patients showed evidence of involvement 
of disease outside the external auditory canal, confirming the diagnosis. Sixteen
out of 23 patients (70%) demonstrated evidence of bone erosion. Four of the 16
showed involvement of the petrous apex. From our subset of ten patients with
cranial nerve involvement, eight demonstrated evidence of bone erosion and two
showed mastoid and middle ear involvement without bone erosion. All four patients
with petrous apical involvement presented with cranial nerve palsies (two lower
cranial nerve palsies, one seventh nerve palsy and one combined lower and seventh
nerve palsy). CT scanning was found to be a fast and economical tool in the
initial assessment of patients with malignant external otitis. Petrous apex
involvement was constantly associated with cranial nerve palsies, usually the
lower cranial nerves. CT findings of temporal bone in itself however, were not
closely correlated to the clinical outcome of the patients.

PMID: 17680261 [PubMed - indexed for MEDLINE]

350: Eur J Dermatol. 2007 Sep-Oct;17(5):405-11. Epub 2007 Aug 2.

Topical tacrolimus treatment for chronic dermatitis of the ear.

Harth W, Caffier PP, Mayelzadeh B, Haupt H, Sedlmaier B, Richard G.

Clinic for skin diseases, Vivantes Klinikum Berlin Friedrichshain, Department of 
Dermatology and Phlebology, Landsberger Allee 49, 10249 Berlin, Germany.
wolfgang.harth@vivantes.de

Recurrent exacerbation in chronic recalcitrant external otitis (EO) often
warrants multidisciplinary treatment and collaboration with a dermatologist. The 
aim of this pilot study was to ascertain the efficacy of topical tacrolimus
ointment application in chronic, non-infectious and therapy-resistant EO.In a
prospective clinical study, the efficacy of tacrolimus ointment 0.1% was examined
in 53 patients with therapy-refractory chronic EO of confirmed non-infectious
etiology. Clinical examination took place prior to treatment (V1), at the end
(V2) and during follow-up investigations (V3) of 28 patients over 10-22 months.
Patients were evaluated for the symptoms otalgia, edema, otorrhea, erythema,
pruritus and desquamation on a 6-point scale.The short-term results after topical
application of tacrolimus (V2) showed a clear improvement in 85% of the patients 
(N = 45) and significant drop in severity scores for all clinical parameters (p <
0.001). The long-term follow-up studies (V3) revealed that a one-time treatment
cycle led to complete remission in 46% of patients (N = 28). The remaining 54%
had recurrent EO events, however, with significantly longer symptom-free
intervals. Within the observation period, no relevant local or systemic side
effects were observed, except for occasional skin burning, stinging, or
itching.This interdisciplinary study between dermatologists and ENT specialists
clearly demonstrates that the topical application of 0.1% tacrolimus ointment is 
an effective and well-tolerated new option in the treatment of chronic
recalcitrant EO. Furthermore, it shows that dermatologists, with their experience
in topical immunomodulatory therapy, can make valuable contributions to the
treatment of inflammatory disorders in other medical fields.

Publication Types: 
    Clinical Trial

PMID: 17673384 [PubMed - indexed for MEDLINE]

351: Pediatrics. 2007 Aug;120(2):281-7.

Management of acute otitis media by primary care physicians: trends since the
release of the 2004 American Academy of Pediatrics/American Academy of Family
Physicians clinical practice guideline.

Vernacchio L, Vezina RM, Mitchell AA.

Slone Epidemiology Center, 1010 Commonwealth Ave, Boston, MA 02215, USA.
lvernacchio@slone.bu.edu

OBJECTIVES: In 2004, the American Academy of Pediatrics and the American Academy 
of Family Physicians released a clinical practice guideline on the management of 
acute otitis media that included endorsement of an observation option for
selected cases and recommendations of specific antibiotics. We sought to describe
primary care physicians' current management of acute otitis media to compare it
with the guideline's recommendations and describe trends since 2004. DESIGN: We
used a mail survey from March through June 2006 within the Slone Center
Office-Based Research Network, a national practice-based pediatric research
network. RESULTS: The response rate was 299 (62.7%) of 477. The observation
option was considered reasonable by 83.3%, compared with 88.0% in 2004, and was
used in a median of 15% of acute otitis media cases over the previous 3 months.
The most common physician-identified barriers to the use of the observation
option were parental reluctance (83.5%) and the cost and difficulty of follow-up 
of children who do not improve (30.9%). In terms of antibiotic choices for acute 
otitis media, agreement with the guideline's antibiotic recommendation for 4
common clinical scenarios was as follows: high-dose amoxicillin for acute otitis 
media with nonsevere symptoms (57.2%), high-dose amoxicillin-clavulanate for
acute otitis media with severe symptoms (12.7%), high-dose
amoxicillin-clavulanate for cases that failed to respond to amoxicillin (42.8%), 
and intramuscular ceftriaxone for cases that failed to respond to treatment with 
amoxicillin-clavulanate (16.7%). Each of these proportions declined from 2004.
CONCLUSIONS: Most primary care physicians accept the concept of an observation
option for acute otitis media but use it only occasionally. Antibiotics
prescribed for acute otitis media differ markedly from the guideline's
recommendations, and the difference has increased since 2004.

Publication Types: 
    Comparative Study

PMID: 17671053 [PubMed - indexed for MEDLINE]

352: Pediatrics. 2007 Aug;120(2):e317-23.

The 4G/4G plasminogen activator inhibitor-1 genotype is associated with frequent 
recurrence of acute otitis media.

Emonts M, Wiertsema SP, Veenhoven RH, Houwing-Duistermaat JJ, Walraven V, de
Groot R, Hermans PW, Sanders EA.

Department of Pediatrics, Erasmus MC-Sophia Rotterdam, Dr Molewaterplein 50, Room
Ee15-02, 3015 GE Rotterdam, The Netherlands. m.emonts@erasmusmc.nl

OBJECTIVES: Plasminogen activator inhibitor-1 counterregulates cell migration,
adhesion, and tissue repair. The PAI1 4G/5G promoter polymorphism has an effect
on expression levels of PAI1. After a first acute otitis media episode, children 
are at increased risk for a next episode. Because the PAI1 4G allele is
associated with higher plasminogen activator inhibitor-1 production and, hence,
decreased tissue repair, we hypothesize that this allele may contribute to
increased recurrence of acute otitis media. PATIENTS AND METHODS: The PAI1 4G/5G 
polymorphism was genotyped in 348 Dutch children aged 1 to 7 years who were
suffering from recurrent acute otitis media and participating in a randomized,
controlled trial and 463 healthy control subjects, representative of the general 
population. RESULTS: No significant difference in PAI1 genotype distribution
between the whole acute otitis media group and control subjects was observed.
However, children with the PAI1 4G/4G genotype had an increased risk of more
frequent acute otitis media episodes compared with those who were homozygous for 
the 5G variant, also after correction for cofactors. This finding was
attributable to children <4 years of age. CONCLUSIONS: Our findings suggest that 
the PAI1 4G/4G genotype is associated with an increased risk for the otitis-prone
condition, potentially because of impaired healing after a previous otitis media 
episode.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 17671042 [PubMed - indexed for MEDLINE]

353: Qual Life Res. 2007 Oct;16(8):1357-73. Epub 2007 Aug 1.

Reliability and validity of functional health status and health-related quality
of life questionnaires in children with recurrent acute otitis media.

Brouwer CN, Schilder AG, van Stel HF, Rovers MM, Veenhoven RH, Grobbee DE,
Sanders EA, Maillé AR.

Department of Paediatrics, Spaarne Hospital, Postbus 770, 2130 AT Hoofddorp, The 
Netherlands.

In this study the reliability and validity of generic and disease-specific
questionnaires has been assessed focusing on responsiveness. This is part of a
study on the effects of recurrent acute otitis media (rAOM) on functional health 
status (FHS) and health-related quality of life (HRQoL) in 383 children with rAOM
participating in a randomized clinical trial. The following generic
questionnaires were studied: 1. RAND general health rating index, 2. Functional
Status Questionnaire (FSQ Generic and FSQ Specific), 3. TNO-AZL Infant Quality of
Life (TAIQOL), and the following disease-specific questionnaires: 1. Otitis
Media-6 (OM-6), 2. Numerical rating scales (NRS) for child and caregiver (NRS
Child and NRS Caregiver), and 3. a new Family Functioning Questionnaire (FFQ).
Reliability was good to excellent (Cronbach's alpha range 0.80-0.90, intraclass
correlation coefficient range 0.76-0.93). Moderate to strong correlations were
found between the questionnaires as well as between questionnaires and relevant
clinical indicators (r = 0.29-0.49), demonstrating construct validity.
Discriminant validity for children with few versus frequent episodes of acute
otitis media per year was good for most questionnaires (P < 0.004) but poor for
the otitis media-related subscales of the TAIQOL (P = 0.10-0.97) and both NRS (P 
= 0.22 and 0.48). Except for the TAIQOL subscales, change scores were significant
(P < 0.003) for generic and disease-specific questionnaires. Effect sizes were
somewhat higher for disease-specific compared to generic questionnaires
(0.55-0.95 versus 0.32-0.60) except for the TAIQOL subscales, which showed very
poor sensitivity to change. Anchor-based methods resulted in a somewhat larger
range of estimates of MCID than distribution-based methods. Combining
distribution-based and anchor-based methods resulted in similar ranges for the
minimally clinical important differences for generic and disease-specific
questionnaires: 2-15 points on a 0-100 scale. Apart from the generic TAIQOL
subscales, both generic and disease-specific questionnaires used in this study
showed good psychometric qualities and responsiveness for use in clinical studies
on children with rAOM.

Publication Types: 
    Validation Studies

PMID: 17668290 [PubMed - indexed for MEDLINE]

354: Eur J Pediatr. 2008 May;167(5):541-8. Epub 2007 Aug 1.

Mastoiditis in children: a prospective, observational study comparing clinical
presentation, microbiology, computed tomography, surgical findings and histology.

Stähelin-Massik J, Podvinec M, Jakscha J, Rüst ON, Greisser J, Moschopulos M,
Gnehm HE.

Department of Paediatrics, Kantonsspital Aarau, 5001 Aarau, Switzerland.
jody.staehelin@ksa.ch

The aim of this study was to obtain comprehensive data on clinical presentation, 
microbiology, computed tomography, surgical findings and histology in acute,
sub-acute and chronic mastoiditis. We performed a prospective, observational
study in children under 16 years of age presenting to our institution during the 
2-year period beginning in April 2000. The children were examined and their
condition treated in accordance with a standardized protocol elaborated by the
paediatric, otolaryngology (ORL) and radiology departments. Thirty-eight patients
were hospitalized (22 with acute mastoiditis, seven with sub-acute mastoiditis,
nine with chronic mastoiditis). There were 30 complications present in 21
patients (55%). Streptococcus pyogenes was the most common pathogen (7/24 cases),
followed by Streptococcus pneumoniae (4/24 cases). Mastoid surgery was performed 
in 29 patients. Histology of mastoid tissue revealed predominantly acute
inflammation in two cases, mixed acute/chronic inflammation in 19 cases and
predominantly chronic inflammation in seven cases. Radiologic data were evaluated
retrospectively. Spiral, volume-based high-resolution (HR) computed tomography
(CT) of the temporal bone had a sensitivity of 100%, specificity of 38%, positive
predictive value (PPV) of 50% and negative predictive value (NPV) of 100% in
detecting coalescence of mastoid trabeculae. Cranial CT with contrast had a
sensitivity of 80%, specificity of 94%, PPV of 80% and NPV of 94% in identifying 
intra-cranial extension. Conclusion: histological evidence suggests that
sub-acute/chronic infection underlies not only sub-acute and chronic mastoiditis,
but most cases of acute mastoiditis as well. HR-CT of the temporal bone is
effective in ruling out coalescence. Cranial CT is valuable in identifying
intra-cranial extension. Cranial and HR-CT are recommended in the examination of 
children with mastoiditis.

PMID: 17668240 [PubMed - indexed for MEDLINE]

355: Otol Neurotol. 2007 Aug;28(5):663-7.

Characterization of otitis media with effusion based on the ratio of albumin and 
immunoglobulin G concentrations in the effusion.

Rezes S, Késmárki K, Sipka S, Sziklai I.

Department of Otorhinolaryngology/Head and Neck Surgery, and Autoimmune Research 
Group of the Hungarian Academy of Sciences, Health Science Center, University of 
Debrecen, Debrecen, Hungary. szrezes@freemail.hu

OBJECTIVE: To characterize the groups of middle ear effusions (MEE) defined on
the basis of the ratio of albumin and immunoglobulin G concentrations (A/G) in
the effusion and to identify the correlation between these groups of MEE and the 
clinical features of otitis media with effusion (OME). STUDY DESIGN: A laboratory
analysis of 88 samples of MEE and a retrospective analysis of the medical history
of all patients was performed. SETTING: Tertiary referral center. PATIENTS:
Thirty-three girls and 23 boys with OME were included in the study. INTERVENTION:
The concentrations of albumin, immunoglobulins (IgG, IgA, and IgM), complement
factors (C3, C4), and C-reactive protein were determined by means of
nephelometry. Enzyme-linked immunosorbent assay was used to measure cytokines
interferon-gamma, tumor necrosis factor alpha, interleukin (IL)-4, and IL-10
concentrations. Groups were defined according to A/G ratio in the effusions.
Thirty-five children underwent allergy testing. MAIN OUTCOME MEASURE: Two groups 
of MEE could be recognized on the basis of A/G ratio; the ratio was lower than
0.7 in group A and was higher than 0.7 in group B. RESULTS: Increased levels of
interferon-gamma and tumor necrosis factor alpha were observed in group A,
whereas IL-4 and IL-10 were dominating in group B. No association was found
between the MEE groups and the clinical features of the disease or the atopic
status of the patient. CONCLUSION: These results suggest that various groups of
OME can be categorized according to the differences in A/G ratio in the
effusions. These differences can reflect the variances in the pathomechanism of
the development of the effusion, the stage of the disease, or the clinical
background of the patients.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17667774 [PubMed - indexed for MEDLINE]

356: Otolaryngol Head Neck Surg. 2007 Aug;137(2):332-7.

Cochlear cytokine gene expression in murine chronic otitis media.

Ghaheri BA, Kempton JB, Pillers DA, Trune DR.

Department of Otolaryngology--Head and Neck Surgery, Oregon Hearing Research
Center, Portland, Oregon 97239, USA. ghaherib@ohsu.edu

OBJECTIVE: To investigate chronic otitis media (COM) induction of cochlear
cytokine genes. STUDY DESIGN: RNA from cochleas of five C3H/HeJ mice with and
without COM was isolated for cytokine expression in gene arrays.
Immunohistochemistry was performed for the protein products of up-regulated genes
to confirm their expression in cochlear tissues. RESULTS: Cochleas from COM mice 
showed increased expression of 29 genes (>2x normal) and decreased expression of 
19 genes (<0.5x normal). Cytokines expressed were largely those related to
inflammation and tissue remodeling. Cochlear immunohistochemistry confirmed the
presence of numerous cytokines, as well as NF-kB, a major inflammatory
transcription factor that drives cytokine expression. CONCLUSION: COM causes
elevated levels of cochlear cytokine mRNA, which demonstrates that inner ear
tissues are capable of NF-kB activation and cytokine production. This may be
another mechanism of otitis media-induced cochlear cytotoxicity in addition to
that caused by migration of inflammatory cytokines from the middle ear.
SIGNIFICANCE: Cochlear tissues are capable of mounting an immunological response 
to middle ear inflammatory stimuli.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17666266 [PubMed - indexed for MEDLINE]

357: Otolaryngol Head Neck Surg. 2007 Aug;137(2):321-6.

Immune modulatory oligonucleotides in the prevention and treatment of OVA-induced
eustachian tube dysfunction in rats.

Blanks DA, Ebert CS Jr, Eapen RP, Zdanski C, Kandimalla ER, Agrawal S, Prazma J.

Department of Otolaryngology--Head and Neck Surgery, University of North Carolina
School of Medicine, Chapel Hill, NC 27599, USA. dblanks@med.unc.edu

BACKGROUND: Otitis media with effusion (OME) is often associated with allergies. 
Immune modulatory oligonucleotides (IMO) mediate allergic inflammation and may
therefore be efficacious in the treatment of airway inflammation. OBJECTIVE: To
evaluate the role of an IMO via transtympanic mucosal application in prevention
and treatment of ovalbumin-induced OME. DESIGN: Forty brown Norway rats were
divided into control and treatment groups. Eustachian tube dysfunction was
evaluated by passive opening pressures, passive closing pressures, active
clearance of negative pressure, and mucociliary clearance transit time. RESULTS: 
Rats who underwent IMO treatment required 50% less pressure to open and close the
eustachian tube (P < 0.05) and were able to actively clear 50% more negative
pressure than the ovalbumin-control rats (P < 0.001). The treatment rats'
mucociliary clearance time was half that of the control group (P < 0.001).
CONCLUSION: IMO via transtympanic application can prevent and treat
allergy-induced eustachian tube dysfunction in rats. IMO may offer substantial
promise in the future management of OME.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17666264 [PubMed - indexed for MEDLINE]

358: Otolaryngol Head Neck Surg. 2007 Aug;137(2):301-5.

Stratification for malignant external otitis.

Peleg U, Perez R, Raveh D, Berelowitz D, Cohen D.

Department of Otolaryngology-Head and Neck Surgery, Shaare Zedek Medical Center, 
Jerusalem, Israel.

OBJECTIVE: To propose a CT-based method for early identification of severe cases 
of malignant external otitis (MEO) by correlating between initial CT findings and
clinical course. STUDY DESIGN AND SETTING: Eighteen MEO patients who underwent CT
on admission were included in this retrospective study conducted at a tertiary
center. The number and extent of anatomical areas involved according to CT were
compared to clinical course severity. RESULTS: The patients were categorized into
two groups according to clinical course. There were 13 patients in the
"nonsevere" group and 5 in the "severe." In six out of eight CT anatomical areas 
the "severe" group had significantly higher scores (P < 0.05 to P < 0.0005). The 
average number of areas involved in the "nonsevere" group was 2.9 and in the
"severe" 5.4 (P < 0.0005). CONCLUSION: We found a clear correlation between
clinical course and initial CT findings in MEO patients. Based on these findings 
it may be possible to predict clinical course severity according to initial CT.

PMID: 17666260 [PubMed - indexed for MEDLINE]

359: Otolaryngol Head Neck Surg. 2007 Aug;137(2):250-5.

Immune modulatory oligonucleotides in prevention of nasal allergen-induced
Eustachian tube dysfunction in rats.

Ebert CS Jr, Rose AS, Blanks DA, Eapen RP, Kandimalla ER, Agrawal S, Prazma J,
Pillsbury HC 3rd.

Department of Otolaryngology-Head and Neck Surgery, University of North Carolina 
School of Medicine, Chapel Hill, NC 27599, USA. cebert@med.unc.edu

OBJECTIVES: Develop a model of nasal allergen-induced Eustachian tube dysfunction
(ETD) in a rat and investigate the role of immune modulatory oligonucleotides
(IMOs) in the prevention of nasal allergen-induced ETD. STUDY DESIGN AND SETTING:
Prospective, randomized study. Brown Norway rats were sensitized to ova albumin
(OVA) and randomized to receive pretreatment with IMOs or phosphate-buffered
saline. All animals were challenged intranasally with aerosolized OVA. Dynamic
measures of Eustachian tube (ET) function were analyzed. RESULTS: Animals that
were OVA-sensitized and IMO-pretreated had significantly lower mean passive
opening (95% confidence interval [95% CI] 15.0,19.4) and closing (95% CI 4.8,7.8)
ET pressures compared with those of (95% CI 24.1,32.7) and (95% CI 12.1,18.8)
OVA-sensitized untreated rats, respectively. In addition, the IMO-pretreated
animals demonstrated the ability to actively clear a significantly higher
proportion of negative pressure (95% CI 0.64,0.96) compared with the untreated
animals (95% CI 0.09,0.39). IMO-pretreated animals also demonstrated
significantly improved mean mucociliary clearance times in seconds (95% CI
115,195) than those in untreated animals (95% CI 308,668). CONCLUSIONS:
Pretreatment with IMOs prevented allergen-induced allergic inflammation around
the Eustachian tube (ET) and resulted in improved ventilatory function of the ET 
compared with sensitized untreated animals. IMOs offer considerable promise in
the management of nasal allergic disease as well as otitis media with effusion.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17666251 [PubMed - indexed for MEDLINE]

360: J Laryngol Otol. 2008 May;122(5):442-6. Epub 2007 Aug 1.

Clinico-epidemiological study of complicated and uncomplicated chronic
suppurative otitis media.

Vikram BK, Khaja N, Udayashankar SG, Venkatesha BK, Manjunath D.

Department of Otolaryngology, Head and Neck Surgery, Karnataka Institute of
Medical Sciences, Hubli, India. entvikram@rediffmail

INTRODUCTION: This study aimed to compare the clinical and epidemiological
profiles of cases of complicated and uncomplicated chronic suppurative otitis
media, based on their prognostic factors. MATERIALS AND METHODS: This was a
prospective, cross-sectional study conducted in a tertiary care medical college
hospital over a period of two and a half years. The study group comprised 187
ears, out of which 62 had complications while 125 did not. The two groups were
compared with respect to nine prognostic variables: age distribution, sex,
patient's domicile, literacy status, duration of ear discharge at presentation,
ear pathology, predisposing disease focus in the nose or throat, ear swab
microbiology, and hearing loss. RESULTS: Patients in the complicated chronic
suppurative otitis media group had a higher male predominance and were younger.
Rural and illiterate patients had a higher risk of developing complications.
Cholesteatoma and granulation tissue were potential risk factors in the
complicated chronic suppurative otitis media group. Ears with complications were 
more prone to develop sensorineural hearing loss. Age, sex, duration of ear
discharge, predisposing disease focus in nose or throat, and ear swab
microbiology were all less useful prognostic indicators of complications.
CONCLUSION: Early detection and timely treatment of chronic suppurative otitis
media in rural and illiterate patients may prevent life-threatening complications
and reduce their incidence. Ears that harbour relatively large quantities of both
cholesteatoma and granulation tissue together require more urgent surgical
intervention and more extensive disease clearance in order to prevent
complications.

PMID: 17666139 [PubMed - indexed for MEDLINE]

361: J Laryngol Otol. 2008 Jun;122(6):584-9. Epub 2007 Aug 1.

Five-year results for use of single-flanged tympanostomy tubes in children.

Knutsson J, von Unge M.

Department of Otorhinolaryngology, Västerås Central Hospital, Sweden.
johan.knutsson@ltv.se

AIMS: To assess the five-year outcome of the use of single-flanged tympanostomy
tubes in children, including the time to extrusion, rate of retained tubes and
rate of persistent perforation. MATERIALS AND METHODS: The medical records
relating to 640 single-flanged tympanostomy tubes intended for short-term use in 
paediatric patients were retrospectively reviewed. RESULTS AND ANALYSIS: We found
that 36.4 per cent of the tubes had extruded within 12 months and 71.0 per cent
within 24 months. Results showed that 14.1 per cent of the tubes had been removed
because of prolonged retention, with a mean time to removal of 38.9 months. The
time to extrusion was longer and the rate of retained tubes was higher than those
reported for several other short-term tubes. We found that 4.5 per cent of tube
insertions had resulted in a persistent perforation, a higher percentage than
previously reported for other tubes intended for short-term use. Within five
years of tube insertion, 70.5 per cent of the tympanic membranes had normalised.

PMID: 17666133 [PubMed - indexed for MEDLINE]

362: FEMS Immunol Med Microbiol. 2007 Oct;51(1):163-70. Epub 2007 Jul 31.

Isolation of Alloiococcus otitidis from Indigenous and non-Indigenous Australian 
children with chronic otitis media with effusion.

Ashhurst-Smith C, Hall ST, Walker P, Stuart J, Hansbro PM, Blackwell CC.

Hunter Area Pathology Service, The John Hunter Hospital, Newcastle, NSW,
Australia. ashhurst@tpg.com.au

During the last decade Alloiococcus otitidis has been identified in specimens
from patients with chronic otitis media with effusion. Whereas most of those
studies employed molecular techniques, we used minor modifications of
conventional microbiological methods to isolate and identify A. otitidis in
samples obtained from 20/50 (40%) children referred for myringotomy. Alloiococcus
otitidis was isolated from 10/22 (45%) Indigenous and 10/28 (36%) non-Indigenous 
children. This is the first report of isolation of A. otitidis from Australian
children with chronic otitis media. All isolates were sensitive to penicillin,
but 14/20 (70%) of the isolates were resistant or partially resistant to
erythromycin as assessed by the E-test.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17666076 [PubMed - indexed for MEDLINE]

363: Adv Ther. 2007 May-Jun;24(3):671-5.

A comparison of ciprofloxacin/dexamethasone with
neomycin/polymyxin/hydrocortisone for otitis externa pain.

Roland PS, Younis R, Wall GM.

Department of Otolaryngology, University of Texas Southwestern Medical School at 
Dallas, Texas, USA. Peter.Roland@UTSouthwestern.edu

Ciprofloxacin 0.3%/dexamethasone 0.1% (CIP/DEX) and neomycin 0.35%(polymyxin B
10,000 IU/mL/hydrocortisone 1.0% (NPH) were compared for relief of pain in
patients with acute otitis externa. Patients received 7 d of treatment with
CIP/DEX twice daily or NPH 3 times daily. Ear pain was assessed by
patients/caregivers twice daily and by the study investigator on days 3, 8, and
18 (4-point scale). Higher percentages of CIP/DEX-treated patients had relief of 
severe pain over time (P=.0013) and relief of significant pain (moderate or
severe pain) over time (P=.0456), compared with NPH-treated patients. The
percentage of CIP/DEXtreated patients with severe pain decreased rapidly within
the first 12 h; this contrasted with an increase in pain among NPH-treated
patients. CIP/DEX-treated patients had significantly less inflammation (P=.0043) 
and edema (P=.0148) than NPH-treated patients. Overall, these results support
greater pain relief attained over the first 3 d in patients with acute otitis
externa treated with CIP/DEX compared with NPH and a rapid reduction in severe
pain after initiation of treatment.

Publication Types: 
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial

PMID: 17660178 [PubMed - indexed for MEDLINE]

364: Eur Arch Otorhinolaryngol. 2007 Dec;264(12):1393-7. Epub 2007 Jul 27.

Factors of the blockage of ventilation tubes in the immediate postoperative
period.

Jeon EJ, Park YS, Lee SK, Chang KH, Park SY, Park KH, Lee DH.

Department of Otolaryngology-HNS, Our Lady of Mercy Hospital, College of
Medicine, The Catholic University of Korea, 665 Bupyung-dong, Bupyung-gu,
Incheon, 403-720, South Korea, parkent@dreamwiz.com.

Postoperative ventilation tube (VT) blockage is relatively common with a reported
incidence of 0.0-13.1%. The purpose of this study was to evaluate the factors
that contribute to postoperative VT blockage. A retrospective chart review was
carried out to compare rates of VT blockage within 2 weeks postsurgery. Analyzed 
factors included: otic drop, nature, and amount of middle ear (ME) effusion,
presence of ME mucosa edema or granulation, bleeding during surgery, number of
prior VT insertion, and the status of the tympanic membrane (TM). One hundred and
twenty-eight ears from 79 patients were enrolled in this study. Eleven VTs (8.6%)
were obstructed within 2 weeks postsurgery. Ears using ciprobay and tarivid otic 
drops showed a significantly higher rate of tube blockage (14.1%) compared to
ears that were not exposed to otic drops (1.8%). Glue effusion caused the highest
rates (14.8%) of tube blockage compared to mucoid (9.6%) and serous (3.0%)
effusions. The amount of effusion, the presence of mucosal edema or granulation, 
bleeding during surgery, number of prior VT insertions and the status of the TM
were not associated with postoperative VT blockage. The results of this study
suggest that the routine use of antibiotic-containing otic drops after the
insertion of VT may not be useful. Viscosity of the effusion appears to have an
effect on the postoperative VT blockage. Thus, more attention should be focused
on the ears with glue or mucoid effusions after surgery.

PMID: 17657506 [PubMed - indexed for MEDLINE]

365: Med Mycol. 2007 Aug;45(5):457-61.

Apophysomyces elegans causing acute otogenic cervicofacial zygomycosis involving 
salivary glands.

Goyal A, Tyagi I, Syal R, Marak RS, Singh J.

Neuro-Otology Unit, Department of Neuro-Surgery, Sanjay Gandhi Post Graduate
Institute of Medical Sciences, Lucknow, UP, India. meetugoyal@yahoo.com

Zygomycosis is an invasive, life threatening fungal infection that usually
affects immunocompromised hosts. In the head and neck region,
rhino-orbito-cerebral zygomycosis is more common than the cervicofacial variety. 
We report the first case of otogenic cervicofacial zygomycosis caused by
Apophysomyces elegans involving the salivary glands, an uncommon site of
infection. The case began after a trivial trauma in a diabetic patient and
despite surgical debridement and liposomal amphotericin B therapy, the patient
died due to extensive involvement and metabolic/hemodynamic complications.

Publication Types: 
    Case Reports

PMID: 17654273 [PubMed - indexed for MEDLINE]

366: Int J Pediatr Otorhinolaryngol. 2007 Oct;71(10):1543-7. Epub 2007 Jul 23.

Quality of life outcomes after ventilating tube insertion for otitis media in an 
Australian population.

Chow Y, Wabnitz DA, Ling J.

Department of Paediatric Otolaryngology-Head and Neck Surgery, Women's and
Children's Hospital, North Adelaide, SA, Australia.

OBJECTIVE: To assess the change in quality of life in a group of Australian
children with recurrent acute otitis media (AOM) and/or otitis media with
effusion (OME) who were treated with ventilating tube (VT) insertion. METHODS:
Prospective pre- and post-intervention outcome study at the Women's and
Children's Hospital, North Adelaide, South Australia. The Otitis Media 6-item
(OM-6) survey was used as a measure of disease-specific quality of life prior to 
surgery and then again at 6 weeks post-operatively. Any patients who were listed 
for any additional ear, nose or throat (ENT) procedures at the same time were
excluded. RESULTS: Complete responses for both pre- and post-surgery
questionnaires were obtained from the parents of 53 patients. The age range was
11 months to 15.4 years (average 5.1 years), and 39.6% (n=21) were suffering from
recurrent AOM whilst the remaining 60.4% (n=32) were suffering from OME. Overall 
ear-related quality of life was found to improve significantly following
insertion of ventilating tubes (p<0.001), as was the mean OM-6 score (p<0.001).
Furthermore, statistically significant improvements were noted in each individual
domain making up the OM-6 survey (physical suffering, hearing loss, speech
impairment, emotional distress, activity limitations and caregiver concerns).
CONCLUSIONS: The disease-specific quality of life of a group of Australian
pediatric patients with otitis media was found to significantly improve following
insertion of ventilating tubes as measured by the OM-6 survey. Improvements were 
found in global ear-related quality of life, in the mean OM-6 score, as well as
in all individual domains of the OM-6 survey.

PMID: 17645949 [PubMed - indexed for MEDLINE]

367: Int J Pediatr Otorhinolaryngol. 2007 Oct;71(10):1549-54. Epub 2007 Jul 23.

Clinical and demographic risk factors associated with chronic suppurative otitis 
media.

Lasisi AO, Olaniyan FA, Muibi SA, Azeez IA, Abdulwasiu KG, Lasisi TJ, Imam ZO,
Yekinni TO, Olayemi O.

Department of Otorhinolaryngology, College of Medicine, University of Ibadan,
Ibadan, Nigeria. sakeemng@yahoo.com

BACKGROUND: The incidence of chronic suppurative otitis media (CSOM) is high
worldwide but increasing occurrence of complications appear peculiar to West
Africa. However, knowledge of associated risk factors is sparse, we report the
sociodemographic risk factors of CSOM with the aim of control of the disease and 
complications; and possible preventive strategies. METHOD: This is a survey of
children with CSOM in five sites spread in two suburban cities in two states in
Nigeria. Questionnaire was administered on the informants followed by examination
of the children. RESULT: Of the 189 children, 114 (60%) had developed ear
suppuration before 6 months of age, the number of attacks within the previous 18 
months ranged between 2-12 with average of 7. Sociodemographic risk factors
included low socioeconomic class in 153 (81%), 136 (72%) live in congested houses
with more than 10 people and 79 (42%) belonged to families with more than 5
children. Indoor-cooking and infant daycare attendance were 117 (62%) while
supine bottlefeeding was 115 (61%) and 34 (18%) of subjects had smoking father.
The clinical risk factors were upper respiratory tract infection (URI) 85 (45%), 
allergy 53 (28%), adenoid 54 (28%) and malnutrition 65 (34%). The univariate
analysis revealed that low social class (OR=7.33, CI=4.18-12.83, P=0.0001),
malnutrition (OR=3.57, CI=1.88-6.76, P=0.00001), bottlefeeding (OR=2.93,
CI=1.63-5.28, P=0.0001), indoor-cooking (OR=1.35, CI=0.88-2.10, P=0.161) and high
number of people in a household (OR=0.59, CI=0.34-0.98, P=0.04) are significant
in development of OM; while multivariate logistic regression analysis showed
malnutrition (OR=3.48, CI=1.633-7.425, P=0.001), low social status (OR=7.74,
CI=4.15-14.43, P=0.0001) and indoor-cooking (OR=2.34, CI=1.18-4.66, P=0.014),
second table. Parental smoking, daycare attendance, allergy,
adenoiditis/adenoidal hypertrophy and upper respiratory tract infection were not 
found significant. CONCLUSION: Low socioeconomic class, malnutrition, congestion 
from high number of children in the household and bottlefeeding constitute
significant risk factor. The early onset of disease (<6 months) may suggest a
prenatal predisposition. We need further research for the understanding of the
biologic effect of these factors while this remains a database for prevention and
control of disease.

PMID: 17643499 [PubMed - indexed for MEDLINE]

368: J Laryngol Otol. 2008 Mar;122(3):233-7. Epub 2007 Jul 19.

Acute mastoiditis in children: presentation and long term consequences.

Glynn F, Osman L, Colreavy M, Rowley H, Dwyer TP, Blayney A.

Department of Otorhinolaryngology Head and Neck Surgery, Children's University
Hospital, Temple Street, Dublin 2, Ireland. fglynn@rcsi.ie

Acute mastoiditis, a destructive bacterial infection of the mastoid bone and air 
cell system, is relatively uncommon today but remains a potentially serious
condition. There is a lack of information in the literature regarding the long
term otological problems that children may face following an episode of this
condition. OBJECTIVES: Our aim was to examine the presentation, complications and
hospital course in this patient population, and to ascertain whether these
patients had long term otological problems. METHODS: We retrospectively reviewed 
the medical records of all patients presenting with acute mastoiditis between
January 1990 and December 2005. Patients' parents were contacted by telephone and
questioned about further otological problems. RESULTS: Twenty-nine patients were 
included in the study, and 27 of these patients' parents were contactable to
complete the telephone questionnaire. Sixty-nine per cent of children had no
previous history of acute otitis media prior to presentation. Forty-five per cent
of patients had received oral antibiotics prior to presentation. Sixty-two per
cent of patients developed complications, i.e. a subperiosteal abscess or failure
to respond to medical therapy, resulting in the need for surgical intervention
(in the form of incision and drainage of periosteal abscess, cortical
mastoidectomy, or grommet insertion). Mean follow up of patients was eight years 
and one month; five (17 per cent) patients had been followed up for less than one
year. Two (7 per cent) patients developed a further episode of mastoiditis within
six weeks of initial presentation, both of whom required cortical mastoidectomy. 
Three (10 per cent) patients had further problems with recurrent acute otitis
media, requiring tympanostomy tube insertion. One patient required a modified
radical mastoidectomy for cholesteatoma (15 years later). Twenty-two patients (91
per cent) had been followed up for longer than one year; these patients had
subjectively normal hearing and were asymptomatic at the time of study.
CONCLUSION: The majority of patients who had suffered an episode of acute
mastoiditis had no adverse long term otological sequelae.

PMID: 17640433 [PubMed - indexed for MEDLINE]

369: Cochrane Database Syst Rev. 2007 Jul 18;(2):CD001727.

Update of:
    Cochrane Database Syst Rev. 2004;(3):CD001727.

WITHDRAWN: Decongestants and antihistamines for acute otitis media in children.

Flynn CA, Griffin GH, Schultz JK.

Faculty of Health Sciences and Medicine, C/O Cochrane ARI Group, Bond University,
Gold Coast, Queensland, Australia, 4229. flynnc@twcny.rr.com

BACKGROUND: Acute otitis media (AOM) is a common and important source of
morbidity in children, although most cases resolve spontaneously. While
frequently recommended, decongestant and antihistamine therapy is of unclear
benefit. OBJECTIVES: To determine the efficacy of decongestant and antihistamine 
therapy in children with AOM on outcomes of AOM resolution, symptom resolution,
medication side effects, and complications of AOM. SEARCH STRATEGY: We searched
the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane
Library Issue 3, 2003); MEDLINE (January 1966 to December 2003), EMBASE (January 
1990 to July 2003) and reference lists of articles for this updated review. We
also contacted study authors and pharmaceutical companies. SELECTION CRITERIA:
Randomized controlled trials evaluating decongestant or antihistamine treatment
for children with AOM were included. Patient-oriented outcomes were considered
most relevant. There were no quality or language restrictions. DATA COLLECTION
AND ANALYSIS: Investigators independently evaluated studies for inclusion,
performed validity assessments, and completed data extraction. Dichotomous data
were pooled to generate relative risks; homogeneity was assessed using
approximate chi-square tests. MAIN RESULTS: Fifteen trials involving 2695 people 
were included. Only the combined decongestant-antihistamine group demonstrated
statistically lower rates of persistent AOM at the two week period (fixed
relative risk (RR) 0.76; 95% confidence interval (CI) 0.60 to 0.96; number needed
to treat (NNT) 10). No benefit was found for early cure rates, symptom
resolution, prevention of surgery or other complications. There was a five to
eight -fold increased risk of side effects for those receiving an intervention,
which reached statistical significance for all decongestant groupings. Validity
sub analyses demonstrated that lower quality studies found benefit, while
analysis of those studies with higher validity scores found no benefit of
treatment. AUTHORS' CONCLUSIONS: Given lack of benefit and increased risk of side
effects, these data do not support the use of decongestant treatment in children 
with AOM. There was a small statistical benefit from combination medication use
but the clinical significance is minimal and study design may be biasing the
results. Thus, the routine use of antihistamines for treating AOM in children
cannot be recommended.

Publication Types: 
    Review

PMID: 17636682 [PubMed - indexed for MEDLINE]

370: Cochrane Database Syst Rev. 2007 Jul 18;(4):CD000473.

Update of:
    Cochrane Database Syst Rev. 2000;(2):CD000473.

WITHDRAWN: Interventions for chronic suppurative otitis media.

Acuin J, Smith A, Mackenzie I.

De La Salle University, Health Sciences Campus, Clinical Epidemiology Unit, Cong.
Road, Dasmariñas, Cavite 4114, Philippines. jmacuin@pworld.net.ph

BACKGROUND: Chronic suppurative otitis media (CSOM) is a serious bacterial
infection of the middle ear that can follow untreated acute otitis media.
OBJECTIVES: To assess the effects of different treatments for CSOM. SEARCH
STRATEGY: We searched Medline from 1966 to 1996 and a bibliographic collection of
the Hearing Impairment Research Group in Liverpool, UK. We handsearched two
otolaryngology journals and contacted members of an international hearing
network. SELECTION CRITERIA: Randomized trials of any method of management for
patients with eardrum perforation and persistent otorrhea. DATA COLLECTION AND
ANALYSIS: Three reviewers independently assessed eligibility and trial quality.
One reviewer extracted data. We contacted investigators for clarifications. MAIN 
RESULTS: Twenty-four trials involving 1660 people were included. Clinical
definitions and severity of CSOM varied, methodological quality was generally low
and follow-up was short. Treatment with antibiotics or antiseptics accompanied by
aural toilet was more effective in resolving otorrhea than no treatment (two
trials, odds ratio 0.37, 95% confidence interval 0.24 to 0. 57) or aural toilet
alone (six trials, odds ratio 0.31, 95% confidence interval 0.23 to 0.43).
Topical treatment with antibiotics or antiseptics was more effective than
systemic antibiotics (six trials, odds ratio 0.46, 95% confidence interval 0.30
to 0.69). Combining topical and systemic antibiotics was not more effective than 
topical antibiotics. Topical quinolones were more effective than non-quinolones
(five trials, odds ratio 0.26, 95% confidence interval 0.16 to 0.41). No
difference in the effectiveness of topical antibiotics and topical antiseptics
was found (three studies, odds ratio 1.34, 95% confidence interval 0.64 to 2.81).
Some topical antibiotic combinations may be more effective than others in
resolving otorrhea. Rates of adverse drug events were low and equal between
groups. AUTHORS' CONCLUSIONS: Treatment of CSOM with aural toilet and topical
antibiotics, particularly quinolones, is effective in resolving otorrhea and
eradicating bacteria from the middle ear. Longterm outcomes such as preventing
recurrences, closure of tympanic perforation and hearing improvement need to be
further evaluated.

Publication Types: 
    Review

PMID: 17636638 [PubMed - indexed for MEDLINE]

371: J Clin Microbiol. 2007 Sep;45(9):3003-7. Epub 2007 Jul 18.

The Binax NOW test as a tool for diagnosis of severe acute otitis media and
associated complications.

Gisselsson-Solén M, Bylander A, Wilhelmsson C, Hermansson A, Melhus A.

Department of Oto-Rhino-Laryngology, Lund University Hospital, Lund, Sweden.

The diagnosis of acute otitis media (AOM) is often difficult, depending heavily
on the experience and skills of the examiner. However, it is important to
identify episodes of AOM that involve the risk of complications and to treat
these episodes appropriately. The present study was performed in order to
evaluate the use of a rapid antigen assay for Streptococcus pneumoniae, the Binax
NOW test, as a diagnostic tool in patients with severe AOM and associated
complications. The study included 70 patients with 74 episodes of AOM, 18 of them
with complications. Cultures, Binax NOW tests, and a PCR assay were performed on 
nasopharyngeal secretions, middle ear fluid, and in some cases mastoid bone,
cerebrospinal fluid, and urine. According to culture and PCR of the middle ear
fluid, 30 (41%) of the episodes were caused by S. pneumoniae. The Binax NOW test 
was positive in 24 of these episodes (80%). It identified pneumococcal AOM
independent of antibiotic treatment, and it was easily adapted to bone tissue.
The test yielded sensitivity, specificity, and positive and negative predictive
values for middle ear specimens of 85%, 100%, 100%, and 89%, respectively. The
corresponding positive and negative values for predicting the bacterial etiology 
with nasopharyngeal secretions were 51% and 75%. This study showed that the Binax
NOW test is a useful diagnostic tool for patients with severe AOM with or without
complications.

Publication Types: 
    Comparative Study
    Evaluation Studies
    Research Support, Non-U.S. Gov't

PMID: 17634299 [PubMed - indexed for MEDLINE]

372: Rev Laryngol Otol Rhinol (Bord). 2007;128(1-2):63-4.

Progressive cochleo-vestibular labyrinthitis.

Boleas-Aguirre MS, Vazquez F, Perez N.

University Hospital and Medecine School, Navarra University, ENT Department, Pio 
XII 36, 31008 Pamplona, Spain.

OBJECTIVE: We report a rare case of sudden deafness and benign paroxysmal
positional vertigo (BPPV) corresponding to a canalithiasis of the ipsilateral
left posterior semicircular canal (PSC). CASE REPORT: The initial examination
showed intact lateral semicircular canal (LSC) function. Cerebral MRI results
were normal. However evoked otoacoustics emissions were absent in the left ear.
The patient developed, in the course of one week, symptoms and signs of an acute 
unilateral vestibulopathy in the same ear. However there were no change in
hearing loss after it. CONCLUSION: The association of BPPV acute vestibulopathy
and sudden deafness is uncommon but usually the former develops well after the
second and third. This case is best explained by a vestibulocochlear
labyrinthitis.

Publication Types: 
    Case Reports

PMID: 17633668 [PubMed - indexed for MEDLINE]

373: Rev Laryngol Otol Rhinol (Bord). 2007;128(1-2):59-61.

Otogenic pneumocephalus: case report and review of the literature.

Glynn F, Skinner LJ, Daly CA, Donnelly M.

Waterford Regional Hospital, Department of Otolaryngology Head and Neck Surgery, 
Dunmore road, Waterford, Ireland. fglynn@rcsi.ie

We report a case of a 70 year old lady who presented to the accident and
emergency department with a three day history of left sided otalgia, drowsiness
and confusion. On admission her temperature was 39 degrees C, glascow coma scale 
was 14/15 and otoscopy revealed a left sided otitis media. There was no sign of
CSF otorrhoea or mastoiditis. Neuro-otological examination was normal. High
resolution CT scan of temporal bones and brain showed evidence of pneumocephalus 
near the left cerebello-pontine angle and posterior to the left petrous bone. No 
focal parenchymal pathology, intra-cranial bleed or defect in the tegmen was
noted. The patient responded very well to conservative management in the form of 
high dose intravenous antibiotics. We would like to emphasise that this
complication of otitis media should be borne in mind when an elderly patient
presents with otalgia and confusion.

Publication Types: 
    Case Reports

PMID: 17633667 [PubMed - indexed for MEDLINE]

374: Int J Pediatr Otorhinolaryngol. 2007 Sep;71(9):1465-70. Epub 2007 Jul 13.

Interleukin-8 induction via NF-kappaB, p38 mitogen-activated protein kinase and
extracellular signal-regulated kinase 1/2 pathways in human peripheral blood
mononuclear cells by Alloiococcus otitidis.

Harimaya A, Koizumi J, Fujii N, Himi T.

Department of Otolaryngology, Sapporo Medical University School of Medicine, S-1,
W-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan. harimaya@sapmed.ac.jp

Alloiococcus otitidis is a newly recognized species of gram-positive bacteria
frequently associated with otitis media. Although immunostimulating activity of
this organism has been investigated, little is known about the signaling pathways
of chemokine/cytokine induction by this organism. We investigated the role of
NF-kappaB and mitogen-activated protein (MAP) kinases in chemokine interleukin-8 
(IL-8) production by human peripheral blood mononuclear cells (PBMCs) after
stimulation with A. otitidis. The organism could induce in vitro IL-8 production 
in human PBMCs. I kappa B alpha, NF-kappaB, p38 MAP kinase, p44/42 MAP kinase
(ERK1/2) became phosphorylated in PBMCs after stimulation with A. otitidis. And, 
inhibitors of NF-kappaB (caffeic acid phenylethyl ester), p38 (SB 203580), or
ERK1/2 (PD 98059) significantly reduced IL-8 induction by the organism. These
results were similar to findings in IL-8 induction by Streptococcus pneumoniae,
another gram-positive major middle ear pathogen. Our preliminary study suggests
that multiple pathways including NF-kappaB, p38, and ERK1/2 were simultaneously
activated, and were associated with IL-8 induction by A. otitidis in human PBMCs.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17629956 [PubMed - indexed for MEDLINE]

375: Vaccine. 2007 Aug 14;25(33):6237-44. Epub 2007 Jun 18.

Assessing vaccine efficacy for the prevention of acute otitis media by
pneumococcal vaccination in children: a methodological overview of statistical
practice in randomized controlled clinical trials.

Jahn-Eimermacher A, du Prel JB, Schmitt HJ.

Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI),
University of Mainz, 55101 Mainz, Germany. jahn@imbei.uni-mainz.de

Acute otitis media (AOM) is the most common bacterial infectious disease among
children. Vaccination is proposed to prevent otitis and several clinical trials
were performed to assess the efficacy of pneumococcal vaccines. The way vaccine
efficacy is analysed varies among trials. However, the clinical meaning of an
estimate of vaccine effect and its statistical test depends on the applied
statistical method. We aim to bring the meaning and validity of statistical trial
results to the attention of researchers. We consider all methodological
approaches for analysing vaccine efficacy applied in pneumococcal vaccination
trials included in a recent Cochrane Review. We demonstrate how different methods
address different scientific questions on the effect of vaccination, how they can
complement each other and why some methods can produce misleading results.

PMID: 17629378 [PubMed - indexed for MEDLINE]

376: Pediatr Neurosurg. 2007;43(4):327-9.

Cerebellar abscess following mastoidectomy for chronic otitis media.

Agrawal A, Pratap A, Singh I, Kumar A, Shrestha S.

Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. 
dramitagrawal@gmail.com

Chronic otitis media although rare in developed countries is still a major
problem in the developing countries. If untreated, it can lead to
life-threatening intracranial complications. In the available literature the
incidence and risk factors for cerebellar abscess following mastoidectomy is not 
known. In this case we would like to emphasize that CT scan before mastoidectomy 
is not possible in all the cases particularly in developing countries. There is a
need to find the factors that will make one suspect the possibility of concurrent
intracranial lesions and which will identify the patients prone to intracranial
complications. Copyright (c) 2007 S. Karger AG, Basel.

Publication Types: 
    Case Reports

PMID: 17627152 [PubMed - indexed for MEDLINE]

377: J Laryngol Otol. 2008 Apr;122(4):351-6. Epub 2007 Jul 11.

Ossicular chain reconstruction improves bone conduction threshold in chronic
otitis media.

Lee HS, Hong SD, Hong SH, Cho YS, Chung WH.

Department of Otorhinolaryngology-Head and Neck Surgery, Pundang Jesaeng
Hospital, Daejin Medical Center, Sungnam, Korea.

This study aimed to assess the elevation of bone conduction threshold in patients
with chronic otitis media and to investigate the mechanism of this phenomenon.
One hundred and six patients with unilateral chronic otitis media who had
undergone a tympanomastoidectomy were reviewed retrospectively. The differences
in the bone conduction thresholds between the diseased and normal sides were
assessed and compared according to the duration of the disease and the presence
of cholesteatoma. Post-operative changes in the bone conduction threshold were
also assessed. The mean bone conduction thresholds were significantly elevated on
the diseased side, ranging from 3.4 to 11.6 dB across frequencies, with a maximal
elevation at 2000 Hz. The duration of disease and the presence of cholesteatoma
did not affect the degree of the bone conduction elevation. After ossicular
reconstruction, bone conduction thresholds improved significantly at all
frequencies, with the greatest improvement being observed at 2000 Hz. These
results suggest that the elevation in the bone conduction threshold in chronic
otitis media is mainly caused by a change in the conductive mechanism in the
middle ear.

PMID: 17623495 [PubMed - indexed for MEDLINE]

378: Am J Rhinol. 2007 May-Jun;21(3):281-5.

The role of the otorhinolaryngologist in the management of central skull base
osteomyelitis.

Cavel O, Fliss DM, Segev Y, Zik D, Khafif A, Landsberg R.

Departments of Otolaryngology-Head and Neck Surgery, Tel-Aviv Sourasky Medical
Center, Sackler Faculty ofMedicine, Tel-Aviv University, Tel-Aviv, Israel.
orencavel@gmail.com

BACKGROUND: Skull base osteomyelitis (SBO) typically evolves as a complication of
external otitis in diabetic patients and involves the temporal bone. Central SBO 
(CSBO) mainly involves the sphenoid or occipital bones without coexisting
external otitis. We characterized a group of patients with CSBO. The endoscopic
nasopharyngeal and clival biopsy technique is described. METHODS: Medical records
of patients diagnosed as having SBO were retrospectively analyzed (from 2001 to
2006). Patients' symptoms and signs, laboratory findings, imaging
characteristics, endoscopic clival and periclival histopathology results,
treatment, and outcome were retrieved. RESULTS: Of 20 patients with SBO, 6
patients without external otitis were studied (age range, 54-76 years; 5 men;
mean follow-up, 21 months). All patients suffered from unilateral headache, three
of six patients had serous otitis media (SOM), three of six patients had cranial 
nerve (CN) palsies, and five of six patients had elevated acute-phase reactants. 
Computed tomography (CT) findings were clival cortical bone erosion and adjacent 
soft tissue swelling. Magnetic resonance (MR) findings were texture changes and
enhancement of the involved bones and soft tissues. Biopsy specimens revealed
chronic inflammation. All six patients were treated with antibiotics for 3-6
months. Headache disappeared in five of six patients, SOM resolved in two of
three patients, and CN palsies partially recovered in two of three patients.
Imaging findings improved in five of six patients. CONCLUSION: CSBO may mimic
malignancy and represents a diagnostic challenge. Typical clinical picture and
imaging findings together with a positive response to ciprofloxacin may suffice
to establish the diagnosis and obviate the need for biopsies. When in doubt,
nasopharyngeal and clival biopsies are performed to rule out malignancy.

PMID: 17621809 [PubMed - indexed for MEDLINE]

379: Int J Pediatr Otorhinolaryngol. 2007 Sep;71(9):1443-7. Epub 2007 Jul 5.

Acute otitis media associated with cytomegalovirus infection in infants and
children.

Yano H, Okitsu N, Watanabe O, Kisu T, Hori T, Hatagishi E, Okamoto M, Ohmi A,
Yamada K, Sagai S, Suetake M, Kobayashi T, Nishimura H.

Virus Research Center, Clinical Research Division, Sendai Medical Center,
Miyagino-ku, Sendai 983-8520, Japan. yanohisa@snh.go.jp

OBJECTIVE: Acute otitis media (AOM) is one of the most common complications of
viral respiratory tract infections in children, but the role of each virus is
still to be elucidated. We analyzed AOM associated with infection by
cytomegalovirus (CMV), which is known as one of the major causes of viral
respiratory tract infection. METHODS: Four hundred and ninety-five children (292 
boys and 203 girls) diagnosed as having AOM in 2002 were studied. All of the
children were under 6 years old, with the average age being 1.31+/-1.36 years.
Bacterial and viral culture of both nasopharyngeal secretions (NPS) and middle
ear fluid (MEF) was performed in all 495 children. The levels of glutamyl pyruvic
transaminase (GPT) and the serum IgM antibody for CMV were measured. CMV
infection was defined on the basis of isolation of this virus by culture and/or
positive anti-CMV IgM antibody. NPS and MEF specimens of the subjects diagnosed
as having CMV infection were tested for the virus by nested PCR. RESULTS: Twelve 
of the 495 children were found to have CMV infection. They included 6 boys and 6 
girls aged from 3 to 25 months, with the average age being 11+/-7 months. Among
10 children in whom CMV infection was diagnosed by viral culture, CMV was
isolated from NPS alone in nine cases and from both NPS and MEF in one case.
Nested PCR was performed in all 12 subjects diagnosed as having CMV infection,
and all NPS samples were positive, as were 8 MEF samples. We obtained serum
samples from 205 children under 2 years of age, including 9 with CMV infection.
The mean serum GPT level of 124 children in whom no viruses were detected was
20.7+/-14.4 IU/L. While, the serum GPT levels of 9 children with CMV infection
ranged from 10 to 280 IU/L with the average titer being 78.4+/-81.9 IU/L, and the
GPT levels of the children with CMV infection were significantly higher than
those of the children in whom no viruses were detected (p<0.05). CONCLUSION: Our 
results suggested that CMV is a causative pathogen of AOM, and that CMV infection
should be suspected in patients with AOM and liver dysfunction.

PMID: 17618694 [PubMed - indexed for MEDLINE]

380: Hear Res. 2007 Sep;231(1-2):23-31. Epub 2007 Jun 2.

Tympanometry assessment of 61 inbred strains of mice.

Zheng QY, Tong YC, Alagramam KN, Yu H.

Department of Otolaryngology Head and Neck Surgery, Case Western Reserve
University, 11100 Euclid Avenue, LKS 5045, Cleveland, OH 44106, USA. qyz@case.edu

Otitis media (OM) accounts for more than 20 million clinic visits in the United
States every year. Resistance to antibiotics has hampered current management of
the disease. Identification of genetic factors underlying susceptibility to OM is
greatly needed in order to develop alternative treatment strategies. Genetically 
defined inbred mouse strains offer a powerful tool for dissecting genetic and
environmental factors that may lead to OM in mice. Here, we report a study of
middle ear function of 61 genetically diverse inbred strains of mice using
tympanometry. Of the 61 inbred strains tested, the 129P1/ReJ, 129P3/J,
129S1/SvImJ, 129X1/SvJ, A/HeJ, BALB/cJ, BUB/BnJ, C57L/J, EL/SuzSeyFrkJ, FVB/NJ,
I/LnJ, LP/J, NZB/BlNJ, PL/J and YBR/Ei strains exhibited tympanograms that were
statistically different from other healthy strains according to parameters
including middle ear pressure, volume and compliance. These differences are most 
likely the result of genetic factors that, when understood, will facilitate
prevention and treatment of otitis media in humans. In addition, a negative
correlation between age and compliance of the tympanic membrane was discovered.
This is the first report to successfully use tympanometry to measure mouse middle
ear function, which has been a challenge for the hearing research field because
of the mouse's tiny ear size.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17611057 [PubMed - indexed for MEDLINE]

381: Ear Hear. 2007 Aug;28(4):451-5.

Prevalence of OME is reduced in young children using chewing gum.

Kouwen HB, DeJonckere PH.

The Institute of Phoniatrics, ENT Department, University Medical Center Utrecht, 
Utrecht, The Netherlands.

OBJECTIVE: The present study investigates a possible relationship between use of 
chewing gum and otitis media with effusion (OME) in children. Chewing obviously
activates jaw movements, increases salivary flow, and, by the way, the rate of
swallowing and the rate of activations of peritubal muscles and tubal openings.
Chewing also requires nasal respiration, thus preventing mouth breathing. DESIGN:
Cross-sectional study: 1756 children (2 to 6 yr of age), apparently in good
health and visiting different Dutch child health centers in the region of Utrecht
were examined between September 1999 and April 2002. OME was diagnosed by
combined tympanometry and otoscopy. The criterion for OME was unilateral or
bilateral type B tympanogram, according to Jerger. The parents had to fill out a 
questionnaire with a question pertaining to the chewing habits of their child.
RESULTS: Logistic regression points out that age and season as well as chewing
gum-consuming habits significantly influence the prevalence of OME. The strongest
effects are age (OME becomes less frequent with age) and season (OME occurs less 
when climate is more favorable), but -- ceteris paribus -- a child consuming
daily or at least weekly chewing gum shows significantly less chance for OME than
a child who seldom consumes or consumes no chewing gum (p = 0.023). CONCLUSIONS: 
In the case of regular use of chewing gum, the probability of having OME in
children is reduced by 40%. It seems plausible that children with immature oral
motorics do not like chewing gum.

PMID: 17609608 [PubMed - indexed for MEDLINE]

382: Acta Otorhinolaryngol Ital. 2007 Apr;27(2):87-9.

Pneumocephalus and meningitis as a complication of acute otitis media: case
report.

Ciorba A, Berto A, Borgonzoni M, Grasso DL, Martini A.

Audiology Department, University Hospital of Ferrara, Ferrara, Italy.

Otogenic pneumocephalus is a rare condition. The case is described of
pneumocephalus and meningitis secondary to acute otitis media. Although the rate 
of intracranial complications related to middle ear disease is only 0.5 to 4%,
mortality still ranges between 5 and 15%.

Publication Types: 
    Case Reports

PMID: 17608137 [PubMed - indexed for MEDLINE]

383: Vet Pathol. 2007 Jul;44(4):547-9.

Cholesterol granuloma associated with otitis media and destruction of the
tympanic bulla in a dog.

Fliegner RA, Jubb KV, Lording PM.

The Department of the Veterinary Clinic and Hospital, University of Melbourne,
Werribee, Victoria 3030 Australia. rflie@unimelb.edu.au

An 8-year-old, male neutered Irish Setter was presented with a 2-week history of 
pain upon opening the mouth and chronic otitis externa. Computed tomography
examination revealed destruction of the left tympanic bulla with a soft-tissue
density within the remains of the tympanic cavity. Cytology of aspirates
collected from tissue adjacent to the tympanic bulla revealed suppurative
inflammation and bacteria. A ventral bulla osteotomy was performed.
Histopathology of granulation tissue within the remains of the tympanic cavity
was diagnostic of cholesterol granuloma.

Publication Types: 
    Case Reports

PMID: 17606522 [PubMed - indexed for MEDLINE]

384: Am J Otolaryngol. 2007 Jul-Aug;28(4):254-6.

Scedosporium apiospermum otomycosis.

Baumgartner BJ, Rakita RM, Backous DD.

Department of Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, 
Tacoma, WA 98431, USA. brianis@doctor.com

We present a case of Scedosporium apiospermum otomycosis in an immunocompetent
62-year-old woman presumably inoculated as a child in Vietnam. She had life-long 
recurrent symptoms of chronic otomastoiditis and otorrhea. The organism was
identified in an unexpected wound infection after a modified radical
mastoidectomy done for chronic otitis media. Treatment consisted of local
debridement of necrotic tissue, topical wound care, and long-term systemic
antifungals.

Publication Types: 
    Case Reports

PMID: 17606042 [PubMed - indexed for MEDLINE]

385: Otolaryngol Head Neck Surg. 2007 Jul;137(1):59-64.

Detection of gastric pepsin in middle ear fluid of children with otitis media.

He Z, O'Reilly RC, Bolling L, Soundar S, Shah M, Cook S, Schmidt RJ, Bloedon E,
Mehta DI.

Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, 
DE 19899, USA. zhe@nemours.org

OBJECTIVE: We sought to confirm the finding of pepsin/pepsinogen in the middle
ear fluid of children with otitis media in a larger sample size using a sensitive
and specific pepsin assay. STUDY DESIGN AND SETTING: We evaluated 152 children
(225 ear samples) in a prospective study at a tertiary care children's hospital. 
The presence of pepsin in middle ear aspirates was determined using enzymatic
assay. RESULTS: Of the patients, 14.4 percent (22 of 152) had detectable pepsin
activity in one or both of the ear samples with no pepsin activity detected in
control serum. Average pepsin concentration in the samples was 96.6 +/- 170.8
ng/ml, ranging from 13 to 687 ng/ml. Pepsin concentration in the middle ear of
children younger than 1.0 year was significantly higher than in older age groups.
CONCLUSION AND SIGNIFICANCE: Results indicate that pepsin/pepsinogen is present
in the middle ears of children with otitis media, although not at the high rate
previously reported. Gastric reflux may be one causative factor in the
pathogenesis of otitis media.

PMID: 17599566 [PubMed - indexed for MEDLINE]

386: Int J Pediatr Otorhinolaryngol. 2007 Sep;71(9):1429-38. Epub 2007 Jun 27.

Hearing screening and middle ear measures in American Indian infants and
toddlers.

Hunter LL, Davey CS, Kohtz A, Daly KA.

University of Utah, Department of Communication Sciences and Disorders, 390
South, 1530 East, 1201 BEHS, Salt Lake City, UT 84112, USA.
lisa.hunter@hsc.utah.edu

American Indian children have three times the rate of otitis media compared to
the general population, yet prospective cohort studies of OME and hearing loss
have not been previously reported in American Indian infants. Between 1997 and
2003, a cohort of 421 infants was enrolled at birth from Minnesota American
Indian reservations and an urban clinic and followed to age 2 years. This study
reports OAE hearing screening results related to OME diagnoses, as well as risk
for recurrent hearing screening failure and OME in American Indian infants and
children. METHODS: Infants were prospectively assessed at regular intervals with 
pneumatic otoscopy, distortion product otoacoustic emissions, and tympanometry by
nurses who were trained in all procedures and validated on pneumatic otoscopy.
RESULTS: In the newborn period, 23.5% of infants failed hearing screening in at
least one ear. Hearing screening failures increased to 29.9% from 2 to 5 months
of age. Technical fail results due to excessive noise occurred frequently in
infants 6-24 months of age, making interpretation of true pass and fail rates
questionable in older infants. OAE test result was associated with OM diagnosis, 
and this relationship strengthened with age, with the strongest association above
6 months of age. CONCLUSIONS: A high rate of hearing screening failures occurred 
among American Indian infants in the first 5 months of age, and was significantly
associated with a correspondingly high rate of otitis media. Only one infant out 
of 366 was identified with sensorineural hearing loss, thus essentially all of
the hearing screening failures reflected either a middle ear origin or other
temporary problems. OAE screening provided a valuable hearing screening measure
in this population at high risk for recurrent otitis media, but due to excessive 
noise in infants 6 months and older, practical use of OAE screening is limited.
Use of behavioral assessment is needed after 6 months of age, when high rates of 
OME persist in this population. Increased efforts to develop public and medical
education, as well as screening, diagnosis and treatment programs are needed to
detect and decrease recurrent OME in American Indian infants and children.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17599470 [PubMed - indexed for MEDLINE]

387: Pediatr Infect Dis J. 2007 Jul;26(7):647-9.

Change in pneumococcal susceptibility to azithromycin during treatment for acute 
otitis media.

Toltzis P, Dul M, Blumer J.

Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western
Reserve University School of Medicine, Cleveland, OH 44106, USA. pxt2@case.edu

Authorities have suggested restriction of azithromycin use as a principal
strategy to contain the spread of azithromycin-nonsusceptible Streptococcus
pneumoniae (ANSP). In 83 children persistently colonized by pneumococcus during
and after treatment of acute otitis media, 17 acquired a new strain, 9 of which
were less susceptible to azithromycin than the original isolate. New appearance
of ANSP was documented after both beta-lactam and azithromycin exposure. ANSP is 
likely to disseminate even with significant reduction of azithromycin use unless 
other antibiotic use is decreased as well.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17596812 [PubMed - indexed for MEDLINE]

388: Pediatr Infect Dis J. 2007 Jul;26(7):589-92.

Is bilateral acute otitis media clinically different than unilateral acute otitis
media?

Leibovitz E, Asher E, Piglansky L, Givon-Lavi N, Satran R, Raiz S, Slovik Y,
Leiberman A, Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center and the
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,
Israel. eugenel@bgu.ac.il

BACKGROUND: Information regarding the specific characteristics of bilateral acute
otitis media (BAOM) versus unilateral acute otitis media (UAOM) is lacking.
OBJECTIVES: To compare the epidemiologic, microbiologic, and clinical
characteristics of BAOM with UAOM in children. PATIENTS AND METHODS: 1026
children aged 3-36 months (61%, <1 year of age) with AOM were enrolled during
1995-2003. All patients had tympanocentesis and middle ear fluid (MEF) culture at
enrollment. Clinical status was determined by a clinical/otologic score
evaluating severity (0 = absent to 3 = severe, maximal score 12) of patient's
fever and irritability and tympanic membrane redness and bulging. Multivariate
logistic regression models were used to estimate the risk of BAOM and UAOM
presenting with a high severity score (> or =8). RESULTS: Six-hundred
twenty-three (61%) patients had BAOM. Positive MEF cultures were recorded in 786 
(77%) patients. More patients with BAOM had positive MEF cultures than patients
with UAOM (517 of 623, 83% versus 269 of 403, 67%; P < 0.01). Nontypable
Haemophilus influenzae was more common in BAOM than in UAOM (390 of 623, 63%
versus 170 of 430, 42%; P < 0.01). Overall, the clinical/otologic score showed
higher severity in culture-positive than in culture-negative patients (8.2 +/-
2.0 versus 7.7 +/- 2.2; P < 0.001) and in BAOM than in UAOM (8.3 +/- 2.1 versus
7.8 +/- 2.1; P = 0.001). Clinical/otologic score of > or =8 was more frequent in 
BAOM than in UAOM patients (371, 61.8% versus 200, 51.3%; P = 0.001). The
estimated risk for BAOM patients (compared with UAOM patients) to present with a 
score > or =8 was 1.5. The association between BAOM and clinical/otologic score >
or = 8 was maintained after adjustment for age, previous AOM history, and culture
results at enrollment. CONCLUSIONS: (1) BAOM is frequent; (2) Nontypable H.
influenzae is more frequently involved in the etiology of BAOM than of UAOM; (3) 
The clinical picture of BAOM is frequently more severe than that of UAOM, but
overlap of clinical symptoms is common.

PMID: 17596799 [PubMed - indexed for MEDLINE]

389: Pediatr Infect Dis J. 2007 Jul;26(7):583-8.

Laterality of acute otitis media: different clinical and microbiologic
characteristics.

McCormick DP, Chandler SM, Chonmaitree T.

Department of Pediatrics, University of Texas Medical Branch at Galveston,
Galveston, TX 77551, USA. david.mccormick@utmb.edu

BACKGROUND: A large individual patient data meta-analysis recently showed that
children aged less than 2 years with bilateral, as compared with unilateral,
acute otitis media (AOM) were at higher risk for persistent symptoms without
antibiotic treatment. Prior studies have shown a propensity for children with
bilateral AOM to be infected with bacterial pathogens, specifically Haemophilus
influenzae. The objectives of this study were to further characterize risk
factors for bilateral AOM and to assess the propensity for specific viral and
bacterial pathogens to predispose to bilateral versus unilateral AOM. METHODS: We
performed a secondary data analysis on 1216 cases of AOM diagnosed and treated at
our institution: 566 subjects underwent tympanocentesis and middle ear fluid
(MEF) culture. We compared subjects with bilateral and unilateral AOM for
demographic characteristics, clinical findings, parent/clinician perception of
AOM severity, and MEF study results for bacteria and viruses. RESULTS: When
compared with children who have unilateral AOM, children with bilateral AOM were 
more likely to be younger (P < 0.001), have H. influenzae isolated from one or
both MEFs (P < 0.0001), and have more severe inflammation of the tympanic
membrane on otoscopic examination (P < 0.0001). CONCLUSION: Compared with
children who have unilateral AOM, children with bilateral AOM are more likely to 
have bacteria in the MEF and have more severe inflammation of the tympanic
membrane. This may help explain why children with bilateral AOM are more likely
to experience persistent symptoms without antibiotic treatment. Laterality of AOM
should be considered when discussing treatment options with parents.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17596798 [PubMed - indexed for MEDLINE]

390: Yonsei Med J. 2007 Jun 30;48(3):449-56.

Squamous metaplasia and BCL-6 in pediatric adenoid accompanied by otitis media
with effusion.

Yeo SG, Park DC, Choo JH, Cha CI.

Department of Otolaryngology, College of Medicine, Kyung Hee University, 1
Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea.

PURPOSE: Deterioration of local immunity in the adenoids may make them vulnerable
to infection by microorganisms, resulting in otitis media with effusion. To
determine the factors associated with this condition, we evaluated adenoid size, 
mucosal barrier, squamous changes of ciliated epithelium, IgA secretion, and
BCL-6 expression in adenoids. MATERIALS AND METHODS: Seventeen children diagnosed
with otitis media with effusion (OME group) and 20 children without any history
of OME (control group) were enrolled. Their adenoids were sized by lateral view
X-ray and stained with hematoxylin and eosin to detect squamous metaplasia. The
adenoids were also stained with cytokeratin to evaluate mucosal barriers, and
with anti- IgA antibody and anti- BCL-6 antibody to determine expression of IgA
and BCL-6. RESULTS: The OME group showed greater incidence of squamous
metaplasia, fewer ciliated cells, and lower expression of BCL-6 (p < 0.05 each). 
Deterioration of the mucosal barrier was detected in the OME group (p > 0.05).
IgA secretion and adenoid size were the same for the OME and the control groups. 
CONCLUSION: These results suggest that increased squamous metaplasia and lower
BCL-6 expression in adenoids may be associated with increased susceptibility to
OME.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17594153 [PubMed - indexed for MEDLINE]

391: J Laryngol Otol. 2008 Jan;122(1):3-10. Epub 2007 Jun 25.

Management of granular myringitis: a systematic review.

Neilson LJ, Hussain SS.

University of Dundee Medical School and the Department of Otolaryngology,
Ninewells Hospital, Dundee, Scotland, UK.

INTRODUCTION: Granular myringitis is a chronic disorder characterised by lateral 
squamous de-epithelialisation and granulation of the tympanic membrane.
Untreated, granular myringitis can lead to post-inflammatory medial external
auditory canal fibrosis, acquired canal atresia and inflammatory infiltration of 
the deep canal. AIM: This study aimed to establish optimal management strategies 
which could be applied to clinical practice, through systematic review of the
current literature. METHODS: Current literature was obtained by searching
evidence-based medical databases, the Cochrane database, the Database of
Abstracts of Reviews of Effects, the Cochrane controlled trials register, Ovid
Medline, the various British Medical Journal imprint journals, individual journal
websites and citation indexes, and by hand-searching current journals. Detailed
inclusion criteria were set. Data were retrieved from the selected studies and
checked for accuracy and consistency. The primary outcome measured was the effect
of the proposed intervention on recurrence of granular myringitis, compared with 
empirical antibiotic therapy. RESULTS: Fifty-eight publications were identified, 
dating from 1964 to 2005; 46 of these were potentially relevant. After assessment
using the preset inclusion criteria, only two studies remained. El-Seifi and
Fouad (2000) found that surgical excision of granulation tissue resulted in an 80
per cent reduction in recurrence of granular myringitis when compared with
conventional antibiotic therapy. However, Jung et al. (2002) demonstrated a 96
per cent reduction in granular myringitis recurrence when managed with dilute
vinegar solution. CONCLUSIONS: There was a reduced recurrence of granular
myringitis in both studies' intervention groups, although neither study was
randomised or blinded, making it difficult to assess the clinical relevance of
the results. However, the following conclusions can be inferred. (1) Conventional
topical antibiotic and steroid drops appear to be less efficacious and more
likely to lead to recurrence of symptoms, compared with other proposed treatment 
modalities. (2) Treatment with dilute vinegar solution presents a logical,
unharmful alternative to conventional antibiotic drops. Further research of high 
value is needed.

Publication Types: 
    Review

PMID: 17592657 [PubMed - indexed for MEDLINE]

392: Braz J Otorhinolaryngol. 2007 Mar-Apr;73(2):231-8.

Audibility threshold for high frequencies in children with medical history of
multiples episodes of bilateral secretory otitis media.

Ferreira Mde S, de Almeida K, Atherino CC.

Universidade Veiga de Almeida.

Relatively poorer audibility threshold for high frequency was found in children
with medical history of multiples episodes of secretory otitis media. AIM: to
characterize the audibility threshold for high frequencies in normal-hearing
children with medical history of multiples episodes of bilateral secretory otitis
media. MATERIALS AND METHODS: a sample of 31 children, from both genders, was
divided in two groups: 14 subjects who had not more than 3 episodes of bilateral 
secretory otitis media (Group 1) and 17 subjects that experienced at least 4
episodes of this condition (Group 2). Pure-tone air conduction audiometry was
tested at frequencies 9,000 to 18,000 Hz. STUDY DESIGN: transversal prospective. 
RESULTS: there was no difference between audibility thresholds comparing right
and left ears of subjects of both Group 1 and Group 2 in all tested frequencies. 
However, there was difference between audibility thresholds between subjects of
Group 2 compared to Group 1 in all tested frequencies. CONCLUSION: 1- There was
an increase in audibility thresholds with the increase in frequency . 2- High
frequency audiometry separates subjects with history of at least four episodes of
secretory otitis media, suggesting that these episodes are sufficient to promote 
statistically significant difference in high frequency thresholds.

PMID: 17589732 [PubMed - indexed for MEDLINE]

393: Braz J Otorhinolaryngol. 2007 Mar-Apr;73(2):165-70.

Sigmoid sinus thrombosis associated to chronic otitis media.

Penido Nde O, Toledo RN, Silveira PA, Munhoz MS, Testa JR, Cruz OL.

UNIFESP-EPM. nopenido@terra.com.br

Otogenous lateral sinus thrombosis (OLST) is a rare disease and presents a
controversial treatment. AIM: Clinical aspects and treatment were reported based 
on our experience. METHODS: Retrospective study. Six cases of OLST were treated
in our institution in the last ten years. Clinical and imaging data were
analyzed. RESULTS: All six patients had the lateral sinus thrombosis detected
during image evaluation for other symptoms related to chronic otitis media (COM) 
complications. Fever, headache and facial paralysis were the main clinical
manifestation related to mastoiditis, meningitis and cerebellar abscess. We could
not identify, in any case, specific features of lateral sinus thrombosis. In all 
cases a mastoidectomy was associated with large spectrum antibiotics maintained
for 3 months. In three cases anticoagulation therapy was introduced and in three 
cases anticoagulation was not indicated. All cases presented a good clinical
evolution, without sequelae. CONCLUSIONS: OLST is almost always associated with
other complications of COM. It is diagnosed almost by accident during the
investigative image study. We believe such disease is underestimated. In our
experience, OLST presents a benign course, and mastoidectomy with antibiotics is 
the treatment of choice.

PMID: 17589723 [PubMed - indexed for MEDLINE]

394: Laryngoscope. 2007 Aug;117(8):1419-23.

Role of extra-esophageal reflux in chronic otitis media with effusion.

Crapko M, Kerschner JE, Syring M, Johnston N.

Department of Otolaryngology and Communication Sciences, Medical College of
Wisconsin, Milwaukee, Wisconsin 53226, USA.

OBJECTIVES/HYPOTHESIS: Otitis media with effusion (OME) is the most common cause 
of childhood hearing loss. Despite its prevalence, the enormous health care
expenditures resulting from its treatment, and the increasing therapeutic
challenges imposed by antimicrobial resistance, very little is known regarding
the cellular and molecular immunologic and inflammatory events in this disease
process. Extra-esophageal reflux (EER) has been implicated in the pathogenesis of
chronic OME. The objective of this study was to confirm that children with OME
have EER into the middle ear as measured by the presence of pepsin in middle ear 
effusions (MEE) removed during tympanostomy tube (TT) placement. STUDY DESIGN:
Prospective, translational, cell biological research study. METHODS: MEE were
obtained from children undergoing TT placement for OME. The fluid was lysed in a 
urea buffer and the presence of pepsin quantitatively determined by Western blot 
analysis using a specific antipepsin antibody. The pH of the samples was recorded
before lysis. RESULTS: Pepsin protein was detected in 18 of 32 (56%) samples
analyzed, with 12 of 20 (60%) patients having at least one positive sample for
pepsin. Pepsin levels ranged from 80 to 1,000 ng/mL. The pH of the samples ranged
from 6.0 to 7.6, with a mean pH of 6.8. CONCLUSIONS: Pepsin was detected in 60%
of patients with OME, confirming that EER into the middle ear occurs in these
children. The pepsin present would have little or no activity at pH 6.0 to 7.6;
however, pepsin is stable below pH 8.0 and thus could be reactivated after a
decrease in pH.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17585281 [PubMed - indexed for MEDLINE]

395: Microb Pathog. 2007 Aug-Sep;43(2-3):114-9. Epub 2007 May 18.

Adherence of Streptococcus pneumoniae to polystyrene plates, effect of serum on
adhesion, and virulence in the gerbil otitis media model.

Huelves L, del Prado G, Rodriguez-Cerrato V, Gracia M, Cenjor C, Granizo JJ,
Ponte C, Soriano F.

Departments of Medical Microbiology and Antimicrobial Chemotherapy, Fundación
Jiménez Díaz, 28040 Madrid, Spain.

The adherence of 11 pneumococcal strains to polystyrene was studied and expressed
as the number of colony-forming units (CFU) recovered per 10(6)CFU of initial
inoculum. Three strains were considered as strong adherent (>100CFU/10(6)), three
as medium adherent (10-100CFU/10(6)), and five as low adherent (<10CFU/10(6)).
All serotype 3 strains were low adherent whilst serotypes 23F and 19F behaved as 
strong or medium adherent. The impact of gerbil sera on adherence of six selected
pneumococcal strains (one strong adherent, one medium adherent, and four low
adherents) to abiotic material was also studied under two experimental
conditions. In the presence of sera, the adherence ability of the strong, medium,
and one low adherent strains decreased significantly. On the other hand, the
adherence significantly increased in all strains when sera were removed following
preincubation of bacteria exposed to sera, although such increase was
statistically significant for five of them. Finally, the ability of two (one
strong adherent and one low adherent) strains to induce otitis media in gerbils
was also evaluated; the strong adherent strain behaved significantly more
virulent than the less adherent in terms of ear damage and animal weight loss.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17583465 [PubMed - indexed for MEDLINE]

396: Int J Pediatr Otorhinolaryngol. 2007 Aug;71(8):1305-10. Epub 2007 Jun 19.

Passive smoking after tympanostomy and risk of recurrent acute otitis media.

Hammarén-Malmi S, Saxen H, Tarkkanen J, Mattila PS.

Department of Otorhinolaryngology, Helsinki University Central Hospital,
Helsinki, Finland.

OBJECTIVE: Exposure to environmental tobacco smoke has been reported to be a risk
factor for childhood otitis media. The effect of parental smoking on the risk of 
otitis media after the insertion of tympanostomy tubes is unknown. We evaluated
the effect of parental smoking on the risk of recurrent otitis media in children 
who had received tympanostomy tubes. METHODS: We enrolled 217 children aged 1-4
years who underwent insertion of tympanostomy tubes because of middle ear
disease. The children were followed-up for 12 months. Otitis media episodes were 
recorded in patient diaries by primary care physicians. Parental smoking habits
were assessed by a questionnaire at the start of the trial and after the 12 month
follow-up had ended. The main outcome measure was risk of recurrent otitis media 
as defined by four or more otitis media episodes after tympanostomy. Altogether
198 children completed the follow-up. RESULTS: Maternal smoking was associated
with a highly increased risk of recurrent acute otitis media (OR 4.15, 95% CI
1.45-11.9) after the insertion of tympanostomy tubes. CONCLUSION: Exposure to
passive smoking is associated with four-fold risk of recurrent otitis media after
tympanostomy. This finding should be used to encourage parents to stop smoking
even after the insertion of tympanostomy tubes to their children.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17582514 [PubMed - indexed for MEDLINE]

397: Arch Otolaryngol Head Neck Surg. 2007 Jun;133(6):587-92.

Evolution of middle ear changes after permanent eustachian tube blockage.

Vicente J, Trinidad A, Ramírez-Camacho R, García-Berrocal JR, González-García JA,
Ibáñez A, Pinilla MT.

Department of Otorhinolaryngology, University Hospital Puerta de Hierro, Calle de
San Martín de Porres 4, 28035 Madrid, Spain. jvicenteh@seorl.net

OBJECTIVE: To develop a valid animal model for otitis media with effusion (OME). 
DESIGN: Forty specific pathogen-free Wistar rats underwent a procedure based on
the permanent obstruction of pharyngeal eustachian tube by means of
electrocoagulation without any manipulation. SETTING: Ear Research Group,
Department of Otorhinolaryngology, Puerta de Hierro Hospital, Universidad
Autonoma de Madrid, Madrid, Spain. MAIN OUTCOME MEASURES: The assessment of OME
by otoscopy and tympanometry. The rats were humanely killed at 15 and 90 days,
and temporal bones were obtained and processed for histopathologic study.
RESULTS: The histopathologic study of the temporal bones demonstrated the
occurrence of chronic effusion and mucosal changes owing to mucoperiosteal
enlargement. CONCLUSIONS: Comparison with other experimental models was made. Our
animal model was consistent and reproducible and resembled human OME.

PMID: 17576910 [PubMed - indexed for MEDLINE]

398: Acta Otolaryngol. 2007 Jul;127(7):700-4.

Vestibular evoked myogenic potentials in middle ear effusion.

Wang MC, Lee GS.

Department of Otolaryngology, Taipei Veterans General Hospital, and School of
Medicine, National Yang-Min University, Taipei, Taiwan.

CONCLUSION: The vestibular evoked myogenic potential (VEMP) responses were
significantly affected by middle ear effusion (MEE). The VEMP was either
non-responsive or significantly delayed. However, after the conductive hearing
loss (CHL) was significantly reduced with tympanic aspiration, the VEMP latencies
and asymmetry ratio returned to the range of healthy controls. In addition, the
recovery of VEMP response was prompt and immediate. OBJECTIVE: To evaluate the
VEMP in various degrees of CHL resulting from MEE and to clarify the responses
after the CHL was reduced. MATERIALS AND METHODS: VEMPs were collected from 21
unilateral subjects with MEE (8 male, 13 female, aged 21-79 years) using
unilateral tone-burst stimulation. The pure tone audiograms and tympanograms were
recorded. The effusion was then cleared with tympanocentesis. The VEMP responses 
were compared to those of the healthy volunteers and the responses after the MEE 
was reduced by tympanic aspiration. RESULTS: The pure tone hearing thresholds
decreased significantly with tympanic aspiration. Before tympanic aspiration, the
VEMP response rate was 67% and increased significantly to 95% (p<0.05) after
tympanic aspiration. The latencies of p13 and n23 were significantly prolonged
before tympanic aspiration (p<0.01), and shortened to the normal range after
tympanic aspiration. The VEMP asymmetry ratio was significantly decreased after
tympanic aspiration (p<0.05).

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17573565 [PubMed - indexed for MEDLINE]

399: Eur J Paediatr Dent. 2007 Jun;8(2):83-8.

Orthodontist-otorhinolaryngologist: an interdisciplinary approach to solve otitis
media.

Cozza P, Di Girolamo S, Ballanti F, Panfilio F.

Department of Orthodontics, School of Dentistry, University of Rome Tor Vergata, 
Italy. paolacozza@tiscali.it

AIM: This was to investigate in oral breathing children with an associated
atypical pattern of swallowing and otitis media, the effects of rapid maxillary
expansion on nasal airway resistance and conductive hearing loss. MATERIALS AND
METHODS: This study examined 24 children (16 males and 8 females) in early mixed 
dentition period, with an age range of 6-8 years (mean age 7 years), diagnosed
with otitis media from the otorhinolaryngology Department of "Tor Vergata"
Hospital. The young patients were seen in the Department of Orthodontics, Faculty
of Dentistry University of Rome "Tor Vergata". All the subjects had an open mouth
breathing pattern with a secondary atypical swallowing mode and a conductive
hearing loss resulting from otitis media. The therapeutic approach was to apply a
RPE fixed appliance (Butterfly expander). RESULTS: Follow up showed that after
rapid maxillary expansion there was nasal resistance reduction, increased nasal
airflow and improvement in conductive hearing loss. CONCLUSION Rapid maxillary
expansion has been used for both dental and rhinological purposes in the belief
that clinically significant reductions in nasal resistance to airflow and an
improvement in conductive hearing loss occur predictably.

PMID: 17571932 [PubMed - indexed for MEDLINE]

400: BMC Microbiol. 2007 Jun 14;7:56.

Virulence phenotypes of low-passage clinical isolates of nontypeable Haemophilus 
influenzae assessed using the chinchilla laniger model of otitis media.

Buchinsky FJ, Forbes ML, Hayes JD, Shen K, Ezzo S, Compliment J, Hogg J, Hiller
NL, Hu FZ, Post JC, Ehrlich GD.

Center for Genomic Sciences, Allegheny-Singer Research Institute/Allegheny
General Hospital, Pittsburgh, Pennsylvania 15212, USA. fjbuch@gmail.com
<fjbuch@gmail.com>

BACKGROUND: The nontypeable Haemophilus influenzae (NTHi) are associated with a
spectrum of respiratory mucosal infections including: acute otitis media (AOM);
chronic otitis media with effusion (COME); otorrhea; locally invasive diseases
such as mastoiditis; as well as a range of systemic disease states, suggesting a 
wide range of virulence phenotypes. Genomic studies have demonstrated that each
clinical strain contains a unique genic distribution from a population-based
supragenome, the distributed genome hypothesis. These diverse clinical and
genotypic findings suggest that each NTHi strain possesses a unique set of
virulence factors that contributes to the course of the disease. RESULTS: The
local and systemic virulence patterns of ten genomically characterized
low-passage clinical NTHi strains (PittAA - PittJJ) obtained from children with
COME or otorrhea were stratified using the chinchilla model of otitis media (OM).
Each isolate was used to bilaterally inoculate six animals and thereafter
clinical assessments were carried out daily for 8 days by blinded observers.
There was no statistical difference in the time it took for any of the 10 NTHi
strains to induce otologic (local) disease with respect to any or all of the
other strains, however the differences in time to maximal local disease and the
severity of local disease were both significant between the strains. Parameters
of systemic disease indicated that the strains were not all equivalent: time to
development of the systemic disease, maximal systemic scores and mortality were
all statistically different among the strains. PittGG induced 100% mortality
while PittBB, PittCC, and PittEE produced no mortality. Overall Pitt GG, PittII, 
and Pitt FF produced the most rapid and most severe local and systemic disease. A
post hoc determination of the clinical origins of the 10 NTHi strains revealed
that these three strains were of otorrheic origin, whereas the other 7 were from 
patients with COME. CONCLUSION: Collectively these data suggest that the
chinchilla OM model is useful for discriminating between otorrheic and COME NTHi 
strains as to their disease-producing potential in humans, and combined with
whole genome analyses, point the way towards identifying classes of virulence
genes.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 17570853 [PubMed - indexed for MEDLINE]

401: Niger J Med. 2007 Jan-Mar;16(1):57-60.

Otoscopy compared with tympanometry: an evaluation of the accuracy of simple
otoscopy.

Orji FT, Mgbor NC.

Department of Otolaryngology and Head and Neck Surgery, University of Nigeria
Teaching Hospital Enugu, Nigeria.

BACKGROUND: Although otoscopy has been shown to compare favourably with results
of tympanometry the actual diagnostic value of otoscopy for otitis media with
effusion (OME) has not been evaluated in Nigeria. The study was aimed at
evaluating the sensitivity, specificity and predictive value of otoscopy in the
diagnosis of OME as compared with tympanometry. METHOD: It was a prospective
hospital-based, descriptive cross-sectional study in which the results of simple 
otoscopy were compared with results of the tympanometry of 82 ears of children
aged between 6 months and 12 years, who presented to the Otolaryngology clinics
of the UNTH Enugu with symptoms of obstructive adenoid enlargement. RESULTS:
Simple otoscopy produced 84.4% agreement with tympanometry in detecting OME. The 
agreement was better in older children than the younger ones (P < 0.05). Simple
otoscopy was more specific in detecting ears considered normal than abnormal
ears. Among the abnormal ears, otoscopy was more sensitive in its detection of
OME than negative middle ear pressure. Retraction of the tympanic membrane was
the most specific otologic finding in detection of OME. CONCLUSION: Simple
otoscopy is comparable to the accuracy of tympanometry in the diagnosis of OME.

Publication Types: 
    Comparative Study

PMID: 17563970 [PubMed - indexed for MEDLINE]

402: J Antimicrob Chemother. 2007 Aug;60(2):323-7. Epub 2007 Jun 11.

Influence of the beta-lactam resistance phenotype on the cefuroxime versus
cefditoren susceptibility of Streptococcus pneumoniae and Haemophilus influenzae 
recovered from children with acute otitis media.

Fenoll A, Aguilar L, Robledo O, Giménez MJ, Tarragó D, Granizo JJ, Gimeno M,
Coronel P.

Spanish National Reference Pneumococcal Laboratory, Instituto de Salud Carlos
III, ctra. Majadahonda-Pozuelo Km. 2, 28220 Majadahonda, Madrid, Spain.
afenoll@isciii.es

OBJECTIVES: To study the influence of resistance phenotypes (based on sentinel
antibiotics: penicillin and amoxicillin with/without clavulanate) on the
cefuroxime versus cefditoren susceptibility of Streptococcus pneumoniae and
Haemophilus influenzae recovered from children with acute otitis media. METHODS: 
Middle ear isolates (193 S. pneumoniae and 114 H. influenzae) received in the
Spanish Reference Laboratory (Instituto de Salud Carlos III) were tested.
Antimicrobial susceptibility to penicillin, amoxicillin with/without clavulanate,
cefuroxime and cefditoren was determined by agar dilution using Mueller-Hinton
agar supplemented with 5% sheep blood for S. pneumoniae and Haemophilus Test
Medium for H. influenzae. Strains were classified according to penicillin
susceptibility (S. pneumoniae) or beta-lactamase production (H. influenzae).
RESULTS: The decrease in penicillin susceptibility of S. pneumoniae (from the
susceptible to the resistant category) decreased amoxicillin and cefuroxime
susceptibility rates from 100% to 34% and 0%, respectively. All pneumococcal
strains were inhibited by 0.5 mg/L cefditoren, including those from
penicillin-resistant serotypes 14, 23F, 6B and 9V with higher amoxicillin versus 
penicillin MICs. Susceptibility rates of beta-lactamase-positive H. influenzae
strains were 93.8% and 85.4% to amoxicillin/clavulanate and cefuroxime,
respectively. Resistance to amoxicillin/clavulanate (MIC>or=8/4 mg/L) was 12.1%
(8 out of 66) and 6.3% (3 out of 48) in beta-lactamase-negative and -positive
strains, respectively. All H. influenzae strains were inhibited by <or=0.06 mg/L 
cefditoren. CONCLUSIONS: Susceptibility to sentinel beta-lactams cannot predict
activity of other members of the group. The addition of clavulanic acid to
amoxicillin does not guarantee 100% coverage of H. influenzae, regardless of
beta-lactamase production.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17562681 [PubMed - indexed for MEDLINE]

403: Infect Dis Clin North Am. 2007 Jun;21(2):409-26, vi.

Diagnosis and treatment of acute otitis media: evaluating the evidence.

Powers JH.

Scientific Applications International Corporation in support of the Collaborative
Clinical Research Branch, National Institute of Allergy and Infectious Diseases, 
National Institutes of Health, USA. powersjohn@mail.nih.gov

Acute otitis media (AOM) is one of the most common illnesses for which children
in the United States receive an antimicrobial agent. Of the six recommendations
offered in recent guidelines for treatment of AOM, only one, the assessment and
treatment of pain with analgesics, is based on strong evidence. This article
reviews the diagnosis of AOM and the accuracy of various signs and symptoms in
indicating a bacterial origin, the data on the effect of antimicrobial agents
compared with placebo in the treatment of AOM, and the gaps in knowledge that
should be addressed by future research and clinical trials.

Publication Types: 
    Review

PMID: 17561076 [PubMed - indexed for MEDLINE]

404: Int J Pediatr Otorhinolaryngol. 2007 Aug;71(8):1251-9. Epub 2007 Jun 7.

Early acute otitis media: predictor for AOM and respiratory infections in
schoolchildren?

Bentdal YE, Karevold G, Nafstad P, Kvaerner KJ.

Faculty Division of Akershus University Hospital, Department of
Otorhinolaryngology, University of Oslo, Norway. y.e.bentdal@medisin.uio.no

OBJECTIVE: It has been reported that acute otitis media (AOM) and respiratory
infectious morbidity still are common in schoolchildren. However, the
significance of early initiation of AOM on later respiratory infections is not
known. The aim of the study was to assess whether early initiation of AOM is a
predictor for AOM and other respiratory infections in schoolchildren, and if
environmental exposures and host factors in early life predict later AOM.
METHODS: A population-based, prospective study of 3754 children born in Oslo in
1992/93, of which 2549 children were followed from birth to 10 years. Main
outcome measures were questionnaire-based information on AOM and other
respiratory infections at ages 6 months, 1 year and 10 years. RESULTS: Of the 190
(5.3%) children with one or more episodes of AOM before 6 months, 97 (51.1%)
remained susceptible the next 6 months. The total number of children with one or 
more episodes of AOM from 6 to 12 months was 812 (25.1%). Of the 336 (13.2%) with
AOM at 10, 95 (28.3%) also had AOM the first year of life. One or more episodes
of tonsillopharyngitis or lower respiratory infections were experienced in 624
(24.4%) of the children at 10 years. There was a predominance of boys with AOM
the first year of life, while girls were more prone to AOM at age 10. AOM the
first year of life was not strongly associated with AOM at age 10 with crude and 
adjusted odds ratios 1.3 (95% CI 1.0-1.6) and 1.2 (95% CI 0.9-1.5), respectively.
A corresponding tendency was found for other respiratory infections
(tonsillopharyngitis or lower respiratory infections) at age 10. Tobacco smoke
exposure at birth, early life atopic eczema and otitis media surgery increased
the risk of AOM at age 10. CONCLUSIONS: We found no strong association between
early AOM and AOM and other respiratory infections in schoolchildren. Parental
smoking at birth, early life atopic eczema and female gender were only weakly
associated with AOM in 10-year olds while otitis media surgery was strongly
associated with AOM in schoolchildren.

PMID: 17559950 [PubMed - indexed for MEDLINE]

405: J Laryngol Otol. 2007 Oct;121(10):911-6. Epub 2007 Jun 11.

History of myringotomy and grommets.

Rimmer J, Giddings CE, Weir N.

Department of Otolaryngology, Whipps Cross University Hospital, Guildford.
jrimmer@doctors.org.uk

The first recorded myringotomy was in 1649. Astley Cooper presented two papers to
the Royal Society in 1801, based on his observation that myringotomy could
improve hearing. Widespread inappropriate use of the procedure followed, with no 
benefit to patients; this led to it falling from favour for many decades. Hermann
Schwartze reintroduced myringotomy later in the nineteenth century. It had been
realised earlier that the tympanic membrane heals spontaneously, and much
experimentation took place in attempting to keep the perforation open. The first 
described grommet was made of gold foil. Other materials were tried, including
Politzer's attempts with rubber. Armstrong's vinyl tube effectively reintroduced 
grommets into current practice last century. There have been many eponymous
variants, but the underlying principle of creating a perforation and maintaining 
it with a ventilation tube has remained unchanged. Recent studies have cast doubt
over the long-term benefits of grommet insertion; is this the end of the third
era?

Publication Types: 
    Historical Article
    Review

PMID: 17559714 [PubMed - indexed for MEDLINE]

406: Otolaryngol Head Neck Surg. 2007 Jun;136(6):982-5.

Type III cartilage "shield" tympanoplasty: an effective procedure for hearing
improvement.

Kyrodimos E, Sismanis A, Santos D.

Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth
University Medical Center, Richmond, VA, USA.

OBJECTIVE: To report the hearing results following type III cartilage "shield"
tympanoplasty. STUDY DESIGN: Retrospective chart review at a tertiary referral
center. METHODS: Conchal cartilage, shaped as a shield, was used to replace the
entire tympanic membrane and reconstruct the ossicular chain in patients with an 
absent incus and diminished space between the stapes superstructure and malleolar
manubrium. RESULTS: Between January 1998 and June 2005, 52 patients were treated.
The mean age was 32.4 years (range, 7 to 72 years). The mean follow-up was 24
months (range, 12 to 36 months). Graft take was successful in all patients. The
average hearing improvement was 11.22 dB (P<0.0001). An air-bone gap of 25 dB or 
less was achieved in 41 (78.8%) patients. Speech discrimination scores remained
unchanged. No complications were identified. CONCLUSION: Type III cartilage
"shield" tympanoplasty is an effective technique for hearing improvement in
selected patients with chronic otitis media. The results of this procedure are
similar to those obtained with partial ossicular replacement prosthesis.

PMID: 17547992 [PubMed - indexed for MEDLINE]

407: Pediatrics. 2007 Jun;119(6):1069-75.

Temporal relationships between colds, upper respiratory viruses detected by
polymerase chain reaction, and otitis media in young children followed through a 
typical cold season.

Winther B, Alper CM, Mandel EM, Doyle WJ, Hendley JO.

Department of Otolaryngology, University of Virginia Health System,
Charlottesville, Virginia, USA.

INTRODUCTION: Otitis media is a frequent complication of a viral upper
respiratory tract infection, and the reported co-incidence of those diseases
increases with assay sensitivity and sampling density. We determined the
incidence of otitis-media complications in young children when referenced to
cold-like illnesses and to concurrent virus recovery from the nasopharynx.
METHODS: A total of 60 children from 24 families were followed from October 2003 
through April 30, 2004, by daily parental recording of illness signs, weekly
pneumatic otoscopic examinations, and periodic polymerase chain reaction assay of
collected nasal fluids for common viruses. RESULTS: One hundred ninety-nine
cold-like illnesses were observed, but a sample for virus assay was not collected
concurrent with 71 episodes. Of the remainder, 73% of cold-like illnesses were
temporally related to recovery of 1 or a combination of the assayed viruses, with
rhinovirus predominating. For non-cold-like illness periods, 54 (18%) of 297
assays were positive for virus, and the virus frequency distribution was similar 
to that for cold-like illnesses. There were 93 diagnosed otitis-media episodes;
65 (70%) of these occurred during a cold-like illness. For the 79 otitis-media
episodes with available nasal samples, 61 (77%) were associated with a positive
virus result. In this population, the otitis-media complication rate for a
cold-like illness was 33%. CONCLUSIONS: A cold-like illness was not a
prerequisite for polymerase chain reaction detection of viruses in the nose and
nasopharynx of young children. Viral detection by polymerase chain reaction in
the absence of a cold-like illness is associated with complications in some
subjects. Otitis media is a complication of viral infection both with and without
concurrent cold-like illnesses, thus downwardly biasing coincidence estimates
that use cold-based illnesses as the denominator.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17545372 [PubMed - indexed for MEDLINE]

408: Pediatrics. 2007 Jun;119(6):e1408-12.

Incidence of acute otitis media and sinusitis complicating upper respiratory
tract infection: the effect of age.

Revai K, Dobbs LA, Nair S, Patel JA, Grady JJ, Chonmaitree T.

Department of Pediatrics, University of Texas Medical Branch, 301 University
Blvd, Galveston, TX 77555-0371, USA.

Infants and young children are prone to developing upper respiratory tract
infections, which often result in bacterial complications such as acute otitis
media and sinusitis. We evaluated 623 upper respiratory tract infection episodes 
in 112 children (6-35 months of age) to determine the proportion of upper
respiratory tract infection episodes that result in acute otitis media or
sinusitis. Of all upper respiratory tract infections, 30% were complicated by
acute otitis media and 8% were complicated by sinusitis. The rate of acute otitis
media after upper respiratory tract infection declined with increasing age,
whereas the rate of sinusitis after upper respiratory tract infection peaked in
the second year of life. Risk for acute otitis media may be reduced substantially
by avoiding frequent exposure to respiratory viruses (eg, avoidance of day care
attendance) in the first year of life.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural

PMID: 17545367 [PubMed - indexed for MEDLINE]

409: Otolaryngol Clin North Am. 2007 Jun;40(3):669-83, xi.

Ototoxicity of ototopical drops--an update.

Haynes DS, Rutka J, Hawke M, Roland PS.

The Otology Group of Vanderbilt, Department of Otolaryngology-Head and Neck
Surgery, Vanderbilt University Medical Center, Medical Center East S. Tower 7209,
1215 21st Avenue South, Nashville, TN 37232-5555, USA.
david.haynes@vanderbilt.edu

Various topical preparations are widely used for treating external otitis, acute 
otitis media with perforation, post-tympanostomy tube otorrhea, and chronic
suppurative otitis media. Solutions and suspensions that enter the middle ear
through a perforated tympanic membrane can reach the inner ear by crossing
through the round window membrane. The safety of various components of otic
solutions used in this way, particularly aminoglycosides, corticosteroids,
solvents, and preservatives, has been questioned in light of their ototoxic
potential. The authors' objective is to review the literature discussing the
safety of commonly used classes of otic preparations in settings in which the
constituents can access the middle and inner ear in high concentrations and
discuss their clinical experience with ototoxicity and experience with
medical-legal issues.

Publication Types: 
    Review

PMID: 17544701 [PubMed - indexed for MEDLINE]

410: Int J Pediatr Otorhinolaryngol. 2007 Aug;71(8):1219-24. Epub 2007 May 31.

Otitis media referrals - the general practitioner perspective.

Kvaerner KJ, Helgaker AB.

Institute for Special Needs, University of Oslo, Oslo, Norway.
k.j.kvarner@medisin.uio.no

OBJECTIVE: Otitis media management involves both primary and specialist health
care. The present study used data on GP referrals to estimate the proportion of
children with otitis media referred from primary to specialist care, study
variation in referral pattern and factors that influence GP behaviour. METHODS:
Data on general practitioners' view on collaborative aspects of specialist health
care was collected in a cross-sectional questionnaire survey among all Norwegian 
GPs in 2004 (N=1633). The outcome of interest was referral routines for otitis
media at first visit and at follow-up. RESULTS: Mean referral for otitis media
was 22%, most commonly at follow-up visit. Twenty-seven percent of children with 
otitis media were sent to ENT departments and 73% to practicing
otolaryngologists. Variation in referral pattern among GPs was moderate. GPs with
specialty in general medicine had 6% fewer referrals. Separate analysis on
referral to practicing otolaryngologists showed that GP work load and
availability to practicing specialists increased referral, whereas availability
to hospital services reduced the probability. CONCLUSION: In Norway, otitis media
management mainly takes place in primary care. Completed specialty in general
medicine reduces referrals and non-medical factors influence referral behaviour. 
We suggest that learning groups may contribute to update knowledge in primary
care and fewer referrals to specialists.

PMID: 17543394 [PubMed - indexed for MEDLINE]

411: Otol Neurotol. 2007 Jun;28(4):551-8.

Tympanometry and laser Doppler interferometry measurements on otitis media with
effusion model in human temporal bones.

Dai C, Wood MW, Gan RZ.

University of Oklahoma, Norman, Oklahoma, USA.

HYPOTHESIS: The aim of this study is to investigate the effect of middle ear
fluid and pressure on tympanic membrane mobility by using laser Doppler
interferometry and to compare these results with tympanometry. BACKGROUND:
Tympanometry has been commonly used for evaluation of otitis media with effusion,
a middle ear disease with fluid in the cavity. However, this test lacks specific 
interpretations of middle ear disorders based on tympanometric data. Laser
interferometry, as an advanced research tool to measure middle ear function, may 
provide knowledge of how tympanic membrane mobility is affected by middle ear
fluid and pressure. METHODS: An otitis media with effusion model was created in
seven human temporal bones for conducting experiments with tympanometry and laser
interferometry. Middle ear pressure varied from -20 to +20 cm water, and the
amount of fluid in the middle ear was gradually increased to fill the cavity.
RESULTS: The displacement of the tympanic membrane measured by laser
interferometry at selected frequencies decreased significantly corresponding to
the middle ear air pressure changes. Tympanometry detected middle ear pressure by
the change of tympanometric peak location, but the tympanogram shape was not
affected by the middle ear pressure. The middle ear fluid was detected by
tympanometry with as little as 0.3 mL, and laser interferometry was able to
measure the displacement change of the tympanic membrane with 0.2 or 0.3 mL fluid
at different frequencies. CONCLUSION: Laser interferometry can detect the effect 
of middle ear pressure and fluid on tympanic membrane movement as well as
tympanometry does.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural

PMID: 17529855 [PubMed - indexed for MEDLINE]

412: Eur J Pediatr. 2008 Apr;167(4):401-7. Epub 2007 May 24.

Determination of pneumococcal serotypes/genotypes in nasopharyngeal secretions of
otitis media children by multiplex PCR.

Billal DS, Hotomi M, Suzumoto M, Yamauchi K, Arai J, Katsurahara T, Moriyama S,
Fujihara K, Yamanaka N.

Department of Otolaryngology - Head and Neck Surgery, Wakayama Medical
University,Wakayama-shi, Wakayama, 641-8509, Japan.

The appropriate clinical applications of pneumococcal polysaccharide vaccines
against recent increases in antimicrobial resistant Streptococcus pneumoniae (S. 
pneumoniae) urgently require accurate analytical methodologies for determining
and characterizing the serotypes. The results of current immunological
determinations of serotypes with anti-capsular polysaccharide-specific sera are
difficult to interpret in terms of quellung changes of the pneumococci. In this
study, we applied the multiplex PCR technique for the rapid identification of
pneumococci and simultaneous rapid determinations of their serotypes and
genotypes that directly correlated with antimicrobial susceptibilities from
nasopharyngeal secretions (NPS). Serogroups 6, 19F and 23F were the predominant
capsular types of S. pnuemoniae in the NPS samples. Strains of serotypes 19F and 
23F frequently had mutations in pbp1a, pbp2x and pbp2b and expressed ermB and
mefA; they also were mostly resistant to both penicillin G (PCG) and
clarithromycin (CAM). Two NPS samples contained the strain of serotype 19F
together with the strain of serotype 23F, although only the strain of serotype
19F was identified by a conventional bacterial culture. Pneumococci were
identified in six NPS samples and their serotypes determined by the multiplex
PCR, while a conventional bacterial culture failed to identify the pathogens. Our
findings suggest that PCR-based serotyping and genotyping can provide an accurate
and rapid distribution of pneumococcal serotypes and antimicrobial resistance.
The relatively minor populations in the nasopharynx may be determined using
molecular techniques.

Publication Types: 
    Comparative Study
    Multicenter Study

PMID: 17522891 [PubMed - indexed for MEDLINE]

413: Infect Immun. 2007 Aug;75(8):4158-72. Epub 2007 May 21.

Multiple consecutive lavage samplings reveal greater burden of disease and
provide direct access to the nontypeable Haemophilus influenzae biofilm in
experimental otitis media.

Leroy M, Cabral H, Figueira M, Bouchet V, Huot H, Ram S, Pelton SI, Goldstein R.

Section of Molecular Genetics, Division of Pediatric Infectious Diseases, The
Maxwell Finland Laboratory for Infectious Diseases, Boston University School of
Medicine, Boston Medical Center, 774 Albany Street, Boston, MA 02118, USA.

The typically recovered quantity of nontypeable Haemophilus influenzae (NTHi)
bacteria in an ex vivo middle ear (ME) aspirate from the chinchilla model of
experimental otitis media is insufficient for direct analysis of gene expression 
by microarray or of lipopolysaccharide glycoforms by mass spectrometry. This
prompted us to investigate a strategy of multiple consecutive lavage samplings to
increase ex vivo bacterial recovery. As multiple consecutive lavage samples
significantly increased the total number of bacterial CFU collected during
nasopharyngeal colonization or ME infection, this led us to evaluate whether
bacteria sequentially acquired from consecutive lavages were similar. Comparative
observation of complete ex vivo sample series by microscopy initially revealed ME
inflammatory fluid consisting solely of planktonic-phase NTHi. In contrast,
subsequent lavage samplings of the same infected ear revealed the existence of
bacteria in two additional growth states, filamentous and biofilm encased. Gene
expression analysis of such ex vivo samples was in accord with different
bacterial growth phases in sequential lavage specimens. The existence of
morphologically distinct NTHi subpopulations with varying levels of gene
expression indicates that the pooling of specimens requires caution until methods
for their separation are developed. This study based on multiple consecutive
lavages is consistent with prior reports that NTHi forms a biofilm in vivo,
describes the means to directly acquire ex vivo biofilm samples without
sacrificing the animal, and has broad applicability for a study of mucosal
infections. Moreover, this approach revealed that the actual burden of bacteria
in experimental otitis media is significantly greater than was previously
reported. Such findings may have direct implications for antibiotic treatment and
vaccine development against NTHi.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17517860 [PubMed - indexed for MEDLINE]

414: J Laryngol Otol. 2007 Oct;121(10):1003-5. Epub 2007 May 22.

Acute disseminated encephalomyelitis after mastoid surgery in a child.

Khan NA, Bhalla RK, de Goede CG, Rothera MP, Ismayl O.

Department of Otolaryngology, Royal Manchester Children's Hospital, Manchester,
UK. drnaveedahmadkhan@doctors.org.uk

We present a case of acute disseminated encephalomyelitis after mastoid surgery
in an 11-year-old child. The aim of this paper is to increase awareness about a
previously unreported and an unusual neurological complication of cholesteatoma
and mastoid surgery.

Publication Types: 
    Case Reports

PMID: 17517165 [PubMed - indexed for MEDLINE]

415: J Laryngol Otol. 2008 Jan;122(1):16-20. Epub 2007 May 22.

Challenges in management of chronic suppurative otitis media in a developing
country.

Akinpelu OV, Amusa YB, Komolafe EO, Adeolu AA, Oladele AO, Ameye SA.

Department of Surgery, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. 
olubunmilola@yahoo.co.uk

BACKGROUND: In developing countries, the rate of complications from chronic
suppurative otitis media is still high, due to factors associated with poverty.
This study aimed to determine the prevalence of chronic suppurative otitis media 
and associated complications. PATIENTS AND METHODS: We prospectively studied all 
patients presenting with chronic suppurative otitis media to the ear, nose and
throat unit of the Obafemi Awolowo University Teaching Hospitals Complex,
Ile-Ife, Nigeria, over a two-year period. RESULTS: One hundred and sixty new
cases of chronic suppurative otitis media were seen. These constituted 11.1 per
cent of all new cases and 21.5 per cent of all otological cases seen. About half 
(51.7 per cent) of these patients were younger than 15 years. Most patients were 
from rural areas and had been previously managed by unlicensed, untrained
practitioners. Complications were mostly seen in children. Intracranial
complications were seen in 10 (6.3 per cent) cases; this was associated with a
high mortality rate. CONCLUSION: This study found that, in Nigeria, a developing 
country, 'safe' chronic suppurative otitis media was not without serious
problems. Provision of adequate health facilities may reduce such problems.

PMID: 17517162 [PubMed - indexed for MEDLINE]

416: Med Mycol. 2007 Jun;45(4):357-61.

Biofilm development by clinical isolates of Malassezia pachydermatis.

Cannizzo FT, Eraso E, Ezkurra PA, Villar-Vidal M, Bollo E, Castellá G, Cabañes
FJ, Vidotto V, Quindós G.

Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y
Parasitología, Facultad de Medicina y Odontología, Universidad del País
Vasco-Euskal Herriko Unibertsitatea, Bilbao, Spain.

Malassezia pachydermatis fungemia has been reported in patients receiving
parenteral nutrition. Biofilm formation on catheters may be related to the
pathogenesis of this mycosis. We investigated the biofilm-forming ability of 12
M. pachydermatis strains using a metabolic activity plate-based model and
electronic microscopic evaluation of catheter surfaces. All M. pachydermatis
strains developed biofilms but biofilm formation showed variability among the
different strains unrelated to their clinical origin. This study demonstrates the
ability of M. pachydermatis to adhere to and form biofilms on the surfaces of
different materials, such as polystyrene and polyurethane.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17510859 [PubMed - indexed for MEDLINE]

417: Eur Arch Otorhinolaryngol. 2007 Sep;264(9):1087-94. Epub 2007 May 15.

Topical treatment of acute otitis externa: clinical comparison of an antibiotics 
ointment alone or in combination with hydrocortisone acetate.

Mösges R, Domröse CM, Löffler J.

Institute of Medical Statistics, Informatics and Epidemiology, Faculty of
Medicine, University of Cologne, Lindenburger Allee 42, 50931 Cologne, Germany.
Ralph@Mosges.com

The study was designed to investigate the potential contribution of
hydrocortisone acetate to the efficacy and safety of an antibiotics ointment in
the treatment of acute otitis externa (AOE). In a double-blind study 151 patients
with a unilateral acute bacterial otitis externa were randomized either to
receive an ointment with polymyxin-B sulfate (7,500 I.E./g) + bacitracin (300
I.E./g) alone (AB) or the same antibiotic ointment with 10 mg hydrocortisone
acetate/g ointment (AB + HC). Primary efficacy endpoint was the change of an
aggregate clinical symptom score (CSS) (subscores: redness, swelling, pain and
secretion) found at Visit 2 versus baseline (Visit 1). Secondary outcome
parameters were the change of the CSS from Visit 1 to the study termination, and 
the changes in the subscores and of a visual analog scale for pain. In the group 
treated with AB + HC, significantly more patients with severe redness [14 (56%)
vs. 7 (28%), P = 0.045] or severe secretion [23 (70%) vs. 10 (40%), P = 0.024] at
inclusion were symptom-free at the last visit. Fewer pain-relieving tablets (1.1 
+/- 2.2 vs. 2.3 +/- 4.6 paracetamol tablets) were used in the AB + HC-group. In
the steroid group there was a slightly larger though not significant reduction in
CSS at Visit 2 and Visit 3 versus baseline. Similar results were documented for
redness, pain and secretion. No serious adverse events occurred. Both ointments
are effective and safe in the topical treatment of AOE. Hydrocortisone acetate
combined with the antibiotics improved individual symptoms better as did the
steroid-free ointment.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 17503066 [PubMed - indexed for MEDLINE]

418: Ear Nose Throat J. 2007 Apr;86(4):223-5.

Comment in:
    Ear Nose Throat J. 2007 Nov;86(11):648; author reply 648-9.

Cerebrospinal fluid otorrhea presenting in complicated chronic suppurative otitis
media.

Bhat V, Manjunath D.

Department of Otolaryngology-Head and Neck Surgery, Karnataka Institute of
Medical Sciences, Hubli, Karnataka, India. entvikram@rediffmail.com

Since the introduction of antibiotics, the simultaneous occurrence of multiple
intra- and extracranial complications in chronic suppurative otitis media (CSOM) 
has been uncommon. Such a combination is associated with high mortality and
morbidity, especially in the pediatric age group. Cerebrospinal fluid (CSF)
otorrhea presenting in CSOM is unusual and rare. To the best of our knowledge,
only 19 cases of CSF otorrhea in complicated CSOM have been previously reported
in the literature. Identifying the site of leak might require a high index of
suspicion. Management of such a case could be challenging in terms of leak
closure, disease clearance, and restoration of function. We report a new case of 
CSF leak in CSOM, and we describe our line of management. Even though CSOM is an 
uncommon indication for radical mastoidectomy today, such surgery might be
necessary for these cases.

Publication Types: 
    Case Reports

PMID: 17500394 [PubMed - indexed for MEDLINE]

419: Int J Pediatr Otorhinolaryngol. 2007 Jul;71(7):1129-37. Epub 2007 May 17.

Healing time, long-term result and effects of stem cell treatment in acute
tympanic membrane perforation.

Rahman A, von Unge M, Olivius P, Dirckx J, Hultcrantz M.

Center for Hearing and Communication Research, Department of Otorhinolaryngology,
Karolinska University Hospital and Institute, 17176 Stockholm, Sweden.
anisur.rahman@ki.se

OBJECTIVE: The incidence of otitis media in children between the age of 2 and 6
years is well documented. Repeated attacks may cause acute and chronic
perforations. The surgical treatment for repairing chronic perforation is quite
uncomfortable for the patients of this age group because of the invasiveness of
this treatment. The aim of this study was to determine the long-term influence of
embryonic stem cells on acute perforations and the effect of gelatin as a vehicle
for applied stem cells. The possibility of teratogenic effects of the stem cells 
was also observed. METHODS: Bilateral laser myringotomy was performed in 17 adult
Sprague-Dawley rats, divided into two groups. Gelatin, a substance suitable as
vehicle for bioactive material was used bilaterally around the perforation in
group A, to serve as a scaffold for repairing tissue. The stem cells were used in
the right tympanic membrane perforation leaving the left tympanic membrane as a
control. The animals in group B received the same treatment except for the use of
gelatin and in addition received an immuno-suppressive agent. After half a year
of observation the mechanical stiffness of the tympanic membrane was measured by 
moiré interferometry for group B and the morphological study was performed by
light microscopy for both groups A and B and electron microscopy for group A.
RESULTS: Stem cell treated ears did not show any enhanced healing of the
perforation although a marked thickening of the lamina propria was observed
compared with control group. After half a year the strength and the stiffness of 
the tympanic membrane was almost the same for both treated and untreated ears. No
evidence of teratoma was found after half a year. CONCLUSION: This study suggests
that the stem cells stimulate the proliferation of connective tissue and fibers
in the lamina propria, possibly mediated by secreted substances, although the
stiffness properties do not seem to be altered. The use of gelatin does not seem 
to enhance the healing process of the tympanic membrane perforation.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17499859 [PubMed - indexed for MEDLINE]

420: Am J Otolaryngol. 2007 May-Jun;28(3):212-7.

Bilateral aberrant internal carotid arteries: treatment of a hemorrhagic
complication.

Knox WJ, Milburn JM, Dawson R.

Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.

The aberrant internal carotid artery is a rare congenital abnormality that may
present with pulsatile hemorrhage if undiagnosed before surgical intervention in 
the middle ear. We present such a patient who was treated successfully with
endovascular sacrifice of one of her bilateral lesions after recurrent episodes
of pulsatile hemorrhage complicating multiple tympanostomy tube revisions.

Publication Types: 
    Case Reports

PMID: 17499144 [PubMed - indexed for MEDLINE]

421: Am J Otolaryngol. 2007 May-Jun;28(3):187-90. Epub 2007 Mar 23.

Comment in:
    Am J Otolaryngol. 2009 Jan-Feb;30(1):69.

Otitic hydrocephalus: case report and literature review.

Sadoghi M, Dabirmoghaddam P.

Otolaryngology Head and Neck Surgery Research Centre, Amiralam Hospital, Tehran
University of Medical Sciences, Tehran, Iran. sadoghim@sina.tums.ac.ir
<sadoghim@sina.tums.ac.ir>

Otitic hydrocephalus is characterized by elevated intracranial pressure without
focal neurologic abnormalities. The pathogenesis of otitic hydrocephalus remains 
unclear, but it usually occurs secondary to lateral sinus thrombosis. With the
advent of new antibiotics, there has been a spectacular decrease in the
complications of otitis media. Otogenic intracranial hypertension, always an
uncommon condition, is seen only very rarely nowadays. Here we present a case of 
otitic hydrocephalus and discuss about its pathophysiology, clinical findings,
and treatment.

Publication Types: 
    Case Reports
    Review

PMID: 17499137 [PubMed - indexed for MEDLINE]

422: Am J Otolaryngol. 2007 May-Jun;28(3):148-52.

The role of allergic rhinitis in the development of otitis media with effusion:
effect on eustachian tube function.

Yeo SG, Park DC, Eun YG, Cha CI.

Department of Otolaryngology, College of Medicine, KyungHee University, Seoul,
South Korea. yeo2park@yahoo.co.kr <yeo2park@yahoo.co.kr>

PURPOSE: The pathogenesis of otitis media with effusion (OME) is considered
multifactorial, with viral upper respiratory tract infection and eustachian tube 
dysfunction. Allergy may be related to the pathogenesis of OME or to another
etiological factor. We investigated the role of allergic rhinitis (AR) in
children with OME and evaluated eustachian tube function in patients with AR.
MATERIALS AND METHODS: We prospectively analyzed the prevalence of AR, serum
eosinophil count, and serum total IgE concentrations in 123 children with OME and
in 141 controls. IgE concentration in middle ear effusion was compared in
children with OME with and without AR, and eustachian tube function after a nasal
provocation test was compared between patients with AR and controls. RESULTS: The
prevalence of AR in children with OME (28.4%) and control subjects (24.1%) did
not differ significantly. These 2 groups also showed no differences in total
eosinophil count and serum and middle ear effusion IgE concentration.
Abnormalities in eustachian tube function were the same in patients with AR and
controls. CONCLUSIONS: Allergic rhinitis may not be related to the development of
OME in children.

PMID: 17499128 [PubMed - indexed for MEDLINE]

423: Int J Pediatr Otorhinolaryngol. 2007 Jul;71(7):1007-11. Epub 2007 May 9.

Acute mastoiditis: increase in the incidence and complications.

Benito MB, Gorricho BP.

Niño Jesus University Children Hospital, Madrid, Spain. mbartolomeb@terra.es

OBJECTIVE: Acute mastoiditis is a serious complication of acute otitis media, but
it can be treated successfully in most of the cases with broad spectrum
intravenous antibiotics and myringotomy. In the last 5 years we have perceived
that there have been more complicated cases in the otic infectious pathology and 
the frequency was also higher. METHODS: We reviewed the cases of mastoiditis in
the last 10 years (1996-2005) in The Niño Jesús University Children Hospital in
Madrid to confirm the clinic impression, the bacteriology, treatments and
evolution of the children and analyze the causes of this clinic situation.
RESULTS: We have studied 215 cases of mastoiditis (0.6-17 years), 67.4% less than
3 years old and 69.3% males. The number of cases every year was the double since 
1999 with the same percentage of admissions in the Pediatric service, and the
triple in 2005. The percentage of surgical treatment grew from 4.3% to 33% in the
last years and to 70% in 2005. Most cases (80%) have received prior antibacterial
agent therapy, but individual pathogens and current complications of periostitis 
or subperiosteal abscess formation were equally distributed between the two
groups. We have detected a 28.57% of Streptococcus pneumoniae and a significative
high rate of Staphylococcus aureus (16.32%). A 53.68% of cases had negative
cultures. CONCLUSIONS: There is a progressive increase in the incidence of acute 
mastoiditis in our medium, and an increase of the surgical treatments. Ten years 
ago the process was controlled with antibiotic therapy only, but now the number
of interventions has been eight times the previous years. Most cases of acute
mastoiditis have responded well to medical management alone. But if higher levels
of resistance predominate, more severe forms of pneumococcal or other pathogen
like S. aureus disease are likely to be seen, these would be less likely to
respond to oral or parenteral antibiotic therapy, so, tympanocentesis for middle 
ear culture may become more valuable and more frequently used in cases of
antibiotic treatment failures, and surgical therapy may be necessary more often
in the future. Our hospital seems to be in this tendency now.

PMID: 17493691 [PubMed - indexed for MEDLINE]

424: Bosn J Basic Med Sci. 2007 May;7(2):127-31.

Acute mastoiditis in children: susceptibility factors and management.

Spremo S, Udovcić B.

Clinic for Otorhinolaryngology, Clinic Center in Banja Luka, Zdrave Korde 1,
78000 Banja Luka, Bosnia and Herzegovina.

The objective was to review our experience with clinical course, diagnostic and
therapeutic profile of children treated for acute mastoiditis, and to investigate
for possible susceptibility factors. Study was designed as retrospective review
of pediatric patients presenting with acute mastoiditis secondary to acute otitis
media over the last 6 years, from 2000 to 2006. The study involved children aged 
from 1 to 16 years treated for acute mastoiditis and subsequent intratemporal and
intracranial complications in Clinic for otorhinolaryngology, Clinic Center Banja
Luka. Selected clinical parameters, mastoid coalescence and risk factors for
necessity of surgical intervention were analyzed. Medical history review of a
total of 13 patients with acute mastoiditis was analyzed. Acute coalescent
mastoiditis occurred 11 patients (84%) while noncoalescent form of acute
mastoiditis occurred in 2 cases (16%). Intracranial complication occurred in 3
patients (2 meningitis and 1 peridural intracranial abscess), while 2 patients
had intratemporal complication (subperiostal abscess) associated to coalescent
mastoiditis. We observed clinical profile of acute mastoiditis in regard to
pathology found on the tympanic membrane, middle ear mucosa and destructions on
the bony wall of the middle ear and mastoid. The main signs of progressive
infection were tympanic membrane perforation, pulsatile suppurative secretion
from the mucosa, and intratemporal abscess. All patients with coalescent
mastoiditis required mastoidectomy, while noncoalescent mastoiditis was treated
conservatively with broad-spectrum intravenous antibiotics and myringotomy. In
conclusion acute mastoiditis is uncommon but serious complication of acute otitis
media in children associated with significant morbidity. Coalescent mastoiditis
concomitant with subperiostal abscess, intracranial complications and mastoiditis
not responsive after 48 hours to intravenous antibiotics should urge clinician to
timely mastoid surgery.

PMID: 17489747 [PubMed - indexed for MEDLINE]

425: Pediatr Infect Dis J. 2007 Mar;26(3):273-4.

An open-label, double tympanocentesis, single-center study of trimethoprim
sulfametoxasole in children with acute otitis media.

Soley C, Arguedas A, Guevara S, Loaiza C, Rincón G, Pérez A, Brilla E, Porras W, 
Arguedas J, Sierra H.

Instituto de Atención Pediftrica, San José, Costa Rica.

Trimethoprim sulfamethoxasole has been recommended for the treatment of acute
otitis media. In this double tympanocentesis study, children aged 3 to 48 months 
with acute otitis media received trimethoprim sulfamethoxasole twice daily (40
mg/kg/d) for 10 days. All children had a baseline tympanocentesis and in
culture-positive children, tympanocentesis was repeated at the on-therapy visit. 
Of 89 children enrolled, 51 (57%) were clinically and bacteriologically
evaluable. Bacteriologic eradication was achieved in 80% (42 of 52) of children, 
and overall clinical response at the end of therapy was 78%. Clinical success was
69% for culture-positive children versus 91% for culture-negative children at
baseline tympanocentesis (P = 0.03). In this study, trimethoprim sulfamethoxasole
clinical response was unsatisfactory, especially among culture-'positive
children.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 17484233 [PubMed - indexed for MEDLINE]

426: Kulak Burun Bogaz Ihtis Derg. 2007;17(1):22-5.

Does topical N-acetylcysteine application after myringotomy cause severe
otorrhea?

Sanli A, Eken M, Evren C, Ateş G, Paksoy M.

Department of Otolaryngology, Dr. Lütfi Kirdar Training and Research Hospital,
Istanbul, Turkey.

OBJECTIVES: The effect of topical N-acetylcysteine (NAC) application was
investigated on the healing of acute experimental tympanic membrane perforations.
MATERIALS AND METHODS: Twenty guinea pigs were used in this study. Under
intraperitoneal ketamine anesthesia, incisional myringotomies were performed in
the posterosuperior quadrant of the tympanic membranes with a straight otologic
hook. The diameter of the perforations was approximately 2 mm. Perforations in
both ears were treated with freshly prepared sponges soaked in either 0.1 ml 0.9%
NaCl solution (10 control animals) or 0.6 mg/0.1 ml NAC (10 animals) for three
consecutive days. All the tympanic membranes were examined by otomicroscopy on
the third, fifth, seventh, and ninth days. RESULTS: In the control group, all the
perforations were completely closed at the end of nine days. During the same
period, only 40% of the perforations were completely closed in the NAC group. The
remaining ears exhibited otorrhea by the third day. CONCLUSION: N-acetylcysteine 
may cause severe otorrhea in the healing process of tympanic membrane
perforations. Further studies including histopathological examinations are
required to elucidate this condition.

PMID: 17483607 [PubMed - indexed for MEDLINE]

427: Int J Pediatr Otorhinolaryngol. 2007 Jul;71(7):1035-9. Epub 2007 May 4.

Otitis media surgery: large variability between Finland and Norway.

Karevold G, Haapkylä J, Pitkäranta A, Kvaerner KJ.

Faculty Division of Akershus University Hospital, University of Oslo, Oslo,
Norway. gunnhild@karevold.no

OBJECTIVE: Bi-national comparison of surgical treatment for paediatric otitis
media. METHODS: Registry based cross-sectional study with complete data on
surgery for otitis media in 2002; 21,811 Finnish and Norwegian children aged 0-16
years. RESULTS: Total rates for otitis media surgery were 82.5 and 146.5 per
10,000 children in Norway and Finland, respectively. Adenoidectomies were four
times more frequently performed in Finland and rates for tympanostomy tube
insertions differed 2-3-fold, Finland having the higher rate. The contrast in
surgery rates was most striking in the age group 0-2 years. Further, the more
sparsely populated regions had significantly higher overall surgery rates.
CONCLUSION: The large variability in the incidence of otitis media surgery
between two similar countries questions whether present guidelines ensure equal
treatment in similarly affected children and pinpoints the difficulty in giving
advice on age, time and type of surgery.

Publication Types: 
    Comparative Study

PMID: 17482284 [PubMed - indexed for MEDLINE]

428: Int J Pediatr Otorhinolaryngol. 2007 Jul;71(7):1079-85. Epub 2007 May 4.

Hearing loss and middle ear involvement in patients with juvenile idiopathic
arthritis.

Ikiz AO, Unsal E, Kirkim G, Erdag TK, Guneri EA.

Dokuz Eylul University School of Medicine, Department of Ear Nose Throat and Head
and Neck Surgery, 35340 Izmir, Turkey. ahmet.ikiz@deu.edu.tr

OBJECTIVE: Evaluation of the hearing status and middle ear function of patients
with juvenile idiopathic arthritis. METHODS: The study group was comprised of 38 
ears of 19 patients (6 males, 13 females) aged between 5 and 23 years. The
control group was comprised of 30 ears of 15 healthy subjects (5 males, 10
females) aged between 5 and 22 years. All subjects were examined audiologically
using tympanometry, stapedial reflex, acoustic reflex decay, pure-tone
audiometry, high frequency audiometry and transient evoked otoacoustic emission
tests. RESULTS: There were statistically significant (p<0.05) number of ears
(32%) with abnormal tympanograms in the patient population while all tympanograms
were normal, type A in the control group. Seven type As, 2 type Ad, and 3 type C 
tympanograms were seen in the patient population. In pure tone audiometry tests
there was no subject having neither a conductive nor sensorineural hearing loss
individually in both groups. But as a group, patients with juvenile idiopathic
arthritis showed statistically significant elevation of air conduction thresholds
at frequencies of 250, 500, 6000, 14,000 and 16,000 Hz for right ears; and at
500, 2000, 12,500 and 16,000 Hz for left ears; and larger air-bone gaps at 500
and 2000 Hz for right ears; and at 500 Hz for left ears (p<0.05). Comparison of
bone conduction thresholds and otoacoustic emission tests between both groups did
not reveal any statistically significant difference (p>0.05). CONCLUSION: This
study suggests a dual effect of disease on both the middle and inner ear of
patients with juvenile idiopathic arthritis. Presence of abnormal tympanograms
together with worse air conduction thresholds at lower frequencies as well as
larger air bone gaps at frequencies of 500 and 2000 Hz suggest subclinical middle
ear involvement; while hearing losses at 6000 Hz and very high frequencies of
12,500, 14,000 and 16,000 Hz suggest inner involvement at an early stage.

PMID: 17482280 [PubMed - indexed for MEDLINE]

429: Otolaryngol Head Neck Surg. 2007 May;136(5):769-72.

Dexamethasone does not alter in vitro antibacterial efficacy of gentamicin.

Drobbin MT, Phelan ST, Antonelli PJ.

Department of Otolaryngology, University of Florida, Gainesville, FL 32610, USA.

OBJECTIVES: Aminoglycoside ototoxicity may be mitigated by administration of
dexamethasone; however, dexamethasone could theoretically impair its
antibacterial properties. The purpose of this experiment was to determine if
dexamethasone decreases the antibacterial activity of gentamicin against
Pseudomonas aeruginosa (PA) and Staphylococcus aureus (SA). STUDY DESIGN: In
vitro microbiological assay. METHODS: Four separate trials of minimum inhibitory 
concentration (MIC) testing were performed for gentamicin against five PA strains
and six SA strains, with and without the addition of high and low concentrations 
of dexamethasone. RESULTS: MICs were not changed by more than one dilution with
the addition of either high or low concentrations of dexamethasone for any of the
PA and SA strains. CONCLUSION: Dexamethasone does not impair the antibacterial
efficacy of gentamicin for PA and SA. This supports the role of dexamethasone as 
an oto-protectant with aminoglycoside therapy.

PMID: 17478213 [PubMed - indexed for MEDLINE]

430: Otolaryngol Head Neck Surg. 2007 May;136(5):699-706.

Executive summary: asthma and the unified airway.

Krouse JH, Veling MC, Ryan MW, Pillsbury HC 3rd, Krouse HJ, Joe S, Heller AJ, Han
JK, Fineman SM, Brown RW.

Wayne State University, Detroit, MI 48201, USA. jkrouse@med.wayne.edu

Asthma is a common comorbid disorder that will be seen by otolaryngologists in
their treatment of patients with rhinitis, rhinosinusitis, and otitis media.
Among otolaryngologists, however, a diagnosis of asthma is infrequently
considered in this patient population. Otolaryngologists, however, may be in an
important position to recognize this potential diagnosis and provide treatment or
appropriate referral. To further develop this relationship among upper and lower 
airway inflammation, and to provide important information to otolaryngologists
regarding this relationship, a multidisciplinary workgroup was impaneled by the
American Academy of Otolaryngologic Allergy in August 2006. The full report of
this meeting is published separately as a Supplement to Otolaryngology-Head and
Neck Surgery. This Executive Summary provides a brief synopsis of that document, 
with a focus on comorbid respiratory inflammation for otolaryngologists. In the
treatment of their patients with allergic rhinitis and rhinosinusitis,
otolaryngologists must be aware of the possible presence of asthma so that
appropriate treatment and/or referral can be initiated. The impact of this
practice will allow more comprehensive treatment of patients with upper and lower
airway disease, and will improve patient symptoms, function, and quality of life.

Publication Types: 
    Congresses

PMID: 17478201 [PubMed - indexed for MEDLINE]

431: Laryngoscope. 2007 May;117(5):907-10.

Cranial nerve involvement in malignant external otitis: implications for clinical
outcome.

Mani N, Sudhoff H, Rajagopal S, Moffat D, Axon PR.

Department of Otolaryngology and Skull Base Surgery, Addenbrooke's Hospital,
Cambridge, UK.

BACKGROUND: Malignant external otitis is an uncommon, potentially lethal
infection of the temporal bone primarily affecting elderly diabetic patients.
OBJECTIVE: To determine whether cranial nerve involvement in malignant external
otitis affects or predicts the clinical outcome in terms of morbidity and
mortality. METHODS: Diagnosis of malignant external otitis was established in 23 
patients (average age, 71 yr; range, 39-87) based on inclusion criteria of severe
pain, otitis externa refractory to conventional treatments, diabetes mellitus,
and Pseudomonas aeruginosa detection. Computed tomography confirmed temporal bone
involvement extending outside the external auditory canal. DATA ANALYSIS:
Retrospective analysis of hospital records. RESULTS: Ten of 23 (43.5%) patients
showed cranial nerve involvement. The following cranial nerves were affected:
facial nerve (6/10), lower cranial nerves (combination of IX, X, XI, XII) (3/10),
and extended nerve palsy (VI, VII, IX, X, XI) (1/10). Thirteen of 23 (56.5%)
patients displayed no cranial nerve involvement. All patients were treated with
long-term, high-dose antibiotic treatment dependent on the microbiological
findings. CONCLUSIONS: All patients with lower cranial nerve palsy recovered
normal function; however, the facial nerve palsy was significantly less likely to
improve by medical treatment. Cranial nerve involvement did not affect the
patient survival rate under an optimized medical treatment in our series.

PMID: 17473694 [PubMed - indexed for MEDLINE]

432: Laryngoscope. 2007 May;117(5):903-6.

Bilateral myringoplasty in chronic otitis media.

Caye-Thomasen P, Nielsen TR, Tos M.

Departments of Oto-Rhino-Laryngology, Head and Neck Surgery, Gentofte University 
Hospital of Copenhagen, Hellerup, Denmark. peca@gentoftehosp.kbhamt.dk

OBJECTIVE: A theoretical risk of iatrogenic sensorineural hearing loss (HL)
during surgery has induced a reluctance to perform bilateral
myringoplasty/tympanoplasty type I among some otosurgeons. This paper presents
results of bilateral surgery in 26 patients. MATERIAL AND METHODS: Twenty-six
patients with bilateral, dry tympanic membrane perforations caused by chronic
otitis media were selected prospectively for bilateral
myringoplasty/tympanoplasty type I (52 ears) at a tertiary referral center. All
patients had a HL corresponding to the size and localization of the perforation
(no suspicion of ossicular chain defect or other pathology). Mean age was 13.3
years, and the male to female ratio was 1.36. All but one ear were operated
through a transcanal approach, and the onlay technique was used most frequently
(83%), with use of fascia (56%), tragal perichondrium (38%), or cartilage
palisades (6%) as graft material. Follow-up examination and hearing tests (pure
tone and speech audiometry) were performed at a mean of 13.8 months after
surgery. RESULTS: Perforation closure was obtained in 49 (94%) of the 52 ears.
Hearing improved significantly, and the air-bone gap was significantly reduced.
The air-bone gap was closed to within 10 dB in 92% and within 20 dB in 100% of
the ears. Surprisingly good hearing was found during postoperative, bilateral ear
canal gauze packing. Iatrogenic sensorineural HL did not occur. CONCLUSIONS: We
conclude that bilateral myringoplasty is safe, with good results, reduces costs, 
and leaves the patient satisfied. The hearing impairment during postoperative ear
canal packing is surprisingly modest and readily acceptable by the patients.

PMID: 17473693 [PubMed - indexed for MEDLINE]

433: Pediatrics. 2007 May;119(5):897-904.

Comment in:
    J Pediatr. 2007 Nov;151(5):555.    Pediatrics. 2007 Dec;120(6):1403; author reply 1403-4.

Effectiveness of trimethoprim/sulfamethoxazole for children with chronic active
otitis media: a randomized, placebo-controlled trial.

van der Veen EL, Rovers MM, Albers FW, Sanders EA, Schilder AG.

Department of Otorhinolaryngology, Wilhelmina Children's Hospital, University
Medical Center Utrecht, Utrecht, Netherlands. e.l.vanderveen@umcutrecht.nl

OBJECTIVE: The goal was to determine the clinical effectiveness of prolonged
outpatient treatment with trimethoprim/sulfamethoxazole for children with chronic
active otitis media. METHODS: We performed a randomized, placebo-controlled trial
with 101 children (1-12 years of age) with chronic active otitis media (defined
as otorrhea for > or =12 weeks). In addition to a short course of steroid and
antibiotic eardrops, children were assigned randomly to receive 6 to 12 weeks of 
orally administered trimethoprim/sulfamethoxazole (18 mg/kg, 2 times per day) or 
placebo and were monitored for 1 year. RESULTS: At 6 weeks, 28% of children in
the trimethoprim/sulfamethoxazole group and 53% of children in the placebo group 
had otomicroscopic signs of otorrhea. At 12 weeks, these values were 32% and 47%,
respectively. At 1 year, the numbers of children with otorrhea were similar in
the 2 groups (25% and 20%, respectively). One child in the
trimethoprim/sulfamethoxazole group developed a skin rash. Vomiting or diarrhea
was reported for 9% of the trimethoprim/sulfamethoxazole group and 2% of the
placebo group. Pure-tone hearing levels and health-related quality of life
improved during the study but did not differ between the
trimethoprim/sulfamethoxazole group and the placebo group. Pseudomonas aeruginosa
was the most frequently isolated bacteria in the otorrhea samples from both
groups. CONCLUSIONS: A 6- to 12-week course of high-dose, orally administered
trimethoprim/sulfamethoxazole therapy is beneficial for children with chronic
active otitis media. The treatment effect is most pronounced with the shorter
course and disappears if administration of the medication is discontinued.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 17473089 [PubMed - indexed for MEDLINE]

434: Pediatr Infect Dis J. 2007 May;26(5):423-7.

Comment in:
    Pediatr Infect Dis J. 2007 Sep;26(9):863-4; author reply 864.

Failure of xylitol given three times a day for preventing acute otitis media.

Hautalahti O, Renko M, Tapiainen T, Kontiokari T, Pokka T, Uhari M.

Department of Pediatrics, University of Oulu, Oulu, Finland.

BACKGROUND: Xylitol administered regularly 5 times a day after each meal is
successful in preventing acute otitis media (AOM) in children, but if given only 
during respiratory infections it is ineffective against AOM. To find a more
convenient dosing regimen, we tested whether xylitol administered 3 times a day
reduces the occurrence of AOM. METHODS: In this 3-month randomized, double-blind 
trial, 663 healthy day care children were randomized to receive either a control 
product (n = 331) or xylitol (n = 332). Xylitol was given in chewing gum or in a 
mixture 3 times a day, the daily dose being 0.5 g in the control group and 9.6 g 
in the xylitol group. The occurrence of the first AOM diagnosed during any period
of respiratory symptoms during the follow-up was the main outcome measure.
RESULTS: At least one AOM episode was diagnosed in 98 of the 331 children who
received control products (30%) and in 94 of the 332 who received xylitol
products (28%). A total of 142 episodes of AOM were diagnosed in the control
group compared with 156 in the xylitol group. The differences were not
statistically significant. CONCLUSIONS: Xylitol given regularly 3 times a day for
3 months during the respiratory infection season failed to prevent AOM.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 17468653 [PubMed - indexed for MEDLINE]

435: Auris Nasus Larynx. 2007 Dec;34(4):523-6. Epub 2007 Apr 27.

A case of an inflammatory myofibroblastic tumor of the mastoid presenting with
chronic suppurative otitis media.

Cho KJ, Lee DH, Jung SH, Kim JH.

Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The
Catholic University of Korea, 505 Banpo-dong, Secho-gu, Seoul 137-701, Republic
of Korea.

Inflammatory myofibroblastic tumors, also known as inflammatory pseudotumors,
include a diverse group of lesions characterized by inflammatory cell
infiltration and variable fibrotic responses. Their occurrence in the temporal
bone is unusual. We present a case of an inflammatory myofibroblastic tumor of
the mastoid bone in a 55-year-old female who complained of repeated otorrhea and 
a hearing impairment. On an otoscopic exam, her tympanic membrane was perforated.
The computed tomographic imaging revealed a soft-tissue density-filled middle ear
and mastoid with sclerotic bony change. The initial clinical diagnosis was
chronic suppurative otitis media and mastoiditis, and the patient underwent a
canal-wall down tympanomastoidectomy through a retroauricular approach. A
histopathologic examination showed the presence of myofibroblastic spindle cells 
with mixed inflammatory infiltrates, and the pathologic diagnosis was
inflammatory myofibroblastic tumor.

Publication Types: 
    Case Reports

PMID: 17467217 [PubMed - indexed for MEDLINE]

436: Int J Pediatr Otorhinolaryngol. 2007 Jul;71(7):1047-54. Epub 2007 Apr 27.

Pacific Islands Families Study: risk factors associated with otitis media with
effusion among Pacific 2-year-old children.

Paterson JE, Carter S, Wallace J, Ahmad Z, Garrett N, Silva PA.

Auckland University of Technology, Auckland, New Zealand.
janis.paterson@aut.ac.nz

OBJECTIVE: This study examined the risk factors associated with middle ear
disease in a cohort of Pacific 2-year-old children residing in New Zealand.
METHODS: The data were gathered as part of the Pacific Island Families: first 2
years of life (PIF) study in which 656 2-year-old were screened using
tympanometry to identify children at risk for otitis media with effusion (OME)
and other otological disorders. RESULTS: Within this 2-year-old cohort of Pacific
children, one set of factors significantly associated with OME was clustered
around the respiratory and auditory health of the child over the past year. OME
was more likely for children who were regularly suffering from fluid/pus
discharge from ears (OR=2.10, 95% CI: 1.01-4.35), children with five or more
coughs/colds in the last year (OR=1.90, 95% CI: 1.22-3.00), and children who
frequently/constantly snored (OR=2.60, 95% CI: 1.09-6.23) to have OME. Those
children who were treated at home for breathing problems were more that two times
more likely to have OME (OR=2.61, 95% CI: 1.55-4.42). A second set of factors was
clustered around environmental risks that exposed children to a large number of
other children. Children who attended a day care centre for more than 20h were
five times more likely (OR=5.21, 95% CI: 2.90-9.35) and those who regularly
attended church (OR=2.78, 95% CI: 1.05-7.40) were almost three times more likely 
to have OME. CONCLUSIONS: These findings portray a child compromised by
persistent ear infections and general coughs and colds as being at increased risk
of contracting OME. In line with international research these findings raise
questions about the negative child health effects associated with the day care
environment for young children.

PMID: 17467064 [PubMed - indexed for MEDLINE]

437: FEMS Immunol Med Microbiol. 2007 Jun;50(1):119-25. Epub 2007 Apr 23.

Characterization of Streptococcus pneumoniae isolated from children with otitis
media.

Onwubiko C, Shires C, Quin LR, Swiatlo E, McDaniel LS.

Department of Microbiology, The University of Mississippi Medical Center,
Jackson, MS 39216, USA.

Streptococcus pneumoniae is the main causative agent of acute otitis media in
children. Serotype-based vaccines have provided some protection against otitis
media, but not as much as anticipated, demonstrating the need for alternative
vaccine options. Pneumococcal otitis media isolates were obtained from children 5
years old or younger from hospitals around Mississippi in the prevaccine era
(1999-2000). These isolates were compared by capsular typing, pneumococcal
surface protein A (PspA) family typing, antibiotic susceptibility, and DNA
fingerprinting. Our study shows that there is great genetic variability among
pneumococcal clinical isolates of otitis media, except with regard to PspA.
Therefore, efforts focused on the development of a PspA-based pneumococcal
vaccine would be well placed.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17456178 [PubMed - indexed for MEDLINE]

438: Scand J Infect Dis. 2007;39(4):370-2.

A case of malignant otitis externa caused by Candida glabrata in a patient
receiving haemodialysis.

Bae WK, Lee KS, Park JW, Bae EH, Ma SK, Kim NH, Choi KC, Shin JH, Cho HH, Cho YB,
Kim SW.

Department of Internal Medicine, Chonnam National University Medical School,
Gwangju, Korea.

A 74-y-old male receiving haemodialysis presented with right-sided otalgia,
otorrhoea and diffuse swelling on the right external auditory canal. Following an
initial successful treatment with prolonged intravenous antibiotics, the patient 
relapsed with a secondary infection in the same site due to Candida glabrata. We 
report an unusual case of malignant otitis externa caused by the fungus C.
glabrata.

Publication Types: 
    Case Reports

PMID: 17454907 [PubMed - indexed for MEDLINE]

439: Acta Otolaryngol. 2007 May;127(5):553-7.

Tuberculous meningitis-induced unilateral sensorineural hearing loss: a temporal 
bone study.

Kuan CC, Kaga K, Tsuzuku T.

Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine,
Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo
113-8655, Japan. volvo9837@yahoo.com

The relationship between meningitis and sensorineural hearing loss (SNHL) has
long been studied. Many histopathological studies of animal models and human
temporal bones with respect to bacterial meningitis have been carried out.
However, the relationship between SNHL and tuberculous meningitis was seldom
addressed and the pathophysiology remains unclear. We carried out temporal bone
studies on material from a 22-year-old patient who developed a right unilateral
SNHL before dying from tuberculous meningitis. The histopathological findings for
the right temporal bone were as follows: (1) inflammation mainly appeared in the 
internal auditory canal, modiolus and Rosenthal's canal and extended to the
osseous spiral ligament, whereas the perilymphatic spaces were less involved; (2)
the organ of Corti, cochlear nerve fibres and spiral ganglion cells were severely
degenerated, particularly in the basal and middle turns; (3) the contralateral
side (for which the patient had no complaints) showed an inner space free from
inflammation, but some granulomatous formations were observed in the middle ear
cavity. We conclude that the modiolus and cochlear aqueduct are the main routes
for the spread of infection from the meninges to the inner ear. The progression
of hearing loss resembles that of bacterial meningitis and shares attributes of
retrocochlear SNHL.

Publication Types: 
    Case Reports

PMID: 17453485 [PubMed - indexed for MEDLINE]

440: Acta Otolaryngol. 2007 May;127(5):480-5.

Acute otitis media in schoolchildren: allergic diseases and skin prick test
positivity.

Bentdal YE, Nafstad P, Karevold G, Kvaerner KJ.

Department of Otorhinolaryngology, Faculty Division of Akershus University
Hospital, University of Oslo, Sykehusvagen 27, 1478 Lørenskog, Norway.
y.e.bentdal@medisin.uio.no

CONCLUSIONS: Single and repeated episodes of acute otitis media (AOM) in
10-year-old children were associated with reported allergic disease. Further,
skin prick test (SPT)-negative children with reported asthma and allergic
rhinoconjunctivitis had increased risk of AOM. We suggest that optimal treatment 
of allergic symptoms may have an effect on AOM in school children. OBJECTIVE: The
objective of the study was to estimate associations between AOM, allergic
diseases and SPT positivity in 10-year-old children. MATERIALS AND METHODS:
Population-based cross-sectional study of 3406 10-year-old children living in
Oslo. Main outcome measures were questionnaire-based information on AOM and
reported physician-diagnosed allergic diseases with symptoms during the last
year. In addition, 2657 children were skin prick tested. Logistic regression
analyses were performed to estimate associations and control for potential
confounders. RESULTS: One or more episodes of AOM were present in 13.8% (n=470)
of the children; 9.7% (n=331) had single episodes, while 4.1% (n=139) had two or 
more infections. We found a statistically significant association between AOM and
reported allergic diseases, strongest for AOM and asthma with odds ratio 2.7 (95%
confidence interval 1.8-4.0) and 2.3 (95% confidence interval 1.3-4.3) for single
and two or more episodes of AOM, respectively. The risk for AOM was increased in 
asthmatic SPT-negative children compared with asthmatic SPT-positive children,
the odds ratios were 3.0 (1.7-5.4) and 1.5 (0.8-2.8), respectively. The same
tendency was found for allergic rhinoconjunctivitis.

PMID: 17453473 [PubMed - indexed for MEDLINE]

441: Acta Otolaryngol. 2007 May;127(5):474-9.

Results of hearing tests after total middle ear reconstruction.

Sasaki T, Xu A, Ishimoto S, Ito K, Yamasoba T, Kaga K.

Department of Otorhinolaryngology, Faculty of Medicine, University of Tokyo,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655. Japan. torusasaki-tky@umin.ac.jp

CONCLUSIONS: Patients treated by mastoidectomy in the past often present with
hearing loss and cavity problems such as pus discharge. Total middle ear
reconstruction (TMER) improves the hearing of these patients by correcting cavity
problems and resolution of ear discharge, which facilitates ossicular chain
reconstruction such as type III or type IV tympanoplasty. OBJECTIVE: To evaluate 
the effectiveness of TMER in improving hearing. PATIENTS AND METHODS: We reviewed
the audiograms of 56 ears of 48 patients who underwent TMER in combination with
either type III or type IV tympanoplasty. Audiometric pure tone thresholds
averaged over three frequencies (500, 1000, and 2000, pure tone average) were
measured and compared before and after surgery. Successful outcome was defined as
improvement of 15 dB or more. The mean follow-up was 5.7 years (range 1.1-12.6). 
We also analyzed the relations between hearing improvement and factors such as
type of tympanoplasty (types III and IV), choice between one-stage and two-stage 
operation, and the interval between original mastoidectomy and final operation.
RESULTS: The mean hearing gain was 13.6 (+/-11.9) dB. Twenty-seven procedures
(48.2%) were considered successful, with improvement of 15 dB or more. The
results of type III tympanoplasty group were significantly superior to those of
type IV (p<0.05, Student's t test). One- and two-stage surgery did not
significantly influence outcome. The interval between the initial operation
correlated weakly and negatively (r = - 0.266, p<0.05) with hearing gain.

Publication Types: 
    Case Reports

PMID: 17453472 [PubMed - indexed for MEDLINE]

442: Acta Otolaryngol. 2007 May;127(5):470-3.

Prediction of gastroesophageal reflux in otitis media with effusion in adults.

Sone M, Yamamuro Y, Hayashi H, Yanagi E, Niwa Y, Nakashima T.

Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine,
65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. michsone@med.nagoya-u.ac.jp

CONCLUSIONS: The measurement of pepsinogen I (PGI) in middle-ear effusions (MEEs)
and a questionnaire on the frequency symptoms of gastroesophageal reflux (GER)
disease are tools that can be used to screen for the existence of GER. OBJECTIVE:
To seek methods that would be beneficial as a screen for the presence of GER
among adult patients with OME. MATERIALS AND METHODS: Fifty-eight adult
outpatients with OME were asked to answer a questionnaire of the frequency scale 
for symptoms of GER disease. Samples of MEEs were obtained from each subject and 
were measured for concentrations of PGI and PGII. Some patients were followed up 
after being treated with a proton pump inhibitor. RESULTS: The percentage of
patients with high PGI concentrations in their MEEs was higher in those with
GER-related symptoms than in those without GER-related symptoms. Moreover, OME
was present bilaterally in a higher percentage of patients with GER-related
symptoms. There were patients in whom PGI levels decreased after receiving
treatment for GER.

PMID: 17453471 [PubMed - indexed for MEDLINE]

443: J Laryngol Otol. 2008 Jan;122(1):25-30. Epub 2007 Apr 20.

Effectiveness of corticosteroids in otitis media with effusion: an experimental
study.

Yaman H, Ozturk K, Uyar Y, Gurbilek M.

Department of Otolaryngology, Meram Medical Faculty, Selcuk University, Konya,
Turkey. hyaman1975@yahoo.com

OBJECTIVE: The aim of the present study was to investigate the dose-related
effectiveness of corticosteroids in the management of otitis media with effusion,
by using the objective assessment techniques of tympanometry and cytokine
measurement. MATERIALS AND METHODS: The eustachian tubes of 42 male rats were
obstructed. Thirty-six subjects with effusion were randomly divided into three
equal groups: controls; 0.5 mg/kg/day corticosteroid; and 1 mg/kg/day
corticosteroid. Concentrations of interleukin-1beta and tumour necrosis factor
alpha in the middle-ear effusions were analysed using enzyme-linked immunosorbent
assay. RESULTS: An effusion occurred on the 14th post-operative day and was
present on the 30th post-operative day in the control group. Otomicroscopic
examination and tympanometric measurement showed an improvement in the
intervention groups. There was a significant difference between both intervention
groups and the control group for both interleukin-1beta and tumour necrosis
factor alpha concentrations (p 0.05). CONCLUSION: The study confirmed a short
term beneficial effect of systemic steroids on resolution of otitis media with
effusion in a rat model. Our results support the theory that corticosteroids
significantly decrease concentrations of both interleukin-1beta and tumour
necrosis factor alpha. In our model, the 0.5 mg/kg corticosteroid dose was as
effective as the 1 mg/kg corticosteroid dose. Further studies should be carried
out to determine the optimal dose and duration of corticosteroids in the
treatment of otitis media with effusion.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17445334 [PubMed - indexed for MEDLINE]

444: Laryngoscope. 2007 Jun;117(6):1046-52.

Comment in:
    Laryngoscope. 2007 Oct;117(10):1893; author reply 1893-4.

Tacrolimus: a new option in therapy-resistant chronic external otitis.

Caffier PP, Harth W, Mayelzadeh B, Haupt H, Sedlmaier B.

Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University
Medicine Berlin, Campus Charité Mitte, Berlin, Germany.
philipp.caffier@charite.de

OBJECTIVE: To evaluate the efficacy of the novel topical immune modulator
tacrolimus in chronic uninfectious otherwise therapy-resistant external otitis
(EO). STUDY DESIGN: Prospective clinical study. PATIENTS AND METHODS: There were 
53 patients aged 5 to 83 years. An ear wick containing 0.1% tacrolimus ointment
(Protopic) was inserted into the external auditory canal every 2nd to 3rd day.
Altogether, the wick was changed three times. The pre-, intra- and
posttherapeutic state of the clinical parameters otalgia, edema, otorrhea,
erythema, pruritus, and desquamation was rated by means of a 6-point score
system. Treatment efficiency was evaluated on the basis of follow-up
investigations at 3-month intervals, a standardized findings sheet, and
photograph documentation. RESULTS: The short-term results showed a clear
improvement in 85% of the patients and significant reductions of the severity
levels for all clinical parameters investigated (P < .001). Concerning the
long-term results, a one-time treatment cycle led to complete healing in 46% of
the patients throughout a follow-up of 10 to 22 months. Of the patients, 54% had 
recurrent EO events with significantly extended mean symptom-free intervals.
Reapplied tacrolimus treatment patterns attenuated the relapsing course of
disease and significantly reduced the number of EO episodes. Within the
observation period, no relevant side effects were observed, except for a local
feeling of heat, occasional skin burning, and itching. CONCLUSIONS: The topical
application of 0.1% tacrolimus ointment in the outer ear canal appears to be an
effective and well-tolerated new option in corticosteroid-free treatment of
chronic therapy-resistant EO.

Publication Types: 
    Clinical Trial

PMID: 17440424 [PubMed - indexed for MEDLINE]

445: Arch Otolaryngol Head Neck Surg. 2007 Apr;133(4):379-82.

Relationship between pediatric obesity and otitis media with effusion.

Kim JB, Park DC, Cha CI, Yeo SG.

Department of Otorhinolaryngology, College of Medicine, Kyung Hee University,
Seoul, Korea.

OBJECTIVE: To investigate the relationship between pediatric otitis media with
effusion and obesity, as determined by body mass index (BMI) (calculated as
weight in kilograms divided by height in meters squared) and serum triglyceride
(TG) and total cholesterol (TC) concentrations. DESIGN: A prospective,
nonrandomized, case-control study. SETTING: University-affiliated hospital.
SUBJECTS: The experimental group comprised 155 children aged 2 to 7 years, who
received unilateral or bilateral ventilation tube insertion for the treatment of 
otitis media with effusion. The control group comprised 118 children with no
history of otitis media with effusion, who underwent operations for conditions
other than ear diseases. Based on BMI and serum TG and TC concentrations, we
divided the experimental group into 2 subgroups, those who were and were not
obese. MAIN OUTCOME MEASURES: We determined the difference between the
experimental and control groups in BMI and serum TG and TC concentrations and the
difference between the obese and nonobese subgroups in frequency of ventilation
tube insertion. RESULTS: Mean +/- SD BMI (22.0 +/- 3.4 vs 16.3 +/- 2.4) (P = .01)
and mean +/- SD TC level (195.0 +/- 31.0 mg/dL vs 159.3 +/- 26.9 mg/dL [5.05 +/- 
0.80 mmol/L vs 4.13 +/- 0.70 mmol/L]) (P = .04), but not mean serum TG level
(109.4 +/- 40.4 mg/dL vs 90.0 +/- 52.3 mg/dL [1.24 +/- 0.46 mmol/L vs 1.02 +/-
0.59 mmol/L]) (P = .13), were significantly higher in the experimental group than
in the control group. Frequency of ventilation tube insertion, however, did not
differ significantly between the obese and nonobese subgroups, whether divided by
BMI (P = .10) or serum TG (P = .12) or TC (P = .07) concentration. CONCLUSION:
Childhood obesity may be associated with the occurrence of otitis media with
effusion.

PMID: 17438253 [PubMed - indexed for MEDLINE]

446: Curr Allergy Asthma Rep. 2007 May;7(2):112-6.

Nonallergic rhinitis in children.

Berger WE, Schonfeld JE.

Allergy and Asthma Associates of Southern California, 27800 Medical Center Road, 
Suite 244, Mission Viejo, CA 92691, USA.

Nonallergic rhinitis in children is a medical condition that has not been well
defined and the true incidence is unknown. Current treatment recommendations are 
based on data obtained from adult studies. The mechanisms of pediatric
nonallergic rhinitis are also unclear. The concept that laryngopharyngeal reflux 
(LPR) events may play a critical role in the pathogenesis of upper airway disease
is presently under investigation. Although LPR is being better delineated and
appropriate methods of diagnosis and treatment are being studied, substantial
evidence links LPR with several disease states including rhinitis, sinus disease,
and middle ear disease. Due to the lack of information concerning the etiology of
nonallergic rhinitis in children, LPR should be considered in the differential
diagnosis of a child with negative skin tests and chronic rhinitis symptoms. The 
clinician should especially give attention to this diagnosis when a child
presents with recurrent co-morbid conditions such as chronic sinusitis or
persistent middle ear disease.

Publication Types: 
    Review

PMID: 17437681 [PubMed - indexed for MEDLINE]

447: J Laryngol Otol. 2007 Sep;121(9):850-2. Epub 2007 Apr 10.

Correlation between a foreign body in the external auditory canal and otitis
media with effusion.

Chalishazar UK, Singh V.

Department of ENT, Prince Charles Hospital, Merthyr Tydfil, Mid Glamorgan, UK.
ukc40@aol.com

OBJECTIVE: To determine if there is a relationship between a foreign body in the 
external auditory canal and undiagnosed otitis media with effusion or significant
eustachian tube dysfunction in children. STUDY DESIGN AND SETTING: This is a
prospective, uncontrolled analysis of 37 consecutive children with a foreign body
in the external auditory canal (group I) and 37 children with non-ENT complaints 
as a control (group II), seen over two years in the ENT unit of a district
general hospital. All the children underwent removal of the foreign body,
examination of both ears by a senior ENT surgeon followed by tympanometry within 
seven to 10 days. RESULT: Thirty-seven children with a foreign body in the
external auditory canal (group I) were analysed and a similar number of children 
with non-ENT problems (group II) were taken as a control. The age range for both 
groups was two years to 10 years with a median age of six years. Of the 37
children, 25 (68 per cent) in group I had an abnormal view of the tympanic
membrane compared to only five (14 per cent) in group II (p < 0.04-chi-squared
test). In group I 20 children (54 per cent) and in group II three children (8 per
cent) had abnormal middle-ear compliance (either type B or type C2) (p <
0.05-chi-squared test). Nineteen (51 per cent) children in group I had a history 
of previous ear symptoms such as irritation, otalgia, blockage or deafness more
than once in the past six months, and none had in the control group (p <
0.03-chi-squared test). CONCLUSION: There is clinical and statistical evidence to
suggest that children may insert a foreign body in the ear as a result of
irritation/pressure sensation secondary to otitis media with effusion or
significant eustachian tube dysfunction. Therefore, we recommend that all
children with a history of a foreign body in the ear should be screened in an ENT
clinic.

PMID: 17419900 [PubMed - indexed for MEDLINE]

448: J Laryngol Otol. 2007 Oct;121(10):943-6. Epub 2007 Apr 10.

Role of otoacoustic emission in children with middle-ear effusion and grommets.

Saleem Y, Ramachandran S, Ramamurthy L, Kay NJ.

Department of ENT, Stepping Hill Hospital, Stockport, Cheshire, UK.
ysaleem@yahoo.com

OBJECTIVE: To evaluate the role of otoacoustic emission in children with
middle-ear effusion and grommets. MATERIALS AND METHODS: A prospective study was 
carried out on a total of 90 ears. All children listed for grommet insertion had 
a pre-operative and post-operative (three to six months after grommet insertion) 
pure tone audiometry, tympanometry and otoacoustic emission recorded. A
comparison was made between pure tone audiometry and otoacoustic emission both
pre-operatively and post-operatively. RESULTS: Pre-operatively, 63 ears had an
abnormal pure tone audiometry of which 59 had absent otoacoustic emission.
Therefore the sensitivity of otoacoustic emission in detecting a conductive loss 
was 59/63 = 94 per cent (95 per cent confidence interval 85 to 98 per cent). All 
27 ears with normal hearing pre-operatively had normal otoacoustic emission. The 
specificity of otoacoustic emission was 27/27 = 100 per cent, (95 per cent
confidence interval, 88 to 100 per cent). The positive predictive value was 59/59
= 100 per cent (95 per cent confidence interval, 94 to 100 per cent). After three
to six months all post-operative patients with grommets had a normal pure tone
audiometry and otoacoustic emission. So both pure tone audiometry and otoacoustic
emission were strongly related both in patients with middle-ear effusion and in
patients with grommets. CONCLUSION: As the demonstration of hearing in young and 
difficult-to-test children can be problematic and time-consuming, we suggest that
otoacoustic emission can be used as an alternative to pure tone audiometry in
patients with middle-ear effusion and grommets.

Publication Types: 
    Comparative Study

PMID: 17419898 [PubMed - indexed for MEDLINE]

449: J Laryngol Otol. 2008 Apr;122(4):425-7. Epub 2007 Apr 10.

Unusual presentation of temporal bone involvement in Churg-Strauss syndrome.

Martinez Del Pero M, Moffat D, Sudhoff H.

Department of Otolaryngology and Skull Base Surgery, Addenbrooke's Hospital,
Cambridge, UK.

OBJECTIVE: To present a case of a 60-year-old male with a history of sudden onset
sensorineural hearing loss due to Churg-Strauss syndrome. CASE REPORT: The
patient had a 20-year history of asthma and recurrent right otitis media and a
nasal polypectomy four years prior to presenting with ear symptoms. Ear, nose and
throat involvement is common in Churg-Strauss syndrome, usually manifesting as
allergic rhinitis and chronic rhinosinusitis with or without polyps. CONCLUSIONS:
Otolaryngologists play an important role in making an early diagnosis of this
disease. To our knowledge this is the first case of Churg-Strauss syndrome
primarily presenting with otological pathology: left sensorineural hearing loss
and right otitis media.

Publication Types: 
    Case Reports

PMID: 17419894 [PubMed - indexed for MEDLINE]

450: Ann Otol Rhinol Laryngol. 2007 Mar;116(3):181-91.

Histopathology of ossicular grafts and implants in chronic otitis media.

Bahmad F Jr, Merchant SN.

Otopathology Laboratory, Massachusetts Eye and Ear Infirmary, Harvard Medical
School, Boston, Massachusetts, 02114, USA.

OBJECTIVES: We describe the histopathology of ossicular grafts and implants so as
to provide insight into factors that may influence functional results after
surgery for chronic otitis media. METHODS: Histopathologic observations were made
on 56 cases: 50 surgical specimens and 6 temporal bone cases in which the graft
was sectioned in situ. RESULTS AND CONCLUSIONS: Autogenous malleus, incus, and
cortical bone grafts behaved in a similar manner and maintained their
morphological size, shape, and contour for extended periods of time, at least up 
to 30 years. These histopathologic observations support the continued use of
autograft ossicular and cortical bone grafts for middle ear reconstruction.
Cartilage grafts developed chondromalacia with resulting loss of stiffness and
showed a tendency to undergo resorption. Synthetic prostheses made of porous
plastic (Plastipore, Polycel) elicited foreign body giant cell reactions with
various degrees of biodegradation of the implants. Prostheses made of
hydroxyapatite and Bioglass were enveloped by a lining of connective tissue and
mucosal epithelium. The Bioglass material was broken down into small fragments
and partially resorbed by a host response within the middle ear. These results
warrant caution in the use of prostheses made of porous plastic or Bioglass.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17419521 [PubMed - indexed for MEDLINE]

451: J Commun Disord. 2008 Jan-Feb;41(1):20-32. Epub 2007 Mar 12.

Early middle ear effusion and language at age seven.

Johnson DL, McCormick DP, Baldwin CD.

University of Houston, Houston, TX, United States. dljohnson@uh.edu

This study examined the relation of middle ear effusion (MEE) in the first 3
years of life to language outcomes at age seven. It was hypothesized, on the
basis of a literature review, that (1) a low, but positive relation between early
MEE and language measures in general will be observed at age seven, and (2) major
effects will be demonstrated for measures of articulation and phonological
sensitivity. MEE was assessed as days with bilateral MEE and episodes of MEE.
Three measures of language status were used: the Test of Auditory Analysis Skill 
(TAAS [Rosner, J. (1975). TAAS: Test of Auditory Analysis Skill. Novato, CA:
Academic Therapy Publications]), Goldman-Fristoe Articulation Test, Sounds in
Words and Sounds in Sentences (GFAT [Goldman, R., & Fristoe, M. (1986).
Goldman-Fristoe Test of Articulation. Circle Pines, MN: American Guidance
Service]), and the Clinical Evaluation of Language Fundamentals-revised (CELF-R
[Semel, E. M., Wiig, E. H., & Secord, W. (1987). CELF: Clinical Evaluation of
Language Fundamentals-Revised. New York: Harcourt Brace Jovanovich]). The sample 
included 179 children who were heterogeneous for SES and ethnicity. There were no
significant correlations for MEE and language measures. These negative results
were sustained when multiple regression was used with controls for socioeconomic 
status and quality of the home environment. Learning outcomes: We conclude that
early MEE may not pose a threat to language development in the early school
years.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17418231 [PubMed - indexed for MEDLINE]

452: Eur Arch Otorhinolaryngol. 2007 Sep;264(9):995-8. Epub 2007 Apr 6.

Applicability of autologous incus: the influence of age and localization of
cholesteatoma.

Stankovic M.

ORL Clinic, Bul. Z. Djindjica 52, 18 000, Nis, Serbia. milan.orl@bankerinter.net

There is a correlation between macroscopic and histologic changes of incus in
chronic otitis with cholesteatoma. The incidence and types of damage of auditory 
ossicles in chronic otitis media were extensively studied, but except some
studies on reoperations there are no morphometric studies of human auditory
ossicles in chronic otitis media. In order to define the rate of ossicular
applicability for tympanoplasties in different macroscopic forms of damage, we
analysed histologic changes of human incudes in correlation to their macroscopic 
alterations. Histomorphometric study of 82 intraoperatively removed human
incudes, from chronic otitis media with cholesteatoma (attic, sinus, tensa
cholesteatoma), was performed. They were divided according to the age of patients
and localization of cholesteatoma. Erosions, vitality, vascular areas,
osteomyelitic zones, and applicability of ossicles were measured. Progressive
increase of erosions, decrease of vitality, dilatation of vascular spaces and
osteomyelitic areas, and decrease of rate of potential applicability for
tympanoplasties were found. Residual osteomyelitis was present in incudes with
advanced external osteitis and ossicular defect. Macroscopic changes of incudes
in cholesteatoma and their histologic structure correlate. Localisation of
cholesteatoma is important for ossicular damage. Defects of long process with
external osteitis of incudes and more intense pathological changes demand their
removal and use of other reconstructive materials for tympanoplasties in order to
avoid tympanoplasty failure.

PMID: 17415579 [PubMed - indexed for MEDLINE]

453: Laryngoscope. 2007 Apr;117(4):668-73.

Biofilms in ear, nose, and throat infections: how important are they?

Vlastarakos PV, Nikolopoulos TP, Maragoudakis P, Tzagaroulakis A, Ferekidis E.

ENT Department, Hippokrateion General Hospital of Athens, Athens, Greece.
pevlast@hotmail.com

BACKGROUND: Biofilms present a new challenging concept in sustaining chronic,
common antibiotic-resistant ear, nose, and throat (ENT) infections. They are
communities of sessile bacteria embedded in a matrix of extracellular polymeric
substances of their own synthesis that adhere to a foreign body or a mucosal
surface with impaired host defense. The aim of this paper is to review the
literature on ENT diseases that can be attributed to biofilm formation and to
discuss options for future treatment. MATERIALS AND METHODS: Literature review
from Medline and database sources. Electronic links and related books were also
included. STUDY SELECTION: Controlled clinical trials, animal models, ex vivo
models, laboratory studies, retrospective studies, and systematic reviews. DATA
SYNTHESIS: Biofilm formation is a dynamic five-step process guided by
interbacterial communicating systems. Bacteria in biofilms express different
genes and have markedly different phenotypes from their planktonic counterparts. 
Detachment of cells, production of endotoxin, increased resistance to the host
immune system, and provision of a niche for the generation of resistant organisms
are biofilm processes that could initiate the infection process. Effective
prevention and management strategies include interruption of quorum sensing,
inhibition of related genes, disruption of the protective extrapolymer matrix,
macrolides (clarithromycin and erythromycin), and mechanical debridement of the
biofilm-bearing tissues. With regard to medical indwelling devices, surface
treatment of fluoroplastic grommets and redesign of cochlear implants could
minimize initial microbial colonization. CONCLUSION: As the role of biofilms in
human infection becomes better defined, ENT surgeons should be prepared to deal
with their unique and tenacious nature.

Publication Types: 
    Review

PMID: 17415138 [PubMed - indexed for MEDLINE]

454: ORL J Otorhinolaryngol Relat Spec. 2007;69(4):207-11. Epub 2007 Apr 4.

Effect of the thickness of the cartilage disk on the hearing results after
perichondrium/cartilage island flap tympanoplasty.

Atef A, Talaat N, Fathi A, Mosleh M, Safwat S.

Department of Otolaryngology, Faculty of Medicine, Cairo University, Cairo,
Egypt. amratef@dr.com

OBJECTIVE/HYPOTHESIS: The aim of this study was to analyze the effect of the
thickness of the cartilage disk on the hearing results after
perichondrium/cartilage island flap tympanoplasty. Our hypothesis was that
thinning the rigid thick cartilage disk to half of its thickness could increase
the compliance and give better acoustic gain and hearing results to patients with
a reconstructed tympanic membrane. STUDY DESIGN: A prospective before/after
clinical trial was conducted between January 2003 and March 2004. METHOD:
Patients with chronic suppurative otitis media (mucosal type), central
perforations and intact ossicular chain were randomly divided into 2 groups: the 
1st group was treated with the perichondrium/cartilage island flap technique
using the full-thickness cartilage disk, while the 2nd group was treated with the
same technique but after bisecting the cartilage to half of its thickness.
Hearing was evaluated using a 4-frequency (500, 1,000, 2,000, 3,000 Hz) pure-tone
average air-bone gap before and then 8-9 months after tympanoplasty, and the
results were compared statistically. Copyright (c) 2007 S. Karger AG, Basel.

Publication Types: 
    Randomized Controlled Trial

PMID: 17409778 [PubMed - indexed for MEDLINE]

455: Paediatr Drugs. 2007;9(2):119-23.

Pharmacokinetics of cefprozil in plasma and middle ear fluid: in children
undergoing treatment for acute otitis media.

Nicolau DP, Sutherland CA, Arguedas A, Dagan R, Pichichero ME.

Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, 
Connecticut 06102-5037, USA. dnicola@harthosp.org

BACKGROUND: Despite the wide-scale use of cefprozil for acute otitis media (AOM),
there are only limited data available regarding the pharmacokinetic profile of
this agent in the pediatric population. OBJECTIVE: To characterize the plasma and
middle ear fluid (MEF) pharmacokinetic profile of cefprozil in pediatric patients
with AOM. METHODS: Pharmacokinetic sampling was obtained as part of a phase IV,
multicenter, open-label study of children with AOM receiving cefprozil suspension
15 mg/kg twice daily. A single blood sample was obtained 4-6 days after the
initiation of cefprozil therapy and a simultaneous MEF sample was obtained by
tympanocentesis when clinically indicated. Cefprozil concentrations in both
matrices were determined using a validated high-performance liquid chromatography
methodology. A composite profile of cefprozil concentration data in each matrix
was constructed and values for the pharmacokinetic parameters were obtained using
conventional modeling techniques. RESULTS: Plasma concentrations were obtained in
53 children aged 6-48 months. In this population the maximum concentration
(C(max)) in plasma was 9.18 microg/mL, the time to C(max) (t(max)) was 1.5 hours,
and the terminal elimination half-life (t((1/2))(beta)) was 0.98 hours.
Simultaneous plasma and MEF concentration data were available in 22 children. In 
this subset the C(max) in plasma was 8.2 microg/mL, the t(max) was 1.9 hours, and
the t((1/2))(beta) was 1.02 hours; the corresponding MEF C(max) was 2.4
microg/mL, the t(max) was 3.5 hours, and the t((1/2))(beta) was 1.23 hours.
Cefprozil MEF penetration as assessed using the ratio of the area under the
concentration-time curves from the two matrices was 28%. Moreover, concentrations
in MEF approximated 1 microg/mL 6 hours' post-dose. CONCLUSIONS: The plasma
profile of cefprozil in the current analysis is consistent with previously
reported values in children receiving the 15 mg/kg twice daily dose. MEF
penetration and the duration of drug exposure at the site of infection support
the clinical utility of this agent for organisms with minimum inhibitory
concentrations (MIC) of < or =1 microg/mL. However, these results also predict
higher clinical failure when using this dose of cefprozil against
penicillin-non-susceptible Streptococcus pneumoniae or Haemophilus influenzae
because of typically higher MIC values for these organisms.

Publication Types: 
    Clinical Trial, Phase IV
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 17407367 [PubMed - indexed for MEDLINE]

456: Pediatrics. 2007 Apr;119(4):707-15.

Erratum in:
    Pediatrics. 2007 Jun;119(6):1270.

Reduction of frequent otitis media and pressure-equalizing tube insertions in
children after introduction of pneumococcal conjugate vaccine.

Poehling KA, Szilagyi PG, Grijalva CG, Martin SW, LaFleur B, Mitchel E, Barth RD,
Nuorti JP, Griffin MR.

Department of Pediatrics, Vanderbilt University Medical Center, Nashville,
Tennessee, USA. kpoehlin@wfubmc.edu

OBJECTIVE: Streptococcus pneumoniae is an important cause of otitis media in
children. In this study we estimated the effect of routine childhood immunization
with heptavalent pneumococcal conjugate vaccine on frequent otitis media (3
episodes in 6 months or 4 episodes in 1 year) and pressure-equalizing tube
insertions. PATIENTS AND METHODS: The study population included all children who 
were enrolled at birth in TennCare or selected upstate New York commercial
insurance plans as of July 1998 and continuously followed until 5 years old, loss
of health plan enrollment, study outcome, or end of the study. We compared the
risk of developing frequent otitis media or having pressure-equalizing tube
insertion for 4 birth cohorts (1998-1999, 1999-2000, 2000-2001, and 2001-2002) by
using Cox regression analysis. We used data from the National Immunization Survey
to estimate the heptavalent pneumococcal conjugate vaccine uptake for children in
these 4 birth cohorts in Tennessee and New York. RESULTS: The proportion of
children in Tennessee and New York who received at least 3 doses of heptavalent
pneumococcal conjugate vaccine by 2 years of age increased from < or = 1% for the
1998-1999 birth cohort to approximately 75% for the 2000-2001 birth cohort. By
age 2 years, 29% of Tennessee and New York children born in 2000-2001 had
developed frequent otitis media, and 6% of each of these birth cohorts had
pressure-equalizing tubes inserted. Comparing the 2000-2001 birth cohort to the
1998-1999 birth cohort, frequent otitis media declined by 17% and 28%, and
pressure-equalizing tube insertions declined by 16% and 23% for Tennessee and New
York children, respectively. For the 2000-2001 to the 2001-2002 birth cohort,
frequent otitis media and pressure-equalizing tubes remained stable in New York
but increased in Tennessee. CONCLUSIONS: After heptavalent pneumococcal conjugate
vaccine introduction, children were less likely to develop frequent otitis media 
or have pressure-equalizing tube insertions.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 17403841 [PubMed - indexed for MEDLINE]

457: J Laryngol Otol. 2007 Apr;121(4):338-40.

Comment in:
    J Laryngol Otol. 2008 Jun;122(6):653; author reply 653.

Accurate consent for insertion and later removal of grommets.

Sood S, Waddell A.

Department of Otolaryngology, Great Western Hospital, Swindon, Wiltshire, UK.
soodsalil@yahoo.com

Each year in the UK over 30,000 patients undergo insertion of grommets. The
grommet insertion may cause many problems like persistent otorrhoea, scarred
drum, retraction pockets and retention. The grommets may be extruded from the
middle ears by the normal epithelial migration mechanism once they have served
their purpose. These may become infected and require removal. We have analysed
the Department of Health Hospital Episode Statistics relating to the insertion
and removal of grommets (ventilation tubes). We have shown that 7.6 per cent of
patients who have grommets inserted will have grommets removed.

PMID: 17403263 [PubMed - indexed for MEDLINE]

458: J Emerg Med. 2007 Apr;32(3):279-84. Epub 2007 Feb 23.

Pediatric acute otitis media: the case for delayed antibiotic treatment.

Johnson NC, Holger JS.

Emergency Medicine Department, Regions Hospital, St. Paul, Minnesota 55101, USA.

Acute otitis media (AOM) is both a commonly diagnosed condition and a frequent
indication for antibiotic use in children. Recent literature suggests that
antibiotics are not needed in many children with AOM, as most cases resolve
spontaneously without complication. However, a majority of AOM infections in
children are still treated with antibiotics. The American Academy of Pediatrics
and American Academy of Family Physicians released a guideline for treatment of
AOM in children. We review the guideline as well as scientific evidence related
to AOM treatment options. We support a set of evidence-based guidelines employing
a delayed prescription option for antibiotic therapy in selected children. If
used appropriately, these cost-effective guidelines will reduce the amount of
antibiotics prescribed, increase parental satisfaction, and may lower rates of
antibiotic resistance while producing similar rates of resolution of AOM.

Publication Types: 
    Review

PMID: 17394992 [PubMed - indexed for MEDLINE]

459: Antimicrob Agents Chemother. 2007 Jun;51(6):2230-5. Epub 2007 Mar 26.

Activity of faropenem against middle ear fluid pathogens from children with acute
otitis media in Costa Rica and Israel.

Stone KC, Dagan R, Arguedas A, Leibovitz E, Wang E, Echols RM, Janjic N,
Critchley IA.

Replidyne Inc., 1450 Infinite Drive, Louisville, CO 80027, USA.

Faropenem was tested against 1,188 middle ear fluid pathogens from children in
Israel and Costa Rica. Against Streptococcus pneumoniae and Haemophilus
influenzae, faropenem was the most active beta-lactam, with activity that was
similar to or greater than of the other oral antimicrobial classes studied.
Faropenem was also active against Moraxella catarrhalis and Streptococcus
pyogenes.

PMID: 17387157 [PubMed - indexed for MEDLINE]

460: Acta Vet Hung. 2007 Mar;55(1):97-105.

In vitro antimicrobial activity of the leaf extract of Harungana madagascariensis
Lam. Ex Poir. (Hypericaceae) against strains causing otitis externa in dogs and
cats.

Moulari B, Pellequer Y, Chaumont JP, Guillaume YC, Millet J.

Equipe Sciences Séparatives et Biopharmaceutiques EA-3924, UFR de Médecine et de 
Pharmacie, Université de Franche-comté, Place Saint-Jacques, 25030 Besançon,
France. bricemoulari@msn.com

Otitis externa in dogs and cats is always caused by a combination of yeasts and
bacteria, among which the most important are Malassezia pachydermatis,
Staphylococcus intermedius and Pseudomonas species. These organisms often develop
resistance to classical antimicrobial agents. Therefore, the aim of this study
was to investigate the antimicrobial activities of an ethyl acetate leaf extract 
of Harungana madagascariensis against the organisms cited, to carry out the
phytochemical investigation of this extract and to determine its bioactive
chemical class using dilution techniques, the bioautography method and the
standard phytochemical method described by Harborne (1973). Phytochemical
analysis revealed the presence of saponins, tannins, flavonoids, alkaloids and
anthracenic derivatives. The bioassay showed that the antimicrobial properties
may be attributed to astilbin, a flavanone derivative identified on the basis of 
its spectroscopic data. The results suggest that the extract could be used in an 
antimicrobial preparation effective against the whole range of organisms
incriminated in otitis externa in dogs and cats, with a minimal inhibitory
concentration (MIC) of 250 microg/ml.

PMID: 17385560 [PubMed - indexed for MEDLINE]

461: Br J Oral Maxillofac Surg. 2007 Oct;45(7):527-33. Epub 2007 Mar 23.

Comment in:
    Br J Oral Maxillofac Surg. 2008 Jul;46(5):426.

The effect of early insertion of grommets on the development of speech in
children with cleft palates.

Merrick GD, Kunjur J, Watts R, Markus AF.

Taunton & Somerset Hospital, Taunton, TA1 5AE, United Kingdom.

The aim of this study was to find out whether simultaneous primary palatoplasty
and myringotomy was advantageous in the management of otitis media with effusion 
in children with cleft lip and palate and whether this combined operation
resulted in improvement in the early development of speech. Assessments of
hearing and speech were made in 50 consecutive patients with cleft lip and palate
who had the combined operation (the cleft group). The results were compared with 
those of an age- and sex-matched control group. The incidence of otitis media
with effusion in the cleft group was 24%, compared with 14% in the control group.
Assessment of speech using the cleft audit protocol for speech showed that 90% of
patients with clefts had speech-intelligibility ratings that were either normal
or showed only minor defects, compared with 98% of controls. Among patients with 
clefts, there was no evidence of cleft-type characteristics of speech in 58%.

PMID: 17383059 [PubMed - indexed for MEDLINE]

462: Eur Arch Otorhinolaryngol. 2007 Aug;264(8):955-8. Epub 2007 Mar 20.

Otogenic cerebellar abscess due to purulent labyrinthitis and defect of the
superior semicircular canal and its propagation through the endolymphatic sac.

Durisin M, Stöver T, Leinung M, Mangold A, Rittierodt M, Lenarz T.

Department of Otorhinolaryngology, Medical University of Hannover,
Carl-Neuberg-Strasse 1, 30625, Hannover, Germany. durisin.martin@mh-hannover.de

The otogenic cerebellar abscess still is one of the most dangerous complications 
of otitis media and implicates a high risk of mortality. Early diagnosis and
therapy are decisive factors for the chances of rehabilitation. Radiologic
imaging (CT/MRI) plays an important role. A broad-spectrum antibiotic according
to antibiogram is indispensable. The type of surgical intervention depends on the
cause and localization of the abscess. In this case the cerebellar abscess was a 
complication resulting from labyrinthitis, which was propagated through the
endolymphatic duct and sac to the posterior fossa dura. Consequently, it could be
cured ultimately only after petrosectomy and abscess drainage toward the mastoid 
cavity. It is mandatory to completely sanitize the infection surgically in order 
to avoid lethal complication especially in case of a delayed clinical course or
recurrent symptoms of labyrinth involvement. Close interdisciplinary
collaboration between ORL, neurosurgery and neuroradiology is desirable for
successful therapy.

Publication Types: 
    Case Reports

PMID: 17372752 [PubMed - indexed for MEDLINE]

463: Int J Audiol. 2007 Feb;46(2):94-6.

Permanent t-tube insertion in two patients with Hurler's syndrome.

Oghan F, Harputluoglu U, Guclu E, Guvey A, Turan N, Ozturk O.

Council of Forensic Medicine, ENT Department, Istanbul, Turkey.
fatihoghan@hotmail.com

Hearing loss in mucopolysaccharidosis is usually both conductive and
sensorineural. The conductive component is attributable to serous otitis media
secondary to dysfunction of the eustachian tube and chronic thickening of the
mucosa of the middle ear. The conductive component may persist after myringotomy 
and insertion of short-term or long-term ventilation tubes. In Hurler's syndrome,
death usually occurs in the first decade of life. In our study, we present two
cases, a three-year-old girl and a four-year-old boy, who were diagnosed with
Hurler's syndrome. Both children have a history of otitis media with effusion
requiring repeated short-term ventilation tube insertions that were unsuccessful.
Permanent t-tubes were inserted in both cases. Results showed an approximate 20
dB improvement in hearing sensitivity postoperatively for each patient.

Publication Types: 
    Case Reports

PMID: 17365060 [PubMed - indexed for MEDLINE]

464: Acta Otolaryngol. 2007 Mar;127(3):323-7.

Diagnosis of the pathological exposure of the mastoid portion of the facial nerve
by CT scanning.

Yu Z, Han D, Dai H, Zhao S, Zheng Y.

Department of Otolaryngology, Affiliated Beijing Tongren Hospital Capital of
University of Medical Sciences, Beijing, PR China. zilongyu88@yahoo.com

CONCLUSIONS: High resolution CT imaging can provide useful information about the 
pathological exposure of the mastoid portion of the facial nerve before mastoid
surgery and can assess the injury site of the facial nerve after operation.
OBJECTIVES: To evaluate the diagnostic value of high resolution CT scanning of
pathological exposure of the mastoid portion of facial nerve and provide valuable
information for otologic surgery, and to analyse the cause of facial nerve
paralysis after operation. MATERIALS AND METHODS: Routine CT scanning was used to
examine patients with chronic suppurative otitis media and external auditory
canal cholesteatoma preoperatively by axial-transverse and coronal views. If
there was any pathological exposure of the mastoid portion of the facial nerve on
CT imaging, then this was compared with intraoperative findings. In addition, one
patient who had suffered postoperative facial nerve paralysis was also examined
by CT scanning to determine whether any pre-existing pathological exposure of
facial nerve could be found. RESULTS: Through routine CT scanning six patients
with chronic suppurative otitis media and three patients with external auditory
canal cholesteatoma were found to have pathological exposure of the mastoid
portion of the facial nerve. Coronal views could more clearly show the size and
the position of the exposure; the corresponding surgical findings (pathological
exposure) for the facial nerve could be confirmed in all nine patients. CT
imaging could also show that the patient who had suffered postoperative facial
nerve paralysis did indeed have pre-existing pathological exposure of the mastoid
portion of the facial nerve.

PMID: 17364372 [PubMed - indexed for MEDLINE]

465: Acta Otolaryngol. 2007 Feb;127(2):132-7.

Tissular changes induced by Pseudomonas aeruginosa in an otitis media rat model
with tubal obstruction.

Trinidad A, Ramírez-Camacho R, García-Berrocal JR, Verdaguer JM, Vicente J, Daza 
R.

Department of Otorhinolaryngology, Hospital Universitario Puerta de Hierro,
Madrid, Spain. atrinid@yahoo.es

CONCLUSIONS. This is a suitable model for the study of different features of
middle ear inflammation. This model allows manipulations inside the middle ear
while preserving relevant structures such as the tympanic membrane, and provides 
a useful model for the study of interactions between bacterial infection and
eustachian tube dysfunction. OBJECTIVES. Analysis of early and late histological 
features in an experimental model of Pseudomonas aeruginosa middle ear
inoculation in the rat designed for the study of middle ear procedures. MATERIALS
AND METHODS. Thirty Wistar rats were inoculated with Pseudomonas aeruginosa in
the tympanic bulla followed by the cauterization of the eustachian tube.
Culturing of middle ear effusion was carried out at 7 days follow-up and at
sacrifice. Processing of the temporal bones for light microscopy was performed at
7, 14, 30 and 60 days. RESULTS. Early cultures were positive in most cases, thus 
proving that middle ear inflammation was due to the presence of inoculated
Pseudomona aeruginosa. Mucoperiosteal inflammatory changes similar to those
observed in human middle ear infection were seen. Acute inflammatory cell
infiltration was seen at 7 and 14 days, gradually decreasing to chronic
inflammatory changes with fibroplasia at 60 days. Bone resorption was observed at
7 and 14 days, changing to a bony deposition at 30 and 60 days.

PMID: 17364343 [PubMed - indexed for MEDLINE]

466: Acta Otolaryngol. 2007 Jan;127(1):93-7.

Mastoiditis complicated with Gradenigo syndrome and a hypertrophic
pachymeningitis with consequent communicating hydrocephalus.

Bravo D, Machová H, Hahn A, Marková H, Otruba L, Mandys V, Houstava L, Kalvach P.

Department of Neurology, Charles University, 3rd Medical Faculty and Faculty
Hospital Královské Vinohrady, Prague, Czech Republic. d.bravo@seznam.cz

We present the clinical, radiological and pathological features of a case of a
cranial hypertrophic pachymeningitis that developed in the course of mastoiditis 
and petrous apex inflammation and responded to immunosuppressive therapy only.
Documented by the development of clinical findings, magnetic resonance imaging,
cerebrospinal fluid changes, histopathology findings, by otosurgical intervention
and finally by the insertion of a ventriculo-peritoneal shunt, the case
illustrates a gradual development of pachymeningitis with consequent
hydrocephalus and intracranial hypertension. We consider this disease development
an example of immune-induced proliferative fibrotic changes in meninges.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 17364337 [PubMed - indexed for MEDLINE]

467: Acta Otolaryngol. 2007 Jan;127(1):29-33.

Paediatric otitis media surgery in Norway.

Karevold G, Haapkylä J, Pitkäranta A, Nafstad P, Kvaerner KJ.

Faculty Division of Akershus University Hospital, University of Oslo, Norway.
gunnhild@karevold.no

CONCLUSIONS: In Norway there are large, regional differences in the incidence of 
surgery and combinations of surgery for otitis media. OBJECTIVES: A descriptive
study of complete national administrative data on frequency of surgery for otitis
media in 2002. MATERIALS AND METHODS: This study analysed anonymous patient data 
from the Norwegian patient registry for 2002 and measured rates of tympanostomy
tube insertions, myringotomy and the combinations of adenoidectomies and
tympanostomy tubes and myringotomy, respectively. Surgical rates were assessed by
region and variations within the country were evaluated. RESULTS: The peak age
for surgical treatment of otitis media was 5 years. Tympanostomy tubes were
inserted in more than half of the children treated and the analysis showed
considerable regional variation in the rates and in choice of surgical treatment.

PMID: 17364326 [PubMed - indexed for MEDLINE]

468: Eur J Pediatr. 2007 Jun;166(6):511-9. Epub 2007 Mar 16.

What is new in otitis media?

Corbeel L.

Department of Pediatrics, University Hospital, Herestraat 49, Leuven, Belgium.
lucien.corbeel@med.kuleuven.be

The "wait and see" approach in acute otitis media (AOM), consisting of postponing
the antibiotic administration for a few days, has been advocated mainly to
counteract the increased bacterial resistance in respiratory infections. This
approach is not justified in children less than 2 years of age and this for
several reasons. First, AOM is an acute inflammation of the middle ear caused in 
about 70% of cases by bacteria. Redness and bulging of the tympanic membrane are 
characteristic findings in bacterial AOM. Second, AOM is associated with
long-term dysfunction of the inflamed eustachian tube (ET), particularly in
children less than 2 years of age. In this age group, the small calibre of the ET
together with its horizontal direction result in impaired clearance, ventilation 
and protection of the middle ear. Third, recent prospective studies have shown
poor long-term prognosis of AOM in children below 2 years with at least 50% of
recurrences and persisting otitis media with effusion (OME) in about 35% 6 months
after AOM. Viruses elicit AOM in about 30% of children. A prolonged course of AOM
has been observed when bacterial and viral infections are combined because viral 
infection is also associated with ET dysfunction in young children. Bacterial and
viral testing of the nasopharyngeal aspirate is an excellent tool both for
initial treatment and recurrence of AOM. Antibiotic treatment of AOM is mandatory
in children less than 2 years of age to decrease inflammation in the middle ear
but also of the ET particularly during the first episode. The best choice is
amoxicillin because of its superior penetration in the middle ear. Streptococci
pneumoniae with intermediary bacterial resistance to penicillin are particularly 
associated with recurrent AOM. Therefore the dosage of amoxicillin should be 90
mg/kg per day in three doses. In recurrent AOM with beta-lactamase-producing
bacilli, amoxicillin should be associated with clavulanic acid at a dose of 6.4
mg/kg per day. The duration of the treatment is not established yet but 10 days
is reasonable for a first episode of AOM. OME may be a precursor initiating AOM
but also a complication thereof. OME needs a watchful waiting approach. When
associated with deafness for 2-3 months in children over 2 years of age, an
antibiotic should be given according to the results of the bacterial resistance
in the nasopharyngeal aspirate. The high rate of complications of tympanostomy
tube insertion outweighs the beneficial effect on hearing loss. The poor results 
of this procedure are due to the absence of effects on ET dysfunction.
Pneumococcal vaccination has little beneficial effects on recurrent AOM and its
use in infants needs further studies. Treatment with amoxicillin is indicated in 
all children younger than 2 years with a first episode of AOM presenting with
redness and bulging of the tympanic membrane. Combined amoxicillin and clavulanic
acid should be given in patients with beta-lactamase-producing bacteria. The
duration of treatment is estimated to be at least 10 days depending on the
findings by pneumo-otoscopy and tympanometry. Bacterial and viral testing of the 
nasopharyngeal aspirate is highly recommended particularly in children in day
care centres as well as for regular follow-up. The high recurrence rate is due to
the long-lasting dysfunction of the eustachian tube and the immune immaturity of 
children less than 2 years of age.

Publication Types: 
    Review

PMID: 17364173 [PubMed - indexed for MEDLINE]

469: Eur Arch Otorhinolaryngol. 2007 Aug;264(8):849-54. Epub 2007 Mar 15.

Multilateral scrutiny of the Gülhane mastoidectomy.

Kahramanyol M, Aktaş D, Uçar C, Yetişer S.

Binses Sitesi, Umitköy, Ankara, Turkey. mkahramanyol@yahoo.com

This study has been conducted in order to analyze the outcomes of a previously
described technique for chronic otitis media surgery: the improved radical
mastoidectomy with flap (formerly IRMF), which consisted of improved radical
mastoidectomy (formerly IRM), inferiorly based fascioperiosteal flap and large
meatoconchoplasty (Kahramanyol, Ear Nose Throat J 71:70-77, 1992; Kahramanyol et 
al., Ear Nose Throat J 79:524-526, 2000). The technique is hereafter referred as 
the Gülhane mastoidectomy. During a period of 22 consecutive years, 255 patients 
have been operated on and treated utilizing the technique mentioned above.
Despite extensive otologic destruction and concomitant severe complications, the 
technique rendered impressive outcomes: the cavities became smaller over time and
remained healthy, providing good life quality for the patients. Cholesteatoma
recurrence was observed in but one patient. The outcomes confirm the value and
usefulness of the technique.

PMID: 17361415 [PubMed - indexed for MEDLINE]

470: Eur Arch Otorhinolaryngol. 2007 Aug;264(8):873-7. Epub 2007 Mar 15.

Tri-adcortyl ointment ear dressing in myringoplasty: an analysis of outcome.

Anderson O, Takwoingi YM.

Department of ENT, City Hospital, Dudley Road, Birmingham, B18 7QH, UK.

In a retrospective study of patients who had undergone myringoplasty at our
department within a 12-month period, we assessed the graft take rate using
tri-adcortyl ointment (TAO) as ear dressing. Data including age, site and size of
perforation, grade of surgeon, surgical approach, use of postoperative ear
dressings, complications and audiometric outcome was collected from the patient
notes and analysed. The overall success rate of the operation (with success being
defined as an intact tympanic membrane at 6 months) was noted. Seventy-seven
patients were operated, but data were complete on 64 patients and these
constituted the study population. TAO was used in 95% of the patients and BIPP
gauze pack in the remaining 5%. Age ranged from 8 to 63 years (mean 34 years).
Mean follow-up period was 13 months. Most of the operations (72.88%) were carried
out by consultants with a success rate of 89% and the remaining patients were
operated by trainees with a success rate of 88% (P = 1.000). The overall success 
rate was 89, 90.16% for TAO and 66.66% (2 out of 3) for BIPP (P = 0.298), 95% for
small and 86% for subtotal perforations (P = 0.573), 85% for anterior and 100%
for posterior perforations (P = 0.240), 91% for adult patients and 88% for
children (P = 1.000). TAO is a suitable ear dressing in myringoplasty. Routine
use of TAO did not affect the success rate of myringoplasty at our centre.

PMID: 17361408 [PubMed - indexed for MEDLINE]

471: Adv Med Sci. 2006;51:242-4.

Alternative therapies in antibiotic-resistant infection.

Weber-Dabrowska B, Zimecki M, Kruzel M, Kochanowska I, Lusiak-Szelachowska M.

Institute of Immunology and Experimental Therapy,e Polish Academy of Sciences,
Wrocław, Poland.

Case report: A 24-year-old woman suffering from post-influenza otitis media
infection was initially treated with several series of a steroid (Elocon) and a
combination of steroids and antibiotics (Atecortin, Dicortineff) without
significant medical benefit. The isolated bacterial strains were identified as
Staphylococcus homis and Staphylococcus epidermidis. Specific phage therapy
applied sequentially over a period of three weeks resulted only in a partial
reduction in inflammation and limited improvement in overall health condition.
Oral application of lactoferrin (LF; 50-mg daily oral doses for seven days with
two-week intervals) led to a complete clearance of both bacterial strains and
full recovery of the patient. The recovery was associated with increased
myelopoiesis and a sustained elevation of serum endogenous LF. In conclusion,
specific bacteriophage therapy combined with the administration of lactoferrin
proved to be effective in the treatment of antibiotic-resistant external ear
infection.

Publication Types: 
    Case Reports

PMID: 17357317 [PubMed - indexed for MEDLINE]

472: Vet Dermatol. 2007 Apr;18(2):120-6.

Variability of laboratory identification and antibiotic susceptibility reporting 
of Pseudomonas spp. isolates from dogs with chronic otitis externa.

Schick AE, Angus JC, Coyner KS.

Dermatology Clinic for Animals, Gilbert, Arizona, USA. antheaschick@gmail.com

The purpose of this study was to evaluate interlaboratory variation in isolation 
and antibiotic susceptibility pattern of Pseudomonas spp. as reported to
veterinarians for cases of canine chronic bacterial otitis externa. Twenty-six
dogs with unilateral or bilateral bacterial otitis externa from multiple referral
practices were included in this prospective study. Triplicate samples collected
simultaneously from the same location in the external ear canal were randomly
submitted to three laboratories for culture and susceptibility testing.
Pseudomonas spp. were isolated from 18 of 34 (53%) ears. All three laboratories
agreed on the presence of Pseudomonas spp. in 15 (83.3%) ears sampled. However,
two laboratories agreed on two (11.1%) occasions, and on one occasion (5.5%)
Pseudomonas spp. were identified in only one laboratory. Minimum inhibitory
concentration (MIC) susceptibilities to 11 antibiotics were compared between
laboratories B and C. Using laboratory-defined susceptibility of sensitive (S),
intermediate (I) and resistant (R), none of the 16 Pseudomonas spp. with MIC data
reported had identical patterns of antibiotic susceptibility. Agreement in
susceptibility to individual antibiotics was observed in 13 of 16 (81%) occasions
for amikacin and gentamicin, 10 of 16 (63%) occasions for ticarcillin, and nine
of 16 (56%) for enrofloxacin. These results indicate that Pseudomonas spp. were
identified by all three laboratories chosen for this study in 83% of the time.
Moreover, antibiotic susceptibility patterns and MIC values reported to
veterinarians may not agree between laboratories. Veterinarians should interpret 
bacterial culture and susceptibility results with multiple caveats including
variability between laboratories.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17355427 [PubMed - indexed for MEDLINE]

473: Vet Dermatol. 2007 Apr;18(2):115-9.

In vitro activity of an ear rinse containing tromethamine, EDTA, benzyl alcohol
and 0.1% ketoconazole on Malassezia organisms from dogs with otitis externa.

Cole LK, Luu DH, Rajala-Schultz PJ, Meadows C, Torres AH.

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The
Ohio State University, Columbus, OH 43210, USA. cole.143@osu.edu

The purpose of this study was to evaluate the in vitro activity of an ear rinse
containing tromethamine, EDTA, benzyl alcohol and 0.1% ketoconazole in purified
water on Malassezia organisms from dogs with otitis externa. Malassezia organisms
were collected from ear swab samples from the external ear canal of 19 dogs with 
otitis externa plus one control strain of Malassezia pachydermatis. Three test
solutions were evaluated: ER (EDTA, tromethamine, benzyl alcohol), ER + keto
(EDTA, tromethamine, benzyl alcohol, ketoconazole), and H2O (purified water).
Ten-millilitre aliquots of each test solution was transferred into 20 tubes and
inoculated with one of the isolates (1 tube per isolate: 19 clinical and 1
control strain). Samples were retrieved from each tube at five time points (0,
15, 30, 45 and 60 min), transferred to Petri dishes, mixed with Sabouraud
dextrose agar supplemented with 0.5% Tween 80 and incubated. Following
incubation, the plates were examined for growth and colonies counted as
colony-forming units per millilitre. The data were analysed using a repeated
measures analysis, with pair-wise comparisons of solution-time combinations.
There was a significant reduction in Malassezia growth in ER + keto at all time
points (P < 0.0001) compared to time zero. Neither ER nor H2O had any effect on
the growth of Malassezia. ER + keto was significantly more effective in reducing 
Malassezia growth (P < 0.0001) at all time points compared to both ER and H2O. ER
+ keto may be useful in the treatment of Malassezia otitis externa. Future
studies should be performed to evaluate the in vivo efficacy of ER + keto as
treatment for otic infections caused by Malassezia.

Publication Types: 
    In Vitro
    Research Support, Non-U.S. Gov't

PMID: 17355426 [PubMed - indexed for MEDLINE]

474: Vet Dermatol. 2007 Apr;18(2):69-77.

Evidence-based veterinary dermatology: a systematic review of interventions for
treatment of Pseudomonas otitis in dogs.

Nuttall T, Cole LK.

Faculty of Veterinary Science, The University of Liverpool Small Animal Teaching 
Hospital, Crown Street, Liverpool L7 7EX, UK. timn@liv.ac.uk

The efficacy and safety of pharmacological interventions to treat canine
Pseudomonas otitis externa and media were evaluated based on the systematic
review of clinical trials published between 1967 and 2006. Clinical trials were
included if Pseudomonas species were cultured from the ears of dogs with otitis
externa or otitis media prior to treatment, and if the outcome of these
interventions was reported at the end of the study. Studies were compared with
regard to design characteristics (randomization generation and concealment,
masking, intention-to-treat analyses), benefit (microbiological and/or clinical
resolution of the Pseudomonas otitis), and adverse effects. Ten trials reporting 
data on 162 patients and 13 different pharmacological interventions were
identified. Based on the accepted criteria for quality of evidence, there is
insufficient evidence for or against recommending the use of any of these
treatments for Pseudomonas otitis in dogs. This is largely because there is only 
one trial supporting the use of each treatment option and none were randomized
controlled trials. Future studies need to be prospective, randomized, blinded and
controlled; designed to evaluate pharmacological interventions for otitis
regardless of the infective organism; have appropriate statistical advice on
recruitment numbers, the power of the study and appropriate statistical analysis;
include details of underlying conditions and concomitant treatments; and be
designed such that inclusion criteria include microbial culture and antimicrobial
sensitivity, and outcome assessments include clinical examination, cytology and
microbial culture.

Publication Types: 
    Review

PMID: 17355420 [PubMed - indexed for MEDLINE]

475: AJNR Am J Neuroradiol. 2007 Mar;28(3):493-6.

Tuberculous otomastoiditis on high-resolution temporal bone CT: comparison with
nontuberculous otomastoiditis with and without cholesteatoma.

Rho MH, Kim DW, Kim SS, Sung YS, Kwon JS, Lee SW.

Department of Radiology, Masan Samsung Hospital, Sungkyunkwan University School
of Medicine, Masan, Korea. rhomh96@yahoo.com

BACKGROUND AND PURPOSE: Our purpose was to evaluate the differential findings of 
tuberculous otomastoiditis (TOM) and nontuberculous chronic otomastoiditis with
or without middle ear cholesteatoma on high-resolution CT of the temporal bone.
MATERIALS AND METHODS: We reviewed 19 cases of TOM, 30 cases of chronic
otomastoiditis (COM), and 30 cases of COM with cholesteatoma (CHOM), all of which
had been confirmed by pathologic examination after surgery or middle ear mucosal 
biopsy. Two neuroradiologists analyzed the findings of temporal bone CT. RESULTS:
The soft tissue attenuation in the entire middle ear cavity, preservation of the 
mastoid air cells without sclerotic change, and soft tissue extension to the
external auditory canal (EAC) or mucosal thickening of the bony EAC, had
statistical significance (chi(2) test, P < .05) between the TOM group and the COM
group and between the TOM group and the CHOM group. Erosion of the ossicles and
scutum was statistically significant (chi(2) test, P < .05) between the TOM group
and the CHOM group. CONCLUSION: Findings of soft tissue in the entire middle ear 
cavity, preservation of mastoid air cells without sclerotic change, soft tissue
extension, or mucosal thickening of the EAC with intact scutum seemed to be
helpful in differentiating TOM from COM and CHOM.

Publication Types: 
    Comparative Study

PMID: 17353320 [PubMed - indexed for MEDLINE]

476: Clin Nutr. 2007 Jun;26(3):314-21. Epub 2007 Mar 13.

Treatment of acute otitis media with probiotics in otitis-prone children-a
double-blind, placebo-controlled randomised study.

Hatakka K, Blomgren K, Pohjavuori S, Kaijalainen T, Poussa T, Leinonen M, Korpela
R, Pitkäranta A.

Valio Ltd, R&D, FIN-00039 Helsinki, Finland. katja.hatakka@valio.fi

BACKGROUND & AIMS: To examine whether probiotics would reduce the occurrence or
duration of acute otitis media (AOM), or the nasopharyngeal carriage of otitis
pathogens in otitis-prone children. METHODS: During this double-blind,
placebo-controlled, randomised, 24-week intervention, 309 otitis-prone children
(10 months-6 years) consumed either one probiotic capsule (Lactobacillus
rhamnosus GG and LC705, Bifidobacterium breve 99 and Propionibacterium
freudenreichii JS) (n=155) or placebo (n=154) daily. Clinical examinations were
carried out and nasopharyngeal samples taken three times. Parents recorded the
symptoms of upper respiratory infection (URI) in a diary. RESULTS: Probiotic
treatment did not reduce the occurrence (probiotic vs. placebo: 72% vs. 65%,
OR=1.48, 95% CI 0.87-2.52, p=n.s.) or the recurrence ( three) of AOM episodes
(18% vs. 17%, OR=1.04, 95% CI 0.55-1.96, p=n.s.). The median duration of AOM
episodes was 5.6 (IQR 3.5-9.4) vs. 6.0 (IQR 4.0-10.5) days, respectively (p=
n.s.). There was a tendency showing a reduction in the occurrence of recurrent (4
to 6) respiratory infections in the probiotic group (OR for 4 URIs: 0.56, 95%CI
0.31-0.99, p=0.046; OR for 6 URIs: 0.59, 95% CI 0.34 to 1.03, p=n.s.). Probiotics
did not affect the carriage of Streptococcus pneumoniae or Haemophilus
influenzae, but increased the prevalence of Moraxella catarrhalis (OR=1.79, 95%
CI 1.06-3.00, p=0.028). CONCLUSIONS: Probiotics did not prevent the occurrence of
AOM or the nasopharyngeal carriage of otitis pathogens in otitis-prone children. 
A tendency showing a reduction in recurrent respiratory infections must be
confirmed in further studies.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 17353072 [PubMed - indexed for MEDLINE]

477: J Laryngol Otol. 2008 Jan;122(1):21-4. Epub 2007 Mar 13.

Otitis media with effusion: what parents want to know.

Vlastos IM, Hajiioannou J, Houlakis M.

Department of Otolaryngology Head and Neck Surgery, Aghia Sophia Children's
Hospital, Athens, Greece. giannisvlastos@yahoo.gr

INTRODUCTION: Otitis media with effusion is a common condition of childhood. The 
development of an information leaflet for parents of children with the condition,
and its impact on clinical management, have not previously been examined.
PATIENTS AND METHODS: Eighteen doctors and 38 parents assessed the content of an 
information leaflet on otitis media with effusion, by applying two rounds of the 
modified Delphi technique. A qualitative assessment of content items was also
performed. RESULTS: From the 23-item list used in the first assessment round,
four items had a low doctor-parent agreement and seven were excluded. Differences
were also noticed in comments on the value of such leaflets, with parents being
more positive about the value of leaflet distribution. CONCLUSION: During the
consultation, doctors may not tell parents what they want to know, especially
regarding daily care of their child. An information leaflet, developed using the 
Delphi technique, can help reduce this discrepancy and increase parents'
satisfaction.

Publication Types: 
    Evaluation Studies

PMID: 17352846 [PubMed - indexed for MEDLINE]

478: Auris Nasus Larynx. 2007 Sep;34(3):379-82. Epub 2007 Mar 9.

Early diagnosis of Wegener's granulomatosis presenting with bilateral facial
paralysis and bilateral serous otitis media.

Ferri E, Armato E, Capuzzo P, Cavaleri S, Ianniello F.

Department of Otorhinolaryngology, General Hospital of Dolo, Riviera XXIX Aprile,
2, 30031 DOLO, Venice, Italy. emaferri@libero.it

Wegener's granulomatosis (WG) is a multi-system disease characterized by
granuloma formation and widespread necrotizing vasculitis. It classically
presents with involvement of the upper and lower respiratory tracts and renal
system. Facial nerve palsy and otologic manifestations have been reported during 
the course of the disease but it is extremely rare as the presenting features. In
Literature only one case of bilateral facial palsy as presenting sign of WG is
reported. The testing of anticytoplasmic antibodies versus neutrophil
polymorphonucleate granules (c-ANCA) are highly specific for the diagnosis of WG,
being positive in 97% of the cases. The early diagnosis and the timely medical
treatment lead to high rates of remission of an otherwise lethal disease. A case 
of WG presenting with bilateral facial paralysis and bilateral serous otitis
media is reported.

Publication Types: 
    Case Reports

PMID: 17350198 [PubMed - indexed for MEDLINE]

479: Diagn Microbiol Infect Dis. 2007 Mar;57(3 Suppl):19S-30S.

Oral beta-lactams in the treatment of acute otitis media.

Block SL, Doern GV, Pfaller MA.

Kentucky Pediatric/Adult Research, Bardstown, KY, USA.

Acute otitis media (AOM) is an important infectious disease among children
throughout the world. The management of AOM is complicated by difficulties in
diagnosis, spontaneous resolution, altered microbiology after pneumococcal
conjugate vaccine use, and expanding antimicrobial resistance. The recent
introduction of the heptavalent pneumococcal vaccine has resulted in a decrease
in AOM due to penicillin-nonsusceptible strains of Streptococcus pneumoniae
(PNSP) and an increase in infection due to beta-lactamase-positive nontypeable
Haemophilus influenzae. The results of in vitro susceptibility testing in the
context of broad surveillance programs provide useful information regarding the
potency and spectrum of the oral beta-lactam antibacterial agents used in the
treatment of AOM. The application of pharmacokinetic/pharmacodynamic breakpoints 
provides an effective means of projecting the potential clinical efficacy of the 
available agents. In view of what appears to be an increase prominence of
beta-lactamase-positive Gram-negative AOM pathogens and a decrease in PNSP, it
appears that empiric therapy for AOM should now include an agent with activity
against beta-lactamase-positive H. influenzae and S. pneumoniae.

Publication Types: 
    Review

PMID: 17349460 [PubMed - indexed for MEDLINE]

480: J Laryngol Otol. 2007 Aug;121(8):796-9. Epub 2007 Mar 12.

Idiopathic, inflammatory, medial meatal, fibrotising otitis presenting with
lichen planus.

Hopsu E, Pitkäranta A.

Department of Otorhinolaryngology, Kymenlaakso Central Hospital, Kotka, Finland. 
erkki.hopsu@kymshp.fi

BACKGROUND: Of the acquired ear canal atresias, idiopathic, inflammatory, medial 
meatal, fibrotising otitis has been suggested as a distinct disease entity, for
reasons of aetiology. OBJECTIVE: To report three more cases of idiopathic,
inflammatory, medial meatal, fibrotising otitis and to further consider the
possible relationship between this condition and lichen planus. PATIENTS: Three
adult patients with idiopathic, inflammatory, medial meatal, fibrotising otitis, 
two with bilateral aural symptoms, treated and followed up at the department of
otorhinolaryngology of Helsinki University Hospital. RESULTS: We found
idiopathic, inflammatory, medial meatal, fibrotising otitis, affecting solely the
glabrous skin of the osseous part of the external ear canals, in three patients
who also suffered from severe oral lichen planus. CONCLUSIONS: The aetiopathology
or pathophysiology of idiopathic, inflammatory, medial meatal, fibrotising otitis
may be linked with lichen planus. Early, active treatment of idiopathic,
inflammatory, medial meatal, fibrotising otitis with local corticosteroids may
prevent total medial meatal atresia.

Publication Types: 
    Case Reports

PMID: 17349098 [PubMed - indexed for MEDLINE]

481: J Am Board Fam Med. 2007 Mar-Apr;20(2):160-3.

Validity of parental reporting of recent episodes of acute otitis media: a Slone 
Center Office-Based Research (SCOR) Network study.

Vernacchio L, Vezina RM, Ozonoff A, Mitchell AA.

Slone Epidemiology Center at Boston University, 1010 Commonwealth Avenue, Boston,
MA 02215, USA. lvernacchio@slone.bu.edu

BACKGROUND: The validity of parental reporting of children's health outcomes is
an important methodological issue in community-based pediatric research. We
assessed the validity of parents' reports of their children's acute otitis media 
(AOM) history over the previous month in a pilot study of xylitol for AOM
prevention. METHODS: Parents of children participating in a study conducted in
the Slone Center Office-Based Research (SCOR) Network were interviewed monthly
for 3 months and asked whether their child had been diagnosed with AOM in the
previous month. A blinded physician reviewed medical records. Results from
parental interviews and medical records were compared by correlation analysis.
RESULTS: Medical records were obtained for 102 of 120 children (85.0%); 272
monthly interviews were completed. Kappa for the agreement between parental
reports and medical records was 0.88 [95% confidence intervals (CI): 0.76 to
0.94]. The positive predictive value of a parental report of an AOM episode
within the previous month was 85.0%, and the negative predictive value was 99.1%.
CONCLUSIONS: The results of this study suggest that parental reporting of
children's recent AOM history correlates well with medical records. Parental
interview is a reasonable approach to collecting data on recent AOM outcomes,
particularly in large-scale community-based studies where obtaining medical
records is often impractical.

Publication Types: 
    Multicenter Study
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural

PMID: 17341752 [PubMed - indexed for MEDLINE]

482: Eur Arch Otorhinolaryngol. 2007 Aug;264(8):867-71. Epub 2007 Mar 6.

Mastoid obliteration combined with soft-wall reconstruction of posterior ear
canal.

Takahashi H, Iwanaga T, Kaieda S, Fukuda T, Kumagami H, Takasaki K, Hasebe S,
Funabiki K.

Department of Otolaryngology - Head and Neck Surgery, Nagasaki University
Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501,
Japan. htak0831@nagasaki-u.ac.jp

To clarify the usefulness of modified soft-wall reconstruction method by combing 
with mastoid obliteration, 96 patients (98 ears) with their age ranging from 5 to
82 (average 51.3), including 62 ears with chronic otitis media (COM) with
cholesteatoma, 18 ears with non-cholesteatomatous COM, 14 ears with postoperative
cavity problem, and 4 ears with adhesive-type COM, who had soft-wall
reconstruction of the posterior ear canal and mastoid obliteration using mainly
bone powder following mastoidectomy, were evaluated their postoperative
conditions more than a year after surgery. Overall success rate was 76.5%
(75/98), and fresh cases showed better success rate (84.8%) than those with a
history of multiple surgeries (69.2%). Among unsuccessful cases, crust and/or
debris accumulation was observed most (nine ears), followed by persistent wet
condition (seven ears), and exposure of the obliterated material (five ears),
while only two ears showed a retraction pocket formation. The success rates
remained almost the same among those who were followed for more than 2 and 3
years (46/61, 75% and 21/28, 75%, respectively). In 60 ears on which
postoperative hearing was assessed, 41.7% showed less than 15 dB of air-bone gap 
(ABG), and 61.7% showed less than 20 dB of ABG. Mastoid obliteration with bone
powder in combination with soft-wall reconstruction of the posterior ear canal
appeared a useful method for obliterating mastoidectomized cavity especially for 
prevention of postoperative pocket formation.

PMID: 17340129 [PubMed - indexed for MEDLINE]

483: Int J Pediatr Otorhinolaryngol. 2007 May;71(5):705-12. Epub 2007 Mar 1.

A community based questionnaire study on the association between symptoms
suggestive of otitis media with effusion, rhinitis and asthma in primary school
children.

Umapathy D, Alles R, Scadding GK.

Audiological Medicine, Bolton PCT NHS Trust, Halliwell Child Development Centre, 
Aylesford Walk, Bolton BL1 3SQ, United Kingdom. Dolores.umapathy@bolton.nhs.uk

OBJECTIVES: To evaluate the association between symptoms suggestive of otitis
media with effusion (OME), rhinitis and asthma in an unselected population of
primary school children and investigate whether our previous observation of such 
an association in a secondary care setting was valid in the community.
METHODOLOGY: A specifically designed questionnaire was administered to 332 new
entrant primary school children across 11 state and independent primary schools
in the East Berkshire district between March and June 1996. It had six sections, 
to ascertain symptoms suggestive of OME, rhinitis, asthma, other atopic features,
treatment for any of these, and a possible family history of atopy. Within the
first three sections, each question was scored and weighted depending on the
importance of each in establishing the possible diagnoses, with three scoring
bands: '0' indicating the absence; '1-5' the possibility and '> or =6' a strong
likelihood that the above conditions were present. The outcome measures were the 
number of children with or without symptoms suggestive of OME, rhinitis, asthma, 
and the correlation of these symptom scores with each other and OME with eczema, 
other atopic manifestations, family history of atopy and educational system.
RESULTS: Thirty two point eight percent, thirty six point six percent and twenty 
four percent had symptoms suggestive of OME, rhinitis and asthma, respectively
with scores of either 1-5 or > or =6. There was a highly significant correlation 
between otological (OME) and nasal scores (p=0.00000), particularly obstructive
nasal symptoms (p=0.00000) and > or =6 upper respiratory tract infections/year
(p=0.00000); otological and chest scores suggestive of asthma (p=0.00001), and a 
family history of asthma (p=0.00178). No association was found between scores for
OME and eczema, urticaria, food or drug allergies. No differences were noted
between the sexes or educational systems. CONCLUSION: The highly significant
association between the symptom scores suggestive of OME and rhinitis in this
unselected population, indicates the importance of enquiring about nasal symptoms
in children with chronic OME, as appropriate treatment of rhinitis may improve
the child's quality of life, reduce health care utilisation and possibly reduce
the need for OME surgery.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Validation Studies

PMID: 17335912 [PubMed - indexed for MEDLINE]

484: BMC Complement Altern Med. 2007 Mar 2;7:7.

Homeopathic and conventional treatment for acute respiratory and ear complaints: 
a comparative study on outcome in the primary care setting.

Haidvogl M, Riley DS, Heger M, Brien S, Jong M, Fischer M, Lewith GT, Jansen G,
Thurneysen AE.

Ludwig Boltzmann Institute for Homeopathy, Graz, Austria.
max.haidvogl@meduni-graz.at <max.haidvogl@meduni-graz.at>

BACKGROUND: The aim of this study was to assess the effectiveness of homeopathy
compared to conventional treatment in acute respiratory and ear complaints in a
primary care setting. METHODS: The study was designed as an international,
multi-centre, comparative cohort study of non-randomised design. Patients,
presenting themselves with at least one chief complaint: acute (< or = 7 days)
runny nose, sore throat, ear pain, sinus pain or cough, were recruited at 57
primary care practices in Austria (8), Germany (8), the Netherlands (7), Russia
(6), Spain (6), Ukraine (4), United Kingdom (10) and the USA (8) and given either
homeopathic or conventional treatment. Therapy outcome was measured by using the 
response rate, defined as the proportion of patients experiencing 'complete
recovery' or 'major improvement' in each treatment group. The primary outcome
criterion was the response rate after 14 days of therapy. RESULTS: Data of 1,577 
patients were evaluated in the full analysis set of which 857 received
homeopathic (H) and 720 conventional (C) treatment. The majority of patients in
both groups reported their outcome after 14 days of treatment as complete
recovery or major improvement (H: 86.9%; C: 86.0%; p = 0.0003 for non-inferiority
testing). In the per-protocol set (H: 576 and C: 540 patients) similar results
were obtained (H: 87.7%; C: 86.9%; p = 0.0019). Further subgroup analysis of the 
full analysis set showed no differences of response rates after 14 days in
children (H: 88.5%; C: 84.5%) and adults (H: 85.6%; C: 86.6%). The unadjusted
odds ratio (OR) of the primary outcome criterion was 1.40 (0.89-2.22) in children
and 0.92 (0.63-1.34) in adults. Adjustments for demographic differences at
baseline did not significantly alter the OR. The response rates after 7 and 28
days also showed no significant differences between both treatment groups.
However, onset of improvement within the first 7 days after treatment was
significantly faster upon homeopathic treatment both in children (p = 0.0488) and
adults (p = 0.0001). Adverse drug reactions occurred more frequently in adults of
the conventional group than in the homeopathic group (C: 7.6%; H: 3.1%, p =
0.0032), whereas in children the occurrence of adverse drug reactions was not
significantly different (H: 2.0%; C: 2.4%, p = 0.7838). CONCLUSION: In primary
care, homeopathic treatment for acute respiratory and ear complaints was not
inferior to conventional treatment.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study

PMID: 17335565 [PubMed - indexed for MEDLINE]

485: Laryngoscope. 2007 Mar;117(3):522-8.

Effects of ciprofloxacin-dexamethasone on myringotomy wound healing.

Hebda PA, Yuksel S, Dohar JE.

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh,
Pittsburgh, Pennsylvania 15213, USA.

OBJECTIVE: To evaluate the effects of the ciprofloxacin-dexamethasone (CDX)
combination ototopical treatment after myringotomy on tympanic membrane (TM)
healing in ears with eustachian tube obstruction (ETO) and unobstructed ears.
STUDY DESIGN: Prospective, randomized, masked, controlled. METHODS: ETO was
created in the left ear of 30 rats to induce a model of otitis media with
effusion (OME). After 3 weeks, bilateral myringotomy was performed (day 0).
Animals were randomized into three groups to receive no treatment or bilateral
once daily ototopical treatment with balanced salt solution (BSS, vehicle) or CDX
for 13 days. Bilateral otomicroscopy was performed on days 7, 14, and 28. On day 
14, five randomly selected animals per group were humanely euthanized and the TM 
harvested for histology. Three additional rats provided normal negative control
ears for histologic comparisons. RESULTS: On day 14, TM perforation healing rates
were 100% in all ears of untreated and BSS-treated animals, 89% (8/9) in
CDX-treated obstructed ears, and 30% (3/10) in CDX-treated unobstructed ears (P <
.05 vs. BSS). On day 28, 100% (5/5) of the CDX-treated unobstructed ears and 80% 
(4/5) of the CDX-treated obstructed ears were healed. Histology showed initial TM
thickening postmyringotomy in all ears but no significant qualitative differences
between groups on day 28. CONCLUSION: Myringotomy healing was transiently
modulated by treatment with CDX but proceeded normally after CDX discontinuation.
This early modulation might enhance middle ear drainage and middle ear
concentrations of CDX when tympanostomy tube surgery is performed in patients
with active OME and ETO, thus potentially reducing otorrhea and preventing or
treating infection. It would not be expected to increase the risk of premature
tube extrusion or adversely affect normal healing of the TM after usual
spontaneous extrusion.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17334316 [PubMed - indexed for MEDLINE]

486: Laryngoscope. 2007 Mar;117(3):466-9.

No negative outcomes of childhood middle ear disease in adulthood.

Welch D, Dawes P.

Dunedin Multidisciplinary Health and Development Research Unit, Department of
Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, 
Dunedin, New Zealand. david.welch@dmhdru.otago.ac.nz

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.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17334307 [PubMed - indexed for MEDLINE]

487: Pediatrics. 2007 Mar;119(3):579-85.

Predictors of pain and/or fever at 3 to 7 days for children with acute otitis
media not treated initially with antibiotics: a meta-analysis of individual
patient data.

Rovers MM, Glasziou P, Appelman CL, Burke P, McCormick DP, Damoiseaux RA, Little 
P, Le Saux N, Hoes AW.

Julius Center for Health Sciences and Primary Care, University Medical Center
Utrecht, Stratenum 6.131, PO Box 85060, 3508 AB Utrecht, The Netherlands.
m.rovers@umcutrecht.nl

OBJECTIVE: The goal was to determine the predictors of a prolonged course for
children with acute otitis media. METHODS: A meta-analysis of data with the
observation groups of 6 randomized, controlled trials was performed. Participants
were 824 children, 6 months to 12 years of age, with acute otitis media. The
primary outcome was a prolonged course of acute otitis media, which was defined
as fever and/or pain at 3 to 7 days. RESULTS: Of the 824 included children, 303
had pain and/or fever at 3 to 7 days. Independent predictors of a prolonged
course were age of < 2 years and bilateral acute otitis media. The absolute risk 
of pain and/or fever at 3 to 7 days for children < 2 years of age with bilateral 
acute otitis media (20% of all children) was 55%, and that for children > or = 2 
years of age with unilateral acute otitis media (47% of all children) was 25%.
CONCLUSIONS: The risk of a prolonged course was 2 times higher for children < 2
years of age with bilateral acute otitis media than for children > or = 2 years
of age with unilateral acute otitis media. Clinicians can use these features (ie,
age of < 2 years and bilateral acute otitis media) to inform parents more
explicitly about the expected course of their child's otitis media and to explain
which features should prompt parents to contact their clinician for reexamination
of the child.

Publication Types: 
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review

PMID: 17332211 [PubMed - indexed for MEDLINE]

488: Clin Pediatr (Phila). 2007 Mar;46(2):99-108.

Consistency of diagnostic criteria for acute otitis media: a review of the recent
literature.

Chandler SM, Garcia SM, McCormick DP.

University of Texas Medical Branch, 400 Harbourside Drive, Galveston, TX 77555,
USA.

Clinicians use various criteria to diagnose acute otitis media (AOM). Using
American Academy of Pediatrics (AAP) guidelines, we reviewed the consistency of
AOM diagnosis in clinical trials (1994-2005). Eighty-one percent of the studies
required at least one of the three AAP criteria. Only 20% of the 88 studies met
all three AAP criteria for a diagnosis. We found no association between the
number of criteria met and study quality or industry sponsorship. Better
agreement on the definition of AOM using AAP criteria could facilitate a more
accurate clinical diagnosis and provide standardization of research and patient
care practices.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 17325082 [PubMed - indexed for MEDLINE]

489: Infect Immun. 2007 May;75(5):2562-71. Epub 2007 Feb 26.

Jun N-terminal protein kinase enhances middle ear mucosal proliferation during
bacterial otitis media.

Furukawa M, Ebmeyer J, Pak K, Austin DA, Melhus A, Webster NJ, Ryan AF.

Department of Surgery, UCSD School of Medicine, Fir Bldg., Rm. 106, 9500 Gilman
Dr. #0666, La Jolla, CA 92037, USA.

Mucosal hyperplasia is a characteristic component of otitis media. The present
study investigated the participation of signaling via the Jun N-terminal protein 
kinase (JNK) mitogen-activated protein kinase in middle ear mucosal hyperplasia
in animal models of bacterial otitis media. Otitis media was induced by the
inoculation of nontypeable Haemophilus influenzae into the middle ear cavity.
Western blotting revealed that phosphorylation of JNK isoforms in the middle ear 
mucosa preceded but paralleled mucosal hyperplasia in this in vivo rat model.
Nuclear JNK phosphorylation was observed in many cells of both the mucosal
epithelium and stroma by immunohistochemistry. In an in vitro model of primary
rat middle ear mucosal explants, bacterially induced mucosal growth was blocked
by the Rac/Cdc42 inhibitor Clostridium difficile toxin B, the mixed-lineage
kinase inhibitor CEP11004, and the JNK inhibitor SP600125. Finally, the JNK
inhibitor SP600125 significantly inhibited mucosal hyperplasia during in vivo
bacterial otitis media in guinea pigs. Inhibition of JNK in vivo resulted in a
diminished proliferative response, as shown by a local decrease in proliferating 
cell nuclear antigen protein expression by immunohistochemistry. We conclude that
activation of JNK is a critical pathway for bacterially induced mucosal
hyperplasia during otitis media, influencing tissue proliferation.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17325051 [PubMed - indexed for MEDLINE]

490: Otolaryngol Head Neck Surg. 2007 Mar;136(3):464-70.

Pepsin assay: a marker for reflux in pediatric glue ear.

Abd El-Fattah AM, Abdul Maksoud GA, Ramadan AS, Abdalla AF, Abdel Aziz MM.

Department of Otolaryngology, Mansoura University, Mansoura, Egypt.

OBJECTIVE: To evaluate if analysis of pepsin/pepsinogen in middle ear effusions
can be considered a diagnostic marker for laryngopharyngeal reflux (LPR) in
children with otitis media with effusion (OME). MATERIAL AND METHODS: Ambulatory 
24-hour dual-probe pH monitoring was carried out on 31 children with OME. Middle 
ear effusions were collected from 17 children during myringotomy. Total
pepsin/pepsinogen concentrations in effusions were measured by ELISA using
antipepsin antibody. RESULTS: Dual-probe pH monitoring showed that 22/31 (71%) of
the studied children had significant LPR. The concentrations of pepsin/pepsinogen
in middle ear effusions, ranged from 0.085 to 5.02 microg/ml, were found to be up
to 4.5 to 231.44 times higher than the serum levels. There was a significant
positive correlation between the level of pepsin/pepsinogen assayed in the
effusions of the 17 children and the number of pharyngeal reflux episodes
measured by pH monitoring. CONCLUSIONS: Control of LPR may be an essential
component in the successful management of OME in pediatric patients.
Pepsin/pepsinogen analysis in effusions of children, using ELISA, can be
considered a reliable marker for assessment of reflux in children with OME.

Publication Types: 
    Comparative Study

PMID: 17321879 [PubMed - indexed for MEDLINE]

491: J Laryngol Otol. 2007 Sep;121(9):897-901. Epub 2007 Feb 26.

Role of surgery in the management of otogenic meningitis.

Slovik Y, Kraus M, Leiberman A, Kaplan DM.

Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical
Center, Beer Sheva, Israel. youvals@bgumail.bgu.ac.il

Meningitis is a life-threatening complication of otitis media. The appropriate
management and the role of surgical intervention are still controversial, and
there are no evidence-based guidelines in this regard. We report three cases of
otogenic meningitis, initially treated with parenteral antibiotics and
myringotomy, followed by surgery. Two patients had an emergency mastoidectomy and
one patient underwent surgery one month post-recovery due to the suspicion of
bone erosion on a computed tomography scan. In two cases, a canal wall up
procedure was performed, and one patient underwent revision of a radical
mastoidectomy. In all cases, no pus or granulations were seen in the mastoid. Two
patients fully recovered and one patient died. We review the literature and
critically discuss the role, timing and preferred type of surgery for otogenic
meningitis.

Publication Types: 
    Case Reports
    Review

PMID: 17320000 [PubMed - indexed for MEDLINE]

492: J Laryngol Otol. 2007 Nov;121(11):1048-54. Epub 2007 Feb 26.

Otitis media in Brazilian human immunodeficiency virus infected children
undergoing antiretroviral therapy.

Miziara ID, Weber R, Araújo Filho BC, Pinheiro Neto CD.

Division of Clinical Otorhinolaryngology, Department of Otorhinolaryngology and
Ophthalmology, Medical School, University of Sao Paulo, Brazil. miz@uol.com.br

OBJECTIVE: To assess changes in the prevalence of otitis media, associated with
the use of highly active antiretroviral therapy, in Brazilian human
immunodeficiency virus (HIV) infected children. SETTING: Division of
otorhinolaryngology, Hospital das Clínicas, Sao Paulo University Medical School, 
Brazil. PATIENTS: A cohort of 459 HIV-infected children aged below 13 years. MAIN
OUTCOME MEASURES: The prevalence of otitis media and the serum cluster of
differentiation four glycoprotein T lymphocyte count were compared for children
receiving highly active antiretroviral therapy (with protease inhibitors) and
those receiving standard antiretroviral therapy (without protease inhibitors).
RESULTS: Otitis media was present in 33.1 per cent of the children. Children aged
from zero years to five years 11 months receiving highly active antiretroviral
therapy had a higher prevalence of acute otitis media (p=0.02) and a lower
prevalence of chronic otitis media (p=0.02). Children who were receiving highly
active antiretroviral therapy had a mean serum cluster of differentiation four
glycoprotein T lymphocyte count greater than that of those who were receiving
standard antiretroviral therapy (p<0.001). CONCLUSIONS: The use of highly active 
antiretroviral therapy in Brazilian HIV-infected children was associated with a
lower prevalence of chronic otitis media.

PMID: 17319998 [PubMed - indexed for MEDLINE]

493: J Laryngol Otol. 2007 Nov;121(11):1020-4. Epub 2007 Feb 26.

Pars flaccida retraction and mastoid size: relationship in clinically normal
specimens.

Todd NW.

Temporal Bone Laboratory, Emory University, Atlanta, Georgia 30322, USA.
ntodd@emory.edu

BACKGROUND: The relationship of pars flaccida retraction with epitympanic
aeration and mastoid size is ill-defined. Both pars flaccida retraction and small
mastoid size are traits of nearly all clinical entities of otitis media.
OBJECTIVES: To determine, in clinically normal specimens, the relationship of
pars flaccida retraction with mastoid pneumatisation and epitympanic aeration.
STUDY DESIGN: Post-mortem anatomical dissection of 41 bequeathed adult crania
without clinical otitis. METHODS: Pars flaccida retractions were viewed with an
operating microscope and judged using Sade's classification. Mastoid sizes were
determined radiographically (by plain Law lateral images). Ten crania, five with 
the largest mastoids and five with the smallest mastoids, were studied by
computed tomography. RESULTS: No specimen had a retraction worse than Sade grade 
two (i.e. retracted onto the neck of the malleus). Retractions were unrelated to 
the extent of mastoid pneumatisation. All epitympani were found to be normal on
both anatomical dissection and computed tomography imaging. CONCLUSION: Pars
flaccida retraction is probably related to prior, presumably transient,
non-aeration of Prussak's space.

PMID: 17319992 [PubMed - indexed for MEDLINE]

494: J Laryngol Otol. 2007 Jun;121(6):530-4. Epub 2007 Feb 26.

Perichondritis of the auricle and its management.

Prasad HK, Sreedharan S, Prasad HS, Meyyappan MH, Harsha KS.

Department of Otolaryngology-Head & Neck Surgery, Kasturba Medical College,
Mangalore, Karnataka, India. kishorecprasad@yahoo.com

OBJECTIVE: To conduct a study of patients presenting with perichondritis of the
auricle and to analyse the possible aetiological factors responsible, the
bacteriological agents involved, the treatment modalities and the complications
of such infections. SETTING: Academic department of otolaryngology. DESIGN: A
retrospective clinical study of patients treated over a five-year period.
PARTICIPANTS: Sixty-one patients with clinically proven perichondritis of the
auricle, with or without diabetes mellitus (i.e. malignant otitis externa).
RESULTS: Based on the severity of the disease, otherwise uncomplicated patients
were assigned to group A and divided into three cohorts. Patients with
perichondritis secondary to malignant otitis externa were analysed separately as 
group B. Men formed the majority of the patients and most were young (16-35
years). Trauma was the main cause (46 per cent) and Pseudomonas aeruginosa the
most common micro-organism isolated. The condition was managed conservatively
with antibiotics alone in 19 patients (31 per cent) and these cases had no
residual deformity at follow up (group A, stage one). Incision and drainage was
performed in a further 19 patients (31 per cent), resulting in minor residual
deformity in one half (group A, stage two). Debridement was performed in 17
patients, and these patients had either gross (29 per cent) or minor residual
deformity (71 per cent; group A, stage three). Six patients with perichondritis
secondary to malignant otitis externa were managed by wound debridement via a
post-auricular approach; all had minor residual deformities. CONCLUSIONS:
Perichondritis can be divided into two groups, depending on cartilage loss and on
the presence or absence of malignant otitis externa. The treatment used and the
residual deformity that will ensue are entirely dependent on the stage of
disease.

PMID: 17319983 [PubMed - indexed for MEDLINE]

495: J Med Microbiol. 2007 Mar;56(Pt 3):435-7.

Bordetella petrii from a clinical sample in Australia: isolation and molecular
identification.

Stark D, Riley LA, Harkness J, Marriott D.

Department of Microbiology, St Vincent's Hospital, Darlinghurst 2010, NSW,
Australia. dstark@stvincents.com.au

The first isolation of Bordetella petrii from a patient with chronic suppurative 
mastoiditis is reported. Molecular characterization of the isolate was performed 
by sequencing the small-subunit rRNA gene, the Bordetella outer-membrane protein 
A gene (ompA) and the RisA response regulator gene (risA). This is the first
reported case of B. petrii causing suppurative mastoiditis and only the second
documented case of a clinically significant B. petrii isolate.

Publication Types: 
    Case Reports

PMID: 17314377 [PubMed - indexed for MEDLINE]

496: Microbiol Immunol. 2007;51(2):223-30.

Colonization and turnover of Streptococcus pneumoniae, Haemophilus influenzae,
and Moraxella catarrhalis in otitis-prone children.

Yokota S, Harimaya A, Sato K, Somekawa Y, Himi T, Fujii N.

Department of Microbiology, Sapporo Medical University School of Medicine,
Hokkaido, Japan.

Recurrent otitis media are frequently intractable during childhood. It is unclear
whether recurrent otitis media is caused by etiological bacteria colonization or 
by new infections. Streptococcus pneumoniae, Haemophilus influenzae and Moraxella
catarrhalis were isolated from the nasopharynx of 7 otitisprone and 2 non-prone
children with recurrent otitis media. Plural bacterial species and strains were
found in all children while affected by otitis media. The same strain was
repeatedly isolated from all otitisprone children even after administration of
antibiotics but was not from the non-prone children. Antibiotic susceptibility
did not differ significantly among the same repeatedly isolated strains. This
pilot study suggests that the etiological bacteria tend to colonize and is hard
to eliminate in otitis-prone children.

PMID: 17310090 [PubMed - indexed for MEDLINE]

497: Int J Pediatr Otorhinolaryngol. 2007 Apr;71(4):623-8. Epub 2007 Feb 14.

Efficacy of vitamin A in experimentally induced acute otitis media.

Aladag I, Guven M, Eyibilen A, Sahin S, Köseoglu D.

Gaziosmanpasa University Medical Faculty, Department of Otorhinolaryngology,
60100 Tokat, Turkey. ibrahimal@hotmail.com

OBJECTIVE: Vitamin A plays a role in the prevention of oxidative tissue damage.
In the present study we investigated therapeutic role of this substance on
healing of middle ear mucosa in experimental acute otitis media (AOM). MATERIALS 
AND METHODS: Otitis media was induced by inoculating Streptococcus pneumoniae via
transtympanic injection. Thirty rats were divided into two groups. Group I
treated with parenteral ampiciline-sulbactam. Group II received same antibiotic
regimen and parenteral single dose of 100,000 IU vitamin A in palmitate form. At 
tenth day post-inoculation, animals were sacrificed and mucosal samples were
excised from the infected tympanic cavities for histpathological examination and 
blood samples were obtained for measurements of activities of superoxide
dismutase (SOD), glutathione peroxidase (GSH-Px) and evaluation of levels of
malondialdehyde (MDA) and nitric oxide (NO). RESULTS: All the infected middle ear
mucosas displayed various degrees of the inflammation, but there was no
meaningful difference between two groups. However, epithelial integrity was
significantly better in group II than group I (p<0.01). While serum NO and MDA
levels decreased in the group receiving both antibiotic and vitamin A, serum SOD 
and GSH activity were found to increased. All of the statistical differences are 
significant. CONCLUSIONS: Pretreatment with vitamin A increases antioxidant
enzyme activities and reduces formation of NO and MDA. Vitamin A may be
considered as an additional medicament for the medical treatment of AOM.

PMID: 17303254 [PubMed - indexed for MEDLINE]

498: Clin Otolaryngol. 2007 Feb;32(1):42-6.

Can we accurately interpret drawings of ears with retractions?

Pothier DD, Awad Z.

Department on ENT, Royal United Hospital, Bath, UK. mail@davepothier.com

Retraction pockets of the pars tensa and flaccida are commonly drawn to monitor
the condition. The clinical value of such drawings has not been assessed. This
study shows that the ability to recognise an identical ear to a reference
photograph from a drawing is poor. Using a drawing to identify the relative stage
of a retraction from a drawing is unreliable. Otoendoscopic photographs are
likely to be more reliable.

PMID: 17298311 [PubMed - indexed for MEDLINE]

499: J Laryngol Otol. 2007 Apr;121(4):401-3. Epub 2007 Feb 13.

Pneumocephalus as a delayed mastoidectomy complication.

Jégoux F, Godey B, Riffaud L, Morandi X.

Department of Otorhinolaryngology, Centre Hospitalier et Universitaire
Pontchaillou, Rennes, France. franck.jegoux@chu-rennes.fr

We report the case of a 43-year-old woman who presented with a spontaneous
pneumocephalus, 37 years after a mastoidectomy. Clinical examination showed a
cerebrospinal fluid leak, meningeal herniation in the superior part of the middle
ear, and an audible noise from her ear when she stood up due to the entrance of
air into the cranium. A computed tomography scan and magnetic resonance imaging
showed the complete destruction of the tegmen tympani and the pneumocephalus in
the temporal lobe. The patient underwent an emergency operation via a double
middle-ear and subtemporal approach. The meningoencephalocoele and pneumocephalus
were probably due to long term pressure upon too thin a tegmen
tympani.Pneumocephalus should be considered as a potential delayed post-operative
complication of middle-ear surgery. Computed tomography and magnetic resonance
imaging scanning supply accurate information and enable a planned surgical
approach; they also allow a pathophysiological understanding and a correlation
between the clinical signs and the radiological and peri-operative findings.

Publication Types: 
    Case Reports

PMID: 17295938 [PubMed - indexed for MEDLINE]

500: J Laryngol Otol. 2007 Sep;121(9):832-9. Epub 2007 Feb 13.

Canal wall down tympanomastoidectomy: the 'on-disease' approach for retraction
pockets and cholesteatoma.

Grewal DS, Hathiram BT, Saraiya SV.

Department of Ear, Nose, Throat and Head and Neck Surgery, Topiwala National
Medical College and B Y L Nair Charitable Hospital, Mumbai, Maharashtra, India.
drdsgrewal@rediffmail.com

It is well known that cholesteatoma is three-dimensional; hence, we feel that its
surgical management requires a three-dimensional approach in order to achieve the
best curative and functional results. Retraction pockets are undeniably caused by
chronic and recurrent eustachian tube obstruction. However, we found that the
presence of a large mastoid antrum was an important, additional aetiological
factor in the formation of a retraction pocket and its progression to
cholesteatoma formation, with bone destruction and subsequent complications.
Canal wall down tympanomastoidectomy--the 'on-disease' approach--is an
innovative, three-dimensional technique based on universally accepted surgical
principles. We modified the technique to ensure complete exposure and thereby
eradication of the disease, with a resultant small cavity. Working in a
three-dimensional field, we began drilling at the posterior meatal wall, lowering
it while simultaneously widening the cavity as the mastoid was drilled to reach
the antrum and the aditus. The bridge was lowered and the incus removed to
completely expose the entire disease. The facial ridge was debulked and the
temporalis fascia graft placed so as to simplify the middle-ear cleft. We present
a comprehensive report of this technique, based upon 600 patients studied
retrospectively over a five-year period. After one-year follow up, 546 patients
had a dry, healed cavity. Canal wall down tympanomastoidectomy performed by the
on-disease approach ensures complete eradication of the disease, with excellent
curative as well as functional results.

PMID: 17295937 [PubMed - indexed for MEDLINE]

501: Laryngoscope. 2007 Mar;117(3):427-33.

Adenoidectomy for middle ear effusion: a study of 50,000 children over 24 years.

Kadhim AL, Spilsbury K, Semmens JB, Coates HL, Lannigan FJ.

Department of Paediatric Otolaryngology, Princess Margaret Hospital, Perth,
Western Australia.

OBJECTIVE: To compare the incidence and outcomes of myringotomy plus ventilation 
tube insertion (MVTI) alone and that concurrent with pharyngeal surgery
(adenoidectomy, adenotonsillectomy, or tonsillectomy) at a population level.
STUDY DESIGN: Observational, retrospective, population-based study using hospital
administrative data. METHODS: All hospital morbidity information was obtained for
children who underwent a first MVTI procedure while less than 10 years of age in 
any Western Australian hospital from 1981 to 2004. Further MVTI procedures and
additional pharyngeal surgery were subsequently identified for each child.
RESULTS: There were 51,373 children less than 10 years of age who underwent at
least one MVTI procedure from 1981 to 2004. Twenty-nine percent underwent
pharyngeal surgery at the time of first MVTI procedure, and of these, 7.4%
(1,096) had pharyngeal surgery in the absence of adenoid or tonsil disease.
Adenoid surgery at time of MVTI was associated with reduced odds of subsequent
MVTI procedures in children with or without adenoid/tonsil disease. In more
recent calendar periods, no differences in the length of hospital stay between
MVTI alone and with adenoidectomy was observed, whereas procedures involving
tonsils required an additional bed day per procedure and were associated with
more episodes of operative and postoperative hemorrhage. CONCLUSION: Having
adenoidectomy or adenotonsillectomy surgery at time of first or subsequent MVTI
was associated with reduced risk of further MVTI surgery. The low complication
rates for adenoidectomy and short hospital stays make adjunctive adenoidectomy a 
potentially cost-effective first line management option for otitis media with
effusion.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17279052 [PubMed - indexed for MEDLINE]

502: Laryngoscope. 2007 Feb;117(2):264-7.

Complications of chronic suppurative otitis media and their management.

Dubey SP, Larawin V.

Department of Ear, Nose and Throat, Port Moresby General Hospital, Papua, New
Guinea. dubeysp@datec.net.pg

OBJECTIVE: The objective of this is to determine the incidence of otogenic
complications of chronic suppurative otitis media (CSOM) and its management.
STUDY DESIGN: The authors conducted a retrospective study. METHODS: The study was
conducted at the tertiary referral and teaching hospital. An analysis was made
about the clinical and operative findings, surgical techniques and approaches,
the overall management and recovery of the patients. The data were then compared 
with the relevant and available literature. RESULTS: Of the 70 cases, 47 (67%)
had a single complication, of which eight (11%) had intracranial and 39 (56%) had
extracranial complications. Twenty-three (33%) had two or more complications. The
commonly encountered intracranial complications were otitic meningitis, lateral
sinus thrombosis, and cerebellar abscess, which were seen in 13 (19%), 10 (14%), 
and 6 (9%) cases, respectively. Among the extracranial complications, mastoid
abscess, postauricular fistula, and facial palsy were encountered in 26 (37%), 17
(24%) and 10 (14%) patients, respectively. Surgeries were the main mode of
treatment for these conditions. According to severity, we found four different
types of the lateral sinus involvement. Three patients with otitic facial palsy
failed to regain full facial function despite surgery. A total of nine patients
with the diagnosis of otitic meningitis, lateral sinus thrombosis and
interhemispheric abscess expired. It constituted the mortality rate of 13% in our
study. CONCLUSION: CSOM complications, despite its reduced incidence, still pose 
a great challenge in developing countries as the disease present in the advanced 
stage leading to difficulty in management and consequently higher morbidity and
mortality.

Publication Types: 
    Comparative Study

PMID: 17277619 [PubMed - indexed for MEDLINE]

503: Laryngoscope. 2007 Feb;117(2):231-7.

Laser eustachian tuboplasty: two-year results.

Poe DS, Grimmer JF, Metson R.

Department of Otology and Laryngology, Harvard Medical School, Boston,
Massachusetts, USA. dennis.poe@childrens.harvard.edu

OBJECTIVE/HYPOTHESIS: Laser eustachian tuboplasty (LETP) combined with
appropriate medical management will eliminate the chronic presence of middle ear 
effusions in selected patients. METHODS: The study population consisted of 13
adults with otitis media with effusion (OME). Patients underwent slow-motion
video endoscopy to identify the location and extent of surgical resection. A
diode or argon laser was used to vaporize areas of hypertrophic mucosa and
submucosa along the cartilaginous eustachian tube. Patients were evaluated at 6, 
12, and 24 months. Successful outcome was defined as absence of OME. Patients
with evidence of reflux disease or allergic rhinitis were treated with medical
therapy before surgery and throughout the follow-up period as indicated. RESULTS:
LETP combined with medical management eliminated OME in 36% (4 of 11) of patients
at 6 months, 40% (4 of 10) at 1 year, and 38% (3 of 8) at 2 years. Failure of
LETP correlated with presence of laryngopharyngeal reflux (P = .01) or allergic
disease (P = .05) for the results at 1 year but not at 2 years. CONCLUSIONS: LETP
combined with appropriate medical management may be an effective treatment in
select patients with chronic persistent eustachian tube dysfunction. A controlled
trial with a larger number of subjects will be necessary to determine the
efficacy of LETP and identify those factors predictive of successful outcome.

PMID: 17277615 [PubMed - indexed for MEDLINE]

504: Laryngoscope. 2007 Feb;117(2):215-9.

5-Fluorouracil ointment for the treatment of otitis media with effusion.

Kanemaru S, Nakamura T, Yamashita M, Magrfov A, Omori K, Ito J.

Department of Otolaryngology-Head and Neck Surgery Graduate School of Medicine,
Kyoto University, Kyoto, Japan. kanemaru@ent.kuhp.kyoto-u.ac.jp

OBJECTIVES/HYPOTHESIS: Our aim was to evaluate the combined effect of
5-fluorouracil (5-FU) and myringotomy for the treatment of otitis media with
effusion (OME). OME is usually treated with medication, myringotomy, or insertion
of a ventilation tube (VT). Except for VT insertion, however, treatment effects
are short-lived. VT insertion has numerous sequelae: increased susceptibility to 
infection, large perforation of the tympanic membrane, cholesteatoma, and
eventual hearing deterioration. We estimated the depressant action of 5-FU on
normal cell proliferation in vitro. In addition, clinically, we assessed whether 
5-FU has the potential to prolong the effect of myringotomy. STUDY DESIGN: An in 
vitro study and a clinical study were conducted. MATERIALS AND METHODS: In study 
I, fibroblasts harvested from the peritoneum of three green fluorescent protein
transgenic mice were cultured with different doses of 5-FU. After 2 weeks, their 
proliferation rates were compared. In study II, patients (54 males, 47 females)
were selected randomly from a group of patients with intractable OME. Myringotomy
with or without a single dose of 5-FU ointment (approximately 0.10-0.30 mg) was
performed in group I (n = 64) and group II (n = 37), respectively. The natural
closure rates of the tympanic membrane were assessed in both groups. RESULTS: In 
vitro, 5-FU inhibited the growth of fibroblasts in a dose-dependent manner. The
average time to tympanic membrane closure was 20.5 days in group I and 8.1 days
in group II. No adverse events were observed in either group. CONCLUSIONS:
Topical application of 5-FU ointment is useful in prolonging the effect of
myringotomy. 5-FU ointment therapy is easy, safe, and cost-effective and may be
of wide application.

Publication Types: 
    Comparative Study

PMID: 17277614 [PubMed - indexed for MEDLINE]

505: Otolaryngol Head Neck Surg. 2007 Feb;136(2):159-68.

Caregiver well-being and child quality of life.

Boruk M, Lee P, Faynzilbert Y, Rosenfeld RM.

Department of Otolaryngology, SUNY Downstate Medical Center and The Long Island
College Hospital, Brooklyn, NY 11201-5514, USA.

OBJECTIVE: To describe the impact of otitis media on the child's family and
caregiver, and how this impact influences the caregiver's perception of child's
quality of life (QOL) and functional health status (FHS). STUDY DESIGN AND
SETTING: Prospective study of children aged 6 months to 12 years with recurrent
or chronic otitis media recruited from a primary care pediatrics practice and a
referral-based pediatric otolaryngology practice. Survey measures were assessed
for test-retest reliability, internal consistency, and validity. Multiple
regression analysis was used to explore relationships. RESULTS: We enrolled 159
families, with mean age of 3.3 years for the child and 34 years for the
caregiver. Most caregivers attended college (80%) and 64% were employed. The
Caregiver Impact Questionnaire (CIQ) had good test-retest reliability (r=0.83),
internal consistency (alpha=0.88), and construct validity (r=0.37 to 0.62). Most 
caregivers (52%) were nervous or agitated at least "some of the time" because of 
their child's ear problems, 29% lost sleep "a good bit of time," and 56% had to
change daily activities. Multivariate analysis showed that caregiver QOL
explained 62% of variability in child disease-specific QOL, and that caregiver
FHS explained up to 45% of the variability in child FHS. CONCLUSION: The 6-item
CIQ survey permits a valid and reliable assessment of otitis media impact on
caregivers and family functioning. Caregiver ratings of child QOL and FHS are
largely influenced by caregiver perceptions of their own personal situation.
SIGNIFICANCE: The caregiver QOL and FHS should be considered when using
proxy-completed surveys to assess the impact of otitis media on children.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17275533 [PubMed - indexed for MEDLINE]

506: FEMS Immunol Med Microbiol. 2007 Feb;49(1):75-83.

Role of Toll-like receptor 4 in innate immune responses in a mouse model of acute
otitis media.

Hirano T, Kodama S, Fujita K, Maeda K, Suzuki M.

Department of Otolaryngology, Faculty of Medicine, Oita University, Oita, Japan.

Nontypeable Haemophilus influenzae (NTHi) is considered a major pathogen
underlying middle ear infection. This study characterized the role of Toll-like
receptor 4 in the innate immune responses to acute otitis media induced by NTHi
in mice. We used C3H/HeJ mice, which have nonfunctional Toll-like receptor 4, and
normal wild-type C3H/HeN mice. NTHi were injected into the tympanic bulla, and
middle ear effusions and tissues were collected. In C3H/HeN mice, the severity of
acute otitis media decreased promptly with a significant reduction in bacterial
recovery from middle ear effusions 48 h after injection. In contrast, all C3H/HeJ
mice had otitis media at all time points examined, and increasing bacterial
counts from middle ear effusions were detected in C3H/HeJ mice 72 h after
injection. Expression of intracellular adhesion molecule-1 by the middle ear
mucosa paralleled the number of polymorphonuclear cells in the middle ear in both
strains. The findings of transmission electron microscopy revealed that
phagocytosis and phagosome maturation of polymorphonuclear cells was impaired in 
C3H/HeJ mice. Our findings indicate that Toll-like receptor 4 plays a part in the
early accumulation and functional promotion of polymorphonuclear cells in the
middle ear for eradicating NTHi infection.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17266713 [PubMed - indexed for MEDLINE]

507: J Prev Med Hyg. 2006 Dec;47(4):146-50.

Prevention and cure of rhinogenous deafness at the Thermal Baths "Bagni delle
Galleraie".

Tozzi A, Blancasio AC, Basagni C, Ricci C, Burzynska J, Battaglia MA.

Department of Physiopathology, Experimental Medicine and Public Health of Siena
University, Italy.

INTRODUCTION: Hearing is foundamental for human social life. Secretory Otitis
Media (SOM) is the most important cause of trasmissive hypoacusis in early
childhood. METHODS: The Department of Physiopathology, Experimental Medicine and 
Public Health of Siena University in collaboration with the Thermal Baths "Bagni 
delle Galleraie" proposed a prevention and cure campaign of rhinogenous deafness 
in June 2002 in some primary schools in the Colle val D'Elsa district. A sample
of 87 children was involved in the study (average age of 5,64 +/- 1,41 years). On
entering the thermal baths a questionnaire was administered to the parents, to
point out possible risk factors. RESULTS: Among the 87 children, 28 cases of SOM 
and 21 cases of severe tubal disorder were found. Only 19 cases out of 49 were
already known to the parents and only 28 joined the study and were examined for
three years consecutively. DISCUSSION: Out of the 35 children examined in 2002,
28 returned to "The Galleraie" for the two following years. They repeated the
thermal cure for two years as a preventive measure. At present they are not
affected by SOM and during the winters suffered a lower number of infections in
the primary airways and took less antibiotics. CONCLUSIONS: Our study focuses on 
infant school children because of their critical age for linguistic and social
development. Early diagnosis and therapy prevent any negative social development.

Publication Types: 
    Clinical Trial

PMID: 17263161 [PubMed - indexed for MEDLINE]

508: Ann Fam Med. 2007 Jan-Feb;5(1):29-38.

Cost-effectiveness analysis of treatment options for acute otitis media.

Coco AS.

Von Hess Healthcare Research Center, Family and Community Medicine, Lancaster
General Hospital, Lancaster, PA 17604-3555, USA. ascoco@lancastergeneral.org

PURPOSE: This study evaluated the costs and utility of observation and routine
antibiotic treatment options for children with acute otitis media. METHODS: The
cost-effectiveness analysis was performed among children aged 6 months to 12
years seen in primary care offices. The interventions studied were watchful
waiting as practiced in the Netherlands, delayed prescription, 5 days of
amoxicillin, and 7 to 10 days of amoxicillin. The main outcome measure was cost
per quality-adjusted life-year (QALY). RESULTS: In the base case analysis,
delayed prescription was the least costly option and 7 to 10 days of amoxicillin 
was the most effective. The incremental cost utility ratio (ICUR) of 7 to 10 days
of amoxicillin compared with delayed prescription was 56,000 dollars per QALY
gained. Watchful waiting and 5 days of amoxicillin were inferior options. The
results were sensitive to the rate of nonattendance in the delayed prescription
strategy: when the rate was less than 23%, watchful waiting was the least costly 
option and delayed prescription was an inferior option. Probabilistic sensitivity
analysis, in which all model variables were simultaneously varied, showed with
95% certainty that compared with delayed prescription, 7 to 10 days of
amoxicillin had a 61% probability of having an ICUR of greater than 50,000
dollars per QALY gained, and watchful waiting had a 23% probability of having an 
ICUR of less than 50,000 dollars per QALY gained. CONCLUSIONS: Economically, an
approach to the treatment of acute otitis media with either an initial period of 
observation or routine treatment with amoxicillin is reasonable.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17261862 [PubMed - indexed for MEDLINE]

509: Infect Immun. 2007 Apr;75(4):1794-800. Epub 2007 Jan 29.

Functional antibodies elicited by two heptavalent pneumococcal conjugate vaccines
in the Finnish Otitis Media Vaccine Trial.

Ekström N, Väkeväinen M, Verho J, Kilpi T, Käyhty H.

Dept. of Vaccines, National Public Health Institute, Mannerheimintie 166, 00300
Helsinki, Finland. nina.ekstrom@ktl.fi

In the Finnish Otitis Media Vaccine Trial, the now-licensed pneumococcal
conjugate vaccine containing polysaccharides conjugated to protein CRM(197)
(PncCRM) and the experimental pneumococcal polysaccharide-meningococcal outer
membrane protein complex conjugate vaccine (PncOMPC), showed similar efficacy
profiles against acute otitis media despite different antibody concentrations in 
sera. We now report the opsonophagocytic activities (OPA) in these sera. OPA,
antibody concentration, and avidity for serotypes 6B, 19F, and 23F were
determined in sera of infants who received either pneumococcal conjugate (PCV) or
control vaccine at 2, 4, and 6 months of age and either the homologous or
pneumococcal polysaccharide vaccine at 12 months of age. OPA varied by vaccine
and serotype. The majority of PCV recipients had positive OPA after the fourth
dose, while OPA was undetectable in the control group. Coinciding with the
efficacy data, the concentration of antibodies required for 50% killing was low
for 6B and high for 19F for both PCVs. Contradictory to the efficacy data,
PncOMPC induced lower functional capacity to 23F than PncCRM. OPA correlated with
antibody concentration, while avidity and functional capacity of antibodies
showed no correlation. The OPA data provide valuable additional information for
serotype-specific differences in protection and when evaluating serotype-specific
immunogenicity and should thus be considered when defining serological correlates
of protection.

Publication Types: 
    Clinical Trial
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 17261612 [PubMed - indexed for MEDLINE]

510: Pediatr Infect Dis J. 2007 Feb;26(2):97-106.

The efficacy of influenza vaccine for healthy children: a meta-analysis
evaluating potential sources of variation in efficacy estimates including study
quality.

Manzoli L, Schioppa F, Boccia A, Villari P.

Section of Epidemiology and Public Health, Department of Medicine and Aging
Sciences, University G. d'Annunzio, Chieti, Italy. lmanzoli@post.harvard.edu

BACKGROUND: Two systematic reviews evaluating influenza vaccine efficacy in
healthy children have recently been published. Although quantitative summary
estimates were similar, authors' conclusions were quite contrasting. We carried
out another meta-analysis reevaluating study inclusion criteria and using
metaregression techniques in addition to sensitivity and subgroups analyses to
evaluate potential sources of heterogeneity of efficacy estimates, including
methodologic quality of studies. METHODS: Only randomized clinical studies
assessing the efficacy of influenza vaccine in healthy children/adolescents (age 
< or =18 years) for preventing naturally occurring influenza and/or acute otitis 
media cases were included. Summary estimates of effect were obtained using a
random effects model. The methodologic quality of each study was assessed using 3
systems: Chalmers scale, Jadad scale and Schulz components (randomization,
allocation concealment and double-blinding). RESULTS: The overall vaccination
efficacy was 36% (95% confidence interval: 31-40%) against clinically diagnosed
illnesses (evaluated by 19 randomized clinical studies for a total of 247,517
children); 67% (51-78%) against laboratory-confirmed cases (18 trials, n = 8574);
and 51% (21-70%) against acute otitis media (11 trials, n = 11,349). Significant 
sources of between-study heterogeneity were participants' age and study quality
both directly correlated with the efficacy. When the analysis was performed
excluding USSR studies, the overall efficacy of the vaccine in preventing
clinical cases substantially increased (from 36% to 61%). CONCLUSIONS: These
findings may indicate that the vaccine efficacy might be greater than the overall
estimates. Although no safety and cost considerations are addressed in this
analysis, the present findings support vaccination as a possible option for the
prevention of influenza in healthy children and adolescents.

Publication Types: 
    Meta-Analysis
    Research Support, Non-U.S. Gov't

PMID: 17259870 [PubMed - indexed for MEDLINE]

511: Audiol Neurootol. 2007;12(3):155-9. Epub 2007 Jan 25.

Mechanism and rate of middle ear fluid absorption.

Petrova P, Freeman S, Sohmer H.

Department of Otolaryngology, Head and Neck Surgery, Hadassah University
Hospital, Jerusalem, Israel.

Several mechanisms have been suggested to explain the clearance of fluids from
the middle ear. These include a pumping action through the eustachian tube,
mucociliary beating through the tube, outflow of water to the blood due to
osmotic gradients and an active Na(+) transport driving water absorption. In
order to assess these mechanisms, the middle ear cavity of paralyzed, ventilated 
(eustachian tube occluded) guinea pigs was filled with fluids varying in osmotic 
pressure (hypotonic, isotonic, hypertonic) to which a vertical tube was attached.
The change in height of fluid in the tube was taken as a measure of changes in
middle ear fluid volume. A greater fluid volume reduction was seen with the
hypotonic (1/5 saline) solution. A small volume increase was observed with the
hypertonic solution. These results provide evidence that in these experimental
conditions, water absorption due to osmotic gradients can contribute to middle
ear fluid clearance. Copyright 2007 S. Karger AG, Basel.

PMID: 17259701 [PubMed - indexed for MEDLINE]

512: Vaccine. 2007 Mar 1;25(11):1962-8. Epub 2006 Dec 26.

ELISA IgG concentrations and opsonophagocytic activity following pneumococcal
protein D conjugate vaccination and relationship to efficacy against acute otitis
media.

Schuerman L, Prymula R, Henckaerts I, Poolman J.

GlaxoSmithKline Biologicals, Rixensart, Belgium.

We explored the relationship between efficacy against acute otitis media (AOM)
and both ELISA anti-polysaccharide IgG geometric mean concentrations (GMCs) and
opsonophagocytic (OPA) geometric mean titres (GMTs) following primary and booster
vaccination with pneumococcal protein D (Haemophilus influenzae-derived)
conjugate vaccine. It was possible to distinguish between the OPA GMTs of low and
high efficacy serotypes, however no such distinction was evident for ELISA GMCs. 
Also, there was a trend towards lower ELISA and OPA serotype-specific responses
in subjects who developed AOM compared to controls. We conclude that
serotype-specific OPA GMTs are an important endpoint to consider for evaluation
of pneumococcal conjugate vaccines with respect to the protective efficacy
against AOM (Study ID: 347414/NCT00119743).

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 17258357 [PubMed - indexed for MEDLINE]

513: Auris Nasus Larynx. 2007 Sep;34(3):365-8. Epub 2007 Jan 25.

Surgical treatment of medial meatal fibrosis. Report of four cases.

Suzukawa K, Karino S, Yamasoba T.

Department of Otolaryngology Head and Neck Surgery, University of Tokyo, Hongo
7-3-1, Bunkyo-ku, Tokyo 113-8665, Japan. suzukawa-tky@umin.ac.jp

OBJECTIVE: We describe four cases of medial meatal fibrosis, a rare condition of 
the external auditory canal, in which hearing improved following surgery.
METHODS: Four patients with medial meatal fibrosis underwent surgical treatment
and had been followed at the University of Tokyo during the last 5 years. We
examined hearing improvement and recurrence. A patient had graft-versus-host
disease (GVHD) with her urethra and vagina, and two patients had methicillin
resistant Staphylococcus aureus (MRSA) infection with their affected ears.
RESULTS: All cases got hearing improvement without any major complications.
CONCLUSIONS: Medial meatal fibrosis may be treated satisfactory with surgical
interventions.

PMID: 17257793 [PubMed - indexed for MEDLINE]

514: B-ENT. 2006;2(4):181-4.

Horner's syndrome as a complication of acute otitis media.

Straetmans J, Lok W, Stokroos R.

Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital
Maastricht, The Netherlands.

A seventeen-year-old girl presented with acute otitis media, unilateral miosis
and ptosis (partial Horner's syndrome) and tenderness of the ipsilateral jugular 
vein. A culture of the otorrhoea showed Staphylococcus aureus and Streptococcus
pyogenes. A CT scan revealed an infiltrate near the ipsilateral carotid artery
and jugular vein. The patient was hospitalised and treated with antibiotics.
Clinical signs disappeared within 6 days. This report discusses the first case
with a partial Horner's syndrome as an unusual complication of acute otitis media
(AOM). Imaging studies suggest extracranial lymphatic spread of the infection
along the adjacent jugular vein causing pressure on the postsynaptic sympathetic 
fibres. Recognition of the Horner's syndrome is of importance because it may be
an early sign of an extracranial complication of AOM.

Publication Types: 
    Case Reports

PMID: 17256405 [PubMed - indexed for MEDLINE]

515: Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004163.

Update of:
    Cochrane Database Syst Rev. 2003;(2):CD004163.

Identification of children in the first four years of life for early treatment
for otitis media with effusion.

Simpson SA, Thomas CL, van der Linden MK, Macmillan H, van der Wouden JC, Butler 
C.

Cardiff University, Department of General Practice, Centre for Health Sciences
Research, School of Medicine, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff,
UK, CF14 4XN. simpsonsa@cf.ac.uk

BACKGROUND: Otitis media with effusion (OME) is the most common cause of acquired
hearing loss in childhood and has been associated with delayed language
development and behavioural problems. This condition has a point-prevalence of
about 20% at the age of two years, a time of rapid language development. It is
most often asymptomatic. Effective treatment exists for clearing effusions. Some 
have argued, therefore, that children should be screened and treated early if
found to have clinically important OME. However, there is a high rate of
spontaneous resolution of effusions and, for some children, effusions may
represent a physiological response that does not reduce hearing significantly or 
impact negatively on language development or behaviour. Previous reviews of the
effect of screening and treatment have included studies using non-randomised
designs. OBJECTIVES: The aim of this review was to assess evidence from
randomised controlled trials about the effect, on language and behavioural
outcomes, of screening and treating children with clinically important OME in the
first four years of their life. The focus was on the first four years of life
because this is the time of most rapid language development. The consequences of 
hearing loss are likely to be most serious during this time. In addition,
children of this age are least likely to be able to report or seek help for
impaired hearing, particularly if these problems have a slow onset and are
subtle. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled 
Trials (CENTRAL, The Cochrane Library, Issue 1 2006), MEDLINE (1950 to 2006) and 
EMBASE (1974 to 2006) in February 2002, and again in January 2006, and the
reference lists of all studies. We also contacted the first authors of the
studies we included in the original review. SELECTION CRITERIA: 1. Randomised
controlled trials evaluating interventions for OME among children with OME
identified through screening.2. Comparison of outcomes for children randomised to
be screened for OME and outcomes for children who were not randomised to be
screened for OME. DATA COLLECTION AND ANALYSIS: Four authors independently
extracted data and assessed trial quality, two in the original review and two for
the update. MAIN RESULTS: We identified no trials comparing outcomes for children
randomised to be screened for OME with outcomes for children who were not
randomised to be screened for OME. We identified three trials evaluating
interventions for OME among children with OME identified through screening, one
of which generated three published studies. These were trials of treatment in
children identified through screening rather than trials of treatment programs.
From these trials, we found no evidence of clinically important benefit in
language development from screening and treating children with clinically
important OME. AUTHORS' CONCLUSIONS: The identified randomised trials do not show
an important benefit on language development and behaviour from screening of the 
general population of asymptomatic children in the first four years of life for
OME. However, these trials were all conducted in developed countries. Evidence
generated in the developed world, where children may enjoy better nutrition,
better living conditions and less severe and different infections may not be
applicable to children in developing countries. The screening aspect of some of
these studies was aimed primarily at identifying suitable children in whom to
evaluate the effects of treatment, rather than to evaluate the effects of
screening programs. Younger children and children with milder disease may have
been included in these treatment trials compared to children who are offered
treatment in pragmatic settings.

Publication Types: 
    Review

PMID: 17253499 [PubMed - indexed for MEDLINE]

516: Pediatr Int. 2007 Feb;49(1):36-9.

Presence of herpesviruses in middle ear fluid of children with otitis media with 
effusion.

Bulut Y, Karlidag T, Seyrek A, Keles E, Toraman ZA.

Department of Microbiology, College of Medicine, Firat University, Elazig,
Turkey. ybulut@firat.edu.tr

BACKGROUND: Otitis media with effusion (OME) is a disease that frequently occurs 
in children. Etiopathogenesis of the diseases has not been completely elucidated.
There are limited numbers of studies on the presence of herpesviruses in otitis
media cases with OME. The present study was undertaken to determine the rate of
some herpesviruses in OME cases of children. METHODS: A total of 92-middle ear
fluids were collected from 51 children. The samples were analyzed using
polymerase chain reaction (PCR) for detection of herpesviruses including Herpes
simplex virus (HSV), cytomegalovirus (CMV), Varicella zoster virus (VZV), and
Epstein-Barr virus (EBV). RESULTS: PCR analysis of the 92 samples showed that
genomes of EBV in 12 (13.04%), HSV in seven (7.60%), CMV in five (5.43%), and VZV
in three (3.26%) were present. Two of these samples were positive for both HSV
and EBV genomes. Therefore, 25 (27.17%) of the samples were determined to be
infected with any of the herpesviruses tested. CONCLUSIONS: In the present study,
herpesviruses were determined at a high rate in middle ear fluids of children
with OME. However, the present study is a preliminary study and more extensive
studies, especially experimental studies, are required to elucidate the role of
herpesviruses in pathogenesis of OME and whether there is a relation between rate
of herpesviruses in OME cases, and the reactivation of latent infections.

PMID: 17250503 [PubMed - indexed for MEDLINE]

517: Int J Pediatr Otorhinolaryngol. 2007 Apr;71(4):659-63. Epub 2007 Jan 22.

Arterial brain infarction in complicated acute otitis media.

Oestreicher-Kedem Y, Ben-Sira L, Grissaru G, DeRowe A.

Pediatric Otolaryngology Unit, Dana Children's Hospital, Tel-Aviv Sourasky
Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv,
Israel. dkyo@barak-online.net.il

We report a rare case of acute otitis media (AOM) complicated by arterial brain
infarction, meningitis and orbital cellulitis. Computed tomography (CT) initially
showed suspected epidural abscess, coalescent mastoiditis, and orbital
cellulitis. Further clinical deterioration occurred following mastoidectomy and
evacuation of the abscess. Magnetic resonance imaging (MRI) revealed subacute
brain infarction and an extra-axial brainstem abscess. Revision of the initial CT
revealed subtle signs suggestive of arterial brain infarction. Although CT with
contrast is the standard of care for suspected AOM complications, MRI should be
considered as an adjunct when CT is not definitive and neurological signs are
present.

Publication Types: 
    Case Reports

PMID: 17241673 [PubMed - indexed for MEDLINE]

518: Int J Pediatr Otorhinolaryngol. 2007 Apr;71(4):591-5. Epub 2007 Jan 18.

Structural features of tympanostomy tube biofilm formation in
ciprofloxacin-resistant Pseudomonas otorrhea.

Jang CH, Cho YB, Choi CH.

Department of Otolaryngology, Chonnam National University Medical School,
Gwangju, South Korea. chulsavio@hanmail.net

OBJECTIVE: Bacterial biofilm formation has been implicated in the high rate of
persistent otorrhea after tympanostomy tube insertion. In this study, we
evaluated Pseudomonal biofilm formation from intractable post tympanostomy tube
otorrhea in children. MATERIALS AND METHODS: Twelve patients (seven males, five
females) with unilateral post tympanostomy tube P. aeruginosa otorrhea were
evaluated prospectively. All patients were treated with ciprofloxacin otic drops 
but the otorrhea failed to resolve. Ear discharge for culture was collected from 
the external auditory canal using a swab. The tympanostomy tubes were removed and
collected for evaluation of biofilm formation using a scanning electron
microscopy. RESULTS: In all cases, ciprofloxacin-resistant P. aeruginosa was the 
only organism grown. The surface of the silicone tube contained undulations or
microfissures throughout. The thick biofilms present on most tube surfaces were
densities with no intervening spaces, consistent with biofilms. CONCLUSION:
Biofilms can be directly observed by scanning electron microscopy. Therefore, our
results demonstrate that bacterial aggregates called biofilms, that are resistant
to treatment by antibiotics, can be detected by standard culture techniques, and 
may play a major etiologic role in posttympanostomy otorrhea.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17239963 [PubMed - indexed for MEDLINE]

519: Rev Esp Quimioter. 2006 Dec;19(4):337-41.

[Acute mastoiditis: increase of incidence and controversies in antibiotic
treatment]

Bartolomé Benito M, Pérez Gorricho B.

Department of Otorrinolaringology, Hospital Infantil Universitario Nino Jesus,
Madrid, Spain.

An important complication of acute otitis media is acute mastoiditis which
responds to antibiotic therapy and myringotomy. Patients with acute mastoiditis
were reviewed during 1996-2005 in the tertiary University Children's Hospital in 
Madrid. The number of patients with acute mastoiditis increased by about 2-fold
during this period. Of 205 children with mastoiditis, ranging from 0.6-17 years
of age, surgical treatment was needed in about 4.3% in 1996 and in 70% in 2005.
In spite of 80% of the children having received antibiotics at the pediatric
visit, the number of complications increased (periostitis, subperiosteal
abscess), and the number of surgical interventions increased by 8-fold.
Etiological agents were Streptococcus pneumoniae (28.5%) and Staphylococcus
aureus (16.3%). Negative cultures were obtained in 53.6% of cases. Lack of
response to conventional therapy may require more tympanocentesis procedures for 
a middle ear culture, and surgical therapy may be necessary more often, as is the
tendency in our hospital.

PMID: 17235402 [PubMed - indexed for MEDLINE]

520: N Engl J Med. 2007 Jan 18;356(3):248-61.

Comment in:
    Evid Based Med. 2007 Jun;12(3):80.    J Fam Pract. 2007 Apr;56(4):269.    J Pediatr. 2007 Jul;151(1):101.    N Engl J Med. 2007 Jan 18;356(3):300-2.

Tympanostomy tubes and developmental outcomes at 9 to 11 years of age.

Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Rockette HE, Pitcairn DL,
Smith CG, Colborn DK, Bernard BS, Kurs-Lasky M, Janosky JE, Sabo DL, O'Connor RE,
Pelham WE Jr.

University of Pittsburgh, Pittsburgh, USA. jpar@pitt.edu

BACKGROUND: Developmental impairments in children have been attributed to
persistent middle-ear effusion in their early years of life. Previously, we
reported that among children younger than 3 years of age with persistent
middle-ear effusion, prompt as compared with delayed insertion of tympanostomy
tubes did not result in improved cognitive, language, speech, or psychosocial
development at 3, 4, or 6 years of age. However, other important components of
development could not be assessed until the children were older. METHODS: We
enrolled 6350 infants soon after birth and evaluated them regularly for
middle-ear effusion. Before 3 years of age, 429 children with persistent effusion
were randomly assigned to undergo the insertion of tympanostomy tubes either
promptly or up to 9 months later if effusion persisted. We assessed literacy,
attention, social skills, and academic achievement in 391 of these children at 9 
to 11 years of age. RESULTS: Mean (+/-SD) scores on 48 developmental measures in 
the group of children who were assigned to undergo early insertion of
tympanostomy tubes did not differ significantly from the scores in the group that
was assigned to undergo delayed insertion. These measures included the Passage
Comprehension subtest of the Woodcock Reading Mastery Tests (mean score, 98+/-12 
in the early-treatment group and 99+/-12 in the delayed-treatment group); the
Spelling, Writing Samples, and Calculation subtests of the Woodcock-Johnson III
Tests of Achievement (96+/-13 and 97+/-16; 104+/-14 and 105+/-15; and 99+/-13 and
99+/-13, respectively); and inattention ratings on visual and auditory continuous
performance tests. CONCLUSIONS: In otherwise healthy young children who have
persistent middle-ear effusion, as defined in our study, prompt insertion of
tympanostomy tubes does not improve developmental outcomes up to 9 to 11 years of
age. (ClinicalTrials.gov number, NCT00365092 [ClinicalTrials.gov].). Copyright
2007 Massachusetts Medical Society.

Publication Types: 
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 17229952 [PubMed - indexed for MEDLINE]

521: Eur J Pediatr. 2007 May;166(5):385-91. Epub 2007 Jan 17.

Grommets in otitis media with effusion: the most frequent operation in children. 
But is it associated with significant complications?

Vlastarakos PV, Nikolopoulos TP, Korres S, Tavoulari E, Tzagaroulakis A,
Ferekidis E.

Ear, Nose and Throat Department, Hippokrateion General Hospital of Athens, 114
Vas. Sofias Ave., Athens, 11527, Greece. pevlast@hotmail.com

INTRODUCTION: Otitis media with effusion is one of the most frequent diseases in 
children, and its management requires the attention of general practitioners,
pediatricians and ear, nose and throat (ENT) surgeons. The main complications
associated with tympanostomy tube insertion, are: (1) purulent otorrhea (10-26%
of cases), in which local otic preparations might be effective, and
biofilm-resistant tubes may decrease this complication in the future; (2)
myringosclerosis (39-65% of operated ears), with usually no serious sequelae; (3)
segmental atrophy (16-75% of cases); (4) atrophic scars and pars flaccida
retraction pockets (28 and 21% of operated ears, respectively); (5) tympanic
membrane perforations (3% of cases, although with T-tubes, the incidence may be
as high as 24%); (6) cholesteatoma (1% of cases), although tympanostomy tubes may
sometimes prevent, rather than contribute to its development; (7) granulation
tissue (5-40% of instances), when the duration of tube retention is prolonged.
CONCLUSION: It would appear that the complications associated with tympanostomy
tube insertion are more frequent than anticipated, reaching 80% of operated ears 
under specific circumstances and in certain subgroups of children. These
complications may resolve with conservative management, but in persistent cases
surgical removal of the tubes is mandatory.

Publication Types: 
    Review

PMID: 17225951 [PubMed - indexed for MEDLINE]

522: J Laryngol Otol. 2007 Sep;121(9):853-6. Epub 2007 Jan 16.

Nasopharyngeal dimensions in magnetic resonance imaging and the risk of acute
otitis media.

Renko M, Kristo A, Tapiainen T, Koivunen P, Ilkko E, Alho OP, Uhari M.

Department of Pediatrics, University of Oulu, Oulu, Finland. marjo.renko@oulu.fi

BACKGROUND: We have previously found by lateral cephalometry an association
between nasopharyngeal anatomy and the risk of acute otitis media (AOM). We
evaluate here the association of nasopharyngeal dimensions in magnetic resonance 
imaging (MRI) with the occurrence of AOM in otherwise healthy children. METHODS: 
Sixty-one healthy children (mean age 5.7 years, range 3.9-6.9) were recruited
from child care centres. The parents filled in a questionnaire on the child's
history of ear infections and adenoidectomy. MRI was performed with a 4 mm slice 
thickness during an upper respiratory infection. Five dimensions and two angles
expressing the structure of the bony nasopharynx were measured in sagittal
images. RESULTS: The dimension from the caudal edge of the septum to the midpoint
of the sella, reflecting the height of the nasopharynx, was on average 2.2 mm
smaller in the children who had had AOM attacks during the last 12 months than
those without attacks (95% confidence interval (CI) 0.9 to 3.4, p=0.001) and the 
nasal base angle was on average 2.1 degrees smaller (95% CI 0.7 to 3.5, p=0.004).
These differences remained significant after adjustment for age, sex and previous
adenoidectomy in the logistic modelling. A history of adenoidectomy did not have 
any effect on the dimensions. CONCLUSIONS: The nasopharynx was smaller in the
children with AOM attacks during the last year. The value of this finding for
predicting susceptibility to recurrent AOM and directing preventive procedures
should be evaluated.

Publication Types: 
    Multicenter Study

PMID: 17224090 [PubMed - indexed for MEDLINE]

523: Braz J Otorhinolaryngol. 2006 Sep-Oct;72(5):641-8.

Histologic description of acquired cholesteatomas: comparison between children
and adults.

Dornelles C, Meurer L, Selaimen da Costa S, Schweiger C.

Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande
do Sul, University Hospital of Porto Alegre, Brazil.

Cholesteatoma is constituted of matrix, perimatrix and cystic content. Some
authors affirm that, in children, its clinical behavior is more aggressive of the
than in adults. AIMS: Histologic compared cholesteatomas of children and adults. 
METHODOLOGY: 74 cholesteatomas been analyzed, being 35 of pediatrics patients
(<18 years). The average number of cellular layers and hyperplasia in the matrix 
had been evaluated; thickness, delimitante epithelium, fibrosis, inflammation and
granuloma in the perimatrix. The analysis statistics was carried through with
program SPSS 10.0, using the coefficients of Pearson and Spearman, test of
chi-square and t test. The number of cellular layers in the matrix was of
8.2+/-4.2. The hyperplasia appears in 17%, fibrosis in 65%, granuloma in 12% and 
the delimitante epithelium in 21%. The perimatrix presented a medium one of 80
micrometers (37 the 232), minimum value zero and maximum value 1.926. The
histological degree of inflammation was considered of moderate the accented one
in 60%. When applying the coefficient of Spearman enters the inflammation degree 
and average of cellular layers of the matrix with the variables of the measure of
thickness of the perimatrix we find correlations, significant, with moderate
magnitudes of the great ones (rs=0.5 and P<0.0001). CONCLUSION: Adults
colesteatomas of and child had not been identified to morphologic differences
between. We find correlation enters the intensity of the inflammation and of the 
average of cellular layers of the matrix with the thickness of the perimatrix,
what it can predict its aggressiveness, more studies are necessary to define the 
paper of this finding in pathogenesis of cholesteatoma.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17221056 [PubMed - indexed for MEDLINE]

524: AJNR Am J Neuroradiol. 2007 Jan;28(1):138-40.

Intracranial aspergillosis involving the internal auditory canal and inner ear in
an immunocompetent patient.

Cho YS, Lee DK, Hong SD, Oh WS.

Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
yscho@smc.samsung.co.kr

We report the MR imaging findings in a case of intracranial aspergillosis
involving the internal auditory canal (IAC) and inner ear in an immunocompetent
patient. The presence of rim enhancement of the vestibulocochlear nerve, abnormal
signal intensity involving the labyrinth, and adjacent meningeal enhancement
might help clinicians to make a correct diagnosis in patients with a mass in the 
IAC and previous history of ear surgery.

Publication Types: 
    Case Reports

PMID: 17213442 [PubMed - indexed for MEDLINE]

525: Otolaryngol Head Neck Surg. 2007 Jan;136(1):23-6.

Clinical and biochemical factors that affect DPOAE expressions in children with
middle ear effusion.

Park SN, Park KH, Park SY, Jeon EJ, Chang KH, Yeo SW.

Department of Otolaryngology-Head and Neck Surgery, Kangnam St Mary's Hospital,
The Catholic University of Korea, College of Medicine, Seoul, Korea.

OBJECTIVES: To evaluate the clinical and biochemical characteristics of middle
ear effusion (MEE) that affect distortion product otoacoustic emissions (DPOAE)
responsiveness and to investigate the possible role of DPOAE as a tool to know
the characteristics of MEE preoperatively. STUDY DESIGN AND SETTING: Prospective 
analysis of children with MEE effusion in a tertiary referral center. DPOAE
results were compared with other audiologic tests, the character, amount of MEE, 
the amount of total protein, and TNF-alpha in the effusion. RESULTS: The negative
DPOAE with MEE group had much more thick mucous fluid in their middle ears than
that of positive DPOAE with MEE group. The levels of total protein and TNF-alpha 
in MEE were significantly higher in the negative DPOAE group than those of the
positive DPOAE group (P < 0.01). CONCLUSIONS AND SIGNIFICANCE: The measurement of
DPOAE in the children with MEE may predict the amount and the characteristics of 
MEE, which may help to decide the treatment methods.

PMID: 17210328 [PubMed - indexed for MEDLINE]

526: Otolaryngol Head Neck Surg. 2007 Jan;136(1):19-22.

Otitis media in adults as a symptom of gastroesophageal reflux.

Sone M, Yamamuro Y, Hayashi H, Niwa Y, Nakashima T.

Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine,
Nagoya, Japan. michsone@med.nagoya-u.ac.jp

OBJECTIVE: To investigate the clinical relationship between gastroesophageal
reflux (GER) and otitis media with effusion (OME) in adults. STUDY DESIGN AND
SETTING: Sixty patients with OME with unknown causes were asked to answer a new
questionnaire specific for the diagnosis of GER disease; pepsinogen (PG) levels
in their middle-ear effusions (MEEs) were measured. RESULTS: The percentage of
patients with high PG concentrations in their MEEs was significantly higher in
those with questionnaire-positive GER than in those with questionnaire-negative
GER. OME was present bilaterally in a significantly higher percentage of patients
with questionnaire-positive GER. The PG levels decreased in some of the patients 
after receiving proton pump inhibitors, which also decreased the symptoms of GER.
CONCLUSION: The presence of PG in MEEs supports the existence of GER; treatment
for GER should be considered in patients with ear complaints, especially in those
who have GER-related symptoms.

PMID: 17210327 [PubMed - indexed for MEDLINE]

527: Microbes Infect. 2007 Feb;9(2):183-91. Epub 2006 Dec 8.

Pathogenesis of cytomegalovirus-associated labyrinthitis in a guinea pig model.

Katano H, Sato Y, Tsutsui Y, Sata T, Maeda A, Nozawa N, Inoue N, Nomura Y, Kurata
T.

Department of Pathology, National Institute of Infectious Diseases, 1-23-1
Toyama, Shinjuku, Tokyo 162-8640, Japan. katano@nih.go.jp

Cytomegalovirus infects fetuses through the placenta, resulting in various
congenital disorders in newborns, including hearing loss. We developed a
monoclonal antibody to guinea pig cytomegalovirus (GPCMV) that was available for 
immunohistochemistry, and investigated the expression of the GPCMV antigen in
animal models of direct and congenital infections. Injection of GPCMV, directly
to the inner ear, increased the sound pressure level and resulted in
labyrinthitis with severe inflammation. Immunohistochemistry detected
GPCMV-infected cells mainly in the scala tympani, scala vestibule and spinal
ganglion, but rarely in the cochlear duct. Injection of GPCMV to 5-week pregnant 
guinea pigs resulted in severe labyrinthitis in fetuses. Immunohistochemistry
detected GPCMV-infected cells in the perilymph area and spinal ganglion, but not 
in the endolymph area, including hair cells. These data suggest that the virus
spreads via the perilymph and neural routes in the inner ear of both models of
direct and congenital infections.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17208485 [PubMed - indexed for MEDLINE]

528: Int J Pediatr Otorhinolaryngol. 2007 Mar;71(3):487-94. Epub 2007 Jan 3.

Etiology of vertigo in children.

Balatsouras DG, Kaberos A, Assimakopoulos D, Katotomichelakis M, Economou NC,
Korres SG.

ENT Department of Tzanion General Hospital, 11 Zani and Afentouli Street,
GR-18536 Piraeus, and Ioannina University School of Medicine, Greece.
balats@panafonet.gr

OBJECTIVE: To detect the most common causes of vertigo in children. METHODS:
Fifty-four children (20 boys and 34 girls) aged 3-16 years, who presented with
vertigo attacks during a 3-year period, were studied. A detailed medical history 
for vestibular symptoms and migraine was obtained from our patients or their
parents. All patients underwent otolaryngologic, ophthalmologic and neurologic
clinical evaluation. A detailed laboratory examination, including serologic tests
for viral infections, was also obtained. Additionally, a complete audiological
and neurotologic evaluation was performed. Computed tomography (CT) scans and
magnetic resonance imaging (MRI) were obtained in selected cases. RESULTS: Viral 
infections, benign paroxysmal vertigo of childhood and migraine were the most
common causes of vertigo accounting for approximately 65% of our patients. Otitis
media, head trauma, benign paroxysmal positional vertigo, Meniere's disease and
brain tumor were less common causes of vertigo. CONCLUSIONS: A peripheral type of
vertigo was found in most cases. Diagnostic approach in vertigo in children
should include a detailed history and clinical examination in conjunction with a 
test battery of audiological and neurotologic tests. When a central cause of
vertigo is suspected an MRI or CT scan should be ordered.

PMID: 17204337 [PubMed - indexed for MEDLINE]

529: Laryngoscope. 2007 Jan;117(1):22-9.

Cochlear cytokine gene expression in murine acute otitis media.

Ghaheri BA, Kempton JB, Pillers DA, Trune DR.

Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science
University, Portland, Oregon, USA. ghaherib@ohsu.edu

OBJECTIVE: Recurrent acute otitis media (AOM) causes sensorineural hearing loss
by unknown mechanisms. It is widely accepted that inflammatory cytokines diffuse 
across the round window membrane to exert cytotoxic effects. This study addresses
whether inner ear cells are capable of expressing genes for inflammatory
cytokines. STUDY DESIGN: The authors conducted a prospective animal study.
METHODS: BALB/C mice underwent transtympanic injection of heat-killed Haemophilus
influenzae to create an acute inflammatory response. These mice were compared
with a control group in addition to a group of uninjected mice found to have
otomicroscopic changes consistent with persistent or chronic otitis media. The
cochleas of these mice were obtained, their RNA harvested, and cytokine gene
expression analyzed using prefabricated cDNA arrays. RESULTS: Four groups of mice
(control, 3-day postinjection, 7-day postinjection, and mice with chronic otitis 
media) with five mice in each group were analyzed. Numerous classes of genes were
found to be upregulated or downregulated by more than twofold. Some genes
differed from control mice by more than 10-fold. These genes included numerous
fibroblast growth factors, interleukins, tumor necrosis factors, and
colony-stimulating factors. CONCLUSION: The genes of numerous inflammatory
cytokines are either up- or downregulated by murine inner ear cells in response
to either acute or chronic inflammation of the middle ear. This study provides a 
novel site of production of cytokines that may be responsible for the damage seen
in sensorineural hearing loss.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17202925 [PubMed - indexed for MEDLINE]

530: Ann Allergy Asthma Immunol. 2006 Dec;97(6):761-6.

Effectiveness of instillation of triamcinolone acetonide into the middle ear for 
eosinophilic otitis media associated with bronchial asthma.

Iino Y, Nagamine H, Kakizaki K, Komiya T, Katano H, Saruya S, Kodera K.

Department of Otolaryngology, Teikyo University School of Medicine, Tokyo, Japan.
yiino@omiya.jichi.ac.jp

BACKGROUND: Eosinophilic otitis media (EOM) is a newly recognized middle ear
disease found in asthmatic patients. EOM is characterized by a highly viscous
middle ear effusion that contains many eosinophils and is extremely unresponsive 
to conventional treatments for common otitis media. To our knowledge, no systemic
study regarding the efficacy of treatments for EOM has been performed. OBJECTIVE:
To determine the effectiveness of instillation of triamcinolone acetonide, which 
is a suspension of steroids, into the mesotympanum and eustachian tube as a
treatment for patients with EOM. METHODS: We studied the efficacy of the
instillation of triamcinolone acetonide in 43 ears of 24 patients with EOM.
Efficacy was evaluated according to the length of the period without middle ear
effusion or otorrhea. We also determined the otomicroscopic findings and the
hearing levels before and after therapy. For controls, 27 ears of 14 patients
treated by topical administration of betamethasone were similarly evaluated.
RESULTS: The middle ear effusion or otorrhea was controlled for more than 3 weeks
after 1 instillation of triamcinolone acetonide in 35 ears, and the efficacy rate
(81%) was significantly higher than that in the controls (7 ears, 26%). In the
triamcinolone acetonide group, the average air conduction hearing level at the
speech frequency range was significantly improved, and deterioration of the bone 
conduction hearing threshold was rarely found during therapy. CONCLUSION: The
instillation of triamcinolone acetonide into the mesotympanum and eustachian tube
is an effective treatment for patients with EOM.

Publication Types: 
    Controlled Clinical Trial

PMID: 17201235 [PubMed - indexed for MEDLINE]

531: Eur J Pediatr. 2007 Oct;166(10):1049-52. Epub 2006 Dec 30.

Effect of pneumococcal vaccination on otitis media with effusion in children
older than 1 year.

Le TM, Rovers MM, Veenhoven RH, Sanders EA, Schilder AG.

Julius Center for Health Sciences and Primary Care, University Medical Center
Utrecht, Utrecht, The Netherlands.

Pneumococcal vaccines may be effective in preventing or decreasing the burden of 
disease related to otitis media. In study reported here, we investigated the
effectiveness of pneumococcal vaccination on otitis media with effusion (OME) in 
children (n = 383 children aged 1-7 years) with a history of recurrent otitis
media within the framework of a randomized double blind placebo controlled trial.
Children were randomized to be immunized with either a 7-valent pneumococcal
conjugate vaccine followed by the 23-valent pneumococcal polysaccharide vaccine, 
or by hepatitis A or B vaccines. The proportion of children diagnosed with OME at
the scheduled follow-up visits--7, 14, 20 and 26 months after randomization--was 
then calculated. OME was diagnosed according to an algorithm combining
tympanometry and otoscopy. The percentage of children diagnosed with OME was
similar in the pneumococcal vaccination group and control group at both baseline 
and the follow-up visits at 7, 14, 20 and 26 months--52.9 versus 52.7, 44.9
versus 44.2, 34.9 versus 31.5, 40.8 versus 32.2 and 31.4 versus 26.1,
respectively (corresponding to p-values of 0.96, 0.89, 0.51, 0.13 and 0.36,
respectively). We conclude that the combined pneumococcal conjugate and the
polysaccharide vaccination have no beneficial effect on OME in children aged 1
year or older with a history of recurrent otitis media. Therefore, these
vaccinations are not indicated in the prevention of OME in these children.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 17195936 [PubMed - indexed for MEDLINE]

532: Otol Neurotol. 2007 Jan;28(1):44-7.

Influence of chronic middle ear diseases on gustatory function: an
electrogustometric study.

Sano M, Ito K, Suzukawa K, Kaga K, Yamasoba T.

Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of
Medicine, Faculty of Medicine, University of Tokyo, Hongo, Tokyo, Japan.
neurootolsano@ybb.ne.jp

OBJECTIVE: We aimed to quantitatively determine whether middle ear inflammation
associated with unilateral chronic otitis media (COM), cholesteatoma, or
otosclerosis affects gustatory function. STUDY DESIGN: Prospective study.
SETTING: University Hospital, Department of Otolaryngology. PATIENTS: Forty-two
patients had unilateral COM (22 men, 20 women; mean age, 54.2 yr), 57 had
unilateral cholesteatoma (35 men, 22 women; mean age, 42.1 yr), and 19 had
unilateral otosclerosis (10 men, 9 women; mean age, 49.3 yr). MAIN OUTCOME
MEASURES: Patients underwent taste testing using electrogustometry (EGM) and
sensation thresholds were compared in the affected and unaffected ears among
groups and between affected and unaffected ears in each group. RESULTS: Patients 
with COM and cholesteatoma exhibited an increase in taste threshold in the
affected ears compared to the unaffected ears (p < 0.05), whereas otosclerosis
patients did not. The extent of the increase of the sensation thresholds in the
affected ears was very similar between patients with COM and those with
cholesteatoma (p = 0.548). CONCLUSION: Our EGM study showed that cholesteatoma
and chronic middle ear inflammation affected gustatory function to a similar
degree.

PMID: 17195745 [PubMed - indexed for MEDLINE]

533: Pediatr Infect Dis J. 2007 Jan;26(1):25-30.

Comparative effects of single-dose ceftriaxone versus three oral antibiotic
regimens on stool colonization by resistant bacilli in children.

Toltzis P, Dul M, O'Riordan MA, Toltzis H, Blumer JL.

Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western
Reserve University School of Medicine, Cleveland, OH 44106, USA. pxt2@case.edu

OBJECTIVE: The use of short-term intramuscular ceftriaxone for pediatric
ambulatory conditions raises concerns regarding the promotion of resistance among
colonizing enteric bacteria. This study was designed to assess the prevalence of 
stool colonization with resistant Gram-negative bacilli after single-dose
ceftriaxone treatment compared with other regimens for acute otitis media.
METHODS: Children age 3 months to 7 years and diagnosed with acute otitis media
were randomized to receive treatment with single-dose ceftriaxone or with oral
cefprozil, amoxicillin or azithromycin. Stool samples were obtained at enrollment
and then 3-5 days, 10-14 days, and 28-30 days after therapy was initiated and
screened for the presence of facultative Gram-negative bacilli resistant to
ceftriaxone, cefprozil, amoxicillin, piperacillin, piperacillin-tazobactam and
tobramycin. Mean prevalence of colonization by resistant organisms for each
treatment group was compared at each time point. RESULTS: One thousand nine
subjects were enrolled. The prevalence of colonization by a Gram-negative
bacillus resistant to at least 1 of the screening antibiotics decreased after
receipt of ceftriaxone but returned close to values measured at study entry by 30
days. A qualitatively similar pattern was noted for the 3 other regimens, but a
quantitatively greater decrease in the prevalence of colonization by a resistant 
bacterium was noted at the 3- to 5-day and 10- to 14-day visits among
azithromycin recipients (P < 0.001). Colonization by a Gram-negative bacillus
resistant specifically to ceftriaxone was unusual at each study visit, regardless
of treatment assignment. CONCLUSIONS: A single intramuscular dose of ceftriaxone 
had a similar effect on the prevalence of antibiotic-resistant Gram-negative
facultative bacilli in the stool of healthy children when compared with commonly 
used oral agents.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17195701 [PubMed - indexed for MEDLINE]

534: Am J Public Health. 2007 Feb;97(2):317-22. Epub 2006 Dec 28.

Early otitis media among Minnesota American Indians: the Little Ears Study.

Daly KA, Pirie PL, Rhodes KL, Hunter LL, Davey CS.

Department of Otolaryngology and the Otitis Media Research Center, School of
Medicine, University of Minnesota, Minneapolis, USA. dalyx002@umn.edu

OBJECTIVES: We examined relationships between otitis media risk factors,
sociodemographic characteristics, and maternal knowledge and attitudes and early 
onset of otitis media. METHODS: Pregnant women from Minnesota American Indian
reservations and an urban clinic were enrolled in our study between 1998 and
2001. Follow-up was performed on enrollees' infants until the children were 2
years old. Research nurses collected data by ear examination, from interviews and
questionnaires given to enrolled mothers, and otitis media episodes that were
abstracted from medical records. RESULTS: Sixty-three percent of infants had
experienced an otitis media episode by 6 months of age. Logistic regression
analyses showed that maternal otitis media history, infant history of upper
respiratory infection, and compliance with study visits were significantly
related to early otitis media onset. Although high percentages of infants were
exposed to cigarette smoke and other children and were formula fed, these factors
were not related to otitis media. Mothers' prenatal awareness of otitis media
risks associated with environmental tobacco smoke exposure and formula feeding
did not predict their postpartum behaviors. CONCLUSIONS: We found that infant
history of upper respiratory infection and maternal otitis media history are risk
factors for early otitis media in American Indian infants. Mothers' prepartum
knowledge and attitudes regarding otitis media did not predict their postpartum
avoidance of risk behaviors.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17194873 [PubMed - indexed for MEDLINE]

535: West Afr J Med. 2006 Jul-Sep;25(3):219-22.

Bacteriology of chronic discharging ears in Port Harcourt, Nigeria.

Wariso BA, Ibe SN.

Box 190, Uniport Post Office, University of Port Harcourt Port Harcourt, Nigeria.

OBJECTIVE: The objective of the study was to isolate and identify aerobic
bacteria in chronic discharging ears and determine their antibiotic
susceptibilities, which is essential for reasonable empiric treatment. METHODS:
Ear swabs of discharging ears aseptically collected from 102 patients of various 
age groups attending Ear, Nose, and Throat out-patient clinic at University of
Port Harcourt Teaching Hospital were cultured for bacterial agents using blood
agar, chocolate agar and MacConkey agar. Culture plates were incubated
aerobically at 37 degrees C for 24-48 hours. Isolates were identified using
standard microbiological methods. Members of the family enterobacteriaceae were
identified using enterotubes. Antibiotic susceptibility test was carried out for 
13 drugs using disc diffusion method. RESULTS: Seventy-eight percent of the
patients studied were in the age group 0-14 years and there were more male
infants than females. Gram negative bacteria comprised 75% of the isolates.
Predominant isolates were Pseudomonas aeruginosa (41%), Proteus sp. (22%),
Staphylococcus aureus (22%), Escherichia coli and other coliforms (11%). Drug
susceptibility profile of the isolates showed that ceftazidime, ceftriazone and
gentamycin were most effective drugs in vitro. CONCLUSION: The predominant
bacterial agents in chronic discharging ears in Port Harcourt, Nigeria were gram 
negative bacteria and included Pseudomonas aeruginosa, Proteus sp., Escherichia
coli. Gram positive bacterial constituted 25 percent of the isolates and included
Staphylococcus aureus, Staphylococcus epidermidis and streptococcus sp.
Ceftazidime, ceftrixone and gentamycin were the most effective drugs in vitro.

PMID: 17191422 [PubMed - indexed for MEDLINE]

536: Indian J Med Microbiol. 2006 Oct;24(4):289-91.

Necrotizing (malignant) otitis externa: an unusual localization of mucormycosis.

Tuzcu A, Bahceci M, Celen MK, Kilinc N, Ozmen S.

Department of Infectious Diseases, Diyarbakir, Turkey.

Malignant otitis externa (MOE) is a severe infection of external auditory canal
and skull base. A 17-year-old diabetic girl was admitted with diabetic
ketoacidosis. Cellulitis of her right ear occurred on the second day of
hospitalization and a black necrotic scar in the same region appeared on the next
day. The lesion rapidly invaded to right side of neck and surrounding tissue of
the patient. Therefore, antimycotic therapy was started. Unfortunately the
patient died on seventh day of hospitalization because of probably extensive
fungal invasion. Physicians should suspect MOE connected to mucormycosis
especially in patients with cutaneous lesions of ear unresponsive to antibiotic
therapy.

Publication Types: 
    Case Reports

PMID: 17185850 [PubMed - indexed for MEDLINE]

537: Clin Otolaryngol. 2006 Dec;31(6):504-7.

Prospective randomised single-blind controlled trial of glacial acetic acid
versus glacial acetic acid, neomycin sulphate and dexamethasone spray in otitis
externa and infected mastoid cavities.

Johnston MN, Flook EP, Mehta D, Mortimore S.

Department of Otolaryngology, Derbyshire Royal Infirmary, Derby, UK.
mark.johnston@derbyhospital.nhs.uk

OBJECTIVES: The literature reports the merits of antibacterial, antibiotic and
steroid agents in treating otological infections but no controlled clinical trial
has directly compared 2% glacial acetic acid (EarCalm; Stafford-Miller Ltd,
Brentford, UK) against 2% glacial acetic acid, 0.1% dexamethasone and 3250 U/ml
of neomycin sulphate (Otomize; Stafford-Miller Ltd) in the treatment of otitis
externa and infected mastoid cavities. DESIGN: Prospective, single-blind
randomised controlled trial. SETTING: Outpatients, Derby Royal Infirmary, Derby, 
UK. PATIENTS: Emergency and GP referrals with acute otitis externa (n = 53) and
infected mastoid cavities (n = 56). MAIN OUTCOME MEASURES: Otoscopy was performed
at initial randomisation and then at 2 and 4 weeks, the ear assessed for active
and inactive disease. RESULTS: Patients with active otitis externa, 71% (15/21)
resolved with glacial acetic acid, dexamethasone and of neomycin sulphate after 2
weeks, increasing to 86% (18/21) after 4 weeks treatment. Patients on glacial
acetic acid had only 38% (12/32) resolution after 4 weeks (P < 0.0005). Two per
cent glacial acetic acid, dexamethasone and neomycin sulphate resolved only 30%
(8/27) of infected mastoid cavities compared to only 10% (3/29) on glacial acetic
acid (P < 0.07). A further 2 weeks treatment this increased to 67%, (18/27) with 
glacial acetic acid, dexamethasone and neomycin sulphate and 48% (14/29) with
glacial acetic acid. These results are not statistically significant. CONCLUSION:
Glacial acetic acid, dexamethasone and neomycin sulphate is significantly more
effective in treating otitis externa when compared with glacial acetic acid. This
effect failed to be significant in the infected mastoid cavities group. We
therefore recommend that in conjunction with aural toilet, antibiotic/steroid
combination is more effective than an antibacterial agent for otitis externa.
Larger numbers of infected mastoid cavities are required to be studied.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 17184455 [PubMed - indexed for MEDLINE]

538: Arch Otolaryngol Head Neck Surg. 2006 Dec;132(12):1294-8.

Ofloxacin otic drops vs neomycin-polymyxin B otic drops as prophylaxis against
early postoperative tympanostomy tube otorrhea.

Poetker DM, Lindstrom DR, Patel NJ, Conley SF, Flanary VA, Link TR, Kerschner JE.

Department of Otolaryngology and Communication Sciences, Medical College of
Wisconsin, Milwaukee, USA.

OBJECTIVES: To evaluate the incidence of tympanostomy tube (TT) sequelae, tube
otorrhea, and tube obstruction immediately postoperatively in patients receiving 
TT for otitis media and to compare patients receiving postoperative otic drops
with controls. DESIGN: Blinded randomized control trial. SETTING: A tertiary
pediatric otolaryngology practice. SUBJECTS: The study population comprised 306
patients undergoing TT placement. INTERVENTIONS: The 306 patients were enrolled
into the following 3 groups: (1) those receiving no postoperative otic drop
prophylaxis (control group), (2) those receiving ofloxacin otic drops (FLOX
group), and (3) those receiving neomycin sulfate-polymyxin B
sulfate-hydrocortisone otic drops (COS group). RESULTS: Overall otorrhea rates
postoperatively were 14.9% for the control group, 8.1% for the FLOX group, and
5.5% for the COS group. When controlling for disease severity, the rate of
otorrhea was significantly higher for the control group than for both the FLOX (P
= .04) and COS (P = .01) groups. Nonpatent, plugged, tube rates were added to
otorrhea rates for a TT failure analysis postoperatively. The control group
demonstrated a significantly greater failure rate (29.9%) than both the FLOX
(12.1%) and COS (7.7%) groups. The only differences between the patients in the 2
groups receiving drops were that ofloxacin was more well liked by patients (P =
.04) and caused less pain (P = .004). CONCLUSIONS: Nonpatency and otorrhea are
the most frequent sequelae immediately following TT placement. Few studies have
compared different treatment regimens in a randomized controlled trial. These
results demonstrate that otic drops clearly provide benefit postoperatively in
preventing TT plugging and otorrhea but primarily in patients who have middle ear
fluid at the time of TT placement. In addition, consideration of drop choice
should be based on patient tolerance and medication safety profiles.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 17178938 [PubMed - indexed for MEDLINE]

539: Biomed Eng Online. 2006 Dec 18;5:65.

Intelligent Bayes Classifier (IBC) for ENT infection classification in hospital
environment.

Dutta R, Dutta R.

University of Reading, Reading RG6 6AY, UK. r.dutta@reading.ac.uk

Electronic Nose based ENT bacteria identification in hospital environment is a
classical and challenging problem of classification. In this paper an electronic 
nose (e-nose), comprising a hybrid array of 12 tin oxide sensors (SnO2) and 6
conducting polymer sensors has been used to identify three species of bacteria,
Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), and Pseudomonas
aeruginosa (P. aeruginosa) responsible for ear nose and throat (ENT) infections
when collected as swab sample from infected patients and kept in ISO agar
solution in the hospital environment. In the next stage a sub-classification
technique has been developed for the classification of two different species of
S. aureus, namely Methicillin-Resistant S. aureus (MRSA) and Methicillin
Susceptible S. aureus (MSSA). An innovative Intelligent Bayes Classifier (IBC)
based on "Baye's theorem" and "maximum probability rule" was developed and
investigated for these three main groups of ENT bacteria. Along with the IBC
three other supervised classifiers (namely, Multilayer Perceptron (MLP),
Probabilistic neural network (PNN), and Radial Basis Function Network (RBFN))
were used to classify the three main bacteria classes. A comparative evaluation
of the classifiers was conducted for this application. IBC outperformed MLP, PNN 
and RBFN. The best results suggest that we are able to identify and classify
three bacteria main classes with up to 100% accuracy rate using IBC. We have also
achieved 100% classification accuracy for the classification of MRSA and MSSA
samples with IBC. We can conclude that this study proves that IBC based e-nose
can provide very strong and rapid solution for the identification of ENT
infections in hospital environment.

PMID: 17176476 [PubMed - indexed for MEDLINE]

540: J Laryngol Otol. 2007 Apr;121(4):318-23. Epub 2006 Dec 13.

Post-operative complications of cochlear implantation in adults and children:
five years' experience in Maastricht.

Postelmans JT, Cleffken B, Stokroos RJ.

Department of ENT/Head and Neck Surgery, University Maastricht, Maastricht, The
Netherlands. rsto@skno.azm.nl

Although cochlear implantation is considered a safe method of rehabilitation for 
profoundly deaf individuals, a number of these patients suffer complications
after surgery. To evaluate post-operative complications after cochlear
implantation, a retrospective chart review was performed for 112 patients who had
undergone implantation in the Maastricht Academic Hospital. Minor complications
were defined as those that could be overcome by medical or audiological
management. These occurred in 36 patients (32 per cent) and all were managed
successfully. Major complications were defined as device extrusion and those
requiring further surgery, and these were identified in four patients (3.6 per
cent). These complications included wound infection and device failure mediated
by middle-ear pathology. In cases of chronic otitis media, we recommend
performance of cochlear implantation as a staged procedure. In order to reduce
the post-operative incidence of acute otitis media, we recommend adenoidectomy,
placement of ventilation tubes and early antibiotic treatment.

PMID: 17164025 [PubMed - indexed for MEDLINE]

541: JNMA J Nepal Med Assoc. 2006 Jan-Mar;45(161):167-72.

Size of typmanic membrane perforation and hearing loss.

Bhusal CL, Guragain RP, Shrivastav RP.

Tribhuvan University, Institute of Medicine, Maharagunj, Kathmandu, Nepal.
pbhusal@ntc.net.np

This prospective study was done to assess the level of preoperative hearing
impairment in different sizes of pars tensa perforation in patients with chronic 
suppurative otitis media (CSOM) tubo-tympanic type undergoing myringoplasty. A
total of 50 patients were recruited from the outpatient Department of
Otorhinolaryngology - Head and Neck Surgery from June 2003 to May 2004. Cases of 
CSOM tubo-tympanic type with dry central perforation, conductive type of hearing 
loss were subjected to myringoplasty. Preoperative audiometric evaluations were
done. While operating under microscope diameter of perforations were measured and
perforations were grouped according to the size. It was observed that greater
hearing loss was reported in group D perforation (44 dB), where as in group A, it
was 31 dBHL. The average hearing loss at 500 Hz was 46.40 dB, at 1000 Hz was
30.90 dB and at 2000 Hz it was 31.9 dB. This shows that the hearing loss is more 
at lower frequencies and less as the frequencies increase. This study shows that 
as the size of perforation is increased, the hearing loss also increases. The
hearing loss is more marked at lower frequencies as compared to higher
frequencies.

PMID: 17160091 [PubMed - indexed for MEDLINE]

542: Vaccine. 2007 Feb 19;25(9):1683-9. Epub 2006 Nov 9.

Role of respiratory syncytial virus in acute otitis media: implications for
vaccine development.

Patel JA, Nguyen DT, Revai K, Chonmaitree T.

Departments of Pediatrics, University of Texas Medical Branch, Galveston, TX
77555-0371, United States. jpatel@utmb.edu

We summarize herein the results of various virologic studies of acute otitis
media (AOM) conducted at our site over a 10-year period. Among 566 children with 
AOM, respiratory syncytial virus (RSV) was the most common virus identified in
either middle ear fluid or nasal wash; it was found in 16% of all children and
38% of virus-positive children. Seventy-one percent of the children with RSV were
1 year of age or older, which was significantly older than all other viruses
combined (P=0.045). RSV infection was associated with the common bacterial
pathogens causing AOM. Past efforts to develop vaccines for RSV have emphasized
prevention of lower respiratory tract infection in infants, which is a more
serious problem but less common than AOM. Our results suggest that RSV vaccines
that work only against infection in older children may have value in preventing
AOM, the most common pediatric disease.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17156899 [PubMed - indexed for MEDLINE]

543: Paediatr Drugs. 2006;8(6):337-46.

Acute otitis media in children aged less than 2 years: drug treatment issues.

Leibovitz E.

Pediatric Infectious Disease Unit, Soroka University Medical Center, Ben-Gurion
University of the Negev, Beer-Sheva, Israel. eugenel@bgu.ac.il

The management of acute otitis media (AOM) in childhood has evolved considerably 
during recent years as a result of the new insights provided by publication (in
2004) of the American Academy of Pediatrics and the American Academy of Family
Physicians guidelines for the treatment of AOM. The new treatment guidelines
establish a clear hierarchy among the various antibacterials used in the
treatment of this disease and also the use of an age-stratified approach to AOM
by recommending an observation strategy ('watchful waiting') without the use of
antibacterials for some groups of patients with AOM. Infants and young children
aged <2 years represent a target population characterized by a high incidence of 
AOM (and in particular of recurrent disease), lack of anatomic and physiologic
maturity of airways, age-related immune humoral and cellular deficiencies, the
presence of antibacterial-resistant pathogens, and a less efficient response to
antibacterial treatment. Presently, the evidence accumulated in the literature is
not sufficient to conclude that the role of antibacterials is only minimal in the
management of AOM and that the watchful waiting policy is the most appropriate
choice for patients aged <2 years with a certain AOM diagnosis. However,
adherence to such a policy in patients with an uncertain or questionable AOM
diagnosis and/or mild-to-moderate symptoms, in addition to its implementation in 
patients aged >2 years, could reduce substantially the use of antibacterials in
children and play a major role in the strategy of decreasing antibacterial
resistance.

Publication Types: 
    Review

PMID: 17154641 [PubMed - indexed for MEDLINE]

544: Laryngoscope. 2006 Dec;116(12):2229-31.

Deep temporal fascial-periosteal flap for canal wall down mastoidectomy.

Lee DH, Jun BC, Jung SH, Song CE.

Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The
Catholic University of Korea, Seoul, Korea. leedh0814@catholic.ac.kr

It is very important to make a safe, dry, trouble-free ear for the canal wall
down mastoidectomy. Although fascia graft is the most common material used for
the repair of the perforated tympanic membrane, it is usually too small to cover 
the whole mastoid cavity in canal wall down mastoidectomy. The presence of
exposed bone delays the epithelialization and results in prolonged otorrhea. We
present a new simple technique that uses a postauricular, inferiorly based
pedicled flap. Although our deep temporalis fascial-periosteal flap is not bulky,
it is large enough to obliterate a sclerotic mastoid cavity without the need for 
additional flaps. It shrinks much less than a muscular flap during the healing
period. In addition to reducing the cavity volume, this flap promotes the
epithelialization over the bone and the shortening of the healing time. Although 
only a small number of patients were included in this study, coverage of a canal 
wall down mastoid cavity by a deep temporalis fascial-periosteal flap is expected
to be a reliable and effective technique that results in a dry, trouble-free
mastoid cavity.

PMID: 17146402 [PubMed - indexed for MEDLINE]

545: Braz J Otorhinolaryngol. 2006 Jul-Aug;72(4):509-14.

HAART impact on prevalence of chronic otitis media in Brazilian HIV-infected
children.

Weber R, Pinheiro Neto CD, Miziara ID, Araújo Filho BC.

Department of Otorhinolaryngology and Ophthalmology, Medical School, University
of São Paulo, Brazil.

The advent of new antiretroviral drugs such as protease inhibitors has generated 
sensible changes in morbity and mortality in HIV-infected patients. OBJECTIVES:
To evaluate the impact of Highly Active Antiretroviral Therapy (HAART) on the
prevalence of chronic otitis media in HIV-infected pediatric population. METHODS:
We analyzed medical charts of 471 children aged zero to 12 years and 11 months
with HIV infection from an Ambulatory of ENT and AIDS. Children were divided
according to the age: 0 to 5 years and 11 months and 6 to 12 years and 11 months 
and classified as having chronic otitis media based on history, physical
examination, audiologic and tympanometric data. Prevalence of chronic otitis
media, as well as CD4+ lymphocyte count were compared between groups in use of
HAART and the group without HAART. RESULTS: Out of 459 children, 65 (14.2%) had
chronic otitis media. We observed that in children aged 0 to 5 years and 11
months who were taking HAART there was significant lower prevalence of chronic
otitis media (p=0.02). The use of HAART was associated to higher mean CD4+
lymphocyte count (p<0.001). CONCLUSION: The use of HAART was associated to
reduction in prevalence of chronic otitis media in HIV infected children,
probably due to increase in mean CD4+ lymphocyte count.

Publication Types: 
    Comparative Study

PMID: 17143430 [PubMed - indexed for MEDLINE]

546: Saudi Med J. 2006 Dec;27(12):1847-9.

Tympanoplasty type-1. Endaural or postaural approach. Should the patient decide?

Ahmed LA, Raza SS.

Department of ENT, Buraidah Central Hospital, PO Box 2290, King Fahd Specialist
Hospital Complex, Buraidah, Al-Qassim, Kingdom of Saudi Arabia.
latifiasrar@hotmail.com

OBJECTIVE: To examine the preferred patient approach to chronic suppurative
otitis media (CSOM) of the safe type. METHODS: We designed a prospective study to
note the variables in the patient's initial choice for approach to CSOM of the
safe type at Buraidah Central Hospital, Al-Qassim, Saudi Arabia from January 2003
to December 2004. RESULTS: During the 24-month study period, we included 63
consecutive patients diagnosed with CSOM of the safe type. We excluded patients
with perforations associated with cholesteatomata, polyps, and acute infections. 
We administered a questionnaire discussing the options for the operation, and
found most males preferred the endaural approach, and most females preferred the 
postaural approach. CONCLUSION: There was a significant preference by younger age
groups for the postaural approach, especially younger females. They were more
concerned about the site, visibility, and cosmetic result from the scar, and
could camouflage the scar behind the pinna by hair or a traditional headscarf.

PMID: 17143362 [PubMed - indexed for MEDLINE]

547: Pediatrics. 2006 Dec;118(6):2298-312.

Safety, efficacy, and effectiveness of cold-adapted influenza vaccine-trivalent
against community-acquired, culture-confirmed influenza in young children
attending day care.

Vesikari T, Fleming DM, Aristegui JF, Vertruyen A, Ashkenazi S, Rappaport R,
Skinner J, Saville MK, Gruber WC, Forrest BD; CAIV-T Pediatric Day Care Clinical 
Trial Network.

Tampere University Medical School/FM3, Biokatu 10, 33520 Tampere, Finland.
timo.vesikari@uta.fi

OBJECTIVE: The goal was to evaluate the safety, tolerability, and efficacy of an 
investigational, refrigerator-stable formulation of live attenuated influenza
vaccine (cold-adapted influenza vaccine-trivalent) against culture-confirmed
influenza, acute otitis media, and effectiveness outcomes in young children in
day care over 2 consecutive influenza seasons. METHODS: Children 6 to <36 months 
of age who were attending day care were assigned randomly in year 1 to receive 2 
doses of vaccine or placebo intranasally, 35 +/- 7 days apart. In year 2,
subjects received 1 dose of the same treatment as in year 1. RESULTS: A total of 
1616 subjects (vaccine: 951 subjects; placebo: 665 subjects) in year 1 and 1090
subjects (vaccine: 640 subjects; placebo: 450 subjects) in year 2 were able to be
evaluated for efficacy. The mean age at first vaccination was 23.4 +/- 7.9
months. In year 1, the overall efficacy of the vaccine against influenza subtypes
similar to the vaccine was 85.4%; efficacy was 91.8% against A/H1N1 and 72.6%
against B. In year 2, the overall efficacy was 88.7%; efficacy was 90.0% against 
H1N1, 90.3% against A/H3N2, and 81.7% against B. Efficacy against all episodes of
acute otitis media associated with culture-confirmed influenza was 90.6% in year 
1 and 97.0% in year 2. Runny nose or nasal discharge after dose 1 in year 1 was
the only reactogenicity event that was significantly more frequent with
cold-adapted influenza vaccine-trivalent (82.3%) than placebo (75.4%).
CONCLUSIONS: Cold-adapted influenza vaccine-trivalent was well tolerated and
effective in preventing culture-confirmed influenza illness in children as young 
as 6 months of age who attended day care.

Publication Types: 
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 17142512 [PubMed - indexed for MEDLINE]

548: Pediatrics. 2006 Dec;118(6):2273-9.

Erratum in:
    Pediatrics. 2007 Jun;119(6):1270.

Association of proinflammatory cytokine gene polymorphisms with susceptibility to
otitis media.

Patel JA, Nair S, Revai K, Grady J, Saeed K, Matalon R, Block S, Chonmaitree T.

Department of Pediatrics, University of Texas Medical Branch, Galveston, TX
77555-0371, USA.

OBJECTIVE: Susceptibility to otitis media results from complex interactions among
genetic factors of the host, exposure to pathogens, and environmental influences.
The objective of this study was to study the role of single-nucleotide
polymorphisms of regulatory elements of proinflammatory cytokine genes tumor
necrosis factor-alpha(-308), interleukin-1beta(+3953), and interleukin-6(-174),
in susceptibility to recurrent otitis media in childhood. METHODS: A total of 505
children (296 otitis media susceptible, 209 nonsusceptible as control) were
enrolled at 2 sites (Texas and Kentucky). DNA of the children was studied for
specific single-nucleotide polymorphisms by restriction fragment length
polymorphism assay and confirmed by gene sequencing. RESULTS: In the overall
study group, tumor necrosis factor-alpha(-308) and interleukin-6(-174)
heterozygous or homozygous polymorphisms (high cytokine-producing genotypes) were
significantly associated with otitis media susceptibility. The same association
was found in a match-paired subgroup of 384 subjects. In the overall study group,
there was a significant step-wise increase in otitis media susceptibility with
increasing number of concomitant polymorphic genotypes. Simultaneous combination 
of tumor necrosis factor-alpha(-308) and interleukin-6(-174) polymorphisms
further increased the risk for otitis media susceptibility. These 2 polymorphic
genotypes also were associated with the increased risk for tympanostomy tube
placement. Children who had tumor necrosis factor-alpha(-308) polymorphism and
were breastfed for <1 month or exposed to cigarette smoke were more likely to be 
otitis media susceptible. CONCLUSIONS: Our data suggest that tumor necrosis
factor-alpha(-308) and interleukin-6(-174) polymorphisms are associated with
increased risk for otitis media susceptibility and placement of tympanostomy
tubes. Environmental factors such as breastfeeding may modify the risk for otitis
media susceptibility in polymorphic individuals.

Publication Types: 
    Multicenter Study
    Research Support, N.I.H., Extramural

PMID: 17142509 [PubMed - indexed for MEDLINE]

549: Otolaryngol Head Neck Surg. 2006 Dec;135(6):872-6.

Systematic facial nerve monitoring in middle ear and mastoid surgeries: "surgical
dehiscence" and "electrical dehiscence".

Choung YH, Park K, Cho MJ, Choung PH, Shin YR, Kahng H.

Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea.
yhc@ajou.ac.kr

OBJECTIVES: To evaluate and systemize intraoperative facial nerve monitoring
(IOFNM) in middle ear and mastoid surgeries. STUDY DESIGN AND SETTING: A
prospective study. METHODS: IOFNM was performed in 100 patients undergoing middle
ear and mastoid surgeries. We checked "surgical dehiscence" under microscopes,
and also estimated the minimal threshold of electric current needed to change the
electromyography of facial muscles using Nerve Integrity Monitor (NIM)-2 (Xomed, 
Minneapolis, MN, USA). RESULTS: Forty-three percent of cases showed "surgical
dehiscence" and responded to electric stimulation of 0.7 mA or less. "Electrical 
dehiscence" (<or=0.7 mA) was presented in 73 (73.0%) cases, and 82.2% of these
cases responded to 0.4 mA or less. The mean threshold of minimal electrical
stimulation was 0.29 mA for tympanic segments and 0.41 mA for mastoid segments.
CONCLUSIONS: We recommend an electrical stimulation of 0.7 mA for the first
screening and 0.4 mA for the second exploration in order to define the facial
nerve using intraoperative NIM-2 monitoring in middle ear and mastoid surgeries.

Publication Types: 
    Evaluation Studies

PMID: 17141076 [PubMed - indexed for MEDLINE]

550: J Laryngol Otol. 2007 Apr;121(4):333-7. Epub 2006 Nov 30.

Topical antibiotic ototoxicity: does it influence our practice?

Ho EC, Alaani A, Irving R.

Department of ENT Surgery, Warwick Hospital, Warwick, UK. euchinho@yahoo.co.uk

INTRODUCTION: We hypothesised that general practitioners and ENT specialists
manage discharging ears differently. This study was designed to investigate this 
further. METHODS AND MATERIALS: Postal questionnaires were sent to all general
practitioners in the Birmingham area and all UK consultants on the British
Association of Otolaryngology-Head and Neck Surgery address list. RESULTS AND
DISCUSSION: In the presence of an intact tympanic membrane, 99 per cent of
consultants and 90 per cent of general practitioners would use topical
antibiotics. In the presence of a perforated tympanic membrane, 97 per cent of
consultants would continue to use topical antibiotics, compared with only 43 per 
cent of general practitioners. This was attributed to a fear of ototoxicity. If a
topical non-ototoxic antibiotic of proven efficacy could be made available, 93
per cent of consultants and 88 per cent of general practitioners in this study
would seriously consider using it as first line treatment. CONCLUSION: The
majority of general practitioners would not use topical antibiotics in the
presence of a perforated tympanic membrane. Most doctors would consider using a
non-ototoxic topical antibiotic as first line treatment should one be made
available.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17134534 [PubMed - indexed for MEDLINE]

551: Pediatr Infect Dis J. 2006 Dec;25(12):1102-9.

An open-label, double tympanocentesis study of levofloxacin therapy in children
with, or at high risk for, recurrent or persistent acute otitis media.

Arguedas A, Dagan R, Pichichero M, Leibovitz E, Blumer J, McNeeley DF, Melkote R,
Noel GJ.

Instituto de Atención Pediátrica, Neeman-ICIC, Universidad de Ciencias Médicas,
San José, Costa Rica. aarguedas@iped.net

BACKGROUND: Levofloxacin has excellent activity against common respiratory
pathogens and therefore is likely to be effective in treating children with
persistent or recurrent otitis media. OBJECTIVE: The objective of this study was 
to assess the efficacy and safety of levofloxacin treatment in the eradication of
bacterial pathogens from the middle ear fluid (MEF) of children with, or at high 
risk for, persistent or recurrent otitis media. METHODS: An open-label
multicenter trial was conducted that involved tympanocentesis at entry and
selectively 3 to 5 days after starting levofloxacin (10 mg/kg twice a day for 10 
days). RESULTS:: Two hundred five children (80% < or =2 years) were enrolled. One
child did not have a confirmed diagnosis of acute otitis media and did not return
for follow-up visits. Of the remaining 204 children, 94 (46%) had bilateral
infection and 63 (31%) were receiving antimicrobials immediately before entry.
One hundred five isolates of Streptococcus pneumoniae, Haemophilus influenzae,
Moraxella catarrhalis and Streptococcus. pyogenes were recovered in pure or mixed
cultures. All isolates were susceptible to levofloxacin. During-treatment
bacterial eradication from MEF occurred in 88% (78 of 89) of bacteriologically
evaluable patients, including 90% (65 of 72) of children < or =24 months of age. 
Bacteria initially isolated from MEF were eradicated in 31 of 37 (84%) children
infected with S. pneumoniae and in 54 of 54 (100%) children infected with H.
influenzae. Overall, clinical success rate after therapy was 94% for the total
study population and 92% for the bacteriologically evaluable population.
Levofloxacin was well tolerated. Vomiting (4%) was the most common
treatment-limiting adverse event. CONCLUSIONS: Levofloxacin was safe and
effective in treating and eradicating common bacterial pathogens from MEF in
children with, or at risk for, recurrent or persistent otitis media.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 17133154 [PubMed - indexed for MEDLINE]

552: Otol Neurotol. 2006 Dec;27(8):1098-103.

Comment in:
    Otol Neurotol. 2007 Oct;28(7):992-3.

Management of lateral sinus thrombosis in chronic otitis media.

Iseri M, Aydin O, Ustündağ E, Keskin G, Almaç A.

Kocaeli University Medical Faculty, Department of Otolaryngology, Izmit/Kocaeli, 
Turkey. metei@superonline.com

OBJECTIVE: To present our experience with the diagnosis and treatment of lateral 
sinus thrombosis (LST) secondary to otogenic disease. PATIENTS AND METHODS: We
have retrospectively reviewed all the cases of LST caused by chronic otitis media
in ten years. RESULTS: In our series of five patients, four patients were
successfully treated by surgery without opening the sigmoid sinus. On the other
hand, one of our patients developed hydrocephalus and ataxia during preoperative 
antibiotic treatment. CONCLUSION: Most patients with thrombotic/nonabscessed
sinuses will have successful outcomes with this approach, but careful observation
is needed, given the possibility of advancing disease.

PMID: 17130799 [PubMed - indexed for MEDLINE]

553: Infect Immun. 2007 Feb;75(2):958-65. Epub 2006 Nov 27.

Phosphorylcholine decreases early inflammation and promotes the establishment of 
stable biofilm communities of nontypeable Haemophilus influenzae strain 86-028NP 
in a chinchilla model of otitis media.

Hong W, Mason K, Jurcisek J, Novotny L, Bakaletz LO, Swords WE.

Department of Microbiology and Immunology, Wake Forest University Health
Sciences, Winston-Salem, NC 27157, USA.

Nontypeable Haemophilus influenzae (NTHi) is a leading causative agent of otitis 
media. Much of the inflammation occurring during NTHi disease is initiated by
lipooligosaccharides (LOS) on the bacterial surface. Phosphorylcholine (PCho) is 
added to some LOS forms in a phase-variable manner, and these PCho(+) variants
predominate in vivo. Thus, we asked whether this modification confers some
advantage during infection. Virulence of an otitis media isolate (NTHi strain
86-028NP) was compared with that of an isogenic PCho transferase (licD) mutant
using a chinchilla (Chinchilla lanigera) model of otitis media. Animals infected 
with NTHi 86-028NP licD demonstrated increased early inflammation and a delayed
increase in bacterial counts compared to animals infected with NTHi 86-028NP. LOS
purified from chinchilla-passed NTHi 86-028NP had increased PCho content compared
to LOS purified from the inoculum. Both strains were recovered from middle ear
fluids as long as 14 days postinfection. Biofilms were macroscopically visible in
the middle ears of euthanized animals infected with NTHi 86-028NP 7 days and 14
days postchallenge. Conversely, less dense biofilms were observed in animals
infected with NTHi 86-028NP licD 7 days postinfection, and none of the animals
infected with NTHi 86-028NP licD had a visible biofilm by 14 days. Fluorescent
antibody staining revealed PCho(+) variants within biofilms, similar to our prior
results with tissue culture cells in vitro (S. L. West-Barnette, A. Rockel, and
W. E. Swords, Infect. Immun. 74:1828-1836, 2006). Animals coinfected with equal
proportions of both strains had equal persistence of each strain and somewhat
greater severity of disease. We thus conclude that PCho promotes NTHi infection
and persistence by reducing the host inflammatory response and by promoting
formation of stable biofilm communities.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural

PMID: 17130253 [PubMed - indexed for MEDLINE]

554: Int J Pediatr Otorhinolaryngol. 2007 Jan;71(1):125-33. Epub 2006 Nov 28.

High frequency distortion product otoacoustic emissions in children with and
without middle ear dysfunction.

Kei J, Brazel B, Crebbin K, Richards A, Willeston N.

Division of Audiology, School of Health and Rehabilitation Sciences, The
University of Queensland, Brisbane 4072, Queensland, Australia. k.kei@uq.edu.au

OBJECTIVE: Distortion product otoacoustic emissions (DPOAEs) (9-16kHz) are a
useful measure of the function of the cochlea, which may be damaged by ototoxic
drugs during anticancer chemotherapy. As children undergoing chemotherapy may
also have middle ear problems, it is necessary to know if middle ear problems
would have a confounding effect on the ability of DPOAEs to assess cochlear
function in the extend high frequency region (9-16kHz). The present study aimed
to investigate the effect of middle ear dysfunction on DPOAEs in the extended
high frequency region in young children. METHODS: The sample was comprised of 100
ears of 50 school-aged children (21 boys and 29 girls) with a mean age of 6.3
years (S.D.=0.5; range 5.3-7.3). Otoscopy, pure tone hearing screening,
tympanometry, acoustic reflexes and DPOAEs for both the conventional and extended
high frequencies were administered to each child under typical school screening
conditions. Participants were classified into one of three groups based on
immittance (tympanometry and acoustic reflex) results. They included a "pass
immittance" group, a "fail immittance" group and an "undetermined" group (with a 
pass in either tympanometry or acoustic reflexes, but not both). DPOAE amplitudes
and signal-to-noise ratios (SNRs) were measured and compared across the three
groups of participants. RESULTS: The fail immittance group showed significantly
smaller DPOAE amplitudes and SNRs when compared to the other two groups at
frequencies ranging from 1 to 9.5kHz and at 13kHz, but not at 10, 11, 12 and
14kHz. There was no significant difference in DPOAE results between the pass
immittance and undetermined groups. CONCLUSIONS: Despite the adverse effects of
middle ear dysfunction, its effect on DPOAEs in the extended high frequency
region was not as severe as that in the lower frequency region. Hence, assessment
of cochlear function in children with a middle ear lesion in the extended high
frequencies using DPOAEs should be made with caution.

PMID: 17126413 [PubMed - indexed for MEDLINE]

555: J Laryngol Otol. 2007 Apr;121(4):324-8. Epub 2006 Nov 24.

Role of ossiculoplasty in canal wall down tympanoplasty for middle-ear
cholesteatoma: hearing results.

De Corso E, Marchese MR, Sergi B, Rigante M, Paludetti G.

Institute of Otorhinolaryngology, Policlinico A Gemelli, Università Cattolica del
Sacro Cuore, Rome, Italy. eugenio.decorso@tin.it

The aim of this study was to evaluate the hearing results of ossiculoplasty in
canal wall down tympanoplasty in one stage middle-ear cholesteatoma surgery.We
carried out a retrospective review of a consecutive series of 142 cases which had
undergone type two or three canal wall down tympanoplasty with ossicular
reconstruction, between January 1995 and December 2002, due to chronic otitis
media with cholesteatoma.Pre-operative audiometric testing revealed a mean air
conduction pure tone average (PTA) of 50.97 dB and a mean bone conduction PTA of 
22.14 dB. The mean post-operative result for air conduction PTA was 37.62 and for
bone conduction PTA was 23.37 dB. The mean pre- and post-operative air-bone gaps 
(ABGs) were 28.83 and 13.94 dB, respectively, with a gain of 14.89 dB. Almost
62.67 per cent of patients closed their ABGs to within 20 dB.Our functional
results are comparable with those of other authors. In the present study, we show
that hearing improvement is possible following cholesteatoma surgery with canal
wall down tympanoplasty and ossicular chain reconstruction.

PMID: 17125581 [PubMed - indexed for MEDLINE]

556: J Laryngol Otol. 2007 Jul;121(7):630-4. Epub 2006 Nov 24.

Transtympanic versus intramuscular steroid administration in a histamine-induced 
inflammatory middle-ear model.

Chimona TS, Panayiotides JG, Papadakis CE, Helidonis ES, Velegrakis GA.

Department of Otolaryngology, University of Crete School of Medicine, Crete.
chimonath@yahoo.gr

OBJECTIVES: Assessment of the histopathologic effect of transtympanic and
intramuscular administration of dexamethasone in an in vivo experimental animal
model of middle-ear mucosal inflammation. METHODS: Fifty healthy rabbits
weighting 1500-1800 g were randomly divided in three groups. In 10 animals
(control group), 0.5 ml of a 20 mg/ml histamine solution was injected
transtympanically. In 20 rabbits (group A), histamine challenge followed a three 
day intramuscular pretreatment with dexamethasone at 1 mg/kg per day. In 20
rabbits (group B), histamine challenge followed pretreatment with dexamethasone
via a transtympanic route (0.3 ml, 1.2 mg dexamethasone). Middle-ear mucosa was
obtained for histopathology 30 minutes after histamine administration. The
following parameters were assessed: inflammation, acute inflammatory component,
presence of eosinophils, inflammatory activity and fibrosis. RESULTS: Oedema,
vascular dilatation and congestion, inflammation, the presence of an acute
(polymorphonuclear) inflammatory component, the presence of eosinophils, and
inflammatory activity were found to be of a lesser grade in the mucosae of group 
B. All differences were found to be statistically highly significant (p<0.01)
using the Mann-Whitney test. CONCLUSION: Our findings validate the transtympanic 
route of dexamethasone administration in counteracting histamine effects.

PMID: 17125577 [PubMed - indexed for MEDLINE]

557: Kulak Burun Bogaz Ihtis Derg. 2006;16(5):214-20.

The effect of systemic prednisolone on propylene glycol-induced otitis media in
guinea pig.

Kayhan FT, Algün Z.

Department of Otolaryngology, Dr. Lütfi Kirdar Kartal Training and Research
Hospital, Istanbul, Turkey. ftulinkayhan@hotmail.com

OBJECTIVES: In this histopathologic study, we investigated the effect of systemic
prednisolone on propylene glycol-induced otitis media in guinea pig ear.
MATERIALS AND METHODS: Ten adult guinea pigs received systemic prednisolone (10
mg, IM, single dose) together with a single application of 60% propylene glycol
(0.2 ml, per ear) to both middle ears. Ten control guinea pigs were given a
single application of 60% propylene glycol (0.2 ml) in the left ear, and a single
application of saline (0.2 ml) in the right ear. Four weeks later, the animals
were sacrificed and temporal bones were removed and prepared for histological
evaluation. Paraffin-embedded specimens were horizontally sectioned at 7 microns.
One of each five sections was stained with hematoxylin and eosin, and studied
under light microscopy. RESULTS: In the control group, otitis media developed in 
six of nine propylene glycol-administered ears (66%), whereas all saline-treated 
ears remained intact. In the prednisolone group, only one (6%) of 16 ears
developed otitis media and cholesteatoma. The difference was statistically
significant. CONCLUSION: Our results suggest that systemic prednisolone has a
potent effect to prevent propylene glycol-induced otitis media in guinea pig
ears.

PMID: 17124441 [PubMed - indexed for MEDLINE]

558: J Laryngol Otol. 2007 Feb;121(2):105-9. Epub 2006 Nov 23.

Advancement in post-meningitic lateral semicircular canal labyrinthitis
ossificans.

Chan CC, Saunders DE, Chong WK, Hartley BE, Raglan E, Rajput K.

Department of Audiological Medicine, St Ann's Hospital, London, UK.

OBJECTIVE: To assess whether lateral semicircular canal (LSCC) ossification is
more advanced than that in the cochlear basal turn, in order to judge the value
of the former as a predictor. METHODS: Retrospective review of 33 paediatric
patients from our cochlear implant programme, with profound sensorineural hearing
loss after bacterial meningitis. Magnetic resonance imaging (MRI), computed
tomography (CT) scans and operative findings were reviewed. RESULTS: On CT, LSCC 
ossification scores were more advanced than those for the cochlear basal turn in 
69.9 per cent of implanted ears. Forty-five per cent (15/33) of children had
ossification at surgery. In predicting this, the sensitivity of CT LSCC
ossification was 90 per cent and that of MRI LSCC ossification was 83.3 per cent.
CONCLUSIONS: The more advanced ossification found in the LSCC, compared with that
in the cochlear basal turn, adds to previous findings of LSCC pathology
predicting cochlear ossification. Surprisingly, CT of the LSCC appears to be no
less valuable than MRI in pre-operative cochlear implant assessment of
post-meningitic children.

PMID: 17123454 [PubMed - indexed for MEDLINE]

559: Arch Otolaryngol Head Neck Surg. 2006 Nov;132(11):1210-5.

Estimated cost-effectiveness of active middle-ear implantation in
hearing-impaired patients with severe external otitis.

Snik AF, van Duijnhoven NT, Mylanus EA, Cremers CW.

Department of Otorhinolaryngology, University Medical Center St Radboud Nijmegen,
Nijmegen, the Netherlands. a.snik@kno.umcn.nl

OBJECTIVE: To determine the cost-effectiveness of middle-ear implantations in
hearing-impaired patients with severe external otitis in the Netherlands. DESIGN:
Cost-effectiveness analysis, using single-subject repeated measures of quality of
life and total cost determinations. SETTING: Hospital based. Patients Moderately 
to severely sensorineurally hearing-impaired patients (n = 21) with severe
chronic external otitis, eligible to receive a middle-ear implant. Main Outcome
Measure Cost per quality-adjusted life-year (QALY), based on scores of the
Medical Outcomes Study Short-Form Health()Survey (SF-36) generic quality of life 
questionnaire. Only direct costs were included in cost calculation of middle-ear 
implantation. RESULTS: Mean health utility gain was 0.046 (0.012-0.079) (P = .01)
measured at the mental component of the SF-36. With a mean profitable time of
19.4 years and an overall cost of euro 14,354, minimal cost-effectiveness of
middle-ear implantation was euro 16,085/QALY. CONCLUSION: Based on the cost per
QALY, middle-ear implantation proved to be a cost-effective and justified health 
care intervention in the Netherlands.

PMID: 17116816 [PubMed - indexed for MEDLINE]

560: Mol Immunol. 2007 Mar;44(9):2446-58. Epub 2006 Nov 20.

A member of the cathelicidin family of antimicrobial peptides is produced in the 
upper airway of the chinchilla and its mRNA expression is altered by common viral
and bacterial co-pathogens of otitis media.

McGillivary G, Ray WC, Bevins CL, Munson RS Jr, Bakaletz LO.

Columbus Children's Research Institute, Center for Microbial Pathogenesis and The
Ohio State University College of Medicine & Public Health, 700 Children's Drive, 
Rm. W591, Columbus, OH 43205, USA.

Cationic antimicrobial peptides (AMPs), a component of the innate immune system, 
play a major role in defense of mucosal surfaces against a wide spectrum of
microorganisms such as viral and bacterial co-pathogens of the polymicrobial
disease otitis media (OM). To further understand the role of AMPs in OM, we
cloned a cDNA encoding a cathelicidin homolog (cCRAMP) from upper respiratory
tract (URT) mucosae of the chinchilla, the predominant host used to model
experimental OM. Recombinant cCRAMP exhibited alpha-helical secondary structure
and killed the three main bacterial pathogens of OM. In situ hybridization showed
cCRAMP mRNA production in epithelium of the chinchilla Eustachian tube and RT-PCR
was used to amplify cCRAMP mRNA from several other tissues of the chinchilla URT.
Quantitative RT-PCR analysis of chinchilla middle ear epithelial cells (CMEEs)
incubated with either viral (influenza A virus, adenovirus, or RSV) or bacterial 
(nontypeable H. influenzae, M. catarrhalis, or S. pneumoniae) pathogens
associated with OM demonstrated distinct microbe-specific patterns of altered
expression. Collectively, these data showed that viruses and bacteria modulate
AMP messages in the URT, which likely contributes to the disease course of OM.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17113647 [PubMed - indexed for MEDLINE]

561: Am Fam Physician. 2006 Nov 1;74(9):1510-6.

Otitis externa: Review and clinical update.

Osguthorpe JD, Nielsen DR.

Otolaryngology and Communicative Sciences Department, Medical University of South
Carolina, 135 Rutledge Avenue, Charleston, SC 29425, USA.

Otitis externa can take an acute or a chronic form, with the acute form affecting
four in 1,000 persons annually and the chronic form affecting 3 to 5 percent of
the population. Acute disease commonly results from bacterial (90 percent of
cases) or fungal (10 percent of cases) overgrowth in an ear canal subjected to
excess moisture or to local trauma. Chronic disease often is part of a more
generalized dermatologic or allergic problem. Symptoms of early acute and most
chronic disease include pruritus and local discomfort. If left untreated, acute
disease can be followed by canal edema, discharge, and pain, and eventually by
extra-canal manifestations. Topical application of an acidifying solution is
usually adequate in treating early disease. An antimicrobial-containing
ototopical is the preferred treatment for later-stage acute disease, and oral
antibiotic therapy is reserved for advanced disease or those who are
immunocompromised. Preventive measures reduce recurrences and typically involve
minimizing ear canal moisture, trauma, or exposure to materials that incite local
irritation or contact dermatitis.

Publication Types: 
    Review

PMID: 17111889 [PubMed - indexed for MEDLINE]

562: Vaccine. 2007 Mar 22;25(13):2471-7. Epub 2006 Sep 25.

Comparison of mucosal and parenteral immunisation in two animal models of
pneumococcal infection: otitis media and acute pneumonia.

Cripps AW, Kyd JM.

Griffith Health, Griffith University, PMB 50 Gold Coast Mail Centre, Qld 9762,
Australia. allan.cripps@griffith.esu.au

Bacterial clearance and immune responses in a mouse model of pneumonia and a rat 
model of otitis media following parenteral or mucosal immunisation in both models
were compared. Both the immunisation routes were equally effective in inducing
bacterial clearance from the lung, upregulated the recruitment of white cells and
lead to an increase in the concentration of TNF-alpha, IL-1beta and specific
antibody in the bronchoalveolar lavage. Both the routes of immunisation enhanced 
clearance of bacteria from the middle ear. Parenteral immunisation was most
effective overall in enhancing bacterial clearance and recruiting white cells to 
the middle ear. Both the routes significantly suppressed the levels of TNF-alpha 
in the middle ear lavage. Mucosal immunisation induced a Streptococcus
pneumoniae-specific IgA antibody response. Both the animal models gave highly
reproducible disease and provided high levels of sensitivity for testing the
efficacy of candidate vaccine antigens. Differences observed in the inflammatory 
responses require further study.

PMID: 17110001 [PubMed - indexed for MEDLINE]

563: Eur Arch Otorhinolaryngol. 2007 May;264(5):477-81. Epub 2006 Nov 11.

Spectral gradient acoustic reflectometry in the diagnosis of middle-ear fluid in 
children.

Lindén H, Teppo H, Revonta M.

Department of Otorhinolaryngology, Kanta-Hame Central Hospital, Hameenlinna,
Finland. heikki.teppo@khshp.fi

Diagnosis of otitis media is based on detection of middle-ear fluid (MEF) and is 
both important and difficult to achieve. Also non-infectious MEF is important to 
detect, since it can compromise hearing. In this prospective, blinded study,
spectral gradient acoustic reflectometry (SG-AR) was evaluated as an indicator of
MEF among children. Sensitivity, specificity and positive and negative predictive
values of SG-AR in detecting MEF were calculated in children undergoing
ambulatory surgery for recurrent or secretory otitis media using otomicroscopic
myringotomy as the reference method of confirming middle-ear status. Final study 
material consisted of 376 ears. Pattern recognition of SG-AR curves reached the
best combination of sensitivity and specificity (69 and 97%, respectively), and
the best combination of positive (PPV) and negative (NPV) predictive values (93
and 83%, respectively), in detection of MEF. With a spectral gradient value of
<80 degrees , the sensitivity was 75% and specificity 71%. With <50 degrees , PPV
was 78%, and with >or=100 degrees , NPV was 86%. The diagnostic power of SG-AR
was comparable to that reported with pneumatic otoscopy and tympanometry. It was 
equally effective in detecting both MEF cases and healthy ears. Pattern
recognition seems to improve its performance. We recommend the use of pattern
recognition of SG-AR as a screening method for MEF among children.

PMID: 17102956 [PubMed - indexed for MEDLINE]

564: Rheumatol Int. 2007 Mar;27(5):493-5.

Comment in:
    Rheumatol Int. 2007 Aug;27(10):995-6.

A novel therapeutic option in Cogan diseases? TNF-alpha blockers.

Fricker M, Baumann A, Wermelinger F, Villiger PM, Helbling A.

Division of Allergology, Policlinics of Allergy and Immunology, Department of
Rheumatology and Clinical Immunology/Allergology, University Hospital
(Inselspital), Bern, Switzerland.

Cogan's syndrome is characterized by noninfectious, interstitial keratitis
combined with a vestibulo-auditory deficit. Despite therapy with corticosteroids 
in combination with immunosuppressive agents, relapses occurred in two subjects
and the clinical course suggested a progression of the disease. Treatment with
anti-TNF-alpha was started leading to a rapid and sustained clinical remission
for over 2 respectively 3 years.

Publication Types: 
    Case Reports

PMID: 17102947 [PubMed - indexed for MEDLINE]

565: J Theor Biol. 2007 Mar 7;245(1):66-76. Epub 2006 Oct 6.

Mathematical model comparisons of potential non-typeable Haemophilus influenzae
vaccine effects.

Lin X, Koopman JS, Chick SE.

Department of Epidemiology, University of Michigan, 109 Observatory Street, Ann
Arbor, MI 48109, USA. xlin@kurron.com

Vaccines to prevent acute otitis media (AOM) caused by non-typeable Haemophilus
influenzae (NTHi) are under development. Because NTHi is highly variable and
colonization rates are high, special vaccine characteristics and trial designs
might be needed. We examined in mathematical models the equilibrium NTHi-caused
AOM rate given hypothetical vaccines that generated immunity identical to
corresponding maximal naturally acquired immunity. Vaccines were examined with
single effects and combinations of immunity affecting (1) AOM rates given
colonization (pathogenicity), (2) susceptibility to colonization, and (3)
contagiousness given colonization. Percent reductions in AOM across all preschool
children were (1) 34%, (2) 31%, (3) 9%, (1 and 2) 57%, (2 and 3) 50%, and (1, 2, 
and 3) 75%. Effects on children in daycare vs. not in daycare were (1) 18 vs.
48%, (2) -1 vs. 57%, (3) 13 vs. 5%, (1 and 2) 30 vs. 79%, (2 and 3) 33 vs. 60%,
and (1, 2, and 3) 64 vs. 85%. Pure pathogenicity effects (1 alone) will need to
be supplemented by transmission effects. The effects of susceptibility (2 alone) 
are diminished or negative because children protected against colonization have
lower levels of immunity to (1) and (3) than unvaccinated children. For trials to
predict population effects, both colonization and AOM outcomes must be studied
and all three effects must be evaluated. This need arises because, unlike H.
influenzae type B, high NTHi exposure diminishes cumulative vaccine effects and
high colonization rates generate rapid accumulation of natural immunity that
alters the indirect effects of vaccine immunity on transmission differently by
age and daycare status.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural

PMID: 17098258 [PubMed - indexed for MEDLINE]

566: Otolaryngol Clin North Am. 2006 Dec;39(6):1237-55.

Complications of chronic otitis media and cholesteatoma.

Smith JA, Danner CJ.

Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for
Medical Sciences, 4301 West Markham Slot #543, Little Rock, AR 72205, USA.
smithjasona@uams.edu

The incidence of complications of chronic otitis media and cholesteatoma has
decreased since the proliferation of antibiotics early in the twentieth century. 
However, these complications continue to occur, and can be lethal if they are not
identified and treated properly. Therapy for the complications associated with
chronic otitis media, unlike that of acute otitis media, usually involves
surgical intervention. As medical (antibiotic) therapy continues to improve, and 
new imaging techniques are introduced, less invasive treatment modalities may be 
shown to be as effective as the classic, time-tested, surgical options.

Publication Types: 
    Review

PMID: 17097444 [PubMed - indexed for MEDLINE]

567: Otolaryngol Clin North Am. 2006 Dec;39(6):1129-42.

Mastoid obliteration.

Mehta RP, Harris JP.

Department of Otology and Laryngology, Massachusetts Eye and Ear
Infirmary/Harvard Medical School, Boston, MA, USA.

Mastoid obliteration is commonly performed to reduce the size of mastoidectomy
cavity following canal wall-down tympanomastoidectomy for chronic otitis media.
The indications and techniques for mastoid obliteration as well as total
tympanomastoid obliteration will be reviewed. The vast majority of obliteration
techniques consist of either local flaps or free grafts (bone, cartilage, fat,
hydroxyapatite). The radiographic and histopathologic features of mastoid
obliteration will also be reviewed.

Publication Types: 
    Review

PMID: 17097437 [PubMed - indexed for MEDLINE]

568: Int J Pediatr Otorhinolaryngol. 2007 Jan;71(1):89-94. Epub 2006 Nov 9.

Tolerability of oral xylitol solution in young children: implications for otitis 
media prophylaxis.

Vernacchio L, Vezina RM, Mitchell AA.

Slone Epidemiology Center at Boston University, Boston, MA 02215, USA.
lvernacchio@slone.bu.edu

OBJECTIVE: Xylitol, given as 2g orally five times-a-day, significantly reduces
the incidence of acute otitis media (AOM) in children. A less frequent dosing
schedule, if tolerable and efficacious, would promote the more widespread use of 
this treatment. We sought to determine the tolerability and acceptability in
young children of oral xylitol solution at doses of 5g three times-a-day (TID)
and 7.5g once daily (QD). METHODS: The study was a 3-month randomized
placebo-controlled trial of the tolerability and acceptability of oral xylitol
solution in 120 children 6-36 months of age performed in the SCOR Network.
RESULTS: Study withdrawals and unscheduled medical visits for gastrointestinal
complaints did not differ significantly among the study groups. The proportions
of subjects in the xylitol TID group who experienced excessive gas or diarrhea at
months 1, 2, and 3 were 22.7%, 10.0%, and 14.3%, respectively, and in the xylitol
QD group were 27.3%, 17.4%, and 14.3%, respectively, and these did not differ
from the placebo groups. The proportions who accepted the study solution easily
or with only minor difficulty at 1, 2, and 3 months in the xylitol TID group were
77.3%, 90.0%, and 90.5% and in the xylitol QD group, 77.3%, 82.6%, and 90.5%,
respectively. CONCLUSIONS: Oral xylitol solution at dosages of 5g TID and 7.5g QD
is well-tolerated by young children. Given the potential for xylitol as a safe,
inexpensive option for AOM prophylaxis, clinical trials using these dosages of
xylitol can be conducted.

Publication Types: 
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural

PMID: 17097152 [PubMed - indexed for MEDLINE]

569: J Microbiol Methods. 2007 Feb;68(2):342-8. Epub 2006 Nov 13.

Evaluation of microbial RNA extractions from Streptococcus pneumoniae.

Li-Korotky HS, Kelly LA, Piltcher O, Hebda PA, Doyle WJ.

Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh,
Pittsburgh, Pennsylvania, 15213, USA. Ha-Sheng.Li@chp.edu

The mechanisms that control Streptococcus pneumoniae's ability to colonize the
nasopharynx or to invade the middle ear and cause acute otitis media are not
understood. Focused study of these mechanisms requires efficient methods for the 
extraction of microbial RNA from minute clinical samples. Several
lysis/extraction methods were tested and compared to determine the optimal
conditions for isolating intact total RNA from pneumococcal cells. The
sensitivity and efficiency of the extractions were evaluated by reverse
transcription polymerase chain reaction (RT-PCR). Compared to other methods,
mechanical homogenization in TRIZOL was the most efficient for releasing
microbial RNA, and addition of polyinosinic acid (Poly I) as an RNA carrier
increased the assay sensitivity to 10(2) colony forming units when detected by
RT-PCR amplification of 16S ribosomal RNA or messenger RNA for penicillin binding
protein 2b. Quantitative results were confirmed using a ribonuclease protection
assay. Penicillin binding protein 2b was also detected in rat middle ear mucosa
recovered 5 weeks after middle ear challenge with S. pneumoniae. This study
describes a useful core methodology for use in identifying pneumococcal virulence
genes from small titer samples and has promising applications in clinical studies
of pneumococcal nasopharyngeal colonization and otitis media pathogenesis.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17095113 [PubMed - indexed for MEDLINE]

570: Br J Educ Psychol. 2006 Dec;76(Pt 4):727-44.

The effects of an early history of otitis media on children's language and
literacy skill development.

Winskel H.

MARCS Auditory Laboratories, University of Western Sydney, Milperra, NSW,
Australia. h.winskel@uws.edu.au

BACKGROUND: Otitis media (OM) or middle ear infection is a common childhood
illness and is most frequent during the crucial first 3 years of life when speech
and language categories are being established, which could potentially have a
long-term effect on language and literacy skill development. AIMS: The purpose of
the current study was to ascertain the effects of a history of OM in early
childhood on later language and literacy skill development. SAMPLE: Forty-three
children from Grade 1 and Grade 2, between 6 and 8 years old with an early
history of OM and 43 control children, matched for chronological age, gender and 
socio-economic status, participated in this study. METHODS: Children were tested 
on multiple measures of phonological awareness, semantic knowledge, narration and
reading ability. The performance of children with and without a history of OM was
compared on the different measures. RESULTS: There was a general tendency for
children with a history of OM to achieve lower scores on phonological awareness
skills of alliteration, rhyme and non-word reading, semantic skills of expressive
vocabulary and word definitions and reading than non-OM children. CONCLUSION:
These findings highlight the potential problems an early history of middle ear
infection can have on school-aged children's later language and literacy
development.

PMID: 17094883 [PubMed - indexed for MEDLINE]

571: FEMS Immunol Med Microbiol. 2007 Feb;49(1):41-5. Epub 2006 Nov 9.

Evidence of local antibody response against Alloiococcus otitidis in the middle
ear cavity of children with otitis media.

Harimaya A, Takada R, Himi T, Yokota S, Fujii N.

Department of Otolaryngology, Sapporo Medical University School of Medicine,
Sapporo, Japan. harimaya@sapmed.ac.jp

Alloiococcus otitidis is a recently discovered bacterium frequently associated
with otitis media. However, no study is available as to whether A. otitidis has a
pathogenic role and induces local immune response in the middle ear as a true
pathogen. Whole bacterial sonicate of A. otitidis was separated by sodium dodecyl
sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), and transferred to a
nitrocellulose membrane. Then, Western blot analysis was performed with
supernatant of the middle ear effusions from children with A. otitidis-positive
otitis media. SDS-PAGE of the bacterial sonicate showed several protein bands,
designated A1-A11. Western blot analysis revealed the presence of IgG, secretory 
IgA, IgG2, and IgM against A. otitidis in the middle ear effusions. Absorption of
the specimens with sonicates of other major middle ear pathogens did not alter
the reactivity of antibodies against the alloiococcal antigens. The results
suggest that specific local immune response against A. otitidis is induced during
middle ear infection of the organism as a true pathogen. A5, A6 or A11 is
expected to be a main antigenic determinant. This is the first report to show
evidence of local antibody response against A. otitidis and to disclose antigenic
components of A. otitidis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17094788 [PubMed - indexed for MEDLINE]

572: Eur Arch Otorhinolaryngol. 2007 Apr;264(4):377-80. Epub 2006 Nov 9.

Preservation of the mastoid aeration and prevention of mastoid dimpling in
chronic otitis media with cholesteatoma surgery using hyaluronate-based
bioresorbable membrane (Seprafilm).

Caylan R, Bektas D.

Department of Otorhinolaryngology, School of Medicine, Karadeniz Technical
University, Trabzon, Turkey. refikcaylan@yahoo.com

During mastoidectomy a hollow-cavity is formed within the mastoid bone after its 
cortex and air cells are removed. Postoperatively, the aerated cavity is usually 
filled with soft tissues. Also it is not so uncommon to see cases with retraction
of the mastoid area skin into the cavity causing a cosmetic problem termed as
mastoid dimpling. In order to achieve an aerated mastoid cavity and minimizing
the mastoid dimpling, an adhesion barrier was utilized to prevent fibrous tissue 
formation within the cavity. Twenty-one patients with middle ear and/or mastoid
cholesteatoma, who underwent tympanoplasty with mastoidectomy (canal wall-up)
with staged procedures, were included in the study. The mastoid cavity was tented
and covered with an adhesion barrier (hyaluranic acid and carboxymethylcellulose,
Seprafilm, (Seprafilm, GENZYME Inc., Cambridge, MA, USA) at the end of the
surgery. Postoperatively, in two cases serohemorrhagic fluid collected between
the adhesion barrier membrane and the subcutaneous tissues requiring drainage.
Second stages were performed 4-6 months after the first stage. Two residual
cholesteatoma cases were present. Patients were followed for a minimum of 2 years
after the second stage. Mean follow-up was 2 years and 5 months. No wound
infection was encountered postoperatively. Late follow-up of minimum 2 years
after the second surgery revealed cosmetically acceptable retroauricular area
with no dimpling. Mild retraction in two cases and two micro-central perforations
in the neotympanic membrane were found. CT scans obtained both prior to the
second stage and at the end of the second year of second stage revealed fully
aerated mastoid cavities covered with periosteum in its natural position. Mastoid
cortex plasty with seprafilm offers a rapid and effective solution to the
preservation of mastoid space and the preservation of the contours of the mastoid
bone.

PMID: 17093997 [PubMed - indexed for MEDLINE]

573: J Clin Microbiol. 2007 Jan;45(1):97-101. Epub 2006 Nov 8.

Characterization of in vitro biofilm-associated pneumococcal phase variants of a 
clinically relevant serotype 3 clone.

McEllistrem MC, Ransford JV, Khan SA.

Division of Infectious Diseases, University of Pittsburgh School of Medicine, PA 
15213-2582, USA. mcellistremc@dom.pitt.edu

An increasing proportion of children with acute otitis media due to Streptococcus
pneumoniae have serotype 3 infections since licensure of the seven-valent
pneumococcal conjugate vaccine. These serotype 3 strains are genetically related 
by molecular subtyping. During otitis media with effusion and recurrent otitis
media, biofilms commonly develop. Pneumococcal in vitro biofilms are comprised of
phase variants that differ in colony morphology. By using a representative strain
of the mucoid serotype 3 clone, rough phase variants with a diverse array of
mutations were detected in biofilms formed in vitro. Most phase variants had
mutations in the cps3D gene, the first gene of the capsular operon. Eleven had
single nucleotide polymorphisms (SNPs) in the cps3D gene, one had an SNP in the
-10 promoter, and three had large deletions in the cps3D gene. Reversion to the
mucoid phenotype was associated with reversion of the mutation in the cps3D gene.
Unlike the phase variants detected in the nasopharynx, which have at least 20% of
the parental amount of capsule, the in vitro biofilm-associated phase variants
had < or =12% of the parental amount of capsule, as determined by capsule
enzyme-linked immunosorbent assays. Using real-time reverse transcription-PCR, we
determined that capsule expression in the phase variants was likely regulated at 
multiple levels. These in vitro phase variation data, which underscore the
plasticity of the pneumococcus, need to be confirmed with in vivo analyses of the
middle ear mucosa during otitis media.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17093036 [PubMed - indexed for MEDLINE]

574: Adv Pediatr. 2006;53:241-54.

Implementing guidelines for the treatment of acute otitis media.

Barenkamp SJ.

Department of Pediatrics, St. Louis University School of Medicine, 1465 South
Grand Boulevard, St. Louis, MO 63104-1095, USA. barenksj@slu.edu

The recently published Clinical Practice Guideline for the Diagnosis and
Management of Acute Otitis Media represents a sincere effort by the AAP andthe
AAFP to provide management guidelines for the practitioner based upon the best
scientific evidence available. Despite many years of research and hundreds of
clinical studies addressing various aspects of the epidemiology, clinical
presentation, and treatment of acute otitis media, important questions remain
unaddressed or have been addressed in a less than optimal fashion. These gaps in 
knowledge and deficiencies in several of the studies that formed the scientific
basis for the proposed guidelines are the major reasons behind continued
disagreement over certain recommendations. Until more comprehensive and careful
analyses can be performed, disagreements are likely to persist. Even so, there is
general agreement about most of the recommendations made in these guidelines, and
these recommendations will provide a very valuable framework for the practicing
physician as he or she cares for children with acute otitis media. To briefly
review the major points, first is the critical importance of accurately
diagnosing acute otitis media using a combination of clinical findings and
observable abnormalities of the tympanic membrane and middle ear space.
Particularly important is the differentiation of acute otitis media from otitis
media with effusion. Second is the value of treating the pain associated with
acute otitis media as a regular component of care, irrespective of any decision
concerning antimicrobial treatment. Third is the option, for a select group of
older patients with nonsevere disease, of withholding antimicrobial therapy for
the first 48 to 72 hours, if close follow-up and active parental involvement can 
be guaranteed. Fourth is the recommendation that if an antimicrobial agent is
used, high-dose amoxicillin (80 to 90 mg/kg/d) is the treatment of choice for
most children at the time of initial presentation unless disease is particularly 
severe or the child has recently failed a previous course of the antibiotic.
Finally highlighted is the importance of ongoing education efforts on the part of
physicians in advising parents about the things they can do in their households
to lessen the risk of future disease.

Publication Types: 
    Practice Guideline
    Review

PMID: 17089870 [PubMed - indexed for MEDLINE]

575: Infect Immun. 2007 Jan;75(1):325-33. Epub 2006 Nov 6.

Role of complement in defense of the middle ear revealed by restoring the
virulence of nontypeable Haemophilus influenzae siaB mutants.

Figueira MA, Ram S, Goldstein R, Hood DW, Moxon ER, Pelton SI.

Section of Pediatric Infectious Diseases, Maxwell Finland Laboratory for
Infectious Diseases, Room 508, 774 Albany Street, Boston Medical Center, Boston, 
MA 02118, USA. maf6559@bu.edu

Nontypeable (NT) Haemophilus influenzae is an important cause of otitis media in 
children. We have shown previously that NT H. influenzae mutants defective in
their ability to sialylate lipopolysaccharide (LPS), called siaB mutants, show
attenuated virulence in a chinchilla model of experimental otitis media (EOM). We
show that complement is a key arm of host innate immunity against NT H.
influenzae-induced EOM. Depleting complement in chinchillas by use of cobra venom
factor (CoVF) rendered two otherwise avirulent siaB mutants fully virulent and
able to cause EOM with severity similar to that of wild-type strains. Clearance
of infection caused by siaB mutants in CoVF-treated animals coincided with
reappearance of C3. Wild-type strains were more resistant to direct
complement-mediated killing than their siaB mutants. The serum-resistant strain
bound less C3 and C4 than the serum-sensitive strain. Neither NT H. influenzae
strain tested bound factor H (alternative complement pathway regulator).
Selective activation of the alternative pathway resulted in more C3 binding to
siaB mutants. LPS sialylation had a more profound impact on the amount of
alternative-pathway-mediated C3 binding ( approximately 5-fold decrease in
fluorescence) when LPS was the main C3 target, as occurred on the more
serum-resistant strain. In contrast, only an approximately 1.5-fold decrease in
fluorescence intensity of C3 binding was seen with the serum-sensitive strain,
where surface proteins predominantly bound C3. Differences in binding sites for
C3 and C4 may account for variations in serum resistance between NT H. influenzae
strains, which in turn may impact their virulence. These data demonstrate a
central role for complement in innate immune defenses against NT H. influenzae
infections and specifically EOM.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17088344 [PubMed - indexed for MEDLINE]

576: Int J Pediatr Otorhinolaryngol. 2007 Jan;71(1):101-6. Epub 2006 Nov 3.

Expressions of cyclooxygenase 1 and 2 in endotoxin-induced otitis media with
effusion in the rat.

Cho JG, Lee ES, Woo JS, Lee HM, Jung HH, Hwang SJ, Chae SW.

Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea
University College of Medicine, 80 Guro-dong, Guro-gu, Seoul 152-703, Republic of
Korea.

OBJECTIVE: Recently, a selective COX-2 inhibitor was developed and used for
reducing the levels of inflammation-inducing prostaglandin (PG) whilst not
inhibiting the release of protective PG by COX-1. COX-1 may be the critical
isoform required for the production of PG with a homeostatic function, whereas
COX-2 may be the main contributor to PG production in inflammation. The purpose
of this study was to investigate COX-1 and 2 expressions in experimental
endotoxin-induced OME in rats and to quantify their temporal expressions.
METHODS: In a rat model, lipopolysaccharides (LPS) were inoculated into the
middle ear cavity. Middle ear mucosa and temporal bone were samples at 0, 1, 3,
6, and 12h, and on days 1, 3 and 7 after instilling either LPS or sterile PBS.
RT-PCR, Western blotting and immunohistochemical staining were performed to
determine the expressions of COX-1 and COX-2. RESULTS: COX-1 mRNA and protein
were detected in normal middle ear mucosa but their levels did not change after
endotoxin instillation. However, COX-2 was not identified in normal middle ear
mucosa, but COX-2 mRNA was maximally increased at 6h after endotoxin instillation
and COX-2 protein was maximally increased at 12h. COX-2 expression, by
immunohistochemical staining, was identified only at 12h after endotoxin
injection. CONCLUSIONS: In this study, the basal expressions of COX-1 and COX-2
mRNA and protein in middle ear mucosa, as well as their regulations by endotoxin 
were investigated. COX-1 was not induced in middle ear mucosa by endotoxin
whereas COX-2 was induced within 12h of stimulation. Our findings indicate that
COX-2 inhibitor administration for the relief of inflammation should be
considered within 12h of the initiation of an inflammatory process. These
findings may provide an understanding of the mechanisms regulating PG formation
in infection of the middle ear cavity.

PMID: 17084463 [PubMed - indexed for MEDLINE]

577: Am J Otolaryngol. 2006 Nov-Dec;27(6):390-5.

Comment in:
    Am J Otolaryngol. 2008 Mar-Apr;29(2):150.

Otogenic intracranial complications. a 7-year retrospective review.

Hafidh MA, Keogh I, Walsh RM, Walsh M, Rawluk D.

The Department of Otolaryngology, Head and Neck Surgery, Beaumont University
Hospital, Dublin, Ireland. maky@esatclear.ie

OBJECTIVES: The objectives of this study were to review our experience on
intracranial complications secondary to otitis media (OM), and to compare the
results to those occurring 10-15 years ago. We also reviewed the timing of both
otologic and neurosurgical treatments. MATERIAL AND METHODS: All patients with
intracranial complications secondary to OM over a 7-year period were identified. 
A retrospective chart review was undertaken at Beaumont University Hospital,
Dublin, Ireland. Clinical presentation, radiological findings, microbiology,
surgical management, and antibiotic use were studied. We compare our findings to 
those of other international investigators. RESULTS: Twelve cases were
identified. Five had brain abscesses, 4 had lateral sinus thrombosis, and 3 had
petrous apicitis. Eight of these cases were secondary to chronic OM and 4 were
secondary to acute OM. Malodorous otorrhea, otalgia, headache, fever, and vertigo
were the primary symptoms. Anaerobic bacteria were the most commonly isolated
organisms followed by Staphylococcus aureus, Proteus mirabilis, and Pseudomonas
aeruginosa. Patients with cholesteatoma underwent modified radical or radical
mastoidectomy, and those who did not have cholesteatoma underwent cortical
mastoidectomy. Two brain abscesses were drained before mastoid surgery; 2 were
drained after mastoid surgery and 1 at the same time as otologic surgery. All
patients received broad-spectrum intravenous antibiotics targeted at individual
culture and sensitivity results. The mortality rate was zero. CONCLUSION:
Clinical presentation and the frequency of occurrence of intracranial
complications are similar to those occurring 10 years ago. The choice of
antibiotics should include adequate anaerobic cover. We recommend that otologic
surgery be performed at the same time as intracranial surgery for patients with
mature brain abscesses.

PMID: 17084222 [PubMed - indexed for MEDLINE]

578: Clin Infect Dis. 2006 Dec 1;43(11):1417-22. Epub 2006 Oct 31.

Comment in:
    Clin Infect Dis. 2006 Dec 1;43(11):1423-5.

Microbiology of acute otitis media in children with tympanostomy tubes:
prevalences of bacteria and viruses.

Ruohola A, Meurman O, Nikkari S, Skottman T, Salmi A, Waris M, Osterback R,
Eerola E, Allander T, Niesters H, Heikkinen T, Ruuskanen O.

Department of Pediatrics, Turku University Hospital, Turku, FIN-20521, Finland.
aino.ruohola@utu.fi

BACKGROUND: Bacteria are found in 50%-90% of cases of acute otitis media (AOM)
with or without otorrhea, and viruses are found in 20%-49% of cases. However, for
at least 15% of patients with AOM, the microbiological etiology is never
determined. Our aim was to specify the full etiology of acute middle ear
infection by using modern microbiological methods concomitantly for bacterial and
viral detection. METHODS: The subjects were 79 young children having AOM with new
onset (<48 h) of otorrhea through a tympanostomy tube. Middle ear fluid samples
were suctioned from the middle ear through the tympanostomy tube. Bacteria were
sought by culture and polymerase chain reaction; viruses were analyzed by
culture, antigen detection, and polymerase chain reaction. RESULTS: At least 1
respiratory tract pathogen was noted in 76 children (96%). Bacteria were found in
73 cases (92%), and viruses were found in 55 (70%). In 52 patients (66%), both
bacteria and viruses were found. Bacteria typical of AOM were detected in 86% of 
patients. Picornaviruses accounted for 60% of all viral findings. CONCLUSIONS: In
the great majority of children, AOM is a coinfection with bacteria and viruses.
The patent tympanostomy tube does not change the spectrum of causative agents in 
AOM. A microbiological etiology can be established in practically all cases.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17083014 [PubMed - indexed for MEDLINE]

579: Vet J. 2007 May;173(3):512-21. Epub 2006 Oct 31.

Anatomy and ultrasonographic appearance of the tympanic bulla and associated
structures in the rabbit.

King AM, Hall J, Cranfield F, Sullivan M.

Institute of Comparative Medicine, Faculty of Veterinary Medicine, University of 
Glasgow, Bearsden Road, Glasgow, Scotland G61 1QH, United Kingdom.
A.King@vet.gla.ac.uk

Otitis media is a relatively common condition in the rabbit although it can be
difficult to evaluate clinically. Diagnostic imaging of the rabbit has
traditionally involved radiography and there are few reports regarding the use of
ultrasound. The aim of this study was to determine if the tympanic bulla (TB) and
associated structures could be evaluated in the rabbit using currently available 
ultrasound equipment. The normal anatomy of the region was established using
gross dissection and emascerated specimens and compared with the dog and cat. Ten
New Zealand white rabbit cadavers were examined using two ultrasound machines and
four transducers from a variety of locations. A 12 MHz linear transducer was
found to be most appropriate. From a lateral approach the external ear canal
could be visualized to the level of the external acoustic meatus while the TB
itself could only be visualized from a ventral approach. The jugular and mastoid 
processes in the rabbit are very prominent and interfered with imaging of the TB 
from all approaches. Water-soluble lubricant introduced into the TB could be
identified through the ventral bone wall of the TB and allowed the lumen and far 
wall to be visualised. Further work is required to determine whether ultrasound
examination of the TB can be performed in live rabbits and to evaluate its
benefits in the evaluation of clinical cases of otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 17079172 [PubMed - indexed for MEDLINE]

580: Lab Anim (NY). 2006 Nov;35(10):40-4.

Spontaneous otitis media in Wistar rats: an overlooked pathology in otological
research.

Verdaguer JM, Trinidad A, González-García JA, García-Berrocal JR, Ramírez-Camacho
R.

Department of Otorhinolaryngology, Hospital Universitario La Paz, Universidad
Autónoma de Madrid, Spain. josem.verdaguer@gmail.com

The rat is commonly employed in otological research, but spontaneous ear
infections can confound the results of experimental procedures--wasting time,
money, and animals. The authors focus on the incidence of spontaneous otitis
media in Wistar rats. They compare disease incidence in animals housed in
standard cages with those housed in barrier units, showing that 20% of their
conventionally housed animals developed spontaneous otitis media, whereas only 5%
of their animals housed in isolated units were infected. These results underscore
the importance of strict control of the shipping, housing conditions, and
manipulation of animals to be used in otological research.

Publication Types: 
    Comparative Study

PMID: 17077834 [PubMed - indexed for MEDLINE]

581: Pediatr Infect Dis J. 2006 Nov;25(11):1032-6.

The value of nasopharyngeal culture in predicting the etiology of acute otitis
media in children less than two years of age.

Syrjänen RK, Herva EE, Mäkelä PH, Puhakka HJ, Auranen KJ, Takala AK, Kilpi TM.

Department of Vaccines, National Public Health Institute, Helsinki, Finland.
ritva.syrjanen@ktl.fi

BACKGROUND: In selecting treatment of acute otitis media (AOM), knowledge of its 
etiology would be valuable. We revisited the possibility to use the
nasopharyngeal culture of Streptococcus pneumoniae (Pnc) and Haemophilus
influenzae (Hi) for predicting their presence in the middle ear fluid (MEF)
during AOM. METHODS: The sensitivity, specificity, positive predictive value
(PPV) and negative predictive value (NPV) of bacterial culture of the
nasopharyngeal aspirate (NPA) in predicting the presence of the same pathogen in 
the MEF were assessed during AOM events among children followed from 2 to 24
months of age. RESULTS: The data comprised 586 AOM events. For Pnc, the
sensitivity and NPV were high, 99% (95% confidence interval = 95-100%) and >99%
(97-100%), respectively. The specificity and PPV were relatively low, 63%
(57-68%) and 50% (43-56%). For Hi, the sensitivity and the NPV were lower (77%,
69-83% and 93%, 90-95%) than for Pnc, but the specificity and the PPV were higher
(88%, 85-91% and 64%, 56-71%). The quantity of Pnc and Hi in the NPA was clearly 
related to their presence in the MEF. If both Pnc and Hi were found in the
nasopharynx, Hi was more likely cultured from MEF. CONCLUSION: Together with
clinical and epidemiologic features of AOM, the nasopharyngeal culture can be
helpful in selecting specific antimicrobial therapy.

Publication Types: 
    Evaluation Studies
    Research Support, Non-U.S. Gov't

PMID: 17072126 [PubMed - indexed for MEDLINE]

582: Pediatr Infect Dis J. 2006 Nov;25(11):1001-7.

Impact of pneumococcal conjugate vaccine and of reduction of antibiotic use on
nasopharyngeal carriage of nonsusceptible pneumococci in children with acute
otitis media.

Cohen R, Levy C, de La Rocque F, Gelbert N, Wollner A, Fritzell B, Bonnet E,
Tetelboum R, Varon E.

Service de Microbiologie, Centre Hospitalier Intercommunal de Creteil, Créteil,
France. robert.cohen@wanadoo.fr

BACKGROUND: Penicillin resistance among pneumococci has increased in the past 15 
years. The implementation of widespread vaccination with the heptavalent
pneumococcal conjugate vaccine (PCV7) and the reduction of inappropriate
antibiotic use could help reduce antibiotic resistance. METHODS: Between
September 2001 and June 2004, 89 pediatricians distributed throughout France took
part in this prospective study. We obtained 1906 nasopharyngeal swabs for culture
from children aged 6 to 24 months with acute otitis media (AOM). At the same time
as PCV7 was introduced into the routine immunization schedule, a plan to promote 
judicious antibiotic use was established. We recorded the frequency of antibiotic
use, as well as the dates of immunization with PCV7. RESULTS: The proportion of
PCV7-vaccinated children (> or =1 dose) increased from 8.2% (year 1) to 61.4%
(year 3). The proportion of children who received antibiotics within 3 months
before enrollment decreased from 51.8% in year 1 to 40.9% in year 3 (P < 0.001). 
Overall pneumococcal carriage and carriage of PCV7 serotypes decreased during the
3-year period by 16% (P < 0.001) and 35% (P < 0.001), respectively. Rates of
highly penicillin resistant strains (PRP) decreased yearly: 15.4%, 10.6%, 6.7% (P
< 0.001), respectively. Risks for PRP carriage were 4.2% for immunized children
who had not received antibiotics, 8.6% for those vaccinated who also had received
antibiotics, 10.3% for unimmunized children who had not received antibiotics, and
16.2% for unimmunized children who had received antibiotics (P < 0.001).
CONCLUSION: Implementation of PCV7, combined with a reduction in antibiotic use, 
in a country with a high prevalence of antibiotic-resistant pneumococci appears
to have a strong impact on the carriage of penicillin nonsusceptible pneumococci 
in children with AOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17072121 [PubMed - indexed for MEDLINE]

583: Otolaryngol Head Neck Surg. 2006 Nov;135(5):787-91.

Otomycosis: clinical features and treatment implications.

Ho T, Vrabec JT, Yoo D, Coker NJ.

Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor
College of Medicine, Houston, Texas, USA.

OBJECTIVES: To determine the clinical presentation, predisposing factors,
complications, and treatment outcomes of otomycosis. STUDY DESIGN AND SETTING:
Retrospective review of 132 patients with a clinical diagnosis of otomycosis
treated from 1998 to 2004 in an academic otology practice. RESULTS: Otalgia and
otorrhea were the most common presenting complaints (48%). Prior otologic
procedures increase the risk of developing otomycosis. Residual disease was
observed in 13% and recurrence in 15% of the subjects. The presence of a mastoid 
cavity was associated with higher recurrent and residual disease rates. Topical
ketoconazole, cresylate otic drops, and aluminum acetate otic drops were all
relatively effective with >80% resolution rate on initial application, although
topical ketoconazole had a higher resolution rate and lower rate of disease
recurrence. CONCLUSIONS AND SIGNIFICANCE: Otomycosis can usually be diagnosed by 
clinical examination and often occurs in the setting of persistent otorrhea.
Complications are not uncommon but usually resolve with application of
appropriate topical antifungal agents. Eradication of disease is more difficult
in the presence of a mastoid cavity.

PMID: 17071313 [PubMed - indexed for MEDLINE]

584: Otol Neurotol. 2007 Jan;28(1):124-8.

Tracing of gastric reflux into the middle ear in a mongolian gerbil model.

Sudhoff H, Bücker R, Groll C, Shagdarsuren S, Dazert S, Schreiber S.

Hals-Nasen-Ohren-Klinik der Ruhr-Universität Bochum, St. Elisabeth Hospital,
Bochum, Germany. Sudhoff@ruhr-uni-bochum.de

OBJECTIVES: The purpose of this study was to trace induced gastric reflux and to 
examine whether it reaches the middle ear in a Mongolian gerbil model.
BACKGROUND: Otitis media with effusion is the most frequent middle ear disease in
childhood. Gastroesophageal reflux is suspected to be a possible factor in its
pathogenesis. METHODS: Seventeen Mongolian gerbils were assigned to three groups:
the control (phosphate-buffered saline application to the lower esophageal
sphincter) and two experimental groups (Aquo-Trinitrosan [Merck, Darmstadt,
Germany] application to the lower esophageal sphincter, low gastric pressure and 
Aquo-Trinitrosan application, higher gastric pressure). We injected Chinese ink
into the stomach to trace the path of a potential gastroesophageal reflux in all 
three groups. The traces of ink were investigated by ear and larynx endoscopy and
histology. RESULTS: There were no signs of gastroesophageal reflux based on the
data obtained from the control group. In animals with traceable laryngeal reflux,
the ink was also shown to advance through the eustachian tube and reach the
middle ear. In addition, we found that when reflux reaches the middle ear on one 
side, it also reaches the contralateral middle ear in most cases. CONCLUSION:
Gastroesophageal reflux induced by relaxation of the lower esophageal sphincter
was shown to reach the middle ear in our Mongolian gerbil model. These results
support recent hypotheses linking gastroesophageal reflux to the development of
otitis media with effusion.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17068408 [PubMed - indexed for MEDLINE]

585: Eur J Clin Microbiol Infect Dis. 2006 Nov;25(11):723-7.

Mycobacterium avium intracellulare otomastoiditis: case report and literature
review.

Muller B, Kemper J, Hartwig NG, Mooi-Kokenberg EA, van Altena R, Versteegh FG.

Department of Pediatrics, Groene Hart Hospital, P.O. Box 1098, 2800 BB, Gouda,
The Netherlands.

Otomastoiditis caused by Mycobacterium avium intracellulare (MAI) is rare.
Sub-optimal management of this condition can lead to significant morbidity and
serious damage to the middle ear. Diagnosis is difficult, especially since most
physicians are not familiar with the mode of presentation and symptoms. Presented
here is a new case, followed by a review of the literature on MAI mastoiditis.

Publication Types: 
    Case Reports
    Review

PMID: 17061096 [PubMed - indexed for MEDLINE]

586: J Laryngol Otol. 2007 Jan;121(1):1-4. Epub 2006 Oct 24.

A long term follow up of conchal flap meatoplasty in chronic otitis externa.

Kumar PJ, Smelt GJ.

Department of Accident & Emergency, City Hospital, Birmingham, United Kingdom.
drpjkumar@gmail.com

A long-standing diffuse chronic otitis externa can lead to itching. Resultant
scratching may then lead to irreversible skin changes with canal stenosis by scar
tissue. The poor ventilation and increased humidity gives rise to bacterial and
fungal growths leading to breakdown of the skin defences and worsening itching.
This vicious itching-scratch cycle or downward spiral often fails to respond to
medical treatment. For these cases a simple conchal flap meatoplasty may improve 
ventilation of the external auditory canal and may lead to a self cleaning ear.
We reviewed 84 patients who had undergone conchal flap meatoplasty in Calderdale 
and Huddersfield NHS Trust Hospitals from April 1993 to June 2002. A long-term
follow up of conchal flap meatoplasty in chronic otitis externa showed no records
of complications or further otitis in 93.2 per cent of cases. Thus surgical
intervention plays an important role in the treatment of otitis externa not
responding to treatment.

PMID: 17059629 [PubMed - indexed for MEDLINE]

587: Lancet. 2006 Oct 21;368(9545):1429-35.

Comment in:
    Arch Dis Child Educ Pract Ed. 2007 Oct;92(5):ep159.    Evid Based Med. 2007 Apr;12(2):47.    Evid Based Nurs. 2007 Apr;10(2):45.    J Pediatr. 2007 May;150(5):562.    Lancet. 2006 Oct 21;368(9545):1397-8.

Antibiotics for acute otitis media: a meta-analysis with individual patient data.

Rovers MM, Glasziou P, Appelman CL, Burke P, McCormick DP, Damoiseaux RA, Gaboury
I, Little P, Hoes AW.

Julius Centre for Health Sciences and Primary Care, University Medical Centre
Utrecht, the Netherlands. M.Rovers@umcutrecht.nl

BACKGROUND: Individual trials to test effectiveness of antibiotics in children
with acute otitis media have been too small for valid subgroup analyses. We aimed
to identify subgroups of children who would and would not benefit more than
others from treatment with antibiotics. METHODS: We did a meta-analysis of data
from six randomised trials of the effects of antibiotics in children with acute
otitis media. Individual patient data from 1643 children aged from 6 months to 12
years were validated and re-analysed. We defined the primary outcome as an
extended course of acute otitis media, consisting of pain, fever, or both at 3-7 
days. FINDINGS: Significant effect modifications were noted for otorrhoea, and
for age and bilateral acute otitis media. In children younger than 2 years of age
with bilateral acute otitis media, 55% of controls and 30% on antibiotics still
had pain, fever, or both at 3-7 days, with a rate difference between these groups
of -25% (95% CI -36% to -14%), resulting in a number-needed-to-treat (NNT) of
four children. We identified no significant differences for age alone. In
children with otorrhoea the rate difference and NNT, respectively, were -36%
(-53% to -19%) and three, whereas in children without otorrhoea the equivalent
values were -14% (-23% to -5%) and eight. INTERPRETATION: Antibiotics seem to be 
most beneficial in children younger than 2 years of age with bilateral acute
otitis media, and in children with both acute otitis media and otorrhoea. For
most other children with mild disease an observational policy seems justified.

Publication Types: 
    Meta-Analysis
    Review

PMID: 17055944 [PubMed - indexed for MEDLINE]

588: Auris Nasus Larynx. 2007 Jun;34(2):173-6. Epub 2006 Oct 19.

Correlation between middle-ear pressure-regulation functions and outcome of
type-I tympanoplasty.

Takahashi H, Sato H, Nakamura H, Naito Y, Umeki H.

Department of Otolaryngology, Head and Neck Surgery, Nagasaki University Graduate
School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki 852-8501, Japan.
htak0831@net.nagasaki-u.ac.jp

OBJECTIVES: To examine the correlation between the middle-ear pressure-regulation
functions including active eustachian tube (ET) functions and transmucosal gas
exchange function, and outcome of tympanoplasty. PATIENTS AND METHODS: Seventy
five patients (78 ears) with non-cholesteatomatous chronic otitis media with
eardrum perforation but without ossicular damage or middle-ear anomaly
participated in this study. Before surgery, patency of the ET was examined by
applying positive pressure to the middle ear through the eardrum perforation, and
then the ET pressure-regulation functions were examined using the
inflation-deflation test. Also their transmucosal gas exchange function was
evaluated by examining the presence or absence of aeration in the mastoid on the 
CT before surgery or through the microscope during the surgery. All of them
underwent type-I tympanoplasty, and their postoperative conditions including the 
hearing were followed for more than 6 months. The outcome of the surgery was
judged as poor outcome when they had any of the following conditions; more than
20 dB of mean air-bone gap, spontaneous perforation within 6 months, or
persistent wet condition including recurrent otorrhea. RESULTS: First, the
outcome of all the four ears of which ETs were considered mechanically obstructed
was poor. Next, among the remaining 74 ears, none of the three individual
parameters, including positive and negative middle-ear pressure-equalizing
functions and mastoid aeration, showed significantly positive correlation with
the outcome of the surgery, but significantly higher incidence of poor outcome
was seen only when all the three parameters were poor. CONCLUSIONS: These results
indicated that impairment of all the middle-ear pressure-regulation functions was
likely to cause poor outcome of tympanoplasty, and also allowed us reconfirm that
ears with mechanically obstructed ETs were contraindicated for tympanoplasty.
Therefore, assessment of mastoid condition is important as well as the ET
function before tympanoplasty.

PMID: 17055205 [PubMed - indexed for MEDLINE]

589: Vaccine. 2007 Mar 22;25(13):2478-84. Epub 2006 Sep 20.

Efficacy of a novel oral carbapenem, tebipenem pivoxil (TBM-PI), against
experimental otitis media caused by penicillin resistant Streptococcus pneumoniae
in chinchilla.

Hotomi M, Suzumoto M, Itahashi K, Nagura J, Fukushima T, Shimada J, Billal DS,
Yamauchi K, Fujihara K, Yamanaka N.

Infection and Immunity Research Center, Wakayama Medical University, Wakayama,
Japan.

An animal model of otitis media using chinchillas was developed to evaluate the
efficacy of tebipenem pivoxil (TBM-PI) against experimental otitis media.
Chinchillas inoculated via the transbullar approach with Streptococcus pneumoniae
serogroup 6 were included in the efficacy study with TBM-PI, amoxicillin (AMX) or
untreated as controls. TBM-PI resulted in survival rate of 83%, compared with 25%
survival for AMX and 0% survival for controls (p<0.01). Quantitative cultures in 
the middle ear effusions at day 5 of the TBM-PI group yielded
3.5+/-2.4log(10)CFUs/ml. TBM-PI is a promising antibiotic for the treatment of
acute otitis media.

PMID: 17055132 [PubMed - indexed for MEDLINE]

590: Cochrane Database Syst Rev. 2006 Oct 18;(4):CD006285.

Autoinflation for hearing loss associated with otitis media with effusion.

Perera R, Haynes J, Glasziou P, Heneghan CJ.

Institute of Health Sciences, Department of Primary Health Care, Old Road,
Headington, Oxford, UK. rafael.perera@dphpc.ox.ac.uk

BACKGROUND: Otitis media with effusion (OME) or 'glue ear' is an accumulation of 
fluid in the middle ear, in the absence of acute inflammation or infection. It is
the commonest cause of acquired hearing loss in childhood and the usual reason
for insertion of 'grommets'. Potential treatments include decongestants,
mucolytics, steroids, antihistamines and antibiotics. Autoinflation devices have 
been proposed as a simple mechanical means of improving 'glue ear'. OBJECTIVES:
To determine the effects of autoinflation in adults and children with otitis
media with effusion. SEARCH STRATEGY: We searched the Cochrane Ear, Nose and
Throat Disorders Group Trials Register, CENTRAL (The Cochrane Library Issue 1,
2006), MEDLINE (1951 to 2006), EMBASE (1974 to 2006) and twelve other databases, 
using the Cochrane Ear, Nose and Throat Disorders Group search strategy.
SELECTION CRITERIA: We selected randomised controlled trials that compared any
form of autoinflation to no autoinflation in individuals with 'glue ear'. DATA
COLLECTION AND ANALYSIS: Two review authors independently assessed studies for
inclusion, assessed quality and extracted data from included studies. MAIN
RESULTS: Six studies met the inclusion criteria. Improvement occurred for the
composite measure of tympanogram or audiometry at less than one month (Relative
Risk of Improvement (RRI) 2.47, 95% confidence interval (CI) 0.93 to 6.58) and at
more than one month (RRI 2.20, 95% CI 1.71 to 2.82). Subgroup analysis based on
the type of intervention showed a significant effect using a Politzer device
under one month (RRI 7.07, 95% CI 3.70 to 13.51) and over one month (RRI 2.25,
95% CI 1.67 to 3.04). Pooled estimates showed non-significant change in
tympanometry (type C2 and B) at less than one month (RRI 1.65, 95% CI 0.49 to
5.56) and non-significant improvement in tympanometry at greater than one month
(RRI 1.89, 95% CI 0.77 to 4.67). Non-significant improvements occurred for
discrete pure tone audiometry (RRI 0.80, 95% CI 0.22 to 2.88) and non-discrete
audiometry (WMD 6.95 dB, 95% CI 21.03 to 7.13). None of the studies demonstrated 
a significant difference in the incidence of side effects between interventions. 
AUTHORS' CONCLUSIONS: All of the studies were small, of limited treatment
duration and short follow up. However, because of the low cost and absence of
adverse effects it is reasonable to consider autoinflation whilst awaiting
natural resolution of otitis media with effusion. Further research should
consider the duration of treatment and the long-term impact of autoinflation on
developmental outcomes in children.

Publication Types: 
    Meta-Analysis
    Review

PMID: 17054290 [PubMed - indexed for MEDLINE]

591: Cochrane Database Syst Rev. 2006 Oct 18;(4):CD004401.

Antibiotics for the prevention of acute and chronic suppurative otitis media in
children.

Leach AJ, Morris PS.

Menzies School of Health Research, Ear Health and Education Unit, Infectious
Diseases Division, PO Box 41096, Casuarina, Northern Territory, Australia.
amanda@menzies.edu.au

BACKGROUND: Acute otitis media (AOM) is a common childhood illness. These middle 
ear infections may be frequent and painful. AOM may be associated with
perforation of the tympanic membrane and can progress to chronic suppurative
otitis media (CSOM). OBJECTIVES: To determine the effectiveness of long-term
antibiotics (for longer than six weeks) in preventing any AOM, AOM with
perforation and CSOM. SEARCH STRATEGY: We searched the Cochrane Central Register 
of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006), MEDLINE
(January 1966 to March Week 3 2006), OLD MEDLINE (1950 to 1965), EMBASE (1990 to 
December 2005) and the references of relevant studies. SELECTION CRITERIA: All
randomised controlled trials of long-term (longer than six weeks) antibiotics
versus placebo or no treatment for the prevention of AOM, AOM with perforation,
or CSOM were eligible. DATA COLLECTION AND ANALYSIS: Two authors independently
extracted the data for: any AOM; episodes of AOM; any recurrent AOM; episodes of 
illness; any side effects; any antibiotic resistance, as well as outcomes at end 
of intervention (any AOM); and following cessation of intervention (any AOM). For
dichotomous outcomes, the summary risk ratio (fixed and random-effects models)
was calculated. For rate outcomes, the summary incidence rate ratio was
calculated. MAIN RESULTS: Sixteen studies involving 1483 children met our
inclusion criteria. All studies enrolled children at increased risk of AOM, and
in seven studies the children were prone to otitis media. The majority of studies
were high quality and most (15 studies) reported data for our primary outcomes.
None reported AOM with perforation or CSOM. Long-term antibiotics reduced any
episode of AOM (13 studies, 1358 children, risk ratio (RR) 0.62, 95% CI 0.52 to
0.75; random-effects model) and number of episodes of AOM (12 studies, 1112
children, incidence rate ratio (IRR) 0.48, 95% CI 0.37 to 0.62; random-effects
model). Approximately five children would need to be treated long term to prevent
one child experiencing AOM whilst on treatment. Antibiotics prevented 1.5
episodes of AOM for every 12 months of treatment per child. Statistical
heterogeneity was explored. Long-term antibiotics were not associated with a
significant increase in adverse events (11 studies, 714 children, RR 1.99, 95% CI
0.25 to 15.89; random-effects model). AUTHORS' CONCLUSIONS: For children at risk,
antibiotics given once or twice daily will reduce the probability of AOM while
the child is on treatment. Antibiotics will reduce the number of episodes of AOM 
per year from around three to around 1.5. We believe that larger absolute
benefits are likely in high-risk children. These conclusions were not affected by
sensitivity analyses.

Publication Types: 
    Meta-Analysis
    Review

PMID: 17054203 [PubMed - indexed for MEDLINE]

592: Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003423.

Comment in:
    Evid Based Nurs. 2007 Jul;10(3):73.    Otolaryngol Head Neck Surg. 2007 Jan;136(1):11-3.

Antihistamines and/or decongestants for otitis media with effusion (OME) in
children.

Griffin GH, Flynn C, Bailey RE, Schultz JK.

Quinte West Medical Centre, 80 Catherine Street, Trenton, Ontario, Canada.
ghgriffin@hotmail.com

BACKGROUND: Otitis media with effusion (OME) is common and may cause hearing loss
with associated developmental delay. Treatment remains controversial. The
effectiveness of antihistamines, decongestants and antihistamine/decongestant
combinations in promoting the resolution of effusions has been assessed by
randomized controlled trials. OBJECTIVES: The objective of this review is to
determine whether antihistamine, decongestant, or combination therapy is
effective in treating children who present with OME. SEARCH STRATEGY: The
Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane
Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1
2006), EMBASE (1974 to 2006), MEDLINE (1951 to 2006) and a gray literature
database were searched using a search strategy created by an experienced medical 
librarian. The date of the last search was March 2006. Reference lists from
included studies and relevant reviews were searched by hand; pharmaceutical
manufacturers of antihistamines and decongestants and first authors of included
studies were contacted to identify other potentially relevant studies. SELECTION 
CRITERIA: Randomized controlled trials (RCTs) using antihistamines, decongestants
or antihistamine/decongestant combinations as treatment for OME in children were 
selected. We excluded trials that randomized on the basis of acute otitis media
(AOM) even though OME was also studied in follow up. DATA COLLECTION AND
ANALYSIS: Data were extracted from the published reports by two authors
independently using standardized data extraction forms and methods. The
methodological quality of the included studies was independently assessed by two 
authors. Dichotomous results were expressed as a relative risk with 95%
confidence intervals using a fixed-effect model when homogeneous and a
random-effects model when heterogeneous. Nearly all outcomes analysed were
homogeneous. Continuous results were discussed qualitatively. Statistical
analysis was conducted using RevMan software. MAIN RESULTS: No statistical or
clinical benefit was found for any of the interventions or outcomes studied.
However, treated study subjects experienced 11% more side effects than untreated 
subjects (number needed to treat to harm = 9). AUTHORS' CONCLUSIONS: Because the 
pooled data demonstrate no benefit and some harm from the use of antihistamines
or decongestants alone or in combination in the management of OME, we recommend
against their use.

Publication Types: 
    Meta-Analysis
    Review

PMID: 17054169 [PubMed - indexed for MEDLINE]

593: Auris Nasus Larynx. 2007 Sep;34(3):375-7. Epub 2006 Oct 18.

Tick bites in the external auditory canal.

Iwasaki S, Takebayashi S, Watanabe T.

Department of Otolaryngology, Hamamatsu University School of Medicine, 1-20-1,
Handayama, Hamamatsu City 431-3192, Japan. iwasaki@hama-med.ac.jp

We report a case of Ixodes ovatus tick in the external auditory canal. Chief
complaints of earfullness and pruritus appeared after the contact with dog. Using
a removal method consisting of excising the abdomen of the tick and suctioning
its body fluids, followed by removal of the tick body 3 days later, the patient
was successfully treated without the development of complications.

Publication Types: 
    Case Reports

PMID: 17052878 [PubMed - indexed for MEDLINE]

594: Ear Nose Throat J. 2006 Sep;85(9):593-6.

Incorporating the endoscope into middle ear surgery.

Ghaffar S, Ikram M, Zia S, Raza A.

Otolaryngology-Head and Neck Surgery Section, Aga Khan University Hospital,
Karachi, Pakistan. sgm@akunet.org

We conducted a study to evaluate the use of a pediatric rigid otoendoscope for
determining the extent of middle ear disease and for assessing ossicular
integrity and mobility during tympanoplasty. Our study population was made up of 
132 patients who were undergoing surgery for the treatment of chronic suppurative
otitis media; of this group, 41 patients underwent otoendoscopy and 91 underwent 
scutum lowering for purposes of visualization. In the otoendoscopy group, the
ossicles were successfully visualized and their mobility assessed in 34 patients;
the remaining 7 patients subsequently underwent scutum lowering. A 30 degrees
endoscope allowed for complete visualization of the middle ear in almost all of
the 34 cases. The mean duration of surgery for the 34 patients in the
otoendoscopy group was 62.85 minutes (+/- 15.57), which was significantly shorter
than the duration of surgery (71.23 +/- 15.65 min) for the 98 patients who
underwent scutum lowering (p < 0.005). A total of 50 patients required less than 
60 minutes of surgical time--26 of 34 (76.5%) in the endoscopy group and 24 of 98
(24.5%) in the scutum-lowering group. Statistical analysis revealed that the
possibility of completing a procedure in less than 60 minutes was 73.65% (+/-
12.56%) when endoscopy was used and 58.62% (+/- 12.60%) when scutum lowering was 
used--again, a statistically significant difference (p < 0.005). We conclude that
incorporation of an angled otoendoscope into middle ear surgery is a worthwhile
alternative to scutum lowering.

PMID: 17044426 [PubMed - indexed for MEDLINE]

595: Arch Otolaryngol Head Neck Surg. 2006 Oct;132(10):1115-8.

Predictors of chronic suppurative otitis media in children.

van der Veen EL, Schilder AG, van Heerbeek N, Verhoeff M, Zielhuis GA, Rovers MM.

Department of Otorhinolaryngology, Wilhelmina Children's Hospital, and Julius
Center for Health Sciences and Primary Care, University Medical Center Utrecht,
Utrecht, the Netherlands. E.L.vanderVeen@umcutrecht.nl

OBJECTIVE: To determine which factors predict development of chronic suppurative 
otitis media (CSOM) in children. DESIGN: Case-control study, with univariate and 
multivariate logistic regression analysis applied to determine which factors
independently predict CSOM. SUBJECTS: Prognostic factors for CSOM were identified
in (1) 100 children with CSOM and 161 controls aged 1 to 12 years and (2) 83
children who developed CSOM in the presence of a tympanostomy tube and 136
children with tympanostomy tubes who did not develop CSOM. RESULTS: Independent
predictors for CSOM were previous tympanostomy tube insertion (odds ratio [OR],
121.4 [95% confidence interval {CI}, 38.9-379.3]); having had more than 3 upper
respiratory tract infections in the past 6 months (OR, 12.2 [95% CI, 3.5-42.3]); 
having parents with a low education level (OR, 14.1 [95% CI, 2.9-68.6]); and
having older siblings (OR, 4.4 [95% CI, 1.6-12.6]). Independent predictors for
CSOM after tympanostomy tube insertion were having experienced more than 3
episodes of otitis media in the past year (OR, 4.9 [95% CI, 2.2-11.0]; attending 
day care (OR, 3.6 [95% CI, 1.7-7.8]); and having older siblings (OR, 2.6 [95% CI,
1.2-5.5]). CONCLUSIONS: Treatment with tympanostomy tubes is the most important
prognostic factor for CSOM in children. In children who are being treated with
tympanostomy tubes for persistent middle ear effusion, the most important
prognostic factor for CSOM is a history of recurrent episodes of acute otitis
media. This information should be taken into consideration and discussed with
parents when considering insertion of tympanostomy tubes in children.

PMID: 17043261 [PubMed - indexed for MEDLINE]

596: Arch Otolaryngol Head Neck Surg. 2006 Oct;132(10):1109-14.

Eustachian tube function in patients with eosinophilic otitis media associated
with bronchial asthma evaluated by sonotubometry.

Iino Y, Kakizaki K, Saruya S, Katano H, Komiya T, Kodera K, Ohta K.

Department of Otolaryngology, Teikyo University School of Medicine, Tokyo, Japan.
yiino@omiya.jichi.ac.jp

OBJECTIVE: To determine eustachian tube function in patients with asthma and with
or without eosinophilic otitis media (EOM), a new middle ear disease entity with 
a highly viscous middle ear effusion containing many eosinophils and usually
associated with bronchial asthma. One of the most important causes of otitis
media (OM) is eustachian tube dysfunction. DESIGN: Retrospective case review.
SETTING: A referral center. PATIENTS: Twenty patients with EOM and patients with 
asthma but without OM. MAIN OUTCOME MEASURES: We studied eustachian tube function
using sonotubometry and a questionnaire. Sonotubometry was also performed on 13
control patients with chronic otitis media (COM) and 7 normal controls. RESULTS: 
The tubal opening duration was significantly longer in patients with EOM than in 
patients with asthma but without OM, controls with COM, and normal controls,
indicating the presence of patulous eustachian tubes in patients with EOM.
Responses to the questionnaire also supported the presence of patulous eustachian
tubes in the patients with EOM. CONCLUSIONS: The presence of a patulous
eustachian tube may be a major cause of EOM in patients with bronchial asthma. In
patients with asthma who have a helper T-cell 2-dominant predisposition, a
patulous eustachian tube easily allows the entry of antigenic materials into the 
middle ear, causing eosinophil-dominant inflammation.

PMID: 17043260 [PubMed - indexed for MEDLINE]

597: J Laryngol Otol. 2007 Feb;121(2):110-3. Epub 2006 Sep 29.

Prospective study of the microbiological flora of hearing aid moulds and the
efficacy of current cleaning techniques.

Ahmad N, Etheridge C, Farrington M, Baguley DM.

Department of Otorhinolaryngology-Head & Neck Surgery, Cambridge University
Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.

INTRODUCTION: Wearing hearing aid earmoulds has been implicated as a predisposing
factor in the development of chronic otitis externa. Audiologists come into
contact with a large number of hearing aid earmoulds and these could potentially 
harbour pathogenic micro-organisms, with the risk of subsequent cross infection. 
Cleaning with dilute alcohol is widely used in an attempt to break the chain of
infection. OBJECTIVE: To determine the presence and nature of microbial flora on 
hearing aid earmoulds and the efficacy of cleaning methods used to prevent cross 
infection. SETTING: Secondary health care within the audiology department of
Addenbrooke's Hospital, Cambridge, UK. DESIGN: A prospective, observational
study. METHODS: Hearing aid earmoulds were swabbed before and after cleaning.
Samples were cultured to determine qualitatively and quantitatively the
microbiological flora present before and after cleaning. RESULTS: Twenty out of
21 (95 per cent) earmoulds had microbes present and, of these, 19/20 (95 per
cent) had a polymicrobial profile. Coagulase negative staphylococci and
diphtheroids were the most frequent microbial isolates, but pathogenic bacteria
and fungi were also demonstrated on earmoulds both before and after cleaning.
CONCLUSIONS: The polymicrobial flora, including recognized pathogens, that
colonizes earmoulds may lead to chronic otitis externa. Cleaning with 70 per cent
alcohol solution was ineffective, in particular for pathogenic fungi on
earmoulds.

PMID: 17040598 [PubMed - indexed for MEDLINE]

598: J Laryngol Otol. 2006 Nov;120(11):972-5. Epub 2006 Aug 15.

Surgical management of only hearing ears with positive indications.

Sakagsami M, Muto T, Adachi O, Mishiro Y, Fukazawa K.

Department of Otolaryngology, Hyogo College of Medicine, Nishinomiya, Hyogo,
Japan. msakaga@hyo-med.ac.jp

Positive surgical indications for an only hearing ear were evaluated in order to 
improve patients' quality of life. Fifteen cases of surgery involving an only
hearing ear over the past eight years were retrospectively reviewed. Of eight
perforated chronic otitis media cases, seven underwent type one tympanoplasty and
one underwent simple underlay myringoplasty regardless of otorrhoea at the time
of surgery. Of six cholesteatoma cases, two received the canal wall up method and
four received the canal wall down method. Ossiculoplasty was carefully performed 
in six cases. Hearing was improved in seven cases, whereas it remained unchanged 
in seven cases and deteriorated in one case. Of nine patients, two did not need a
hearing aid after surgery. Five patients with severe combined hearing loss (>90
dB) were able to communicate with a hearing aid, alleviating their anxiety
regarding hearing loss. Only hearing ears with chronic otitis media and
cholesteatoma can be successfully treated by tympanoplasty with or without
ossiculoplasty.

PMID: 17040591 [PubMed - indexed for MEDLINE]

599: J Laryngol Otol. 2006 Oct;120(10):818-21.

Should we aspirate middle-ear effusions prior to insertion of ventilation tubes?

Laina V, Pothier DD.

Department of Otolaryngology, Gloucestershire Royal Hospital, Gloucester, UK.

BACKGROUND: Routine aspiration of middle-ear effusions prior to ventilation tube 
(grommet) insertion is practised by many surgeons. It has been suggested that
removing the fluid from the middle ear improves immediate post-operative hearing 
levels and reduces the chance of the ventilation tube becoming obstructed. The
potential adverse effects of applying suction to the middle ear include acoustic 
trauma and an increased risk of tympanosclerosis and otorrhoea. We undertook a
review of the literature in order to determine the benefits or side effects
associated with middle-ear aspiration prior to ventilation tube insertion.
OBJECTIVES: To compare clinical outcomes associated with aspirating versus not
aspirating the middle ear prior to ventilation tube insertion. METHODS: The
Cochrane ENT group trials register, DARE, the Cochrane central register of
controlled trials (CENTRAL), MEDLINE (1960-2005) and EMBASE (1960-2005) were
searched using relevant terms. Reference lists of selected studies were scanned
for additional research material. RESULTS: Seven studies were identified, of
which three fitted the inclusion criteria of our review. Current evidence
suggests that aspiration of middle-ear effusions prior to insertion of
ventilation tubes is not associated with any improvement in clinical outcome, in 
terms of post-operative hearing levels, otorrhoea or rates of blockage of
ventilation tubes. Significantly increased rates of tympanosclerosis were
observed in one study and the development of acoustic trauma was observed;
however, no significant association was confirmed. Although more research is
needed, there is no evidence that aspiration of middle-ear effusion prior to
grommet insertion confers any advantage.

Publication Types: 
    Evaluation Studies
    Review

PMID: 17038228 [PubMed - indexed for MEDLINE]

600: Hum Mol Genet. 2006 Nov 15;15(22):3273-9. Epub 2006 Oct 11.

A mutation in the F-box gene, Fbxo11, causes otitis media in the Jeff mouse.

Hardisty-Hughes RE, Tateossian H, Morse SA, Romero MR, Middleton A,
Tymowska-Lalanne Z, Hunter AJ, Cheeseman M, Brown SD.

MRC Mammalian Genetics Unit, Harwell, UK.

Otitis media (OM), inflammation of the middle ear, is the most common cause of
hearing impairment and surgery in children. Recurrent and chronic forms of OM are
known to have a strong genetic component, but nothing is known of the underlying 
genes involved in the human population. We have previously identified a novel
semi-dominant mouse mutant, Jeff, in which the heterozygotes develop chronic
suppurative OM (Hardisty, R.E., Erven, A., Logan, K., Morse, S., Guionaud, S.,
Sancho-Oliver, S., Hunter, A.J., Brown, S.D. and Steel, K.P. (2003) The deaf
mouse mutant Jeff (Jf) is a single gene model of otitis media. J. Assoc. Res.
Otolaryngol., 4, 130-138.) and represent a model for chronic forms of OM in
humans. We demonstrate here that Jeff carries a mutation in an F-box gene,
Fbxo11. Fbxo11 is expressed in epithelial cells of the middle ears from late
embryonic stages through to day 13 of postnatal life. In contrast to Jeff
heterozygotes, Jeff homozygotes show cleft palate, facial clefting and perinatal 
lethality. We have also isolated and characterized an additional hypomorphic
mutant allele, Mutt. Mutt heterozygotes do not develop OM but Mutt homozygotes
also show facial clefting and cleft palate abnormalities. FBXO11 is one of the
first molecules to be identified, contributing to the genetic aetiology of OM. In
addition, the recessive effects of mutant alleles of Fbxo11 identify the gene as 
an important candidate for cleft palate studies in the human population.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17035249 [PubMed - indexed for MEDLINE]

601: Otol Neurotol. 2007 Jan;28(1):100-3.

Infective causes of facial nerve paralysis.

Makeham TP, Croxson GR, Coulson S.

Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

OBJECTIVE: To review the functional recovery in a cohort of patients with facial 
nerve paralysis (FNP) due to infective cause. STUDY DESIGN: Retrospective review 
based on patients identified from a prospectively maintained database of patients
with FNP. The case notes of identified patients were reviewed. SETTING: Tertiary 
referral center. PATIENTS: The patients were identified from a database of 1074
patients with FNP. One hundred twenty of the 150 patients identified as having
FNP due to an infectious disease caused by herpes zoster oticus were excluded
from the study. The remaining 30 patients were included in the study.
INTERVENTIONS: Patients were treated both operatively and nonoperatively.
Operative treatment included myringotomy and ventilation tube placement, cortical
mastoidectomy, modified radical (canal wall down) mastoidectomy, petrous
apicectomy, and lateral temporal bone resection. MAIN OUTCOME MEASURES: This
study used the House-Brackmann (HB) grade of facial function at 1 year after
initial assessment. The patients were identified from a prospectively maintained 
database of all patients presenting with FNP to a single specialist
otolaryngologist (G.R.C.) between June 1988 and April 2005. The database contains
information including demographic details, dates of presentation, diagnostic
modalities used, diagnosis, interventions, and HB grade. The patients in this
series presented between August 4, 1989 and August 26, 2003. RESULTS: Twenty-nine
patients with 30 facial nerve paralyses were identified. The causes of FNP were
acute otitis media (n = 10); cholesteatoma (n = 10 [acquired, 7; congenital, 3]);
mastoid cavity infections (n = 2); malignant otitis externa (n = 2);
noncholesteatomatous chronic suppurative otitis media (CSOM; n = 2); tuberculous 
mastoiditis (n = 1); suppurative parotitis (n = 1); and chronic granulomatosis (n
= 1). The patients with noncholesteatomatous CSOM who presented sooner after the 
onset of facial nerve symptoms had greater facial nerve recovery when assessed
using the HB grade at 1 year. CONCLUSION: FNP due to infective causes other than 
herpes zoster oticus is rare. Patients with noncholesteatomatous CSOM and FNP
have a better outcome than those with FNP due to cholesteatoma. Patients with FNP
due to acute otitis media tend to have a good prognosis without surgical
decompression of the facial nerve being required.

Publication Types: 
    Case Reports

PMID: 17031324 [PubMed - indexed for MEDLINE]

602: Vaccine. 2007 Mar 22;25(13):2389-93. Epub 2006 Sep 22.

An overview of acute otitis media in Australian Aboriginal children living in
remote communities.

Morris PS, Leach AJ, Halpin S, Mellon G, Gadil G, Wigger C, Mackenzie G, Wilson
C, Gadil E, Torzillo P.

Menzies School of Health Research, Darwin, Northern Territory, Australia.
peterm@menzies.edu.au

Australian Aboriginal children experience early, persistent and severe middle ear
infections. We conducted a review of the medical literature that addressed acute 
otitis media (AOM) in Australian Aboriginal children. Comparisons were made with 
the recent guidelines on the diagnosis and management of AOM prepared by the
American Academies of Pediatrics and Family Physicians (AAP & AAFP 2004). Otitis 
media in Aboriginal children living in remote communities begins in the first 3
months of life following early bacterial colonisation. Young children with
persistent signs of suppurative disease (bulging of the tympanic membrane or
middle ear discharge) are probably most at risk of developing chronic suppurative
otitis media.

PMID: 17030497 [PubMed - indexed for MEDLINE]

603: PLoS Genet. 2006 Oct 6;2(10):e149.

Mutation at the Evi1 locus in Junbo mice causes susceptibility to otitis media.

Parkinson N, Hardisty-Hughes RE, Tateossian H, Tsai HT, Brooker D, Morse S,
Lalane Z, MacKenzie F, Fray M, Glenister P, Woodward AM, Polley S, Barbaric I,
Dear N, Hough TA, Hunter AJ, Cheeseman MT, Brown SD.

Mammalian Gentics Unit, Medical Research Council, Harwell, United Kingdom.

Otitis media (OM), inflammation of the middle ear, remains the most common cause 
of hearing impairment in children. It is also the most common cause of surgery in
children in the developed world. There is evidence from studies of the human
population and mouse models that there is a significant genetic component
predisposing to OM, yet nothing is known about the underlying genetic pathways
involved in humans. We identified an N-ethyl-N-nitrosourea-induced dominant mouse
mutant Junbo with hearing loss due to chronic suppurative OM and otorrhea. This
develops from acute OM that arises spontaneously in the postnatal period, with
the age of onset and early severity dependent on the microbiological status of
the mice and their air quality. We have identified the causal mutation, a
missense change in the C-terminal zinc finger region of the transcription factor 
Evi1. This protein is expressed in middle ear basal epithelial cells,
fibroblasts, and neutrophil leukocytes at postnatal day 13 and 21 when
inflammatory changes are underway. The identification and characterization of the
Junbo mutant elaborates a novel role for Evi1 in mammalian disease and implicates
a new pathway in genetic predisposition to OM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17029558 [PubMed - indexed for MEDLINE]

604: Vaccine. 2007 Mar 22;25(13):2434-6. Epub 2006 Sep 18.

Molecular characterisation of pneumococcal serotype 16F: Established predominant 
carriage and otitis media serotype in the 7vPCV era.

Marsh RL, Smith-Vaughan H, Beissbarth J, Hare K, Kennedy M, Wigger C, Mellon G,
Stubbs E, Gadil JR, Pettit A, Mackenzie G, Tipakalippa P, Morris PS, Leach AJ.

Menzies School of Health Research, Darwin, Northern Territory, Australia.
robyn.marsh@menzies.edu.au

Young Australian Aboriginal children in remote communities experience very high
rates of pneumococcal carriage and otitis media. Prior to introduction of the
7-valent pneumococcal conjugate vaccine (7vPCV, Prevenar), serotype 16F was an
important type found in nasal and ear discharge swabs. Since commencement of
pneumococcal immunisation for Aboriginal infants in 2001, 16F has become the
predominant established serotype in carriage and otitis media in young Aboriginal
children. BOX typing and multi-locus sequence typing revealed a diverse
population of serotype 16F strains, and evidence of potential capsule switching
from a vaccine serotype 4 to a serotype 16F.

PMID: 17028080 [PubMed - indexed for MEDLINE]

605: Eur Arch Otorhinolaryngol. 2007 Jan;264(1):9-14. Epub 2006 Oct 5.

The use of trichloroacetic acid in the treatment of acute external otitis.

Kantas I, Balatsouras DG, Vafiadis M, Apostolidou MT, Pournaras A, Danielidis V.

ENT Department, "G.Genimmatas" General hospital, Thessaloniki, Greece.

The purpose of this study was to evaluate the effectiveness of 5% trichloroacetic
acid (TCA) in the treatment of acute external otitis (AEO) in comparison with a
standard clinical treatment. All patients who consecutively presented in our
emergencies with AEO during the summer months of the previous year were included 
in the study. They were randomly divided into two groups: the study group
included 117 patients treated with TCA and the control group included 98 patients
treated with ear drops containing antibiotic and corticosteroid. Occasionally, an
antibiotic was administered orally for 7 days, in severe cases of AEO. All
patients were evaluated on days 1, 3, 5, 7 and 10, whereas another review
appointment was given 20 days later. Outcome measures included evaluation of
efficacy using a six-step infection score and tolerability by visual analogue
scale. Additionally, adverse reactions, complications and recurrencies were
recorded. Treatment was successful for all patients of the study group, whereas 8
failures were found in the control group. The infection score improved faster in 
the study group than in the control group, resulting in an earlier clinical cure 
(mean 4.1 and 8.6 days, respectively). Tolerability was significantly better in
the study group, on all points of evaluation. Complications and adverse reactions
were minimal on both groups. Our results show that TCA is a very effective and
nontoxic agent for the treatment of AEO. Rapid pain relief and prevention of
recurrencies are its main advantages.

Publication Types: 
    Randomized Controlled Trial

PMID: 17021784 [PubMed - indexed for MEDLINE]

606: Eur Arch Otorhinolaryngol. 2007 Mar;264(3):227-30. Epub 2006 Sep 21.

Tuberculous otitis media developing as a complication of tympanostomy tube
insertion.

Kim CW, Jin JW, Rho YS.

Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University
College of Medicine, 445 Gil-Dong, Gangdong-gu, Seoul, 134-701, South Korea.
kcw5088@dreamwiz.com

Primary tuberculous otitis media of which infection focus cannot be found
elsewhere in the body is a rare disease. Route of the infection has been
hypothesized as Eustachian tube or external auditory canal with tympanic membrane
perforation but it is hard to ascertain in the patient. We present a case of an
8-year-old child who suffered chronic otorrhea after tympanostomy tube insertion.
The radiological and histopathological findings revealed tuberculous otitis
media, which occurred as a complication of tympanostomy tube insertion.

Publication Types: 
    Case Reports

PMID: 17021778 [PubMed - indexed for MEDLINE]

607: Pediatr Allergy Immunol. 2006 Nov;17(7):514-8.

Human rhinoviruses in otitis media with effusion.

Chantzi FM, Papadopoulos NG, Bairamis T, Tsiakou M, Bournousouzis N,
Constantopoulos AG, Liapi G, Xatzipsalti M, Kafetzis DA.

2nd Pediatric Clinic, University of Athens, P & A Kyriakou Children's Hospital,
Athens, Greece. fchantzi@yahoo.co.uk

Frequent viral upper respiratory tract infections (URTI) are considered to be
risk factors for otitis media with effusion (OME). Atopy has also been associated
with both OME and viral infections. The aim of this study was to evaluate the
presence of viruses in middle ear effusions (MEE) in children 2-7 yr old with
OME, and to determine risk factors for virus detection in the MEE. MEE samples,
collected at the time of myringotomy from 37 children with OME were assessed.
Physical examination, skin prick tests and a standardized questionnaire on OME
and allergy were also performed. Viral RNA was detected by the use of reverse
transcription PCR (RT-PCR). Fifteen samples (40.5%) were positive for rhinovirus 
(RV). One enterovirus and no other respiratory viruses were detected. Two out of 
five (40%), 3/7 (43%) and 10/25 (40%) were positive for RV in acute, subacute and
chronic cases, respectively. Children with frequent episodes of OM, with early
onset of OM (<2 yr old), and a positive family history of allergy had a
statistically increased risk of RV detection. The two groups were comparable with
respect to all other parameters examined. RV is the predominant virus recovered
by RT-PCR in the middle ear cavity of children with asymptomatic OME, especially 
those with a history of longstanding OME or repeated episodes, or children with a
family history of allergy. Interactions between allergy and RV infections are
likely to predispose to middle ear disease.

PMID: 17014626 [PubMed - indexed for MEDLINE]

608: Otolaryngol Head Neck Surg. 2006 Oct;135(4):585-9.

Effects of ototopic steroid and NSAIDS in clearing middle ear effusion in an
animal model.

Cutler JL, Wall M, Labadie RF.

Department of Otolaryngology-Head and Neck Surgery, Nashville, Tennessee
37232-8605, USA.

OBJECTIVE: A model of otitis media with effusion (OME) has been developed in the 
Sprague-Dawley (SD) rat. This model was used to study the effects of an ototopic 
steroid and nonsteroidal anti-inflammatory drug (NSAID) on lipopolysaccharide
(LPS)-induced OME. STUDY DESIGN: Twenty-six rats were randomized into 4 groups:
saline solution, LPS, NSAID + LPS, and steroids + LPS. Test substance was
injected into the middle ear at 0, 2, and 4 hours. The effusion was collected at 
2, 4, and 6 hours. Statistical analysis of effusion volume and albumin
concentration was performed. RESULTS: The LPS group demonstrated statistically
significant increase in both effusion volume and albumin concentration compared
with saline solution. Intergroup comparison revealed significantly less effusion 
volume in the steroid group and less albumin concentration in the NSAID group
when compared with the LPS group. CONCLUSIONS: Transtympanic steroid reduced LPS 
induced middle ear effusion while NSAID reduced albumin concentration in the rat 
model. SIGNIFICANCE: Our results lend support to the current use of
anti-inflammatory ototopicals in the treatment of inflammatory middle ear
disease.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17011422 [PubMed - indexed for MEDLINE]

609: Vaccine. 2007 Mar 22;25(13):2507-12. Epub 2006 Sep 20.

Brief review of the clinical effectiveness of PREVENAR against otitis media.

Fletcher MA, Fritzell B.

International Scientific & Clinical Affairs, Wyeth Vaccines Research, Coeur
Défense-Tour A, 05TA077, La Défense 4, 110 esplanade du Général de Gaulle, 92931 
Paris La Défense Cedex, France. fletchm@wyeth.com

Pre-licensure trials in Finnish and US infants demonstrated that PREVENAR was
associated, respectively, with a 6% (95% CI, -4% to 16%) and an 8.9% (95% CI,
5.8-11.8%) overall reduction in clinical AOM incidence. Long-term follow-up of
these cohorts revealed that there was an approximately 10-50% vaccine efficacy
against recurrent otitis media or for the prevention of tympanostomy tube
placement. In surveillance reports from the USA that followed infants with
serious AOM, generalized PREVENAR vaccination led to an important fall in the
incidence of pneumococcal otitis media, particularly for cases that would have
been frequent or would have been refractory to antibiotic treatment. The rate of 
pneumococcal MEF isolates fell by 39% for severe otitis media [McEllistrem MC,
Adams JM, Patel K, Mendelsohn AB, Kaplan SL, Bradley JS, et al. Acute otitis
media due to penicillin-nonsusceptible Streptococcus pneumoniae before and after 
the introduction of the pneumococcal conjugate vaccine. Clin Infect Dis
2005;40(12):1738-44], by 42%, among persistent or treatment-resistant otitis
media [Casey JR, Pichichero ME, Changes in frequency and pathogens causing acute 
otitis media in 1995-2003. Pediatr Infect Dis J 2004;23(9):824-8 [see comment]]
and by 66% among severe otitis media cases or from 'otitis-prone' children [Block
SL, Hedrick J, Harrison CJ, Tyler R, Smith A, Findlay R, et al. Community-wide
vaccination with the heptavalent pneumococcal conjugate significantly alters the 
microbiology of acute otitis media. Pediatr Infect Dis J 2004;23(9):829-33 [see
comment]].

Publication Types: 
    Review

PMID: 17011085 [PubMed - indexed for MEDLINE]

610: Eur Arch Otorhinolaryngol. 2006 Dec;263(12):1082-6. Epub 2006 Sep 28.

Canal wall reconstruction and mastoid obliteration with composite multi-fractured
osteoperiosteal flap.

Uçar C.

ENT Department, Private Türkiye Hospital, Darülaceze cad, Nadide sok. no. 7
Sişli, 80270 Istanbul, Turkey. hcucar@yahoo.com

We used inferior pedicled composite multi-fractured osteoperiosteal flap (CMOF), 
our original and new surgical approach, to obliterate the mastoid cavity and
reconstruct the external auditory canal (EAC) to prevent the open cavity
problems. CMOF was used to obliterate the mastoid cavity and reconstruct the EAC 
in 24 patients (13 women, 11 men; age span 12-51 years) who underwent radical
mastoidectomy to treat the chronic otitis media between 1998 and 2004. Small
meatoplasty was done in all 24 patients to relieve their aesthetical concerns.
Temporal bone CT scanning was done to observe the neo-osteogenesis in the
mastoidectomy cavity and the CMOF, and the EAC volume was measured
postoperatively. All our patients were followed-up for 2 years. The
epithelization of the new EAC in our patients was complete at the end of the
second month. Cholesteatoma, granulation, and recurrence of osteitis did not
occur in any of the patients. We saw the new bone formation filling the mastoid
cavity in the postoperative temporal bone CT scanning images. The mean volume of 
the new EAC on the 24th month was 1.83 +/- 0.56 cm(3). We had an almost natural
EAC, which owed its existence to the neo-osteogenesis that grows behind the CMOF,
which we use to obliterate the mastoid cavity and to reconstruct the EAC.

PMID: 17006636 [PubMed - indexed for MEDLINE]

611: Otol Neurotol. 2006 Oct;27(7):992-8.

Serous otitis media revealing temporal en plaque meningioma.

Ayache D, Trabalzini F, Bordure P, Gratacap B, Darrouzet V, Schmerber S,
Lavieille JP, Williams M, Lescanne E.

Otology-Neurotology Unit, Fondation A. de Rothschild, Paris, France.
dayache@fo-rothschild.fr

OBJECTIVES: To present a series of temporal en plaque meningiomas involving the
middle ear or mastoid, whose main symptoms suggested a serous otitis media. STUDY
DESIGN AND SETTINGS: Multicentric retrospective study reviewing clinical records 
originating from eight tertiary referral centers. MATERIALS AND METHODS: The
clinical records of 10 patients presenting with signs and symptoms suggesting
serous otitis media and whose neuroimaging studies revealed a temporal en plaque 
meningioma involving the middle ear or mastoid are reported. RESULTS: All the
patients were women, ranging from 49 to 71 years old. The delay between the onset
of symptoms and the diagnosis of meningioma varied from 1 to 10 years. All the
patients underwent various procedures usually applied for the treatment of serous
otitis media, which failed in all the cases, particularly ventilating tube
placement, which was followed by severe episodes of discharge. In all cases, the 
computed tomographic scans showed three imaging signs: soft tissue mass filling
the middle ear or mastoid, hyperostosis of the petrous bone, and hairy aspect of 
the intracranial margins of the affected bone. This imaging triad must alert the 
otologist of the possibility of intracranial meningioma. Magnetic resonance
imaging was the method of choice to assess the diagnosis of intracranial
meningioma involving the middle ear or mastoid. When analyzing management
options, it appeared that conventional middle ear procedures were inefficient.
CONCLUSION: Temporal en plaque meningioma involving the middle ear or mastoid can
mimic a serous otitis media. A computed tomographic scan is recommended for cases
of atypical or prolonged unilateral serous otitis media to investigate indirect
signs of a meningioma, which has to be confirmed with magnetic resonance imaging.

Publication Types: 
    Case Reports
    Multicenter Study

PMID: 17006350 [PubMed - indexed for MEDLINE]

612: Otol Neurotol. 2006 Oct;27(7):937-44.

Internal jugular vein thrombosis associated with acute mastoiditis in a pediatric
age.

Redaelli de Zinis LO, Gasparotti R, Campovecchi C, Annibale G, Barezzani MG.

Department of Otolaryngology-Head and Neck Surgery, University of Brescia, Italy.
redaelli@med.unibs.it

OBJECTIVE: To discuss the clinical aspects and management of internal jugular
vein thrombosis associated with acute otitis media. STUDY DESIGN: Case reports
and review of the literature. SETTING: University hospital, tertiary referral
center. PATIENT: The authors describe two cases of internal jugular vein
thrombosis, without sigmoid sinus thrombosis, secondary to acute otomastoiditis. 
INTERVENTION: Jugular vein thrombosis was diagnosed in both cases by observation 
of filling defects of the involved jugular bulb on contrast-enhanced computed
tomography and confirmed by conventional magnetic resonance and magnetic
resonance venography. RESULTS: Both patients recovered after recanalization of
the vessel concomitant to anticoagulation and antibiotic treatment associated
with a simple mastoidectomy. CONCLUSION: Internal jugular vein thrombosis may be 
a complication of acute otitis media, without involvement of the sigmoid sinus
and with a starting point in the jugular bulb. Anticoagulation associated with
antibiotic therapy can be considered a safe and effective treatment. Surgery
should only be performed to eliminate the source of infection from the middle ear
and mastoid.

Publication Types: 
    Case Reports
    Review

PMID: 17006344 [PubMed - indexed for MEDLINE]

613: Otol Neurotol. 2006 Oct;27(7):928-33.

Hypertrophic cranial pachymeningitis associated with middle ear inflammation.

Iwasaki S, Ito K, Sugasawa M.

Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Tokyo,
Japan. iwashin-tky@umin.ac.jp

OBJECTIVE: To describe a series of patients with hypertrophic cranial
pachymeningitis (HCP) associated with chronic middle ear inflammation. STUDY
DESIGN: Retrospective case review. SETTING: University Hospital. PATIENTS: Six
consecutive patients between the years 2000 and 2004 who had both middle ear
disease and HCP (three men and three women; age range, 36-72 yr, mean age, 58.2
yr). The diagnosis of HCP was made by the use of contrast-enhanced magnetic
resonance imaging scans of the brain in all patients. INTERVENTIONS:
Contrast-enhanced magnetic resonance imaging (MRI) of the brain, dural biopsy,
and otomicroscopic examination. MAIN OUTCOME MEASURE: Thickening and abnormal
enhancement of the dura mater on the MRI of the brain. RESULTS: All of the six
patients had chronic inflammatory middle ear diseases. Three patients had otitis 
media with effusion, two had chronic otitis media, and one had postoperative
otorrhea. The most common presentations of HCP were headache and cranial nerve
palsies. Cranial Nerves V and VIII were the most frequently involved. On
contrast-enhanced MRI examination of the brain, an enhancement of the dura mater 
was observed on the same side as the middle ear diseases in five of the six
patients, whereas bilateral enhancement was observed in one patient.
Corticosteroid therapy was effective for alleviating the symptoms in all six
patients. CONCLUSION: Chronic middle ear inflammation might be involved in the
pathogenesis of HCP, probably mediated by the venous return.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 17006342 [PubMed - indexed for MEDLINE]

614: J Clin Microbiol. 2006 Dec;44(12):4316-25. Epub 2006 Sep 27.

Identification of new genetic regions more prevalent in nontypeable Haemophilus
influenzae otitis media strains than in throat strains.

Xie J, Juliao PC, Gilsdorf JR, Ghosh D, Patel M, Marrs CF.

Department of Epidemiology, University of Michigan School of Public Health, 109
Observatory Street, Ann Arbor, MI 48109-2029, USA.

Nontypeable (NT) Haemophilus influenzae strains cause significant respiratory
illness and are isolated from up to half of middle ear aspirates from children
with acute otitis media. Previous studies have identified two genes, lic2B and
hmwA, that are associated with NT H. influenzae strains isolated from the middle 
ears of children with otitis media but that are not associated with NT H.
influenzae strains isolated from the throats of healthy children, suggesting that
they may play a role in virulence in otitis media. In this study, genomic
subtraction was used to identify additional genetic regions unique to middle ear 
strains. The genome of NT H. influenzae middle ear strain G622 was subtracted
from that of NT H. influenzae throat strain 23221, and the resultant gene regions
unique to the middle ear strain were identified. Subsequently, the relative
prevalence of the middle ear-specific gene regions among a large panel of otitis 
media and throat strains was determined by dot blot hybridization. By this
approach, nine genetic regions were found to be significantly more prevalent in
otitis media strains. Classification tree analysis of lic2B, hmwA, and the nine
new potential otitis media virulence genes revealed two H. influenzae pathotypes 
associated with otitis media.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17005745 [PubMed - indexed for MEDLINE]

615: Laryngoscope. 2006 Oct;116(10):1798-804.

Quality of life of patients with otitis media and caregivers: a multicenter
study.

Lee J, Witsell DL, Dolor RJ, Stinnett S, Hannley M.

Duke University Medical Center, the Division of Otolaryngology-Head and Neck
Surgery, Durham, North Carolina, USA.

OBJECTIVE: The objective of this study was to determine the quality of life of
otitis media (OM) patients and their caregivers. STUDY DESIGN: A cross-sectional 
study was conducted at 11 otolaryngology and five pediatric clinics in the United
States between July 1998 and August 1999. All patients, regardless of primary
complaint, completed a demographic survey, OM-6 survey, and Child Health
Questionaire-PF28 survey by proxy. Physicians completed an International
Classification of Diseases, 9th Revision diagnosis sheet for each patient.
METHODS: Analysis, including Spearman rank correlation, was restricted to study
patients with active OM. RESULTS: A total of 1,001 patients with active OM were
identified: 503 OM with effusion, 267 acute OM, and 258 recurrent acute OM.
Median patient age was 2 years (interquartile range, 1-5). Mean caretaker age was
32.6 years (standard deviation, 7.4). There was moderate correlation between OM
frequency and physical suffering (r = 0.50; P < .001) and caregiver concerns (r =
0.45; P < .001). Moderate correlation was found between percentage of time with
fluid in the ears and caregiver concerns (r = 0.46; P < .001) and physical
suffering (r = 0.43; P < .001). OM patients over 5 years of age scored
significantly worse than healthy children ages 5 to 7 years in almost all areas
of global health, including physical functioning and impact on caretaker's
personal time and emotions. CONCLUSION: The global quality of life of patients
with OM over 5 years of age is worse than that of healthy children of similar
age. Physical suffering and caregiver concerns are associated with frequent OM or
effusion duration. Hopefully, these results will direct the focus of future
outcomes studies.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 17003729 [PubMed - indexed for MEDLINE]

616: Laryngoscope. 2006 Oct;116(10):1820-3.

Histomorphometric estimation of air cell development in experimental otitis
media.

Mey KH, Sørensen MS, Homøe P.

Otopathological Laboratory, Department of Otorhinolaryngology Head & Neck
Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
q.qui@med.umcg.nl

OBJECTIVES: The objectives of this study were to examine the effect of acute
otitis media on the bony development of the growing middle ear air cell system
with a reliable and concise stereologic histomorphometric method and to generate 
a standard baseline growth plot for the middle ear of the rat. STUDY DESIGN: The 
authors conducted a histomorphometric analysis of bullar volume during the entire
growth period after early induction of unilateral otitis media. METHODS: The
authors conducted undecalcified processing of 27 rat skulls sectioned
horizontally at various ages from 20 to 83 days after unilateral transtympanic
injection of Streptococcus pneumoniae at 19 days postpartum. Stereologic
estimation of bullar volume was performed in the experimental and the control ear
with Cavalieri's principle. Body mass and air cell volume were plotted as
functions of subject age using standard developmental equations on the
experimental results. RESULTS: Volumes of the middle ear air cell system were
consistently smaller in the otitis ears. Bullar growth was completed at 60 days
regardless of otitis history, but body mass was increasing throughout the
experimental period. CONCLUSIONS: A single incident of otitis media introduced
early in life is sufficient to significantly reduce the final volume of the bulla
in rats. This finding may mimic the effect of otitis media contracted in early
childhood on the development of the mastoid air cells. The standard growth plot
provides a timeframe for studies of signaling molecules responsible for bone
modeling in pneumatization.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17003720 [PubMed - indexed for MEDLINE]

617: Ambul Pediatr. 2006 Sep-Oct;6(5):280-7.

Early middle ear effusion and school achievement at age seven years.

McCormick DP, Johnson DL, Baldwin CD.

Department of Pediatrics, Division of General Academic Pediatrics, University of 
Texas Medical Branch at Galveston, 400 Harborside Drive, Galveston, TX
77555-1119, USA. david.mccormick@utmb.edu

OBJECTIVE: This study tested the hypothesis that children with early persistent
middle ear effusion (MEE) are at risk for later deficits in academic performance.
METHODS: We recruited 698 newborns and monitored them for MEE every 2 to 4 weeks 
at home until age 3 years. At age 7 years, it was possible to obtain school data 
for 226 children. Tests included the Iowa Tests of Basic Skills or the Stanford
Achievement tests, the Woodcock Reading Mastery Tests, and the Woodcock-Johnson
Tests of Achievement. RESULTS: There was no significant relationship between
early MEE and measures of school achievement as shown by correlations or multiple
regression. Differences between extreme MEE groups were not significant. School
achievement was strongly associated with ethnicity, home environment, and
socioeconomic status. CONCLUSIONS: Early persistent MEE does not appear to affect
achievement in school at age 7 years.

Publication Types: 
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural

PMID: 17000418 [PubMed - indexed for MEDLINE]

618: J Laryngol Otol. 2006 Dec;120(12):1014-8. Epub 2006 Sep 25.

Obliteration of the tympanomastoid cavity: long term results of the Rambo
operation.

Kos MI, Chavaillaz O, Guyot JP.

Department of Otolaryngology, Head and Neck Surgery, Geneva University Hospital, 
Geneva, Switzerland. izabel.kos@hcuge.ch

INTRODUCTION: Radical mastoidectomy and tympanomastoid obliteration with fat
tissue, also called the Rambo operation, is proposed to those patients suffering 
chronic middle-ear disease, with or without cholesteatoma, who have no useful
hearing in an ear which cannot be kept dry despite all conservative treatment.
METHODS: We analysed retrospectively a series of 46 patients operated upon in our
department. Information recorded included the surgical indications, surgical
observations, post-operative care and complications. All patients were invited to
comment on their long term anatomical and functional results and to express their
degree of satisfaction with the procedure. RESULTS: Recurrent infectious episodes
were observed in seven cases. Residual cholesteatoma were observed in three
cases. After treatment, these patients did not present with further
complications. One case presented with multiple episodes of infection with
recurrences of cholesteatoma and finally had the obliterated cavity transformed
into an open cavity again. For most of the patients, in the long term (i.e. one
to 23 years post-operatively (mean eight years)), the operation resulted in a dry
ear, ending the need for frequent consultations to clean and disinfect diseased
ears or open cavities. CONCLUSION: Obliteration of the tympanomastoid cavity, as 
proposed by Tom Rambo, shortens considerably the post-operative care period, in
comparison with canal wall down mastoidectomy, and is therefore indicated if no
serviceable hearing can be expected. In the long term, the rate of complications 
is low and patients are satisfied.

PMID: 16995962 [PubMed - indexed for MEDLINE]

619: J Laryngol Otol. 2007 Feb;121(2):118-23. Epub 2006 Sep 25.

Resistance of Pseudomonas to ciprofloxacin: implications for the treatment of
malignant otitis externa.

Bernstein JM, Holland NJ, Porter GC, Maw AR.

Department of ENT, St Michael's Hospital, Bristol, UK. jbernstein2001@hotmail.com

For fifteen years oral ciprofloxacin has been the standard treatment for
malignant otitis externa, a sometimes fatal osteomyelitis of the skull base
usually caused by Pseudomonas aeruginosa. Resistance to ciprofloxacin is
developing. Over a 16-month period, we saw five cases where malignant otitis
externa progressed, with the development of cranial nerve palsies in four cases, 
despite oral ciprofloxacin. Prolonged intravenous antibiotic therapy became
necessary. One case was managed largely as an out-patient, but four patients
spent many weeks in hospital. Only two cases had diabetes and this was monitored 
and controlled. Pseudomonas aeruginosa was isolated in four of the five cases,
but antibiotic sensitivity to ciprofloxacin was not determined. In one case a
later isolate was tested and found to be ciprofloxacin resistant. Progress was
monitored by serial C-reactive protein (CRP) and white cell count. For diagnosis 
and assessing response to treatment we considered serial magnetic resonance
imaging or computed tomography more useful than isotope bone scan. There must be 
a readiness to use intravenous antibiotics, as a response to ciprofloxacin can no
longer be assumed. Bacterial isolates must be tested for sensitivity to
antibiotics including ciprofloxacin, and further biopsy and culture are essential
if treatment fails.

Publication Types: 
    Case Reports

PMID: 16995959 [PubMed - indexed for MEDLINE]

620: Expert Rev Vaccines. 2006 Aug;5(4):553-64.

Pneumococcal conjugate vaccines: emerging clinical information and its
implications.

Lockhart SP, Hackell JG, Fritzell B.

Wyeth Vaccine Research, Clinical Research Taplow, Maidenhead, Berkshire, SL6 0PH,
United Kingdom. lockhas@wyeth.com

Since 2000, when the first pneumococcal conjugate vaccine was introduced into
routine use in the USA, it has had a substantial impact on invasive pneumococcal 
disease both in the immunized and nonimmunized population. It has also been shown
to reduce pneumonia and otitis in young children and has reduced antibiotic
nonsusceptible pneumococcal infections. In the USA, three primary doses and a
booster dose are recommended (a so-called '3 + 1 schedule'). Some countries have 
or will soon introduce routine immunization with fewer doses, with either two
primary doses and a booster dose ('2 + 1 schedule') or no booster dose ('3 + 0
schedule'). Some serotypes produce less antibody in a two-dose compared with a
three-dose primary series. The booster dose may also be important in reducing
nasopharyngeal carriage, hence absence of a booster dose may reduce indirect
protection. It remains to be seen whether these schedule changes will reduce
vaccine effectiveness within the population. Important future developments
include extending the number of serotypes included in the vaccine and the
possible extension of use into adults in whom indirect protection has been
useful, but not as extensive as might be possible with direct immunization.

Publication Types: 
    Review

PMID: 16989635 [PubMed - indexed for MEDLINE]

621: Expert Rev Vaccines. 2006 Aug;5(4):517-34.

Prospects for a vaccine against otitis media.

Cripps AW, Otczyk DC.

Griffith University, School of Medicine, Gold Coast Campus, PMB 50, Gold Coast,
MC, QLD, 9726, Australia. allan.cripps@griffith.edu.au

Otitis media is a major cause of morbidity in 80% of all children less than 3
years of age and often goes undiagnosed in the general population. There is
evidence to suggest that the incidence of otitis media is increasing. The major
cause of otitis media is infection of the middle ear with microbes from the
nasopharynx. The anatomical orientation of the eustachian tube, in association
with a number of risk factors, predisposes infants and young children to the
infection. Bacteria are responsible for approximately 70% of cases of acute
otitis media, with Streptococcus pneumoniae, nontypeable Haemophilus influenzae
and Moraxella catarrhalis predominating as the causative agents. The respiratory 
viruses, respiratory syncytial virus, rhinovirus, parainfluenza and influenza,
account for 30% of acute otitis media cases. Over the past decade, there has been
a profound increase in the reported resistance to antibiotics, which, with
increased disease burden, has focussed attention on vaccine development for
otitis media. A polymicrobial formulation containing antigens from all major
pathogens would have the greatest potential to deliver a sustained reduction in
the disease burden globally. The disappointing outcomes for otitis media seen
with the polysaccharide pneumococcal conjugate vaccine have raised major
challenges for the vaccination strategy. Clearly, more knowledge is required
concerning immune mechanisms in the middle ear, as well as vaccine formulations
containing antigens that are more representative of the polymicrobial nature of
the disease. Antigens that have been extensively tested in animal models are now 
available for testing in human subjects.

Publication Types: 
    Review

PMID: 16989632 [PubMed - indexed for MEDLINE]

622: East Afr Med J. 2006 Jun;83(6):322-5.

Chronic suppurative otitis media in Tanzanian school children and its effects on 
hearing.

Minja BM, Moshi NH, Ingvarsson L, Bastos I, Grenner J.

ORL Department, Muhimbili University College of Health Sciences, P.O. Box 650001,
Dar es Salaam, Tanzania.

OBJECTIVES: To compare different treatment regimens of chronic suppurative otitis
media (CSOM) in school children, in regard to their consequence in hearing and
discharge from the ear drum perforation. DESIGN: Randomised controlled trial.
SETTING: Randomly selected primary schools within Dar es Salaam. SUBJECTS: Three 
hundred and twenty eight children between 5-17 years of age with CSOM in one or
both ears. RESULTS: Three to four months after the onset of treatment 31% of
group 1, 54% of group 2, and 56% of group 3, had dry ears. Treatment with dry
mopping and boric acid in alcohol ear drops was significantly better than dry
mopping alone. Adding amoxicillin to the treatment did not improve the end
results. Hearing test performed before and after treatment showed that the
hearing thresholds were the same or better after the treatment. The possible risk
that boric acid in alcohol ear drops should lead to sensorineural hearing loss
has not been confirmed. CONCLUSION: Based on the above results, the treatment of 
choice for CSOM in children in Dar es Salaam should be dry mopping and boric acid
in spirit ear drops.

Publication Types: 
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16989377 [PubMed - indexed for MEDLINE]

623: Otol Neurotol. 2006 Dec;27(8):1089-93.

TH1/TH2 and regulatory cytokines in adults with otitis media with effusion.

Kariya S, Okano M, Hattori H, Sugata Y, Matsumoto R, Fukushima K, Schachern PA,
Cureoglu S, Paparella MM, Nishizaki K.

Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate
School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
skariya@cc.okayama-u.ac.jp

OBJECTIVE: Otitis media with effusion is one of the most common and intractable
ear diseases. However, the role of Th1, Th2, and immunoregulatory cytokines on
the pathogenesis of the disease in adult patients remains to be determined. The
aim of this study is to disclose the cytokine expression in middle ear effusions 
(MEEs) in adults and to compare the profile on the basis of the presence of
allergic rhinitis and the type of effusions. STUDY DESIGN: A prospective
controlled clinical study. PATIENTS: MEEs were collected from 80 adult subjects. 
The concentration of interleukin (IL)-2, IL-4, IL-5, IL-10, IL-12, and interferon
(IFN)-gamma in MEEs were determined by using enzyme-linked immunosorbent assay.
RESULTS: IL-2, IL-4, IL-5, IL-10, IL-12, and IFN-gamma in MEEs were detected in
60 (75.0%), 33 (41.3%), 42 (52.5%), 14 (17.5%), 80 (100%), and 66 (82.5%)
samples, respectively. Among these cytokines, only the concentration of IL-4 in
the allergic rhinitis-positive group was significantly higher than that in the
allergic rhinitis-negative group. On the other hand, IL-2, IL-12, and IFN-gamma
were detected, regardless of the presence of allergic rhinitis, and the
concentration of these cytokines correlated with each other. The correlation
between the concentration of IL-4 and IL-5 was also detected. In addition, both
the incidence rate and the concentration of IL-10 in MEEs were significantly
higher in the mucoid type compared with those in the serous type effusions.
CONCLUSION: Regardless of allergic status, IL-12 may play a critical role in the 
pathogenesis of otitis media with effusion by affecting the production of IL-2
and IFN-gamma. In addition, IL-4 may have some impact on the immunologic
condition in adults with allergic rhinitis. IL-10 potentially affects the
viscosity of MEEs.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16988618 [PubMed - indexed for MEDLINE]

624: Otol Neurotol. 2006 Dec;27(8):1094-7.

Granular myringitis: Incidence and clinical characteristics.

Wolf M, Primov-Fever A, Barshack I, Polack-Charcon S, Kronenberg J.

Department of Otorhinolaryngology Head and Neck Surgery, The Chaim Sheba Medical 
Center, Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Tel
Aviv, Israel. wolfm@post.tau.ac.il

OBJECTIVE: To examine the incidence and the clinical features of granular
myringitis (GM). STUDY DESIGN: A 2-year prospective cohort study. SETTING: A
primary otolaryngology clinic affiliated with a tertiary academic referral
center. PATIENTS: All-aged patients diagnosed with GM who had no apparent middle 
ear disease or did not undergo ear surgery. INTERVENTION: Otoscopy and
bacteriologic and histopathologic studies. MAIN OUTCOME MEASURES: Granular
myringitis was noted in 0.41% of patient's population presenting different forms.
RESULTS: Granular myringitis was detected in 26 patients. Recurrent infection
occurred in seven (26.9%) and bilateral GM in five patients (19.2%). Perforation 
of the tympanic membrane (TM) was noted in eight patients (30.7%), six of which
closed spontaneously. Otoscopic findings could be classified into three grades:
focal de-epithelization (in 10), focal polypoid granulations (in 13), and diffuse
polypoid formation over the entire TM (in 3). Histopathologic examination
disclosed tiny fragments of granulation tissue infiltrated by nonspecific chronic
and acute inflammatory reaction. CONCLUSION: Granular myringitis is encountered
not infrequently in primary otolaryngology practice and presented different
forms, recurrent episodes, and bilateral involvement. Topical application of
antibiotics or caustic agents was successful in all cases. Perforation of the TM 
may develop and resolve spontaneously during the course of the disease.

PMID: 16985477 [PubMed - indexed for MEDLINE]

625: Int J Technol Assess Health Care. 2006 Fall;22(4):454-9.

Cost-effectiveness of implementing national guidelines in the treatment of acute 
otitis media in children.

Koskinen H, Rautakorpi UM, Sintonen H, Honkanen P, Huikko S, Huovinen P, Klaukka 
T, Palva E, Roine RP, Sarkkinen H, Varonen H, Mäkelä M; MIKSTRA Collaborative
Study Group.

Social Insurance Institution and National Research and Development Centre for
Welfare and Health, Helsinki, Finland. hanna.koskinen@kela.fi

OBJECTIVES: Acute otitis media (AOM) is one of the most common diseases of
childhood, representing a major disease burden on the society. New evidence-based
guidelines for AOM, focusing on children under 7 years of age, were introduced in
Finland in 1999. The aim of this study was to evaluate the cost-effectiveness of 
implementing those guidelines in Finland. METHODS: A 5-year prospective trial was
conducted in thirty community primary healthcare centers in Finland. All AOM
patients between 0 and 6 years of age visiting the study health centers for the
first time, for this episode of illness, during 1 week in November 1998 (n = 579)
and November 2002 (n = 369) were included in this study. The outcome measure was 
the percentage of symptom-free patients. RESULTS: The mean direct cost of an AOM 
episode per patient stayed almost the same after implementing the guidelines,
euro152 in 1998 and euro150 in 2002. After implementing the guidelines, the
percentage of symptom-free patients was 10 percentage points higher than before
the guidelines. The treatment after the implementation of the guidelines, thus,
was a dominant strategy. CONCLUSIONS: Implementing the guidelines to the
treatment of AOM in children was associated with extra health benefits at
slightly lower direct costs and, thus, is a dominant strategy. The focus of this 
study was on the short-term effects of the treatment; including long-term effects
in the analysis might affect the results.

Publication Types: 
    Evaluation Studies
    Research Support, Non-U.S. Gov't

PMID: 16984678 [PubMed - indexed for MEDLINE]

626: Otol Neurotol. 2006 Dec;27(8):1162-5.

Comparative study of laser versus radiofrequency myringotomy in rabbits: The
effectiveness of mitomycin C application.

Lachanas VA, Prokopakis EP, Christodoulou PN, Hajiioannou JK, Malandrakis SG,
Karatzanis AD, Velegrakis GA.

Department of Otolaryngology, University of Crete, School of Medicine, Heraklion,
Crete, Greece.

OBJECTIVE: To compare laser-assisted tympanostomy (LAT) with radiofrequency
myringotomy (RFM), as well as the effectiveness of mitomycin C (MC) on the above 
techniques, in rabbits. STUDY DESIGN: Experimental animal research protocol.
SETTING: University of Crete, School of Medicine, Medical Experimental Education 
and Research Center. METHODS: Bilateral myringotomies were performed under
general anesthesia on 40 rabbits. LAT was performed on 20 animals (40 ears) and
RFM on the remaining 20 animals (40 ears). MC (0.3 mg/mL) pledgets were applied
to the right ears and saline pledgets to the left ears. Animals were monitored
weekly using otomicroscopy until myringotomy closure. Kaplan-Meier survival
techniques were used to compare myringotomy patency times. INTERVENTIONS: Under
general anesthesia, bilateral LAT was performed on 20 rabbits and bilateral RFM
on 20 rabbits. MAIN OUTCOME MEASURES: Myringotomy patency time. RESULTS: The mean
patency times of the saline-treated ears were: 1.85 weeks (95% confidence
interval [CI], 1.556-2.144 wk) for the LAT group and 1.70 weeks (95% CI,
1.494-1.906 wk) for the RFM group. This difference was not significant (p > 0.5).
MC application significantly prolonged mean patency time (p < 0.0001) in both LAT
and RFM groups. The mean patency times in the MC-treated ears were 5.45 weeks
(95% CI, 5.226-5.674 wk) for the LAT group and 5.55 weeks (95% CI, 5.285-5.815
wk) for the RFM group. This difference was not significant (p > 0.5). CONCLUSION:
There is no significant difference in myringotomy patency times between LAT and
RFM techniques in rabbits, whereas MC significantly prolongs the patency rate of 
either technique.

Publication Types: 
    Comparative Study
    Evaluation Studies

PMID: 16983316 [PubMed - indexed for MEDLINE]

627: Curr Opin Otolaryngol Head Neck Surg. 2006 Oct;14(5):341-6.

Mouse models of otitis media.

MacArthur CJ, Trune DR.

Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science
University, Portland, Oregon 97239-3098, USA. macarthc@ohsu.edu

PURPOSE OF REVIEW: Otitis media is one of the most prevalent inflammatory
diseases in the pediatric population. The personal and societal costs for otitis 
media are significant. Problems arising from antibiotic use have led to
considerable animal research efforts to better understand the mechanisms of acute
otitis media and to develop new strategies for its prevention and treatment.
RECENT FINDINGS: Various animal models induce acute otitis media from a variety
of interventions, including direct injection of whole bacteria or their products 
into the middle ear. The mouse model has begun to emerge as a model for otitis
media. The mouse affords many advantages for in-vivo research, including ease of 
genetic manipulation, availability of numerous inbred and transgenic strains, and
an extensively studied immune system. Experimental reagents for cellular and
molecular studies are widely available for the mouse. The mouse is an excellent
model for investigating the genetics and molecular bases for otitis media due to 
the extensive understanding of the mouse genome. SUMMARY: With the increased
availability of knockout and transgenic mice, and the large amount of data to
indicate that human disease is accurately modeled in the mouse, the mouse model
is increasingly becoming a model of choice.

Publication Types: 
    Review

PMID: 16974149 [PubMed - indexed for MEDLINE]

628: Int J Pediatr Otorhinolaryngol. 2007 Jan;71(1):7-10. Epub 2006 Sep 12.

Tympanometry by nurses--can allocation of tasks be optimised?

Blomgren K, Haapkylä J, Pitkäranta A.

Helsinki University Central Hospital, Department of Otorhinolaryngology,
Haartmaninkatu 4 E, FI-00029 Helsinki, Finland. karin.blomgren@hus.fi

OBJECTIVE: Acute otitis media and secretory otitis media are the most common
pediatric infectious disease with a substantial impact on especially primary
health care. If nurses could perform and interpret tympanometries, family
practitioners workload could be reduced. We wanted to investigate the ability of 
nurses to perform tympanometry and evaluate the amount of training required.
METHODS: Prospective study comparing results from tympanometry with results at
myringotomy at a University Central Hospital was conducted. Nurses at the
Paediatric Ear, Nose, and Throat Department performed tympanometry prior to
myringotomy. Sensitivity and specificity of tympanometries versus myringotomy
were calculated. Nurses' opinions about tympanometry and training required were
evaluated. RESULTS: During a 1-year period, 199 children were enrolled in the
study and 392 tympanograms were analyzed. Sensitivity of tympanograms to detect
middle-ear fluid was 0.54, and specificity 0.82. Secretion occurred in 22.5% of
children with type A curves and 45.3% of those with type C curves. Nurses
evaluated their training in tympanometry as adequate. CONSCLUSIONS: A single
training session in tympanometry is inadequate to qualify nurses to perform
tympanometry independently. Thorough research and testing to evaluate the quality
of such training is required to produce reliable tympanograms.

Publication Types: 
    Evaluation Studies

PMID: 16973222 [PubMed - indexed for MEDLINE]

629: Eur J Emerg Med. 2006 Oct;13(5):299-301.

A case of group A streptococcal meningitis following acute otitis media.

Golmarvi S, Devue K, Hachimi-Idrissi S.

Departments of Internal Medicine, Vrije Universiteit Brussel, AZ-VUB Brussels,
Belgium. shabnam_golmarvi@hotmail.com

Group A streptococcal meningitis is less common than other forms of meningitis;
however, the occurrence of this infection is associated with high mortality and
morbidity. Early recognition and a prompt treatment are therefore essential. We
review one case of an Asian women admitted with group A streptococcal meningitis 
as a complication of otitis media.

Publication Types: 
    Case Reports

PMID: 16969237 [PubMed - indexed for MEDLINE]

630: JAMA. 2006 Sep 13;296(10):1235-41.

Comment in:
    J Pediatr. 2007 Mar;150(3):319.    JAMA. 2006 Sep 13;296(10):1290-1.    JAMA. 2007 Jan 10;297(2):152; author reply 152-3.

Wait-and-see prescription for the treatment of acute otitis media: a randomized
controlled trial.

Spiro DM, Tay KY, Arnold DH, Dziura JD, Baker MD, Shapiro ED.

Department of Pediatrics, Yale University School of Medicine, New Haven, Conn,
USA. spirod@ohsu.edu

CONTEXT: Acute otitis media (AOM) is the most common diagnosis for which
antibiotics are prescribed for children. Previous trials that have evaluated a
"wait-and-see prescription" (WASP) for antibiotics, with which parents are asked 
not to fill the prescription unless the child either is not better or is worse in
48 hours, have excluded children with severe AOM. None of these trials were
conducted in an emergency department. OBJECTIVES: To determine whether treatment 
of AOM using a WASP significantly reduces use of antibiotics compared with a
"standard prescription" (SP) and to evaluate the effects of this intervention on 
clinical symptoms and adverse outcomes related to antibiotic use. DESIGN,
SETTING, AND PATIENTS: A randomized controlled trial conducted between July 12,
2004, and July 11, 2005. Children with AOM aged 6 months to 12 years seen in an
emergency department were randomly assigned to receive either a WASP or an SP.
All patients received ibuprofen and otic analgesic drops for use at home. A
research assistant, blinded to group assignment, conducted structured phone
interviews 4 to 6, 11 to 14, and 30 to 40 days after enrollment to determine
outcomes. MAIN OUTCOME MEASURES: Filling of the antibiotic prescription and
clinical course. RESULTS: Overall, 283 patients were randomized either to the
WASP group (n = 138) or the SP group (n = 145). Substantially more parents in the
WASP group did not fill the antibiotic prescription (62% vs 13%; P<.001). There
was no statistically significant difference between the groups in the frequency
of subsequent fever, otalgia, or unscheduled visits for medical care. Within the 
WASP group, both fever (relative risk [RR], 2.95; 95% confidence interval [CI],
1.75 - 4.99; P<.001) and otalgia (RR, 1.62; 95% CI, 1.26 - 2.03; P<.001) were
associated with filling the prescription. CONCLUSION: The WASP approach
substantially reduced unnecessary use of antibiotics in children with AOM seen in
an emergency department and may be an alternative to routine use of
antimicrobials for treatment of such children. TRIAL REGISTRATION:
clinicaltrials.gov Identifier: NCT00250900.

Publication Types: 
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16968847 [PubMed - indexed for MEDLINE]

631: Curr Med Res Opin. 2006 Sep;22(9):1839-47.

Efficacy, tolerability, and parent reported outcomes for cefdinir vs. high-dose
amoxicillin/clavulanate oral suspension for acute otitis media in young children.

Block SL, Schmier JK, Notario GF, Akinlade BK, Busman TA, Mackinnon GE 3rd,
Halpern MT, Nilius AM.

Kentucky Pediatric/Adult Research, Bardstown, KY 40004, USA. slblock@pol.net

OBJECTIVES: To compare efficacy, tolerability, and parental satisfaction of
cefdinir and high-dose amoxicillin/clavulanate oral suspensions given to young
children with non-refractory acute otitis media (AOM) based on clinical endpoints
and outcomes measures. RESEARCH DESIGN AND METHODS: This was an
investigator-blinded, multicenter study in which 318 children 6 months through 6 
years of age with a clinical diagnosis of AOM were randomized to receive 10 days 
of either cefdinir (14 mg/kg divided BID) or high-dose amoxicillin/clavulanate
(90/6.4 mg/kg divided BID). MAIN OUTCOME MEASURES: Investigators evaluated
clinical response at an end-of-therapy (EOT) office visit conducted on day 12-15.
Outcomes of satisfaction, tolerability, and adherence were also assessed at that 
visit using an Otitis Parent Questionnaire. RESULTS: The treatment groups were
similar at baseline with respect to patient demographics. At the EOT visit, for
cefdinir and amoxicillin/clavulanate, respectively, intent-to-treat (ITT)
clinical cure rates were 82% (129/158) and 85% (134/158) (p = 0.547; 95%
confidence interval [CI] -11.7 to 5.4) and per-protocol cure rates were 82%
(123/150) and 90% (129/143) (p = 0.045; 95% CI -16.4 to 0.0). This difference was
driven primarily by reduced cefdinir response in patients with recurrent AOM (p =
0.010) and those younger than 24 months (p = 0.039). Comparing cefdinir with
amoxicillin/clavulanate, parents more often reported significantly better ease of
use (89% vs. 57%; p < 0.0001), better taste (85% vs. 39%; p < 0.0001), and better
adherence (at least 95% of doses) (82% vs. 61%; p < 0.0001). Diarrhea/loose
stools were more common in the amoxicillin/clavulanate group than in the cefdinir
group (28% vs. 18%, respectively; p = 0.0341). One patient in the cefdinir group 
and eight patients in the amoxicillin/clavulanate group withdrew from the study
prematurely due to at least one adverse event (p = 0.0364). Study limitations
included assessment of clinical recurrence by telephone call rather than office
visit, exclusion of children with refractory AOM, and no assessment of middle ear
microbiology. CONCLUSIONS: Among young children with non-refractory AOM, cefdinir
was as efficacious as high-dose amoxicillin/clavulanate in the ITT group, but
somewhat less effective in per-protocol analysis. From the parental perspective, 
cefdinir was easier to administer, had a better taste, caused less diarrhea, and 
resulted in higher treatment adherence than high-dose amoxicillin clavulanate.

Publication Types: 
    Clinical Trial, Phase IV
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16968587 [PubMed - indexed for MEDLINE]

632: Curr Med Res Opin. 2006 Sep;22(9):1725-36.

Once-daily ofloxacin otic solution versus neomycin sulfate/polymyxin B
sulfate/hydrocortisone otic suspension four times a day: a multicenter,
randomized, evaluator-blinded trial to compare the efficacy, safety, and pain
relief in pediatric patients with otitis externa.

Schwartz RH.

Advanced Pediatrics, Vienna, VA 22180, USA. rhs738@aol.com

INTRODUCTION: Otitis externa (OE) is an infection of the external auditory canal 
affecting children and adults and is associated with symptoms of local pain and
tenderness. Twice-daily topical treatment with ofloxacin otic solution (0.3%
[Floxin otic solution]) for 10 days has been reported to be as effective and well
tolerated as neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension 
(Cortisporin otic suspension) administered four times daily for 10 days.
OBJECTIVE: This study compared the efficacy, safety, and ear-pain resolution of
once-daily ofloxacin otic solution (0.3%) versus neomycin sulfate/polymyxin B
sulfate/hydrocortisone otic suspension administered four times daily, in children
with OE. RESEARCH DESIGN, PATIENTS, AND METHODS: This multicenter, randomized,
parallel-group, evaluator-blinded study was conducted at 34 centers in 278
pediatric OE patients aged 6 months to 12 years. Patients received five drops of 
ofloxacin otic solution (0.3%) in the affected ears once daily or three drops of 
neomycin sulfate/polymyxin B sulfate/hydrocortisone otic suspension four times
daily, for 7-10 days. Patient evaluations were performed at pretherapy (day 1),
end of therapy (days 7-9), and test of cure (7-10 days post-treatment) visits.
Data for 208 patients were clinically evaluable and those for 90 patients were
microbiologically evaluable. Scores were obtained for patient assessments of pain
severity. MAIN OUTCOME MEASURES: The overall clinical response was cure in the
clinically evaluable patients, demonstrated by resolution of OE signs and
symptoms at the test of cure visit. The overall clinical-microbiological response
was cure in the microbiologically evaluable patients demonstrated by both
clinical cure and microbiological eradication. RESULTS: For the clinically
evaluable patients, equivalent cure rates were obtained between the once-daily
ofloxacin-treated and four-times-daily neomycin sulfate/polymyxin B
sulfate/hydrocortisone-treated patients (93.8% and 94.7%, respectively). For the 
clinically and microbiologically evaluable patients, the overall cure rates were 
96.4% versus 97.1% for the ofloxacin-treated and neomycin sulfate/polymyxin B
sulfate/hydrocortisone-treated patients, respectively. The eradication rates for 
the prevalent pathogen, Pseudomonas aeruginosa, were 98% versus 100% for
ofloxacin-treated and neomycin sulfate/polymyxin B sulfate/hydrocortisone-treated
patients, respectively. Decreases in pain severity were similar in both treatment
groups. Statistical analyses were limited by the small numbers of patients in
each treatment group. CONCLUSION: In the treatment of OE in children, once-daily 
ofloxacin otic solution was as effective and safe as neomycin sulfate/polymyxin B
sulfate/hydrocortisone otic suspension given four times daily. The two treatments
provide rapid and comparable pain relief; however, ofloxacin otic solution does
not have the risk of ototoxicity associated with neomycin and provides effective 
pain relief without adjunctive steroids.

Publication Types: 
    Clinical Trial, Phase III
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16968576 [PubMed - indexed for MEDLINE]

633: Eur J Pediatr. 2007 Mar;166(3):223-8. Epub 2006 Sep 12.

Acute otitis media and respiratory viruses.

Bulut Y, Güven M, Otlu B, Yenişehirli G, Aladağ I, Eyibilen A, Doğru S.

Department of Microbiology, Gaziosmanpasa University, Yesilirmak Mah. Bosna Cad. 
Mevlana Sitesi, 9 Blok Daire 5, Tokat 60100, Turkey.

The present study was performed to elucidate the clinical outcome, and etiology
of acute otitis media (AOM) in children based on virologic and bacteriologic
tests. The study group consisted of 120 children aged 6 to 144 months with AOM.
Middle ear fluid (MEF) was tested for viral pathogens by reverse transcriptase
polymerase chain reaction (RT-PCR) and for bacteria by gram-staining and culture.
Clinical response was assessed on day 2 to 4, 11 to 13, 26 to 28. Respiratory
viruses were isolated in 39 patients (32.5%). Respiratory syncytial virus (RSV)
(46.5%) was the most common virus identified in MEF samples, followed by human
rhinovirus (HRV) (25.6%), human coronavirus (HCV) (11.6%), influenza (IV) type A 
(9.3%), adenovirus type sub type A (AV) (4%), and parainfluenza (PIV) type -3
(2%) by RT-PCR. In total 69 bacterial species were isolated from 65 (54.8%) of
120 patients. Streptococcus pneumoniae (S. pneumoniae) was the most frequently
isolated bacteria. Viral RNA was detected in 31 (56.3%) of 55 bacteria-negative
specimens and in 8 (12.3%) of 65 bacteria-positive MEF samples. No significant
differences were found between children representing viral infection alone,
combined viral and bacterial infection, bacterial infection alone, and neither
viral nor bacterial infection, regarding clinical cure, relapse and reinfection
rates. A significantly higher rate of secretory otitis media (SOM) was observed
in alone or combined RSV infection with S. pneumonia or Haemophilus influenzae
(H. influenzae) than in other viruses infection. Conclusion. This study provides 
information about etiologic agents and diagnosis of AOM in Turkish children. The 
findings highlight the importance of common respiratory viruses and bacterial
pathogens, particularly RSV, HRV, S. pneumoniae and H. influenzae, in
predisposing to and causing AOM in children.

Publication Types: 
    Clinical Trial

PMID: 16967296 [PubMed - indexed for MEDLINE]

634: Pediatr Res. 2006 Nov;60(5):555-9. Epub 2006 Sep 11.

Impact of ibuprofen therapy in the outcome of experimental pneumococcal acute
otitis media treated with amoxicillin or erythromycin.

del Prado G, Martínez-Marín C, Huelves L, Gracia M, Rodríguez-Cerrato V,
Fernández-Roblas R, Ponte C, Cenjor C, Soriano F.

Unit for Research in Medical Microbiology and Antimicrobial Chemotherapy,
Fundación Jiménez Díaz-Capio, 28040 Madrid, Spain.

The impact of ibuprofen combined with amoxicillin or erythromycin for therapy of 
penicillin-resistant pneumococcal acute otitis media (AOM) was evaluated in a
gerbil model. Ibuprofen (at 2.5 or 7.5 mg/kg, orally) and/or amoxicillin or
erythromycin (5 mg/kg each, s.c.) were administered at 5 h (early therapy, as
single-dose regimen) or at 18 h (delayed therapy, five doses) postinoculation
(PI). Each antibiotic alone and combined with ibuprofen was more effective
administered as early regimen than as delayed treatment when evaluating the
presence of otorrhea, otoscopic aspect, culture-positive and bacterial counts in 
middle ear (ME) samples, and loss of body weight. There was a trend for a better 
bacteriological outcome in animals receiving amoxicillin or erythromycin and
ibuprofen, especially with the high dose. Such a dose of ibuprofen, associated
with each antibiotic regimen, also preserved the animal well-being, avoiding a
great weight loss in comparison to those receiving the antibiotic alone but a
statistically significant difference was only observed for animals receiving
delayed therapy with erythromycin and high-dose ibuprofen. In conclusion,
ibuprofen combined with antibiotics seemed to improve the outcome of this
experimental pneumococcal AOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16966357 [PubMed - indexed for MEDLINE]

635: Environ Health Perspect. 2006 Sep;114(9):1414-8.

Traffic-related air pollution and otitis media.

Brauer M, Gehring U, Brunekreef B, de Jongste J, Gerritsen J, Rovers M, Wichmann 
HE, Wijga A, Heinrich J.

University of British Columbia, School of Occupational and Environmental Hygiene,
Vancouver, British Columbia, Canada. brauer@interchange.ubc.ca

BACKGROUND: Otitis media is one of the most common infections in young children. 
Although exposure to environmental tobacco smoke is a known risk factor
associated with otitis media, little information is available regarding the
potential association with air pollution. OBJECTIVE: We set out to study the
relationship between exposure to traffic-related air pollution and otitis media
in two birth cohorts. METHODS: Individual estimates of outdoor concentrations of 
traffic-related air pollutants-nitrogen dioxide, fine particles [particulate
matter with aerodynamic diameters </= 2.5 microm (PM2.5)], and elemental
carbon-were calculated for home addresses of approximately 3,700 and 650 infants 
from birth cohort studies in the Netherlands and Germany, respectively. Air
pollution exposure was analyzed in relation to physician diagnosis of otitis
media in the first 2 years of life. RESULTS: Odds ratios (adjusted for known
major risk factors) for otitis media indicated positive associations with
traffic-related air pollutants. An increase in 3 microg/m3 PM2.5, 0.5 microg/m3
elemental carbon, and 10 microg/m3 NO2 was associated with odds ratios of 1.13
(95% confidence interval, 1.00-1.27) , 1.10 (1.00-1.22) , and 1.14 (1.03-1.27) in
the Netherlands and 1.24 (0.84-1.83) , 1.10 (0.86-1.41) , and 1.14 (0.87-1.49) in
Germany, respectively. CONCLUSIONS: These findings indicate an association
between exposure to traffic-related air pollutants and the incidence of otitis
media. Given the ubiquitous nature of air pollution exposure and the importance
of otitis media to children's health, these findings have significant public
health implications.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16966098 [PubMed - indexed for MEDLINE]

636: Int J Med Microbiol. 2006 Nov;296(7):501-9. Epub 2006 Sep 7.

Spontaneous development of otitis media in plasminogen-deficient mice.

Eriksson PO, Li J, Ny T, Hellström S.

Department of Clinical Sciences, Otorhinolaryngology, Umeå University, SE-901 85 
Umeå, Sweden.

Inflammatory conditions of the ear, otitis media, are one of the most common
disease entities in children. In this study, the role of the plasminogen
(plg)/plasmin system for the spontaneous development of chronic otitis media was 
investigated by the analysis of plg-deficient mice. Whereas essentially all of
the wild-type control mice kept a healthy status of the middle ear, all the
plg-deficient mice gradually developed chronic otitis media with various degrees 
of inflammatory changes during an 18-week observation period. Five bacterial
strains were identified in materials obtained from the middle ear cavities of six
plg-deficient mice. Morphological studies revealed the formation of an amorphous 
mass tissue and inflammatory changes in the middle ears of plg-deficient mice.
Immunohistochemical studies further indicate a mass infiltration of neutrophils
and macrophages as well as the presence of T and B cells in the middle ear mucosa
of these mice. Extensive fibrin deposition and an abnormal keratin formation were
also observed in the tympanic membrane, the middle ear cavity and external ear
canal in these mice. These results suggest that plg plays an essential role in
protecting against the spontaneous development of chronic otitis media. Our
findings also suggest the possibility of using plg for clinical therapy of
certain types of otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16956791 [PubMed - indexed for MEDLINE]

637: Drugs. 2006;66(12):1565-76.

Recent developments in the treatment of otitis media with effusion.

Mandel EM, Casselbrant ML.

ENT Research Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 
15213, USA. mandele@pitt.edu

The management of otitis media with effusion (OME) has received much attention
recently as a result of, among other factors, the development of resistant
bacteria and the finding of less long-term impact of middle-ear effusion (MEE) on
development than previously believed. Guidelines have recently been published for
the management of OME promoting more accurate diagnosis, particularly
distinguishing acute otitis media from OME, and recommending the 'judicious' use 
of antibacterials. Today, more emphasis is being placed on prevention of disease 
by reducing risk factors and the development of vaccines. The identification of
susceptibility genes may lead to better understanding of the pathogenesis of
otitis media, which in turn may lead to the development of more innovative and
satisfactory methods for prevention and treatment.

Publication Types: 
    Review

PMID: 16956304 [PubMed - indexed for MEDLINE]

638: Laryngoscope. 2006 Sep;116(9):1642-6.

Effect of inhibitor of tumor necrosis factor-alpha and oxatomide on immune
mediated otitis media.

Park YS, Auo HJ, Jeon EJ, Chang KH, Lee SK, Lee DH.

Department of Otolaryngology-HNS, College of Medicine, The Catholic University of
Korea, Incheon, Korea.

OBJECTIVE: Inflammatory mediators (IMs) play a major role in the production of
middle ear effusion (MEE). Tumor necrosis factor (TNF)-alpha and leukotrienes
(LTs) appear to be important in the pathogenesis of otitis media with effusion
(OME). The purpose of this study is to determine the effect of TNF-alpha and LT
antagonist on the outcome of experimental immune-mediated OME. STUDY DESIGN:
Prospective. METHODS: Otitis media was induced in rats by injecting keyhole
limpet hemocyanin (KLH) transtympanically 7 days after systemic immunization.
Experimental groups were treated with soluble TNF receptor type I (sTNF RI) or
oxatomide simultaneously. Seventy-two hours after transtympanic injection, MEE
was aspirated, and temporal bone was taken. Vascular permeability (VP) of the
middle ear mucosa was measured using the Evans blue dye technique.
Hematoxylin-eosin stain and immunohistochemical stain for leukocyte common
antigen was performed. RESULTS: In KLH, sTNF RI, and oxatomide groups, MEE was
developed in 83%, 0%, and 66% of the ears, respectively. The sTNF RI group showed
significant decrease in effusion production, inflammation, mucosal thickening,
and VP compared with the KLH group. These parameters were less significant in the
oxatomide group than in the sTNF RI group. CONCLUSION: Transtympanic
administration of sTNF RI and oxatomide appears to suppress the development of
immune-mediated MEE.

PMID: 16954996 [PubMed - indexed for MEDLINE]

639: Braz J Otorhinolaryngol. 2006 Mar-Apr;72(2):267-71.

Tympanoplasty: surgical results and a comparison of the factors that may
interfere in their success.

Fukuchi I, Cerchiari DP, Garcia E, Rezende CE, Rapoport PB.

Medical School of the ABC, Brazil. ilfukuchi@hotmail.com

Chronic otitis media has a high prevalence on the population and their treatment 
continuous to be a challenge for the otorhinolaryngologists. AIM: To demonstrate 
the factors that could interfere in the tympanoplasty success and the surgical
results during 2002. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD:
were included 37 patients with chronic otitis media non cholesteatoma (COMNC)
undergo to tympanoplasty (in lay or underlay, with homologous graft). All the
patients were submitted to a survey pre and postoperative include clinical,
physical examinations, flexible nasal endoscope and audiometry. RESULTS: The age,
the dimension and localization of the tympanic membrane perforation; the
condition of middle ear mucosa; number of otorrhea/year; smoking; parents history
of otorrhea and hearing loss; personals history of otological surgery; monthly
family income; the graft, technique and access used were not significantly to
repair tympanic membrane perforations. The closure rate was 65% and the gain in
air-bone gap was 100%. CONCLUSION: The timpanoplasty must be considerate in the
treatment of the COMNC.

Publication Types: 
    Comparative Study

PMID: 16951864 [PubMed - indexed for MEDLINE]

640: Pediatrics. 2006 Sep;118(3):865-73.

National impact of universal childhood immunization with pneumococcal conjugate
vaccine on outpatient medical care visits in the United States.

Grijalva CG, Poehling KA, Nuorti JP, Zhu Y, Martin SW, Edwards KM, Griffin MR.

Department of Preventive Medicine, Division of Pharmacoepidemiology,Vanderbilt
University School of Medicine, Nashville, TN 37232-2637, USA.

BACKGROUND: Since introduction of the heptavalent pneumococcal conjugate vaccine 
in the United States in 2000, rates of invasive pneumococcal disease have
declined. However, the national impact of heptavalent pneumococcal conjugate
vaccine on pneumonia and otitis media remains unknown. OBJECTIVES: We compared
national rates of outpatient visits for pneumonia and otitis media in children
before and after heptavalent pneumococcal conjugate vaccine introduction.
METHODS: Rates of ambulatory visits for pneumococcal and nonspecific pneumonia,
otitis media, and other acute respiratory infections were compared before
(1994-1999) and after (2002-2003) heptavalent pneumococcal conjugate vaccine
introduction using the National Ambulatory Medical Care Survey and the National
Hospital Ambulatory Medical Care Survey. To evaluate vaccine effects while
accounting for temporal variability, ratios of pneumococcal-related disease rates
in children < 2 years old (vaccine target population) and in children 3 to 6
years old (not routinely vaccinated) were evaluated using a Poisson regression
analysis. For children < 2 years old, the differences between observed and
expected rates were the estimated vaccine effects. RESULTS: After the
introduction of heptavalent pneumococcal conjugate vaccine, otitis media visit
rates declined by 20% in children aged < 2 years. This decline represented 246
fewer otitis media visits per 1000 children aged < 2 years annually. There were
no significant decreases in outpatient visit rates for pneumonia or other acute
respiratory infections for children aged < 2 years. CONCLUSIONS: After
heptavalent pneumococcal conjugate vaccine introduction, national rates of otitis
media visits declined significantly in children < 2 years old. Persistence of
this trend will produce a significant reduction of the otitis media burden and
further enhance the cost-effectiveness of heptavalent pneumococcal conjugate
vaccine.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 16950975 [PubMed - indexed for MEDLINE]

641: Otolaryngol Head Neck Surg. 2006 Sep;135(3):392-6.

Unusual Corynebacterium mucifaciens isolated from ear and nasal specimens.

Morinaka S, Kurokawa M, Nukina M, Nakamura H.

Department of Otorhinolaryngology, Kobe Japanpost Hospital, 6-2-43
Kamitsutsui-dori, Chuo-ku, Kobe 651-8798, Japan. smorinakaent@yahoo.co.jp

OBJECTIVE: Corynebacterium mucifaciens was first proposed as a novel
Corynebacterium species in 1997. This report describes our experience with the
unexpectedly frequent isolation of C mucifaciens. STUDY DESIGN: By using agar
supplemented with several antibiotics, microbiological studies were performed on 
specimens collected from the ear and nose. SETTING: A primary and secondary
referral hospital. RESULTS: The organisms grew slowly. Five strains of C
mucifaciens were found in specimens of middle ear effusion (MEE) from patients
with otitis media with effusion (OME), and four strains were isolated from the
nasal polyps and nasal discharge of patients with chronic sinusitis (CRS).
CONCLUSIONS: C mucifaciens was isolated from nine otorhinological specimens.
SIGNIFICANCE: This is the first report about the isolation of C mucifaciens from 
MEE, nasal polyps, and nasal discharge. Although its pathogenetic role is
unknown, the characteristics of this microorganism might make it a potential
cause of OME and/or CRS, so further studies are necessary. EBM rating: C-4.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16949970 [PubMed - indexed for MEDLINE]

642: Auris Nasus Larynx. 2006 Dec;33(4):451-4. Epub 2006 Sep 1.

A case of nasopharyngeal actinomycosis leading to otitis media with effusion.

Ono T, Yoshida Y, Izumaru S, Nakashima T.

Department of Otorhinolaryngology and Head and Neck Surgery, School of Medicine, 
Kurume University, Asahimachi 67, Kurume, Japan. ono123@med.kurume-u.ac.jp

Nasopharyngeal actinomycosis is extremely rare, and to our knowledge, only seven 
cases have previously been reported. Diagnosis of actinomycosis is made by
clinical finding, observation of the bacteria and histopathological examination. 
Treatment for actinomycosis is surgical debridement and administration of
antibioticus, especially penicillin for several weeks with good prognosis. We
report a case of nasopharyngeal actinomycosis, which lead to otitis media with
effusion. Endoscopic surgery and prolonged penicillin administration for 2 months
were effective for treatment of actinomycosis in the nasopharynx.

Publication Types: 
    Case Reports

PMID: 16949780 [PubMed - indexed for MEDLINE]

643: Ann Otol Rhinol Laryngol. 2006 Aug;115(8):617-23.

Effects of tumor necrosis factor alpha antagonist, platelet activating factor
antagonist, and nitric oxide synthase inhibitor on experimental otitis media with
effusion.

Kim DH, Park YS, Jeon EJ, Yeo SW, Chang KH, Lee SK.

Department of Otolaryngology, Ajou University School of Medicine, Suwon, South
Korea.

OBJECTIVES: We studied the inflammatory responses in otitis media with effusion
induced by lipopolysaccharide (LPS) in rats, and compared the preventive effects 
of tumor necrosis factor (TNF) soluble receptor type I (sTNFRI, a TNF-alpha
antagonist), platelet activating factor antagonist, and the nitric oxide synthase
inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME). METHODS: We used 2 control
groups of Sprague Dawley rats (untreated and saline-treated) and 4 experimental
groups, which all received an intratympanic injection of LPS, followed in 3
groups by experimental treatment of the same ear. The LPS group had no additional
treatment. The L-NAME group received intraperitoneal injection of L-NAME and was 
reinjected after 12 hours. The A-85783 group was first given an intraperitoneal
injection of A-85783. The sTNFRI group was first given an intratympanic injection
of sTNFRI. Twenty-four hours after the initial intratympanic injection of LPS,
temporal bones from each group were examined histopathologically and the vascular
permeability of the middle ear mucosa was measured by Evans blue vital dye
staining. RESULTS: The L-NAME, A-85783, and sTNFRI groups showed significantly
reduced capillary permeability, subepithelial edema, and infiltration of
inflammatory cells in comparison with the LPS group. There were no differences in
capillary permeability, subepithelial edema, or infiltration of inflammatory
cells between the A-85783 and sTNFRI groups. The L-NAME group showed no
difference in vascular permeability or subepithelial edema in comparison with the
A-85783 and sTNFRI groups, but showed more infiltration of inflammatory cells.
CONCLUSIONS: We conclude that sTNFRI, A-85783, and L-NAME can be proposed as
alternative future treatments for otitis media with effusion. However, L-NAME may
be the least effective of these agents.

PMID: 16944661 [PubMed - indexed for MEDLINE]

644: Pediatr Infect Dis J. 2006 Sep;25(9):782-90.

Upper respiratory tract bacterial carriage in Aboriginal and non-Aboriginal
children in a semi-arid area of Western Australia.

Watson K, Carville K, Bowman J, Jacoby P, Riley TV, Leach AJ, Lehmann D;
Kalgoorlie Otitis Media Research Project Team.

Telethon Institute for Child Health Research, Centre for Child Health Research,
The University of Western Australia, Western Australia, Australia.

BACKGROUND: Streptococcus pneumoniae, Haemophilus influenzae and Moraxella
catarrhalis are associated with otitis media (OM). Indigenous children experience
particularly high rates of OM. Few studies worldwide have described upper
respiratory tract (URT) carriage in Indigenous and non-Indigenous children living
in the same area. AIM: The aim of this study was to describe URT bacterial
carriage in Aboriginal and non-Aboriginal children in the Kalgoorlie-Boulder
area, Western Australia, as part of an investigation into causal pathways to OM. 
METHODS: Five hundred four and 1045 nasopharyngeal aspirates were collected from 
100 Aboriginal and 180 non-Aboriginal children, respectively, followed from birth
to age 2 years. Standard procedures were used to identify bacteria. RESULTS:
Overall carriage rates of S. pneumoniae, M. catarrhalis and H. influenzae in
Aboriginal children were 49%, 50% and 41%, respectively, and 25%, 25% and 11% in 
non-Aboriginal children. By age 2 months S. pneumoniae and M. catarrhalis had
been isolated from 37% and 36% of Aboriginal children and from 11% and 12% of
non-Aboriginal children, respectively. From age 3 months onward, carriage rates
in Aboriginal children were 51% to 67% for S. pneumoniae and M. catarrhalis and
42% to 62% for H. influenzae; corresponding figures for non-Aboriginal children
were 26% to 37% for S. pneumoniae and M. catarrhalis and 11% to 18% for H.
influenzae. Non-Aboriginal children had higher carriage rates in winter than in
summer, but season had little effect in Aboriginal children. Staphylococcus
aureus carriage was highest under age 1 month (55% Aboriginal, 61%
non-Aboriginal) and was always higher in non-Aboriginal than Aboriginal children.
CONCLUSIONS: Interventions are needed to reduce high transmission and carriage
rates, particularly in Aboriginal communities, to avoid the serious consequences 
of OM.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 16940834 [PubMed - indexed for MEDLINE]

645: Int J Pediatr Otorhinolaryngol. 2006 Dec;70(12):2019-26. Epub 2006 Aug 30.

The role of immunomodulatory oligonucleotides in prevention of OVA-induced
Eustachian tube dysfunction.

Ebert CS Jr, Rose AS, Patel MR, Hardy SM, Kandimalla ER, Agrawal S, Prazma J,
Pillsbury HC 3rd.

Department of Otolaryngology-Head and Neck Surgery, CB# 7070, G0412 Neurosciences
Hospital, University of North Carolina School of Medicine, Chapel Hill, NC
27599-7070, United States. cebert@med.unc.edu

OBJECTIVE: To evaluate the potential role of immunomodulatory oligonucleotides
(IMO) in the prevention of OVA-induced Eustachian tube dysfunction (ETD) in a rat
model. METHODS: Brown-Norway rats were sensitized to ovalbumin (OVA) and
randomized to receive pre-treatment with IMO or phosphate buffered saline (PBS). 
After systemic sensitization, subjects received a transtympanic OVA challenge
followed by evaluation of the Eustachian tube's dynamic function. RESULTS:
Pre-treatment of OVA sensitized animals with IMO normalized passive opening and
closing Eustachian tube pressures, improved active clearance of negative pressure
in the middle ear, and resulted in reduced mean mucociliary transit times
compared to untreated OVA-sensitized animals (P<0.001). CONCLUSION: These data
demonstrate that pre-treatment with IMO prevent OVA-induced ETD in the rat. IMO
treatment in the future may offer considerable promise in the management of OME
in children.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16939693 [PubMed - indexed for MEDLINE]

646: Int J Clin Pract. 2006 Sep;60(9):1115-9.

Topical antibiotic ear drops: are they safe?

Pappas S, Nikolopoulos TP, Korres S, Papacharalampous G, Tzangarulakis A,
Ferekidis E.

1st ENT Department, Hippokratio General Hospital, Athens Medical School, Athens, 
Greece. sot1971doc@yahoo.gr

A discharging ear is a very common condition for the general practitioner and the
ENT surgeon. Oral and intravenous antibiotics have potential complications, are
costly, and exhibit increasing resistance. This study explores the advantages and
disadvantages of all common otic preparations and compares effectiveness, safety,
cost and complication rates. In chronic otitis media (chronic discharging ears), 
topical antibiotics seem to be the treatment of choice by comparison with oral or
intravenous antibiotics. Cultures and antibiograms do not correspond directly to 
clinical efficacy, as laboratory determination of resistance does not take into
account the high concentration of antibiotics in local preparations. It is safer 
to use quinolone drops as a first-line treatment, but it is still possible to use
short courses of other drops if quinolones are either unavailable or
contraindicated (e.g. allergy), or when bacteria are resistant to them. However, 
in such a situation, a round window membrane involved in an established
inflammatory process and therefore less permeable to the passage of topical
preparations is the preferred setting, as ototoxicity is a potential
complication, especially in the case of gentamicin, in which case patients should
be warned accordingly.

Publication Types: 
    Review

PMID: 16939554 [PubMed - indexed for MEDLINE]

647: Can Vet J. 2006 Aug;47(8):799-800.

Pseudomonas aeruginosa otitis media and interna in a chinchilla ranch.

Wideman WL.

Ontario Veterinary College, University of Guelph, Guelph, Ontario.

Pseudomonas aeruginosa has been associated with conjunctivitis, enteritis,
pneumonia, septicemia, sudden death, and abortion in chinchillas. This case
report describes an unusual clinical presentation and diagnosis of P. aeruginosa 
otitis media and interna with neurologic manifestations. To our knowledge, this
clinical presentation has not been reported previously in chinchillas.

Publication Types: 
    Case Reports

PMID: 16933561 [PubMed - indexed for MEDLINE]

648: Clin Tech Small Anim Pract. 2006 Aug;21(3):96-105.

Otitis techniques to improve practice.

Griffin CE.

Animal Dermatology Clinic and Animal Allergy Specialists, San Diego, CA 92111,
USA. skinvet44@aol.com

Successful management of otitis externa requires recognition of changes in the
anatomy and physiology of the external and middle ear, as well as the adequate
tools and examinations to detect changes from normal. Otoscopy and methods for
assessing the normalcy of the tympanum, collection of samples for cytologic
evaluation or culture, and myringotomy are diagnostic techniques important in
practice. Treatment tubes and intralesional triamcinolone injections are
techniques that improve the response in some cases.

Publication Types: 
    Review

PMID: 16933476 [PubMed - indexed for MEDLINE]

649: Clin Vaccine Immunol. 2006 Oct;13(10):1177-9. Epub 2006 Aug 23.

Serum antibodies to pneumococcal neuraminidase NanA in relation to pneumococcal
carriage and acute otitis media.

Simell B, Jaakkola T, Lahdenkari M, Briles D, Hollingshead S, Kilpi TM, Käyhty H.

Vaccine Immunology Laboratory, National Public Health Institute, Mannerheimintie 
166, 0300 Helsinki, Finland. birgit.simell@ktl.fi

Pneumococcal neuraminidase, NanA, is a pneumococcal vaccine candidate. Prior
culture-confirmed pneumococcal contacts were shown to induce serum anti-NanA
antibodies during the first 2 years of life. The antibody concentrations at
neither 12 nor 18 months were significantly associated with the risk of
subsequent pneumococcal carriage or acute otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16928889 [PubMed - indexed for MEDLINE]

650: Acta Otolaryngol. 2006 Oct;126(10):1040-5.

Expression of beta-defensins in the tubotympanum of experimental otitis media.

Jin Shin D, Gan-Undram S, Jin Kim S, Joon Jun Y, Jung Im G, Hyun Jung H.

Department of Otolaryngology-Head and Neck Surgery, Korea University College of
Medicine, Seoul, Republic of Korea.

CONCLUSION: Since the expression levels of beta-defensins 2-4 were up-regulated
in experimental otitis media, they may play a protective role in the pathogenesis
of otitis media. OBJECTIVES: Defensins are antimicrobial peptides that play a
major role in innate immunity. The goal of this study was to identify the
expression of defensins in experimental otitis media of the mouse. MATERIALS AND 
METHODS: The expression of three alpha-defensins (cryptdins, cryptdin-related
sequences 1-C (CRS1-C), and CRS4-C) and four beta-defensins (mBD1, mBD2, mBD3,
and mBD4) was investigated in the tubotympanum of experimental otitis media in
mice by a semi-quantitative reverse transcription-polymerase chain reaction
(RT-PCR), and the expression levels of three beta-defensins (mBD2, mBD3, mBD4)
were evaluated by Western blotting. RESULTS: The alpha-defensins were not
expressed in the tubotympanum. mBD1 was expressed constitutively in normal middle
ear mucosa and Eustachian tube mucosa, but up-regulated expression of mBD2, mBD3,
and mBD4 was observed with RT-PCR and Western blotting in the tubotympanums in
experimental otitis media, while the normal tubotympanums did not express them.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16923707 [PubMed - indexed for MEDLINE]

651: Acta Otolaryngol. 2006 Oct;126(10):1036-9.

Acute otitis media and mastoid growth.

Sadé J, Russo E, Fuchs C, Ar A.

Hearing Research Laboratory, Department of Bio-Medical Engineering, Faculty of
Engineering, and Sackler Faculty of Medicine, Tel Aviv University, Israel.
jsade@netvision.net.il

CONCLUSIONS: This study implies that the hypothesis that acute otitis media (AOM)
in infancy inhibits the growth of the mastoid system cannot be accepted.
OBJECTIVE: To establish a relationship between AOM in children and their mastoid 
pneumatization development. PATIENTS AND METHODS: Lateral Schüller mastoid
radiographs (LMRs) were measured in two groups of children at ages 2-11 years.
Group A (n=116) had a history of recurrent AOM; group B (n=108) had no such
history. Patients were treated in a private clinic. Data were analysed at Tel
Aviv University. The patients had their LMR taken and measured planimetrically.
LMR areas on left and right sides were compared in each group and age and were
tested for possible differences using the paired Student's t test. When no
left/right difference was detected, the values were averaged. Groups A and B were
compared at different ages using two-tailed two-sample unequal variance and
correlation coefficients. RESULTS: The analyses show that the LMR area became
gradually and significantly larger with age in group A (R2=0.858; p<0.05). It did
not develop significantly in group B.

PMID: 16923706 [PubMed - indexed for MEDLINE]

652: Pediatr Med Chir. 2005 Jan-Apr;27(1-2):67-74.

[Patologie delle alte vie respiratorie del bambino in ambulatorio: un'esperienza 
italiana. Diseases of the upper respiratory tract in children in ambulatory care:
an Italian experience]

Benoni G, Zaffani S, Meneghelli G, Gangemi M, Murgia V, Chiamenti G, Cuzzolin L.

Department of Medicine & Public Health-Section of Pharmacology, University of
Verona, Italy. giuseppina.benoni@univr.it

BACKGROUND: Overuse of antibiotics for children is widespread and contributes to 
the emergence of antibiotic-resistant bacteria. Moreover, non steroidal
antiinflammatory drugs (NSAIDs) are often overprescribed despite of their renal
and gastrointestinal side-effects. OBJECTIVES: To assess the behaviour and the
factors influencing the prescribing practice of family pediatricians for the
common upper respiratory diseases of pre-school children in an outpatient
setting. METHODS: 125 family pediatricians, who provide primary care in an
outpatient setting to young children in North-East of Italy (Veneto region),
adhered to a survey consisting in a 40-item questionnaire about the factors that 
could influence their prescribing practice as regards otitis media (OM),
pharyngitis (FGT) and broncopneumoniae (BPN) treatment of patients aged 0 to 5
years. Data were collected in November 2002. Descriptive analysis of data was
performed using DELPHI TM7 professional Study Program. RESULTS: The child's age
resulted an important factor, influencing the antibiotic prescription either in
OM or in BPN. 86% of pediatricians emphasized the use of antipneumococcal
vaccine, overall in children younger than 2 years with recurrent OM, while 71%
adviced this vaccination in children younger than 5 years with relapsing BPN. The
awareness of complications in OM and BPN often induced pediatricians to prescribe
drugs. The most frequently prescribed antibiotic in OM, FGT and also BPN was
amoxicillin for 7-10 days. According to the international guidelines, a small
percentage (14%) of clinicians prescribe antibiotics for 5 days in OM, but most
of them generally wait some hours to prescribe antibiotics. PenV was considered
the most active drug in FGT and its disappearance from the market was considered 
negatively by italian pediatricians. Moreover, even if the rapid immunoenzymatic 
test for Group A beta-hemolyticus Streptococcus (GABHS) is considered sensitive, 
many pediatricians defined the throat culture the most accurate test to diagnose 
a GABHS pharyngitis. Paracetamol was frequently prescribed in these diseases,
between 74% for OM and 53% for BPN. Among NSAIDs, niflumic acid and ibuprofen
were the drugs most frequently prescribed in FGT and in OM respectively. About
30% of pediatricians refers that parents require drugs in the treatment of upper 
respiratory tract diseases. CONCLUSIONS: Our results show that antibotics are
generally not over-prescribed by italian pediatricians, but often prescribed for 
a long time, likely because of fear of complications and uncertainty of the
diagnosis, particularly in OM, being not always available the pneumotoscope.
About NSAIDs, niflumic acid is frequently not evidence-based used in Italy.
Frequently, side-effects associated with NSAIDs administration were reported.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16922047 [PubMed - indexed for MEDLINE]

653: Auris Nasus Larynx. 2007 Mar;34(1):9-13. Epub 2006 Aug 21.

Efficacy of mastoidectomy on MRSA-infected chronic otitis media with tympanic
membrane perforation.

Mutoh T, Adachi O, Tsuji K, Okunaka M, Sakagami M.

Department of Otolaryngology, Hyogo College of Medicine, 1-1 Mukogawa,
Nishinomiya City, Hyogo 663-8501, Japan. mutochin@hyo-med.ac.jp

OBJECTIVES: To retrospectively evaluate the efficacy of mastoidectomy on
methicillin-resistant Staphylococcus aureus (MRSA)-infected chronic otitis media 
in comparison with methicillin-susceptible Staphylococcus aureus (MSSA)-infected 
otitis media. METHODS: Between January 1998 and October 2003, 18 ears underwent
surgery for MRSA-infected chronic otitis media with tympanic membrane perforation
at the Department of Otolaryngology, Hyogo College of Medicine. Another 33 ears
underwent surgery for MSSA-infected chronic otitis media with tympanic membrane
perforation during the same period. The postoperative results of graft success
rate, hearing results and other complications were compared between MRSA-infected
and MSSA-infected ears with or without mastoidectomy, and discharging or dry
ears. RESULTS: In MRSA, the mastoidectomy group tended to have a better graft
success rate than the non-mastoidectomy group. In MSSA, there were almost the
same graft success rate and hearing results between the mastoidectomy and
non-mastoidectomy groups regardless of the presence of discharge. In
MRSA-infected discharging ears, the rate of postoperative complications (ear drum
perforation, persistent otorrhea, and dehiscence of skin incision) were
significantly lower in the mastoidectomy group than in the non-mastoidectomy
group (p=0.046). CONCLUSION: Mastoidectomy had significantly better results
concerning postoperative complications in discharging ears with MRSA-infected
chronic otitis media. We recommend performing tympanoplasty with mastoidectomy in
MRSA-infected chronic otitis media.

PMID: 16920308 [PubMed - indexed for MEDLINE]

654: J Laryngol Otol. 2006 Mar;120(3):E18.

Cervicofacial necrotizing fasciitis: an unusual complication of chronic
suppurative otitis media.

Sethi A, Sabherwal A, Puri R, Jain P.

Department of ENT, MAMC and Associated LN Hospital, New Delhi, India.
dr_sethi@rediffmail.com1

Necrotizing fasciitis is a rare microbial soft tissue infection characterized by 
rapidly spreading areas of necrosis and a high mortality rate. It may be of
odontogenic or traumatic origin or may arise from insect bites, burns or surgical
infections. We present a clinical case of an eight-year-old child with facial and
cervical necrotizing fasciitis as a complication of chronic suppurative otitis
media. The causes, diagnosis and management of necrotizing fasciitis are
reviewed.

Publication Types: 
    Case Reports

PMID: 16917994 [PubMed - indexed for MEDLINE]

655: J Laryngol Otol. 2006 Feb;120(2):e10.

An alternative use of video-telescopic guidance for insertion of myringotomy
tube.

Lee FP.

Department of Otolaryngology, Taipei Medical University Hospital, Taipei Medical 
University, Taipei, Taiwan. fplee@tmu.edu.tw

The insertion of a myringotomy tube is a common ENT procedure. Traditionally,
this procedure is performed under otomicroscopic view. In this paper I describe a
technique using rigid endoscopy with the Hopkins rod and a video monitor as a
visual aid for the insertion of myringotomy tube in older children and adults.
The technique is safe and effective; it allows demonstration of the entire
tympanic membrane during surgery and also enables better teaching of the
procedure than does the otomicroscope.

PMID: 16917987 [PubMed - indexed for MEDLINE]

656: Brain Res. 2006 May 26;1091(1):9-15.

Mouse models as a tool to unravel the genetic basis for human otitis media.

Zheng QY, Hardisty-Hughes R, Brown SD.

Department of Otolaryngology, Case Western Reserve Universuty, Cleveland, OH
44106, USA. qyz@case.edu

The pathogenesis of otitis media (OM) is multifactorial and includes infection,
anatomical factors, immunologic status, genetic predisposition, and environmental
factors. OM remains the most common cause of hearing impairment in childhood.
Genetic predisposition is increasingly recognized as an important factor. The
completion of the mouse genome sequence has offered a powerful basket of tools
for investigating gene function and can expect to generate a rich resource of
mouse mutants for the elucidation of genetic factors underlying OM. We review the
literature and discuss recent progresses in developing mouse models and using
mouse models to uncover the genetic basis for human OM.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review

PMID: 16917982 [PubMed - indexed for MEDLINE]

657: Clin Otolaryngol. 2006 Aug;31(4):321-4.

How we do it: tympanoplasty: are different three- and four-frequency averages
comparable?

Dawes PJ, Welch D, Lee P.

Department of ORL-HNS, University of Otago, Dunedin, New Zealand.
patrickd@healthotago.co.nz

The results of tympanoplasty may be reported in a variety of ways. Pure-tone
audiometry underpins reporting, yet there is no constancy in the pure-tone
threshold average used. We examine the relationship between the 0.5, 1, 2 kHz,
0.5, 1, 2, 3 kHz and 0.5, 1, 2, 4 kHz pure-tone audiometry averages. Using
audiometric data collected for 77 patients, we have compared hearing threshold
using three different frequency averages derived from pure-tone audiometry. The
0.5, 1, 2 kHz, 0.5, 1, 2, 3 kHz and 0.5, 1, 2, 4 kHz three- and four-frequency
averages are significantly different, this difference being primarily determined 
by the changes in the 4-kHz threshold. Using an average including 4 kHz results
in 8% few patients achieving an ABG closure to within either 10 dB or 20 dB. When
comparing surgical results with others, surgeons should use reports employing
comparable audiometric measures of analysis.

PMID: 16911654 [PubMed - indexed for MEDLINE]

658: J Dev Behav Pediatr. 2006 Aug;27(4):281-9.

Comment in:
    J Dev Behav Pediatr. 2006 Aug;27(4):336-7.

The relationship of otitis media in early childhood to attention dimensions
during the early elementary school years.

Hooper SR, Ashley TA, Roberts JE, Zeisel SA, Poe MD.

Department of Psychiatry and The Clinical Center for the Study of Development and
Learning, University of North Carolina School of Medicine, Chapel Hill, NC
27599-7255, USA. Stephen.hooper@cdl.unc.edu

This study examined the impact of otitis media with effusion (OME) and associated
hearing loss between 6 and 48 months of age on attention dimensions (i.e.,
selective/focus, sustained) during the elementary school years. A prospective
cohort design in which 74 African American infants were recruited between ages 6 
and 12 months. Ear examinations were done repeatedly using both otoscopy and
tympanometry, and hearing was assessed using standard audiometric procedures
between 6 and 48 months. Multiple measures of attention (i.e., direct assessment,
behavioral observations, parent/teacher ratings) were administered from
kindergarten through second grade to assess two theoretical dimensions of
attention: selective/focused and sustained. The home environment was assessed
annually. Results indicated that neither early childhood OME nor hearing loss
showed significant correlations with any of the longitudinal or cross-sectional
measures of selective/focused attention and sustained attention. In contrast,
children with mothers who had fewer years of education and who lived in less
responsive and supportive home environments scored higher on both parent and
teacher ratings of sustained attention (i.e., hyperactivity) through the second
grade of elementary school. For NEPSY Auditory Attention in second grade, a
significant interaction between the Home Observation for Measurement of the
Environment and hearing loss was uncovered. This interaction showed that children
with hearing loss from poor home environments experienced greater difficulties on
the NEPSY Auditory Attention task than those with hearing loss from good home
environments. These findings do not support a direct linkage of a history of OME 
and associated hearing loss to difficulties in selective/focused attention or
sustained attention in early elementary school children. Relationships between
sociodemographic variables and attention-related functions appear stronger and
should be considered as mediators in any examination of the linkages between
early OME and subsequent attention functions.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 16906002 [PubMed - indexed for MEDLINE]

659: Int J Pediatr Otorhinolaryngol. 2006 Oct;70(10):1811-6. Epub 2006 Aug 14.

Severe acute middle ear infections: microbiology and treatment.

Heslop A, Ovesen T.

University Hospital of Aarhus, The Ear, Nose and Throat Department, DK-8000
Aarhus, Denmark. heslop@dalnet.dk

OBJECTIVE: The database at the ENT-Department, Aarhus University Hospital
describing the specific local flora of acute otitis media (AOM) and acute
mastoiditis (AM) in Aarhus County has become the key element in securing a
rational and specific antibiotic treatment. We present our data concerning AOM,
mastoidismus and AM. Our purpose is to determine (I) clinical presentation, (II) 
causative pathogens, (III) resistance patterns, (IV) type of antibiotic
treatment, and (V) accuracy of the antibiotic treatment. METHODS: Patients under 
the age of 18 years, treated for AOM with extensive affected well-being and AM,
at the ENT-Department, Aarhus University Hospital during 3 years from January
2001 to December 2003. RESULTS: A total of 106 patients were identified.
Sixty-seven patients with AOM and 39 patients with AM. The overall bacterial
flora found is dominated by S. pneumococci all 100% susceptible to penicillin.
However, Staphylococcus aureus is the primary bacterial pathogens cultured from
patients treated with preadmission antibiotics. CONCLUSION: If a specimen from an
AOM patient is obtained after the initiation of antibiotic treatment one should
consider the possibility of the culture found being a result of the initial led
treatment and not the causative AOM pathogen. Our data suggest that a restricted 
use of antibiotics in children with AOM may be associated with a higher incidence
of acute mastoiditis. Significant higher leucocytes count and CRP are found in
the acute mastoiditis group compared to the AOM group.

PMID: 16904758 [PubMed - indexed for MEDLINE]

660: Int J Pediatr Otorhinolaryngol. 2006 Nov;70(11):1941-4. Epub 2006 Aug 9.

Otoacoustic emissions in children with otitis media with effusion.

Akdogan O, Ozkan S.

Department of Otorhinolaryngology, Ankara Numune Research and Training Hospital, 
Boncuk Street 14/8, Kurtuluş, Ankara, Turkey. drozgurakdogan@yahoo.com

OBJECTIVES: Otoacoustic emissions (OAE) are transmitted from the cochlea to the
ear canal via the middle ear and the transmission properties of the middle ear
directly influence OAE characteristics. The purpose of this study was to
establish the mechanisms of changes occurred in middle ear by tympanometric,
audiometric and OAE examination. METHODS: Audiometric and tympanometric
examination were performed and otoacoustic emissions were recorded from 22 normal
ears and 52 ears with middle ear effusions and repeated 3 months later. RESULTS: 
Results of the air conduction in study group were significantly different from
the control group and we found significant recovery in 3 months. When we analysed
the DPOAE evaluation results in our study, some of the DPOAE parameters were
found to be different between the control and the study group at low frequencies.
Changes in the amplitude, especially at low frequencies, were statistically
significant after 3 months. CONCLUSION: The results of this study revealed that
measurement of otoacoustic emissions, especially distortion product otoacoustic
emissions, is helpful in evaluating the condition of middle ear during the
treatment.

PMID: 16904196 [PubMed - indexed for MEDLINE]

661: Value Health. 2006 Jul-Aug;9(4):219-26.

An economic evaluation of two ototopical treatments for acute otitis media in
tympanostomy tube patients.

Roland PS, Waycaster CR, Wall GM, Glass JD.

Department of Otolaryngology, University of Texas Southwestern Medical Center,
Dallas, TX, USA.

OBJECTIVE: The goal of this research was to determine the cost-effectiveness of
ciprofloxacin 0.3%/dexamethasone 0.1% (CD) otic suspension versus ofloxacin 0.3% 
otic solution (OFX) for treatment of acute otitis media in tympanostomy tube
patients. METHODS: A decision-analytic model was used to emulate the ototopical
treatment of acute otitis media in patients with tympanostomy tubes. The economic
outcome was the cost per otorrhea-free day (OFD) achieved per episode of care.
Three tiers of antimicrobial therapy were modeled, with each successive tier
representing the retreatment of clinical failures from the preceding tier.
First-tier therapy compared CD and OFX using outcome measures obtained from a
randomized clinical trial (n = 599). Second-tier therapy modeled the use of
amoxicillin/clavulanate (ACA) using outcome measures obtained from a physician
survey and medical literature. Third-tier therapy was modeled as
pathogen-specific and curative. It could follow one of three pathways: 1)
intramuscular ceftriaxone; 2) oral fluconazole; or 3) hospitalization for
intravenous antibiotics. Third-tier outcomes were based on a physician survey.
Cost data were obtained from standard references and presented from a payer
perspective. RESULTS: The expected therapeutic costs were 249.40 dollars for the 
CD pathway and 265.44 dollars for the OFX pathway. The estimated number of OFDs
per episode of care was 25.88 for the CD pathway and 23.86 for the OFX pathway.
The cost-effectiveness ratios for CD and OFX therapies were 9.64 dollars and
11.13 dollars per OFD, respectively. CONCLUSION: CD is both more effective and
less costly than OFX for the treatment of acute otitis media in patients with
tympanostomy tubes.

Publication Types: 
    Comparative Study
    Evaluation Studies

PMID: 16903991 [PubMed - indexed for MEDLINE]

662: Int J Pediatr Otorhinolaryngol. 2006 Oct;70(10):1805-9. Epub 2006 Aug 9.

Tympanoplasty in pediatric patients.

Uyar Y, Keleş B, Koç S, Oztürk K, Arbağ H.

Department of Otorhinolaryngology, Meram Medical Faculty, Selçuk University,
Konya, Turkey.

OBJECTIVE: The aim of this study is to analyze the clinical features and
follow-up of a series of pediatric patients with chronic otitis media undergoing 
tymponaplasty surgery and to identify the effect of the factors on the course.
METHODS: Forty-one children (mean age 15.1+/-2.62 years, range from 8 to 16
years) who had undergone tympanoplasty with or without ossicular reconstruction
were evaluated. Age, gender, size and site of perforation, status of operated ear
(dry/discharging), status of the contralateral ear, underlying cause of the
perforations, surgical technique, preoperative and postoperative hearing levels, 
average postoperative follow-up time, and postoperative complications were
recorded. RESULTS: Myringoplasty in 28 patients (68.3%), incus interposition in 7
patients (17.1%), partial ossicular replacement prostheses in 4 patients (9.7%)
and total ossicular replacement prostheses in 2 patients (4.9%) were performed.
In the 37 (90.2%) of patients, intact graft was determined during postoperative
follow-up. Surgical success including intact graft and postoperative air-bone gap
of less than 25 dB were obtained in 34 (82.9%) cases. CONCLUSIONS: The present
study suggested that tympanoplasty was a quite successful method in the
appropriate pediatric patients between the ages of 8 and 16 years. In the
preoperative evaluation for surgery success, some factors, such as dry middle
ear, healthy contralateral ear and concordant to postoperative care should be
considered.

PMID: 16901554 [PubMed - indexed for MEDLINE]

663: Auris Nasus Larynx. 2006 Dec;33(4):455-60. Epub 2006 Aug 8.

Successful treatment of eosinophilic otitis media using ramatroban: report of two
cases.

Wada T, Uemaetomari I, Murashita H, Tobita T, Tsuji S, Tabuchi K, Okubo H, Hara
A.

Department of Otolaryngology, Graduate School of Comprehensive Human Sciences,
University of Tsukuba, 1-1-1 Tennnodai, Tsukuba, Ibaraki, Japan.
twada@md.tsukuba.ac.jp

OBJECTIVE: The pathogenesis of eosinophilic otitis media is not yet fully
understood. The purpose of this paper is to describe the clinical course of our
two patients with eosinophilic otitis media and to discuss the pathogenesis and
treatment of this intractable condition. METHODS: Two cases of eosinophilic
otitis media were treated with ramatroban. RESULTS: The middle ear effusion has
been well controlled in both patients for more than 1 year with minimal
corticosteroid therapy. CONCLUSIONS: Our experience suggests that the
pathogenesis of eosinophilic otitis media is related to the pharmaceutical
effects of ramatroban, i.e., inhibition of the thromboxane A2 receptor (TP) and
the chemoattractant receptor-homologous molecule expressed on Th2 cells (CRTH2).

Publication Types: 
    Case Reports

PMID: 16899348 [PubMed - indexed for MEDLINE]

664: Int J Pediatr Otorhinolaryngol. 2006 Oct;70(10):1817-23. Epub 2006 Aug 8.

Otitic hydrocephalus associated with lateral sinus thrombosis and acute
mastoiditis in children.

Kuczkowski J, Dubaniewicz-Wybieralska M, Przewoźny T, Narozny W, Mikaszewski B.

Department of Otolaryngology, Medical University of Gdansk, ul. Debinki Street 7,
bld 16, 80-211 Gdansk, Poland. jerzyk@amg.gda.pl

The incidence of intracranial complications of acute otitis media (AOM) has
decreased and the need for operative and medical treatment is declined during the
antibiotic era. To describe pathognomonic signs, evaluation management, operative
findings, clinical course and outcome of otitic hydrocephalus and lateral sinus
thrombosis as complications of AOM and mastoiditis in pediatric patients. Two
children, 9 and 13 years old, with the diagnosis of OH and TK and MRI findings
are presented. Intracranial complications in children resulted from unsuccessful 
treatment of AOM, which led to acute mastoiditis and lateral sinus thrombosis.
Both of the presented children had thrombus in their sigmoid sinus
preoperatively, demonstrated by MRI, causing decreased blood flow. Both patients 
underwent a mastoidectomy and delamination of sigmoid sinus with puncture of
sinuses. After medical and surgical treatment, blood flow through the sinus
increased significantly. In both cases signs of increased intracranial pressure
ceased. The clinical presentation of otogenic lateral sinus thrombosis (LST) as a
complication of acute otitis media (AOM) can be masked by antibiotic treatment.
The episodes of vomiting, headache, visual impairment and a history of AOM seem
to be indicative for otitic hydrocephalus. MRI scans of patients with similar
symptoms should be carefully studied to facilitate the early diagnosis of dural
sinus thrombosis with increased intracranial pressure. Contrast-enhanced computed
tomography scan and magnetic resonance imaging play a major role in determining
diagnosis and treatment plans in this intracranial complications. Management
included systemic antibiotics, short-term heparin anticoagulation and surgical
decompression. In our patients intensive i.v. antibiotic treatment, steroids,
anticoagulants and surgery led to a significant improvement in the clinical
condition.

Publication Types: 
    Case Reports

PMID: 16899305 [PubMed - indexed for MEDLINE]

665: Otolaryngol Clin North Am. 2006 Aug;39(4):723-40, vi-vii.

Revision mastoidectomy.

Nadol JB Jr.

Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA.
joseph_nadol@meei.harvard.edu

The first three priorities in surgery for chronic otitis media are (1) the
elimination of progressive disease to produce a safe and dry ear, (2)
modification of the anatomy of the tympanomastoid compartment to prevent
recurrent disease, and (3) reconstruction of the hearing mechanism. The
indications for revision following mastoidectomy for chronic otitis media thus
involve failure to achieve any of these goals, including recurrent cholesteatoma,
recurrent suppuration, recurrent perforation, or recurrent or residual conductive
hearing loss. The focus of this article is the management of recurrent
cholesteatoma or suppuration; that is, failure to achieve either of the first two
priorities.

Publication Types: 
    Review

PMID: 16895781 [PubMed - indexed for MEDLINE]

666: Clin Vaccine Immunol. 2006 Aug;13(8):892-7.

Erratum in:
    Clin Vaccine Immunol. 2006 Dec;13(12):1375.

Association of CD14 promoter polymorphism with otitis media and pneumococcal
vaccine responses.

Wiertsema SP, Khoo SK, Baynam G, Veenhoven RH, Laing IA, Zielhuis GA, Rijkers GT,
Goldblatt J, Lesouëf PN, Sanders EA.

Department of Pediatric Immunology, University Medical Center Utrecht, Utrecht,
The Netherlands.

Innate immunity is of particular importance for protection against infection
during early life, when adaptive immune responses are immature. CD14 plays key
roles in innate immunity, including in defense against pathogens associated with 
otitis media, a major pediatric health care issue. The T allele of the CD14
C-159T polymorphism has been associated with increased serum CD14 levels. Our
objective was to investigate the hypothesis that the CD14 C-159T allele is
protective against recurrent acute otitis media in children. The association
between the CD14 promoter genotype and the number of acute otitis media episodes 
was evaluated both retrospectively and prospectively in a cohort of 300 children.
Serotype-specific immunoglobulin G (IgG) antibody responses after pneumococcal
vaccinations were examined according to CD14 genotype to compare immune
responsiveness across genotypes. An age-dependent association was found: compared
with that for CC homozygotes aged between 12 to 24 months, TT homozygotes had
fewer episodes of acute otitis media (79 versus 41%, respectively; P = 0.004);
this relationship was absent in older children. Additionally, TT homozygotes
showed higher serotype-specific anti-pneumococcal IgG antibody levels. Our data
suggest that genetic variation in CD14, a molecule at the interface of innate and
adaptive immune responses, plays a key role in the defense against middle ear
disease in childhood and in pneumococcal vaccine responsiveness. These findings
are likely to be important to these and other immune-mediated outcomes in early
life.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16893989 [PubMed - indexed for MEDLINE]

667: Clin Pediatr (Phila). 2006 Jul;45(6):518-24.

A safety-net antibiotic prescription for otitis media: the effects of a PBRN
study on patients and practitioners.

Siegel RM, Bien J, Lichtenstein P, Davis J, Khoury JC, Knight JE, Kiely M,
Bernier J.

Cincinnati Pediatric Research Group, Division of General and Community
Pediatrics, Cincinnati Children's Hospital Medical Center, and Department of
Environmental Health, University of Cincinnati Medical Center, Ohio 45229, USA.

Pediatricians can decrease antibiotic use by treating acute otitis media (AOM)
with a safety-net antibiotic prescription (SNAP). This study assessed whether the
practitioners of the Practice-Based Research Network who participated in the
study continued to use the SNAP and report a 60-day follow-up of the study
patients. Charts were reviewed of study patients for 60 days following study
enrollment. A survey on antibiotic use for AOM was mailed to the 17 study
practitioners (SP) and 30 randomly selected community pediatricians (CP). Eight
of the SP used the SNAP more than 20 times over the year following the study vs 1
of the CP. Sixty-two percent of patients never received antibiotics. The
recurrence/relapse rate was greater in children younger than 2 years old compared
to those older, 34% vs 10%. Practitioners who participate in a Practice-Based
Research Network study are more likely to use a study intervention than others.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16893856 [PubMed - indexed for MEDLINE]

668: Clin Pediatr (Phila). 2006 Jul;45(6):493-502.

Pathogen shifts and changing cure rates for otitis media and tonsillopharyngitis.

Pichichero ME.

Department of Microbiology and Immunology, Pediatrics and Medicine, University of
Rochester Medical Center, Elmwood Pediatric Group, Rochester, New York 14642,
USA.

Pneumococcal conjugate vaccine use has caused a decrease in the incidence of
recurrent and refractory acute otitis media in the United States and a shift in
the predominant pathogens. Now Haemophilus influenzae is the most commonly
isolated organism (about 60% of the total), and more than half the strains make
beta-lactamase, rendering them resistant to amoxicillin. Penicillin
nonsusceptible pneumococci, the main target of antibiotic therapy in the 1990s,
has become a much less common isolate (10%- 25% of the total). These changes
impact antibiotic selection for acute otitis media. Penicillin treatment of group
A streptococcal tonsillopharyngitis does not meet the minimum United States Food 
and Drug Administration standards for first-line treatment, which is 85% or
greater eradication at the end of therapy. Recent results with amoxicillin
suggest its efficacy is also waning. Cephalosporins have the highest
bacteriologic and clinical efficacy. This has implications for optimal antibiotic
therapy.

Publication Types: 
    Review

PMID: 16893853 [PubMed - indexed for MEDLINE]

669: Hear Res. 2006 Sep;219(1-2):12-23. Epub 2006 Aug 2.

Evaluation of the mouse model for acute otitis media.

MacArthur CJ, Hefeneider SH, Kempton JB, Parrish SK, McCoy SL, Trune DR.

Department of Otolaryngology and Oregon Hearing Research Center, Oregon Health & 
Science University, 3181 SW Sam Jackson Park Road, PV-01, Portland, OR
97239-3098, USA. macarthc@ohsu.edu

Various animal models have been employed for otitis media research. The mouse has
been studied less, in spite of its many advantages. To better understand the
suitability of the mouse for studies of otitis media, an evaluation was made of
its middle ear inflammatory processes following inoculation with heat-killed
Streptococcus pneumoniae (strain 6A), one of the three most common bacteria to
cause otitis media in the human. A total of 94 BALB/c mice were injected
transtympanically with three concentrations of heat-killed bacteria (10(4),
10(6), and 10(9) organisms per ml) and inflammation evaluated with both
histologic examination and auditory brainstem response audiometry. Dose-related
measures of the time course of inflammation showed it was maximal at 3 days.
PBS-injected control mice also demonstrated some degree of middle ear
inflammation. Therefore, inflammation measures from PBS injected mice were used
as the threshold above which histologic inflammatory changes would be considered 
a response to bacteria. These quantitative comparisons of bacterial and PBS
inoculations revealed the most significant middle ear measures of inflammation
were amount of fluid in the middle ear, tympanic membrane thickness, and number
of inflammatory cells. The induction of middle ear inflammation in the mouse
demonstrated the applicability of this model for investigations of otitis media.

Publication Types: 
    Evaluation Studies
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16887307 [PubMed - indexed for MEDLINE]

670: Trop Doct. 2006 Jul;36(3):165-6.

Clinical and microbiological profiles of ear infections in Osogbo, Nigeria.

Tobih JE, Taiwo SS, Olowe OA, Olaosun OA, Adejumao SD.

Department of Ear, Nose and Throat, Ladoke Akintola University Teaching Hospital,
Osogbo, Nigeria.

Despite the fact that discharging ears (DE) are one of the most common
presentations to ear, nose and throat (ENT) clinics in the tropics, few reports
have documented the aetiologic agents involved. The pathogenesis is therefore not
fully understood and treatment remains controversial. We present in this report
the microbiological characteristics of DE over a 3-year-period at the ENT clinic 
of Ladoke Akintola University Teaching Hospital, Osogbo, Southwest Nigeria.

PMID: 16884625 [PubMed - indexed for MEDLINE]

671: BMC Med Genet. 2006 Aug 2;7:68.

Association of surfactant protein A polymorphisms with otitis media in infants at
risk for asthma.

Pettigrew MM, Gent JF, Zhu Y, Triche EW, Belanger KD, Holford TR, Bracken MB,
Leaderer BP.

Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department
of Epidemiology and Public Health, Yale University School of Medicine, New Haven,
CT, USA. melinda.pettigrew@yale.edu

BACKGROUND: Otitis media is one of the most common infections of early childhood.
Surfactant protein A functions as part of the innate immune response, which plays
an important role in preventing infections early in life. This prospective study 
utilized a candidate gene approach to evaluate the association between
polymorphisms in loci encoding SP-A and risk of otitis media during the first
year of life among a cohort of infants at risk for developing asthma. METHODS:
Between September 1996 and December 1998, women were invited to participate if
they had at least one other child with physician-diagnosed asthma. Each mother
was given a standardized questionnaire within 4 months of her infant's birth.
Infant respiratory symptoms were collected during quarterly telephone interviews 
at 6, 9 and 12 months of age. Genotyping was done on 355 infants for whom whole
blood and complete otitis media data were available. RESULTS: Polymorphisms at
codons 19, 62, and 133 in SP-A1, and 223 in SP-A2 were associated with
race/ethnicity. In logistic regression models incorporating estimates of
uncertainty in haplotype assignment, the 6A4/1A5haplotype was protective for
otitis media among white infants in our study population (OR 0.23; 95% CI
0.07,0.73). CONCLUSION: These results indicate that polymorphisms within SP-A
loci may be associated with otitis media in white infants. Larger confirmatory
studies in all ethnic groups are warranted.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 16884531 [PubMed - indexed for MEDLINE]

672: Pediatrics. 2006 Sep;118(3):e561-9. Epub 2006 Jul 31.

Comment in:
    J Pediatr. 2007 Jan;150(1):115-6.    Pediatrics. 2006 Sep;118(3):1252-3.

Topical ciprofloxacin/dexamethasone superior to oral amoxicillin/clavulanic acid 
in acute otitis media with otorrhea through tympanostomy tubes.

Dohar J, Giles W, Roland P, Bikhazi N, Carroll S, Moe R, Reese B, Dupre S, Wall
M, Stroman D, McLean C, Crenshaw K.

Department of Otolaryngology, Children's Hospital of Pittsburgh, Pittsburgh,
Pennsylvania, USA.

OBJECTIVE: This study was a comparison of topical ciprofloxacin/dexamethasone
otic suspension to oral amoxicillin/clavulanic acid suspension in children with
acute otitis media with otorrhea through tympanostomy tubes. METHODS: This was a 
randomized, observer-masked, parallel-group, multicenter trial of topical
ciprofloxacin/dexamethasone otic suspension versus amoxicillin/clavulanic acid
suspension in 80 children aged 6 months to 12 years with acute otitis media with 
otorrhea through tympanostomy tubes of < or = 3 weeks' duration and visible
otorrhea. Patients were randomly assigned to receive either 4 drops of topical
ciprofloxacin 0.3%/dexamethasone 0.1% (Ciprodex Sterile Otic Suspension) into the
affected ear(s) twice daily for 7 days or 600 mg of amoxicillin/42.9 mg of
clavulanic acid oral suspension (Augmentin ES-600 Oral Suspension) every 12 hours
for 10 days. Clinical signs and symptoms of acute otitis media with otorrhea
through tympanostomy tubes were evaluated on days 1 (baseline), 3, 11
(end-of-therapy), and 18 (test-of-cure), and twice-daily assessments of otorrhea 
were recorded in patient diaries. RESULTS: The median time to cessation of
otorrhea was significantly shorter with ciprofloxacin/dexamethasone otic
suspension than with amoxicillin/clavulanic acid suspension (4.0 vs 7.0 days; n =
79). This resulted in significantly more clinical cures at the test-of-cure visit
(85% vs 59%, respectively). Frequent adverse events (> 3%) related to
ciprofloxacin/dexamethasone otic suspension included ear pain (5.1%) and related 
to amoxicillin/clavulanic acid suspension included diarrhea (19.5%), dermatitis
(7.3%), and gastroenteritis (4.9%). CONCLUSIONS: Topical otic treatment with
ciprofloxacin/dexamethasone otic suspension is superior to treatment with oral
amoxicillin/clavulanic acid suspension and results in more clinical cures and
earlier cessation of otorrhea with fewer adverse effects in children with acute
otitis media with otorrhea through tympanostomy tubes.

Publication Types: 
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16880248 [PubMed - indexed for MEDLINE]

673: Braz J Otorhinolaryngol. 2005 Nov-Dec;71(6):792-7.

Correlation of cholesteatomas perimatrix thickness with patient's age.

Dornelles C, da Costa SS, Meurer L, Schweiger C.

Program of Post-Graduation in Medical Sciences: Pediatrics-UFRGS, and Hospital de
Clínicas de Porto Alegre-Federal University of Rio Grande do Sul.

Cholesteatoma may occur either in children as in adults; in children, however,
they have a more aggressive and extensive growth. OBJECTIVE: To compare the
thickness of the perimatrix, in microm, between adults (>18 years old) and
children cholesteatomas. STUDY DESIGN: transversal cohort. MATERIAL AND METHOD:
74 cholesteatomas (35 of children) obtained from othologic surgeries were
included, fixed in formol 10%. It was made laminas with HE and Picrossisius, with
were studied at the optic microscope. We obtained digital images of the laminas
at the Image Pro-Plus and we used Spearman's coefficient for data analysis.
Differences were considered statistically significant if P.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16878250 [PubMed - indexed for MEDLINE]

674: Otol Neurotol. 2006 Aug;27(5):667-71.

Tuberculous otitis in infants: temporal bone histopathology and clinical
extrapolation.

Nicolau Y, Northrop C, Eavey R.

Pediatric Otolaryngology Service, the Massachusetts Eye and Ear Infirmary,
Harvard Medical School, Boston, Massachusetts 02115, USA.
ynicolau@genetics.med.harvard.edu

HYPOTHESIS: The study of infant temporal bones with tuberculosis (TB) of the
middle ear and mastoid could provide information to assist with clinical
diagnosis in this population. BACKGROUND: The TB pandemic has become a critical
global public health problem. With the rising incidence of the disease,
otolaryngologists might encounter an increased frequency of otologic TB.
Pediatric temporal bone reports of TB are rare. METHODS: Light microscopic
examination was performed on both temporal bones from an infant who died as a
result of miliary TB. RESULTS: The tympanic membranes were thickened with dilated
blood vessels, yet were intact without perforations. Purulence, granulation
tissue, and classic tubercles were observed in the middle ears and mastoids.
Serous labyrinthitis and inflammatory cells surrounding the Cranial Nerve VIII in
the internal auditory canal were observed in the inner ear. CONCLUSIONS: The
histological findings suggest that a clinical presentation of infantile
tuberculous otitis media and mastoiditis could be a patient with otoscopic
findings consistent with common otitis media with an intact tympanic membrane,
likely in conjunction with inner ear symptoms. Lacking the classic finding of
multiple tympanic membrane perforations, tuberculous otitis might be
underappreciated in this population.

Publication Types: 
    Case Reports

PMID: 16868514 [PubMed - indexed for MEDLINE]

675: Otol Neurotol. 2006 Sep;27(6):871-3.

Investigation of Helicobacter pylori in the middle ear of the patients with
chronic otitis media by CLO test and 14C urea breath test.

Dagli M, Eryilmaz A, Uzun A, Kayhan B, Karabulut H.

Otolaryngology Department, Ankara Numune Research and Training Hospital, Ankara, 
Turkey. mdagli@hotmail.com

OBJECTIVE: The aim of this study was to investigate the presence of Helicobacter 
pylori by CLO test in the middle ear of the patients with chronic otitis media.
We also investigated the relationship between H. pylori in the stomach and in the
middle ear by 14C urea breath test (14C UBT) for the possible source of this
bacterium. STUDY DESIGN: A prospective controlled clinical study. METHODS: Tissue
samples were obtained from the middle ear mucosa of 41 patients undergoing ear
surgery for chronic suppurative otitis media and placed in the CLO test kit. C
UBT was performed in 24 patients and 20 normal subjects. RESULTS: The CLO test
results were positive in 22 patients (53.6%). Results of 14C UBT that was
performed in 24 patients were positive in 19 patients (79.1%) and were positive
in 6 control subjects (30%). CONCLUSION: Fifty-three percent of the middle ear
mucosae obtained from 41 patients with chronic otitis media were shown to be
positive for H. pylori, and although our results suggest that the source of this 
bacterium is the stomach, further clinical studies are needed.

Publication Types: 
    Clinical Trial

PMID: 16865050 [PubMed - indexed for MEDLINE]

676: Acta Otolaryngol. 2006 Sep;126(9):910-5.

Effect of topical dexamethasone versus rimexolone on middle ear inflammation in
experimental otitis media with effusion.

Florea A, Zwart JE, Lee CW, Depew A, Park SK, Inman J, Wareham R, Johnson K, John
E, Wall GM, Jung T.

Division of Otolaryngology-Head & Neck Surgery, Loma Linda University School of
Medicine, Loma Linda, CA, USA.

CONCLUSION: The lipopolysaccharide (LPS)-induced chinchilla otitis media (OM)
model was proven useful in screening anti-inflammatory agents for topical use.
Both 1% rimexolone and 1% dexamethasone are effective in reducing the volume of
middle ear effusion and mucosal thickness compared with control groups. Topical
corticosteroid therapy was efficacious in reducing middle ear mucosal
inflammation. OBJECTIVE: OM is one of the most common diseases in the pediatric
population. Our previous studies have shown that treatment with systemic
antibiotics and corticosteroids was more efficacious than antibiotics alone. The 
purpose of this study was to determine the effectiveness of topically applied
corticosteroids on the outcome of OM. The long-term goal of this study was to
develop a better method of OM treatment by demonstrating effectiveness of
topically applied anti-inflammatory agents, such as corticosteroids, avoiding
systemic side effects. MATERIALS AND METHODS: Three experimental groups were
studied in chinchillas. OM with effusion was induced in all groups by injecting
LPS. Group 1 consisted of controls in three subgroups as follows. Control-LPS
alone, vehicle of dexamethasone (control-dexa), vehicle of rimexolone
(control-rimex). Group 2 was treated with dexamethasone and included subgroups of
separate concentrations of dexamethasone: 0.1% and 1% suspensions. Group 3 was
treated with rimexolone and included subgroups of separate concentrations of
rimexolone: 0.1% and 1% suspensions. A total of 58 animals were used: 18 for
controls and 40 for experimental groups. All test substances (saline,
control-dexa, control-rimex, dexamethasone and rimexolone, 200 microl) were
injected at -2, 48 and 60 h; LPS was injected at 0 h. Animals were monitored by
daily otomicroscopy. After 4 days, samples of middle ear effusion (MEE) were
collected for analysis and temporal bones were harvested for histopathological
studies. RESULTS: At the end of 4 days, only in five ears (3/20 with 1%
dexamethasone, 1/20 with 1% rimexolone, and 1/20 with 0.1% rimexolone) had the
fluid diminished to the point of being unobservable. The volume of MEE, thickness
of mucoperiosteum, and the degree of inflammation of middle ear mucosa with 1%
dexamethasone and 1% rimexolone was significantly less compared with other
groups.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16864486 [PubMed - indexed for MEDLINE]

677: Acta Otolaryngol. 2006 Sep;126(9):905-9.

Behaviour of middle ear cleft mucosa during inflammation: histo- morphometric
study.

Matanda R, Van de Heyning P, Bogers J, Ars B.

University of Antwerp and the University Hospital, Edegem, Belgium.

CONCLUSION: This histo-morphometric study shows a significant reduction in the
distance between the blood vessel's centre and the basal membrane of the middle
ear cleft mucosa during inflammatory process. This could suggest that gaseous
exchange is faster and more abundant in inflamed mucosa. The distance is
significantly shorter in the postero-superior compartment of the middle ear
cleft, possibly favouring a specific gas exchange function. OBJECTIVES: The aim
was to try to understand the morphologic changes that occur when the middle ear
cleft mucosa suffers from chronic inflammation. MATERIALS AND METHODS: Light
microscopic computerized morphometry was used to measure the distance between the
centre of the blood vessels and the basement membrane of the middle ear cleft
mucosa. RESULTS: In inflammation, the distance from blood vessel to mucosa is
reduced in all five regions of the middle ear cleft. This distance is
statistically the shortest in the postero-superior compartment of the middle ear 
cleft.

PMID: 16864485 [PubMed - indexed for MEDLINE]

678: Eur J Pediatr. 2006 Dec;165(12):851-7. Epub 2006 Jul 22.

Parental suspicion of hearing loss in children with otitis media with effusion.

Lo PS, Tong MC, Wong EM, van Hasselt CA.

Division of Otorhinolaryngology, Department of Surgery and Institute of Human
Communicative Research, The Chinese University of Hong Kong, Prince of Wales
Hospital, Hong Kong SAR, People's Republic of China. sylo@cuhk.edu.hk

OBJECTIVE: This study aimed to evaluate the parental suspicion of hearing loss in
children with otitis media with effusion (OME). As part of a population-based
survey in a screening programme among 6- to 7-year-old Chinese children in Hong
Kong, OME cases and controls were studied for the value of parental observations 
in the prediction of OME and hearing test results. SUBJECTS AND METHODS: Prior to
the otoscopic and tympanometric examination of the children on school premises, a
self-administered binary-choice question was sent to the parents asking whether
there was any suspicion of hearing impairment. Positive screens and randomly
selected negative screens were seen in a hospital clinic for the confirmation of 
case and control status 2 to 3 weeks after the school screening. Aural
examination under microscopy, repeated tympanometry and stapedial reflex testing,
and pure-tone audiometry (PTA) were conducted, and 117 cases and 159 controls
were included in this study. RESULTS: The average PTA conductive threshold levels
in the individual children with OME ranged from 3.8 dB to 40.0 dB with a group
mean of 17.0 dB in the better-hearing ears. Parental suspicion of hearing deficit
was significantly associated with OME (p<0.001) but not PTA findings (p=0.686).
The sensitivity of parent-suspected hearing impairment to detect OME however was 
very low (19.7%). DISCUSSION: In other words, if we had relied on parental
suspicion as the first screening, at least 80% of the OME cases would have been
missed. We conclude that the parental suspicion of hearing loss is inadequate for
the identification of mild hearing loss as caused by OME. Health education is
recommended to improve parental awareness of the disease.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16862437 [PubMed - indexed for MEDLINE]

679: J Laryngol Otol. 2006 Sep;120(9):781-3. Epub 2006 Jul 24.

A quartet of lateral sinus thrombosis, extradural abscess, subdural abscess and
occipital abscess: complications of acute mastoiditis in a pre-adolescent child.

Charlett SD, Moor JW, Jenkins CN, Coatesworth AP.

ENT Department, York Hospital, York, UK.

Neurological complications of acute mastoiditis are rare but can be life
threatening. Their presentation may be masked by the use of antibiotics. We
present a unique case of acute otitis media progressing to occipital, extradural 
and subdural abscess formation and lateral sinus thrombosis in a child. The
clinical course and management of a pre-adolescent male is presented and
discussed. We review the incidence, presentation and treatment of occipital
abscesses and lateral sinus thrombosis with acute mastoiditis. Following extended
cortical mastoidectomy, neck exploration and broad spectrum intravenous
antibiotics, the patient made a full recovery. This is the first reported case of
acute mastoiditis associated with occipital abscess in a child. Early, aggressive
treatment is required for a successful outcome. The rarity of neurological
complications, in addition to the insidious onset and subtle symptoms associated 
with antibiotic therapy, can make diagnosis extremely difficult. Patients with
acute otitis media who fail to respond fully to treatment should be referred
early for a specialist otology opinion.

Publication Types: 
    Case Reports
    Review

PMID: 16859571 [PubMed - indexed for MEDLINE]

680: Scand J Infect Dis. 2006;38(8):719-21.

Acute group A streptococcal mastoiditis complicated by pneumocephaly in a
previously healthy adult.

Laupland KB, Bosch JD.

Department of Medicine, Peter Lougheed Centre and University of Calgary, Alberta,
Canada. kevin.laupland@calgaryhealthregion.ca

Streptococcus pyogenes is a rare cause of mastoiditis in adults. We report a
previously healthy adult patient who had acute bacteraemic S. pyogenes
mastoiditis complicated by intra-cranial air. This novel report adds
pneumocephaly to the currently recognized list of complications of acute
mastoiditis.

Publication Types: 
    Case Reports

PMID: 16857625 [PubMed - indexed for MEDLINE]

681: Cochrane Database Syst Rev. 2006 Jul 19;3:CD005657.

Topical analgesia for acute otitis media.

Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C.

Faculty of Health Sciences and Medicine, Cochrane Acute Respirartory Infections
Group, Bond University, Gold Coast, Queensland, Australia 4229.
rfoxlee@staff.bond.edu.au

BACKGROUND: Acute otitis media (AOM) is a spontaneously remitting disease for
which pain is the most distressing symptom. Antibiotics are now known to have
less benefit than previously assumed. OBJECTIVES: To assess the effectiveness of 
topical analgesia for AOM. SEARCH STRATEGY: We searched the Cochrane Central
Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006),
MEDLINE (1966 to May Week 3 2006), EMBASE (1990 to December 2005) and LILACS
(1982 to September 2005) without language restriction, and the reference lists of
articles. We also contacted manufacturers and authors. SELECTION CRITERIA:
Double-blind randomised or quasi-randomised controlled trials comparing an otic
preparation with an analgesic effect (excluding antibiotics) versus placebo or an
otic preparation with an analgesic effect (excluding antibiotics) versus any
other otic preparation with an analgesic effect, in adults or children presenting
at primary care settings with AOM without perforation. DATA COLLECTION AND
ANALYSIS: Potential studies were screened independently and trial quality was
assessed by three authors, and differences were resolved by discussion. Data was 
then independently extracted from the trials selected by two authors. We
contacted the authors of three trials to acquire additional information not
available in published articles. MAIN RESULTS: Our searches yielded 356 records; 
four trials met our criteria. One trial with 54 participants compared treatment
with anaesthetic ear drops versus an olive oil placebo immediately at diagnosis. 
All patients were also given paracetamol. There was a statistically significant
pain reduction of 25% in those receiving anaesthetic drops 30 minutes after
instillation. Three trials (with one common co-author) compared anaesthetic ear
drops with naturopathic herbal ear drops in 274 patients. One of these trials
also used antibiotics in both groups. There were statistically significant
differences at instillation of drops, or 15 or 30 minutes after the instillation 
(or both) on one to three days after diagnosis, always favouring the naturopathic
group in each trial. AUTHORS' CONCLUSIONS: The evidence from these four
randomised controlled trials, only one of which addresses the most relevant
question of primary effectiveness, is insufficient to know whether ear drops are 
effective or not.

Publication Types: 
    Meta-Analysis
    Review

PMID: 16856108 [PubMed - indexed for MEDLINE]

682: Cochrane Database Syst Rev. 2006 Jul 19;3:CD001935.

Update of:
    Cochrane Database Syst Rev. 2002;(4):CD001935.

Oral or topical nasal steroids for hearing loss associated with otitis media with
effusion in children.

Thomas CL, Simpson S, Butler CC, van der Voort JH.

Cardiff University, Department of General Practice, Centre for Health Sciences
Research, School of Medicine, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff,
UK CF14 4XN. kellycl@cf.ac.uk

BACKGROUND: Otitis media with effusion (OME) is common and may cause hearing loss
with associated developmental delay. Treatment remains controversial. OBJECTIVES:
To examine evidence for or against treating children with hearing loss associated
with OME with systemic or topical intranasal steroids. SEARCH STRATEGY: We
searched the Cochrane Ear, Nose and Throat Disorders Group Specialised Register, 
the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane
Library Issue 4 2005, MEDLINE (1966 to 2006), EMBASE (1974 to 2006), and the
CINAHL, LILACS, Zetoc, IndMED, SAMED, KoreaMed, MEDCARIB and Cambridge Scientific
Abstracts databases in January 2006. SELECTION CRITERIA: Randomised controlled
trials of oral and topical intranasal steroids, either alone or in combination
with another agent such as an antibiotic, were included. Exclusions: publications
in abstract form only; uncontrolled, non-randomised or retrospective studies;
studies reporting outcomes with ears (rather than children). DATA COLLECTION AND 
ANALYSIS: Data were extracted from the published reports by the authors
independently using standardised data extraction forms and methods. The
methodological quality of the included studies was independently assessed by the 
authors as described in the Cochrane Handbook. Dichotomous results were expressed
as an odds ratio using a fixed-effect model together with the 95% confidence
intervals. Continuous data were analysed using the weighted mean difference in a 
fixed-effect model. Tests for heterogeneity between studies were performed using 
a Mantel-Haenszel approach. In trials with a cross-over design, post cross-over
treatment data were not used. MAIN RESULTS: No study prospectively documented
hearing loss associated with OME prior to randomisation. Follow up was mainly
short term. The odds ratio for OME persisting after short-term follow up in
children treated with oral steroids compared to control was 0.22 (95% CI 0.08 to 
0.63). The odds ratio for OME persisting after short-term follow up for children 
treated with oral steroids plus antibiotic compared to control plus antibiotic
was 0.37 (95% CI 0.25 to 0.56). However, there was significant heterogeneity
between studies included in the latter comparison (P < 0.01). Trends favoured
steroids for most other comparisons, but confidence intervals included unity.
There was no evidence of benefit for steroid treatment for OME or hearing loss
associated with OME in the longer term. AUTHORS' CONCLUSIONS: Both oral and
topical intranasal steroids alone or in combination with an antibiotic lead to a 
quicker resolution of OME in the short term, however, there is no evidence of
longer term benefit.

Publication Types: 
    Meta-Analysis
    Review

PMID: 16855980 [PubMed - indexed for MEDLINE]

683: Cleft Palate Craniofac J. 2006 Jul;43(4):420-8.

Audiological issues in children with cleft lip and palate in one area of the U.K.

Moss AL, Fonseca S.

St. George's Hospital, London, UK. amoss@sgul.ac.uk

OBJECTIVE: The purpose of this study was to determine the extent of
multidisciplinary care and audiological services rendered to children with CL/P
who underwent surgical repair of the cleft in 1998 and 1999. This followed
proposals to radically reorganize cleft lip and palate services in the U.K. after
unsatisfactory findings in a national review. METHOD: Information was obtained
from questionnaires sent to clinicians (audiologists; ear, nose, and throat
surgeons; and community pediatricians) from audiology teams, and parents were
asked to retrieve information from their Personal Child Health Record. Standards 
chosen were based on the Clinical Standards Advisory Group, the South Thames
Audiology Audit Group, and the National Deaf Children's Society. RESULTS: None of
the agreed standards were achieved at an acceptable level. CONCLUSIONS: This
demonstrates the need for better communication systems between teams, including
better use by parents and professionals of the Personal Child Health Record. A
clinical care pathway is suggested here with other recommendations.

PMID: 16854199 [PubMed - indexed for MEDLINE]

684: Can J Vet Res. 2006 Jul;70(3):234-6.

In vivo efficacy study of the anti-inflammatory properties of Surolan.

Bolinder A, Cameron K, Faubert L, Wilson J, Aramini J, Hare J.

International Bio-Institute Corporation, Fergus, Ontario.

This study evaluated the anti-inflammatory properties of Surolan with the use of 
a pinna model of inflammation in 80 mice and a randomized complete block design. 
Within each of 8 blocks, 10 treatments, consisting of different combinations of
the constituents of Surolan with and without the prednisolone acetate component, 
were randomly assigned to the 9-wk-old CD-1 mice. The treatments were
administered as a single dose 30 min after pinna inflammation was induced with
tetradecanoylphorbol acetate. Ear-skin edema and erythema were assessed and
measured 4 and 6 h thereafter. Treatment effects were evaluated with
repeated-measures analysis of variance. Inclusion of prednisolone acetate with
the Surolan vehicle, either alone or in combination with the nonsteroidal
constituents of the suspension, resulted in a significant reduction in mean
ear-skin thickness and erythema. The inflammation-reducing properties of
prednisolone were not significantly affected by the other components of Surolan.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16850948 [PubMed - indexed for MEDLINE]

685: Arch Otolaryngol Head Neck Surg. 2006 Jul;132(7):752-5.

Influence of sampling technique on detection of potential pathogens in the
nasopharynx.

van der Veen EL, Rovers MM, Leverstein-van Hall MA, Sanders EA, Schilder AG.

Department of Otorhinolaryngology, Wilhelmina Children's Hospital, Julius Center 
for Health Sciences and Primary Care, Utrecht, The Netherlands.
E.L.vanderVeen@umcutrecht.nl

OBJECTIVES: To determine the optimal approach for nasopharyngeal culture and to
establish which approach children tolerate best. DESIGN: Cross-sectional study.
SETTING: A pediatric otolaryngology department of a Dutch tertiary care hospital.
PATIENTS: A cohort of 42 children with chronic suppurative otitis media.
INTERVENTION: Paired nasopharyngeal samples were collected transorally and
transnasally and cultured for potential aerobic pathogens. MAIN OUTCOME MEASURES:
The isolation rate of both samples and the amount of discomfort measured by the
visual analog scale. RESULTS: Forty-six (87%) of 53 samples obtained transnasally
were culture positive vs 40 (75%) of 53 samples obtained transorally (P = .20).
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and
Staphylococcus aureus were found more frequently with the transnasal than with
the transoral approach: 34% vs 13% (P = .003), 62% vs 51% (P = .20), 30% vs 19%
(P = .15), and 21% vs 11% (P = .18), respectively. Mean (SD) visual analog scale 
scores were 5.3 (1.0) and 3.4 (1.7) (P<.001) for the transnasal and transoral
approaches, respectively. CONCLUSIONS: Although the transoral approach is better 
tolerated in children, the isolation rate of the transnasal approach is higher,
especially for S. pneumoniae. The transnasal sampling technique should therefore 
be the preferred approach for detection of potential pathogens in the nasopharynx
in children.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16847184 [PubMed - indexed for MEDLINE]

686: Arch Otolaryngol Head Neck Surg. 2006 Jul;132(7):729-33.

Association of the FBXO11 gene with chronic otitis media with effusion and
recurrent otitis media: the Minnesota COME/ROM Family Study.

Segade F, Daly KA, Allred D, Hicks PJ, Cox M, Brown M, Hardisty-Hughes RE, Brown 
SD, Rich SS, Bowden DW.

Department of Internal Medicine, Wake Forest University School of Medicine,
Winston-Salem, NC 27157, USA.

OBJECTIVE: The FBXO11 gene is the human homologue of the gene mutated in the
novel deaf mouse mutant jeff (Jf), a single gene model of otitis media. We have
evaluated single nucleotide polymorphisms (SNPs) in the FBXO11 gene for
association with chronic otitis media with effusion/recurrent otitis media
(COME/ROM). DESIGN: A total of 13 SNPs were genotyped across the 98.7 kilobases
of genomic DNA encompassing FBXO11. Data were analyzed for single SNP association
using generalized estimating equations, and haplotypes were evaluated using
Pedigree Disequilibrium Test methods. PATIENTS: The Minnesota COME/ROM Family
Study, a group of 142 families (619 subjects) with multiple affected individuals 
with COME/ROM. MAIN OUTCOME MEASURES: Genetic association of COME/ROM with
polymorphisms in FBXO11. RESULTS: The FBXO11 SNPs are contained in a single
linkage disequilibrium haplotype block. Ten of the 13 SNPs were sufficiently
polymorphic in the sample to permit analysis. In univariate genetic analysis, 1
reference SNP (hereinafter rs) (rs2134056) showed nominal evidence of association
to COME/ROM (P = .02), and 2 SNPs approached significance (rs2020911, P = .06;
rs3136367, P = .09). In multivariable analyses, including known risk factors for 
COME/ROM (sex, exposure to smoking, attending day care centers, no prior
breastfeeding, and having allergies), the evidence of independent association was
reduced for each SNP (eg, rs2134056, from P = .02 to P = .08). In subsequent
analyses using the Pedigree Disequilibrium Test, the association of FBXO11 SNP
rs2134056 (P = .06) with COME/ROM was confirmed. Incorporating multiple SNPs in
2- and 3-locus SNP haplotypes, those haplotypes containing rs2134056 also
exhibited evidence of association of FBXO11 and COME/ROM (P values ranging from
.03 to .10). CONCLUSION: We have observed evidence consistent with an association
between polymorphisms in FBXO11, the human homologue of the Jeff mouse model
gene, and COME/ROM.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 16847180 [PubMed - indexed for MEDLINE]

687: Ambul Pediatr. 2006 Jul-Aug;6(4):187-95; discussion 196-7.

Differences in diagnosis and treatment using telemedicine versus in-person
evaluation of acute illness.

McConnochie KM, Conners GP, Brayer AF, Goepp J, Herendeen NE, Wood NE, Thomas A, 
Ahn DS, Roghmann KJ.

Department of Pediatrics, university of Rochester, Rochester, NY 14642, USA.
ken_mcconnochie@urmc.rochester.edu

OBJECTIVE: We designed a telemedicine model for diagnosis of common, acute
illness to compare telemedicine and in-person evaluations on reproducibility of
diagnosis and treatment. METHODS: Subjects were seen by usual physicians in
ambulatory settings. Subjects were also evaluated separately by experienced
general pediatricians (study physicians), either in person or via telemedicine,
based on random assignment. The primary measure of reproducibility was study
physician agreement with usual physician on primary diagnosis. Analysis compared 
reproducibility for telemedicine versus in-person evaluations. Relevance of
agreement on primary diagnosis was measured by comparing agreement on prescribed 
medications. RESULTS: Agreement on diagnosis of study physicians with usual
physicians for the 492 visits studied was 89%. The difference in the proportion
of visits with disagreements between telemedicine study and in-person study
evaluations (13.8% vs 8.3%, respectively) bordered on significance (P = .051).
Disagreement proportions for prescriptions were similar (32.2% vs 27.4%),
however. Telemedicine evaluation for children with upper respiratory tract
(URI)-ear symptoms involved unique technical requirements and clinical judgments.
For this largest subgroup of 202 visits, disagreement on diagnosis for
telemedicine occurred more often than for in-person evaluation (17.6 vs 6.3%, P <
.02). For the remaining 290 visits, telemedicine and in-person study physicians
disagreed on diagnosis about equally (11.5 vs 9.9%). CONCLUSIONS: Excluding the
URI-ear group, reproducibility of telemedicine diagnosis did not differ from that
of in-person diagnosis. For the URI-ear group, reproducibility of diagnosis by
telemedicine and in-person evaluation varied significantly.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

PMID: 16843248 [PubMed - indexed for MEDLINE]

688: JAMA. 2006 Jul 12;296(2):202-11.

Direct detection of bacterial biofilms on the middle-ear mucosa of children with 
chronic otitis media.

Hall-Stoodley L, Hu FZ, Gieseke A, Nistico L, Nguyen D, Hayes J, Forbes M,
Greenberg DP, Dice B, Burrows A, Wackym PA, Stoodley P, Post JC, Ehrlich GD,
Kerschner JE.

Center for Genomic Sciences, Allegheny-Singer Research Institute, Pittsburgh, Pa 
15212, USA.

CONTEXT: Chronic otitis media (OM) is a common pediatric infectious disease.
Previous studies demonstrating that metabolically active bacteria exist in
culture-negative pediatric middle-ear effusions and that experimental infection
with Haemophilus influenzae in the chinchilla model of otitis media results in
the formation of adherent mucosal biofilms suggest that chronic OM may result
from a mucosal biofilm infection. OBJECTIVE: To test the hypothesis that chronic 
OM in humans is biofilm-related. DESIGN, SETTING, AND PATIENTS: Middle-ear mucosa
(MEM) biopsy specimens were obtained from 26 children (mean age, 2.5 [range,
0.5-14] years) undergoing tympanostomy tube placement for treatment of otitis
media with effusion (OME) and recurrent OM and were analyzed using
microbiological culture, polymerase chain reaction (PCR)-based diagnostics,
direct microscopic examination, fluorescence in situ hybridization, and
immunostaining. Uninfected (control) MEM specimens were obtained from 3 children 
and 5 adults undergoing cochlear implantation. Patients were enrolled between
February 2004 and April 2005 from a single US tertiary referral otolaryngology
practice. MAIN OUTCOME MEASURES: Confocal laser scanning microscopic (CLSM)
images were obtained from MEM biopsy specimens and were evaluated for biofilm
morphology using generic stains and species-specific probes for H influenzae,
Streptococcus pneumoniae, and Moraxella catarrhalis. Effusions, when present,
were evaluated by PCR and culture for evidence of pathogen-specific nucleic acid 
sequences and bacterial growth, respectively. RESULTS: Of the 26 children
undergoing tympanostomy tube placement, 13 (50%) had OME, 20 (77%) had recurrent 
OM, and 7 (27%) had both diagnoses; 27 of 52 (52%) of the ears had effusions, 24 
of 24 effusions were PCR-positive for at least 1 OM pathogen, and 6 (22%) of 27
effusions were culture-positive for any pathogen. Mucosal biofilms were
visualized by CLSM on 46 (92%) of 50 MEM specimens from children with OME and
recurrent OM using generic and pathogen-specific probes. Biofilms were not
observed on 8 control MEM specimens obtained from the patients undergoing
cochlear implantation. CONCLUSION: Direct detection of biofilms on MEM biopsy
specimens from children with OME and recurrent OM supports the hypothesis that
these chronic middle-ear disorders are biofilm-related.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 16835426 [PubMed - indexed for MEDLINE]

689: J Laryngol Otol. 2006 Jul;120(7):556-60.

Adenoid mast cells and their role in the pathogenesis of otitis media with
effusion.

Abdullah B, Hassan S, Sidek D, Jaafar H.

Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical
Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
baharudin@kb.usm.my

INTRODUCTION: Otitis media with effusion (OME) is an inflammation of the middle
ear in which a collection of liquid is present in the middle-ear space while the 
tympanic membrane is intact. The association between adenoid inflammation and OME
has long been noted but the exact mechanism is still much debated. We studied the
role of adenoid mast cells in the causation of OME. OBJECTIVE: To study the
distribution and role of adenoid mast cells in the causation of OME. METHODOLOGY:
A cross-sectional, prospective study was carried out in the otorhinolaryngologic 
clinic, department of otorhinolaryngology (ORL), Science University of Malaysia, 
from June 1999 to September 2001. A total number of 50 cases were studied.
Twenty-five of these patients underwent adenoidectomy, while another 25 patients 
underwent adenoidectomy and myringotomy with ventilation tube insertion. The
adenoid specimens from all patients were examined for the number of adenoid mast 
cells present, using light microscopy and toluidine blue as the staining agent.
The results were analysed using SPSS version 10.0 computer software. RESULT: The 
population of adenoid mast cells in children with OME was significantly greater
than that in children without OME (p=0.000). CONCLUSION: The increased number of 
adenoid mast cells in patients with OME suggests that inflammation may play a
role in this condition.

PMID: 16834804 [PubMed - indexed for MEDLINE]

690: Int J Pediatr Otorhinolaryngol. 2006 Oct;70(10):1771-8. Epub 2006 Jul 7.

Pacific Islands families study: the prevalence of chronic middle ear disease in
2-year-old Pacific children living in New Zealand.

Paterson JE, Carter S, Wallace J, Ahmad Z, Garrett N, Silva PA.

Auckland University of Technology, New Zealand. janis.paterson@aut.ac.nz

OBJECTIVE: The aim of this study was to determine the prevalence of chronic
middle ear disease in 2-year-old Pacific children living in New Zealand. METHODS:
The data were gathered as part of the Pacific Islands Families: First Two Years
of Life (PIF) Study in which 1001 two year olds were screened using tympanometry 
to identify children at risk for otitis media with effusion (OME) and other
otological disorders. Those failing the screening tests were referred to Manukau 
Superclinic where they had a further tympanometry test, and if they failed this
test, were followed up with a comprehensive otological examination by an
otolaryngologist using otomicroscopy and pneumatic otoscopy. RESULTS: Bilateral
otitis media with effusion (OME) was the most common abnormality detected (N=102)
with further cases of unilateral OME (N=8), and unilateral OME resolving (N=2).
Other cases of OME were associated with acute otitis media (AOM), impacted wax
(N=1), perforation (N=1), and mild retraction (N=2). Overall there were 118
children with unilateral or bilateral OME. AOM of any form was seen in nine
cases. Retraction of the tympanic membrane was seen in 26 cases. The population
prevalence among Pacific 2-year-old children was estimated as 25.4% for OME, 1.9%
for AOM, and 26.9% for OME or AOM. CONCLUSIONS: These findings reveal that over
25% of Pacific Island 2-year-old were affected by OME and recommend the
consideration of national screening for OME and other otological disorders at
this earlier age.

PMID: 16828885 [PubMed - indexed for MEDLINE]

691: Laryngoscope. 2006 Jul;116(7):1071-9.

Erratum in:
    Laryngoscope. 2006 Nov;116(11):2098.

C3H/HeJ mouse model for spontaneous chronic otitis media.

MacArthur CJ, Hefeneider SH, Kempton JB, Trune DR.

Department of Otolaryngology & Oregon Hearing Research Center, Oregon Health &
Science University, and the Department of Immunology, Veteran's Affairs Medical
Center, Portland, Oregon, USA. macarthc@ohsu.edu

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.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16826039 [PubMed - indexed for MEDLINE]

692: Ear Hear. 2006 Aug;27(4):353-68.

Early otitis media with effusion, hearing loss, and auditory processes at school 
age.

Gravel JS, Roberts JE, Roush J, Grose J, Besing J, Burchinal M, Neebe E, Wallace 
IF, Zeisel S.

Albert Einstein College of Medicine, Bronx, New York, USA.

OBJECTIVES: To examine the effect of conductive hearing loss (HL) secondary to
otitis media with effusion (OME) in the first 3 years of life on physiologic,
peripheral, and higher-order behavioral auditory measures examined at school age.
METHODS: Peripheral hearing sensitivity for conventional and extended
high-frequency audiometric ranges, physiologic (distortion product otoacoustic
emissions, contralateral and ipsilateral acoustic middle ear muscle reflexes),
auditory brain stem response (ABR), and higher-order auditory processing measures
(masking level difference; Virtual Auditory Localization, Speech Intelligibility 
Gain; adaptive Pediatric Speech Intelligibility task) were examined at the end of
the second grade of elementary school in two cohorts (North Carolina, N = 73, and
New York, N = 59). All participants (mean age, 8 years) were followed
prospectively in infancy and early childhood (7 to 39 months) for middle ear
status and hearing loss (using pneumatic otoscopy/tympanometry and repeated
conditioned behavioral audiometric response procedures). Multivariate analyses
were conducted to address whether early OME and early conductive HL were related 
to physiologic, peripheral, and higher-order auditory processes. RESULTS: Early
hearing loss and OME were significantly associated with peripheral hearing at
school age; extended high-frequency thresholds accounted for the result.
Similarly, hearing loss in early life and OME were significantly associated with 
the acoustic middle ear muscle reflex: The contralateral stimulation condition
accounted for the association. Significant associations with both early OME and
early HL were also found for the auditory brain stem response measure and were
explained by the correlations between early hearing loss and the ABR Wave V
latency but not other ABR indices. There were no reliable associations between
either early OME or early HL on any other auditory processes evaluated at the end
of second grade. CONCLUSIONS: Extended high-frequency hearing and brain stem
auditory pathway measures in childhood were significantly associated with
children's experiences with OME and hearing loss from 7 to 39 months of age.
However, no significant associations were found for psychoacoustic measures of
binaural processing or a behavioral adaptive speech-in-noise test at school age.

Publication Types: 
    Multicenter Study
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 16825885 [PubMed - indexed for MEDLINE]

693: J Infect. 2007 Feb;54(2):e103-6. Epub 2006 Jul 7.

Otitis media and a neck lump--current diagnostic challenges for Paragonimus-like 
trematode infections.

Schuster H, Agada FO, Anderson AR, Jackson RS, Blair D, McGann H, Kelly G.

Microbiology Department, Leeds General Infirmary, Great George Street, Leeds LS1 
3EX, UK.

A 29 year-old Nigerian studying in the UK presented with a neck lump and otitis
media. Paragonimus-like trematode eggs were found in the neck lump aspirate.
Morphologically these eggs resembled Paragonimus uterobilateralis or
Achillurbainia congolensis. We favoured the diagnosis of achillurbainiasis over
extrapulmonary paragonimiasis on the basis of clinical features and because we
could not amplify DNA sequences using PCR primers specific for Paragonimus
species. We discuss current diagnostic challenges for this rare parasitic
infection.

Publication Types: 
    Case Reports

PMID: 16824610 [PubMed - indexed for MEDLINE]

694: Int J Pediatr Otorhinolaryngol. 2006 Oct;70(10):1683-6. Epub 2006 Jul 5.

Iatrogenic cholesteatoma in children with OME in a training program.

Al Anazy FH.

King Abdulaziz University Hospital, P.O. Box 245, Riyadh 11411, Saudi Arabia.
waelamro@hotmail.com

PURPOSE: To report the occurrence of cholesteatoma following myringotomy and
insertion of ventilating tube (VT) in a residency training program. MATERIALS AND
METHODS: Nine hundred and eighty-four children who were operated for grommet
insertion with or without adenotonsillectomy during the year 1999-2003 were
included in the study. Children were divided into two groups: group 1 (648
children) operated by residents and group 2 (305 children) operated by
consultant. All procedures were carried out under general anesthesia using Ziess 
operating microscope. Shah ventilating tubes were used in most cases and Goody T 
tube in some others. RESULTS: Nine ears developed cholesteatoma, six with
perforation and three with pearl cholesteatoma cyst and intact tympanic membrane.
The rate of iatrogenic cholesteatoma occurrence was 0.62% when done by residents 
(group 1) and 0.33% when operated by consultants (group 2). The overall
prevalence was 0.48%. CONCLUSION: Iatrogenic cholesteatoma occuring as a
complication following VT insertion is not uncommon. It occurs more often
following surgery done by inexperienced surgeons. Excessive manipulation may
cause meatal wall and drum surface epithelium injury. This epithelium might be
pushed with the VT into the middle ear.

PMID: 16822553 [PubMed - indexed for MEDLINE]

695: Curr Allergy Asthma Rep. 2006 Jul;6(4):334-41.

Acute otitis media guidelines: review and update.

Lieberthal AS.

Keck School of Medicine, University of Southern California, Kaiser Permanente,
Panorama City, CA 91402, USA. allan.s.lieberthal@kp.org

In 2004, the Subcommittee on Management of Acute Otitis Media of the American
Academy of Pediatrics and American Academy of Family Physicians published
evidence-based clinical practice guidelines on the "Diagnosis and Management of
Acute Otitis Media." The guidelines included a definition of acute otitis media
(AOM) that included three components: 1) a history of acute onset of signs and
symptoms; 2) the presence of middle-ear effusion; and 3) signs and symptoms of
middle-ear inflammation. An option to observe selected children with AOM for 48
to 72 hours without initial antibiotic therapy was proposed. This option was
based on age, severity of illness, and certainty of diagnosis. Despite the
changing prevalence of bacterial pathogens and increasing resistance of
Streptococcus pneumoniae, amoxicillin remains the first-line antibiotic for
initial antibacterial treatment of AOM. The guideline also addresses the
management of otalgia, choice of antibiotics after initial treatment failure, and
methods for preventing AOM.

Publication Types: 
    Historical Article
    Review

PMID: 16822388 [PubMed - indexed for MEDLINE]

696: Curr Allergy Asthma Rep. 2006 Jul;6(4):327-33.

Glucocorticosteroids in allergic inflammation: clinical benefits in otitis media 
with effusion.

Dhooge I, Verbruggen K, Vandenbulcke L.

Ghent University Hospital, Belgium. ingeborg.dhooge@Ugent.be

Allergy and otitis media with effusion are often considered as comorbidities.
Evidence points to a role for allergy in the pathogenesis of otitis media with
effusion in reports of increased prevalence of allergy in patients with otitis
media with effusion and presence of late-phase allergic-response inflammatory
mediators and cytokines in the middle-ear effusion of allergic subjects. However,
the exact mechanism remains unknown. Many speculations have been made, but
well-controlled studies to prove the efficacy of anti-allergic medication in the 
treatment of otitis media with effusion are lacking. Therefore, we do not
recommend the use of glucocorticosteroids in allergic patients with otitis media 
with effusion.

Publication Types: 
    Review

PMID: 16822387 [PubMed - indexed for MEDLINE]

697: Curr Allergy Asthma Rep. 2006 Jul;6(4):321-6.

Adenoidectomy and tympanostomy tubes in the management of otitis media.

Mattila PS.

Department of Otorhinolaryngology, PO Box 220, Helsinki University Central
Hospital, 00290 Helsinki, Finland. petri.mattila@hus.fi

Otitis media is one of the most common childhood infections and the most frequent
cause for antibiotic prescriptions in children. As respiratory infections are
also associated with childhood asthma, children with recurrent otitis media or
with persistent middle-ear effusion are also at an increased risk for developing 
asthma, which should be appreciated when a child with middle-ear disease is
evaluated. The first choice of surgery in chronic middle-ear inflammatory disease
is the insertion of tympanostomy tubes. It is warranted when the middle-ear
effusion has lasted for 3 or more months. When chronic adenoid infection is
suspected, adenoidectomy may be beneficial in treating otitis media in children
who are older than 4 years of age and who have previously undergone
tympanostomy-tube insertion.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 16822386 [PubMed - indexed for MEDLINE]

698: Curr Allergy Asthma Rep. 2006 Jul;6(4):316-20.

Evolving role of leukotrienes in the pathogenesis of viral infections, including 
otitis media.

Gentile D.

Division of Allergy, Asthma and Immunology, Allegheny General Hospital, 320 E
North Avenue, Pittsburgh, PA 15212, USA. dgentile@wpahs.org

Otitis media (OM) is one of the most common childhood disorders and has been
associated with an alarming rise in prevalence. Because medical therapy with
antibiotics, antihistamines, decongestants, and corticosteroids has no
demonstrable efficacy in the treatment of OM, the mainstay of treatment is
surgical intervention. Although effective, surgical treatment is quite expensive 
and exposes patients to the risks associated with general anesthesia. Results of 
recent studies suggest that locally produced leukotrienes may play a role in the 
pathogenesis of OM. As such, a potential candidate for treatment of OM is the
leukotriene receptor antagonist, montelukast, which has been approved by the US
Food and Drug Administration for the treatment of asthma and/or allergic
rhinitis. If proven effective, this drug's safety/convenience profiles and
indication for children as young as 6 months of age would make it suitable for
treatment of OM, and perhaps even prophylaxis of OM in at-risk populations.

Publication Types: 
    Review

PMID: 16822385 [PubMed - indexed for MEDLINE]

699: Pediatrics. 2006 Jul;118(1):1-13.

Tympanometric findings and the probability of middle-ear effusion in 3686 infants
and young children.

Smith CG, Paradise JL, Sabo DL, Rockette HE, Kurs-Lasky M, Bernard BS, Colborn
DK.

Department of Audiology and Communication Disorders, Children's Hospital of
Pittsburgh, 3705 Fifth Ave, Pittsburgh, Pennsylvania 15213, USA.

OBJECTIVE: We examined relationships between tympanometric findings and the
presence or absence of middle-ear effusion in a population-based sample of
children under the age of 3 years. METHODS: In a study of children's development 
in relation to early-life otitis media, we enrolled 6350 infants soon after birth
and evaluated them regularly for the presence of middle-ear effusion. In 3686 of 
the children, we compared tympanometric findings with otoscopic diagnoses. We
categorized tympanograms according to varying combinations of tympanometric peak 
height, peak pressure, and width, and calculated for each resulting category the 
percentage of the associated ears diagnosed as having effusion. Using these
findings we developed algorithms for estimating the probability of middle-ear
effusion associated with tympanograms of any configuration. RESULTS: For
tympanograms generally, the lower their height and the greater their width, the
greater was the probability of associated middle-ear effusion; the probability
also was greater when peak pressure was negative rather than positive. Among
children > or = 6 months of age, effusion was diagnosed in only 2.7% of ears with
tympanometric height > or = 0.6 mL, but in 80.2% of ears with flat tympanograms. 
Relationships among younger infants were similar but less consistent. In both age
groups, the tympanographic configurations most commonly encountered were
associated with either a relatively low probability (<30%) or a relatively high
probability (>70%) of the presence of middle-ear effusion. The receiver operating
characteristic curve we generated using the algorithm we developed for children >
or = 6 months of age gave an area under the curve of 0.84. The algorithm
performed equally well when applied to a separate group of children, suggesting
that it is generalizable to other unselected populations. CONCLUSIONS: The
present report offers two alternative methods for estimating the probability of
middle-ear effusion in children aged 6 through 35 months, given any combination
of tympanometric values.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 16818543 [PubMed - indexed for MEDLINE]

700: Otolaryngol Head Neck Surg. 2006 Jul;135(1):111-5.

Alpha1-antitrypsin single dose adjuvant therapy for acute otitis media.

Antonelli PJ, Schultz GS, Sundin DJ, Pemberton PA, Barr PJ.

Department of Otolaryngology, University of Florida, 1600 SW Archer Road,
Gainesville, FL 32610, USA. antonpj@ent.ufl.edu

OBJECTIVES: Proteases have been shown to play a role in the pathogenesis of
otitis media. Inhibition of these proteases can improve treatment outcomes in
certain conditions. The goal of this study was to determine if intratympanic
administration of a single dose of the protease inhibitor, recombinant alpha
1-antitrypsin (rAAT), can facilitate resolution of acute otitis media (AOM) in
the chinchilla. METHODS AND MEASURES: Pneumococcus was injected into both middle 
ears of 12 chinchillas. After 3 to 4 days, middle ears were cultured, systemic
antibiotics were initiated, and rAAT or its vehicle was administered into the
middle ears of all animals. Serial tympanic membrane (TM) scoring, tympanometry, 
and auditory-evoked brain stem response testing were performed. Animals were
sacrificed at varying timepoints and temporal bones studied for objective
measures of OM. RESULTS: Although not reaching statistical significance, there
was a trend to more rapid resolution of AOM in rAAT-treated ears. Tympanometry,
auditory thresholds, and quantitative histologic parameters did not differ
between rAAT and vehicle treated ears. CONCLUSIONS: A single dose of
intratympanic rAAT likely does not facilitate the resolution of
antibiotic-treated pneumococcal AOM in the chinchilla model. Serial
administration of this protease inhibitor may be necessary to see a significant
treatment effect.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16815194 [PubMed - indexed for MEDLINE]

701: Otolaryngol Head Neck Surg. 2006 Jul;135(1):106-10.

Treatment of pediatric suppurative mastoiditis: is peripherally inserted central 
catheter (PICC) antibiotic therapy necessary?

Moore JA, Wei JL, Smith HJ, Mayo MS.

Department of Otolaryngology-Head and Neck Surgery, University of Kansas School
of Medicine, Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.

OBJECTIVE: A review of the treatment of pediatric acute mastoiditis requiring
surgical intervention managed with and without PICC therapy postoperatively.
STUDY DESIGN AND SETTING: Retrospective study of 42 cases from 1989 to 2004
treated at a regional children's hospital. RESULTS: Sixteen patients received
postoperative PICC therapy and 26 received a course of oral antibiotics. The PICC
group received on average 12.12 days of intravenous antibiotics compared to only 
3.53 days for the non-PICC group (P < 0.001). No differences were observed
between the two groups in treatment outcomes. One patient from each group
required rehospitalization. One minor complication was experienced in a patient
in the PICC group. There were no surgical complications. The total cost for
outpatient PICC therapy increased treatment costs by approximately $1500 to
$2500. CONCLUSIONS: Oral antibiotic therapy is sufficient after surgical
intervention for acute pediatric suppurative mastoiditis without intracranial
complications and does not result in adverse treatment outcome. SIGNIFICANCE: Use
of PICC therapy after surgical intervention for mastoiditis should be limited.
EBM rating: B-3b.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural

PMID: 16815193 [PubMed - indexed for MEDLINE]

702: Int J Pediatr Otorhinolaryngol. 2006 Oct;70(10):1725-30. Epub 2006 Jun 30.

A high prevalence of new onset otitis media during parent diagnosed common colds.

Winther B, Doyle WJ, Alper CM.

Department of Otolaryngology, University of Virginia Health System, United
States.

INTRODUCTION: Past studies suggest that the majority of new otitis media (OM)
diagnoses is a complication of a colds/flu. A prospective format was used to
determine the coincidence of otitis media and parent diagnosed cold/flu episodes 
in young children followed over a typical cold/flu season. METHODS: Eighteen
families with children aged 1-8 years were followed from October 1 to April 30
using parent-completed daily diaries focused on cold/flu signs and weekly
examinations using pneumatic otoscopy for diagnosis of the presence/absence of
otitis media. RESULTS: Overall, 108 cold episodes were documented in 36 enrolled 
children with 20 colds (19%) occurring during a pre-existing OM episode and 40
colds (37%) complicated by a new OM episode. Conversely, there were 82 new OM
episodes, 40 (49%) were associated with a cold in the individual child and 18
(22%) with a concurrent cold in a family member. The median duration of the OM
episodes was approximately 2 weeks but this was longer for OM episodes where
earache was reported. CONCLUSION: The results confirm past observation relating
new OM episodes to a concurrent cold/flu but show these episodes to usually be of
short duration. Two sources of potential bias were identified for point
prevalence study formats: the presence of a pre-existing OM for a new onset
cold/flu and the possibility of subclinical colds in patients with new OM
episodes. These biases reinforce the need for longitudinal study formats to
address this important relationship.

PMID: 16814403 [PubMed - indexed for MEDLINE]

703: Ear Nose Throat J. 2005 Jul;84(7):418, 420-2, 424.

Tympanostomy tubes for otitis media: quality-of-life improvement for children and
parents.

Mui S, Rasgon BM, Hilsinger RL Jr, Lewis B, Lactao G.

Department of Head and Neck Surgery, Kaiser Permanente Medical Center, San
Francisco, Oakland, Calif 94118, USA. Stanley.Mui@kp.org

We measured quality of life issues for both children and their parents on the
premise that parental quality of life should be an aspect of cost-effectiveness
in otitis media treatment. The patients were less than 18 years of age and had
had myringotomy with tube insertion at the head and neck surgery department of a 
large health maintenance organization. Quality of life for patients, parents, and
caregivers was evaluated by telephone survey of parents or caregivers and by
retrospective chart review of the number of pre- and postoperative healthcare
visits and antibiotic usage. Chart review showed a significant postoperative
reduction in the number of clinic visits and in use of antibiotic drugs after
insertion of tympanostomy tubes. Improved postoperative hearing was noted, and
tympanostomy tube insertion was shown to be safe. The chart-review cost analysis 
showed that tympanostomy tube insertion is a cost-effective treatment for otitis 
media in children, and the telephone survey results showed that it improves
quality of life for children and their parents or other caregivers.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16813031 [PubMed - indexed for MEDLINE]

704: Ear Nose Throat J. 2005 Jul;84(7):416-7.

Tympanostomy tube obstruction related to ototopical drug therapy.

Bassim MK, Drake AF.

Department of Otolaryngology-Head and Neck Surgery, School of Medicine,
University of North Carolina at Chapel Hill NC 27599, USA. mbassim@mac.com

Obstruction of tympanostomy tubes is a potentially significant complication,
sometimes requiring replacement of the nonfunctioning tube. Early blockage can
occur secondary to bleeding during the tube placement procedure. Delayed
obstruction is usually caused by inspissated secretions or epithelial casts. We
briefly report our treatment of 9 cases of delayed ventilation tube obstruction
that were associated with the use of an ototopical antibiotic/steroid suspension.

Publication Types: 
    Comparative Study

PMID: 16813030 [PubMed - indexed for MEDLINE]

705: Pediatr Infect Dis J. 2006 Jul;25(7):602-7.

Site-specific disease potential of individual Streptococcus pneumoniae serotypes 
in pediatric invasive disease, acute otitis media and acute conjunctivitis.

Shouval DS, Greenberg D, Givon-Lavi N, Porat N, Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center and the
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,
Israel.

BACKGROUND: Recent studies have shown that some Streptococcus pneumoniae
serotypes possess a higher potential to cause invasive disease than others.
However, it is unknown whether disease potential for specific serotypes is
similar for mucosal disease. Our objective was to assess the disease potential of
individual S. pneumoniae serotypes causing invasive pneumococcal disease (IPD),
acute otitis media (AOM) and acute conjunctivitis (AC) in children. METHODS:
Serotypes of pneumococcal isolates from children with IPD, AOM and AC were
compared with those carried by healthy children aged <3 years. All children
resided in the same area and were studied during the same period. Odds ratios for
disease were calculated for each diagnosis following multivariate analysis,
including gender, age, ethnic group, previous antibiotic treatment and year
variability. RESULTS: A total of 5,500 isolates were collected: 189 from blood or
cerebrospinal fluid, 3,200 from middle ear fluid, 348 from conjunctiva and 1,763 
from nasopharynx of healthy children. A significant positive association with IPD
was demonstrated for serotypes 1, 5 and 12F; with AOM for serotypes 1, 3, 5, 12F,
19A and 19F; and with AC for serotype 3 and nontypeable S. pneumoniae. A
significant negative association with IPD was demonstrated for nontypeable S.
pneumoniae and with AOM for serotypes 6A, 6B, 15A and nontypeable S. pneumoniae. 
CONCLUSIONS: Our results reflect the importance of the polysaccharide capsule in 
site-specific disease potential and provide useful information regarding disease 
potential of nonvaccine serotypes shown to be involved in carriage replacement
after vaccination with the 7-valent conjugate vaccine.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16804429 [PubMed - indexed for MEDLINE]

706: Acta Otolaryngol. 2006 Jul;126(7):782-4.

Surgical management of acute mastoiditis with epidural abscess.

Park H, Jang H, Shim D, Shin H, Ahn J, Shin J.

Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School
of Medicine, Seoul, Korea. hpark@kuh.ac.kr

The prevalence of intracranial complications of acute coalescent mastoiditis in
children has decreased significantly; however, this clinical problem persists,
with a relatively high mortality. The common practice for management of acute
mastoiditis with epidural abscess is mastoidectomy, drainage and placement of a
ventilation tube, which means that the main pathology is confined to the mastoid 
cavity. We suggest that tympanic exploration is mandatory in certain cases, an
example of which we present here. We report one case of acute mastoiditis with
epidural abscess, in which mastoidectomy with tympanic exploration was needed to 
ensure drainage throughout the cavities and to prevent pressure rebuilding in the
mastoid and tympanic cavities. We stress that if the tympanic membrane is
thickened and no fluid is drained when placing a pressure equalization tube,
there could be granulation tissue in the tympanum and tympanic exploration is
mandatory, especially in a case of acute mastoiditis with intracranial
complications accompanied by prolonged symptoms.

Publication Types: 
    Case Reports

PMID: 16803722 [PubMed - indexed for MEDLINE]

707: Eur Arch Otorhinolaryngol. 2006 Sep;263(9):875-8. Epub 2006 Jun 24.

Otomycosis: subdermal growth in calcified mass.

Hoshino T, Matsumoto M.

Hamamatsu ENT Surgicenter, 1696 Tenno-cho, Hamamatsu, Shizuoka 435-0052, Japan.
hoshino@ent-surgicenter.com

Reports on clear identification of fungi in subdermal tissue in chronic fungal
external otitis are rare in recent years. Our patient was an immunocompetent
adult male with an 8 year history of chronic otitis externa who presented with
pustules on the external auditory canal (EAC) and necrosis and perforation of the
tympanic membrane. Type I tympanoplasty was performed, but wound healing was
delayed and swelling of the EAC occurred. Incision biopsy and staining
(Gomori-Grocott and PAS) revealed fungal hyphae within small, calcified,
subepidermal masses. A 3 month course of oral itraconazole was effective in
healing the lesion. Calcification, a rarely reported finding in otomycosis, may
represent a protective reaction against topical use of antifungal drugs.

Publication Types: 
    Case Reports

PMID: 16799802 [PubMed - indexed for MEDLINE]

708: Eur Arch Otorhinolaryngol. 2006 Oct;263(10):906-9. Epub 2006 Jun 23.

Acute mastoiditis in infants.

Baljosevic I, Mircetic N, Subarevic V, Markovic G.

Department of Otorhinolaryngology, Mother and Child Health Institute, Radoja
Dakica 6-8, 11070, Novi Beograd, Serbia and Montenegro. balos@net.yu

We present a retrospective study of 37 infants who were operated for acute
mastoiditis during the period 2000-2004 in Mother and Child Health Care
Institute, Belgrade, Serbia and Montenegro. About 23 patients (62.2%) were male
and 14 (37.8%) were female. Acute mastoiditis developed just after the first
infection of the middle ear in 26 patients (70.3%). All patients had local and
general symptoms. The most common local symptoms were blurred tympanic membrane
in all patients, painful tenderness of mastoid in 21 (57%) and redness of
tympanic membrane in 13 (36%). General signs of infection were loss of body
weight in 28 (75.7%) patients, fever in 21 (56.8%), vomiting in 19 (51.3%),
diarrhea in 19 (51.3%) and severe anemia that requested red blood cell
transfusion in 6 (16.2%). Suppuration did not appear in any of the patients.
Tympanocentesis had been performed prior to surgery in all patients. The most
frequently isolated causative microorganism was Streptococcus pneumoniae which
was found in 12 (32.5%) patients, Staphylococcus aureus was found in 8 (21.5%)
and Hemophilus influenzae in 2 (5.5%). In 15 (405%) patients there was no
bacterial isolation. Eleven patients (29.7%) who had previously had acute otitis 
media were implanted ventilation tubes during the surgical intervention. All
patients were treated with antibiotics prior and after the surgical intervention.
The finding on mastoidectomy was positive in all cases. According to the results 
of our study the combination of antibiotic and surgical treatment is optimal in
treating acute mastoiditis. Making a diagnosis of acute mastoiditis might not be 
easy since there are no specific symptoms. We emphasize that it should always be 
considered as a differential diagnosis in cases of prolonged acute otitis media
with no improvement after 10 days of antibiotic treatment, especially when
accompanied with weight loss and general condition worsening.

PMID: 16794812 [PubMed - indexed for MEDLINE]

709: Surg Neurol. 2006 Jul;66(1):94-9; discussion 99.

Unusual presentations of craniovertebral junction tuberculosis: a report of 2
cases and literature review.

Mohindra S, Gupta SK, Mohindra S, Gupta R.

Department of Neurosurgery, Postgraduate Institute of Medical Education and
Research, Chandigarh 160012, India. satya_sandee@yahoo.com

BACKGROUND: CVJ tuberculosis is a described entity requiring challenging ways of 
management. Severe neck pain, causing restricted neck movements and torticollis, 
is a characteristic presentation of neurologically asymptomatic suboccipital
Pott's disease. CASE DESCRIPTION: Two patients with unusual CVJ tuberculosis form
the basis for the present communication. The first patient presented with
tubercular otitis media, causing progressive erosion of the petrous part of
temporal bone, and destruction of the occipital condyle, along with the lateral
mass of atlas, leading to CVJ instability. This is a first report of such a
presentation, according to our knowledge. Detailed bony architectural destruction
demonstrable on CT scan has been described. The second patient, with CVJ
tuberculosis, presented with skull base syndrome and with multiple cranial nerve 
palsies. Both patients were managed without surgical intervention and showed
clinical and radiological recovery. CONCLUSION: In such patients with unusual
clinical presentations, histopathologic examination is necessary to arrive at a
correct diagnosis. The management of patients with tubercular involvement of CVJ 
remains controversial. In the present communication, both the patients were
managed successfully with full dose of antitubercular drugs and immobilization.

Publication Types: 
    Case Reports

PMID: 16793457 [PubMed - indexed for MEDLINE]

710: J Am Osteopath Assoc. 2006 Jun;106(6):327-34.

Comment in:
    J Am Osteopath Assoc. 2007 Jul;107(7):277-8.    J Am Osteopath Assoc. 2007 Jul;107(7):278-9.

Osteopathic evaluation and manipulative treatment in reducing the morbidity of
otitis media: a pilot study.

Degenhardt BF, Kuchera ML.

A.T. Still University of Health Sciences, 800 W Jefferson St, Kirksville, MO
63501-1443, USA. bdegenhardt@atsu.edu

OBJECTIVE: To study the effects of osteopathic manipulative treatment in routine 
pediatric care for children with recurrent acute otitis media. STUDY DESIGN:
Pilot cohort study with 1-year posttreatment follow-up. At follow-up, subjects'
parents or legal guardians and their referring and/or family physicians were
contacted to determine recurrence of otitis media since intervention. Subjects: A
referred and volunteer sample of pediatric patients ranging in age from 7 months 
to 35 months with a history of recurrent otitis media (N=8). INTERVENTION: For 3 
weeks, all subjects received weekly osteopathic structural examinations and
osteopathic manipulative treatment. This intervention was performed concurrently 
with traditional medical management. Results: Five (62.5%) subjects had no
recurrence of symptoms. Of the three remaining subjects in this cohort, one had a
bulging tympanic membrane, another had four episodes of otitis media, and the
last underwent surgery after recurrence at 6 weeks posttreatment. Closer analysis
of the posttreatment course of the last two subjects indicates that there may
have been a clinically significant decrease in morbidity for a period of time
after intervention. CONCLUSION: The present study indicates that osteopathic
manipulative treatment may change the progression of recurrent otitis media, a
finding that supports the need for additional research in this area.

PMID: 16790538 [PubMed - indexed for MEDLINE]

711: Otol Neurotol. 2006 Sep;27(6):874-81.

Long-term results in ossiculoplasty: an analysis of prognostic factors.

Yung M, Vowler SL.

Department of Otolaryngology, The Ipswich Hospital NHS Trust, Ipswich, Suffolk,
UK. matthewyung@btconnect.com

OBJECTIVES: The aim of the present study is to examine the prognostic factors
based on 6-month and 5-year results of ossiculoplasty. STUDY DESIGN:
Retrospective analysis was made on the ossiculoplasty cases in a county hospital.
The information was extracted from a computer database. METHODS: All patients who
had ossiculoplasty were routinely followed up in a dedicated ear audit clinic on 
a yearly basis. Between 1988 and 1999, 242 ossiculoplasties for chronic otitis
media were performed on 197 patients. Only the first ossiculoplasty operation
performed on each patient during the study period was included in the analysis.
The 6-month and 5-year results were analyzed. Two different statistical methods
were used--logistic regression analysis and the analysis of variance (ANOVA). A
successful ossiculoplasty is defined as a postoperative air-bone gap (ABG) of 20 
dB or better. RESULTS: The overall success rate of ossiculoplasty was 66.5% at 6 
months and 50.3% at 5 years. In a multivariate analysis using logistic
regression, those with present malleus were 6.36 times more likely to be
successful. Using ANOVA, absent malleus and otorrhea were unfavorable factors of 
the 6-month ABG. Using logistic regression for the 5-year analysis, malleus
remained a significant predictor at 5 years. Those with malleus were 2.65 times
more likely to be successful. Using ANOVA, absent malleus was the only
significant unfavorable factor of postoperative ABG at 5 years. In the univariate
analysis, absent stapes and revision surgery are regarded as possible unfavorable
factors. CONCLUSION: In the present study, the authors try to define the studied 
population (chronic otitis media) and the follow-up period (6 months and 5
years), and use logistic regression and ANOVA for statistical analysis. Absent
malleus and otorrhea are important unfavorable factors for short-term outcome in 
ossiculoplasty (6 months), whereas absent malleus is the only important
unfavorable factor for long-term outcome in ossiculoplasty (5 years).

PMID: 16788423 [PubMed - indexed for MEDLINE]

712: Vet Clin Pathol. 2006 Jun;35(2):194-8.

Comparison of 4 fixation and staining methods for the cytologic evaluation of ear
canals with clinical evidence of ceruminous otitis externa.

Toma S, Cornegliani L, Persico P, Noli C.

Ospedale Veterinario Cuneese, Via Cuneo 52/N, 12011 Borgo S. Dalmazzo (CN),
Italy.

BACKGROUND: Swab cytology of ear canals is one of the most useful and rapid
methods to assess the presence of external ear infections. Smears are generally
stained with rapid Romanowsky-type stains, with or without prior heat fixation.
OBJECTIVES: The aim of this study was to compare 4 different methods of fixation 
and staining of ear swab cytology samples from dogs. METHODS: Eight dogs with
otitis externa were selected from a dermatology referral population. A cotton
swab was used to obtain ceruminous material from 12 ear canals. Four smears of
each swab were prepared on glass slides (randomly identified as A, B, C, or D)
and air-dried for cytologic examination. Samples marked A were stained with Dip
Quick (Jorgensen Laboratories Inc, Loveland, CO, USA) after heat fixation;
samples marked B were stained without heat fixation; samples marked C were
heat-fixed and dipped only in the counterstain (the blue reagent) of Dip Quick;
and samples marked D were dipped only in the counterstain, without heat fixation.
Ten high-power fields (hpf; X100 oil immersion objective) in each slide were
evaluated by 2 observers, and total numbers of keratinocytes, yeast, bacteria,
and neutrophils were counted. Statistical comparison was performed using an ANOVA
model applied after verifying the normal distribution of the data, and using
nonparametric sign tests and Wilcoxon signed rank tests. RESULTS: No
statistically significant differences were observed in the numbers of
keratinocytes, yeast, bacteria, or neutrophils among the 4 staining methods (P > 
.05), although significant interobserver differences were found. CONCLUSION: We
conclude that heat fixation does not improve the quality of ceruminous ear swab
samples for cytologic evaluation, and propose a 1-step dip in the blue reagent
alone as a rapid method of staining samples from canine ear canals.

PMID: 16783712 [PubMed - indexed for MEDLINE]

713: Int J Audiol. 2006 Jun;45(6):353-9.

The effects of childhood otitis media on the acoustic reflex threshold at age 15.

Welch D, Dawes PJ.

Dunedin Multidisciplinary Health and Development Research Unit, Dunedin School of
Medicine, University of Otago, Dunedin, New Zealand.
david.welch@dmhdru.otago.ac.nz

Previous research has found that childhood otitis media leads to elevated
adulthood acoustic reflex thresholds because of worsened audiometric thresholds
in the stimulation ear, and abnormality of the tympanic membrane in the ear from 
which acoustic reflexes were measured. To confirm and expand this finding, our
research utilized longitudinal data from 631 general-population-sampled children 
assessed between ages 5 and 15. Otitis media was assessed to age 9, audiometric
thresholds were measured at age 11, and otoscopy and acoustic reflex thresholds
testing were performed at age 15. Our findings support the earlier research, in
that acoustic reflex threshold was higher in those with the worst experience of
childhood otitis media. However, this was directly mediated not by audiometric
threshold in the ear to which the stimulus was delivered, but by the amount of
tympanic membrane abnormality in both the stimulus and probe ears. This appeared 
to have an effect independent of audiometric threshold. Furthermore, only those
who suffered the worst, persistent, binaural childhood otitis media showed raised
acoustic reflex thresholds.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16777782 [PubMed - indexed for MEDLINE]

714: Clin Microbiol Infect. 2006 Jul;12(7):679-82.

Relationship between clinical signs and symptoms and nasopharyngeal flora in
acute otitis media.

Cohen R, Levy C, Hentgen V, Boucherat M, de La Rocque F, d'Athis P, Bingen E.

Service de Microbiologie, Centre Hospitalier Intercommunal Créteil, Créteil,
France. robert.cohen@wanadoo.fr

Possible links between the clinical signs and symptoms of acute otitis media and 
the composition of the nasopharyngeal flora were investigated by reviewing the
files of 1807 children enrolled in four randomised, multicentre trials. A
standard protocol was used, nasopharyngeal samples were cultured, and signs and
symptoms were recorded. Carriage of Haemophilus influenzae was associated
positively with conjunctivitis (OR 4.83, 95% CI 3.76-6.20) and negatively with
fever (OR 0.69, 95% CI 0.56-0.86). Carriage of pneumococci was associated
positively with fever (OR 1.32, 95% CI 1.08-1.63) and negatively with
conjunctivitis (OR 0.50, 95% CI 0.40-0.63).

PMID: 16774568 [PubMed - indexed for MEDLINE]

715: J Ayub Med Coll Abbottabad. 2006 Jan-Mar;18(1):55-8.

Management outcome of secretory otitis media.

Khan F, Asif M, Farooqi GH, Shah SA, Sajid T, Ghani R.

Department ENT, Ayub Medical College, Abbottabad.

BACKGROUND: Secretory otitis media is a common otological manifestation, that
most of the time is left undiagnosed on account of unawarenes s and negligence in
seeking early medical attention for trivial ailments. Untreated, it might end up 
in serious consequences in the form of poor speech and intellectual development
and permanent anatomical disabilities within middle ear cleft. The objectives of 
the study were to determine most affected age group, the common etiological
factors. to access the efficacy of medical and surgical treatment and finally to 
find out the coumplication associated with the surgical procedures. METHODS: This
study was conducted in the ENT, Head and Neck Surgery department of the Ayub
Teaching Hospital, Abbottabad from January 2001 to December 2003. Only the
diagnosed cases of SOM were included in the study. After detailed history,
clinical examination, routine investigations and special investigations such as
pure tone audiogram and tympanometry were carried out to confirm the diagnosis of
SOM . All patients were initially treated by medical therapy. In cases of
failure, underwent myringotomy with or without ventilation tube insertion and
where indication present adenotonsillectomy and antial lavage was done. Follow up
of cases was carried out from 18-24 months. RESULTS: It included 87 patients, 58 
were males (66.6%) and 29 females (33.3%). Majority of the patients were between 
5-8 years (62%). The most common aetiological factor was rhinosinusitis (36.7%)
followed by hypertrophic adenoids (34.5%). All patients were initially given
medical treatment. Out of 87 patients,30 patients (34.4%) improved and 57
patients (65.5%) had no response and underwent surgery. Surgical procedures
included myringotomy with and without ventilation tube insertion.,
adenotonsillectomy and antral lavage. CONCLUSION: lt is concluded from this study
that conservative treatment has a definite role and should be tried before any
surgical step is taken however surgery is the treatment of choice in more
resistant cases.

PMID: 16773972 [PubMed - indexed for MEDLINE]

716: Med Mycol. 2006 Jun;44(4):369-73.

Susceptibility of yeast isolates from cattle with otitis to aqueous solution of
povidone iodine and to alcohol-ether solution.

Duarte ER, Hamdan JS.

Department of Microbiology, Biological Sciences Institute, Federal University of 
Minas Gerais, Brazil.

Lipid-dependent Malassezia species, Candida spp. and Rhodotorula mucilaginosa
have been associated with bovine parasitic otitis. This paper evaluated the
susceptibility of 63 yeast isolates from cattle with otitis to a povidone iodine 
aqueous solution (1% and 0.5% v/v) and to an alcohol-ether solution (1:1 v/v).
The effectiveness of these antiseptics was assessed using the European suspension
test. Products achieving equal to or greater than 5-log reduction in numbers of
the challenge organism after 5 min contact are considered to have as acceptable
microbicidal effect (ME). The two antiseptic solutions achieved ME greater than
5, when tested at 1 and 5 min contact time, against the majority of yeast
strains. The exceptions were alcohol and ether solution against two Candida
tropicalis strains. Urea broth macrodilution method was used to determine the
minimum inhibitory concentration (MIC), defined as the lowest concentration that 
resulted in a visually negative urease test or, in the case of Candida spp.,
turbidity inhibition when compared with that produced by the growth control.
Analysis of the results for all 63 isolates showed Malassezia sympodialis and
Rhodotorula mucilaginosa to be more susceptible to povidone iodine and Malassezia
furfur strains to be less susceptible. Malassezia sympodialis was significantly
more susceptible to alcohol-ether solution than other species. This study showed 
the in vitro efficacy of alcohol-ether solution and povidone iodine and proposes 
the need for clinical evaluation of the topical treatment and control of bovine
otitis with these antiseptics and their effects on the ear microbiota and the ear
canal.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16772232 [PubMed - indexed for MEDLINE]

717: J Laryngol Otol. 2006 Jun;120(6):439-41.

Routine nasopharyngeal biopsy in adults presenting with isolated serous otitis
media: is it justified?

Glynn F, Keogh IJ, Ali TA, Timon CI, Donnelly M.

Department of Otolaryngology Head and Neck Surgery, Royal Victoria Eye and Ear
Hospital, Dublin, Ireland. fglynn@rcsi.ie

Nasopharyngeal malignancy accounts for less than 2 per cent of all head and neck 
cancers. Serous otitis media (SOM) causing deafness is a recognized indicator of 
nasopharyngeal obstruction and the possibility of a nasopharyngeal malignancy
must be considered in all adults. Examination under anaesthesia (EUA) and biopsy 
of the nasopharynx is routinely undertaken in many centres to rule out
nasopharyngeal malignancy in adults with SOM. The purpose of this 10-year
retrospective study was to evaluate the case records of all adult cases of SOM,
including their presentation, clinical findings, management and nasopharyngeal
biopsy results. Eighty-five patients were included in the study. Fifty-nine
presented with unilateral SOM and 26 with bilateral SOM. The primary presenting
complaint in all cases was hearing loss. A nasopharyngeal mass was documented in 
55 patients (69 per cent). Four nasopharyngeal masses were noted to have
irregular or exophytic mucosa on flexible nasendoscopy. All patients underwent a 
EUA of the ears and a nasopharyngeal biopsy. The four patients with
suspicious-looking masses were all found to have malignancies (two squamous cell 
carcinomas, one B-cell non-Hodgkin lymphoma and one adenocarcinoma). Three of
these patients presented with unilateral SOM and one with bilateral SOM. All
other patients with masses were found to have benign lymphoid hyperplasia. In
total, 4.7 per cent of the adults with conductive hearing loss secondary to SOM
were found to have a malignancy on nasopharyngeal biopsy. We would advocate a
high index of suspicion of a nasopharyngeal tumour in adults presenting with SOM.
If a mass is found in the nasopharynx then it should be biopsied. If no mass is
found then it is not necessary to biopsy; however, close follow up, with repeat
fibre-optic nasendoscopy, is advised.

PMID: 16772052 [PubMed - indexed for MEDLINE]

718: Brain Res. 2006 May 26;1091(1):3-8. Epub 2006 Jun 9.

Mouse models of induced otitis media.

Ryan AF, Ebmeyer J, Furukawa M, Pak K, Melhus A, Wasserman SI, Chung WH.

Department of Surgery, Division of Otolaryngology, UCSD School of Medicine and VA
Medical Center, La Jolla, CA 92093-0666, USA. afryan@ucsd.edu

The mouse has seen limited use as a model for experimental otitis media, due
primarily to the small size of its middle ear. However, the genetic resources of 
this species offer substantial potential benefits. These include detailed genomic
information, a wealth of genetic models, and gene arrays that represent virtually
all mouse genes. This has led to the development of methods for inducing otitis
in mice. These include surgical approaches to the middle ear, documentation of
the murine middle ear response to various pathogens and inflammatory factors, as 
well as characterization of induced otitis media in several mouse strains. The
results indicate that induced otitis media in the normal mouse is in most
respects comparable to that observed in other animal models and in humans. They
further suggest that the considerable genetic resources of this species can be
harnessed to increase our understanding of this disease.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review

PMID: 16764829 [PubMed - indexed for MEDLINE]

719: Kulak Burun Bogaz Ihtis Derg. 2006;16(1):11-7.

The incidence of atopy in adults with recurrent secretory otitis media: screening
with Phadiatop.

Firat Y, Koç C, Olcay I, Selçuk A, Firat AK, Ozdem C.

Department of Otolaryngology, Ankara Numune Training and Research Hospital,
Ankara, Turkey. yezdanf@yahoo.com

OBJECTIVES: This is a preliminary report of a relatively new method, Phadiatop,
in screening atopic adult patients with recurrent secretory otitis media (SOM).
The sensitivity and specificity, and its use in atopic adult patients with
recurrent SOM were evaluated. PATIENTS AND METHODS: Eighty-four patients (54
females, 30 males; mean age 36.7; range 19 to 62 years) who were diagnosed as
recurrent SOM were included in the study. The patients were evaluated with
respect to history, laboratory tests, skin-prick test, and total IgE. Patients
with at least one positive skin-prick test result and/or a high total IgE level
with a positive history were considered to be in atopic status. RESULTS:
According to certain criteria, atopy was detected in 31 of 84 patients. Negative 
Phadiatop values were found in all non-atopic patients as well as in one atopic
patient. Among 31 patients having atopy, 30 patients showed positive Phadiatop
values (specificity 1.00, sensitivity 0.97, positive predictive value 1.00,
negative predictive value 0.98). CONCLUSION: These results indicate that
Phadiatop is an effective test to detect atopy in patients with recurrent SOM.

Publication Types: 
    Evaluation Studies

PMID: 16763409 [PubMed - indexed for MEDLINE]

720: Indian J Pathol Microbiol. 2005 Jul;48(3):413-6.

Bacteriological study of paediatric and adult chronic suppurative otitis media.

Saini S, Gupta N, Aparna, Seema, Sachdeva OP.

Department of Pathology, Pt. B.D. Sharma PGIMS, Rohtak.

Chronic suppurative otitis media (CSOM) is one of the commonest illnesses in ENT 
practice which requires medical attention all the more in children of poor
socio-economic status having in past inadequate treatment and negligent medical
care. The present study was conducted to find out the various aerobic and
anaerobic microorganisms associated with CSOM in paediatric and adult cases and
their current antimicrobial susceptibility pattern as a guide to therapy. Samples
were collected from 109 clinically diagnosed cases of CSOM and processed
according to standard protocols. Out of 74 paediatric CSOM cases, 72 (97.2%) were
bacterial culture positive while out of 35 adult CSOM cases, 28 (80%) were
culture positive. Bilateral CSOM was slightly more common in adults (25%) than
paediatric (21.4%) age group. Polymicrobial nature of CSOM was noted in both
paediatric (70.8%) and adult (71.4%) cases while number of organisms isolated per
lesion was slightly higher in adults (2.5) as compared to paediatric (1.95)
cases. In paediatric CSOM, Staphylococcus aureus was the commonest aerobic
isolate while in adult CSOM, Pseudomonas aeruginosa was the commonest one. Among 
anaerobes Peptostreptococcus spp. was commonest in CSOM where as Prevotella
melaninogenica in adult CSOM. Sensitivity of S. aureus to cefuroxime was 72.2%
while that of gram negative bacilli was higher to cefotaxime (90 to 100%). Among 
anaerobes higher sensitivity was seen to metronidazole (98.6%), clindamycin
(95.7%) and chloramphenicol (98.6%). In view of the polymicrobial etiology of
CSOM, prompt appropriate antimicrobial therapy can effectively reverse the
disease process thereby preventing longterm sequelae.

PMID: 16761774 [PubMed - indexed for MEDLINE]

721: Infect Control Hosp Epidemiol. 2006 Jun;27(6):581-5. Epub 2006 May 25.

Outbreak of methicillin-resistant Staphylococcus aureus colonization and
infection in a neonatal intensive care unit epidemiologically linked to a
healthcare worker with chronic otitis.

Bertin ML, Vinski J, Schmitt S, Sabella C, Danziger-Isakov L, McHugh M, Procop
GW, Hall G, Gordon SM, Goldfarb J.

Department of Infection Control and Epidemiology, Division of Nursing, The
Cleveland Clinic, Cleveland, OH 44195, USA. Bertinm@ccf.org

OBJECTIVE: To describe the investigation and interventions necessary to contain
an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization
and infection in a neonatal intensive care unit (NICU). DESIGN: Retrospective
case finding that involved prospective performance of surveillance cultures for
detection of MRSA and molecular typing of MRSA by repetitive-sequence polymerase 
chain reaction (rep-PCR). SETTING: Level III NICU in a tertiary care center.
PARTICIPANTS: Three neonates in a NICU were identified with MRSA bloodstream
infection on April 16, 2004. A point prevalence survey identified 6 additional
colonized neonates (attack rate, 75% [9 of 12 neonates]). The outbreak strain was
phenotypically unusual. INTERVENTIONS: Cohorting and mupirocin therapy were
initiated for neonates who had acquired MRSA during the outbreak. Contact
precautions were introduced in the NICU, and healthcare workers (HCWs) were
retrained in cleaning and disinfection procedures and hand hygiene. Noncolonized 
neonates and newly admitted patients had surveillance cultures performed 3 times 
per week. RESULTS: Two new colonized neonates were identified 1 month later. HCW 
X, who had worked in the NICU since June 2003, was identified as having chronic
otitis. MRSA was isolated from cultures of swab specimens from HCW X's ear canal 
and nares. HCW X was epidemiologically linked to the outbreak. Molecular typing
(by rep-PCR) confirmed that the isolates from HCW X and from the neonates were
more than 90% similar. Retrospective review of NICU isolates revealed that the
outbreak strain was initially cultured from a neonate 2 months after HCW X began 
working on the unit. The epidemic strain was eradicated after removing HCW X from
patient care in the NICU. CONCLUSION: An outbreak of MRSA colonization and
infection in a NICU was epidemiologically linked to a HCW with chronic otitis
externa and nasal colonization with MRSA. Eradication was not achieved until
removal of HCW X from the NICU. Routine surveillance for MRSA may have allowed
earlier recognition of the outbreak and is now standard practice in our NICU.

PMID: 16755477 [PubMed - indexed for MEDLINE]

722: J Allergy Clin Immunol. 2006 Jun;117(6):1344-50. Epub 2006 Apr 27.

Functional polymorphisms in the mannan-binding lectin 2 gene: effect on MBL
levels and otitis media.

Wiertsema SP, Herpers BL, Veenhoven RH, Salimans MM, Ruven HJ, Sanders EA,
Rijkers GT.

Department of Pediatric Immunology, University Medical Center Utrecht, The
Netherlands.

BACKGROUND: Mannan-binding lectin (MBL) can bind to microorganisms, initiating
the lectin pathway of complement activation. Aberrant MBL serum levels, caused by
MBL2 gene polymorphisms, are a possible risk factor for recurrent infections.
Within the 7 common MBL haplotypes, still considerable variation in MBL serum
levels exists. OBJECTIVE: To investigate functional MBL levels and MBL2
polymorphisms in a large cohort of children with recurrent acute otitis media.
METHODS: Twelve genetic variants in the MBL2 gene and functional MBL serum levels
were determined in a cohort of children with recurrent acute otitis media.
Haplotypes were constructed and associated with functional MBL serum levels and
the number of otitis episodes in the previous year. RESULTS: The 7 common MBL2
haplotypes mainly determine the level of functional MBL in serum. In addition,
the 3130G>C single nucleotide polymorphism, located in exon 4, further
significantly influenced functional MBL levels within the LXPA haplotype. LXPA
carriers with 3130G showed a significantly lower geometric mean functional MBL
serum level of 0.19 mug/mL compared with 0.70 mug/mL in 3130C carriers (P =
.026). Nonwild-type MBL2 carriers between 12 and 24 months had a significantly
increased number of otitis episodes (5.1/y) compared with wild-type MBL2 carriers
(4.1/y; P = .027). In older children, this association was not found anymore.
CONCLUSION: Additional single nucleotide polymorphisms within the 7 common
haplotypes can further explain the observed variation in functional MBL serum
levels. MBL seems to be of particular clinical importance during early childhood,
when maternally derived antibodies have waned, and protective adaptive immunity
is not well developed yet. CLINICAL IMPLICATIONS: Single nucleotide polymorphisms
in the promoter region, in exon 1, and in exon 4 of MBL2 contribute to increased 
risk for otitis media in children younger than 2 years.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16750996 [PubMed - indexed for MEDLINE]

723: Int J Pediatr Otorhinolaryngol. 2006 Sep;70(9):1561-8. Epub 2006 Jun 5.

Recurrent otitis media and tonsillitis: common disease predisposition.

Kvestad E, Kvaerner KJ, Røysamb E, Tambs K, Harris JR, Magnus P.

Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
ellen.kvestad@fhi.no <ellen.kvestad@fhi.no>

OBJECTIVE: To estimate the relative contribution of genetic and environmental
effects to the association between recurrent otitis media and recurrent
tonsillitis. METHODS: Self-report questionnaire data from a population-based
cohort of 9479 Norwegian twins born from 1967 to 1979. Recurrent otitis media and
recurrent tonsillitis were main outcome measures. Structural equation modelling
was used to fit alternative biometric models to the twin data and to estimate the
relative contribution of genetic and environmental effects to the association
between otitis media and tonsillitis. RESULTS: The lifetime prevalence was 11.7% 
(95% CI: 11.0-12.3) for recurrent tonsillitis and 11.2% (95% CI 10.5-11.9) for
recurrent otitis media. Tetrachoric correlations were greater in monozygotic than
in dizygotic twins in both males and females. A model specifying additive genetic
effects and individual environmental effects for otitis media and tonsillitis and
non-additive genetic effects for tonsillitis yielded the best fit. There was no
evidence for sex differences in the genetic source or magnitude of the genetic
effects. There was a substantial overlap in genetic factors influencing variation
in liability to otitis media and tonsillitis. CONCLUSION: Common genetic factors 
contribute substantially to comorbidity between recurrent otitis media and
recurrent tonsillitis.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Twin Study

PMID: 16750862 [PubMed - indexed for MEDLINE]

724: Acta Otorhinolaryngol Ital. 2005 Dec;25(6):359-64.

Quality of life and psycho-social development in children with otitis media with 
effusion.

Bellussi L, Mandalà M, Passàli FM, Passàli GC, Lauriello M, Passali D.

ENT Department, Siena University Medical School, Italy. bellussi@unisi.it

Purpose of this study was to correlate results from a survey on otitis media and 
the State-Trait Anxiety Inventory test. This survey investigated prevalence of
otitis media (OM) in our territory, influence on development of language and
personality and social costs. State-Trait Anxiety Inventory is a suitable test to
differentiate state anxiety caused by a specific event [in this case, otitis
media with effusion (OME)] from a trait anxiety (anxious personality) in parents 
and caregivers. The otitis media study was conducted, retrospectively, in two
primary public schools in Colle Val D'Elsa (Siena) on 252 children (6-11 years
old). The State-Trait Anxiety Inventory test had been administered to the parents
or caregivers of 20 paediatric outpatients (4-12 years, mean 6.8) at the ENT
Department of Siena University. The results of the OM survey showed a correlation
between OM and difficulties in speech and reading, delayed answering and limited 
vocabulary. All these problems improved as children grew up. On the other hand,
psycho-social development appeared to be more problematic even in the 4th and 5th
class, mostly due to persistent attention disturbances. In the State-Trait
Anxiety Inventory test, 50% of parents or caregivers had a high state-anxiety
score and so were mostly concerned with health status of the children. The
State-Trait Anxiety Inventory results indicated that 50% of parents or caregivers
had a high trait-anxiety score and thus had an anxious personality. These
findings could be helpful in understanding the real severity of symptoms. The two
proposed tests could provide complementary data to evaluate children with OME:
the OM survey can be used as a screening test to detect children with
non-symptomatic OME, to establish whether delayed language development may be
associated with OME, to predict prognosis and children's quality of life as well 
as social costs of OME; the State-Trait Anxiety Inventory test can be used to
reveal a state or a trait anxiety in parents and caregivers in order to better
understand their point of view. Parents' and caregivers' personality has a marked
influence on the impact of OME on the children's quality of life. Quality of life
in children with otitis media with effusion is one of the most important
parameters to be taken into consideration on account of the possible correlation 
with problems in development.

PMID: 16749604 [PubMed - indexed for MEDLINE]

725: Pediatrics. 2006 Jun;117(6):1879-86.

Trends in doctor consultations, antibiotic prescription, and specialist referrals
for otitis media in children: 1995-2003.

Plasschaert AI, Rovers MM, Schilder AG, Verheij TJ, Hak E.

Julius Center for Health Sciences and Primary Care, University Medical Center
Utrecht, Utrecht, The Netherlands.

BACKGROUND: Reported trends regarding the incidence of otitis media and
antibiotic prescription rates are inconsistent. OBJECTIVE: Our goal was to assess
changes in incidence of consultation rates, antibiotic prescription, and referral
rates for otitis media in children over the years 1995-2003. METHODS: A cohort
study including all children aged 0 to 13 years within the research database of
the Netherlands University Medical Center Utrecht Primary Care Network covering
the period 1995-2003. Otitis media diagnoses were recorded according to the
International Classification of Primary Care codes and antibiotic prescription
according to the Anatomic Therapeutic Chemical Classification System codes.
Otitis media incidence rates were calculated as episodes per 1000 person-years.
Antibiotic prescription and referral rates were calculated per 100 otitis media
episodes. RESULTS: From 1995 to 2003, the overall general practitioner
consultation rates for acute otitis media and otitis media with effusion declined
by 9% and 34%, respectively. In children aged 2 to 6 years and those aged 6 to 13
years, the incidence rates of acute otitis media and otitis media with effusion
declined by 15% and 41% and 40% and 48%, respectively. In children <2 years of
age, the incidence rates of acute otitis media and otitis media with effusion
increased by 46% and 66%, respectively. Antibiotic prescription rates for acute
otitis media and otitis media with effusion increased by 45% and 25%,
respectively. The referral rate for acute otitis media did not change, whereas
the referral rate for otitis media with effusion increased by 45%. CONCLUSIONS:
Consultation rates for otitis media have changed considerably over the last
decade, and so have antibiotic prescriptions and specialist referrals. The rising
antibiotic prescription rate for otitis media causes concern, because this may
induce increasing medical costs and antibiotic resistance.

PMID: 16740826 [PubMed - indexed for MEDLINE]

726: Pediatrics. 2006 Jun;117(6):e1087-94.

Empiric first-line antibiotic treatment of acute otitis in the era of the
heptavalent pneumococcal conjugate vaccine.

Garbutt J, Rosenbloom I, Wu J, Storch GA.

Division of General Medical Sciences, Washington University School of Medicine,
St Louis, Missouri, USA. jgarbutt@im.wustl.edu

OBJECTIVES: Our goal was to estimate the local prevalence of Streptococcus
pneumoniae nonsusceptible to penicillin and amoxicillin after widespread use of
the heptavalent pneumococcal vaccine and to revise community-specific
recommendations for first-line antibiotic treatment of acute otitis media.
METHODS: We conducted serial prevalence surveys between 2000 and 2004 in the
offices of community pediatricians in St Louis, Missouri. Study participants were
children <7 years of age with acute upper respiratory infections. Children
treated with an antibiotic in the past 4 weeks were excluded. S pneumoniae was
isolated from nasopharyngeal swabs using standard techniques. Isolates with a
penicillin minimum inhibitory concentration >2 microg/mL were considered to be S 
pneumoniae nonsusceptible to amoxicillin. RESULTS: There were 327 patients
enrolled in the study. Between 2000 and 2004, vaccine coverage with > or =3 doses
of heptavalent pneumococcal vaccine increased from 0% to 54%, but nasopharyngeal 
carriage of S pneumoniae was stable at 39%. The prevalence of S pneumoniae
nonsusceptible to penicillin fell from 25% to 12% among patients, did not vary if
<2 years of age, was reduced in children with > or =3 doses of heptavalent
pneumococcal vaccine, and increased in child care attendees but reduced in
attendees who had > or =3 doses of heptavalent pneumococcal vaccine. The
prevalence of S pneumoniae nonsusceptible to amoxicillin in patients remained
<5%. CONCLUSIONS: In our community, widespread use of heptavalent pneumococcal
vaccine has reduced the prevalence of S pneumoniae nonsusceptible to penicillin, 
and the prevalence of S pneumoniae nonsusceptible to amoxicillin remains low
(<5%). If antibiotic treatment is elected for children with uncomplicated acute
otitis media, we recommend treatment with standard-dose amoxicillin (40-45 mg/kg 
per day) for children with > or =3 doses of heptavalent pneumococcal vaccine,
regardless of age and child care status. High-dose amoxicillin should be used for
children with <3 doses of heptavalent pneumococcal vaccine and those treated
recently with an antibiotic.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16740811 [PubMed - indexed for MEDLINE]

727: J Laryngol Otol. 2006 Sep;120(9):736-9. Epub 2006 Jun 2.

Malleus-stapes assembly: experience with two prostheses.

Al-Qudah M, Dawes PJ.

Department of ORL-HNS, Division of Medical and Surgical Sciences, University of
Otago, Dunedin, New Zealand.

Tympanoplasty is often a necessary part of middle-ear surgery, the most common
defect being that between an intact, mobile stapes and the malleus handle. The
most readily available tissue is the patient's incus, reshaped to bridge the
space between an intact stapes and the malleus. When the incus cannot be used,
the hydroxyapatite Wehrs incus prosthesis can be used as an
alternative.Twenty-six patients had an autograft incus ossiculoplasty and 20
patients underwent modified Wehrs incus prosthesis ossiculoplasty. The average
post-operative air-bone gaps (ABGs) were 16.2 dB hearing loss (dBHL) and 17.2
dBHL, respectively. Air-bone gap closure to within 15 dBHL was achieved for 48
per cent of incus autografts and for 57 per cent of Wehrs prostheses, and to
within 20 dBHL for 77 per cent and 62 per cent, respectively. Over four years
follow up, the reconstruction was stable for each group, the ABGs being 17.7 dBHL
and 17.1 dBHL, respectively.

Publication Types: 
    Evaluation Studies

PMID: 16740203 [PubMed - indexed for MEDLINE]

728: Am J Vet Res. 2006 Jun;67(6):1040-4.

In vitro activity of an ear rinse containing tromethamine, EDTA, and benzyl
alcohol on bacterial pathogens from dogs with otitis.

Cole LK, Luu DH, Rajala-Schultz PJ, Meadows C, Torres AH.

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The
Ohio State University, Columbus, OH 43210, USA.

OBJECTIVE: To evaluate the in vitro activity of an ear rinse (ER) containing
tromethamine, EDTA, and benzyl alcohol on bacterial pathogens from dogs with
otitis. SAMPLE POPULATION: Organisms were collected from ear swab specimens from 
the external and middle ear and included Staphylococcus spp (n = 11;
Staphylococcus intermedius [7] and Staphylococcus spp [4]), Pseudomonas
aeruginosa (5), Proteus spp (5), beta-hemolytic streptococcus (11), and 1 control
strain of each organism. PROCEDURES: 3 test solutions were evaluated including
EDTA, tromethamine, and benzyl alcohol (ER); EDTA and tromethamine (ER without
benzyl alcohol [ER - BA]); and purified water. Ten-milliliter aliquots of each
test solution were transferred into 36 tubes and inoculated with one of the
organisms. Samples were retrieved from each tube at 0, 15, 30, 45, and 60
minutes, transferred to Petri dishes, mixed with soybean-casein digest agar, and 
incubated. After incubation, plates were examined for growth, and the number of
colonies was expressed as CFU per milliliter. RESULTS: ER significantly decreased
bacterial growth in vitro of P aeruginosa and beta-hemolytic streptococcal
organisms within 15 minutes, Proteus spp within 30 minutes, and Staphylococcus
spp within 60 minutes. Comparatively, the presence of benzyl alcohol in ER
significantly decreased bacterial growth of beta-hemolytic streptococcus and
Proteus spp. CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of results of this 
study, future studies should be performed to evaluate the in vivo efficacy of ER 
alone as a treatment for otic infections caused by beta-hemolytic streptococcus, 
P aeruginosa, and Proteus spp and of ER combined with an antimicrobial agent for 
otic infections caused by Staphylococcus spp.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16740099 [PubMed - indexed for MEDLINE]

729: Ann Otol Rhinol Laryngol. 2006 May;115(5):330-3.

Tympanoplasty for chronic otitis media in post-irradiated nasopharyngeal
carcinoma patients.

Hsu YC, Su CY.

Department of Otolaryngology, Chang Gung University, Chang Gung Memorial
Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan.

OBJECTIVES: We evaluated the surgical outcome of tympanoplasty for chronic otitis
media in post-irradiated patients with nasopharyngeal carcinoma. METHODS:
Nineteen ears were treated in 15 patients with nasopharyngeal carcinoma who had
undergone radiotherapy in this retrospective clinical series. Only patients with 
simple perforations of the tympanic membrane and normal or near-normal eustachian
tube function were enrolled in this study. All patients underwent type I
tympanoplasty. RESULTS: All patients had been treated with radiotherapy of 64.8
to 81.0 Gy. The intervals between radiotherapy and surgery ranged from 17 months 
to 20 years. The tympanic membranes in 10 of 19 ears were intact after surgery.
Otorrhea had subsided in 11 ears (58%), and the incidence of otorrhea was
decreased in 6 ears (32%). Thirteen of the 15 patients (86.7%) reported that
their quality of life had improved. CONCLUSIONS: Surgical intervention benefits
some patients with nasopharyngeal carcinoma with chronic otitis media resulting
from radiotherapy.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16739662 [PubMed - indexed for MEDLINE]

730: Laryngoscope. 2006 Jun;116(6):921-7.

Erratum in:
    Laryngoscope. 2006 Nov;116(11):2098.

Tuberculous otitis media: a clinical and radiologic analysis of 52 patients.

Cho YS, Lee HS, Kim SW, Chung KH, Lee DK, Koh WJ, Kim MG.

Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, 
Sungkyunkwan University School of Medicine, Seoul, Korea.

OBJECTIVE: This retrospective study reports on the clinical and radiologic
features and the treatment outcomes of patients with tuberculous otitis media
(TOM). METHODS: We reviewed the medical records of 52 patients (53 ears) with TOM
between 1993 and 2005 and analyzed temporal bone computed tomography scans of 23 
patients. The diagnosis of TOM was made if a specimen of the middle ear revealed 
the presence of acid fast bacilli (AFB), grew Mycobacterium tuberculosis (M. Tb) 
on a culture, revealed characteristic histology, and/or was positive for
polymerase chain reaction (PCR) for M. Tb. RESULTS: The highest incidence of the 
disease was observed among patients in their 30s. The main symptom was otorrhea, 
and the duration of symptoms was shorter than with nonspecific chronic otitis
media. Most patients demonstrated a moderate to severe hearing loss. Five
patients (9.6%) demonstrated a peripheral-type facial palsy. Temporal bone CT
scans demonstrated relatively well-pneumatized mastoids and occupation by soft
tissue of the entire tympanum and mastoid air cells. Six patients demonstrated
bone destruction that involved the cortex of the mastoid bone. In most patients, 
antituberculous medication was effective treatment. The patients who underwent
chemotherapy after surgery achieved more rapid healing of the ear and more
frequent closure of the tympanic membrane than those who did not receive surgery.
CONCLUSIONS: Clinicians should have a high index of suspicion and be aware of the
clinical and radiologic characteristics of TOM.

PMID: 16735889 [PubMed - indexed for MEDLINE]

731: J Vet Intern Med. 2006 May-Jun;20(3):648-56.

Clinical signs, magnetic resonance imaging features, and outcome after surgical
and medical treatment of otogenic intracranial infection in 11 cats and 4 dogs.

Sturges BK, Dickinson PJ, Kortz GD, Berry WL, Vernau KM, Wisner ER, LeCouteur RA.

Department of Surgical and Radiological Sciences, School of Veterinary Medicine, 
University of California, Davis 95616-8747, USA. bksturges@ucdavis.edu

Brainstem dysfunction resulting from central extension of infection is a
life-threatening complication of otitis media/interna (OMI) that has been
described infrequently in dogs and cats. We review the clinical signs of disease,
diagnostic findings, and results of surgical and medical treatments of brainstem 
disease attributable to otogenic intracranial infection in cats and dogs. Eleven 
cats and 4 dogs were examined because of acute, subacute, or chronic clinical
signs of brain disease including central vestibular signs, altered mentation,
abnormal posture/gait, cranial nerve deficits, and seizures. Results of a minimal
database (CBC, serum biochemical panel, urinalysis, thoracic radiographs, and
abdominal ultrasonographic images or radiographs) were within reference intervals
in all animals. Magnetic resonance (MR) images of the head were acquired for all 
animals, and cisternal cerebrospinal fluid (CSF) from 9 of 11 cats and 3 of 4
dogs was examined. Surgical exploration and ventral bulla osteotomy were done for
12 of 15 animals, followed by 1-3 months of antibiotic therapy; the remaining
animals were euthanized before treatment. In all animals, MR imaging was
effective in characterizing the location and extent of the pathologic changes
intracranially as well as within middle/inner ear structures. Results of CSF
analysis were characteristic of bacterial infection in most of the animals with
acute or subacute disease. Since long-term outcome in all treated animals was
very good to excellent, it was concluded that dogs and cats with intracranial
disease secondary to extension of otitis media/interna have a good-to-excellent
prognosis when the condition was diagnosed and was treated by surgical
exploration and appropriate antibiotic therapy.

PMID: 16734103 [PubMed - indexed for MEDLINE]

732: Pediatr Infect Dis J. 2006 Jun;25(6):546-52.

Advances in understanding the pathogenesis of pneumococcal otitis media.

Tonnaer EL, Graamans K, Sanders EA, Curfs JH.

Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen,
The Netherlands. e.tonnaer@kno.umcn.nl

In this review, a state of the art on otitis media research is provided with
emphasis on the role of Streptococcus pneumoniae in the pathogenesis of this
disease. Articles have been selected by MEDLINE search supplemented with a manual
crosscheck of bibliographies. Pathogenic mechanisms in middle ear and eustachian 
tube are described. Furthermore, pneumococcal characteristics and
pneumococcus-host interactions are highlighted as well as the possible role of
biofilms in persistence or recurrence of otitis media. Because of the
availability of new techniques, an increasing number of pneumococcal features
contributing in the pathogenesis of otitis media are identified and in-depth
knowledge of pneumococcus-host interactions has been gained. The present advances
in research on otitis media open up new perspectives for therapeutic or
preventive strategies.

Publication Types: 
    Review

PMID: 16732155 [PubMed - indexed for MEDLINE]

733: Sex Transm Infect. 2006 Jun;82(3):219-20.

Otitis media in adults with chlamydial conjunctivitis.

Goh BT, Hadley JM, Lomax NJ, Patel HC, Viswalingam ND.

Diagnostic Clinic, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK.
beng.goh@bartsandthelondon.nhs.uk

The aim of this study was to assess the prevalence of otological symptoms in
patients with chlamydial conjunctivitis. We report four cases of chlamydial
conjunctivitis, in association with otitis media, that were investigated by an
otologist.

Publication Types: 
    Case Reports

PMID: 16731671 [PubMed - indexed for MEDLINE]

734: Otolaryngol Head Neck Surg. 2006 Jun;134(6):936-9.

Does otitis media in early childhood affect reading performance in later school
years?

Golz A, Westerman ST, Westerman LM, Gilbert DA, Netzer A.

Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center and The
Bruce Rappaport Faculty of Medicine, The Technion, Haifa, Israel.
golz@netvision.net.il

OBJECTIVE: To evaluate reading performance in children with recurrent otitis
media during childhood once middle-ear diseases have resolved and the children
grew older. STUDY DESIGN AND SETTING: Seventy-five children with middle-ear
problems during childhood and poor reading performance in first grades and 60
healthy controls free of middle ear diseases were enrolled in the study. All
children underwent an otologic and audiologic evaluation followed by reading
tests. RESULTS: Reading performance was not affected once otitis media had been
cured and hearing restored; reading scores of the healed children were almost the
same as those of the otitis-free children (3.39% and 3.1%, respectively).
Children who still suffer from middle-ear problems and hearing loss had an
average percentage of reading mistakes of 7.3%. CONCLUSIONS AND SIGNIFICANCE:
Once children are cured from their middle-ear diseases and hearing is restored,
previously noted reading impairments are no longer evident. Reading is still
impaired among children who continue to suffer from middle-ear problems and
hearing loss even when they grow older. EBM RATING: B-2b.

PMID: 16730533 [PubMed - indexed for MEDLINE]

735: Vaccine. 2006 Jul 7;24(27-28):5584-92. Epub 2006 May 8.

Intranasal vaccination of neonatal mice with polysaccharide conjugate vaccine for
protection against pneumococcal otitis media.

Sabirov A, Metzger DW.

Center for Immunology & Microbial Disease, Albany Medical College (MC-151), 47
New Scotland Ave., Albany, NY 12208, USA.

Streptococcus pneumoniae is the leading bacterial cause of acute otitis media
(OM) in young children, and can often produce invasive disease. Typical
intramuscular routes of vaccination are poorly protective against development of 
OM. In the present study, we intranasally (i.n.) inoculated neonatal 1-week-old
mice with pneumococcal polysaccharide conjugate vaccine using IL-12 as a mucosal 
adjuvant. The protective efficacy of this treatment was tested by challenging
immunized infant (3-week-old) mice with bacteria to induce OM and invasive
disease. i.n. vaccination was found to enhance levels of specific antibodies in
middle ear (ME) washes and sera from wild-type (but not IFN-gamma(-/-)) mice.
Immunization in the presence of IL-12 resulted in enhanced clearance of S.
pneumoniae from the ME. Opsonization of bacteria with ME wash fluids or sera from
immunized mice caused increased bacterial clearance from the ME of naïve mice. In
addition, immunized mice demonstrated 89% survival after OM-induced invasive
pneumococcal infection, compared to 22% survival in unvaccinated mice. These
results indicate that i.n. vaccination of neonatal mice in the presence of IL-12 
is able to enhance IFN-gamma dependent ME mucosal and systemic immune responses
to pneumococci and efficiently protect against both OM and invasive infection.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16730398 [PubMed - indexed for MEDLINE]

736: Curr Opin Otolaryngol Head Neck Surg. 2006 Jun;14(3):187-90.

The links between allergy and otitis media with effusion.

Tewfik TL, Mazer B.

Department of Otolaryngology, McGill University, Montreal, Canada.
ted.tewfik@mcgill.ca

PURPOSE OF REVIEW: In this review we will examine evidence indicating that
allergic inflammation is present in middle ear effusion. We will also discuss
several of the problems relating to the diagnosis of allergy and allergic
sensitization, and why anti-allergy treatments have been unsuccessful. This will 
provide a rationale for future studies in the field linking allergic inflammation
with otitis media with effusion. RECENT FINDINGS: Recent findings in atopic
children demonstrated higher levels of eosinophils, T lymphocytes, and
interleukin-4+ and interleukin-5+ cells compared with nonatopic patients.
T-helper 2 cells and cytokines were found not only in middle ear effusions in
atopic children but also in specimens from adenoid tissue. This demonstrates a
strong correlation between allergic reaction in the middle ear and the upper
airway. SUMMARY: In summary, as our knowledge of the allergic and nonallergic
influences on inflammation broadens, the paradigms of treatment may be altered.
The accumulating experimental and clinical data suggest that it may be wiser to
screen every child with otitis media with effusion for allergic rhinitis and
ultimately to manage those with allergic inflammation differently to nonatopic
individuals with otitis media with effusion.

Publication Types: 
    Review

PMID: 16728898 [PubMed - indexed for MEDLINE]

737: Acta Otolaryngol. 2006 Jun;126(6):564-9.

Spiral ligament fibrocytes release chemokines in response to otitis media
pathogens.

Moon SK, Park R, Lee HY, Nam GJ, Cha K, Andalibi A, Lim DJ.

Department of Gonda Cell and Molecular Biology, House Ear Institute, Los Angeles,
CA 90057, USA.

CONCLUSION: Spiral ligament fibrocytes (SLFs) may be involved in the innate
immune response of the inner ear by producing chemoattractants for recruiting
inflammatory cells such as neutrophils and monocytes. OBJECTIVE: The purpose of
this study was to investigate the cellular responses of SLFs when challenged by
inflammatory stimuli such as components of otitis media pathogens or
proinflammatory cytokines. MATERIALS AND METHODS: To detect released inflammatory
cytokines and chemokines, cells were treated for 48 h with whole lysates of
nontypable Haemophilus influenzae (NTHi), Streptococcus pneumoniae, or with
interleukin 1 alpha (IL-1alpha). The culture medium was then collected and
applied to protein arrays. To compare mRNA levels of chemokines, total RNA was
extracted after 3 h of treatment with the above agents, and quantitative
real-time PCR was performed. RESULTS: Protein array analysis showed that in
response to NTHi or S. pneumoniae, rat SLFs released monocyte chemotactic protein
1, macrophage inflammatory protein 3 alpha, TNF-alpha, and cytokine-induced
neutrophil chemoattractant 2 and 3. Treatment with IL-1alpha, on the other hand, 
resulted in release of MCP-1 but not the other molecules. Tissue inhibitor of
metalloproteinase 1 and vascular endothelial growth factor were released
regardless of the inflammatory stimulus used.

PMID: 16720438 [PubMed - indexed for MEDLINE]

738: Auris Nasus Larynx. 2007 Mar;34(1):91-3. Epub 2006 May 23.

Pneumocephalus secondary to mastoid surgery: a case report.

Lee DH, Cho HH, Cho YB.

Department of Otolaryngology-Head and Neck Surgery, Chonnam National University
Medical School, 8 Hackdong, Donggu, Gwangju 501-190, Korea.

Pneumocephalus secondary to mastoid surgery is uncommon. Serious sequelae and
central nervous system infection may result from inadequate management. It is
diagnosed by careful history, physical examination and imaging studies.
Treatments of pneumocephalus secondary to mastoid surgery are conservative
treatment or surgery. The aim of surgery is to detect communication between
mastoid cavity and brain, and to correct it. We present a case of pneumocephalus 
secondary to mastoid surgery in 22-year-old man, which was treated with surgery.

Publication Types: 
    Case Reports

PMID: 16720088 [PubMed - indexed for MEDLINE]

739: Clin Radiol. 2006 Jun;61(6):495-504.

MRI findings and spreading patterns of necrotizing external otitis: is a poor
outcome predictable?

Kwon BJ, Han MH, Oh SH, Song JJ, Chang KH.

Department of Radiology, Seoul National University College of Medicine, and
Clinical Research Institute, Seoul National University Hospital, South Korea.

AIM: To evaluate spreading patterns of necrotizing external otitis (NEO) by
magnetic resonance imaging (MRI) and to identify spreading patterns related to a 
poor outcome. MATERIALS AND METHODS: Fourteen patients with NEO were divided into
good and poor outcome groups according to their final clinical outcomes. Initial 
MRI images were retrospectively reviewed for regional abnormalities, and
follow-up MRI images were reviewed for ICA flow void abnormality and for the
following five spreading patterns: medial, crossed, anterior, intracranial, and
combined. The frequencies of the abnormal flow void or spreading patterns were
compared between the good and poor response groups. RESULTS: Seven (50%) and
seven (50%) patients were respectively allocated to the good and poor outcome
groups. Retrocondylar fat infiltration was the most commonest finding on initial 
MRI images (93%). The frequencies of the abnormal flow void and spreading
patterns in the good and poor groups, respectively, were: abnormal flow void, 0
and four (57%); anterior, two (29%) and three (43%); medial, six (86%) and seven 
(100%); crossed, six (86%) and seven (100%); intracranial middle cranial fossa,
one (14%) and four (57%); intracranial posterior cranial fossa, four (57%) and
six (86%); intracranial foramen magnum, one (14%) and six (86%). CONCLUSIONS: NEO
almost always involves the retrocondylar fat and spreads via various pathways to 
extracranial or intracranial spaces. The presence of an abnormal flow void and
intracranial dural enhancement, particularly in the middle cranial fossa and
foramen magnum, may indicate a poor prognosis.

PMID: 16713420 [PubMed - indexed for MEDLINE]

740: Scand J Infect Dis. 2006;38(4):265-7.

Management of pain in acute otitis media in Finnish primary care.

Pulkki J, Huikko S, Rautakorpi UM, Honkanen P, Klaukka T, Mäkelä M, Palva E,
Roine R, Sarkkinen H, Varonen H, Huovinen P; MIKSTRA Collaborative Study Group.

Department of Bacterial and Inflammatory Diseases, National Public Health
Institute, Turku, Finland. johanna.pulkki@ktl.fi

Most treatment recommendations for acute otitis media favour active use of pain
relief medication. These data comprised 3059 Finnish primary care acute otitis
media patients. We found that 10.4% of the patients were prescribed or
recommended analgesics, which is in contrast to treatment recommendations.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16709526 [PubMed - indexed for MEDLINE]

741: Eur J Immunol. 2006 Jun;36(6):1527-36.

Alloiococcus otitidis is a ligand for collectins and Toll-like receptor 2, and
its phagocytosis is enhanced by collectins.

Konishi M, Nishitani C, Mitsuzawa H, Shimizu T, Sano H, Harimaya A, Fujii N, Himi
T, Kuroki Y.

Department of Biochemistry, Sapporo Medical University School of Medicine, Japan.

Alloiococcus otitidis has been found to be associated with otitis media with
effusion. In this study we investigated whether TLR2 and collectins, surfactant
protein A (SP-A) and mannose-binding lectin (MBL), interacted with A. otitidis.
Both SP-A and MBL bound to A. otitidis in a Ca(2+)-dependent manner. A. otitidis 
induced IL-8 secretion from U937 cells and NF-kappaB activation in
TLR2-transfected HEK293 cells. However, the cells transfected with the mutant
TLR2(P681H) did not respond to A. otitidis. In addition, A. otitidis
co-sedimented a recombinant soluble form of the extracellular TLR2 domain,
indicating direct binding of the bacterium to TLR2. SP-A and MBL augmented the
phagocytosis of A. otitidis by J774A.1 cells. The collectin-stimulated
phagocytosis of A. otitidis was significantly attenuated when fucoidan and
polyinosinic acid were co-incubated. Immunoblotting analysis revealed that MBL
was present in the middle ear effusion from patients with otitis media. These
results demonstrate that A. otitidis is a ligand for the collectins and TLR2, and
that the collectins enhance the phagocytosis of A. otitidis by macrophages,
suggesting important roles of the collectins and TLR2 in the innate immunity of
the middle ear against A. otitidis infection.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16708401 [PubMed - indexed for MEDLINE]

742: Pediatrics. 2006 Jun;117(6):e1119-23. Epub 2006 May 15.

Clinical manifestations and risk factors of children receiving triple ventilating
tube insertions for treatment of recurrent otitis media with effusion.

Ahn JH, Yoon TH, Pae KH, Kim TS, Chung JW, Lee KS.

Department of Otolaryngology, Asan Medical Center, University of Ulsan College of
Medicine, Seoul 138-736, Korea.

OBJECTIVE: Our goal was to determine risk factors for children receiving
additional ventilating tube insertions after initial tube insertion and to
determine the changes of clinical manifestations in children who have undergone 3
ventilating tube insertion procedures. STUDY DESIGN: We retrospectively analyzed 
medical and operation records of 423 young patients who had ventilating tube
insertion because of chronic otitis media with effusion from January 1993 to
December 1998. The single-operation group included patients who had 1 ventilating
tube insertion only, and the triple-operation group included patients who
received ventilating tube insertion 3 times because of recurring chronic otitis
media with effusion. RESULTS: At the first operation, there were significant
differences between the single- and triple-operation groups in mean age, the
proportion who received a concurrent adenoidectomy, the mean indwelling period of
the first ventilating tube, the proportion who developed postoperative otorrhea
within 1 month, and the proportion who had early extrusion of the ventilating
tube within 3 months of surgery. In the triple-operation group, the accumulated
number of adenoidectomies, the indwelling period of the ventilating tube, and the
time interval before subsequent ventilating tube insertion after ventilating tube
extrusion significantly increased as ventilating tube insertion procedures were
performed repeatedly. Although there was no difference when compared with the
single-operation group, the proportion of glue-like effusion significantly
decreased as ventilating tube insertion procedures were performed repeatedly.
There were no significant differences between the single- and triple-operation
groups in male/female ratio, site of ventilating tube insertion, and the
proportion of patients with glue-like effusion at the first ventilating tube
insertion. CONCLUSIONS: The probability of receiving additional ventilating tube 
insertion because of recurrent otitis media with effusion significantly increased
in younger patients at the time of first ventilating tube insertion. The
concurrent adenoidectomy, duration of the ventilating tube, postoperative
otorrhea within 1 month, and early extrusion of the ventilating tube also
influenced the probability of additional ventilating tube insertion.

PMID: 16702251 [PubMed - indexed for MEDLINE]

743: Acta Otolaryngol. 2006 May;126(5):460-6.

Inner ear and facial nerve complications of acute otitis media with focus on
bacteriology and virology.

Hydén D, Akerlind B, Peebo M.

Department of Otolaryngology, Linköping University Hospital, Linköping, Sweden.
dag.hyden@lio.se

CONCLUSION: Among 20 patients with inner ear complications and/or peripheral
facial palsy secondary to acute otitis media (AOM) a proven or probable
bacteriological cause was found in 13 (65%). In seven patients (35%), a proven or
probable viral cause was found. Only two of the patients (10%), with a proven
bacterial AOM and a clinical picture of a purulent labyrinthitis in both,
together with a facial palsy in one, had a substantial degree of dysfunction.
Although the number of patients in this study is relatively low our findings show
that inner ear complications and facial palsy due to AOM can be of both bacterial
and viral origin. Severe sequelae were found only where a bacterial origin was
proven. OBJECTIVES: Inner ear complications and/or peripheral facial palsy
secondary to AOM are rare. The general understanding is that they are due to
bacterial infections. However, in some of these patients there are no clinical or
laboratory signs of bacterial infections and they have negative bacterial
cultures. During recent years different viruses have been isolated from the
middle ear or serologically proven in AOM patients and are thought to play a
pathogenetic role. We suggest that in some cases of AOM complications from the
inner ear and the facial nerve can be caused by viruses. The purpose of our study
was to analyze infectious agents present in patients with inner ear complications
and/or facial palsy arising from AOM. PATIENTS AND METHODS: The medical records
of 20 patients who had inner ear complications and/or facial palsy following AOM 
( unilateral in 18, bilateral in 2) between January 1989 and March 2003 were
evaluated. Bacterial cultures were carried out for all patients. Sera from 12 of 
the patients were stored and tested for a battery of specific viral antibodies.
In three patients, investigated between November 2002 and March 2003, viral
cultures were also performed on samples from the middle ear and nasopharynx.
RESULTS: Nineteen patients had inner ear symptoms. Eight of them had a unilateral
sensorineural hearing loss and vertigo, three had vertigo as an isolated symptom 
and one, with bilateral AOM, had bilateral sensorineural hearing loss. Seven
patients had a combination of facial palsy and inner ear symptoms (unilateral
sensorineural hearing loss in three, unilateral sensorineural hearing loss and
vertigo in two, bilateral sensorineural hearing loss and vertigo in one, with
bilateral AOM, and vertigo alone in one). One patient had an isolated facial
palsy. Healing was complete in 11 of the 20 patients. In seven patients a minor
defect remained at follow-up (a sensorineural hearing loss at higher frequencies 
in all). Only two patients had obvious defects (a pronounced hearing loss in
combination with a moderate to severe facial palsy (House-Brackman grade 4) in
one, distinct vestibular symptoms and a total caloric loss in combination with a 
high-frequency loss in the other. Eight patients had positive bacteriological
cultures from middle ear contents: Streptococcus pneumoniae in two,
beta-hemolytic Streptococcus group A in two, beta-hemolytic Streptococcus group A
together with Staphylococcus aureus in one, Staph. aureus alone in one and
coagulase-negative staphylococci (interpreted as pathogens) in two. In the 12
patients with negative cultures, there was a probable bacteriological cause due
to the outcome in SR/CRP and leukocyte count in five. In four patients
serological testing showed a concomitant viral infection that was interpreted to 
be the cause (varicella zoster virus in two, herpes simplex virus in one and
adenovirus in one.) In three there was a probable viral cause despite negative
viral antibody test due to normal outcome in SR/CRP, normal leukocyte count,
serous fluid at myringotomy and a relatively short pre-complication antibiotic
treatment period.

PMID: 16698694 [PubMed - indexed for MEDLINE]

744: Bioorg Med Chem. 2006 Aug 15;14(16):5673-7. Epub 2006 May 11.

Topical anti-inflammatory activity of 2alpha-hydroxy pentacyclic triterpene acids
from the leaves of Ugni molinae.

Aguirre MC, Delporte C, Backhouse N, Erazo S, Letelier ME, Cassels BK, Silva X,
Alegría S, Negrete R.

Laboratory of Natural Products, Department of Pharmacological and Toxicological
Chemistry, Faculty of Chemical and Pharmaceutical Sciences, University of Chile, 
Santiago 1. mcaguirr@ciq.uchile.cl

Leaf extracts of Ugni molinae Turcz. are used in the Chilean cosmetic industry on
the assumption that they have decongestant, regenerative, and anti-aging
properties. A bioassay-guided fractionation of this plant material showed that
some extracts have potent anti-inflammatory activities. Further fractionation led
to the isolation and identification of betulinic acid, a mixture of ursolic and
oleanolic acids, and the 2alpha-hydroxy derivatives alphitolic, asiatic, and
corosolic acids. The latter three were evaluated in vivo in the mouse ear assay
for their topical anti-inflammatory activity, inducing inflammation with either
arachidonic acid (AA) or 12-O-tetradecanoylphorbol-13 acetate (TPA). Only
corosolic acid was active in the AA assay, with similar potency to nimesulide,
but all three triterpene acids inhibited TPA-induced inflammation with potencies 
comparable to that of indomethacin.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16697209 [PubMed - indexed for MEDLINE]

745: Scand J Prim Health Care. 2006 Jun;24(2):88-92.

Detection of middle-ear fluid in children with spectral gradient acoustic
reflectometry: a screening tool for nurses?

Teppo H, Revonta M, Lindén H, Palmu A.

Department of Otorhinolaryngology, Kanta-Hame Central Hospital, Hameenlinna,
Finland. heikki.teppo@khshp.fi

OBJECTIVE: To evaluate the validity of spectral gradient acoustic reflectometry
(SG-AR) in the hands of nurses in screening children for middle-ear fluid (MEF). 
DESIGN: Prospective, blinded study. SETTING: A satellite study within the Finnish
Otitis Media Vaccine Trial in primary care in 1995-99. PATIENTS: Some 739 ear
examinations among a cohort of 271 children under the age of 2 years during
different healthcare contacts (acute sick visits, check-up visits after otitis
media, and scheduled healthy control visits at 24 months of age). MAIN OUTCOME
MEASURES: Specificity, sensitivity and positive and negative predictive values of
SG-AR performed by nurses in detecting MEF using pneumatic otoscopy by trained
physicians as a reference. RESULTS: SG-AR was successful in 585 (79%) ears. None 
of the cut-off points assessed resulted in both excellent sensitivity and
specificity. Nevertheless, at the sick visits, positive predictive values at 50
and 60 degrees were as high as 94% and 89%, respectively. However, negative
predictive value for the cut-off point of 100 degrees was considerably lower, at 
75%. At the non-acute visits, negative predictive values were excellent.
CONCLUSION: SG-AR is a useful device for nurses in screening MEF among children. 
It detects ears with both very high and very low probability of MEF and is
especially effective in detecting MEF during sick visits and in ruling out MEF
among non-acute patients. We recommend the use of the SG-AR cut-off point of 60
degrees as a sign of MEF when screening sick children, and the cut-off point of
100 degrees as a sign of a healthy ear among non-symptomatic patients.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 16690556 [PubMed - indexed for MEDLINE]

746: APMIS. 2006 Apr;114(4):285-91.

Otomicroscopic findings and systemic interleukin-6 levels in relation to
etiologic agent during experimental acute otitis media.

Foglé-Ansson M, White P, Hermansson A, Melhus A.

Department of Oto-Rhino-Laryngology, KSS, Skövde, Sweden.

The aim of the present study was to explore whether it was possible to
differentiate the clinical course and the otomicroscopic appearance of acute
otitis media (AOM) caused by common otitis pathogens in an animal model. Systemic
interleukin (IL)-6 levels as early markers for bacterial AOM were also studied.
Four groups of rats were inoculated with either Streptococcus pneumoniae,
Streptococcus pyogenes, non-typeable Haemophilus influenzae or Moraxella
catarrhalis. The animals were monitored by otomicroscopy, photos of the tympanic 
membrane, cultures and IL-6 detection in serum the following 4 days. The
gram-positive S. pneumoniae and S. pyogenes induced severe AOM with opaque
effusion behind the tympanic membrane, pronounced dilation of the vessels and
spontaneous perforations. The gram-negative H. influenzae and M. catarrhalis
induced a less severe infection with cloudy, sometimes foamy effusion, and no
spontaneous perforations. With the otomicroscopic findings it was possible to
distinguish between infections induced by gram-positive bacteria and
gram-negative bacteria. Detection of interleukin-6 in serum appeared to be of
limited use for all infections except the pneumococcal AOM, but this needs to be 
further investigated.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16689828 [PubMed - indexed for MEDLINE]

747: J Vet Med Sci. 2006 Apr;68(4):373-4.

Therapeutic effects of beta-thujaplicin eardrops on canine Malassezia-related
otitis externa.

Nakano Y, Matsuo S, Tani H, Sasai K, Baba E.

Department of Veterinary Clinical Science, Graduate School of Life and
Environmental Sciences, Osaka Prefecture University, Japan.

An eardrop solution of beta-thujaplicin was examined for therapeutic effects on
canine Malassezia-related otitis externa. Half to one ml of beta-thujaplicin
solution of 100 microg/ml including DMSO 2% was injected everyday into both
external ear canals of 31 cases for test-of-cure agreement. Fifteen score phases 
were established from the symptoms and cerumen smear biopsy findings, and score
changes were recorded at least once a week. The means of the second and the third
inspection day scores decreased significantly more than the previous value of
each. In addition, the numbers of yeast-like organisms clearly decreased. These
results suggest that beta-thujaplicin eardrops are effective for
Malassezia-related otitis externa in dogs.

Publication Types: 
    Clinical Trial

PMID: 16679729 [PubMed - indexed for MEDLINE]

748: B-ENT. 2006;2(1):7-12.

Wegener's granulomatosis presenting as otomastoiditis. A case report.

Kloeck I, Crols R, De Belder T, Vandist V, Schmelzer B.

ENT Department, AZ Middelheim, Antwerpen.

A 55-year-old male presented with left-sided otorrhoea, hearing loss and tinnitus
of 3 months duration. On clinical examination polypoid tissue was seen prolapsing
in the external ear canal. A CT scan of the mastoid cells and middle ear showed
otomastoiditis with osteolysis. Oral antibiotic therapy and eardrops were
started. When a facial nerve paresis appeared one month later, a mastoidectomy
was performed. The mastoid cells and middle ear were filled with a connective
tissue-like substance. Postoperative corticosteroids were administered. Despite
the therapy the facial nerve problem aggravated and the patient developed severe 
parietotemporal headache, meningeal irritation and somnolence. The diagnosis of
neurosarcoidosis was hypothesised. Blood analysis, including c-ANCA's, culture of
the otorrhoea and biopsies of the connective tissue were inconclusive. A CT scan 
of the brain showed thickening of the left tentorium. A biopsy of the dura
indicated a diagnosis of Wegener's granulomatosis. The patient was treated with
immunosuppressive medication with satisfactory results.

Publication Types: 
    Case Reports

PMID: 16676840 [PubMed - indexed for MEDLINE]

749: J Laryngol Otol. 2006 Jul;120(7):537-42. Epub 2006 May 4.

Bone-anchored hearing aids: results of the first eight years of a programme in a 
district general hospital, assessed by the Glasgow benefit inventory.

Gillett D, Fairley JW, Chandrashaker TS, Bean A, Gonzalez J.

ENT Department, William Harvey Hospital, Ashford, UK.

OBJECTIVES: To report the clinical results of a bone-anchored hearing aid (BAHA) 
programme in a district general hospital, compared with those in an established, 
large, university teaching hospital centre. DESIGN: A retrospective postal
questionnaire sent to BAHA patients, with two month waiting time and one
reminder, combined with case note analysis. Results compared by appropriate
statistical tests with published outcomes data from the largest UK series.
SETTING: Public sector (National Health Service) district general hospital,
England. Catchment population: 300,000 (mixed rural and small towns).
PARTICIPANTS: Case note analysis of sixty-three patients implanted between 1994
and 2003 (age range, six to 88 years). The commonest indication was chronic
otitis media, with inability to wear a conventional hearing aid. Otitis externa, 
otosclerosis and sensorineural hearing loss were other indications. The
questionnaire was sent to 59 patients who had worn their aid for at least six
months; it was returned by 41 (69 per cent). MAIN OUTCOME MEASURES: Glasgow
benefit inventory (GBI, change in health status following otolaryngological
intervention); incidence of complications. RESULTS: Bone-anchored hearing aid
implantation significantly improved quality of life as measured by the GBI
(p<0.001). The degree of improvement was similar to that achieved in Birmingham
by Proops et al. (p>0.05, chi-squared test). Minor temporary skin infection was
common (33 per cent). Thickening of the skin around the implant occurred in 17
per cent. One implant (2 per cent) failed. There were no serious complications.
CONCLUSION: The BAHA is a safe, reliable and effective treatment for selected
patients. A successful BAHA programme can be run in a district general hospital.

PMID: 16672090 [PubMed - indexed for MEDLINE]

750: Pediatrics. 2006 May;117(5):1823-9.

Effect of pneumococcal conjugate vaccine on nasopharyngeal bacterial colonization
during acute otitis media.

Revai K, McCormick DP, Patel J, Grady JJ, Saeed K, Chonmaitree T.

Department of Pediatrics, University of Texas Medical Branch, Galveston, TX
77555-0371, USA.

The heptavalent pneumococcal conjugate vaccine (PCV7) has been shown to reduce
the incidence of acute otitis media (AOM) caused by Streptococcus pneumoniae by
34% and reduces the overall incidence of AOM by 6% to 8%. More recent studies
have shown increases in the proportion of Haemophilus influenzae and Moraxella
catarrhalis in the middle-ear fluid of PCV7-immunized children. There has been no
report on the effect of PCV7 on all 3 bacterial pathogens combined, either in the
middle-ear fluid or nasopharynx of individual children with AOM. We investigated 
the impact of PCV7 on nasopharyngeal colonization with bacterial pathogens during
AOM in the pre-PCV7 and post-PCV7 vaccination eras. Four hundred seventeen
children (6 months to 4 years of age) were enrolled onto AOM studies between
September 1995 and December 2004. Of these, 200 were enrolled before the vaccine 
use (historical controls), and 217 were enrolled after the initiation of PCV7
vaccination (101 were underimmunized, and 116 were immunized). Although the
nasopharyngeal colonization rate for S pneumoniae was not different between the 3
groups, a significantly higher proportion of PCV7-immunized children with AOM
were colonized with M catarrhalis. Overall, the mean number of pathogenic
bacteria types isolated from immunized children (1.7) was significantly higher
than in controls (1.4). The increase in bacterial colonization of the nasopharynx
during AOM could be associated with an increase in AOM pathogens and
theoretically can predispose PCV7-immunized children with AOM to a higher rate of
antibiotic treatment failure or recurrent AOM.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 16651345 [PubMed - indexed for MEDLINE]

751: J Infect Chemother. 2006 Apr;12(2):83-96.

Study of upper respiratory tract bacterial flora: first report. Variations in
upper respiratory tract bacterial flora in patients with acute upper respiratory 
tract infection and healthy subjects and variations by subject age.

Konno M, Baba S, Mikawa H, Hara K, Matsumoto F, Kaga K, Nishimura T, Kobayashi T,
Furuya N, Moriyama H, Okamoto Y, Furukawa M, Yamanaka N, Matsushima T, Yoshizawa 
Y, Kohno S, Kobayashi K, Morikawa A, Koizumi S, Sunakawa K, Inoue M, Ubukata K.

Teikyo University School of Medicine, Tokyo, Japan. mrsa@interlink.or.jp

With the appearance of penicillin-resistant Streptococcus pneumoniae, there has
been increasing debate concerning antimicrobial treatments for acute upper
respiratory tract infection (AURTI) and acute otitis media in children. This
study compares the nasopharyngeal bacterial flora in patients with AURTI (AURTI
group; 710 subjects) and healthy subjects (HS group; 380 subjects). The
comparisons were made between subjects aged 6 years or younger (0-6 subgroup: 330
subjects), between 7 and 74 years (7-74 subgroup: 668 subjects), and 75 years and
older (92 subjects), because the subjects were subgrouped as described above
dependent on the maturity of the protective immunity. In the HS group 7-74
subgroup, viridans group streptococci, Staphylococcus aureus, coagulase-negative 
staphylococci, and Corynebacterium sp. with a detection rate of 10% or more were 
classified as normal nasal flora (NNF), and Streptococcus pyogenes, Streptococcus
pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were classified as 
drum cavity pathogens (DCP). In the 0-6 subgroup, although the detection rate for
DCP bacteria in the AURTI group tended to be high, it did not reach a significant
difference, whereas the detection rate for NNF bacteria was significantly lower. 
This trend was also observed to some degree in the other age subgroup. In the 0-6
subgroup, leukocyte infiltration observed with a microscope indicated the closest
relationship between S. pneumoniae detection rate and detection quantity. These
results suggest that in the 0-6 subgroup the tendency for patients with AURTI to 
have NNF bacteria as well as DCP bacteria should be taken into consideration.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16648948 [PubMed - indexed for MEDLINE]

752: Otolaryngol Head Neck Surg. 2006 May;134(5):772-7.

Helicobacter pylori: a possible association with otitis media with effusion.

Yilmaz T, Ceylan M, Akyön Y, Ozçakýr O, Gürsel B.

Department of Otolaryngology-Head and Neck Surgery, Hacettepe University Faculty 
of Medicine, Ankara, Turkey. tyilmaz@hacettepe.edu.tr

OBJECTIVE: Evaluate possible role of Helicobacter Pylori in pathogenesis of
otitis media with effusion (OME). STUDY DESIGN AND SETTING: Randomized controlled
trial, tertiary referral center. STUDY GROUP: Middle ear fluid was aspirated, a
biopsy was taken from the promontorium of 22 children with OME. CONTROL GROUP: A 
small biopsy was taken from the promontorium of 20 children with normal otologic 
findings. For both groups, 5 mm deep tissue specimens were obtained from tonsil
and adenoid. RESULTS: H pylori presence in the middle ear, the tonsillar and
adenoid tissues by culture and PCR was significantly more frequent in the study
group compared to the control group (P<0.05). CONCLUSIONS: This study is the
first to grow H pylori in middle ear in OME. Significantly increased colonization
by H pylori of the middle ear, and tonsillar and adenoid tissue in patients with 
OME indicates that the bacteria might be involved in the pathogenesis of OME. EBM
rating: A-1b.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16647533 [PubMed - indexed for MEDLINE]

753: Pediatr Infect Dis J. 2006 May;25(5):401-4.

Effectiveness of inactivated influenza vaccine for prevention of otitis media in 
children.

Ozgur SK, Beyazova U, Kemaloglu YK, Maral I, Sahin F, Camurdan AD, Kizil Y, Dinc 
E, Tuzun H.

Department of Pediatrics, Gazi University Medical Faculty, Ankara, Turkey.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of
inactivated influenza vaccine in preventing acute otitis media (AOM) and otitis
media with effusion (OME) in children aged 6 to 60 months who attend day care.
STUDY DESIGN: This prospective, single-blind study was conducted in 8 day care
centers in Ankara, Turkey. One hundred nineteen (61 vaccinated and 58
unvaccinated against influenza) healthy children were examined at study entry and
at 6-week intervals for 6 months by the same 2 otorhinolaryngologists who were
blinded about the vaccination status of the children. The frequency of AOM and
OME is compared between the 2 groups and the effect of influenza season on
frequency of episodes was evaluated. Based on national influenza laboratory data,
the influenza season was determined to be the period between December 15, 2003,
and January 31, 2004. RESULT: The frequencies of AOM, OME and total otitis media 
episodes in vaccinated children were 2.3%, 22.8% and 25.2%, respectively, and
these frequencies were 5.2%, 31.1% and 36.3% in the unvaccinated group. The
difference was statistically significant (P < 0.01). This difference was
especially prominent in the influenza season (P < 0.05). CONCLUSION: Influenza
vaccine is effective in reducing AOM and OME episodes in 6- to 60-month-old day
care children, especially during influenza season.

Publication Types: 
    Clinical Trial

PMID: 16645502 [PubMed - indexed for MEDLINE]

754: Pediatr Infect Dis J. 2006 May;25(5):385-9.

Knowledge and practices relating to the 2004 acute otitis media clinical practice
guideline: a survey of practicing physicians.

Vernacchio L, Vezina RM, Mitchell AA.

Slone Epidemiology Center at Boston University, Boston, MA 02215, USA.
lvernacchio@slone.bu.edu

OBJECTIVE: To identify primary care physicians' familiarity with the 2004 acute
otitis media (AOM) clinical practice guideline and to compare their practices
with its recommendations. DESIGN: Mail survey October through December 2004 to
all active physician members of the Slone Center Office-based Research Network, a
national, practice-based, pediatric research network. RESULTS: The response rate 
was 276 of 469 (58.8%). Overall, 90.5% had read the guideline or summaries of it.
Pneumatic otoscopy was always used by 16.2%, used half the time or more by 23.1%,
used less than half the time by 34.6% and never used by 26.2%. Observation is
considered a reasonable option for some AOM cases by 88.0% and, over the previous
3 months, these physicians used observation a median of 10% of the time (25th and
75th percentiles, 5% and 25%, respectively). In terms of concern that the
observation option may increase AOM complications, 75.6% were not at all or only 
slightly concerned; 24.4% were moderately or very concerned. In general, these
physicians have altered their antibiotic prescribing practices for AOM towards
the guideline's recommendations since its publication. However, antibiotic
choices deviated most widely from the guideline in cases of AOM with severe
illness, where only 17.9% follow the recommendation for high-dose
amoxicillin-clavulanate, and in cases of children who fail treatment with
amoxicillin-clavulanate, where only 27.7% favor the recommended intramuscular
ceftriaxone. CONCLUSIONS: Most physicians in this survey are familiar with the
AOM guideline, but many do not follow its diagnostic and antibiotic
recommendations. Observation for selected cases is acceptable to most of these
physicians and is currently used in a small proportion of cases.

PMID: 16645499 [PubMed - indexed for MEDLINE]

755: Otol Neurotol. 2006 Apr;27(3):332-6.

Cochlear implant explantation as a sequela of severe chronic otitis media: case
report and review of the literature.

Roehm PC, Gantz BJ.

Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals 
and Clinics, Iowa City, Iowa 52242-1078, USA.

INTRODUCTION: In the 1980s, intracranial and inner ear infections were feared
complications in patients with recurrent or chronic otitis media (COM) who had
undergone cochlear implantation. Current studies show a low incidence of such
complications. We present a case of a patient who developed severe COM requiring 
cochlear explantation. CASE: Our patient had a previous cleft palate repair and
as a three-year-old was implanted with a Nucleus-24 implant. She developed
chronic otorrhea in the implanted ear, which was managed by her pediatrician
until her cochlear implant stopped functioning. Radiographic imaging revealed
erosion of the cochlea and extrusion of the distal electrode medially in the
petrous apex. SETTING: Tertiary care university hospital. INTERVENTION/RESULTS:
The patient underwent cochlear explantation, subtotal petrosectomy, obliteration 
of ear, and intravenous antibiotic therapy. One month later she was implanted in 
the contralateral ear. CONCLUSION: COM poses potentially severe complications in 
patients receiving cochlear implants. Patients receiving cochlear implants who
are at high risk for COM require follow-up for an extended period of time.

Publication Types: 
    Case Reports
    Review

PMID: 16639270 [PubMed - indexed for MEDLINE]

756: Otolaryngol Head Neck Surg. 2006 Apr;134(4 Suppl):S24-48.

Systematic review of topical antimicrobial therapy for acute otitis externa.

Rosenfeld RM, Singer M, Wasserman JM, Stinnett SS.

Department of Otolaryngology, State University of New York Downstate Medical
Center and The Long Island College Hospital, Brooklyn, NY, USA.
richrosenfeld@msn.com

OBJECTIVE: To determine the efficacy of topical antimicrobials for acute otitis
externa. STUDY DESIGN: Systematic review and random effects meta-analysis of
randomized, controlled trials with parallel groups permitting one or more of the 
following comparisons: antimicrobial vs placebo, antiseptic vs antimicrobial,
quinolone antibiotic vs nonquinolone antibiotic, steroid-antimicrobial vs
antimicrobial, or antimicrobial-steroid vs steroid. RESULTS: Twenty trials met
inclusion criteria and 18 had data suitable for pooling. Topical antimicrobials
increased absolute clinical cure rates over placebo by 46% (95% confidence
interval [CI], 29% to 63%) and bacteriologic cure rates by 61% (95% CI, 46% to
76%). No significant differences were noted in clinical cure rates for other
comparisons, except that steroid alone increased cure rates by 20% compared with 
steroid plus antibiotic (95% CI, 3% to 38%). Quinolone drops increased
bacteriologic cure rates by 8% compared with nonquinolone antibiotics (95% CI, 1%
to 16%), but had statistically equivalent rates of clinical cure and adverse
events. CONCLUSION: Topical antimicrobial is highly effective for acute otitis
externa with clinical cure rates of 65% to 80% within 10 days of therapy. Minor
differences were noted in comparative efficacy, but broad confidence limits
containing small effect sizes make these of questionable clinical significance.
SIGNIFICANCE: Summary estimates from the 13 meta-analyses can be used to
facilitate evidence-based management recommendations and clinical practice
guideline development.

Publication Types: 
    Review

PMID: 16638474 [PubMed - indexed for MEDLINE]

757: Otolaryngol Head Neck Surg. 2006 Apr;134(4 Suppl):S4-23.

Clinical practice guideline: acute otitis externa.

Rosenfeld RM, Brown L, Cannon CR, Dolor RJ, Ganiats TG, Hannley M, Kokemueller P,
Marcy SM, Roland PS, Shiffman RN, Stinnett SS, Witsell DL; American Academy of
Otolaryngology--Head and Neck Surgery Foundation.

Department of Otolaryngology, SUNY Downstate Medical Center and Long Island
College Hospital. richrosenfeld@msn.com

OBJECTIVE: This guideline provides evidence-based recommendations to manage
diffuse acute otitis externa (AOE), defined as generalized inflammation of the
external ear canal, which may also involve the pinna or tympanic membrane. The
primary purpose is to promote appropriate use of oral and topical antimicrobials 
and to highlight the need for adequate pain relief. STUDY DESIGN: In creating
this guideline, the American Academy of Otolaryngology-Head and Neck Surgery
Foundation (AAO-HNSF) selected a development group representing the fields of
otolaryngology-head and neck surgery, pediatrics, family medicine, infectious
disease, internal medicine, emergency medicine, and medical informatics. The
guideline was created with the use of an explicit, a priori, evidence-based
protocol. RESULTS: The group made a strong recommendation that management of AOE 
should include an assessment of pain, and the clinician should recommend
analgesic treatment based on the severity of pain. The group made recommendations
that clinicians should: 1) distinguish diffuse AOE from other causes of otalgia, 
otorrhea, and inflammation of the ear canal; 2) assess the patient with diffuse
AOE for factors that modify management (nonintact tympanic membrane, tympanostomy
tube, diabetes, immunocompromised state, prior radiotherapy); and 3) use topical 
preparations for initial therapy of diffuse, uncomplicated AOE; systemic
antimicrobial therapy should not be used unless there is extension outside of the
ear canal or the presence of specific host factors that would indicate a need for
systemic therapy. The group made additional recommendations that: 4) the choice
of topical antimicrobial therapy of diffuse AOE should be based on efficacy, low 
incidence of adverse events, likelihood of adherence to therapy, and cost; 5)
clinicians should inform patients how to administer topical drops, and when the
ear canal is obstructed, delivery of topical preparations should be enhanced by
aural toilet, placing a wick, or both; 6) when the patient has a tympanostomy
tube or known perforation of the tympanic membrane, the clinician should
prescribe a nonototoxic topical preparation; and 7) if the patient fails to
respond to the initial therapeutic option within 48 to 72 hours, the clinician
should reassess the patient to confirm the diagnosis of diffuse AOE and to
exclude other causes of illness. And finally, the panel compiled a list of
research needs based on limitations of the evidence reviewed. CONCLUSION: This
clinical practice guideline is not intended as a sole source of guidance in
evaluating patients with AOE. Rather, it is designed to assist clinicians by
providing an evidence-based framework for decision-making strategies. It is not
intended to replace clinical judgment or establish a protocol for all individuals
with this condition and may not provide the only appropriate approach to the
diagnosis and management of this problem. SIGNIFICANCE: This is the first,
explicit, evidence-based clinical practice guideline on acute otitis externa, and
the first clinical practice guideline produced independently by the AAO-HNSF.

Publication Types: 
    Practice Guideline
    Research Support, Non-U.S. Gov't

PMID: 16638473 [PubMed - indexed for MEDLINE]

758: Expert Opin Emerg Drugs. 2006 May;11(2):251-64.

Emerging therapies for the treatment and prevention of otitis media.

Aliphas A, Prufer N, Grundfast KM.

Boston Medical Center, Department of Otolaryngology--Head & Neck Surgery, 88 East
Newton Street, D616 Boston, MA 02118, USA. avners@bu.edu

Otitis media is one of the most common disorders occurring in children, and there
is growing concern that bacteria are quickly becoming resistant to
antimicrobials. As a result, global antibiotic treatment is no longer the
standard of care and treatment of otitis media has changed dramatically in the
last decade. In addition to new antimicrobials currently in development, the
effects of the pneumococcal conjugate vaccine are just beginning to be
understood. Furthermore, new surgical techniques are for the first time being
tested as alternatives for tympanostomy tubes for recurrent acute otitis media.
This review discusses current and emerging otitis media therapeutics, with
particular attention to acute otitis media. Topics include antimicrobial use,
antimicrobial resistance, effects of vaccination and new surgical techniques.

Publication Types: 
    Review

PMID: 16634700 [PubMed - indexed for MEDLINE]

759: Eur Arch Otorhinolaryngol. 2006 Jul;263(7):680-4. Epub 2006 Apr 22.

Value of hyperbaric oxygen in bacterial and fungal malignant external otitis
treatment.

Narozny W, Kuczkowski J, Stankiewicz C, Kot J, Mikaszewski B, Przewozny T.

ENT Department, Medical University of Gdansk, Debinki Str 7, bld 16, 80-211,
Gdansk, Poland. naroznyw@wp.pl

Malignant external otitis (MEO) is an invasive, morbidity, even mortality, mainly
pseudomonal infection of the external auditory canal, frequently involving the
base of the skull, multiple cranial nerve and the meninges. In many cases
conventional therapy has been prolonged, intensive and relatively ineffective,
especially in infections other than bacterial (mainly fungal). We presented
theoretical principles of hyperbaric oxygen (HBO) treatment in MEO, our own
experience and others' experience in applying this treatment method. We treated
eight patients with MEO applying pharmacotherapy, topical management, surgery in 
one case and also adjunct HBO. In six patients, infection was caused by
Pseudomonas aeruginosa, in one by Staphylococcus sp. and in one by Aspergillus
sp. Complete recovery was achieved in seven patients. In the patient with MEO
caused by Aspergillus sp., intracranial complications developed and the patient
died. Our experiences in employing HBO in bacterial-caused MEO have confirmed the
role of HBO as a valuable, beneficial, supporting classical treatment method.
Small number of patients with MEO, especially with non-bacterial infection, and
unforeseen clinical course of disease make our experience difficult to
objectivize.

PMID: 16633825 [PubMed - indexed for MEDLINE]

760: J Paediatr Child Health. 2006 Apr;42(4):204-5.

Antibiotic prescribing rates for acute otitis media in a paediatric emergency
department.

Steinmann K, Babl FE.

Emergency Department, Royal Children's Hospital, and Murdoch Childrens Research
Institute, Melbourne, Australia.

OBJECTIVE: To audit antibiotic prescribing rates for acute otitis media (AOM) at 
a tertiary paediatric emergency department (ED). METHODS: All children who
presented to the ED in 2002 (during defined 4-week periods in spring, summer,
autumn and winter) and were given a diagnosis of AOM were eligible for analysis. 
Data were extracted retrospectively, providing information on demographics and
antibiotic therapy. RESULTS: A total of 306 patients with AOM were available for 
analysis. Forty-three children (14%) were <1 year, 69 (23%) 1-2 years, and 194
(63%) > 2 years of age. Sixty-eight patients (22%) were receiving antibiotics
prior to presentation to the ED, and antibiotics were prescribed for 206 (67%).
Antibiotic prescribing was independent of patient age. CONCLUSIONS: Despite ready
access to clinical guidelines that recommend an expectant approach for children
with AOM who are older than 1 or 2 years of age, antibiotic prescribing rates
were high in the ED.

PMID: 16630322 [PubMed - indexed for MEDLINE]

761: Infect Immun. 2006 May;74(5):2562-7.

Bacterial sinusitis and otitis media following influenza virus infection in
ferrets.

Peltola VT, Boyd KL, McAuley JL, Rehg JE, McCullers JA.

Department of Infectious Diseases, St. Jude Children's Research Hospital, 332 N. 
Lauderdale St., Memphis, TN 38105-2794, USA.

Streptococcus pneumoniae is the leading cause of otitis media, sinusitis, and
pneumonia. Many of these infections result from antecedent influenza virus
infections. In this study we sought to determine whether the frequency and
character of secondary pneumococcal infections differed depending on the strain
of influenza virus that preceded bacterial challenge. In young ferrets infected
with influenza virus and then challenged with pneumococcus, influenza viruses of 
any subtype increased bacterial colonization of the nasopharynx. Nine out of 10
ferrets infected with H3N2 subtype influenza A viruses developed either sinusitis
or otitis media, while only 1 out of 11 ferrets infected with either an H1N1
influenza A virus or an influenza B virus did so. These data may partially
explain why bacterial complication rates are higher during seasons when H3N2
viruses predominate. This animal model will be useful for further study of the
mechanisms that underlie viral-bacterial synergism.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16622191 [PubMed - indexed for MEDLINE]

762: Clin Otolaryngol. 2006 Apr;31(2):151-2.

How we do it: a new 'one stop' ear wick.

Badran K, Jani P.

Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK.
badran99@hotmail.com

In some practices, otitis externa is treated with ear wick and patient is asked
to remove it independently without re-attending clinic. * Although this method
reduces workload on aural care services, it can be unhygienic and difficult to
perform. * We propose a new design whereby the wick is tied to a string to
facilitate its later removal. * Out of 18 patients treated with this method, only
4 opted to re-attend for further aural care.

PMID: 16620338 [PubMed - indexed for MEDLINE]

763: Clin Otolaryngol. 2006 Apr;31(2):130-3.

Total serum IgE and IgE antibodies specific to house dust mite found in two
aged-matched cohorts of children with and without otitis media with effusion.

Coulson CJ, Drake-Lee AB, Plant T, Drayson MT.

Department of ENT, Queen Elizabeth Hospital, Birmingham, UK.
chriscoulson@doctors.org.uk

OBJECTIVES: To determine whether otitis media with effusion (OME) is associated
with elevated serum immunoglobulin E (IgE) and IgE specific for house dust mite. 
DESIGN: Forty-seven children who had evidence of bilateral OME, both
otoscopically and on tympanometry, on two separate occasions, 3 months apart were
admitted for ventilation tubes. Forty-eight children admitted for minor eye
surgery who had otoscopically normal ears and no history of middle ear problems
were used as controls. Bloods samples were taken under anaesthesia. Total IgE and
IgE radioallergosorbent test (RAST) to house dust mite was measured by the
Pharmacia Unicap 100 system. The results from the two groups were compared.
Setting: Birmingham Children's Hospital. PARTICIPANTS: Children between the ages 
of 3 and 10. Children with Down's syndrome, cleft lip and palate, ciliary
abnormalities, known immunodeficiencies and cardiac abnormalities were excluded. 
MAIN OUTCOME MEASURES: Total IgE and RAST to house dust mite. A RAST of >0.35 was
taken to be positive. RESULTS: There was no statistical difference between the
control and study groups for the total IgE. Six children from both study and
control groups had a raised house dust mite RAST. There was no difference in the 
levels between either group. CONCLUSIONS: Our findings indicate that there is no 
direct relationship between OME and biochemical evidence of allergy, specifically
to house dust mite.

PMID: 16620332 [PubMed - indexed for MEDLINE]

764: Avian Dis. 2006 Mar;50(1):135-8.

Otitis interna (labyrinthitis) associated with Salmonella enterica arizonae in
turkey poults.

Shivaprasad HL, Cortes P, Crespo R.

California Animal Health and Food Safety Laboratory System, Fresno Branch, School
of Veterinary Medicine, University of California, Davis, 2789 South Orange
Avenue, Fresno, CA 93725, USA.

Otitis interna was diagnosed in five 9-to-21-day-old turkey poults with clinical 
signs of paralysis, opisthotonus, torticollis, blindness, and increased
mortality. Gross and microscopic lesions in the poults included omphalitis,
typhlitis, hepatitis, meningoencephalitis, ophthalmitis, neuritis and
ganglionitis of the vestibulocochlear nerve, and otitis interna. Salmonella
enterica arizonae was isolated from the brains, eyes, intestines, yolk sacs, and 
livers of poults. Birds with otitis interna also had meningoencephalitis. It is
most likely that the S. enterica arizonae infection spread from the brain to the 
internal ears through the vestibulocochlear nerve. This is the first
documentation of otitis interna caused by bacteria in an avian species.

Publication Types: 
    Case Reports

PMID: 16617998 [PubMed - indexed for MEDLINE]

765: Vaccine. 2006 May 29;24(22):4804-11. Epub 2006 Mar 27.

Passive immunization with human anti-protein D antibodies induced by
polysaccharide protein D conjugates protects chinchillas against otitis media
after intranasal challenge with Haemophilus influenzae.

Novotny LA, Jurcisek JA, Godfroid F, Poolman JT, Denoël PA, Bakaletz LO.

Columbus Children's Research Institute, Center for Microbial Pathogenesis, The
Ohio State University College of Medicine and Public Health, 700 Children's
Drive, W591, 43205, USA.

Passive transfer of a pediatric human serum pool generated against
polysaccharide-protein D conjugate vaccines conferred approximately 34%
protection against development of ascending NTHI-induced OM when used in a
chinchilla viral-bacterial co-infection model. These data are in line with
results obtained using a similar 11-valent-protein D conjugate vaccine in a
pediatric clinical trial, wherein a vaccine efficacy of 35.6% was shown against
acute OM episodes caused by NTHI. These observations strongly support the
chinchilla passive transfer-superinfection model as one that could predict
clinical trials outcomes for vaccines to prevent NTHI-induced OM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16616975 [PubMed - indexed for MEDLINE]

766: J Pediatr (Rio J). 2006 Mar-Apr;82(2):87-96.

Systematic literature review of modifiable risk factors for recurrent acute
otitis media in childhood.

Lubianca Neto JF, Hemb L, Silva DB.

Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Porto Alegre, RS,
Brazil. jlubianc@terra.com.br

OBJECTIVE: Review evidence about modifiable risk factors for recurrent acute
otitis media. SOURCE OF DATA: MEDLINE with no language restriction, from January 
1966 to July 2005, using descriptors "acute otitis media/risk factors". Two
hundred and fifty-seven articles were obtained. These included randomized
clinical trials, cohorts, case-control and cross-sectional studies that contained
analyses of modifiable risk factors for the development of recurrent acute otitis
media as the main objective and with samples of individuals up to the age of 18
years. Except when relevant, the following were excluded: non-systematic reviews,
reports of cases, series of cases, and medical society guidelines. SUMMARY OF
DATA: Nine risk factors linked to the host and eight linked to the environment
were identified. Of the first group, allergy, craniofacial abnormalities,
gastroesophageal reflux and the presence of adenoids were classified as
modifiable. In the second category, upper airway infections, day care center
attendance, presence of siblings/family size, passive smoking, breastfeeding and 
use of pacifiers were included. Afterwards, the risk factors were classified in
accordance with levels of evidence. CONCLUSIONS: The risk factors established for
recurrent acute otitis media and capable of being modified were the use of
pacifiers and care in daycare centers. The probable risk factors were privation
of mother's milk, presence of siblings, craniofacial abnormalities, passive
smoking and presence of adenoids. No modifiable factor was classified as
unlikely. Among those that need further study are allergy, gastroesophageal
reflux and passive smoking during gestation.

Publication Types: 
    Meta-Analysis
    Review

PMID: 16614761 [PubMed - indexed for MEDLINE]

767: Braz J Otorhinolaryngol. 2005 Sep-Oct;71(5):668-74. Epub 2006 Mar 31.

Otomicroscopic and histologic findings of induced myringosclerosis in rats: a
critical study of an experimental model.

Santos PF, Leal MC, Peixoto C, Caldas Neto S, Rosas ST.

Center of Health Sciences, Federal University of Pernambuco.

Myringosclerosis is characterized by hyaline changes of the lamina propria of the
tympanic membrane. Experimental studies have used otomicroscopy or histology to
evaluate myringosclerosis in animals, but they do not correlate precisely these
two methods. AIM: The present study evaluates the accuracy of otomicroscopy in
the diagnosis of myringosclerosis in rats. STUDY DESIGN: Experimental. MATERIAL
AND METHOD: Myringosclerosis was induced by transtympanic inoculation of
Streptococcus pneumoniae in 25 Wistar rats, which were examined weekly through
otomicroscopy and sacrificed after eight weeks for histologic study of their
tympanic membranes. RESULTS: From the comparison of the otomicroscopic data in
relation to the histologic findings, we could observe sensibility of 80% and
specificity of 75% for the otomicroscopy. CONCLUSION: Considering the results in 
this study, otomicroscopy did not represent a good method to evaluate
myringosclerosis in this experimental model.

PMID: 16612530 [PubMed - indexed for MEDLINE]

768: Braz J Otorhinolaryngol. 2005 Sep-Oct;71(5):639-43. Epub 2006 Mar 31.

Intracranial complications of chronic suppurative otitis media in children.

Miura MS, Krumennauer RC, Lubianca Neto JF.

Complexo Hospitalar Santa Casa, Porto Alegre.

In spite of significant decrease after antibiotic advent, intracranial
complications of otitis media still represent a challenging situation owing to
its high mortality rate (36%). The most common presentations are meningitis,
cerebral abscess, extradural abscess and lateral sinus thrombophlebitis. For
early management, it is necessary to have a high index of suspicion. It is
important to identify non-typical cases because they might be masqueraded by
antibiotic use. AIM: We present six cases of intracranial complications due to
otitis media in children and adolescents at Complexo Hospitalar Santa Casa de
Porto Alegre for the past two years. STUDY DESIGN: Series review.

Publication Types: 
    Case Reports

PMID: 16612527 [PubMed - indexed for MEDLINE]

769: Braz J Otorhinolaryngol. 2005 Sep-Oct;71(5):644-8. Epub 2006 Mar 31.

Equivalent volume: study in subjects with chronic otitis media.

Alencar AP, Iório MC, Morales DS.

Federal University of Sao Paulo, Escola Paulista de Medicina.
anapalencar@yahoo.com.br

The equivalent ear canal volume ranges from 0.3 ml to 1.0 ml in children and from
0.65 to 1.75 ml in adults. In subjects with chronic otitis media these values can
be different, according to the disease status. AIM: To study the equivalent ear
canal volume in 52 ears of patients with chronic otitis media with and without
active infection. STUDY DESIGN: Clinical prospective with transversal cohort.
MATERIAL AND METHOD: The equivalent ear canal volume was obtained from 52 ears
diagnosed with chronic otitis media with and without active infection and in age 
and gender matched control group. The study group with active infection was
evaluated before and after clinical treatment. RESULTS: Equivalent ear canal
volume mean for the studied groups with and without infection and for the control
group was 2.86 ml; 1.42 ml and 0.80 ml, respectively. The equivalent ear canal
volume mean for the study group with infection prior and post clinical treatment 
was 1.42 ml and 1.82 ml, respectively. CONCLUSIONS: The equivalent ear canal
volume mean was higher in patients with chronic otitis media. We did not observe 
variation of equivalent ear canal volume before and after clinical treatment.

PMID: 16612526 [PubMed - indexed for MEDLINE]

770: Can Vet J. 2006 Mar;47(3):253-5.

Update on antimicrobial susceptibilities of bacterial isolates from canine and
feline otitis externa.

Hariharan H, Coles M, Poole D, Lund L, Page R.

Diagnostic Services, Atlantic Veterinary College, University of Prince Edward
Island, Charlottetown, Prince Edward Island. hhariharan@upei.ca

The in vitro susceptibility of a total of 1819 bacterial isolates from canine and
103 isolates from feline otitis externa cases to 13 antimicrobial drugs over a
5-year period was evaluated. Among topically used drugs, 90% of isolates were
susceptible to gentamicin. Susceptibility of Pseudomonas aeruginosa to gentamicin
was 85%, and to polymyxin B 100%. For isolates other than the Pseudomonas sp.,
susceptibility was highest to amoxicillin-clavulanic acid.

PMID: 16604982 [PubMed - indexed for MEDLINE]

771: Vet Ther. 2006 Spring;7(1):15-26.

The efficacy of an antiseptic and microbial anti-adhesive ear cleanser in dogs
with otitis externa.

Rème CA, Pin D, Collinot C, Cadiergues MC, Joyce JA, Fontaine J.

Medical Department, Virbac Laboratories, 13eme rue LID, BP 27, F-06511 Carros,
France.

A new antimicrobial ear cleanser was evaluated for the treatment of bacterial and
yeast ear infection in dogs. Forty-five dogs with erythemato-ceruminous or
purulent otitis externa were randomly allocated to two treatment groups:
reference ear cleanser (Epiotic, Virbac) or test ear cleanser (Epiotic Advanced, 
Virbac). Ear cleansing was performed twice daily for 2 weeks, and no other
treatment was allowed. By week 2, clinical (exudate quantity, erythema, stenosis,
excoriation, and odor) and discomfort (pain, ear scratching, and head shaking)
scores were significantly decreased (P < .0001 for all) and no microbial
overgrowth could be detected in 25 (64.1%) and 32 (68.1%) ears treated with
Epiotic and Epiotic Advanced, respectively. The new pH-balanced, propylene
glycol-free test ear cleanser, which incorporates microbial adhesin-blocking
carbohydrates, proved as effective as the reference acidic formula.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16598680 [PubMed - indexed for MEDLINE]

772: Int J Syst Evol Microbiol. 2006 Apr;56(Pt 4):709-14.

Pseudomonas otitidis sp. nov., isolated from patients with otic infections.

Clark LL, Dajcs JJ, McLean CH, Bartell JG, Stroman DW.

Alcon Research Ltd, 6201 South Freeway, R0-17, Fort Worth, TX 76134-2099, USA.

A novel Pseudomonas species, for which the name Pseudomonas otitidis sp. nov. is 
proposed, was identified from clinical specimens of infected human ears.
Forty-one pseudomonads (34 from patients with acute otitis externa, six from
patients with acute otitis media with otorrhoea and one from a patient with
chronic suppurative otitis media) were recovered that did not match any known
species. On the basis of genetic analyses and biochemical characterization, these
isolates were shown to belong to the genus Pseudomonas. 16S rRNA gene sequence
analysis and DNA-DNA hybridization studies indicated that this novel bacterium is
closely related to, but different from, Pseudomonas aeruginosa. A description of 
this species is based on polyphasic studies of 11 clinical isolates. The type
strain of Pseudomonas otitidis is MCC10330T (=ATCC BAA-1130T = DSM 17224T).

PMID: 16585681 [PubMed - indexed for MEDLINE]

773: Pediatrics. 2006 Apr;117(4):1009-17.

Effectiveness of Centers for Disease Control and Prevention recommendations for
outcomes of acute otitis media.

Bauchner H, Marchant CD, Bisbee A, Heeren T, Wang B, McCabe M, Pelton S;
Boston-Based Pediatric Research Group.

Department of Pediatrics, Boston University School of Medicine, Boston,
Massachusetts, USA. howard.bauchner@bmc.org

OBJECTIVES: To determine whether we could increase adherence to the Centers for
Disease Control and Prevention (CDC) recommendations with well-accepted
approaches to improving quality of care and adherence to the CDC recommendations 
resulted in improved outcomes for acute otitis media (AOM). METHODS: A cluster
randomization study was conducted in 12 pediatric practices (6 intervention and 6
control sites). The main outcome measures were adherence to the CDC
recommendations (modified to include 2 additional antimicrobial agents) and a
subsequent antibiotic prescription for AOM within 30 days after diagnosis.
RESULTS: Of 3152 patients referred to research assistants, 2584 (82%) were
eligible. Of those eligible, 1368 (99%) of 1382 at the intervention sites and
1138 (99%) of 1146 at the control sites consented to participate. Rates of
adherence to the CDC recommendations were not significantly higher at the
intervention sites than at the control sites, for initial enrollment episodes
(78.2% vs 70.6%) or second episodes (62.6% vs 59.9%). After controlling for
clustering according to site and covariates, children who were not treated in
adherence to the CDC recommendations for both episodes had 1.60 times the odds of
a subsequent prescription within 12 days, compared with those treated in
adherence at both episodes. CONCLUSIONS: Despite using evidence-based approaches 
that are known to influence physician behavior, we were unable to increase
adherence to the CDC recommendations for treatment of AOM. However, we did
establish that prescription of antimicrobial therapy consistent with the CDC
recommendations for a second episode of AOM was associated with improved
outcomes, measured as the need for subsequent antibiotic prescription. Because of
the selection of resistant otopathogens, adherence to the CDC recommendations is 
likely more important in subsequent episodes of AOM than in the initial episode.

Publication Types: 
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16585294 [PubMed - indexed for MEDLINE]

774: Vet J. 2007 May;173(3):638-44. Epub 2006 Apr 3.

Comparison of ultrasonography, radiography and a single computed tomography slice
for fluid identification within the feline tympanic bulla.

King AM, Weinrauch SA, Doust R, Hammond G, Yam PS, Sullivan M.

Institute of Comparative Medicine, Faculty of Veterinary Medicine, University of 
Glasgow, Bearsden Road, Glasgow G61 1QH, UK. A.King@vet.gla.ac.uk

Evaluation of the tympanic bulla (TB) in cases of acute feline otitis media can
be a diagnostic challenge, although a feature often associated with this
condition is the accumulation of fluid or material within the middle ear cavity. 
A technique is reported allowing optimum imaging of the feline TB using
ultrasound (US) and recording of the appearance of gas and fluid-filled TB. A
random number of bullae in 42 feline cadavers were filled with lubricant and
rostroventral-caudodorsal oblique radiographs, single slice computed tomography
(CT) images and US images were created and interpreted by blinded operators. The 
content (fluid or gas) of each TB was determined using each technique and the
cadavers were then frozen and sectioned for confirmation. CT remained the most
accurate diagnostic method, but US produced better results than radiology. Given 
the advantages of US over other imaging techniques, these results suggest that
further work is warranted to determine applications of this modality in the
evaluation of clinical cases of feline otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16580850 [PubMed - indexed for MEDLINE]

775: J Infect. 2006 Nov;53(5):e227-9. Epub 2006 Mar 31.

Osteomyelitis of the ear canal caused by Staphylococcus lugdunensis.

Thomas S, Hoy C, Capper R.

Department of Surgery, Doncaster Royal Infirmary, Armthorpe Road, Doncaster,
South Yorkshire DN2 5LT, UK. shalini1thomas2@yahoo.co.uk

Osteomyelitis of the temporal bone caused by Staphylococcus lugdunensis has never
been reported before. This infection was diagnosed in a 51-year-old diabetic man.
S. lugdunensis is an unusually virulent coagulase negative staphylococcus and has
been implicated in a variety of severe infections. Considering the serious
morbidity and mortality associated with osteomyelitis and in particular with S.
lugdunensis, special awareness and alertness are required when otitis externa,
which predisposes to osteomyelitis, is refractory to treatment.

Publication Types: 
    Case Reports

PMID: 16580074 [PubMed - indexed for MEDLINE]

776: Ann Otol Rhinol Laryngol. 2006 Mar;115(3):186-90.

Penicillin resistance is not extrapolable to amoxicillin resistance in
Streptococcus pneumoniae isolated from middle ear fluid in children with acute
otitis media.

Rosenblüt A, Santolaya ME, Gonzalez P, Borel C, Cofré J.

Otorhinolaryngology Service, Hospital Dr Sótero del Rio, Santiago, Chile.

OBJECTIVES: We evaluated the in vitro antibacterial activity of amoxicillin
against penicillin-susceptible and -nonsusceptible Streptococcus pneumoniae
strains isolated from children with acute otitis media (AOM). METHODS: Children
more than 3 months of age with AOM who were seen in the Dr Sótero del Rio and
Luis Calvo Mackenna Hospitals in Santiago, Chile, between July 1998 and December 
2002 were subjected to tympanic puncture for middle ear fluid culture. The
penicillin and amoxicillin susceptibilities of the S pneumoniae isolates were
determined by epsilometer test (E test). RESULTS: A bacterial pathogen was
isolated in 432 of 543 children (80%) as follows: S pneumoniae, 40%; Haemophilus 
influenzae, 29%; Moraxella catarrhalis, 7%; and Streptococcus pyogenes, 4%.
Penicillin-susceptible S pneumoniae strains were less common than
amoxicillin-susceptible strains (60% versus 95%; odds ratio [OR], 0.08; 95%
confidence interval [CI], 0.04 to 0.18). Both intermediate- and high-resistance
strains were more common for penicillin (22% versus 4.5%; OR, 5.6; 95% CI, 2.5 to
12.7) than for amoxicillin (18% versus 0.5%; OR, 41.3; 95% CI, 6.0 to 821).
CONCLUSIONS: Penicillin resistance is not extrapolable to amoxicillin among S
pneumoniae strains isolated from middle ear fluid of children with AOM. Our
results support the recommendation to evaluate the minimal inhibitory
concentrations of penicillin-nonsusceptible S pneumoniae for amoxicillin and to
continue use of this antimicrobial as a first-line antimicrobial choice for
children with AOM.

Publication Types: 
    Comparative Study
    In Vitro
    Multicenter Study

PMID: 16572607 [PubMed - indexed for MEDLINE]

777: ORL J Otorhinolaryngol Relat Spec. 2006;68(4):237-42. Epub 2006 Mar 27.

Complications in children with long-term cochlear implants.

Lin YS, Lee FP, Peng SC.

Department of Otolaryngology, Chi Mei Medical Center, Taipei Medical University, 
Taipei City, Taiwan, ROC.

OBJECTIVES: To evaluate the complications in children who underwent cochlear
implantation between 1991 and 2002 at Chi Mei Medical Center, Taipei Medical
University. METHOD: The medical records of 169 cases of pediatric cochlear
implants from 1991 to 2002 with a follow-up period of 3-11 years were reviewed
for demographics and complications. A follow-up phone call and clinical visits
were performed to determine the long-term results. RESULTS: The medical-surgical 
complications were facial nerve stimulation, transient dizziness, flap breakdown,
minor change of taste, cholesteatoma, otitis media with effusion and mastoiditis.
The device-related complications included 4 device failures and 1 device breakage
in a traffic accident. CONCLUSION: Chronic otitis media and cholesteatoma
developed in children as long-term complications and surgical challenges.
Nevertheless, cochlear implantation surgery in children is a reliable and safe
procedure with a low percentage of severe complications. To prevent cholesteatoma
formation, parents are advised to schedule a regular ENT consultation at least
yearly for early identification and treatment in the stages of acute otitis media
or drum retraction. Copyright (c) 2006 S. Karger AG, Basel.

PMID: 16567948 [PubMed - indexed for MEDLINE]

778: Int J Audiol. 2006 Feb;45(2):121-8.

An apparatus for diagnosis of ossicular chain mobility in humans.

Koike T, Murakoshi M, Hamanishi S, Yuasa Y, Yuasa R, Kobayashi T, Wada H.

Department of Mechanical Engineering and Intelligent Systems, The University of
Electro-Communications, 1-5-1 Chofugaoka, Chofu, Tokyo 182-8585, Japan.
koike@mce.uec.ac.jp

Confirmation of the conditions of the ossicles is essential for tympanoplasty.
However, at present, ossicular mobility is experimentally estimated with
palpation by a surgeon, and the results depend on the surgeon's skill. In this
study, a new apparatus for quantitatively measuring ossicular mobility was
developed. With this apparatus, the ossicles were displaced and the reaction
force from the ossicles, (i.e. the load applied to the ossicles) was
simultaneously detected. Ossicular mobility of three patients with otosclerosis
or chronic otitis media was measured to evaluate the usability of the apparatus. 
The apparatus can distinguish the differences in ossicular mobility between
normal and fixed ossicles, and it makes estimating the change of mobility between
pre- and posttreatments for ossicular fixation possible. Positive correlation was
seen between ossicular mobility and hearing level.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 16566250 [PubMed - indexed for MEDLINE]

779: Int J Pediatr Otorhinolaryngol. 2006 Aug;70(8):1333-42. Epub 2006 Mar 27.

Viral upper respiratory tract infections in young children with emphasis on acute
otitis media.

Nokso-Koivisto J, Hovi T, Pitkäranta A.

Department of Virology and Immunology, National Public Health Institute,
Mannerheimintie 166, 00300 Helsinki, Finland. johanna.nokso-koivisto@ktl.fi

Viral upper respiratory infection is the most common reason for seeking medical
care for children. Recurrent viral respiratory infections and subsequent
complications (e.g. acute otitis media (AOM)) are a burden for children, their
families and society. Over the past decade, our knowledge on the significance of 
respiratory viruses has broadened remarkably. Viruses cause large variety of
respiratory diseases and cause alone diseases, which previously have been assumed
to be bacterial only (e.g. AOM and pneumonia). Methods for detection analysis of 
respiratory viruses are developing making both the diagnosis and epidemiological 
investigations of respiratory infections easier. Accurate diagnosis of
respiratory infections and awareness of possible viral etiology could reduce the 
use of antibiotics. Etiologic studies of viral infections are becoming
increasingly important, with the emergence of new antiviral drugs and vaccines.

Publication Types: 
    Review

PMID: 16564578 [PubMed - indexed for MEDLINE]

780: Otolaryngol Head Neck Surg. 2006 Apr;134(4):674-9.

Hearing loss with stapedotomy and treated otitis media.

Lo TM, Zhang M, Young LJ, Antonelli PJ.

Department of Otolaryngology, University of Florida, Gainesville 32610-0264, USA.

OBJECTIVE: To determine if treated Pseudomonas aeruginosa otitis media (PA OM)
increases the risk of sensorineural hearing loss (SNHL) with stapedotomy. STUDY
DESIGN AND SETTING: PA OM was induced in 28 guinea pigs. Half of the animals
underwent unilateral stapedotomy before antibiotic therapy (untreated), and half 
underwent stapedotomy after treatment (treated). Control animals underwent saline
injections followed by stapedotomy. Electrocochleographic thresholds were
measured before and after stapedotomy. Temporal bones were analyzed
histomorphologically. RESULTS: Less SNHL was seen after stapedotomy in treated
ears than in untreated ears (P = 0.0268). SNHL after stapedotomy in treated ears 
was similar to controls (P = 0.9370). Severe damage to cochlear outer hair cells 
was found in untreated ears. CONCLUSIONS: Ears with PA OM treated previously are 
not at increased risk of SNHL with stapedotomy. SIGNIFICANCE: Stapedotomy may be 
carried out with caution in the setting of inactive, chronic OM.

Publication Types: 
    Comparative Study

PMID: 16564395 [PubMed - indexed for MEDLINE]

781: Eur Arch Otorhinolaryngol. 2006 Jul;263(7):622-6. Epub 2006 Mar 18.

TNFalpha blockers do not improve the hearing recovery obtained with
glucocorticoid therapy in an autoimmune experimental labyrinthitis.

Lobo D, Trinidad A, García-Berrocal JR, Verdaguer JM, Ramírez-Camacho R.

Ear Research Group, Department of Otorhinolaryngology, Hospital Universitario
Puerta de Hierro, Universidad Autónoma de Madrid, San Martín de Porres 4, 28035, 
Madrid, Spain.

The effectiveness of etanercept [tumour necrosis factor-alpha (TNFalpha) blocker]
and corticoids in treating immuno-mediated inner ear disease (IMIED) was compared
in an animal model of autoimmune labyrinthitis. IMIED is one of the few forms of 
sensorineural hearing loss that is reversible with proper medical treatment.
While the effectiveness and usefulness of immunomodulating agents
(corticosteroids) in treating IMIED have been demonstrated, TNFalpha antagonists,
which inhibit granuloma formation in rheumatoid arthritis and other autoimmune
diseases, have been considered as an alternative therapy. The efficacy of
etanercept (anti-TNFalpha) was evaluated in a guinea pig model of experimental
autoimmune labyrinthitis in which 25 guinea pigs were divided in a control group,
which was used to document the rise in hearing thresholds following immunisation,
and two experimental groups, which were treated with steroids
(6-methylprednisolone) and anti-TNFalpha (etanercept), respectively, after the
immunisation. Comparison of the auditory thresholds obtained by means of auditory
brainstem response (ABR) revealed that the auditory thresholds of the two
experimental groups were not statistically different (6-methylprednisolone: 41.5 
dB, SD: 8.51; etanercept: 37.5 dB, SD: 7.91) and that both compared favourably
with that of the control group (60 dB, SD: 7.91) at p=0.001. We therefore
conclude that etanercept is as effective as glucocorticoids in an animal model of
autoimmune labyrinthitis; however, the potential adverse effects and high price
of the former advise against its use as an initial therapy for IMIED.

PMID: 16547758 [PubMed - indexed for MEDLINE]

782: Laryngoscope. 2006 Mar;116(3):365-9.

Up-regulation of MUC5AC and MUC5B mucin genes in nasopharyngeal respiratory
mucosa and selective up-regulation of MUC5B in middle ear in pediatric otitis
media with effusion.

Elsheikh MN, Mahfouz ME.

Department of Otolaryngology, Tanta University, Egypt. mnel_sheikh@hotmail.com

OBJECTIVES: Mucins are the major component responsible for the gel-like
properties of mucus secretion. Currently, little is known about the regulation of
mucins in otitis media with effusion (OME). We investigated the expression of
MUC5AC and MUC5B mucin gene messenger (m)RNAs in middle ear effusions as well as 
in tissue biopsies of the respiratory mucosa of the nasopharynx by means of
reverse-transcription polymerase chain reaction (RT-PCR). STUDY DESIGN: A
prospective, controlled, clinical trial. METHODS: The study group consisted of 25
children with a diagnosis of OME who were to undergo bilateral ventilation tube
insertion with adenoidectomy. A sample of middle ear effusion (n = 50) as well as
tissue biopsy from nasopharyngeal respiratory mucosa (n = 25) were obtained from 
each patient. For the nasopharyngeal mucosal biopsies, two control groups were
made up from 30 children with healthy ears who underwent tonsillectomy +/-
adenoidectomy operation; control A, 15 children with adenoid hypertrophy, and
control B, 15 children with healthy nasopharynx. RNAs were extracted from
effusion and tissue samples, and semiquantitative RT-PCR was performed for MUC5AC
and MUC5B to investigate their expression. RESULTS: In the middle ear effusions, 
MUC5B mRNA expression was detected in 48 (96%), whereas MUC5AC mRNA was detected 
in 8 (16%). On semiquantitative analysis, MUC5AC/glyceraldehyde 3-phosphate
dehydrogenase (GAPDH) and MUC5B/GAPDH mRNA ratios in the study group were
significantly increased compared with those in both control groups (P < .05).
CONCLUSIONS: The results suggest that the middle ear has a unique mucin gene
expression pattern when compared with that of the nasopharynx. Up-regulation of
MUC5B in the ear may play an important role in the pathogenesis of middle ear
effusions.

Publication Types: 
    Comparative Study

PMID: 16540890 [PubMed - indexed for MEDLINE]

783: Eur Arch Otorhinolaryngol. 2006 Jul;263(7):603-7. Epub 2006 Mar 15.

Toll-like receptors 2, 3 and 4 (TLR-2, TLR-3 and TLR-4) are expressed in the
microenvironment of human acquired cholesteatoma.

Szczepański M, Szyfter W, Jenek R, Wróbel M, Lisewska IM, Zeromski J.

Department of Clinical Immunology, University of Medical Sciences, 49
Przybyszewskiego Street, 60-355, Poznan, Poland.

Human toll-like receptors (TLR 1-10) are crucial in the induction and activation 
of innate immunity in the course of an infection. They are expressed mainly on
the cells of the immune system, and also on some epithelia and endothelia. Their 
ligands so called pathogen associated molecular patterns are abundant on invading
microbes. TLR-ligand binding results in cell signal transduction and subsequent
production of various proinflammatory cytokines such as IL-1 and TNF-alpha.
Acquired cholesteatoma is formed during chronic otitis media in the proportion of
cases. It has adverse effects on ear structures, resulting in osteolysis and bone
resorption. Its formation and pathogenesis are not fully understood. The current 
study attempted to search the possible role of TLRs in this somewhat awkward
pathological condition. Surgical specimens of human acquired cholesteatoma (n=15)
and normal external auditory canal skin (n=5, control tissues) were tested by
immunohistochemistry for the presence of TLRs. Three TLRs were examined: TLR-2,
TLR-3 and TLR-4. All TLRs tested were demonstrated in matrix (layer of
keratinizing epithelium) and perimatrix (granulation tissue) of this inflammatory
tumour. Expression of particular TLRs within the keratinizing epithelium was
distinct and uneven. In the perimatrix, numerous T (CD3+) cells were seen and
relatively few macrophages (CD11c+, HLA-DR+). There was a weak expression of all 
TLRs on normal (non-inflammatory) skin. Expression of TLR-3 both on the
epithelium and some cells within the perimatrix and the presence of T cells may
suggest that apart from innate immune responses, mechanisms of adaptive immunity 
also operate in cholesteatoma. Weak expression of these receptors on normal skin 
may also suggest the important role of TLRs in the etiopathogenesis of
cholesteatoma.

PMID: 16538507 [PubMed - indexed for MEDLINE]

784: Br J Gen Pract. 2006 Mar;56(524):176-82.

Comment in:
    Br J Gen Pract. 2006 Mar;56(524):164-6.

Longer term outcomes from a randomised trial of prescribing strategies in otitis 
media.

Little P, Moore M, Warner G, Dunleavy J, Williamson I.

Community Clinical Sciences (Primary Medical Care Group), University of
Southampton, Aldermoor Health Centre, Southampton. p.little@soton.ac.uk

BACKGROUND: There are limited data about the longer-term outcomes in acute otitis
media (AOM) when comparing the realistic alternatives of immediate prescription
of antibiotics and a 'wait and see' or delayed prescribing policy. AIM: The aim
was to assess the medium and longer term outcomes of two prescribing strategies
for otitis media. DESIGN OF STUDY: Follow-up of a randomised controlled trial
cohort. SETTING: Primary care. METHOD: Three-hundred and fifteen children aged 6 
months to 10 years presenting with AOM were randomised to immediate antibiotics, 
or antibiotics delayed at the parents discretion 72 hours if the child still had 
significant otalgia or fever, or was not improving. Episodes of earache since
study entry were documented, and a poor score (of 9 or more--the top 20%) on a
reliable six-item functional rating scale (Cronbach's alpha = 0.75). RESULTS: The
delayed prescribing strategy did not significantly increase reported episodes of 
earache in the 3 months since randomisation (odds ratio [OR] = 0.89; 95%
confidence interval [CI] = 0.48 to 1.65) or over 1 year (OR = 1.03; 95% CI = 0.60
to 1.78) nor of poor scores on the function scale at 3 months (OR = 1.16; 95% CI 
= 0.61 to 2.22) or 1 year (OR = 1.12; 95% CI = 0.57 to 2.19), and controlling for
subsequent antibiotic use after the randomised episode did not alter these
estimates. The number of prior episodes of AOM documented in the doctor's notes
predicted episodes of earache reported (0, 1, > or = 2 episodes, respectively; OR
= 1, 2.42, 2.61; chi2 for trend 8.04; P<0.01). There was weaker evidence that
prior episodes also predicted poor function at 1 year (OR = 1, 1.86, 2.28; chi2
for trend 5.49; P = 0.019). For children with recurrent AOM (two or more previous
episodes documented in the doctor's notes, n = 43) there was possible evidence of
fewer episodes of earache in the 3 months since study entry in the immediate
antibiotic group (10% compared to 39% in the delayed group, chi2 4.8, P = 0.029),
but no effect from randomisation to 1 year. CONCLUSIONS: For most children,
delayed prescribing is not likely to have adverse longer-term consequences.
Children with recurrent AOM are more likely to have poorer outcomes. Secondary
analysis should be treated with caution and requires confirmation, but suggests
that treating such children with antibiotics immediately may not alter
longer-term outcomes.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16536957 [PubMed - indexed for MEDLINE]

785: Br J Gen Pract. 2006 Mar;56(524):170-5.

Comment in:
    Br J Gen Pract. 2006 Mar;56(524):164-6.    Br J Gen Pract. 2006 May;56(526):379-80.

Consultations for middle ear disease, antibiotic prescribing and risk factors for
reattendance: a case-linked cohort study.

Williamson I, Benge S, Mullee M, Little P.

Department of Primary Medical Care, Community Clinical Science Division, School
of Medicine, University of Southampton, Southampton. I.G.Williamson@soton.ac.uk

BACKGROUND: Otitis media is the most common reason for children to receive
antibiotics, but there is no evidence about the effect of prescribing on
reattendance. AIM: To evaluate the changing workload of middle ear disease in
general practice, and the impact on surgery reattendance of prescribing
antibiotics at first attendance. DESIGN OF STUDY: A case-linked cohort analysis
for antibiotic prescribing versus no prescribing at first consultation event.
SETTING: Two hundred and ninety-one practices spread throughout the UK recording 
for the General Practice Research Database (GPRD) and incorporating individual
patient data records for 2,265,574 patients. METHOD: All middle ear disease coded
events that can be classed within acute otitis media (AOM) or glue ear
sub-categories (and excluding chronic suppurative otitis media) were selected for
analysis when the first event was from 1991-2001. The effect of antibiotic
prescription on the risk of reattendance using Cox proportional hazards
regression was analysed. RESULTS: Total consultations for AOM have fallen
markedly over this decade, and glue ear consultations have risen but by a much
smaller extent (26,000 decrease versus 4000 increase in consultations per year), 
which makes relabelling an unlikely explanation of the fall in AOM consultations.
In the 2-10 years age range, consultations for AOM fell from 105.3 to 34.7 per
1000 per year, with glue ear consultations unaltered (15.2 to 16.7 per 1000 per
year). Antibiotic prescribing for AOM has stayed remarkably constant (80-84% of
consultations), but antibiotic prescribing for glue ear has risen sharply (13 to 
62%). Prescribing antibiotics increased the risk of reattendance for AOM (hazard 
ratio [HR] = 1.09, 95% confidence interval [CI] = 1.07 to 1.10) and has reduced
the risk of reattendance for glue ear (HR = 0.92, 95% CI = 0.88 to 0.96).
CONCLUSION: Prescribing antibiotics for AOM probably increased reattendance, but 
the opposite effect has been noted for glue ear, which suggests a treatment
effect of antibiotics in glue ear. Further research is needed to clarify whether 
this possible benefit is worth the known harms, and if so in which subgroups of
children.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16536956 [PubMed - indexed for MEDLINE]

786: Am J Med Qual. 2006 Mar-Apr;21(2):134-43.

Introducing a multifaceted intervention to improve the management of otitis
media: how do pediatricians, internists, and family physicians respond?

Francis DO, Beckman H, Chamberlain J, Partridge G, Greene RA.

University of Rochester School of Medicine and Dentistry, Rochester, New York,
USA.

The objective of this study was to compare pediatricians, family practitioners,
and internist's adherence rates to an individual practice association-developed
otitis media practice guideline. The study included a cohort of primary care
physicians treating acute otitis media between January 1, 1999, and December 31, 
2001, using administrative data. All panel pediatricians, family practitioners,
and internists were included in the analysis. Specialty otitis media guideline
adherence rates were compared pre- and postintervention. The guideline was
adapted from the 1999 Centers for Disease Control and Prevention's treatment
recommendations. The outcome measure was overall and specific exceptions to
practice guideline components prior to and after intervention per 1000 episodes. 
Pediatricians and internists significantly reduced overall exceptions per 1000
episodes (P < .000) from the pre- to postintervention periods. Family
practitioners did not improve adherence to overall guideline recommendations
postintervention (P > .05). Pediatricians had significantly higher compliance
than did family practitioners (P < .000). Primary care physicians significantly
increased adherence to an otitis media guideline. Pediatricians improved more
than internists and significantly more than family physicians.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16533905 [PubMed - indexed for MEDLINE]

787: Saudi Med J. 2006 Mar;27(3):357-60.

The role of multifrequency tympanometry in otitis media.

Abou-Elhamd KE, Abd-Ellatif AE, Sultan MA.

Department of Ear, Nose and Throat, Sohag Faculty of Medicine, South Valley
University, Sohag, Egypt. Kamal375@yahoo.com

OBJECTIVE: To evaluate the diagnostic value of multifrequency tympanometry in
otitis media with effusion and adhesive otitis media. METHODS: We selected 50
patients with long standing or recurrent attacks of otitis media with effusion
from the outpatient clinic of the Ears, Nose and Throat (ENT) Department, Sohag
Medical School, Egypt between May 2002 and December 2002. A control group was
also selected, consisting of 25 patients with normal hearing levels and with no
history of ENT problems. We conducted full audiological investigations in the
form of pure tone audiometry, speech audiometry and immittancemetry.
Immittancemetry included low probe tone frequency and multifrequency
tympanometry. Each subject in the study group had undergone myringotomy and
examination under microscope to decide if the case had either otitis media with
effusion or adhesive otitis media. RESULTS: Resonant frequency proved to have the
best performance in reflecting middle ear pathology. It was lowest in otitis
media with effusion with a mean value of 428 +/- 159 Hz and it was highest in
adhesive otitis media with a mean of 1336 +/- 230 Hz. CONCLUSION: Multifrequency 
tympanometry has an efficacy of 100% in the diagnosis of otitis media with
effusion and 70% in the diagnosis of adhesive otitis media.

PMID: 16532097 [PubMed - indexed for MEDLINE]

788: J Clin Microbiol. 2006 Mar;44(3):946-9.

High incidence of Alloiococcus otitidis in children with otitis media, despite
treatment with antibiotics.

Harimaya A, Takada R, Hendolin PH, Fujii N, Ylikoski J, Himi T.

Department of Otolaryngology, Sapporo Medical University School of Medicine, S-1,
W-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan. harimaya@sapmed.ac.jp

Acute otitis media (AOM) and otitis media with effusion (OME) are common diseases
in childhood. Alloiococcus otitidis is a newly recognized species of
gram-positive bacterium which was recently discovered as a pathogen associated
with OME. Although some studies show that A. otitidis is frequently detected in
children with OME, no study is available concerning the clinical efficiency of
antibiotics against this organism. The prevalence of A. otitidis in 116 middle
ear effusion specimens from 36 AOM and 52 OME patients was examined by culture
and PCR. In addition, the prevalence of the bacterium was retrospectively
investigated in relation to antibiotic use. A. otitidis was detected in 20 (50%) 
AOM and 47 (61%) OME specimens. The organism was the most frequent bacterium in
AOM as well as in OME and was highly detected even in patients who had been
treated with antibiotics, such as beta-lactams or erythromycin. The incidence of 
A. otitidis in our study was higher than that in Western countries, and our
results suggest that drug-resistant strains of A. otitidis may be frequently
spread in Japanese children. Our study suggests that antibiotics such as
beta-lactams or erythromycin may not be sufficiently effective to eliminate this 
organism. Further investigation is expected to reveal the clinical role of the
organism in otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16517881 [PubMed - indexed for MEDLINE]

789: Lancet. 2006 Mar 4;367(9512):740-8.

Comment in:
    J Pediatr. 2006 Jul;149(1):142-3.    Lancet. 2006 Jun 10;367(9526):1897-8; author reply 1898.    Lancet. 2006 Jun 10;367(9526):1897; author reply 1898.

Pneumococcal capsular polysaccharides conjugated to protein D for prevention of
acute otitis media caused by both Streptococcus pneumoniae and non-typable
Haemophilus influenzae: a randomised double-blind efficacy study.

Prymula R, Peeters P, Chrobok V, Kriz P, Novakova E, Kaliskova E, Kohl I, Lommel 
P, Poolman J, Prieels JP, Schuerman L.

Department of Epidemiology, Faculty of Military Health Sciences, University of
Defence, Hradec Kralove, Czech Republic. prymula@pmfhk.cz

BACKGROUND: Acute otitis media is one of the most commonly-diagnosed childhood
infections. This study assessed the efficacy of a novel vaccine that contained
polysaccharides from 11 different Streptococcus pneumoniae serotypes each
conjugated to Haemophilus influenzae-derived protein D in prevention of acute
otitis media. METHODS: 4968 infants were randomly assigned to receive either
pneumococcal protein D conjugate or hepatitis A vaccine at the ages of 3, 4, 5,
and 12-15 months and were followed-up until the end of the second year of life.
Middle-ear fluid was obtained for bacteriological culture and serotyping in
children who presented with abnormal tympanic membrane or presence of middle-ear 
effusion, plus two predefined clinical symptoms. The primary endpoint was
protective efficacy against the first episode of acute otitis media caused by
vaccine pneumococcal serotypes. Analysis was per protocol. FINDINGS: From 2 weeks
after the third dose to 24-27 months of age, 333 clinical episodes of acute
otitis media were recorded in the protein D conjugate group (n=2455) and 499 in
the control group (n=2452), giving a significant (33.6% [95% CI 20.8-44.3])
reduction in the overall incidence of acute otitis media. Vaccine efficacy was
shown for episodes of acute otitis media caused by pneumococcal vaccine serotypes
(52.6% [35.0-65.5] for the first episode and 57.6% [41.4-69.3] for any episode). 
Efficacy was also shown against episodes of acute otitis media caused by
non-typable H influenzae (35.3% [1.8-57.4]). The vaccine reduced frequency of
infection from vaccine-related cross-reactive pneumococcal serotypes by 65.5%,
but did not significantly change the number of episodes caused by other
non-vaccine serotypes. INTERPRETATION: These results confirm that using the H
influenzae-derived protein D as a carrier protein for pneumococcal
polysaccharides not only allowed protection against pneumococcal otitis, but also
against acute otitis media due to non-typable H influenzae. Whether this approach
would also allow improved protection against lower respiratory tract infections
warrants further investigation.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16517274 [PubMed - indexed for MEDLINE]

790: Vet Dermatol. 2006 Apr;17(2):147-50.

Evaluation of otoscope cone cleaning and disinfection procedures commonly used in
veterinary medical practices: a pilot study.

Newton HM, Rosenkrantz WS, Muse R, Griffin CE.

Animal Dermatology Clinic, Tustin, CA, USA. heidemarie@mindspring.com

The objective of this study was to evaluate the relative efficacy of otoscope
cone cleaning and disinfection methods commonly used in veterinary practices.
Using sterile technique, 60 new gas-sterilized 4-mm otoscope cones were
inoculated with a broth culture of 1.5 billion Pseudomonas aeruginosa bacteria
per mL then allowed to dry for 10 min. Six study groups of 10 cones each were
created. Group 1 served as positive control and received no cleaning or
disinfection. Group 2 cones were wiped with sterile cotton-tipped applicators and
gauze then rinsed with water. Group 3 cones were wiped with 70% isopropyl
alcohol. Group 4 cones were scrubbed in a speculum cleaner with Cetylcide II
solution (Cetylite Industries, Inc., Pennsauken, NJ). Groups 5 and 6 cones were
soaked for 20 min in Cetylcide II and chlorhexidine gluconate 2% solutions,
respectively. Using sterile technique and after 10-15 min drying time, the cones 
were swabbed in a consistent pattern, and samples were submitted for quantitative
culture. Culture results showed no growth from cones soaked in Cetylcide II or
chlorhexidine solutions. Two of the 10 cones wiped with alcohol, 3/10 cones wiped
then rinsed with water, and 3/10 cones scrubbed with the speculum cleaner showed 
growth of P. aeruginosa. All (10/10) cones in the control group showed heavy
growth of P. aeruginosa. These results show that P. aeruginosa can survive on
otoscope cones cleaned and disinfected by several commonly used methods. Further 
study is needed to determine practical and optimal cleaning and disinfection
methods for otoscope cones.

Publication Types: 
    Evaluation Studies

PMID: 16515658 [PubMed - indexed for MEDLINE]

791: Vet Dermatol. 2006 Apr;17(2):128-33.

Ciprofloxacin as a representative of disk diffusion in vitro susceptibility of
enrofloxacin for bacterial organisms from the middle-ear tissue of dogs with
end-stage otitis externa.

Cole LK, Kwochka KW, Hillier A, Kowalski JJ, Smeak DD, Kelbick NT.

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The
Ohio State University, Columbus, Ohio, USA. cole.143@osu.edu

The purposes of this study were to determine whether ciprofloxacin disk diffusion
susceptibility test (DDT) results could be used to assess the in vitro
susceptibility of otic bacterial organisms to enrofloxacin and to determine the
effect of concurrent enrofloxacin administration on the DDT results for
enrofloxacin and ciprofloxacin. Thirty dogs with end-stage otitis externa
undergoing unilateral total ear canal ablation were enrolled. The dogs were
randomized to one of four enrofloxacin-treatment groups or to the control group. 
Each dog in the treatment groups received two intravenous doses of enrofloxacin
prior to surgical removal of the middle-ear tissue while the control group did
not receive any enrofloxacin. One dog was excluded from the study as no
middle-ear tissue was removed during surgery. Twenty-four dogs were in the
enrofloxacin-treatment groups and five dogs were in the control group. In 12 of
29 dogs (41.4%), 14 of 82 (17.1%) of bacteria had discrepancies in DDT results
for enrofloxacin and ciprofloxacin. Discrepancies between the control group and
treatment groups were not significantly different even though the percentage of
discrepancies for the combined treatment group was 19.4% compared to 6.7% for the
control group. In this study, ciprofloxacin DDT results were not an accurate
indicator of the in vitro susceptibility of enrofloxacin for bacteria isolated
from the middle-ear tissue of dogs with end-stage otitis.

Publication Types: 
    Randomized Controlled Trial

PMID: 16515655 [PubMed - indexed for MEDLINE]

792: Vet Dermatol. 2006 Apr;17(2):121-7.

In vitro investigation of ceruminolytic activity of various otic cleansers for
veterinary use.

Sánchez-Leal J, Mayós I, Homedes J, Ferrer L.

Departamento de Tecnología de Tensioactivos, IIQAB-Consejo Superior de
Investigaciones Científicas (CSIC), Barcelona, Spain.

Knowledge of the ceruminolytic activity of commercially available ear cleansing
products assists the practitioner to choose the best available product for
specific clinical situations. The aim of this study was to quantify and compare
the ceruminolytic activity of commercially available canine ear cleansers. For
this purpose, the ceruminolytic activity of 13 ear cleansers was evaluated using 
a standardized synthetic cerumen (SSC) that mimics the composition and texture of
canine cerumen. The test products were incubated with mild agitation for 20 min
with 500 mg of SSC previously compacted at the bottom of a test tube.
Ceruminolytic activity was then assessed by quantifying the SSC removed by
decantation. This procedure was repeated five consecutive times on each tube
simulating repeated applications in the canine ear canal. Good repeatability
among replicates was found in this assay, allowing direct comparisons between
products. The final percentage of SSC elimination ranged from none (similar to
water), between 8 and 39% for three products and up to 90% for one product
(P<0.001). It is concluded that, in the experimental conditions used in this
study, only 1/13 products had significant ceruminolytic activity.

Publication Types: 
    Evaluation Studies
    In Vitro

PMID: 16515654 [PubMed - indexed for MEDLINE]

793: Psychol Rep. 2005 Dec;97(3):819-31.

First psychometric evaluation of a disease-specific questionnaire for children's 
behavior related to otitis media with effusion.

Timmerman A, Anteunis L, Meesters C.

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of 
Maastricht, The Netherlands. ATI@skno.azm.nl

The major goal of the present study is a psychometric analysis of two
age-specific questionnaires for the assessment of Otitis Media with
Effusion-specific behavior in young children, intended for use in case-finding.
In total, 172 children ages 12 to 24 mo. and 121 children ages 24 to 48 mo. were 
available initially. Caregivers completed the questionnaires on two occasions
before tympanostomy tube insertion and once 6 wk. later. Factor analysis of a
matrix for 30 items yielded four factors for the younger age group and six
factors for a 33-item matrix for the older age group, showing more
differentiation of factors in terms of developmental specificity for behavior
related to Otitis Media with Effusion. The total internal consistency was .82,
and each factor measured different aspects of disease-specific behavior (alpha < 
or = 0.25) in both questionnaires. Sensitivity to change seemed promising and was
significant for the age group 12 to 24 mo. Research with revised questionnaires
is recommended, in an ongoing validation process, to create optimal developmental
conditions for children with chronic or persistent Otitis Media with Effusion.

Publication Types: 
    Evaluation Studies
    Research Support, Non-U.S. Gov't

PMID: 16512300 [PubMed - indexed for MEDLINE]

794: Pediatr Infect Dis J. 2006 Mar;25(3):211-8.

A multicenter, open label, double tympanocentesis study of high dose cefdinir in 
children with acute otitis media at high risk of persistent or recurrent
infection.

Arguedas A, Dagan R, Leibovitz E, Hoberman A, Pichichero M, Paris M.

Instituto de Atención Pediátrica, Neeman-ICIC, Hospital Nacional de Niños, San
José, Costa Rica. aarguedas@iped.net

BACKGROUND: Given the relatively high prevalence of recurrent and persistent
acute otitis media (AOM) and the prominent etiologic role of Streptococcus
pneumoniae, especially penicillin-nonsusceptible strains in children with these
conditions, new alternative treatments are desirable. METHODS: Children 6
months-4 years of age with AOM considered to be at risk for recurrent or
persistent infection received large dosage cefdinir 25 mg/kg oral suspension once
daily for 10 days. Children were evaluated pretreatment (day 1), on therapy (days
4-6), end of therapy (days 12-14) and at follow-up (days 25-28). All children had
tympanocentesis at enrollment. In culture-positive children, tympanocentesis was 
repeated after 3-5 days (days 4-6) unless evidence of absence of middle ear
effusion was documented. RESULTS: Of 447 children enrolled, 230 were clinically
and bacteriologically evaluable (74% 2 years old or younger; 57% treated for AOM 
in previous 3 months). Bacteriologic eradication, based on repeat tympanocentesis
on days 4-6, was achieved in 74% (170 of 230) of children; 76% (201 of 266) of
AOM pathogens were eradicated. Eradication of penicillin-susceptible,
-intermediate and -resistant S. pneumoniae was 91% (50 of 55), 67% (18 of 27) and
43% (10 of 23), respectively (P < 0.001); eradication of H. influenzae was 72%
(90 of 125). Overall clinical response at days 12-14 was 83% (76 and 82% for
children with S. pneumoniae and Haemophilus influenzae, respectively). Sustained 
clinical response at days 25-28 was 85%. Clinical response was 83% for
culture-positive children versus 96% for culture-negative children at baseline
tympanocentesis (P < 0.001). CONCLUSIONS: In this study of AOM among children at 
risk for persistent or recurrent infection, large dose cefdinir resulted in an
overall successful clinical response at end of treatment of 83%. This regimen was
efficacious against penicillin-susceptible S. pneumoniae, but effectiveness was
markedly decreased against nonsusceptible strains and was moderate for H.
influenzae strains.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 16511382 [PubMed - indexed for MEDLINE]

795: Pediatrics. 2006 Mar;117(3):603-8.

Effect of combined pneumococcal conjugate and polysaccharide vaccination on
recurrent otitis media with effusion.

van Heerbeek N, Straetemans M, Wiertsema SP, Ingels KJ, Rijkers GT, Schilder AG, 
Sanders EA, Zielhuis GA.

Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre, PO
Box 9101, Nijmegen 6500 HB, The Netherlands. n.vanheerbeek@kno.umcn.nl

BACKGROUND: Otitis media with effusion (OME) is very common during childhood.
Because Streptococcus pneumoniae is one of the most common bacterial pathogens
involved in OME, pneumococcal vaccines may have a role in the prevention of
recurrent OME. OBJECTIVE: We sought to assess the effect of combined pneumococcal
conjugate and polysaccharide vaccinations on the recurrence of OME. METHODS: A
randomized, controlled trial was performed with 161 children, 2 to 8 years of
age, with documented persistent bilateral OME. All subjects were treated with
tympanostomy tubes (TTs). One half of the subjects were assigned randomly to
additional vaccination with a 7-valent pneumococcal conjugate vaccine 3 to 4
weeks before and a 23-valent pneumococcal polysaccharide vaccine 3 months after
tube insertion. Blood samples were drawn at the first vaccination, at the time of
TT placement, and 1 and 3 months after the second vaccination. Levels of IgA and 
IgG serum antibody against the 7-valent pneumococcal conjugate vaccine serotypes 
4, 6B, 9V, 14, 18C, 19F, and 23F were measured with enzyme-linked immunosorbent
assays. All children were monitored for recurrence of OME for 6 months after
spontaneous extrusion of the TTs. RESULTS: The overall recurrence rate of
bilateral OME was 50%. Pneumococcal vaccinations induced significant 4.6- to
24.4-fold increases in the geometric means of all conjugate vaccine serotype
antibody titers but did not affect recurrence of OME. CONCLUSIONS: Combined
pneumococcal conjugate and polysaccharide vaccination does not prevent recurrence
of OME among children 2 to 8 years of age previously known to have persistent
OME. Therefore, pneumococcal vaccines are not indicated for the treatment of
children suffering from recurrent OME.

Publication Types: 
    Randomized Controlled Trial

PMID: 16510637 [PubMed - indexed for MEDLINE]

796: Ear Nose Throat J. 2006 Jan;85(1):60-2.

Atypical presentation of cutaneous tuberculosis and a retropharyngeal neck
abscess.

Agada FO, Sharma R, Makura ZG.

Department of Otolaryngology-Head and Neck Surgery, Leeds General Infirmary,
Leeds, UK. foagada@aol.com

A 70-year-old Asian man with noninsulin-dependent diabetes presented with a
4-month history of left-sided otitis externa and right-sided facial palsy.
Physical examination of the left ear revealed a punched-out ulcerative lesion on 
the tragus, an edematous and inflamed external auditory canal, and a purulent
nonmucoid discharge. Computed tomography of the brain and neck demonstrated a
large retropharyngeal abscess, an abscess in the left parapharyngeal space, and a
small collection adjacent to the right carotid sheath at the level of C4; the
cervical vertebrae and lungs were normal. Microscopy of drained pus and histology
of left ear and neck node biopsies identified tuberculosis. The patient was
started on antituberculosis drug therapy, but he died within 2 weeks of
treatment. We discuss the characteristics of this unusual presentation of
tuberculosis infection.

Publication Types: 
    Case Reports

PMID: 16509249 [PubMed - indexed for MEDLINE]

797: Ear Nose Throat J. 2006 Jan;85(1):36-9.

Surgical management of intracranial complications of otogenic infection.

Bento R, de Brito R, Ribas GC.

Department of Otolaryngology, University of São Paulo School of Medicine, São
Paulo, Brazil.

We conducted a prospective study of 24 patients to evaluate the evolution of
intracranial complications resulting from otogenic infection and to correlate the
course of the disease with surgical treatment. Almost half of the patients were
younger than 18 years, and most were male. The most common intracranial
complication was brain abscess, followed by meningitis, lateral sinus thrombosis,
and extradural abscess. Cholesteatoma was found in 14 patients. After the
complications were confirmed by computed tomography, initial treatment consisted 
of intravenous systemic antibiotics followed by mastoid surgery. The surgical
approach was determined by the type of ear disease, not by the type of neurologic
complication. Modified radical mastoidectomy was performed in 16 patients,
tympanomastoidectomy in 6, and myringotomy in 2. No significant morbidity,
mortality, recurrence, or residual neurologic deficit was observed at the 6-month
follow-up. Early surgical intervention is important in achieving positive
outcomes in patients with such intracranial complications.

PMID: 16509241 [PubMed - indexed for MEDLINE]

798: Scand J Infect Dis. 2006;38(3):172-80.

Prehospital diagnostic and therapeutic management of otogenic Streptococcus
pneumoniae meningitis.

Østergaard C, Høiby N, Konradsen HB, Samuelsson S.

National Centre for Antimicrobials and Infection Control, Statens Serum
Institute, Copenhagen, Denmark. coa@ssi.dk

Prehospital diagnostics and therapeutic management, as well as clinical and
laboratory data from 57 consecutive cases with otogenic pneumococcal meningitis
(OPM) in Denmark during a 2-y period (1999-2000) were studied by review of
discharge and medical records including a questionnaire sent to the general
practitioners responsible for the individual patient. 12 cases were <2 y of age, 
whereas the remaining 45 cases were >21 y of age. Fever (in 98%) and altered
consciousness (in 98%), respectively, were significantly more frequent
prehospital symptoms (median duration of symptoms: 2 d (1-4)) than earache (in
71%, p < 0.0001), tympanic perforation (in 38%, p < 0.0001), and back rigidity
(in 25%, p < 0.0001) in OPM. Some 82% visited a physician before admission, and
an otogenic focus was diagnosed in 57%, a myringotomy was performed in 12%, and
antibiotic therapy was initiated in 29% of these cases. Prehospital antibiotic
therapy was more likely to be initiated in patients where the physician found an 
otogenic focus compared to patients where an otogenic was not found (46% vs 6%,
respectively, p = 0.01). However, <10% of cases with OPM were treated for otitis 
media with adequate dosing of antibiotics for more than 1 d based on
pharmacodynamic estimates. The clinical course was more severe in adults than in 
children (e.g. need for assisted ventilation (61% vs 0%, respectively, p < 0.01),
development of sequelae (75% vs 8%, respectively, p < 0.01) together with higher 
CSF WBC and CSF protein levels (3738 vs 1361 cells/microl and 3.8 vs 1.6 g/l,
respectively, p < 0.01), whereas corticosteroids were more frequently given to
children than to adults (55% vs 3%, p < 0.001). Prehospital antibiotic therapy
was not significantly associated with a more favourable outcome of OPM (50% vs
60%, respectively, p = 0.73). In conclusion, our results suggest that an otogenic
focus is as frequent in adults as in children with pneumococcal meningitis and
that an otogenic examination should be performed on patients presenting with
fever and altered consciousness. Moreover, OPM seems predominantly to occur in
patients receiving no or inadequate antibiotic therapy for otitis media.

PMID: 16507498 [PubMed - indexed for MEDLINE]

799: Am J Otolaryngol. 2006 Mar-Apr;27(2):109-11.

Middle ear effusion in intensive care unit patients with prolonged endotracheal
intubation.

Lin CC, Lin CD, Cheng YK, Tsai MH, Chang CS.

Department of Otolaryngology, China Medical University Hospital, Taichung,
Taiwan, ROC.

OBJECTIVES: The purpose of this study is to explore the factors related to the
occurrence of middle ear effusion (MEE) in prolonged endotracheal intubation
patients in the intensive care unit (ICU). METHODS: Information about the age,
sex, duration of endotracheal intubation, level of consciousness, and placement
of nasogastric tube was retrospectively collected from medical charts of 20
prolonged endotracheal intubation (>7 days) patients in the ICU. All patients
received otoscopic examination, tympanometry studies, and spectral gradient
acoustic reflectometry for evidence of MEE. RESULTS: Among the 40 ears examined
in this study, 20 ears had MEE (50%), 14 ears were normal (35%), and 6 ears had
negative pressure in the middle ear (15%). In addition, patients with conscious
disturbance and those who had been intubated for 14 days had a significantly
higher incidence of MEE. Nasogastric tube was not implicated in MEE in this
study. No episodes of acute otitis media or systemic infection were encountered
in this study. CONCLUSIONS: Prolonged endotracheal intubation (>7 days) in adult 
ICU patients contributed to the high incidence of MEE (50%). Moreover, conscious 
disturbance and endotracheal intubation for 14 days were also significant
contributing factors of MEE.

PMID: 16500474 [PubMed - indexed for MEDLINE]

800: Am J Otolaryngol. 2006 Mar-Apr;27(2):81-5.

Cyclooxygenase 2 expression in otitis media with effusion.

Kakiuchi M, Tsujigiwa H, Orita Y, Nagatsuka H, Yoshinobu J, Kariya S, Haginomori 
S, Orita S, Fukushima K, Okano M, Nagai N, Nishizaki K.

Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate
School of Medicine and Dentistry, Okayama, Japan.

OBJECTIVES: To study whether cyclooxygenase 2 (COX-2) plays a role in the
development of otitis media with effusion (OME). STUDY DESIGN/METHODS: An
experimental model of endotoxin-induced OME was used in healthy BALB/c mice.
Solutions of Salmonella typhimurium endotoxin were injected into the middle ears 
of the mice, and COX-2 expression in the middle ears was studied using reverse
transcription-polymerase chain reaction (RT-PCR) and in situ hybridization (ISH).
RESULTS: Analysis by RT-PCR showed that COX-2 expression in the middle ear
increased in a dose-dependent fashion after injection of endotoxin. ISH
demonstrated that COX-2 had distinct expression patterns in the epithelium of
middle ears with endotoxin-induced OME. COX-2 expression, however, was not
detected in normal middle ears. CONCLUSIONS: COX-2 expression may be one factor
contributing to the development of OME.

PMID: 16500468 [PubMed - indexed for MEDLINE]

801: Otolaryngol Head Neck Surg. 2006 Mar;134(3):443-50.

Revision chronic ear surgery.

Kaylie DM, Gardner EK, Jackson CG.

Otology Group of Vanderbilt, 300 20th Avenue North, Suite 502, Nashville, TN
37203, USA. david.kaylie@vanderbilt.edu

OBJECTIVE: To report results of revision chronic ear surgery following guidelines
of the American Academy of Otolaryngology-Head and Neck Surgery and to establish 
expectations for infection and cholesteatoma control and hearing outcomes. STUDY 
DESIGN: Retrospective case review of all patients who underwent revision chronic 
ear surgery from January 1, 1990 to December 31, 2000. Revision chronic ear
surgery included canal wall up and canal wall down procedures with ossicular
chain reconstruction performed as needed. Cholesteatoma control, hearing
improvement, and closure of middle ear space are main outcome measures. SETTING: 
Tertiary referral center. RESULTS: Cholesteatoma recurrence rate was 57% at 1
year after surgery and 14% in patients with a minimum of a 5-year follow-up.
Disease control was achieved in 96% of patients. Hearing was significantly
improved in all surgical groups. Closure of the air-bone gap for revision partial
ossicular replacement prosthesis cases (PORP) to less than 20 dB occurred in 50% 
of patients. Closure of the air-bone gap to within 30 dB for revision total
ossicular replacement prosthesis (TORP) occurred in 60% of patients. Canal wall
down status had a significant impact on hearing results after PORPs and TORPs;
patients with intact canal walls had significantly better hearing results.
Diagnosis of cholesteatoma significantly impacted hearing results for TORPs but
not PORPS. CONCLUSIONS: Cholesteatoma control rates after revision surgery are
similar to primary cases. Significant improvement in hearing can be expected
after revision chronic ear surgery. Hearing results after a revision surgery that
requires a PORP is worse than primary cases and is canal wall status dependent.
Closure of the middle ear space and creation of a safe dry ear can be expected
after revision chronic ear surgery. SIGNIFICANCE: This is a review of a large
series of exclusively revision chronic ear surgery. EBM rating: C-4.

PMID: 16500442 [PubMed - indexed for MEDLINE]

802: Acta Paediatr. 2006 Mar;95(3):359-63.

Disappearance of middle ear effusion in acute otitis media monitored daily with
tympanometry.

Renko M, Kontiokari T, Jounio-Ervasti K, Rantala H, Uhari M.

Department of Paediatrics, University of Oulu, Oulu, Finland. marjo.renko@oulu.fi

BACKGROUND: Disappearance of middle ear effusion is one of the most important
outcomes in the treatment of acute otitis media (AOM). AIM: To evaluate the
duration of effusion in AOM treated by antimicrobials and to find factors
influencing it. METHODS: Parents of 90 children with AOM monitored daily the
disappearance of effusion with tympanometry. The children were randomly allocated
to be treated with either oral amoxicillin or cefuroxime-axetil for 10 d. Daily
monitoring lasted for 14 d or until the tympanogram was normal (curve A or C) in 
both ears. Pneumatic otoscopy was carried out every 2 wk. RESULTS: Normal
tympanograms were obtained after a median time of 7.5 d (range 1-58 d) among 75
successfully monitored patients. In two-thirds (69%) of them, effusion resolved
in 14 d. The median duration of effusion did not differ significantly between the
two treatment groups (8 vs 7 days, p=0.7). The children who had unilateral AOM
cured more rapidly than those with bilateral AOM (5 vs 19 d, p<0.001). In
logistic regression analysis adjusted for age, bilaterality explained treatment
failure at 2 wk with an odds ratio of 28.1 (95% CI 4.6-169.5, p<0.001).
CONCLUSION: The choice of antimicrobials did not influence the duration of middle
ear effusion, which was much shorter than had been thought previously. Children
with unilateral AOM were cured much more quickly than those with bilateral AOM.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 16497649 [PubMed - indexed for MEDLINE]

803: Clin Ther. 2006 Jan;28(1):118-23.

Current face of acute otitis media: microbiology and prevalence resulting from
widespread use of heptavalent pneumococcal conjugate vaccine.

Brunton S.

Cabarrus Family Medicine Residency, Charlotte, North Carolina 28226, USA.
ozdoc@aol.com

BACKGROUND: Many causes can be proposed for a change in the microbiologic makeup 
of a specific disease state. However, when viewed through the scope of recent
events, only one is likely to be the true cause of a change in the microbiology
of acute otitis media (AOM): the release and widespread use of heptavalent
pneumococcal conjugate vaccine (PCV-7). OBJECTIVE: The aim of this report was to 
review the microbiology and prevalence of AOM before and after the release and
widespread use of PCV-7. METHODS: For this brief review, we used a MEDLINE search
to identify English-language literature related to the microbiology of AOM before
and after the release of PCV-7 in 2000 in the United States (key terms: acute
otitis media, AOM, Haemophilus influenzae, H influenzae, Streptococcus
pneumoniae, and S pneumoniae; years: 1980-2005). Studies using tympanocentesis to
identify the pathogen in recurrent or persistent AOM were examined; US studies
reporting AOM microbiology before and after the release of PCV-7 in the same
population were considered for the post-PCV-7 analysis. RESULTS: Following the
release of PCV-7, a decrease in the overall rates of AOM was noted. This decrease
brings into question the resultant effect on the microbiology of AOM. Our
literature search revealed 2 studies that examined the microbiology of AOM before
and after the release of PCV-7 in the United States. These 2 studies, conducted
in dispersed geographic regions (rural Kentucky and Rochester, New York),
illustrated a change in the predominant causative pathogen in AOM, from S
pneumoniae to H influenzae in the population of children 7 to 24 months of age
with recurrent AOM. Given the time period of the change, these shifts could be
related to the release and widespread use of PCV-7. CONCLUSIONS: Since the 1990s,
the predominant causative pathogen in recurrent AOM changed from S pneumoniae to 
H influenzae, possibly as a result of the release and widespread use of PCV 7.
Although PCV-7 use was slowed from August 2001 to May 2003 and again from
February to September 2004 by nationwide shortages, those shortages have now been
resolved, and compliance with the full vaccine schedule is expected to increase.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 16490585 [PubMed - indexed for MEDLINE]

804: FEMS Immunol Med Microbiol. 2006 Mar;46(2):166-8.

Development of antibodies against the putative proteinase maturation protein A in
relation to pneumococcal carriage and otitis media.

Bogaert D, Holmlund E, Lahdenkari M, de Groot R, Kilpi T, Hermans PW, Kayhty H.

Laboratory of Pediatrics, Erasmus MC-Sophia, Rotterdam, The Netherlands.

The putative pneumococcal proteinase maturation protein A is a potential
pneumococcal vaccine candidate. We examined serum antipneumococcal proteinase
maturation protein A antibodies at 6, 12, 18 and 24 months of age, and showed
that the age-related development of antipneumococcal proteinase maturation
protein A antibodies is associated with pneumococcal contacts. A higher
antipneumococcal proteinase maturation protein A antibody concentration at 18
months of age tends to predict for a lower risk of pneumococcal acute otitis
media in the following 6 months (relative risk: 0.84, 95% confidence interval:
0.62-1.13).

PMID: 16487297 [PubMed - indexed for MEDLINE]

805: Trop Doct. 2006 Jan;36(1):56-7.

Relapse in a child with otogenic tetanus.

Sharma A, Kapoor S.

PGIMS, Rohtak, Medical College & Hospital, Maharishi Dayanand University,
Haryana, India. dr_anitasharma@yahoo.com

Otogenic tetanus is common in a developing country like India. However, adequate 
sedation and elimination of spasms by medical treatment is sufficient in most
cases. Once treated, relapses are rare. The authors report a 2-year-old girl who 
relapsed twice after near complete recovery. This communiqué is intended to
highlight that tetanus is still a significant health problem in third-world
countries and a relapse after such a dreadful disease is terrifying.

Publication Types: 
    Case Reports

PMID: 16483443 [PubMed - indexed for MEDLINE]

806: Laryngoscope. 2006 Jan;116(1):47-51.

Should ossicular reconstruction be staged following tympanomastoidectomy.

Kim HH, Battista RA, Kumar A, Wiet RJ.

Wilson Ear Clinic, Portland, Oregon 97209, USA. galbey@yahoo.com

OBJECTIVES: To determine whether ossicular reconstruction (OCR) performed
concurrent with tympanomastoidectomy for cholesteatoma results in significantly
different hearing results when compared to OCR performed in a separate, staged
procedure. STUDY DESIGN: Retrospective. MATERIALS AND METHODS: Study subjects
were patients undergoing OCR within a 2-year period. Intervention was OCR
concurrent with tympanomastoidectomy for cholesteatoma (group 1) or staged
following tympanomastoidectomy for cholesteatoma (group 2). Main outcome measures
were mean postoperative air-bone gap (ABG), proportion achieving ABG closure to
<20 dB and <30 dB for group 1 and group 2 overall and when controlling for type
of mastoid cavity created (open or closed) and the status of the stapes
suprastructure (TORP vs. PORP OCR). RESULTS: Eighty-three patients were
identified. Forty underwent OCR concurrent with tympanomastoidectomy and 43
underwent a staged OCR after tympanomastoidectomy. Overall, similar hearing
results were seen in the two groups. When considering the status of the stapes
and mastoid cavity, concurrent OCR resulted in improved mean postoperative ABG in
a closed mastoid cavity with an intact stapes suprastructure (P = .024).
Furthermore, a greater proportion of patients who had concurrent OCR within this 
group achieved ABG <20 dB and ABG <30 dB, although this difference did not reach 
statistical significance (P = .092 and P = .078, respectively). By contrast,
staged OCR resulted in improved mean postoperative ABG and ABG <30 dB in open
mastoid cavities with an absent stapes suprastructure (P = .040, and P = .019,
respectively). Similarly, a greater proportion achieved ABG <20 dB, approaching
statistical significance (P = .055). CONCLUSIONS: Staged OCR is advantageous in
those with most severe disease, whereas those with least severe disease may
benefit from a concurrent OCR.

Publication Types: 
    Comparative Study

PMID: 16481808 [PubMed - indexed for MEDLINE]

807: Int J Pediatr Otorhinolaryngol. 2006 Jul;70(7):1251-6. Epub 2006 Feb 14.

Risk factors for otitis media: an international perspective.

Rovers MM, de Kok IM, Schilder AG.

Julius Center for Health Sciences and Primary Care, University Medical Center
Utrecht, Stratenum 6.139, P.O. Box 85060, 3508 AB Utrecht, The Netherlands.
M.Rovers@umcutrecht.nl

BACKGROUND: Opinions about otitis media (OM) as an illness and about the need for
antibiotic or surgical treatment vary internationally. It is not known how this
is to be explained, whether by cultural differences or by other factors, such as 
variation in environmental risk factors for OM. OBJECTIVES: To report on
variation in environmental risk factors for OM across Western countries, and on
the organisation of health care in these countries. METHODS: Main environmental
risk factors for OM were identified by searching Pubmed. Data on the distribution
of these risk factors and the organisation of health care across countries were
obtained from the OECD and WHO websites. RESULTS: Main risk factors for OM were
day-care, number of siblings, smoking, breastfeeding, birth weight,
socio-economic status (SES) and air pollution. Data were available for several
European countries, the United State, Canada and Australia. Large international
differences were found regarding the proportion of children attending day-care
(Sweden 75% versus Italy 6%) and being breastfed at age 6 months (Norway 80%
versus Poland 6%), and the rate of female smokers (Germany, France and Norway
30-40% versus Portugal <10%). CONCLUSION: It appears that differences in risk
factor exposure between populations are often overshadowed by other culturally or
demographically significant factors. Attempts to discern these factors within
populations and between countries may be important in the management of OM and
warrants further study.

PMID: 16481051 [PubMed - indexed for MEDLINE]

808: ORL J Otorhinolaryngol Relat Spec. 2006;68(4):195-8. Epub 2006 Feb 13.

Practical use of MESNA in atelectatic ears and adhesive otitis media.

Yilmaz M, Goksu N, Bayramoglu I, Bayazit YA.

Department of Otolaryngology, Faculty of Medicine, Gazi University, Besevler,
Ankara, Turkey.

OBJECTIVE: MESNA is a synthetic sulfur compound that produces mucolysis by
disrupting disulfide bonds. This study aimed to address indications and technique
of MESNA application in otologic surgery, especially in retraction pockets and
adhesive otitis media. METHODS: MESNA application was performed in 42 ears of 39 
patients. The diagnoses were retraction pockets fixed to incudostapedial joint,
stapes or promontorium, and adhesive otitis media in 24 and 17 ears,
respectively. Calculations were performed according to 24 ears of 23 patients
with follow-up data. RESULTS: One or more of the following surgical interventions
were performed: MESNA application alone and ventilation tube insertion,
reinforcement or mastoidectomy in addition to MESNA application. Sensorineural
hearing loss was not encountered after MESNA application. The operation was
successful in 79.2%. Overall revision surgery was needed in 20.8% of the ears. In
71.4% of the ears treated with MESNA alone, revision surgery was needed.
CONCLUSION: In the light of our experience, we advocate the use of MESNA in
atelectatic ears, because it makes the operation easy and safe by allowing
elevation of the tympanic membrane by its mechanical and chemical actions.
Copyright (c) 2006 S. Karger AG, Basel.

PMID: 16479146 [PubMed - indexed for MEDLINE]

809: Vet Rec. 2006 Feb 11;158(6):193-5.

Comparison of an antifungal agent with a mixture of antifungal, antibiotic and
corticosteroid agents for the treatment of Malassezia species otitis in dogs.

Bensignor E, Grandemange E.

Dermatology Referral Service, 6 rue Mare Pavée, 35510 Cesson Sévigné, France.

Twenty dogs with otitis externa in both ears and numerous Malassezia species
yeasts on cytological examination were treated in one ear with a combination
product containing clotrimazole, marbofloxacin and dexamethasone, and in the
other ear with a topical antifungal containing miconazole. The effects of the
treatments were analysed on the basis of the scores for pruritus, erythema and
amount of cerumen, and the number of yeasts on cytological smears. There were
reductions in the counts of Malassezia species after both treatments, but the
combination product gave significantly greater reductions in erythema, cerumen
and pruritus.

Publication Types: 
    Comparative Study

PMID: 16474052 [PubMed - indexed for MEDLINE]

810: Mymensingh Med J. 2006 Jan;15(1):4-9.

Extracranial complications of chronic suppurative otitis media.

Hossain MM, Kundu SC, Haque MR, Shamsuzzaman AK, Khan MK, Halder KK.

Mymensingh Medical College and Hospital.

The aim of this study was to find out the pattern of extracranial complications
of CSOM cases who attended to the department of ENTD, Mymensingh Medical College 
Hospital during the period from July'1999 to June' 2001. Different types of
extracranial complications of CSOM were presented here. A total of 100 cases,
diagnosed clinically and radiologically were included in the study of which 66
were male and 34 were female giving a male to female ratio of 1.94 : 1 (p <
0.05). Majority cases (53) were in the age group of 11- 20 years followed by the 
age group of below 10 years where there were 30 cases. Majority (64) cases came
from low socio-economic class. The number of different types of extracranial
complications of CSOM were as follows: mastoid abscess 57, discharging sinuses
28, purulent labyrinthitis 07, Bezold's abscess 04, fascial nerve paralysis 03
and zygomatic abscess 01. In all cases of CSOM Cholesteatoma were detected. In 14
cases, Cholesteatoma were associated with granulation tissue/polyp. Modified
radical mastoidectomy were performed in all cases. On analyzing the findings of
the present study it was observed that mastoid abscess were the predominant
extracranial complications of CSOM, affecting mostly the male population of 11 - 
20 years age group coming from low socio-economic class.

PMID: 16467754 [PubMed - indexed for MEDLINE]

811: Ann Otol Rhinol Laryngol. 2006 Jan;115(1):81-8.

Transforming growth factor beta expression during an inner ear immune response.

Satoh H, Billings P, Firestein GS, Harris JP, Keithley EM.

Division of Otolaryngology-Head and Neck Surgery, University of California San
Diego, USA.

OBJECTIVES: The involvement of transforming growth factor beta (TGF-beta), a
strong mediator of fibrogenesis, during cochlear immune responses was
investigated. METHODS: An inner ear adaptive immune response to antigen was
created in mice that were painlessly sacrificed 3 to 48 hours and 7 days after
initiation of the immune response. The cochleas were assayed by
immunocytochemistry for TGF-beta and latency-associated peptide (LAP). RESULTS:
We found LAP expressed in normal cochleas and the endolymphatic sac, in the small
round cells in the cochlear scalae and the mesothelial cells under the basilar
membrane, and in the endolymphatic sac perisaccular area. We found TGF-beta
expressed in infiltrated, inflammatory cells in the scalae and the endolymphatic 
sac lumen 3 hours after cochlear antigen challenge. At this time, LAP
immunoreactivity was decreased. This rapid shift in immunoreactivity provides
evidence for activation of TGF-beta during an immune response. This reversal of
expression persisted for 48 hours, but conditions reverted to normal after 7
days. Surgical controls did not show TGF-beta expression. CONCLUSIONS: We
conclude that TGF-beta activation occurs in the early phase of a cochlear
adaptive immune response and is down-regulated as the response resolves. This
finding suggests that the process of cochlear fibrosis starts early and that
proper treatment could prevent cochlear fibrosis.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16466104 [PubMed - indexed for MEDLINE]

812: Pediatr Neurosurg. 2006;42(2):125-8.

Pott's puffy tumor: a rare complication of mastoiditis.

Khan MA.

Department of Neurosurgery, Riyadh Medical Complex, Riyadh, Saudi Arabia.
akramk61@hotmail.com

Pott's puffy tumor is rarely seen in the modern era of antibiotics. It is usually
seen as intracranial complication following inappropriately treated frontal
sinusitis. Up until 2001 there have been only 21 pediatric cases reported in the 
literature and most have been secondary to frontal sinusitis. Only 1 case has
been reported following a latent mastoiditis and that has been in an adult [1].
We report a case in a child who developed Pott's puffy tumor following
mastoiditis. Copyright (c) 2006 S. Karger AG, Basel.

Publication Types: 
    Case Reports

PMID: 16465085 [PubMed - indexed for MEDLINE]

813: ORL J Otorhinolaryngol Relat Spec. 2006;68(3):156-8. Epub 2006 Feb 6.

The influence of mastoidectomy on natural history of secretory otitis media in
cochlear implant children.

Migirov L, Amir A, Kronenberg J.

Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center,
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
smigirov@leumit.co.il

Secretory otitis media (SOM) is a common childhood disease. The goal of the
present study was to determine the influence of mastoidectomy on the incidence of
postimplantation SOM in cochlear implant children. We conducted a retrospective
study of all the children up to the age of 8 years, who underwent cochlear
implantation from 1993 to 2001 in our department. The children were divided into 
two groups according to the surgical technique used for the implantation: 94
children underwent implantation with the posterior tympanotomy approach
(including mastoidectomy) and 48 children were implanted with a suprameatal
approach (without mastoidectomy). The incidence of SOM before and after the
implantation was compared between the two groups. There were no significant
differences between the two study groups in terms of age and the pre- and
postimplantation incidence of SOM. Mastoidectomy failed to demonstrate any
influence on the natural history of SOM. Copyright 2006 S. Karger AG, Basel

Publication Types: 
    Comparative Study

PMID: 16465069 [PubMed - indexed for MEDLINE]

814: Neurosurgery. 2006 Feb;58(2):E386; discussion E386.

Resolution of an infectious pseudoaneurysm in a cervical petrous carotid vein
bypass graft after covered stent placement: case report.

Kim LJ, Albuquerque FC, McDougall CG, Spetzler RF.

Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's
Hospital and Medical Center, Phoenix, Arizona 85013, USA.

OBJECTIVE AND IMPORTANCE: Covered stenting of the carotid artery has been used to
treat aneurysms and dissections. We describe a unique case of covered stenting in
the setting of an infected psuedoaneurysm in a previously placed
cervical-to-petrous vein bypass graft. Operating in an infected field and
reopening a surgical wound at the craniocervical junction that had previously
been exposed to penetrating trauma created substantial risks to open surgical
repair. We therefore chose an endovascular strategy to repair this lesion.
CLINICAL PRESENTATION: A 57-year-old diabetic man with a previously placed
cervical-to-petrous vein bypass graft presented with chronic otitis media and
acute hemorrhage from his right external auditory meatus. Evaluation revealed an 
infectious pseudoaneurysm of the vein graft at the skull base. TECHNIQUE: The
patient was treated with intravenous antibiotics and endovascular placement of an
8-mm x 25-mm polytetrafluoroethylene-covered stent across the pseudoaneurysm.
Angiography obtained 8 months later confirmed successful obliteration of the
lesion. CONCLUSION: The patient's clinical outcome was excellent. Despite the
active infection, covered stenting of the pseudoaneurysm was an effective
treatment strategy, obviating the need for open debridement and graft revision.

Publication Types: 
    Case Reports

PMID: 16462468 [PubMed - indexed for MEDLINE]

815: Pediatr Infect Dis J. 2006 Feb;25(2):181-2.

Failure of a 5-day course of intramuscular ceftriaxone to eradicate Streptococcus
pneumoniae from the middle ear.

Anon JB, Ripple WL, Jacobs MR.

Department of Otolaryngology, University of Pittsburgh School of Medicine, Erie, 
PA, USA.

A 10-kg 9-month-old infant with recurrent, unresponsive otitis media presented
with bilateral acute otitis media caused by Streptococcus pneumoniae type 19A,
resistant to all oral agents and intermediately susceptible to ceftriaxone.
Treatment with myringotomies and intramuscular ceftriaxone, 50 mg/kg/d for 5
days, was unsuccessful. The patient responded to pressure equalization tubes and 
local ciprofloxacin with dexamethasone drops.

Publication Types: 
    Case Reports

PMID: 16462302 [PubMed - indexed for MEDLINE]

816: Pediatr Infect Dis J. 2006 Feb;25(2):101-7.

Development of a practical tool for assessing the severity of acute otitis media.

Friedman NR, McCormick DP, Pittman C, Chonmaitree T, Teichgraeber DC, Uchida T,
Baldwin CD, Saeed KA.

Departments of Pediatrics, University of Colorado, Denver, CO, USA.

BACKGROUND: Watchful waiting management of nonsevere acute otitis media (AOM) can
reduce the use of antibiotics, but it requires a reliable means of assessing
clinical severity. OBJECTIVE: We present the development of a pocket AOM card
with which the clinician can rapidly assess total AOM severity. DESIGN/METHODS:
The components of the pocket card consisted of a faces scale, to assess parent
perception of severity, and a standard set of tympanic membrane photographs, with
which the pediatrician can grade the severity of tympanic membrane inflammation. 
The components of the pocket card were tested for validity, reliability and
responsiveness with the use of data from parents, pediatricians and pediatric
otolaryngologists. STATISTICS: Instruments were assessed for concurrent
correlation, sequence validity and reliability against previously published
questionnaires with the use of Spearman correlation. Responsiveness was
calculated with the use of enrollment, day 12 and day 30 data from a randomized
clinical trial. RESULTS: The components of the pocket AOM card demonstrated
excellent sequence validity, concurrent correlation and reliability (r =
0.58-0.99). Total AOM card severity, consisting of the sum of the 2 scales,
demonstrated better responsiveness to change than any of the scales taken
individually. CONCLUSIONS: The AOM card combines a parent assessment of symptoms 
and the clinician assessment of the tympanic membrane to provide an assessment of
total AOM severity that can be used to facilitate shared decision making between 
parent and clinician. The combined score of the AOM card was more responsive to
change than any of the instruments used alone. The AOM card provides a useful
tool for teaching and research.

Publication Types: 
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16462284 [PubMed - indexed for MEDLINE]

817: ORL J Otorhinolaryngol Relat Spec. 2006;68(3):139-45. Epub 2006 Feb 3.

High prevalence of Streptococcus pneumoniae with mutations in pbp1a, pbp2x, and
pbp2b genes of penicillin-binding proteins in the nasopharynx in children in
Japan.

Hotomi M, Billal DS, Shimada J, Suzumoto M, Yamauchi K, Fujihara K, Yamanaka N.

Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, 
Wakayama, Japan.

OBJECTIVE: To evaluate the resistances of Streptococcus pneumoniae to
beta-lactams developed by stepwise alterations in high-molecular-weight
penicillin-binding proteins (PBPs) with a reduced binding affinity of
beta-lactams. Among the numerous mutations in pbp genes that alter the affinity
for beta-lactams, the decreased affinity of PBP1A, 2X and 2B is especially
important in the development of resistances to beta-lactams. STUDY DESIGN:
Retrospective review. METHODS: In this study, we investigated the mutations in
pbp1a, pbp2x, and pbp2b genes evaluated by polymerase chain reaction (PCR) in 866
pneumococcal isolates collected from the nasopharynx of Japanese children with
acute otitis media. RESULTS: 210 strains (24.3%) exhibited no mutations in the
three pbp genes. 333 strains (38.5%) had mutations in the three pbp genes, 78
(9.0%) in two pbp genes, whereas 245 (28.3%) displayed mutations in only one pbp 
gene. Among the 656 strains with mutations in pbp genes, 620 (94.5%) strains had 
mutations in pbp2x. The annual prevalence of antimicrobial-resistant S.
pneumoniae showed a gradual increase in strains with mutations in the three pbp
genes and a parallel decrease in strains without mutations. CONCLUSIONS:
PCR-based genotyping can characterize the antimicrobial resistances in
pneumococci along with minimal inhibitory concentrations (MICs). Physicians
should pay attention to the recent increase in antimicrobial-resistant S.
pneumoniae when treating pediatric acute otitis media.

PMID: 16462149 [PubMed - indexed for MEDLINE]

818: J Laryngol Otol. 2006 Mar;120(3):250-2. Epub 2006 Feb 7.

Septate fungal invasion in masked mastoiditis: a diagnostic dilemma.

Kuruvilla G, Job A, Mathew J, Ayyappan AP, Jacob M.

Department of ENT - Head and Neck Surgery, Christian Medical College & Hospital, 
Vellore, Tamil Nadu, India. gkthamara@yahoo.com

Invasive fungal mastoiditis is a rare entity, seen almost entirely in
immunocompromized patients. It has been reported primarily in patients with
leukaemia and more recently with acquired immunodeficiency syndrome. A literature
search revealed only a few reports in diabetic patients, in whom the invasive
fungus was identified as mucormycosis in all cases. We report the first case in
the English literature of invasive septate fungal mastoiditis in a diabetic
patient with intact tympanic membranes.

Publication Types: 
    Case Reports

PMID: 16460579 [PubMed - indexed for MEDLINE]

819: ORL J Otorhinolaryngol Relat Spec. 2006;68(3):135-8. Epub 2006 Jan 15.

Evaluation of serotypes of Streptococcus pneumoniae isolated from otitis media
patients by multiplex polymerase chain reaction.

Billal DS, Hotomi M, Tasnim S, Fujihara K, Yamanaka N.

Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, 
Wakayama, Japan.

The increasing difficulty in the management of pneumococcal acute otitis media in
parallel with increases in antimicrobial-resistant strains has led to much
interest in pneumococcal capsular types for the adoption of effective prevention 
by vaccines. This study shows that multiplex polymerase chain reaction is a
valuable and expeditious method for the capsular typing of pneumococci. The
multiplex polymerase chain reaction method accurately detects the majority of
serotypes and serogroups frequently isolated from pediatric patients with acute
otitis media, allowing the characterization of the colonization patterns for
further implications of pneumococcal vaccines. Copyright 2006 S. Karger AG, Basel

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16449822 [PubMed - indexed for MEDLINE]

820: Braz J Otorhinolaryngol. 2005 Jul-Aug;71(4):415-20. Epub 2005 Dec 15.

Tympanostomy tube sequelae in children with otitis media with effusion: a
three-year follow-up study.

Pereira MB, Pereira DR, Costa SS.

Federal University of Rio Grande do Sul.

Tympanostomy tube (TT) insertion is one of the most frequently performed
procedures in otolaryngology. Otorrhea, tympanosclerosis, retraction,
perforation, and cholesteatoma are complications reported in the literature after
its application. AIM: To determine the incidence and the type of TT insertion
sequelae/complications in children presenting with recurrent otitis media and
chronic otitis media with effusion undergoing myringotomy and tube placement.
STUDY DESIGN: Prospective cohort study. MATERIAL AND METHOD: A total of 75
children (150 ears) aged 11 months to 10 years were regularly followed up for up 
to 38 months after TT insertion. RESULTS: Incidence of sequelae/complications:
otorrhea--47.3% of the ears; perforation--2.1%; retractions--39.7%;
tympanosclerosis--23.3%. Average length of stay: 12.13 months. Mean age at
initial tube placement of children not requiring a second set of tubes = 35.9
months and mean age at initial tube insertion of children requiring an additional
set of tubes = 25.6 months (P = 0.04). TT stayed longer in the ears that had more
episodes of otorrhea (P = 0.01). TT insertion with adenoidectomy was associated
with a smaller number of otorrhea episodes (P = 0.02) CONCLUSIONS: Otorrhea was
the most frequently found complication. TT placement with adenoidectomy was
associated with fewer otorrhea episodes. TT extruded later in those ears that had
more episodes of otorrhea. Younger age at the time of the initial tube placement 
is associated with higher incidence of additional tube placement. One in six
patients will probably require a second set of ventilation tubes.

Publication Types: 
    Comparative Study

PMID: 16446953 [PubMed - indexed for MEDLINE]

821: ORL J Otorhinolaryngol Relat Spec. 2006;68(2):118-22. Epub 2006 Jan 27.

Intractable otitis media with eosinophils: Importance of diagnosis and validity
of treatment for hearing preservation.

Nakagawa T, Matsubara A, Shiratsuchi H, Kakazu Y, Nakashima T, Koike K, Umezaki
T, Komune S.

Department of Otorhinolaryngology, Faculty of Medicine, Kyushu University,
Fukuoka, Japan. nakataka@qent.med.kyushu-u.ac.jp

This study investigated hearing levels in cases of intractable otitis media with 
eosinophils and validated the treatment strategy. Medical charts were reviewed
retrospectively. The diagnosis was made when the proportion of eosinophils in
middle ear secretions exceeded 10%. Twelve patients were identified and treated
with an antihistaminergic agent, leukotriene receptor antagonist and topical
steroid. The air-bone conductance gap decreased significantly with the relief of 
subjective symptoms. Bone conduction hearing levels at 4 and 8 kHz were higher
than at lower frequencies. There was a significant correlation between subjective
symptom duration and bone conduction hearing level at 8 kHz, which diminished
with treatment. Compared with suppurative otitis, active otitis with eosinophilia
damages high-tone sensory hearing in a time-dependent manner, and antiallergic
treatment prevents progression of the high-tone sensory hearing loss. We
emphasize the importance of diagnosis and the validity of treatment for
intractable otitis media with eosinophils. Copyright 2006 S. Karger AG, Basel.

PMID: 16446559 [PubMed - indexed for MEDLINE]

822: Drugs Exp Clin Res. 2005;31 Suppl:7-10.

Improvement of otitis media with effusion after treatment of asthma with
leukotriene antagonists in children with co-existing disease.

Balatsouras DG, Eliopoulos P, Rallis E, Sterpi P, Korres S, Ferekidis E.

Department of Otolaryngology, Tzanion General Hospital, Piraeus, Greece.

Otitis media with effusion (OME) is a common pediatric disease and there is great
controversy concerning its management. Mechanical, medical and surgical
treatments have not proven adequate in resolving the disease and serve mainly to 
manage complications. Leukotriene inhibitors are new drugs that have been
approved recently for the treatment of asthma in children. The aim of this study 
was to evaluate the impact of leukotriene inhibitor therapy for asthma on the
clinical course of OME in children with co-existing disease. Fifty children with 
bilateral OME and asthma, divided equally into two groups, were studied. The
children in the first group were treated with budesonide and terbutaline inhalers
together with the leukotriene inhibitor montelukast, whereas the children in the 
second group were treated with the inhalers alone. Duration of treatment was 30
days. Pneumatic otoscopy, tympanometry and pure-tone audiometry were performed at
the beginning and at the end of treatment. Fifteen (60%) of the children
receiving inhalers and montelukast and nine (36%) of those receiving only
inhalers were found free of OME after 30 days of therapy. Thus, it may be
concluded that a statistically significant beneficial effect on the clinical
course of OME resulted from the addition of montelukast to the treatment of
children with co-existing asthma and OME. Given that no medication has been shown
to be effective in OME therapy, further investigation of the possible effects of 
leukotriene inhibitors is warranted.

Publication Types: 
    Clinical Trial
    Comparative Study

PMID: 16444906 [PubMed - indexed for MEDLINE]

823: J Laryngol Otol. 2006 Mar;120(3):219-21. Epub 2006 Jan 27.

Role of revision adenoidectomy in paediatric otolaryngological practice.

Liapi A, Dhanasekar G, Turner NO.

Department of Otolaryngology, Manor Hospital, Walsall, UK.

OBJECTIVES: We aimed to determine the need for revision adenoidectomy following
the standard technique of blind curettage with digital palpation. METHODS: Within
a district general hospital, we undertook a retrospective study of 3231 children 
who underwent adenoidectomy between 1996 and 2003, 53 of whom required revision
adenoidectomy. The main outcome measure was the number of children needing
revision adenoidectomy. RESULTS: A total of 53 children required a repeated
operation for recurrence of symptoms (1.6 per cent); of these, 42 were for
treatment of glue ear, five were for nasal symptoms and six were for adenoidal
infection. CONCLUSION: Adenoidectomy performed without vision may be one of the
reasons for recurrence of symptoms. Residual adenoids are acknowledged in the
literature as one of the complications of the traditional technique. We highlight
the fact that the need for revision adenoidectomy is not uncommon and suggest
that we should improve our surgical technique in the UK by visualization of the
postnasal space either by a mirror or an endoscope.

PMID: 16441971 [PubMed - indexed for MEDLINE]

824: J Laryngol Otol. 2006 Mar;120(3):226-7. Epub 2006 Jan 27.

Grommet insertion: a novel technique.

Sharma RK, Bateman N, Bull PD.

Department of ENT, Head and Neck, Sheffield Children's Hospital, Sheffield, UK.
ravibha@hotmail.com

We describe a new technique for inserting grommets which is both easy to master
and provides better visualization of the tympanic membrane. This is particularly 
helpful in patients with narrow ear canals.

PMID: 16441969 [PubMed - indexed for MEDLINE]

825: Clin Otolaryngol. 2006 Feb;31(1):69-72.

How we do it: laser reduction of peri-tubal adenoids in selected patients with
otitis media with effusion.

Smith W, Yung M.

Department of Otolaryngology, Addenbrookes Hospital NHS Trust, Hills Road,
Cambridge, UK. grommetsmith@doctors.org.uk

.The literature supports the benefit of adenoidectomy in patients with otitis
media with effusion (OME). .It is difficult to clear adenoid tissue from around
the Eustachian tubes using curettes and this conventional method of adenoidectomy
is contra-indicated in patients with cleft palates. .Laser reduction of
peri-Eustachian adenoid tissue without myringotomies or grommet insertion was
performed in three patients with OME. Two patients had previous adenoidectomies
performed with curettes and one patient had a cleft palate. .In all three
patients, the OME resolved and all had closure of the air-bone gap that was
maintained during long-term follow-up (14 months-4 years). .This technique
resolved OME without the need for myringotomies or grommet insertion and should
be considered particularly in patients who have peri-tubal recurrence of
adenoidal tissue following conventional adenoidectomy or in patients with cleft
palate where there is concern with regards to palatal incompetence.

Publication Types: 
    Case Reports

PMID: 16441808 [PubMed - indexed for MEDLINE]

826: Cochrane Database Syst Rev. 2006 Jan 25;(1):CD005608.

Comment in:
    ACP J Club. 2006 Sep-Oct;145(2):48.    Evid Based Med. 2006 Oct;11(5):151.

Systemic antibiotics versus topical treatments for chronically discharging ears
with underlying eardrum perforations.

Macfadyen CA, Acuin JM, Gamble C.

Liverpool School of Tropical Medicine, International Health Research Group,
Pembroke Place, Liverpool, UK, L3 5QA. carolynm@liv.ac.uk

BACKGROUND: Chronic suppurative otitis media (CSOM) causes ear discharge and
impairs hearing. OBJECTIVES: To compare systemic antibiotics and topical
antiseptics or antibiotics (excluding steroids) for treating chronically
discharging ears with an underlying eardrum perforation (CSOM). SEARCH STRATEGY: 
The Cochrane ENT Disorders Group Specialised Register, Cochrane Central Register 
of Controlled Trials (CENTRAL, The Cochrane Library Issue 1, 2005), MEDLINE
(January 1951 to March 2005), EMBASE (January 1974 to March 2005), LILACS
(January 1982 to March 2005), AMED (1985 to March 2005), CINAHL (January 1982 to 
March 2005), OLDMEDLINE (January 1958 to December 1965) PREMEDLINE, Metadatabase 
of registers of ongoing trials (mRCT), and article references. SELECTION
CRITERIA: Randomised controlled trials; any systemic versus topical treatment
(excluding steroids); participants with CSOM. DATA COLLECTION AND ANALYSIS: One
author assessed eligibility and quality, extracted data, entered data into
RevMan; two authors provided a second assessment of titles and abstracts, and
inputted where there was ambiguity. We contacted investigators for
clarifications. MAIN RESULTS: Nine trials (833 randomised participants; 842
analysed participants or ears). CSOM definitions and severity varied; some
included mastoid cavity infections, other diagnoses, or complications.
Methodological quality varied; generally poorly reported, follow-up short,
handling of bilateral disease inconsistent. Topical quinolone antibiotics were
better than systemic antibiotics at clearing discharge at 1-2 weeks: relative
risks (RR) were, 3.21 (95% confidence interval (CI) 1.88 to 5.49) using systemic 
non-quinolone antibiotics (2 trials, N = 116), and 3.18 (1.87 to 5.43) using
systemic quinolone (3 trials, N = 175); or 2.75 (1.38 to 5.46) in favour of
systemic plus topical quinolone over systemic quinolone alone (2 trials, N = 90).
No statistically significant benefit was seen at 2-4 weeks for topical
non-quinolone antibiotic (without steroids) or topical antiseptic over systemic
antibiotics (mostly non-quinolones), but numbers were small: one trial tested
topical non-quinolones (N = 31); two tested antiseptics (N = 152). No benefit of 
adding systemic to topical treatment at 1-2 weeks was detected either, although
evidence was limited (three trials, N = 204). Evidence regarding safety was
generally weak. Adverse events reported were generally mild, although hearing
worsened by ototoxicity (damaging auditory hair cells) was seen with
chloramphenicol drops (non-quinolone antibiotic). AUTHORS' CONCLUSIONS: Topical
quinolone antibiotics can clear aural discharge better than systemic antibiotics;
topical non-quinolone antibiotic (without steroids) or antiseptic results are
less clear. Evidence regarding safety was weak. Further studies should clarify
topical non-quinolones and antiseptic effectiveness, assess longer-term outcomes 
(for resolution, healing, hearing, or complications), and include further safety 
assessments, particularly to clarify the risks of ototoxicity and whether there
may be fewer adverse events with topical quinolones than other topical or
systemic treatments.

Publication Types: 
    Meta-Analysis
    Review

PMID: 16437533 [PubMed - indexed for MEDLINE]

827: Otol Neurotol. 2006 Feb;27(2):265-9.

Mitigation of hearing loss from semi-circular canal transection in pseudomonas
otitis media with ciprofloxacin-dexamethasone irrigation.

Shefelbine SE, Young LJ, Antonelli PJ.

Department of Otolaryngology, University of Florida, Gainesville, Florida
32610-0264, USA.

HYPOTHESIS: Irrigation of the mastoid with a quinolone antibiotic-steroid
solution may mitigate hearing loss caused by iatrogenic semicircular canal injury
in the presence of Pseudomonas aeruginosa (PA) otitis media (OM). BACKGROUND:
Studies have shown the cochlea to be more vulnerable to semicircular canal
transection (SCT)-related hearing loss in the presence of PA OM. Prophylactic
systemic antibiotics and steroids may decrease this hearing loss, but SCT is
usually not planned. The aim of this study was to determine if irrigation with
ciprofloxacin-dexamethasone (cipro-dex) could improve hearing outcomes following 
SCT in PA OM. METHODS: PA OM was induced in 28 animals. After three to five days,
unilateral SCT was performed in each animal, with sham SCT on the contralateral
ear. At surgery, half of the animals (n = 14) underwent irrigation of the both
mastoid bullae with cipro-dex; the second group of animals (n = 14) underwent
irrigation of the bullae with sterile saline. Auditory thresholds were obtained
immediately prior to SCT and 7-10 days after SCT. RESULTS: SCT ears treated with 
cipro-dex showed a mean click threshold improvement of 4.6 dB from
pre-transection to 7-10 days post-transection, whereas thresholds in the SCT ears
treated with saline worsened by 7.5 dB (p = 0.15). CONCLUSION: Irrigation of the 
guinea pig bulla with cipro-dex following SCT in the setting of PA OM appears
safe and may yield beneficial effects on hearing.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16436999 [PubMed - indexed for MEDLINE]

828: Allergy. 2006 Mar;61(3):332-6.

IgE sensitization, respiratory allergy symptoms, and heritability independently
increase the risk of otitis media with effusion.

Chantzi FM, Kafetzis DA, Bairamis T, Avramidou C, Paleologou N, Grimani I,
Apostolopoulos N, Papadopoulos NG.

Department of Allergy, 2nd Pediatric Clinic, P. & A. Kyriakou Children's
Hospital, Athens, Greece.

BACKGROUND AND AIMS: Epidemiological evidence examining the role of atopy and/or 
allergy in the pathogenesis of otitis media with effusion (OME) is inconclusive. 
The aim of this study was to assess any increased risk for OME attributable to
allergy-related factors, in a well-characterized population using a case-control 
design and multivariate analysis. SUBJECTS AND METHODS: Eighty-eight 1-7-year-old
children with OME, diagnosed by clinical and tympanometric evaluation and 80
matched controls were enrolled. A standardized questionnaire was completed, in
order to assess factors related to OME and allergy-related symptoms and diagnoses
using strict clinical definitions. Specific IgE was measured by skin-prick tests 
and/or CAP-FEIA. RESULTS: The patient and control groups were well matched.
Factors conferring increased risk for OME in the univariate analysis included IgE
sensitization, dyspnea, wheezing, asthma, paroxysmal sneezing, rhinitis, eczema, 
'any allergic disease,' family history of otitis media, and family history of
allergy. After multivariate analysis IgE sensitization, wheezing, nasal
obstruction, family history of otitis, and child-care attendance remained as
independent risk factors for development of OME. CONCLUSION: IgE sensitization
and respiratory allergy symptoms are independent risk factors for the development
of OME, suggesting that both immunological and mechanical pathways may contribute
to the development of the disease. Otitis heritability provides additional risk, 
as well as frequent exposure to viral upper respiratory tract infections in
children attending daycare. Treatment and/or prevention of OME using
anti-allergic medications should be further examined.

Publication Types: 
    Comparative Study

PMID: 16436142 [PubMed - indexed for MEDLINE]

829: J Chemother. 2005 Dec;17(6):628-35.

Evaluation of antimicrobial treatments in children with acute otitis media in
Spain: a pharmacokinetic-pharmacodynamic (PK/PD) approach.

Beobide I, Canut A, Gascón AR, Isla A, García-Rey C, De La Maza I, Labora A,
Pedraz JL.

Hospital Pharmacy, Txagorritxu Hospital, Vitoria-Gasteiz, Spain.

Pharmacokinetic/pharmacodynamic (PK/PD) principles are priceless tools for
evaluating the effectiveness of different antimicrobial treatments for different 
infections. However, very few studies deal with pediatric dosages and take into
account the unbound drug serum levels. Our study is focused on the most frequent 
antibiotic dosing schedules used in Spain for the treatment of acute otitis media
(AOM) in children, where high rates of penicillin and macrolide resistance exist 
among pneumococcal isolates. Pharmacokinetic parameters of antibiotics in
children where obtained from the literature. The minimum inhibitory
concentrations (MIC90) of antibiotics for pediatric strains of Streptococcus
pneumoniae and Haemophilus influenzae were obtained from the SAUCE 2 project.
Only ceftriaxone (50 mg/kg single intramuscular dose) and high doses of
co-amoxiclav (27-33 mg/kg q8h) provided adequate efficacy indexes (tss(%)>MIC)
for both S. pneumoniae and H. influenzae in AOM in children. These results are
consistent with MEF (medium ear fluid) levels obtained from the literature. Our
results confirm the utility of serum unbound levels to predict efficacy of
antibiotics in children with AOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16433193 [PubMed - indexed for MEDLINE]

830: Vet Radiol Ultrasound. 2006 Jan-Feb;47(1):45-52.

Comparative performance of radiography and computed tomography in the diagnosis
of middle ear disease in 31 dogs.

Rohleder JJ, Jones JC, Duncan RB, Larson MM, Waldron DL, Tromblee T.

Department of Veterinary Clinical Sciences, Lynn Hall of Veterinary Medicine,
Purdue University, Room 1352, 625 Harrison Street, West Lafayette, IN 47907-2026,
USA.

The purpose of this study was to compare computed tomography (CT) and radiography
for diagnosing the presence and severity of middle ear disease in dogs with a
history of chronic otitis externa. Thirty-one dogs undergoing a total ear canal
ablation and bulla osteotomy were studied. Three normal dogs served as controls. 
All dogs were examined using radiography and CT. Three radiologists independently
evaluated imaging studies in random order. A visual analog scale method was used 
for scoring certainty and severity of middle ear disease. Surgical findings were 
recorded intra-operatively. Bulla lining samples were submitted for
histopathologic evaluation and scored by a single pathologist who also used a
visual analog scale system. Findings from both imaging modalities agreed more
closely with surgical findings than with histopathologic findings. With either
surgical or histopathologic findings as the gold standard, CT was more sensitive 
than and as specific as radiographs for predicting presence and severity of
middle ear disease. Observer performance with CT was more consistent than the
performance with radiographs in the detection of changes that occur with middle
ear disease. Both radiography and CT were more accurate for predicting the
severity of the disease than its presence. Findings indicate that CT is more
accurate and reliable than radiography in diagnosing middle ear disease for dogs 
having concurrent otitis externa, but only when severity of disease is moderate
or high. With low severity of disease, diagnostic certainty for both modalities
becomes more variable.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16429984 [PubMed - indexed for MEDLINE]

831: B-ENT. 2005;1(4):173-6.

Ventilation tubes in infants increase the risk of otorrhoea and antibiotic usage.

Ingels K, Rovers MM, van der Wilt GJ, Zielhuis GA.

Department of Otorhinolaryngology, Radboud University Medical Centre, Nijmegen,
The Netherlands. K.Ingels@kno.umcn.nl

1) PROBLEM/OBJECTIVE: The effect of ventilation tubes on acute otitis related
symptoms (otorrhoea, earache, and fever) and on antibiotic usage was investigated
in children with persistent otitis media with effusion, as part of a multicenter,
randomised, controlled clinical trial. 2) METHODOLOGY: One hundred-eighty-seven
children were randomly placed into either a watchful waiting group (WW group) (n 
= 94) or a group treated with ventilation tubes (VT group) (n = 93). Both groups 
were followed for 12 months. Data were collected from parental reports and from
medical files kept by the attending ENT-surgeons. 3) RESULTS: There were
significant differences in the reported frequency of otorrhoea (but not of
earache or fever) between both groups during follow-up, i.e. children in the VT
group had more episodes of otorrhoea than the children in the WW group (p <
0.003). As a consequence, children in the VT group had been prescribed
antibiotics more often. 4) CONCLUSIONS: Young children treated with ventilation
tubes due to persistent otitis media with effusion have a higher risk of
developing otorrhoea because of the tubes, and they have a higher risk of needing
treatment with antibiotics.

Publication Types: 
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial

PMID: 16429748 [PubMed - indexed for MEDLINE]

832: Acta Otolaryngol. 2006 Feb;126(2):154-9.

Does Helicobacter pylori colonize the nasopharynx of children and contribute to
their middle ear disease?

Bitar M, Mahfouz R, Soweid A, Racoubian E, Ghasham M, Zaatari G, Fuleihan N.

Department of Otolaryngology-Head and Neck Surgery, School of Medicine, American 
University of Beirut Medical Center, Beirut, Lebanon. mb36@aub.edu.lb

OBJECTIVE: There is growing interest in studying the presence of HP in the upper 
aerodigestive tract. It was shown in several pilot studies that it colonizes the 
area, while other authors found no evidence of its presence there and a third
group of authors believed that it had only a transient presence there. In this
study we investigated a possible role for HP in middle ear disease in children.
MATERIAL AND METHODS: Consecutive patients undergoing myringotomy and
adenoidectomy for chronic otitis media with effusion or recurrent otitis media
were enrolled. Middle ear fluids were cultured on three types of agar plate
(Brucella + laked horse blood; Brucella + sheep blood; and chocolate). A double
polymerase chain reaction (PCR) was run to detect urease-C and adhesion subunit
genes. Rapid urease enzyme testing and PCR were used on the adenoid specimens.
Parents were interviewed regarding symptoms suggestive of gastroesophageal reflux
in their children. RESULTS: Eighteen patients were enrolled in the study (mean
age 4.4 years; age range 3-8 years) with an equal gender distribution. All 28
middle ear fluid cultures were negative in all 3 media. Twenty-one of the 28
samples contained DNA, yet PCR revealed that none of them belonged to HP. Ten of 
the 13 adenoid specimens obtained were positive on rapid urease testing, but none
on PCR. Seven of the 18 patients had at least 1 symptom suggestive of
gastroesophageal reflux during the 6 months preceding the study but this did not 
have an impact on any of the results. CONCLUSION: There was no evidence from this
study that Helicobacter pylori (HP) colonizes the nasopharynx of children with
middle ear disease, whether dyspeptic or not. There is also no apparent role for 
this bacterium in middle ear pathology.

PMID: 16428192 [PubMed - indexed for MEDLINE]

833: Acta Otolaryngol. 2006 Feb;126(2):130-7.

Antimicrobial resistance in Haemophilus influenzae isolated from the nasopharynx 
among Japanese children with acute otitis media.

Hotomi M, Sakai KF, Billal DS, Shimada J, Suzumoto M, Yamanaka N.

Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, 
Wakayama, Japan.

CONCLUSION: High prevalence of penicillin-binding protein (PBP) gene mutated
(PGM) strains of H. influenzae should be taken into account when treating otitis 
media in children. OBJECTIVE: To evaluate prevalence of ss-lactamase nonproducing
ampicillin-resistant (BLNAR) strains of Haemophilus influenzae with mutations in 
ftsI gene encoding penicillin-binding protein 3 (PBP3) among children with otitis
media. METHODS: A total of 644 nasopharyngeal isolates of H. influenzae was
collected from pediatric acute otitis media (AOM) patients with or without otitis
media with effusions (OME) at the clinics of Otolaryngology-Head and Neck
Surgery, Wakayama Medical University Hospital and six affiliated hospitals in
Wakayama prefecture between January 1999 and December 2003. Minimal inhibitory
concentrations (MICs) of ampicillin (AMP), cefditoren (CDN), cefdinir (CFD),
cefaclor (CCL), cefpodoxime (CPD), and cefcapene (CFPN) were determined by the
microbroth dilution method according to the recommendations of the National
Committee for Clinical Laboratory Standards (NCCLS). Types of mutations in PBP3
gene (ftsI) were evaluated by a polymerase chain reaction (PCR)-based genotyping 
method. ss-Lactamase gene (bla) was also identified by PCR. RESULTS:
ss-Lactamase-producing (BLP) strains with the bla gene were identified in 16
(2.5%) of isolates. PGM strains were identified in 279 (43.3%) isolates. There
were 242 (37.6%) PGM1-nonBLP strains with mutations in variable mutated locus of 
ftsI, 35 (5.4%) PGM2-nonBLP strains with mutations in highly mutated locus of
ftsI, 2 (0.3%) BLP-PGM strains with mutations in ftsI and producing ss-lactamase.
BLP-nonPGM strains producing ss-lactamase without mutations in ftsI were
identified in 14 (2.2%) isolates. MICs of PGM1-nonBLP strains to AMP were 0.5-2.0
microg/ml. The MIC(90) of CDN to the PGM1-nonBLP strains was lowest (0.06
microg/ml). Proportions of PGM1-nonBLP strains rapidly increased during 1999 to
2002 and then decreased in 2003. In contrast, PGM2-nonBLP strains increased in
2003.

Publication Types: 
    Multicenter Study

PMID: 16428188 [PubMed - indexed for MEDLINE]

834: Auris Nasus Larynx. 2006 Jun;33(2):135-41. Epub 2006 Jan 20.

Otologic manifestations of relapsing polychondritis. Review of literature and
report of nine cases.

Bachor E, Blevins NH, Karmody C, Kühnel T.

Universitäts-HNO Klinik, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg,
Germany. ebmail@web.de

OBJECTIVE: Relapsing polychondritis (RP) is an episodic disease most likely of
autoimmune etiology, characterized by recurrent inflammation of cartilaginous
structures. METHODS: Retrospective case study at two tertiary referral centers
with presentation of nine patients with otologic involvement of RP, review of the
spectrum of otologic disorders seen, and treatment. RESULTS: The clinical course 
of otologic manifestations of RP was highly variable and ranged from mild to
moderate. In 6/9 patients there was an association with other autoimmune
disorders. In addition to recurrent auricular chondritis, which was present in
8/9 patients, our patients had otitis externa, chronic myringitis, Eustachian
tube dysfunction, conductive hearing loss, sensorineural hearing loss, and
tinnitus. All patients had their diagnosis of RP made on the basis of their
otologic involvement and the response to systemic corticosteroids. CONCLUSION:
The diagnosis of RP is primarily clinical, but laboratory studies and biopsy may 
contribute as well. Once the diagnosis is suspected, the otolaryngologist should 
consider consultation with a rheumatologist to assist in the management of
additional systemic manifestations.

Publication Types: 
    Case Reports
    Review

PMID: 16427754 [PubMed - indexed for MEDLINE]

835: Int J Pediatr Otorhinolaryngol. 2006 Jul;70(7):1189-93. Epub 2006 Jan 19.

Association of human metapneumovirus with acute otitis media.

Williams JV, Tollefson SJ, Nair S, Chonmaitree T.

Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
37232, USA. john.williams@vanderbilt.edu

OBJECTIVE: Human metapneumovirus (hMPV) is a recently described paramyxovirus
that has been associated with acute upper and lower respiratory infection (LRI)
in infants and children worldwide. We previously observed that one-third of the
children with hMPV-associated LRI had been diagnosed with a concomitant acute
otitis media (AOM). In the current study, we sought to investigate an association
between hMPV and children presenting with AOM as a primary diagnosis. METHODS: We
used realtime RT-PCR for hMPV to retrospectively test 144 paired nasal wash (NW) 
and middle ear fluid (MEF) specimens that had been prospectively collected from
children with AOM during a 3-year period from 1990-1992. RNA was extracted from
archived, frozen samples and realtime RT-PCR for hMPV was performed. RESULTS: We 
detected hMPV in 8/144 (6%) NW and 1/144 MEF. Several of the children still
tested positive for hMPV in NW 3 days later, showing persistent virus shedding.
All were detected from November-May and six had bacterial co-pathogens. Two of
the eight (25%) hMPV-infected children had no bacterial pathogen isolated,
suggesting that hMPV may be associated with AOM as a sole pathogen. CONCLUSIONS: 
These data show that hMPV is associated with a proportion of AOM and thus has
additional morbidity and healthcare impact related to these illnesses.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 16427144 [PubMed - indexed for MEDLINE]

836: Pediatr Allergy Immunol. 2006 Feb;17(1):43-8.

Ketotifen induced inhibition of histamine release in a non-IgE model of middle
ear effusion.

Berger G, Berger R, Goldberg A.

Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar
Saba 44281, Israel. berger45@netvision.net.il

The inhibitory effects of ketotifen, a histamine H1-receptor antagonist and mast 
cell stabilizer, were examined on a non-IgE experimental model of middle ear
effusion. Thirty rats were divided into three groups. Group A (n = 9) was
subjected to mechanical stimulation of the external auditory canal (EAC); group B
(n = 11) was pre-treated with intraperitoneal administration of 0.2 mg ketotifen,
90 min before mechanical stimulation of the EAC; and group C (n = 10), the
control group, was neither exposed to mechanical stimulation nor given ketotifen.
Thirty minutes after completion of the experiment, the eardrums were inspected,
histamine levels were determined by a fluorometric assay, and the pars flaccida
underwent histological assessment. An attic effusion was observed in group A; a
similar phenomenon but to a lesser extent was also seen in group B. Statistical
analysis confirmed that the mean histamine concentration of the rinsing fluid
obtained from group A was significantly higher than that of group C (p = 0.004)
or group B (p = 0.008). No significant difference was found between the mean
histamine concentration of groups C and group B (p = 0.311). Histological
assessment revealed that the thickness of the pars flaccida of group A was
considerably greater than that of groups C and B and was characterized by marked 
edema. Furthermore, the pars flaccida mast cell population was significantly
depleted compared with groups C and B. The data indicate that mechanical
stimulation of the EAC triggered the pars flaccida mast cells to degranulate in a
non-mediated IgE fashion and that histamine is implicated in most of these
histological changes. It is concluded that administration of ketotifen before
mechanical stimulation of the EAC had a stabilizing effect and abolished mast
cell degranulation, therefore, may be considered as a potential therapeutic agent
for the treatment of middle ear disease in the pediatric population.

PMID: 16426254 [PubMed - indexed for MEDLINE]

837: Int J Pediatr Otorhinolaryngol. 2006 Jul;70(7):1165-7. Epub 2006 Jan 18.

The posterior attic: An observational study of aboriginal Australians with
chronic otitis media (COM) and a theory relating to the low incidence of
cholesteatomatous otitis media versus the high rate of mucosal otitis media.

Jassar P, Murray P, Wabnitz D, Heldreich C.

Hull Royal Infirmary, Hull, UK.

OBJECTIVE: The incidence of COM without cholesteatoma in Australian aboriginals
is quoted as being between 25 and 47%. The incidence of cholesteatomatous OM is
very low in comparison (between 1 and 3%). A comprehensive literature search
found no studies offering an explanation for the large discrepancy between these 
two types of OM. We offer a theory to account for the disproportionate rates of
the two types of OM together with an observational study on aboriginals with COM 
to substantiate our argument. METHOD/RESULTS: The crux of our hypothesis centres 
on the anatomy of the posterior attic. We found that in a study of 40 aboriginal 
patients undergoing tympanoplasty with audiometric evidence of an intact
ossicular chain that, after posterior tympanomeatal flap elevation, no part of
the incudostapedial assembly was visible in 95% of cases denoting its location
behind the posterior attic wall. CONCLUSION: We hypothesise that in aboriginal
ears the resulting 'crowding' of the posterior attic by the incudostapedial
assembly results in narrowing of the epitympanic space which compromises
atticoantral drainage, thus leading to mucosal COM, however supporting the
posterior-superior segment of the tympanic membrane, impeding the formation of a 
retraction pocket, and cholesteatoma formation migrating into the mastoid antrum.

PMID: 16420963 [PubMed - indexed for MEDLINE]

838: Chin J Integr Med. 2005 Dec;11(4):243-8.

Evaluation of the clinical efficacy of Qingqiao capsule in treating patients with
secretory otitis media.

Sun YD, Chen LH, Hu WJ, Jiang YL, Chen XL, Zhang SB.

Department of Otolaryngology, Sixth People's Hospital of Zigong, Sichuan 643020. 
sunyongd@126.com

OBJECTIVE: To observe the clinical efficacy of Qingqiao Capsule (QQC) in treating
patients with secretory otitis media (SOM). METHODS: A total of 90 patients were 
randomly assigned into the treated group (n = 45) and the control group (n = 45).
Patients in the treated group were administrated with QQC, 5 capsules each time, 
3 times a day for totally 10-14 days, and those in the control group were given
per os cefaclor capsules 0.5 g each time for adult, 3 times a day, or 20
mg/(kg.d) for children, for 10-14 days. The therapeutic efficacy of treatment on 
the patients was observed and compared after treatment and followed up for 3-6
months. RESULTS: (1) The clinical efficacy in the treated group was superior to
that in the control group with significant statistical difference (P < 0.01); (2)
Comparison of the efficacies in patients of three different TCM syndrome types
(the external pathogenic wind invasion caused auditory orifice stuffiness type,
the Gan-Dan damp-heat steaming up auditory orifice type and the Pi-deficiency
dysfunction induced dirty dampness blocking ear type) showed no statistically
significant difference (P > 0.05); (3) The vanishing rate and time needed of the 
main symptoms and signs in the treated group were superior to those in the
control group on ear muffle, tinnitus, hearing impairment, hydrotypanum, pure
tone threshold and abnormal tongue figure, and the difference was statistically
significant (P < 0.05 or P < 0.01), only those of earache, otopiesis and abnormal
pulse figure were insignificantly different between the two groups (P > 0.05).
CONCLUSION: QQC is an effective Chinese composite medicine on patients with SOM, 
and shows no obvious adverse reaction.

Publication Types: 
    Randomized Controlled Trial

PMID: 16417772 [PubMed - indexed for MEDLINE]

839: Int J Pediatr Otorhinolaryngol. 2006 Mar;70(3):407-10. Epub 2006 Jan 18.

The bacteriostatic properties of ear tubes made of absorbable polylactic acid.

Ludwick JJ, Rossmann SN, Johnson MM, Edmonds JL.

Bobby R. Alford Department of Otolaryngology, Baylor College of Medicine, Texas
Children's Hospital, Houston, TX 77030, USA.

OBJECTIVE: Tympanostomy tube placement remains the most common reason children
are brought to the operating room. Of the known complications, transient,
recurrent, and chronic otorrhea represent the most common and challenging
sequelae of tube insertion. This study was performed to determine if the acidic
nature of the polymer of lactic acid (PLA), a possible material for the
construction of ear tubes, would have bacteriostatic properties. MATERIAL AND
METHODS: Experimental PLA tubes and control fluoroplastic tubes were inoculated
with a broth of Pseudomonas aeruginosa or Staphylococcus aureus and incubated.
Fluid recovered from the tubes was plated and incubated again. Colony counts were
recorded at 24 and 48 h. Two separate trials were conducted for each organism.
Repeated measures analysis of variance (ANOVA) models were used to assess the
effects of the type of tube, the experimental run, and the tube by run
interaction on colony counts. RESULTS: In the Pseudomonas experiments, the mean
colony count of the PLA tube group (Run 1: 1.0; Run 2: 26.6) was significantly
lower than the mean colony count in the fluoroplastic tube group (Run 1: 132.6;
Run 2: 122.2; p=0.0150). Similarly, in the S. aureus experiments, the mean colony
count of the PLA tube group (Run 1: 88.2; Run 2: 92.6) was significantly lower
than the mean colony count in the fluoroplastic tube group (Run 1: 335.0; Run 2: 
325.8; p<0.0001). CONCLUSION: PLA has many properties including an apparent
bacteriostatic quality, which may make it an attractive material for the
construction of tympanostomy tubes.

PMID: 16414128 [PubMed - indexed for MEDLINE]

840: Int J Pediatr Otorhinolaryngol. 2006 Jul;70(7):1175-82. Epub 2006 Jan 18.

Indications for surgery in acute mastoiditis and their complications in children.

Zanetti D, Nassif N.

Department of Otolaryngology, University of Brescia, Piazzale Spedali Civili 1,
25100 Brescia, Italy.

OBJECTIVE: To review the clinical charts of 45 paediatric patients treated for
acute otomastoiditis at the ORL Department of the University of Brescia (Italy)
between January 1994 and March 2005 and to discuss the diagnostic workup and the 
outcome of treatment. METHODS: Twenty-six males and 19 females were admitted with
acute mastoiditis and subperiosteal abscess. Thirteen of them (28.9%) presented
an intracranial complication. Only three of them were not operated upon; one
received a ventilation tube (VT); all the others underwent a mastoidectomy within
48-72 h. Twenty out of 32 uncomplicated mastoiditis were treated conservatively
and the remaining 12 underwent myringotomy+/-VT, associated with a mastoidectomy 
in 9 cases. RESULTS: Antibiotics alone or with VTs achieved a full recovery in 28
out of 32 uncomplicated cases. Mastoidectomy resolved the disease in 13 patients 
(9 with complications). In severe complications, a canal wall down (CWD) (n=2) or
an intact canal wall (ICW) mastoidectomy (n=7) were preferred, based on the
extent of the lesions and the degree of hearing loss. All children recovered
completely at 1 year follow-up. In the uncomplicated cases that were operated
upon, the mean hospital stay was 7.8 days (versus 4.3 days for the conservative
group). In children with intracranial complications the mean hospital stay was
12.8 days, significantly less than the four non-surgical patients, who remained
hospitalized for an average of 18 days. CONCLUSION: Acute mastoiditis can fully
recover with conservative treatment or myringotomy+VTs. Immediate surgical
treatment is indicated for intracranial complications, if the neurological
conditions are not critical. A simple mastoidectomy+/-tympanoplasty is warranted 
in: (1) exteriorization, if the child is older than 30 months or >15 kg of
weight, (2) intracranial complications (combined with a neurosurgical procedure
as needed) and (3) cholesteatoma or granulation tissue.

PMID: 16413617 [PubMed - indexed for MEDLINE]

841: Int J Pediatr Otorhinolaryngol. 2006 Jul;70(7):1155-8. Epub 2006 Jan 18.

Expression of matrix metalloproteinase-9 and -2 in pediatric chronic otitis media
with effusion.

Jang CH, Shin SH, Cho HH, Moon SJ, Cho YB.

Department of Otolaryngology, Chonnam National University Medical School,
Hak-dong 8, Gwangju, South Korea. chulsavio@hanmail.net

OBJECTIVE: To evaluate the role of MMP-9 and MMP-2 in pediatric patients with
middle ear effusion (MEE) and determine the pathogenesis of otitis media with
effusion (OME) and allergy. METHODS: The MEE samples were collected from 25
patients with allergy and 20 patients without allergy as a control. The levels of
MMP-9 and MMP-2 were measured using a commercially available enzyme-linked
immunosorbent assay (ELISA). The activity of MMP-9 and MMP-2 were measured by
gelatin-zymography. The Mann-Whitney U-test was used for comparisons between the 
allergy positive and control groups. RESULTS: The level of MMP-9 was
significantly elevated in MEE from the allergy positive group compared to
controls. The amount of MMP-9 activity significantly increased in the allergy
positive group compared to controls. CONCLUSION: MMP-9 and MMP-2 are mediators of
inflammation in the OME; in addition, MMP-9 may play a significant role in the
pathophysiology of OME with allergy.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16413616 [PubMed - indexed for MEDLINE]

842: Int J Pediatr Otorhinolaryngol. 2006 Jun;70(6):1081-4. Epub 2006 Jan 6.

Prevalence of middle ear pathologies in children with bilateral sensorineural
hearing loss.

Abou-Elhamd KE, Moussa AE, Soltan MA.

Sohag Faculty of Medicine, Sohag, Egypt. kamal375@yahoo.com

OBJECTIVES: In poor countries, hearing aids are too expensive for sensorineural
hearing loss (SNHL) children's parents to offer for their children. These
children may have middle ear problem, this will aggravate the level of hearing
loss which may lead to delay in their ability to speak. This study is to
highlight the prevalence of middle ear pathology in SNHL children. METHODS: Two
hundred children with bilateral sensorineural hearing loss (SNHL) were selected
in our study from the outpatient clinic of ENT department of Sohag University
Hospital, Egypt. Children were classified into three categories according to
their middle ear status. They were normal middle ear, middle ear with unhealthy
tympanic membrane or otitis media with intact drum and chronic suppurative otitis
media with perforation. RESULTS: Seventy percent of cases were normal, 25% had
middle ear problem with intact tympanic membrane and 5% had chronic suppurative
otitis media with perforation. CONCLUSION: Thirty percent of SNHL children have
middle ear pathology which aggravate the degree of hearing loss. Regular
evaluation of SNHL children to treat those having middle ear pathology medically 
and/or surgically and this may help those having no ability to have hearing aids 
to learn language early.

PMID: 16406124 [PubMed - indexed for MEDLINE]

843: Int J Pediatr Otorhinolaryngol. 2006 Jun;70(6):1077-80. Epub 2006 Jan 6.

Contact diode laser myringotomy for medium-duration middle ear ventilation in
children.

D'Eredità R, Shah UK.

Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric
Otolaryngology, Vicenza Civil Hospital, Vicenza, Italy.
riccardo.deredita@ulssvicenza.it

OBJECTIVE: To prospectively compare contact diode laser for myringotomy (CDLM) to
myringotomy with tube insertion (M&T) for the surgical management of otitis media
with effusion (OME) in children. STUDY DESIGN AND SETTING: Prospective randomized
controlled study at a tertiary care pediatric institution. METHODS: Thirty
children for whom PE tube insertion was indicated were randomized for treatment
by CDLM or by M&T, in order to investigate length of time for middle ear
ventilation, and complication rates. Surgical time was measured, post-operative
parental questionnaires were reviewed, and follow-up examinations were performed.
INTERVENTION: Middle ear ventilation by CDLM or M&T. RESULTS: Middle ear
ventilation by CDLM took an average of 4.1min, and was maintained for an average 
of 3.5 months, compared to surgical time of 10.2min for M&T, and duration of
middle ear ventilation of 6.3 months. These differences were statistically
significant (p=0.005 for surgical time, and p<0.001 for duration of ventilation).
Complication rates were equivalent. CONCLUSION: CDLM allowed for medium-duration 
middle ear ventilation in children compared to M&T. Further study to clarify the 
role of CDLM in the management of OME in children is indicated.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 16406076 [PubMed - indexed for MEDLINE]

844: Int J Pediatr Otorhinolaryngol. 2006 Jun;70(6):1069-76. Epub 2006 Jan 6.

Alteration of adenoid tissue alkaline and acid phosphatase in children with
secretory otitis media.

Jesic S, Stojiljkovic L, Petrovic Z, Djordjevic V, Nesic V, Stosic S.

Institute for Otorhinolaryngology and Maxillofacial surgery, Clinical Centre of
Serbia, 11000 Belgrade, Pasterova 2 Street, Serbia and Montenegro.
xeniam@sezampro.yu

OBJECTIVE: The role of pharyngeal lymphoid tissue in etiopathogenesis of
secretory otitis is not yet defined. The influence of tonsillar and adenoid mass,
weight, obstruction of naspharyngeal orrifitium, bacterial reservoire or some
immunological events are of scientific interest. Tissue nonspecific alkaline
phosphatase (TNAP) and acid phosphatase (ACP) are enzymes detected in lymphoid
tissue, TNAP as characteristic of B cells, ACP as a characteristic of macrophages
and folucullardentritic cells. These enzymes interfere in cell metabolism by
removing 5' phosphate group from nucleotides and proteins. Specific activity and 
kinetic properties were studied in palatinal tonsils and adenoids of children
with secretory otitis (OME) and compared with children with recurrent tonsillitis
without ear involvement. METHOD: Adenoid and tonsillar tissue of l7 children with
OME and 30 children with recurrent tonsillitis were subjected to biochemical
investigation using method of releasing of p-nitrophenol from
p-nitrophenylphosphate (pNPP). Kinetic parameters as Michaelis-Menten constant
were calculated by non-linear regression estimation method. RESULTS: Specific
activity of adenoid alkaline phosphatase was lower in children with OME in
relation to children with recurrent tonsillitis (t=5.733507, p<0.01). Specific
activity of adenoid acid phosphatase was also lower in children with OME
(t=3.655456, p<0.01). pH optimum for both enzymes was the same in these two
groups of children. Michaelis-Menten constant for both enzymes was significantly 
higher in adenoid of children with OME than in children with recurrent
tonsillitis suggesting lower enzyme affinity for the substrate. CONCLUSION:
Differences in specific activities and kinetic properties of adenoid alkaline and
acid phosphatases between children with OME and children with recurrent
tonsillitis without OME were verified in this study. The results of the study are
not able to explain the alteration of alkaline and acid phosphatase
characteristics but could point to some possible and specific role of
nasopharyngeal lymphoid tissue in pathogenesis of secretary otitis.

Publication Types: 
    Comparative Study

PMID: 16406075 [PubMed - indexed for MEDLINE]

845: Clin Otolaryngol. 2005 Dec;30(6):511-6.

Acute complications of otitis media in adults.

Leskinen K, Jero J.

Department of Otolaryngology, Helsinki University Central Hospital,
Haartmaninkatu 4E, PO Box 220, FIN-00029 HUCH, Helsinki, Finland.
kimmo.leskinen@hus.fi

OBJECTIVES: To establish the incidence, current treatment and outcome of adult
patients with acute intratemporal and intracranial complications of otitis media 
(OM). DESIGN: A retrospective chart review with a sent questionnaire. SETTING:
Tertiary referral centre, University hospital. PARTICIPANTS: Adult patients
treated for acute intratemporal and intracranial complications of OM over the
past 15 years (1990-2004) in the study hospital. MAIN OUTCOME MEASURES:
Incidence, treatment and outcome of patients with intratemporal and intracranial 
complications of OM. RESULTS: Fifty patients aged 16-75 years were treated. The
annual age-adjusted incidence of acute intratemporal and intracranial
complications was 0.32/100 000. Forty-one (82%) of the complications were
intratemporal and nine (18%) were intracranial. The ear disease behind the acute 
complication was acute otitis media (AOM) in 80% (40/50), chronic otitis media
(COM) in 12% (6/50) and COM with cholesteatoma in 8% (4/50). Mastoiditis was
complicated by subperiosteal abscess, labyrinthitis and facial paresis in 7%
(3/41), 15% (6/41) and 32% (13/41) respectively. Mastoidectomy was performed on
56% (28/50) of the patients. Four (44%) of the intracranial complications were
intracranial abscesses, four (44%) were meningitis and one (11%) was sinus
thrombosis. Permanent hearing loss occurred in 13 (26%) patients and one patient 
died due to otogenic meningitis. CONCLUSIONS: Severe complications of the OM in
adults are rare in Finland. The commonest cause is AOM rather than COM. Operative
treatment is predominantly needed for intracranial complications and
intratemporal abscesses. Complications of OM are still associated with
considerable morbidity, and early recognition is most likely to form the basis
for effective treatment.

PMID: 16402975 [PubMed - indexed for MEDLINE]

846: Otolaryngol Head Neck Surg. 2006 Jan;134(1):126-31.

Effect of nitric oxide and peroxynitrite on mucociliary transport function of
experimental otitis media.

Jeon EJ, Park YS, Lee SK, Yeo SW, Park SN, Chang KH.

Department of Otolaryngology-HNS, College of Medicine, The Catholic University of
Korea, Our Lady of Mercy Hospital, 665 Bupyung-dong, Bupyung-gu, Incheon 403-720,
Korea.

OBJECTIVE: To determine the role of nitric oxide (NO) and peroxynitrite on
mucociliary activity in experimental otitis media with effusion (OME). STUDY
DESIGN AND SETTING: Twenty guinea pigs were divided into 1 control and 3
experimental groups; lipopolysaccharide (LPS), N(G)-nitro-L-arginine methyl ester
(L-NAME), and uric acid (UA) groups. Ten ears were used in each group. OME was
induced by transtympanic injection of LPS in experimental groups. Twenty-four
hours after the transtympanic injection, dye transfer time (DTT) was measured and
the temporal bone was taken for histopathologic examination. Expression of
peroxynitrite was determined by immunohistochemical stain for 3-nitrotyrosine
(3-NT). RESULTS: Dye transfer time was significantly delayed in LPS group
compared to control group; by contrast it was significantly reduced in L-NAME or 
UA treated groups (P < 0.01). Histopathologic examination showed reduced
inflammation and mucosal thickening in the treatment groups when compared to LPS 
group. These findings, however, were not statistically significant.
Immunoreactivity to 3-NT was intense in LPS group and decreased in the treatment 
groups (P < 0.05). CONCLUSIONS: It is suggested that LPS induced mucociliary
dysfunction in the middle ear by NO and peroxynitrite-mediated pathways.

PMID: 16399192 [PubMed - indexed for MEDLINE]

847: J Vet Med Sci. 2005 Dec;67(12):1243-7.

Effects of beta-thujaplicin on anti-Malassezia pachydermatis remedy for canine
otitis externa.

Nakano Y, Wada M, Tani H, Sasai K, Baba E.

Department of Veterinary Clinical Science, Graduate School of Life and
Environmental Sciences, Osaka Prefecture University, Osaka, Japan.

The antifungal activity of beta-thujaplicin was evaluated against 51 Malassezia
pachydermatis strains isolated from canine ear canals with or without otitis
externa. For comparison, sensitivity tests were performed on M. pachydermatis
isolates for nystatin, ketoconazole, and terbinafine HCl, all clinically
available antifungal agents. The minimal inhibition concentrations over 50% of
the tested isolates (MIC50) were 3.13 microg/ml for beta-thujaplicin and
nystatin, 0.016 microg/ml for ketoconazole, and 1.56 microg/ml for terbinafine
HCl. The antifungal effect for M. pachydermatis of beta-thujaplicin compared
favorably with commercial antifungal agents. None of the 51 M. pachydermatis
isolates showed resistance against any of the tested antibiotics investigated in 
this study. Ten representative isolates of M. pachydermatis were subcultured for 
30 generations at concentrations close to the MIC levels of beta-thujaplicin,
nystatin, ketoconazole, and terbinafine HCl, and examined to determine whether
they had acquired resistance to each drug. As a result, M. pachydermatis was
found to achieve resistance more easily for ketoconazole and terbinafine HCl than
for beta-thujaplicin or nystatin. The MIC50 of beta-thujaplicin did not change
during the course of subculture, and it is thought that the potential development
of a resistant strain is low, even with continuous infusion for otitis externa
therapy. beta-Thujaplicin is an inexpensive and safe treatment with
anti-inflammatory and deodorant effects that can be recommended as an effective
remedy for canine otitis externa.

Publication Types: 
    Comparative Study

PMID: 16397383 [PubMed - indexed for MEDLINE]

848: Pediatr Infect Dis J. 2006 Jan;25(1):19-24.

Serogroup 19 pneumococci containing both mef and erm macrolide resistance
determinants in an American city.

Toltzis P, Dul M, O'Riordan MA, Jacobs MR, Blumer J.

Department of Pediatrics, Rainbow Babies and Children's Hospital, University
Hospitals of Cleveland, Case Western Reserve University School of Medicine,
Cleveland, OH, USA. pxt2@case.edu

BACKGROUND: Asia has experienced a striking incidence of infection by highly
resistant pneumococi containing both principal macrolide resistance determinants,
namely, the mef efflux pump and the erm ribosomal methylase. mef/erm-containing
pneumococci have not been identified in significant numbers in North America.
METHODS: Pneumococci were isolated as part of a larger study in Cleveland, OH
examining colonization patterns among children randomized to 1 of 4 outpatient
antibiotics for acute otitis media. Azithromycin-resistant organisms were tested 
for the presence of mef and erm sequences by polymerase chain reaction. The
clonal relationship of pneumococci containing both genes was determined by pulsed
field gel electrophoresis and multilocus sequence testing. Selected
characteristics of children harboring mef/erm-containing organisms were compared 
with other participants of the larger study. RESULTS: Of 221 children colonized
by pneumococci, 17 (7.7%) were colonized with an organism containing both
determinants. All mef/erm-positive organisms demonstrated azithromycin minimum
inhibitory concentrations > or =256 microg/mL and were coresistant to all other
agents tested. The mef/erm-containing organisms were serotype 19A and 19F, all
but 1 of which manifested similar pulsed field gel electrophoresis patterns.
Multilocus sequence testing analysis indicated a relationship to the Taiwan-14
macrolide-resistant strain that has spread throughout Eastern Asia. More than
one-third of children colonized by a mef/erm-containing organism had received >
or =1 dose of conjugate pneumococcal vaccine, a significantly higher proportion
than children carrying less resistant organisms (P< 0.01). No other
characteristics distinguished children harboring a mef/erm-containing
pneumococcus from other children enrolled in the larger study. CONCLUSION:
Clonally related mef/erm-containing serogroup 19 pneumococci were prominent among
otherwise healthy children in a North American metropolitan area. Our findings
suggest that spread of these organisms may be poorly contained by immunization.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16395097 [PubMed - indexed for MEDLINE]

849: Ear Nose Throat J. 2005 Oct;84(10):660-1.

Surgical emphysema following tonsillectomy.

Patel N, Brookes G.

Department of Otolaryngology, Royal National Throat, Nose, and Ear Hospital,
London. nitesh.hema@talk21.com

Complications of tonsillectomy have been well documented. However subcutaneous
emphysema of the neck following tonsillectomy has rarely been described. We
report a case of this complication in a young man who forcefully performed
Valsalva's maneuver following a tonsillectomy.

Publication Types: 
    Case Reports

PMID: 16382749 [PubMed - indexed for MEDLINE]

850: Ear Nose Throat J. 2005 Oct;84(10):646, 648, 650 passim.

Nonsurgical home treatment of middle ear effusion and associated hearing loss in 
children. Part II: Validation study.

Silman S, Arick DS, Emmer MB.

Center for Auditory Research, Brooklyn College, CUNY, 2900 Bedford Ave.,
Brooklyn, NY 11210, USA. ssilman@brooklyn.cuny.edu

In this prospective follow-up investigation, we examined the efficacy of a
modified Politzer device in the home treatment of persistent middle ear effusion 
(MEE) and associated hearing loss in children who had previously participated in 
a similar clinical trial. Our study group was made up of 38 patients who had been
either (1) untreated control participants in the previous study whose hearing in 
one or both ears had not returned to normal within 11 weeks of their initial
audiologic pretest ("former control group"; n = 30), or (2) active-treatment
participants in the previous study whose hearing sensitivity in at least one ear 
had not improved to within normal limits after treatment and who elected to
undergo a continuation of treatment ("extended-treatment group"; n = 8).
Treatment efficacy was determined by comparing differences in pre- and
posttreatment air-conduction thresholds and otoscopic findings. Following
treatment, the former control group experienced significant improvements in
hearing sensitivity at all frequencies; at the posttreatment test, hearing
sensitivity was within normal limits in 43 of 60 ears (71.7%), and normal or
moderate tympanic membrane mobility was observed in 30 of 34 otoscopically
examined ears (88.2%). In the extended-treatment group, hearing sensitivity
returned to within normal limits in 9 of 10 impaired ears (90.0%). These findings
further substantiate the efficacy of our modified Politzer device in improving
middle ear function and hearing sensitivity in children with MEE, and they
support the reliability of the findings reported in our previous study. These
results also indicate that many patients in whom initial treatment is not
successful may benefit from extended treatment.

Publication Types: 
    Research Support, N.I.H., Extramural
    Validation Studies

PMID: 16382747 [PubMed - indexed for MEDLINE]

851: Eur Arch Otorhinolaryngol. 2006 Apr;263(4):344-6. Epub 2005 Dec 24.

Necrotizing external otitis in a patient caused by Klebsiella pneumoniae.

Yang TH, Kuo ST, Young YH.

Department of Otolaryngology, National Taiwan University Hospital and College of 
Medicine, 1 Chang-Te St., Taipei, Taiwan.

Necrotizing external otitis is a potentially life-threatening infection involving
the temporal and adjacent bones. The most frequent pathogen is attributed to
Pseudomonas aeruginosa, but is rarely caused by Klebsiella pneumoniae. Recently, 
we encountered a 47-year-old diabetic man with a swollen obliterated external ear
canal with granulation tissue on the right ear. Image study demonstrated skull
base osteomyelitis, epidural abscess and cerebral venous sinus thrombi. It was
later proved to be necrotizing external otitis caused by Klebsiella pneumoniae.
He then underwent craniotomy for drainage of the epidural abscess, followed by
intravenous ciprofloxacin and metronidazole for 2 consecutive weeks until both
pus and blood cultures depicted no growth of pathogens. Based on this case,
synergistic antibiotic therapy using a third-generation cephalosporin or
quinolone (ciprofloxacin), accompanied by metronidazole, and even a short-term
aminoglycoside is recommended for the treatment of severe Klebsiella-induced
necrotizing external otitis. Surgical intervention should be limited without
shedding of the pathogens.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 16378221 [PubMed - indexed for MEDLINE]

852: J Laryngol Otol. 2006 Jan;120(1):20-3.

Comment in:
    J Laryngol Otol. 2007 Dec;121(12):1213-4; author reply 1214.

Is phenol a safe local anaesthetic for grommet insertion?

Robertson A, Whitwell R, Osborne J.

Wrexham Maelor Hospital, Wrexham, North Wales, UK. anrobertson@hotmail.com

Two studies were performed to determine whether topical phenol is a safe and well
tolerated local anaesthetic for grommet insertion. Study 1 was a retrospective
examination of audiological outcomes and complications. Data were obtained
regarding 71 procedures in 57 patients. One late infection and nine early
extrusions were noted. No statistically significant changes between pre- and
post-operative bone conduction thresholds were found. Study 2 was a prospective
analysis of patients' perceptions of the procedure. Data from 17 patient
questionnaires were analysed as follows: pain rating--not painful, three
patients; slightly painful, 14 patients. Overall experience rating--pleasant,
four patients; slightly unpleasant, 10; unpleasant, three. All patients stated
that they would undergo the procedure again. In conclusion, we found no evidence 
of phenol-induced hearing loss. The complication rate was within normal limits
and patients were satisfied with the procedure. Grommet insertion using phenol as
a local anaesthetic is safe and acceptable to patients.

PMID: 16375777 [PubMed - indexed for MEDLINE]

853: J Laryngol Otol. 2006 Mar;120(3):193-9. Epub 2005 Dec 5.

Audit of specialist registrar training in tympanomastoid surgery for chronic
otitis media.

Mahendran S, Bennett AM, Jones SE, Young BA, Prinsley PR.

Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK.

BACKGROUND: A prospective audit of specialist registrars' (SRs') training in
tympanomastoid surgery for chronic otitis media within the Anglia Regional
Training Scheme is described. This audit recorded the surgical activity of the
trainees and their contribution to operative procedures, and assessed the results
of the procedures. This type of systematic approach to the audit of surgical
training is important in light of the current shortened training programmes and
increased accountability of trainers. OBJECTIVES: The study aimed to establish
the levels of exposure to, supervision of and outcome of ear operations for
chronic otitis media performed by ENT trainees in the East Anglia region. METHOD:
A prospective, region-wide, minimum otology dataset-based proforma audit was
undertaken, with compulsory SR participation. Proformas were completed at the
time of operation (form one) and at a minimum interval of nine months
post-operatively (form two). Data on form one included hospital, supervising
consultant, name and training year of SR, contribution of SR (based on England
Royal College of Surgeons guidelines interpreted by the SR), pre-operative
audiology average (air conduction/bone conduction over 0.5, 1, 2 and 4 kHz), the 
pathology and the state of the ear at the time of surgery, and a breakdown of the
procedure(s) undertaken. Form two recorded data relevant to form one as well as
information regarding patient satisfaction and the operative result obtained,
graded as 'gold' (no disease, dry ear and hearing average < 25 dB), 'silver' (two
of these three) and 'bronze' (one of these three). All completed forms were
analysed using Microsoft Access software. RESULTS: Completed copies of 409 form
ones and 156 form twos were analysed. With advancing years, SRs' contributions to
procedures increased without significant effect on the graded outcome, which
appeared to be independent of SR year of training. Different regional hospitals
were compared. Data collected also provided an otology training portfolio for
SRs, forming part of their registrar in-training assessment (RITA). CONCLUSION:
The East Anglia SR audit of SRs' training in tympanomastoid surgery for chronic
otitis media was a powerful training tool. It demonstrated the safe progression
of SR training in supervised ear surgery, with SRs' results being comparable to
those for consultant-performed procedures.

PMID: 16372980 [PubMed - indexed for MEDLINE]

854: Expert Rev Vaccines. 2005 Dec;4(6):843-53.

Vaccine development for non-typeable Haemophilus influenzae and Moraxella
catarrhalis: progress and challenges.

Murphy TF.

University at Buffalo, State University of New York, Medical Research 151,
Buffalo VAMC, 3495 Bailey Avenue, Buffalo, NY 14215, USA. murphyt@buffalo.edu

An urgent need exists for vaccines to prevent infections caused by nontypeable
Haemophilus influenzae and Moraxella catarrhalis. These bacteria cause otitis
media in children, a clinical problem associated with enormous morbidity and
cost. H. influenzae and M. catarrhalis also cause lower respiratory tract
infections in adults with chronic lung disease. Infections in this clinical
setting are associated with disability and death. Recent progress in identifying 
potential vaccine antigens in both bacteria raises great promise in developing
effective vaccines. This paper reviews the key issues in vaccine development for 
H. influenzae and M. catarrhalis, including areas where progress has been
stalled, and proposes areas that deserve investigation in the next 5 years.

Publication Types: 
    Review

PMID: 16372880 [PubMed - indexed for MEDLINE]

855: Otol Neurotol. 2006 Jan;27(1):33-6.

Titanium mesh for functional reconstruction of the mastoid cortex after
mastoidectomy.

Kim HH, Wilson DF.

Wilson Ear Clinic, Portland, Oregon 97209, USA. galbey@yahoo.com

OBJECTIVE: To describe a rapid and effective means of reconstructing the mastoid 
cortex after mastoidectomy for chronic otitis media with and without
cholesteatoma. STUDY DESIGN: Retrospective. SETTING: Tertiary referral otology
clinic. PATIENTS: Those undergoing tympanoplasty and mastoidectomy for chronic
otitis media. INTERVENTION: After tympanoplasty and mastoidectomy, the
mastoidectomy defect was reconstructed using titanium mesh with subsequent
closure as routine. MAIN OUTCOME MEASURES: Evaluation of soft-tissue ingrowth
into the mastoid 12 to 24 months after surgery and clinical evaluation of the
postauricular surgical site for accentuation of the postauricular sulcus.
RESULTS: In 99 patients, the mastoidectomy defect was reconstructed using
titanium mesh. None was found to have pitting of the postauricular sulcus. One
patient had partial extrusion of the mesh through the ear canal. No instance of
wound infection was observed. Soft-tissue growth into the mastoid cavity was
found to be minimized. CONCLUSION: Titanium mesh is a rapid and effective means
of minimizing soft-tissue ingrowth into the mastoid and preventing accentuation
of the postauricular sulcus after mastoid surgery.

PMID: 16371844 [PubMed - indexed for MEDLINE]

856: Otol Neurotol. 2006 Jan;27(1):4-7.

Radiofrequency myringotomy with the topical use of mitomycin C: an experimental
study.

Lachanas VA, Prokopakis EP, Malandrakis SG, Hajiioannou JK, Christodoulou PN,
Velegrakis GA.

Department of Otolaryngology, University of Crete, School of Medicine, Heraklion,
Crete, Greece.

OBJECTIVE: To assess the use of radiofrequency myringotomy in combination with
mitomycin C as an alternative myringotomy technique on rabbits. STUDY DESIGN:
Experimental animal research protocol. SETTING: University of Crete, School of
Medicine, Medical Experimental Education and Research Center. METHODS:
Radiofrequency myringotomies were performed under general anesthesia on both ears
of 20 rabbits. Mitomycin C (0.3 mg/ml) pledgets were applied in the right ears
(study group) and saline pledgets in the left ears (control group). Animals were 
monitored using otomicroscopy weekly until myringotomy closure. Kaplan-Meier
survival techniques were used to compare myringotomy patency time between the two
sides. INTERVENTION: Radiofrequency myringotomy under general anesthesia on both 
ears of 20 rabbits. MAIN OUTCOME MEASURE: Myringotomy patency time. RESULTS: The 
mean patency time of the study group was 5.45 weeks (95% confidence interval,
5.185-5.715 weeks). The mean patency rate for the control side was 1.60 weeks
(95% confidence interval, 1.38-1.82 weeks). The Breslow (generalized Wilcoxon)
test showed the study group to have significantly longer patency of
radiofrequency myringotomy than the control group (p<0.0001). CONCLUSION: The
patency period of radiofrequency myringotomy was not long enough to be proposed
as an alternative to the insertion of ventilation tubes, although mitomycin C had
a significant adjunct effect in prolonging the patency rate of radiofrequency
myringotomy on rabbits.

Publication Types: 
    Comparative Study

PMID: 16371839 [PubMed - indexed for MEDLINE]

857: B-ENT. 2005;Suppl 1:3-13; quiz 14-5.

Management of otitis media with effusion in children.

Dhooge I, Desloovere C, Boudewyns A, Van Kempen M, Dachy JP.

ENT Department, Ghent University Hospital, Gent, Belgium.
ingeborg.dhooge@ugent.be

Otitis media with effusion in children: B-ENT Guidelines. OME is highly prevalent
among young children, with peak prevalences at around two and five years of age. 
Although serious complications are rare, the burden of OM is large with impaired 
quality of life and high direct and indirect socio-economic costs. To date,
medical treatment of OME is not recommended because of the limited scientific
evidence that this treatment is effective in the long term. Surgical candidacy
for OME depends largely on hearing status, associated symptoms, the child's
developmental risk and the anticipated chance of spontaneous resolution of the
effusion. Ultimately, the recommendation for surgery must be individualized.

PMID: 16363264 [PubMed - indexed for MEDLINE]

858: J Laryngol Otol. 2006 Feb;120(2):103-7. Epub 2005 Nov 25.

Otoacoustic emissions in young adults with a history of otitis media.

Yilmaz S, Karasalihoglu AR, Tas A, Yagiz R, Tas M.

Department of Otorhinolaryngology, Faculty of Medicine, Trakya University,
Edirne, Turkey.

The aim of this study was to investigate otoacoustic emissions in young adults
who had a history of otitis media (OM) in childhood and to assess whether a
history of OM had an irreversible effect on hearing. We studied 116 cases between
15 and 25 years of age, divided into three groups. Each subject underwent a
single examination comprising otoscopy, pure-tone audiometry (PTA), tympanometry,
and transient evoked otoacoustic emission (TEOAE) and distortion product
otoacoustic emission (DPOAE) testing. Subjects in the first and second groups had
normal audiometric hearing thresholds and type A tympanograms. The only
difference between the first and second group was the presence or absence of a
history of OM. The third group consisted of patients diagnosed as having active
OM; these patients had poorer hearing thresholds and type B or C tympanograms.
After statistical analysis of TEOAE and DPOAE results (one-way analysis of
variance test), significant differences were noted between groups. Otoacoustic
emission levels were, unsurprisingly, lowest in the third group, as expected.
However, the most striking result in the study was that significantly fewer
otoacoustic emissions were detected in subjects with a history of OM than in
subjects without a history of OM. These findings suggest that OM in childhood may
cause minor but irreversible damage to the middle ear or cochlea. Otoacoustic
emissions testing can be used to detect this sub-clinical damage.

PMID: 16359151 [PubMed - indexed for MEDLINE]

859: J Laryngol Otol. 2006 Mar;120(3):188-92. Epub 2005 Nov 25.

CO2 laser myringotomy in children with otitis media with effusion.

Lin SH, Lai CC, Shiao AS.

Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan,
ROC.

BACKGROUND: The study aimed to evaluate the clinical application of CO2 laser
myringotomy in children with otitis media with effusion (OME) under topical
anaesthesia in an office setting. METHODS: Laser myringotomy was performed with
the CO2 laser Otoscan (OtoLAM) in 54 children (73 ears) with OME. The procedure
on the tympanic membrane was performed under topical anaesthesia using Bonain's
solution or 10 per cent Xylocaine (lidocaine) solution for 30 minutes before
surgery. A circular perforation was created with a power of 15 W, single pulse
duration of 200 msec and a scanned area of 1.9 mm in diameter. RESULTS: The mean 
healing time was 2.51 weeks (range 1-5 weeks). Effusion content was not a
predictive prognostic factor for perforation healing time. Perforation location
over anterior inferior or posterior inferior quadrants was not a predictive
factor for perforation healing time. Xylocaine was the more effective
anaesthestic. The OME resolution rate was 73 per cent. CONCLUSION: Laser
myringotomy provides intermediate duration middle-ear ventilation. It could be
beneficial in selected children with OME.

PMID: 16359145 [PubMed - indexed for MEDLINE]

860: J Laryngol Otol. 2006 Jan;120(1):63-4. Epub 2005 Nov 25.

Successful treatment of MRSA otorrhoea: a case report.

Hunt A, Robb PJ.

Department of Otolaryngology, Royal Surrey County Hospital, Guildford, and the
Department of Otolaryngology, Epsom & St Helier University Hospitals NHS Trust,
Epsom, UK. huntpickering@aol.com

Infection with methicillin-resistant Staphylococcus aureus (MRSA) is increasing. 
It may be community or hospital acquired and is characteristically difficult to
eradicate. Here we report a case of a two-year-old girl who sustained a traumatic
tympanic membrane perforation following a minor burns injury. She was seen as an 
out-patient in a burns unit and subsequently developed MRSA otorrhoea. This was
treated with a two-week course of fusidic acid topical drops. At three-week
follow up the tympanic membrane had healed and the infection had healed
completely. Fusidic acid is safe and effective in the treatment of MRSA
otorrhoea. We need to maintain vigilance in the treatment of otorrhoea, as MRSA
may become an increasingly common pathogen in the future.

Publication Types: 
    Case Reports

PMID: 16359141 [PubMed - indexed for MEDLINE]

861: Oral Health Prev Dent. 2005;3(3):165-71.

Dental caries and ear infections in preschool-aged children.

Nelson S, Nechvatal N, Weber J, Canion S.

Department of Community Dentistry, School of Dental Medicine, Case Western
Reserve University, Cleveland, Ohio 44106-4905, USA. sxn15@case.edu

PURPOSE: The purpose of this case-control study was to assess the association
between ear infection and dental caries. MATERIALS AND METHODS: The sample
consisted of 126 children (range: two to five years) with no major medical
problems or craniofacial anomalies. Ear infection history, demographic, dental,
health and diet history of each child was determined using a questionnaire
administered to the parent/guardian of the child. Dental charts were used to
abstract dmft (decayed, missing and filled teeth) scores for children with dental
caries (DC: dmft > or = 1) and without caries (NDC: dmft = 0), and oral hygiene
index (OHI) scores. RESULTS: Chi-square analysis indicated no differences in ear 
infection history between the 71 DC and 55 NDC (past year: 35% vs. 40%; lifetime:
30% vs. 31%) children. However, there was a trend (p = 0.07) for the mean number 
of ear infections to be higher in DC versus the NDC group. Baby bottle use was
highest among those who had both ear infection and caries. Multivariate
regression model revealed that OHI scores, reason for dental visit, and frequency
of visits were the best predictors of dmft scores. CONCLUSION: An association
between dental caries and ear infection was not observed in this sample. Future
investigations should explore common risk factors in increasing the risk of both 
diseases simultaneously.

PMID: 16355650 [PubMed - indexed for MEDLINE]

862: J Laryngol Otol. 2005 Dec;119(12):946-9.

Cochlear implantation in chronic otitis media.

Olgun L, Batman C, Gultekin G, Kandogan T, Cerci U.

Cochlear Implant Center, SSK Izmir Hospital, Izmir, Turkey.

Chronic otitis media (COM) patients who had a multichannel device implanted were 
evaluated regarding surgical problems and technical modifications. In a
multicentric study, implantees whose aetiology was COM were retrospectively
evaluated. Patients were operated on and evaluated at three different tertiary
referral centres: SSK Izmir Hospital Cochlear Implantation (CI) Center (32
cases), Istanbul Marmara University ENT Clinic (six cases), Eskişehir Anadolu
University CI Center (one case). Thirty-nine implantees were evaluated with
respect to surgical problems, technical modifications, complications and hearing 
results. All patients had lost their hearings as a result of COM. Three out of 39
cases were children. Thirty-seven of the patients either had a radical cavity or 
ear converted to radical at the first stage or concomittantly with the
implantation. Patients were evaluated in order to find out the best possible
surgical solutions to specific problems caused by COM. In seven cases electrode
array disrupted the epithelial lining of the cavity despite specific measures.
Five of those cases were re-implanted, passing the electrode array through a
tunnel under the facial nerve. Seven recent cases were also implanted with the
same subfacial route. In all patients but one, satisfactory hearing results were 
achieved one to five years after implantation (SDS scores with monosyllabic word 
list were between 59 and 89 per cent, median 67.4 per cent). CI in COM patients
necessitates technical modifications. In radical cavities subfacial implantation 
seems to be a good solution for the protection of the electrode array.

Publication Types: 
    Evaluation Studies
    Multicenter Study

PMID: 16354355 [PubMed - indexed for MEDLINE]

863: J Laryngol Otol. 2005 Nov;119(11):926-7.

Spitting in the ear: a falsified disease using video evidence.

Bennett AM, Bennett SM, Prinsley PR, Wickstead M.

Department of ENT, Norfolk and Norwich University Hospital, Norwich, UK.
a1bennett@hotmail.com

We present the case of Munchausen's syndrome by proxy (MSBP) in which the mother 
spat and placed blood in her child's ear, and videoed the result, in order to
gain the attentions of the medical profession. This is the first case report of
this kind and may represent a disturbing trend in the use of digital photography 
and video to support factitious illnesses.

Publication Types: 
    Case Reports
    Review

PMID: 16354350 [PubMed - indexed for MEDLINE]

864: J Laryngol Otol. 2005 Nov;119(11):862-5.

Impact of antibiotics on pathogens associated with otitis media with effusion.

Hamamoto Y, Gotoh Y, Nakajo Y, Shimoya S, Kayama C, Hasegawa S, Nibu K.

Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, 
Kobe University, Kobe, Japan.

OBJECTIVE: To further understand the roles of bacteria and antibiotics in the
development of otitis media with effusion (OME). METHODS: Samples of middle-ear
effusion (MEE) were collected during the placement of ventilation tubes to treat 
chronic OME. Children with acute otitis media within the past three months were
excluded from this study. We used polymerase chain reaction (PCR) to detect
pathogens and to test the susceptibility of Streptococcus pneumoniae to
penicillin. RESULTS: Among MEE samples from 52 children, PCR detected bacterial
DNA in 32 per cent (24/75) of them. S. pneumoniae was detected more frequently in
middle ears that required ventilation tube insertion at least twice compared with
those requiring ventilation tube insertion only once (5/15 versus 4/60; p =
0.013). Higher levels of S. pneumoniae were detected in MEE from children with,
than without, a long history of antibiotic administration (7/10 versus 2/14; p = 
0.0187). The pbp genes of all isolated S. pneumoniae contained mutations.
CONCLUSIONS: Long exposure to antibiotics might significantly influence the
bacterial genome in MEE.

PMID: 16354337 [PubMed - indexed for MEDLINE]

865: Acta Otolaryngol. 2005 Nov;125(11):1236-9.

Primary tuberculous petrositis.

Sethi A, Sabherwal A, Gulati A, Sareen D.

Department of ENT and Head and Neck Surgery, Maulana Azad Medical College and LN 
Hospital, New Delhi, India. dr_sethi@rediffmail.com

Tuberculous osteomyelitis of the temporal bone is a rare and dangerous entity
that should be included in the differential diagnosis of infectious processes of 
the base of the skull. We present the case of an 11-year-old child who presented 
with diplopia, ear discharge and hearing loss. The radiological and
histopathological findings revealed tuberculous otitis with osteomyelitis and an 
abscess in the petrous apex. The child responded to anti-tuberculous
chemotherapy. The diagnosis and management of tuberculous osteomyelitis are
discussed and a brief review of the literature is presented.

Publication Types: 
    Case Reports

PMID: 16353409 [PubMed - indexed for MEDLINE]

866: Acta Otolaryngol. 2005 Nov;125(11):1230-5.

Delayed otogenic hydrocephalus after acute otitis media in pediatric patients:
the changing presentation of a serious otologic complication.

Koitschev A, Simon C, Löwenheim H, Kumpf M, Besch D, Ernemann U.

Department of Otorhinolaryngology and Head and Neck Surgery, University of
TübingenTübingen, Germany. assen.koitschev@med.uni-tuebingen.de

CONCLUSIONS: The clinical presentation of otogenic dural sinus thrombosis (DST)
as a complication of acute otitis media (AOM) can be masked by antibiotic
treatment. Morning episodes of vomiting and/or headache, visual impairment and a 
history of AOM seem to be indicative of otogenic hydrocephalus. We therefore
advocate that the MRI scans of patients with similar symptoms should be carefully
studied to facilitate the early diagnosis of a potentially life-threatening
complication. OBJECTIVE: To describe the frequency, pathognomonic signs, clinical
course and outcome of otogenic hydrocephalus and DST as complications of AOM in
pediatric patients. MATERIAL AND METHODS: We undertook a retrospective chart
review of all pediatric patients (age 1-14 years) treated for otitis media and
its complications at an academic medical center between 1999 and 2003. The main
outcome measures were otologic and ophthalmologic findings and CT and MRI scans
at the beginning of treatment and 3 months later. RESULTS: We report on five
cases with otogenic DST following AOM. All but one of them presented initially
with diplopia caused by otogenic hydrocephalus. In four cases the otologic
complaints had already disappeared by the time of MRI confirmation of the
diagnosis. Only one child was referred with severe otologic symptoms. Management 
included systemic antibiotics, short-term heparin anticoagulation and surgical
decompression. In our cases, even after intensive i.v. antibiotic treatment, only
surgery led to a significant improvement in the clinical condition.

Publication Types: 
    Case Reports

PMID: 16353408 [PubMed - indexed for MEDLINE]

867: Acta Otolaryngol. 2005 Nov;125(11):1176-9.

Effect of i.v. dexamethasone on postoperative dizziness, nausea and pain during
canal wall-up mastoidectomy.

Ahn JH, Kim MR, Kim KH.

Department of Otolaryngology, Asan Medical Center, University of Ulsan College of
Medicine, Seoul, South Korea. meniere@amc.seoul.kr

CONCLUSION: Prophylactic i.v. administration of 10 mg of dexamethasone reduced
postoperative dizziness and nausea without adverse effects in patients undergoing
canal wall-up mastoidectomy, but did not reduce postoperative pain. OBJECTIVE: To
investigate the efficacy of dexamethasone in reducing postoperative dizziness,
nausea and pain in patients undergoing canal wall-up mastoidectomy. MATERIAL AND 
METHODS: A prospective, randomized, double-blind study was performed between
January 2002 and December 2004. A total of 162 patients (66 males, 96 females)
scheduled for canal wall-up mastoidectomy were enrolled and randomly assigned to 
receive either i.v. dexamethasone (10 mg in 2 ml) or i.v. placebo (2 ml of normal
saline) during mastoidectomy. A standard general anesthetic technique was
employed throughout the surgical procedure. At 3, 6 and 24 h after surgery,
patients completed questionnaires regarding postoperative dizziness, nausea and
pain, with their responses being given on a visual analog scale. RESULTS: There
were no postoperative complications in either group. Compared to the placebo
group, the dexamethasone group showed reduced postoperative dizziness and reduced
nausea (p<0.05 for both) at 24 h postoperatively. Compared to the placebo group, 
dexamethasone had no effect on postoperative pain.

Publication Types: 
    Randomized Controlled Trial

PMID: 16353395 [PubMed - indexed for MEDLINE]

868: Kulak Burun Bogaz Ihtis Derg. 2005;15(1-2):36-9.

Computed tomography findings of labyrinthitis ossificans secondary to meningitis:
a case report.

Saygili OB, Topçu B, Tarhan NC, Yavuz H.

Department of Radiology, Medicine Faculty of Başkent University Adana Research
Medical Center, Adana, Turkey. obarutcu@yahoo.com

A 26-year-old man was admitted to our hospital with chronic left ear drainage. He
had a history of meningitis when he was a child. Computed tomography (CT) of the 
temporal bone showed complete obliteration of the otic labyrinth by sclerotic
tissue. Based on CT findings, the patient was diagnosed as labyrinthitis
ossificans. Computed tomography is an appropriate method of examination for the
identification of labyrinthitis ossificans and is of particular importance for
the evaluation of patients before cochlear implantation.

Publication Types: 
    Case Reports

PMID: 16340290 [PubMed - indexed for MEDLINE]

869: Kulak Burun Bogaz Ihtis Derg. 2005;14(5-6):97-100.

Assessment of antibacterial activity of some topical otological solutions.

Uçüncü H, Aktaş AE, Yazgi H, Yiğit N, Aktan B, Sütbeyaz Y.

Department of Otolaryngology, Medicine Faculty of Atatürk University, Erzurum,
Turkey. hucuncu@atauni.edu.tr

OBJECTIVES: Otological solutions have long been used in the treatment of the
bacterial and fungal infections of the ear. We investigated antibacterial
activity of some otic solutions against the most common bacteria isolated from
discharging ears. STUDY DESIGN: Three solutions were used (Castellani's,
Burrow's, and 2% salicyl alcohol) for 20 fresh isolates of each of the following 
organisms: Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa,
Escherichia coli, and Enterobacter spp.. The activity of each solution was
determined by the size of the zone of inhibition of bacterial growth. RESULTS:
The Castellani's solution showed significantly larger average inhibition zones
than the other solutions did (p<0.001). CONCLUSION: The Castellani's solution may
be considered a good option against bacterial or mixed infections (bacterial and 
fungal) of the ear.

PMID: 16340276 [PubMed - indexed for MEDLINE]

870: Pharmacoeconomics. 2005;23(12):1243-55.

A willingness-to-pay assessment of parents' preference for shorter duration
treatment of acute otitis media in children.

Gueylard Chenevier D, LeLorier J.

Department of Biomedical Sciences, University of Montreal, Montreal, Canada.

OBJECTIVE: To assess parental willingness to pay (WTP) for a shorter course of
antibacterial treatment versus conventional antibacterial therapy for acute
otitis media (AOM). METHODS: The study population consisted of 562 parents of
children who had been seen and treated by a paediatrician for an episode of AOM
between February and November 2002 in Montreal, Quebec, Canada. At the end of the
AOM treatment, a questionnaire that included demographic information about the
parents and child, details of the child's AOM history, a global wellbeing (i.e.
quality of life) assessment, an evaluation of treatment compliance and a scripted
WTP question was administered over the telephone. Descriptive analyses were
performed in addition to a multivariate analysis to estimate possible predictors 
of parental WTP. RESULTS: The children with AOM were representative of the AOM
patient population, with 46% being <2 years of age and the majority attending
day-care or school. Parents were willing to pay a median of 31.66 Can dollars
(2002 values) for a mono-dose (one dose, on 1 day) and 26.63 Can dollars for a
tri-dose (one dose daily, for 3 days) antibacterial treatment. Regression
analyses demonstrated that the amount parents were willing to pay was positively 
associated with increasing household income, increasing number of AOM episodes
during the previous year and experiencing adverse effects of treatment.
CONCLUSION: Parents of children with AOM were willing to pay more for their child
to benefit from a shorter duration of antibacterial treatment than for a standard
course. Short duration of treatment appears to be associated with better
compliance and parents' perception of better general wellbeing for their child.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16336018 [PubMed - indexed for MEDLINE]

871: Arch Pediatr Adolesc Med. 2005 Dec;159(12):1151-6.

Erratum in:
    Arch Pediatr Adolesc Med. 2006 Jun;160(6):588.

Comment in:
    Arch Pediatr Adolesc Med. 2005 Dec;159(12):1183-5.    J Pediatr. 2006 May;148(5):699-700.

Hearing thresholds and tympanic membrane sequelae in children managed medically
or surgically for otitis media with effusion.

Stenstrom R, Pless IB, Bernard P.

Department of Emergency Medicine, St Paul's Hospital, Vancouver, British
Columbia, Canada. rstenstrom@providencehealth.bc.ca

OBJECTIVE: To determine the long-term effects of ventilation tube insertion on
hearing thresholds and tympanic membrane pathologic abnormalities in children
with otitis media with effusion. DESIGN: Prospective cohort study. SETTING:
Tertiary care children's hospital, otorhinolaryngology and audiology service.
PARTICIPANTS: Patients aged 8 to 16 years who participated in a randomized
controlled trial of medical vs surgical (ventilation tube [VT]) treatment for
recurrent otitis media with effusion at ages 2.5 to 7 years. MAIN OUTCOME
MEASURES: Hearing thresholds and tympanic membrane sequelae. METHODS: One hundred
thirteen of 125 children who had participated in the trial underwent blinded
audiometric, tympanometric, otomicroscopic, and parental questionnaire evaluation
6 to 10 years following the trial. Thirty of 57 [corrected] medical subjects
received ventilation tubes and 18 of 56 [corrected] VT subjects received more
than 1 set of tubes. To evaluate sequelae risk associated with ventilation tubes 
independent of disease severity, we compared 27 medical subjects who never
received ventilation tubes and 38 subjects randomized to VT who only received 1
set of tubes. RESULTS: Tympanic membrane pathologic abnormalities were present in
81% of VT subjects and 19% of medical subjects (relative risk, 4.4; 95%
confidence interval, 2.2-9.9). Hearing thresholds were 2.1 to 8.1 dB higher in
subjects treated with tubes (P = .005). CONCLUSIONS: In children who were
candidates for ventilation tube insertion randomly assigned to receive medical or
VT treatment for otitis media with effusion, elevated hearing thresholds and
tympanic membrane pathologic abnormalities were more common in VT subjects 6 to
10 years after insertion.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16330739 [PubMed - indexed for MEDLINE]

872: Eur Arch Otorhinolaryngol. 2006 Apr;263(4):365-9. Epub 2005 Dec 3.

Cochlear implantation in a patient with eosinophilic otitis media.

Iwasaki S, Nagura M, Mizuta K.

Department of Otolaryngology, Hamamatsu University School of Medicine, 1-20-1
Handayama, 431-3192, Hamamatsu City, Japan. iwasaki@hama-med.ac.jp

Eosinophilic otitis media is an intractable middle ear disease with gelatinous
mucoid fluid containing eosinophils associated with bronchial asthma and nasal
allergy that sometimes induces deterioration of sensorineural hearing loss. Here,
we report a case of eosinophilic otitis media in a 50-year-old woman who received
a Nucleus 22 multi-channel cochlear implant in the right ear at the age of 42
years. She had received treatment for bronchial asthma, chronic sinusitis with
nasal allergy and otitis media with effusion since the age of 30 years and had
noted bilateral sudden deafness and vertigo at the age of 35 years. Preoperative 
CT and MRI showed cochlear ossification in the left ear, in which mastoidectomy
was performed as treatment of eosinophilic otitis media. Long-term follow-up
revealed that cochlear implant is indicated for deafness induced by eosinophilic 
otitis media, and an early decision for cochlear implant surgery is necessary.
Steroid administration was remarkably useful in controlling eosinophilic otitis
media in patients with bronchial asthma and chronic sinusitis with nasal allergy.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 16328408 [PubMed - indexed for MEDLINE]

873: Eur Arch Otorhinolaryngol. 2006 May;263(5):404-8. Epub 2005 Nov 22.

Prevalence and risk factors of otitis media with effusion in Trabzon, a city in
northeastern Turkey, with an emphasis on the recommendation of OME screening.

Caylan R, Bektas D, Atalay C, Korkmaz O.

Department of Otolaryngology, Black Sea Technical University School of Medicine, 
Trabzon, Turkey. refikcaylan@yahoo.com

This cross-sectional study was undertaken to assess the prevalence and risk
factors for otitis media with effusion (OME) in Trabzon, a city in northeastern
Turkey, and evaluate the need for screening for OME in the normal population. In 
kindergartens, daycare centers, public and private schools in the rural and
central areas of Trabzon, 1,077 children aged between 5 and 12 years were
examined. OME prevalence was 11.14% (120/1,077). Young age, attendance at
kindergarten/daycare, low economical status, the mother's working status
(housewife), history of snoring and acute otitis media, antibiotic use in the
previous 3 months and active upper respiratory tract infection (URTI) were found 
to be the risk factors for OME. A history of hearing loss reported by the parents
and teachers was found significant in the diagnosis of OME despite the low
predictive value. When the parents suspected that their child had experienced
hearing loss (in 36 cases), they did not refer them to a healthcare facility. To 
conclude, the approach to OME in developing countries should be more
interventional as healthcare coverage is usually low and behavioral factors such 
as the demand for healthcare is poor.

PMID: 16328401 [PubMed - indexed for MEDLINE]

874: Hum Exp Toxicol. 2005 Nov;24(11):567-71.

Effect of dantrolene on lipid peroxidation, lutathione and glutathione-dependent 
enzyme activities in experimental otitis media with effusion in guinea pigs.

Ucuncu H, Taysi S, Aktan B, Buyukokuroglu ME, Elmastas M.

Department of Otorhinolaryngology-Head and Neck Surgery, Ataturk University,
Medical School, Erzurum, Turkey.

The aims of our study were to assess whether the increased oxidative stress in
experimental otitis media with effusion (OME) induced by histamine was reflected 
erythrocytes and middle ear effusion fluid by lipid peroxidation; to survey the
alterations in antioxidant enzyme activities in experimental OME; and to
determine the effect of dantrolene on this oxidative stress. Erythrocyte and
middle ear effusion malondialdehyde (MDA) level, erythrocyte glutathione (GSH)
and glutathione peroxidase (GSH-Px), glutathione reductase (GRD) and
glutathione-S-transferase (GST) activities were measured in three groups of seven
guinea pigs, 3 hours after injection of 0.1 mL of histamine (or saline) into the 
middle ear in guinea pigs with OME (experimental group), in a dantrolene sodium
group and in a control group. Erythrocyte and effusion MDA levels in the
dantrolene group were significantly lower than those of the experimental group.
Erythrocyte GSH-Px, GST, GRD activities, and GSH levels were significantly higher
in the dantrolene group than in the experimental group. Dantrolene sodium
decreased the erythrocyte and effusion MDA levels, on the other hand, it
increased the GSH and GSH-dependent enzymes. These findings suggest that reactive
oxygen species (ROS) play a role in histamine-induced OME. Pre-treatment with
dantrolene sodium increases antioxidant enzymes activities and decreases
formation of MDA, the indicator of lipid peroxidation, in histamine-induced OME.

PMID: 16323573 [PubMed - indexed for MEDLINE]

875: Pediatrics. 2005 Dec;116(6):1267-75.

An assessment of the shared-decision model in parents of children with acute
otitis media.

Merenstein D, Diener-West M, Krist A, Pinneger M, Cooper LA.

Robert Wood Johnson Clinical Scholars Program, Johns Hopkins School of Medicine, 
Baltimore, Maryland, USA. djm23@georgetown.edu

OBJECTIVE: Medicine is shifting from a doctor-centered approach to a model
entailing more shared decision-making. Many organizations now recommend a
shared-decision approach to treating children with acute otitis media (AOM). Our 
primary objectives in this study were to assess (1) which style of
decision-making on the physician's part would most effectively reduce parents'
proclivity to use antibiotics for treatment of their child's AOM and (2) parental
satisfaction with different doctor-patient decision-making styles. METHODS: We
conducted a cross-sectional survey to examine how parents respond to
doctor-patient communication styles in 3 clinical vignettes that presented 2
versions of a shared-decision model (SDM) and 1 paternalistic model. Parents were
randomly assigned to receive 1 of 3 vignettes. The main predictor variable was
the vignette assignment, and the main outcomes were (1) parent proclivity to use 
antibiotics and (2) parent ratings of care by the physician in the vignette.
Using logistic regression, we adjusted for caregivers' age, gender, income,
knowledge of antibiotics, decision-making preference, confidence in physician,
and length of relationship with personal physician. RESULTS: Four hundred
sixty-six parents met inclusion criteria, with a response rate of 94%. General
characteristics were similar across vignette assignment groups. Parents who
received the paternalistic-model vignettes were more likely to say that they
would use antibiotics than those who received the SDM vignettes (odds ratio: 4.9;
95% confidence interval: 2.3-10.6). This result remained statistically
significant after adjustment for potential confounders. In addition, parents in
the shared-decision groups were more satisfied (93% and 84%) than those in the
paternalistic-model group (76%). CONCLUSIONS: To our knowledge, this is the first
study to examine parent interest, acceptance, and satisfaction with the SDM. Our 
findings suggest that shared decision-making for AOM may lead to less antibiotic 
usage and higher levels of parental satisfaction. Although more studies are
needed to examine how best to incorporate parents in the SDM, our study serves as
an example of the potential benefit of this approach in pediatric medicine.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16322146 [PubMed - indexed for MEDLINE]

876: Br J Educ Psychol. 2005 Dec;75(Pt 4):623-43.

Parent versus professional views of the developmental impact of a multi-faceted
condition at school age: otitis media with effusion ('glue ear').

Higson J, Haggard M.

MRC External Scientific Staff Team in Children's Middle-ear Disease, UK.

BACKGROUND: Several aspects of children's health and development are known from
empirical studies to be associated with otitis media with effusion (OME; 'glue
ear'). The 'diffuse image' has been an obstacle to defining a core set of impacts
about which inter-profession and parent-professional communication can be
effective. AIMS: The study quantifies similarities and differences in how the
signs, symptoms, and developmental impact of OME are attributed and construed,
between teachers, parents, and ear, nose, and throat (ENT)surgeons. SAMPLE:
Convenience samples were achieved of 118 teachers and 154 parents of affected
children; 178 ENT surgeons from a professional sampling frame (association
membership) responded. METHOD: Questionnaires elicited the perceived frequency
and concern-value of over 30 manifestations of OME--the various signs, symptoms, 
and behaviours suggested by the literature. Factor scores derived on the combined
sample were compared between respondent groups. RESULTS: Teachers assign high
importance to education and language problems but, relative to parents, they
accord lower importance to continuing hearing problems. Teachers and parents
weighted behaviour and balance problems similarly, placing behaviour higher, but 
balance lower, than the ENT specialists did. CONCLUSIONS: (1) A four-factor
reduction of simple questionnaire items well defines the domains of impact of
OME, and can express the ways in which views of impact differ between teachers,
ENT specialists and parents.(2) Considerable differences of perspective exist
between the groups examined. (3) In valuing a set of measured outcomes on actual 
children, or for other policy research, sets of weights are now available to
represent the differing perspectives of parents and professionals (e.g. in
testing robustness of a conclusion across differing stakeholder perspectives).
(4) The research and development need in respect of teachers' involvement with
OME could profitably play to existing strengths. This implies the systematic and 
structured acquisition and evaluation of teacher-provided impact information.

Publication Types: 
    Comparative Study

PMID: 16318682 [PubMed - indexed for MEDLINE]

877: Int J Audiol. 2005 Oct;44(10):593-8.

Predisposing factors for inner ear hearing loss association with chronic otitis
media.

Redaelli de Zinis LO, Campovecchi C, Parrinello G, Antonelli AR.

Department of Otolaryngology, University of Brescia School of Medicine, Italy.
lucaosre@tin.it

The aim of the present study was to investigate the consequences of chronic
otitis media on inner ear function. Retrospective analysis of conventional
pure-tone audiometry tests was carried out on 344 patients who were scheduled for
surgical treatment of unilateral chronic otitis media without other risk factors 
for sensorineural hearing loss. Bone conduction thresholds of diseased ears were 
compared with those of contralateral, non-diseased ears. Selected clinical
features were assessed among diseased ears to examine possible influences on
inner ear function. Mean bone conduction threshold differences varied from 0.6 dB
at 0.5 kHz to 3.7 dB at 4 kHz. These differences augmented with increasing
duration of middle ear disease. Impaired hearing by bone conduction thresholds of
diseased ears correlated with increased age at every frequency and with an
interruption of the ossicular chain only at higher frequencies. The severity of
sensorineural hearing loss correlated with longer duration of middle ear disease.
Thus, surgical treatment of dry and apparently stable tympanic membrane
perforation is warranted.

PMID: 16315450 [PubMed - indexed for MEDLINE]

878: J Clin Oncol. 2005 Dec 1;23(34):8588-96.

Ototoxicity in children receiving platinum chemotherapy: underestimating a
commonly occurring toxicity that may influence academic and social development.

Knight KR, Kraemer DF, Neuwelt EA.

Department of Neurology, Neurosurgery, and Pediatric Audiology, Oregon Health and
Science University, Portland 97201, USA.

PURPOSE: To describe the frequency and severity of ototoxicity in a series of
pediatric patients treated with platinum-based chemotherapy. PATIENTS AND
METHODS: Serial audiologic evaluations were conducted for 67 patients aged 8
months to 23 years who received platinum-based chemotherapy. Audiologic data was 
analyzed to determine time to hearing-loss using American Speech-Language-Hearing
Association (ASHA) criteria, and the effects of treatment and patient
characteristics on the incidence and severity of ototoxicity. RESULTS: Bilateral 
decreases in hearing were seen in 61% of patients (median time to hearing loss,
135 days). Children treated for medulloblastoma, osteosarcoma, and neuroblastoma 
had greater incidence and severity of hearing loss. Agreement between the usually
reported National Cancer Institute Common Terminology Criteria for Adverse Events
(CTCAE) and ASHA criteria was inadequate. CONCLUSION: Traditional reporting of
toxicity data (CTCAE) has under-reported ototoxicity and minimized the
significance of hearing loss in children. As pediatric patients experience
improved survival, the effects and implications of high-frequency hearing loss
with regard to academic achievement and speech and language development are
important considerations, especially in patients younger than 5 years.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16314621 [PubMed - indexed for MEDLINE]

879: Int J Pediatr Otorhinolaryngol. 2006 Jun;70(6):1009-14. Epub 2005 Nov 28.

High frequency of Alloiococcus otitidis in the nasopharynx and in the middle ear 
cavity of otitis-prone children.

Harimaya A, Takada R, Somekawa Y, Fujii N, Himi T.

Department of Otolaryngology, Sapporo Medical University School of Medicine,
Sapporo, Japan. harimaya@sapmed.ac.jp

OBJECTIVE: Colonization of middle ear pathogens is facilitated in the nasopharynx
of otitis-prone children, and is associated with the development of otitis media.
Recently, a new species of bacterium, Alloiococcus otitidis, is considered as one
of the major middle ear pathogens. However, as far as we know, no study has been 
reported concerning the prevalence of A. otitidis in the nasopharynx of
otitis-prone children. And, no study has been conducted on the association of A. 
otitidis in the nasopharynx with otitis media. METHODS: The frequency of A.
otitidis in 83 middle ear effusions (MEE) and 56 nasopharyngeal swab (NPS)
specimens from 56 children with otitis media was investigated by culture and
polymerase chain reaction (PCR). RESULTS: A. otitidis was detected in 24 (28.9%) 
of MEE and in 6 (10.7%) of NPS specimens. When the frequency was investigated in 
relation to proneness to otitis media, A. otitidis was detected in 16 (64%) of 25
MEE and in 5 (29.4%) of 17 NPS specimens from otitis-prone children, whereas it
was detected in 8 (13.8%) of 58 MEE and in 1 (2.6%) of 39 NPS specimens from
non-otitis-prone children. The frequency of A. otitidis in both NPS and MEE
specimens was significantly higher in otitis-prone than in non-otitis-prone
children. CONCLUSIONS: Our results suggest that colonization of A. otitidis is
facilitated in the nasopharynx of otitis-prone children. And, nasopharyngeal
colonization of A. otitidis may be associated with the frequency of otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16310863 [PubMed - indexed for MEDLINE]

880: Auris Nasus Larynx. 2006 Jun;33(2):183-6. Epub 2005 Nov 22.

Pleomorphic adenoma of the external auditory canal complicated by hearing loss
secondary to chronic otitis media.

Tsukahara K, Suzuki M, Tokashiki R, Motohashi R, Iwaya K.

Department of Otolaryngology, Tokyo Medical University, Tokyo, Japan.
tsuka1116@nifty.com

Pleomorphic adenoma (PA) rarely occurs in the external auditory canal (EAC). A
case of PA complicated with chronic otitis media is reported. The patient was a
36-year-old male who began to experience a hearing loss in the left ear in 1996. 
He sought medical attention only after ear pain developed in April 2003. At the
initial examination, a tumor covered by smooth skin was seen filling the left
EAC. Pure-tone audiometry showed residual hearing at low frequencies and
scale-out across middle to high frequency range. The CT and MRI findings led to a
diagnosis of a tumor of the left EAC complicated with an inflammatory middle-ear 
lesion. The tumor was excised en bloc with the overlying skin, and tympanoplasty 
was performed. The pathological diagnosis was PA of the left EAC and inflammatory
granuloma of the middle ear.

Publication Types: 
    Case Reports

PMID: 16309867 [PubMed - indexed for MEDLINE]

881: Int J Pediatr Otorhinolaryngol. 2006 May;70(5):899-903. Epub 2005 Nov 23.

Acute otitis media and mastoiditis following cochlear implantation.

Migirov L, Yakirevitch A, Henkin Y, Kaplan-Neeman R, Kronenberg J.

Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, and
Sackler School of Medicine, Tel Aviv University, Tel Hashomer 5262l, Israel.
smigirov@leumit.co.il

OBJECTIVE: To examine the incidence of acute otitis media (AOM) and mastoiditis
in children after cochlear implantation (CI) and to evaluate the role of
mastoidectomy in decreasing the rate of AOM in implanted children by comparing
two surgical techniques: the Posterior tympanotomy approach (MPTA, with
mastoidectomy) and the Suprameatal approach (SMA, without mastoidectomy).
METHODS: A retrospective study was conducted on 234 children up to 16 years of
age who underwent CI between 1993 and 2003 in our department. The children were
divided into two groups according to the surgical technique that had been used
for the implantation: the MPTA group and the SMA group. RESULTS: Part of the
children with a history of pre-implantation AOM (22 of 29 in MPTA group and 26 of
38 in SMA group) did not suffer from AOM post-CI (p=0.59), and an incidence of
AOM after CI in children who did not have history of AOM prior to implantation
(13 patients of MPTA group and 15 patients of SMA group) was unrelated to
surgical approach (p=0.65). The incidence of pre-implantation AOM was similar for
the two groups and declined after CI unrelated to performing of mastoidectomy in 
surgical technique. Overall, 47 children (20.1%) had post-CI AOM compared to 67
children (28.6%) who had pre-CI AOM. Mastoiditis developed in 11 children (4.7%),
all 11 in the MPTA group. A subperiosteal abscess was incised and drained with
the retroauricular approach in three of these children and the others were
managed with intravenously administered ceftriaxone 50mg/kg/day for 3-5
consecutive days, followed by a course of oral cephalexin until there is complete
clinical resolution of the effusion in the middle ear. The implants were
preserved in all cases. Seven out of 11 children with mastoiditis had no history 
of AOM prior to implantation. CONCLUSIONS: AOM and mastoiditis represent common
complications of CI that can be successfully treated with the prompt use of
antibiotics. However, the subperiosteal abscess could require surgical drainage. 
In our opinion, the decrease of incidence of AOM in implanted children is the
result of natural history of otitis media and is unrelated to the surgical
approach.

Publication Types: 
    Comparative Study

PMID: 16309750 [PubMed - indexed for MEDLINE]

882: Int J Pediatr Otorhinolaryngol. 2006 May;70(5):829-34. Epub 2005 Nov 23.

Chronic otitis media with effusion and Helicobacter pylori.

Agirdir BV, Bozova S, Derin AT, Turhan M.

Akdeniz University, Medical Faculty, ENT & HNS, Arapsuyu, Akdeniz, Antalya 07070,
Turkey. abulent@akdeniz.edu.tr

OBJECTIVE: The aim of this study is to investigate the presence of Helicobacter
pylori (HP) in the middle ear effusion by Campylobacter-like organism (CLO) test 
and whether it has a role in the ethiopathogenesis of chronic otitis media with
effusion (OME). STUDY DESIGN: A prospective randomized and controlled study.
METHODS: This study was performed with 45 patients with the diagnosis of chronic 
OME and adenoid hypertrophy, between the ages 3 and 13 (median 6). Thirty
patients constituted the study group (18 male (60%) and 12 (40%) female).
Adenoidectomy with myringotomy with ventilation tube insertion were performed to 
this group. Middle ear effusion and adenoid tissue pieces were collected and H.
pylori presence was investigated by "CLO" testing. Fifteen patients of the
matching age group (9 male (66.7%) and 6 (33.3%) female) constituted the control 
group to whom adenoidectomy with myringotomy were performed but no middle ear
effusion could be determined (empty myringotomy patients). The wash out liquid of
middle ear and pieces of adenoid tissue samples were also collected from the
control group. By using CLO testing, the presence of H. pylori was investigated
in the adenoid tissues and middle ear of the empty myringotomy patients. RESULTS:
In 20 (66.6%) patients of the study group, CLO testing was positive in the middle
ear effusions. None of the patients demonstrated positive CLO test in the wash
out liquid of middle ear. There was significant difference of positive CLO
testing in the middle ear effusions of two groups (p<0.001). CONCLUSIONS: These
findings showed us that presence of HP in the middle ear effusion using CLO
testing and this may be responsible for the ethiopathogenesis of chronic OME.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16309749 [PubMed - indexed for MEDLINE]

883: Pharmacotherapy. 2005 Dec;25(12 Pt 2):124S-129S.

Comparison of amoxicillin with alternative agents for the treatment of acute
otitis media in children.

Toltzis P.

Division of Pharmacology and Critical Care, Rainbow Babies and Children's
Hospital, Cleveland, Ohio 44106, USA. pxt2@case.edu

Expert panels have recommended high-dose amoxicillin (80-90 mg/kg/day) as the
therapy of choice for uncomplicated acute otitis media in children. This
recommendation is based primarily on pharmacokinetic data predicting
bacteriologic cure of most middle ear infections by using amoxicillin at the
recommended dosage. However, comparisons of aminopenicillin-containing regimens
with alternative treatments, particularly azithromycin, have not consistently
demonstrated superiority of the former, even in recent trials with stringent
designs. Moreover, amoxicillin exposure may perturb nasopharyngeal colonization
more profoundly than do alternative agents. These perturbations may theoretically
promote the dissemination of beta-lactam-resistant pneumococci in the community
more than other drugs approved for use in otitis media. Such findings suggest
that several factors should be considered when choosing an agent to treat otitis 
media and that reexamination of high-dose amoxicillin as the superior first-line 
agent for this condition might be warranted.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Review

PMID: 16305281 [PubMed - indexed for MEDLINE]

884: Pharmacotherapy. 2005 Dec;25(12 Pt 2):109S-123S.

Microbiologic surrogate end points in clinical trials of infectious diseases:
example of acute otitis media trials.

Powers JH.

Office of Antimicrobial Products, Center for Drug Evaluation and Research, United
States Food and Drug Administration, Rockville, Maryland, USA.
POWERSJOH@cder.fda.gov

Clinical outcomes that measure how patients feel, function, or survive are the
most important and relevant outcomes of therapy in clinical trials and in
clinical practice. Surrogate end points, which do not directly measure clinical
benefit to the patient, may function as substitutes for clinical end points in
clinical trials. Such surrogates are attractive as they may allow measurement of 
outcomes earlier in time or with a smaller sample size than with clinical
outcomes. Microbiologic biomarkers, such as culture results at a specific time
after start of therapy, or pharmacodynamic analyses of the effect of drugs on
organisms often are proposed as surrogate end points in clinical trials of
therapies for infectious diseases. However, evaluation of biomarkers as surrogate
end points poses distinct challenges, and only a few biomarkers have been useful 
replacements for clinical end points. Evaluation of biomarkers as potential
surrogate end points first requires an understanding of the differences among
measurements of the cause of a disease, risk factors for outcome, and
measurements of treatment effects. We will discuss the definitions of clinical
and surrogate end points and the reasons why surrogate end points may not predict
the true clinical benefit of therapies. We will use the example of the biomarker 
of microbiologic outcomes from tympanocenteses performed during therapy as the
sole measure of clinical effectiveness in clinical trials of acute otitis media
to illustrate the challenges in evaluating biomarkers as surrogate end points.

Publication Types: 
    Review

PMID: 16305280 [PubMed - indexed for MEDLINE]

885: Pharmacotherapy. 2005 Dec;25(12 Pt 2):105S-10S.

Predictive value of double tympanocentesis in acute otitis media.

Schaad UB.

University Children's Hospital, Basel, Switzerland. b.schaad@unibas.ch

Advances in the understanding of acute otitis media (AOM), lessons learned from
antibacterial trials, and the emergence of pathogens with decreased
susceptibility to commonly used antibiotics explain the need to redefine the role
of tympanocentesis. The diagnostic value of tympanocentesis at baseline to
establish the bacterial cause of AOM is well accepted. However, relevant ethical 
and scientific arguments conclude that repeat (or double) tympanocentesis cannot 
be recommended as routine procedure, either for the individual patient or for
each treatment trial. Relevant aspects on trial design for AOM, with special
emphasis on the value of double tympanocentesis, are reviewed.

Publication Types: 
    Review

PMID: 16305279 [PubMed - indexed for MEDLINE]

886: Vet Ther. 2005 Fall;6(3):252-9.

Comparison of bacterial organisms and their susceptibility patterns from otic
exudate and ear tissue from the vertical ear canal of dogs undergoing a total ear
canal ablation.

Cole LK, Kwochka KW, Hillier A, Kowalski JJ, Smeak DD.

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The
Ohio State University, Columbus, OH 43210, USA.

The purpose of this prospective study was to compare bacterial organisms and
their susceptibility patterns from otic exudate and ear tissue from the vertical 
ear canal of six dogs with end-stage otitis undergoing a total ear canal
ablation. Twenty-six organisms, 13 from the exudate and 13 from the tissue, were 
morphologically and biochemically similar, and their susceptibility patterns were
compared. There were discrepancies for only 5 antibiotics for 4 organisms from 3 
dogs. Culture of otic exudate from the vertical ear canal of dogs with chronic
end-stage otitis externa provides an accurate reflection of the bacterial species
present and the antimicrobial susceptibility patterns of these infections.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16299671 [PubMed - indexed for MEDLINE]

887: Acta Otolaryngol. 2005 Oct;125(10):1051-4.

Analysis of risk factors for childhood persistent middle ear effusion.

Hammarén-Malmi S, Tarkkanen J, Mattila PS.

Department of Otorhinolaryngology, University of Helsinki and Helsinki University
Central Hospital, Helsinki, Finland.

Although exposure to infectious agents and parental smoking are known to
influence the overall risk of otitis media, these risk factors do not appear to
be linked with the tendency to develop chronic otitis media with effusion (COME) 
instead of recurrent acute otitis media (RAOM). The genetic inflammatory response
type of the child appears to influence the risk of persistent middle ear effusion
in COME.Two different clinical presentations of childhood otitis media are
encountered: RAOM; and COME, which is associated with persistent effusion in the 
middle ear. The objective of this study was to assess putative factors that may
regulate the development of persistent middle ear effusion in COME.In total, 159 
children with RAOM and their parents (n=304), and 55 children with COME and their
parents (n=110) were evaluated. All the children with COME or RAOM were aged <4
years.There was no difference in the frequency of attendance at day care outside 
the home, number of siblings or parental smoking between children with RAOM and
those with COME. The frequency of parental allergy and asthma was lower among
children with COME than those with RAOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16298785 [PubMed - indexed for MEDLINE]

888: Acta Otolaryngol. 2005 Oct;125(10):1043-50.

Evidence of T-helper cell 2 cytokine regulation of chronic otitis media with
effusion.

Smirnova MG, Birchall JP, Pearson JP.

Institute for Cell and Molecular Biosciences & School of Biomedical Sciences,
Medical Faculty, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
Marina.Smirnova@ncl.ac.uk

Cytokine and cellular patterns of effusions may reflect stages of middle ear
inflammation. The local interplay between IL-2 and -4 is likely to play a crucial
role in the switching of inflammation in the chronic stage. The T-helper cell 2
(Th2) cytokines IL-4, -5 and -13 and the Th2/Th1 cytokine granulocyte-macrophage 
colony-stimulating factor (GM-CSF) regulate the cellular and molecular processes 
of chronic inflammation in the middle ear and therefore the chronic condition of 
otitis media with effusion (OME). Early identification of the cytokine and
cellular patterns of effusions can be helpful in directing the clinical treatment
of OME.We hypothesized that IL-2 and the group of Th2 cytokines regulate chronic 
inflammation in the middle ear and chronic OME.Effusions from children with
persistent OME were analysed to determine the presence of cytokines (the Th1
cytokine IL-2, the Th2 cytokines IL-4, -5 and -13 and the Th1/Th2 cytokine
GM-CSF), inflammatory cells (CD4+ T cells, eosinophils, macrophages and
neutrophils) and mucin. Cytokines were evaluated by means of a quantitative
"sandwich"-type ELISA, inflammatory cells by means of alkaline
phosphatase-anti-alkaline phosphatase immunocytostaining and mucin by means of a 
modified periodic acid-Schiff method based on a slot-blot technique.The cytokine 
pattern in effusions varied from patient to patient. GM-CSF correlated positively
and IL-4 inversely with IL-2 and the increased level of IL-4 may have had an
inhibitory effect on IL-2. IL-5 and -13 correlated with IL-4. Inflammatory cells 
correlated with cytokines as follows: CD4+ T cells with IL-2 and -4; macrophages 
and neutrophils with GM-CSF; and eosinophils with IL-5. Some cytokine-cellular
correlations in effusions were reflected at the clinical level. The mucin content
of effusions correlated with the concentrations of IL-4 (>10 pg/ml) and -13,
suggesting involvement of IL-4 and -13 in upregulation of the middle ear mucin
metabolism.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16298784 [PubMed - indexed for MEDLINE]

889: Int J Pediatr Otorhinolaryngol. 2006 May;70(5):817-22. Epub 2005 Nov 16.

Particularities of bacterial ecology of acute otitis media in an African
subtropical country (Cote d'Ivoire).

Tanon-Anoh MJ, Kacou-Ndouba A, Yoda M, Ette-Akre E, Sanogo D, Kouassi B.

ENT and Cervico-Facial Surgery Unit, Yopougon's Teaching Hospital, 21 BP 622
Abidjan 21, Côte d'Ivoire. anohjose@aviso.ci

BACKGROUND: Acute otitis media (AOM) is the commonest infectious disease of
childhood. Its treatment is based on a probabilistic antibiotic therapy.
OBJECTIVE: To determine the prevalence of different bacteria responsible for AOM 
in children in Abidjan (Côte d'Ivoire). MATERIALS AND METHODS: This is a
prospective study, between November 2002 and August 2003. To identify bacterial
isolates, 60 children under 15 years old with AOM were enrolled. In 52 cases, the
sample was recovered by aspiration of a spontaneous otorrhea and in eight cases, 
it was taken by paracentesis. Nasopharyngeal swabs were cultured. Antibiotic
susceptibility tests were performed on isolates. RESULTS: 75% of children were
under 24 months of age. Pseudomonas aeruginosa was recovered in 31.8% of cases
followed by Streptococcus pneumoniae (21%), Proteus (7.4%) and Staphylococcus
(6.2%). The rate of penicillin-nonsusceptible S. pneumoniae (NSSP) was 11.8%.
Resistance to erythromycin was 6%. For Pseudomonas, resistances to antibiotics
were 35.5% to ceftazidim and 16% to pefloxacin, respectively, but all the strains
were sensible to colistin, iminepem and ciprofloxacin. CONCLUSION: These data can
modify therapeutic approaches for treatment of AOM in our country. This study
should encourage surveillance of AOM microbiology.

PMID: 16297453 [PubMed - indexed for MEDLINE]

890: J Am Acad Audiol. 2005 Sep;16(8):596-9.

An unusual case of otitis media.

Hull RH.

Department of Communicative Disorders and Sciences, Wichita State University, KS 
67260-0075, USA. ray.hull@wichita.edu

This case report of bilateral otitis media in a 39-year-old woman secondary to
Wegener's Granulomatosis highlights, for the audiologist, the importance of being
aware of some of the less common etiologies of middle ear disease. Bilateral
otitis media that resists usual forms of medical treatment may represent one of
the earliest signs of Wegener's Granulomatosis, a potentially life-threatening
disease. According to recent literature, involvement of the ears, nose, and
throat can in many instances be the only early manifestation of the disease. It
is important that audiologists be aware of the early signs in order to make
appropriate referral for treatment, particularly since they are usually among the
first to see these patients. Early diagnosis and referral is critical since the
mean survival of untreated WG is five months, with 82% of patients dying within
one year, and more than 90% dying within two years. The disease involves a
systemic vasculitis that may involve any organ system: however, pulmonary or
renal disease appear to be among the later signs, while both middle ear and upper
respiratory involvement are frequently among the earliest.

Publication Types: 
    Case Reports

PMID: 16295246 [PubMed - indexed for MEDLINE]

891: Int J Pediatr Otorhinolaryngol. 2006 May;70(5):947-50. Epub 2005 Nov 15.

Hemifacial spasm associated with otitis media with effusion: a first reported
case.

Lavon H, Cohen-Kerem R, Uri N.

Department of Otolaryngology, Head and Neck surgery, Carmel Medical Center,
Haifa, Israel.

Hemifacial spasm is a condition consisting of unilateral paroxysmal involuntary
contractions of the muscles innervated by the facial nerve. The most common
etiology is a vascular loop compression at the root exit zone of the nerve. We
present here a first reported case of hemifacial spasm associated with otitis
media with effusion, in a 6-year-old girl, which was relieved immediately
following ventilation tubes insertion. A proposed mechanism is described.

Publication Types: 
    Case Reports

PMID: 16293320 [PubMed - indexed for MEDLINE]

892: Int J Pediatr Otorhinolaryngol. 2006 May;70(5):915-23. Epub 2005 Nov 15.

Bacterial etiology of acute otitis media and clinical efficacy of
amoxicillin-clavulanate versus azithromycin.

Guven M, Bulut Y, Sezer T, Aladag I, Eyibilen A, Etikan I.

Department of Otorhinolaryngology, Faculty of Medicine, Gaziosmanpasa University,
Tokat, Turkey. guvenmehmet28@yahoo.com

BACKGROUNDS: Acute otitis media (AOM) is one of the most common acute bacterial
infection in childhood and also the most frequent reason for outpatient
antibiotic therapy. Little recent information about susceptibility patterns of
AOM bacterial pathogens in Turkish children has been reported. OBJECTIVE: To
determine the bacterial etiology of acute otitis media in children and to compare
the efficiency of 3 days course of azithromycin with a 10 days course of
amoxicillin-clavulanate. METHODS: This prospective, single blind, randomised
comparative study was carried out in 180 children with AOM. Paracentesis was
performed for middle ear fluid culture before the first dose antibiotic therapy. 
Children with acute otitis media were randomised to receive either low dose
amoxicillin-clavulanate (45/6.4 mg/kg/day in two divided doses for 10 days) or
low dose azithromycin (10mg/kg/day for 3 days). Clinical response was assessed on
days 2-4, 11-13, 26-28. RESULTS: Bacterial pathogens were isolated from 108 (60%)
of 180 children. Streptococcus pneumoniae was the most common isolated pathogen
(39.7%), followed by Haemophilus influenzae (20.7%), Moraxella catarrhalis
(15.5%), Staphylococcus aureus (13.8%), Group A beta-hemolytic streptococcus
(5.1%), Escherichia coli (3.4%) and Enterococcus faecalis (1.7%). This study
demonstrated low resistance rates compared to studies of different countries.
Although clinical response rates were better in patients treated with
amoxicillin-clavulanate, this was not statistically significant [86.6% (78 of
90)] versus [95.2% (80 of 84)]. Success rates of amoxicillin-clavulanate were
high for both S. pneumoniae and H. influenzae. Difference between success rates
was not statistically significant (P=0.144 and 0.352). CONCLUSIONS: Bacteria were
isolated in 60% of AOM cases. The clinical efficiency of amoxicillin-clavulanate 
was found to be equal compared to azithromycin in children with acute otitis
media.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16293317 [PubMed - indexed for MEDLINE]

893: J Infect. 2005 Nov;51(4):e237-40.

Isolation of measles virus from middle ear fluid of infants with acute otitis
media.

Yano H, Suetake M, Endo H, Takayanagi R, Numata M, Ohyama K, Sagai S, Okitsu N,
Okamoto M, Nishimura H, Kobayashi T.

Department of Otolaryngology, Tohoku Rosai Hospital, Aoba-ku, Sendai 981-8563,
Japan. yanohisa@tohokuh.rofuku.go.jp

Measles virus was isolated from the middle ear fluid (MEF) of two infant cases of
acute otitis media (AOM) associated with measles. This is the first report on the
isolation of measles virus from the MEF in patients with AOM, and possibility of 
the measles virus as a causative agent of AOM was suggested.

PMID: 16291278 [PubMed - indexed for MEDLINE]

894: Vaccine. 2006 Mar 10;24(11):1792-9. Epub 2005 Oct 25.

Serum antibodies to putative proteinase maturation protein A in children with
acute otitis media.

Vainio A, Fagerlund R, Melén K, Lehtinen MJ, Julkunen I, Virolainen A.

Department of Bacterial and Inflammatory Diseases, National Public Health
Institute (KTL), Mannerheimintie 166, FIN-00300 Helsinki, Finland.

The pneumococcal genes encoding for the surface associated proteins have been
proposed to be important for pneumococcal protein vaccine development. We cloned 
the full-length putative proteinase maturation protein A gene SP098l/ppmA (as
published by Tettelin et al. in 2001) and produced the encoded protein in high
levels in E. coli. The purified recombinant PpmA was used as an antigen in
Western blotting to study systemic antibody responses to PpmA in animals and in
children with acute otitis media (AOM). In children, the geometric mean titers of
serum IgG antibodies against PpmA increased with age and differed significantly
in relation to pneumococcal findings in middle ear fluid and/or nasopharyngeal
aspirate. The serum IgG antibody titers against PpmA were low in children with
Streptococcus pneumoniae cultured in the middle ear, and the highest in children 
with pneumococci in the nasopharynx, without them being found in the middle ear
fluid. We conclude that PpmA is immunogenic in humans, and therefore an
interesting antigen to study further in developing pneumococcal multicomponent
protein vaccines.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16288938 [PubMed - indexed for MEDLINE]

895: Cell Biochem Funct. 2006 Sep-Oct;24(5):471-3.

Nitric oxide synthase activity and nitric oxide level in erythrocytes of guinea
pigs with experimental otitis media with effusion.

Yilmaz A, Uslu C, Akyuz M.

Nenehatun Obstetric and Gynecology Hospital, Cat yolu, Erzurum, Turkey.
yilmazadnan69@hotmail.com

Free radicals have been implicated in the pathogenesis of an increasing number of
disease and inflammatory states. They may cause cell and tissue damage by
chemical modification of proteins, carbohydrates, nucleotides and lipids. Under
physiological conditions free radicals are parts of normal regulatory circuits
and are neutralized by antioxidants. Infections are one cause of increased free
radicals production. The aim of our study was to assess whether increased
oxidative stress is reflected by erythrocyte nitric oxide synthase activity and
nitric oxide levels in guinea pigs with experimental otitis media with effusion
(n = 6) and in a control group (n = 6). Erythrocyte nitric oxide synthase
activity and nitric oxide levels were measured in both groups. The nitric oxide
synthase activity and nitric oxide level in the experimental otitis media with
effusion were significantly higher than those of the control group. There was a
significant positive correlation between the nitric oxide synthase activity and
nitric oxide in the experimental otitis media with effusion group. Thus,
increased nitric oxide levels may play an important role in cell and tissue
damage due to experimental otitis media with effusion.

PMID: 16287214 [PubMed - indexed for MEDLINE]

896: Ann Otol Rhinol Laryngol. 2005 Oct;114(10):804-8.

Nitrotyrosine in otitis media with effusion.

Hisamatsu K, Inoue H, Makiyama K, Homma M.

Department of Otorhinolaryngology, Nihon University Surugadai Hospital, Tokyo,
Japan.

OBJECTIVES: Our purpose was to investigate mucosal cell injury due to the nitric 
oxide (NO)-superoxide system in otitis media with effusion. METHODS: We
determined the levels of nitrotyrosine (NT) and NO and the activities of
superoxide dismutase (SOD) and lactic dehydrogenase (LDH) in 90 middle ear fluid 
samples. RESULTS: The NT concentration was significantly higher in group A (<16
years old) than in group C (>50 years old; p < .05), and significantly higher in 
the acute group than in the chronic group (p < .05). The NO concentration did not
show a significant difference among the groups. The activity of SOD showed
significant correlations with the concentrations of NT and NO and with LDH
activity (p < .05). The LDH activity was significantly greater in group A than in
group C (p < .05). CONCLUSIONS: Our results indicate involvement of the
NO-superoxide system in the pathogenesis of otitis media with effusion, showing
evidence of protein and/or cell injury in the middle ear.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 16285272 [PubMed - indexed for MEDLINE]

897: Int J Pediatr Otorhinolaryngol. 2006 Apr;70(4):741-3. Epub 2005 Nov 8.

Prolonged diplopia following sinus vein thrombosis mimicking Gradenigo's
syndrome.

Dorn M, Liener K, Rozsasi A, Keck T.

Department of Otorhinolaryngology, University of Ulm, Frauensteige 12, 89075 Ulm,
Germany.

We report about a boy with the symptoms of Gradenigo's syndrome (abducens nerve
palsy, acute otitis media, unilateral headache). The MR imaging showed a sinus
vein thrombosis instead of the expected petroapicitis. After 2 weeks of
conservative therapy with antibiotics and anticoagulation, without any clinical
effort the boy underwent a mastoidectomy. Headache and otitis media recovered
quickly but the diplopia still remained after 25 months.

Publication Types: 
    Case Reports

PMID: 16280172 [PubMed - indexed for MEDLINE]

898: West Afr J Med. 2005 Jul-Sep;24(3):239-41.

Acute Otitis media, malaria and pyrexia in the under five age group.

Amusa YB, Ogunniyi TA, Onayade OO, Okeowo PA.

ENT Unit, Department of Surgery, OAUTHC, Ile Ife. yamusa@oauife.edu.ng

BACKGROUND: Acute Otitis media is one of the most common childhood infections. It
is responsible for every third visit to a pediatrician in a developed world.
However, in Nigeria there is scanty knowledge about the incidence of Acute Otitis
Media (AOM). OBJECTIVE: This study aimed at determining the incidence of AOM
among under five year old children presenting with pyrexia, and to compare the
incidence of AOM as a cause of pyrexia with the incidence of malaria in pyrexic
children. DESIGN: It is a cohort study of 200 children of between the ages of 2
weeks and five years with a rectal temperature of 38 degrees C and above, seen
over a period of 3 months. SETTING: The study was conducted at the Obafemi
Awolowo University Teaching Hospital (OAUTHC) Comprehensive Health Centre,
Eleiyele, and the children emergency room of the OAUTHC, Ile-Ife. PATIENTS AND
METHODS: A questionnaire to collect information on the demographic data was
administered to each mother/guardian of the patient. Otoscopic examination using 
a battery-operated hand held otoscope and magnifying lenses were done in addition
to general systemic physical examination. Thin and thick blood smears were made
for malaria parasite. The dried slides were examined under the microscope using
the X 100 objective. Sixteen of the patients' slides were lost after processing. 
RESULTS: Out of the 200 patients that were studied, 58 (29%) had AOM. The highest
incidence was recorded in the age group 12-24 months while the least age of
occurrence was found to be the age group 4-5 years. Malaria parasitemia was found
in 81 (43.5%) while 21 (25.9%) of those with parasitemia also had AOM. But 76
(36%) of the study population had neither AOM nor malaria parasitemia.
CONCLUSION: Acute Otitis media was found in 29% of under five years old
presenting with pyrexia. It was found to be highest in the first and second year 
of life, and was found to be least in the 5th year of life. Malaria was found in 
81 (43.5%) of the children, and 21 (10.5%) of the children had malaria with a
co-existing AOM.

Publication Types: 
    Comparative Study

PMID: 16276703 [PubMed - indexed for MEDLINE]

899: West Afr J Med. 2005 Jul-Sep;24(3):227-30.

Epidemiology of otitis media in a local tropical African population.

Amusa YB, Ijadunola IK, Onayade OO.

Department of Surgery, ENT Unit, College of Health Sciences, Faculty of Clinical 
Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
yamusa@oauife.edu.ng

BACKGROUND: Otitis media is one of the most common childhood infections. There
are however very few community based studies on the prevalence of this disease in
Nigeria children. OBJECTIVES: To establish the community prevalence of otitis
media: and to identify associated environmental and the host risk factors in
Nigerian children. SETTING: A semi urban community of Ife Central Local
Government area of Osun State, Southwestern part of Nigeria. MATERIAL AND
METHODS: Thirty enumeration areas within the study location were randomly picked 
and their boundaries were defined with the assistance of the National Population 
Commission (NPC) Officials. Households were used as sampling units within the
area. Children aged 1 day old-12 years in each selected household were
identified. A questionnaire was administered to the mother/guardian of each
child. Otoscopic examination, in addition to the general physical examination was
carried out on each child. The data were analyzed using simple descriptive
statistics, correlation and multivariate regression technique. RESULT: 600
children aged 0-12 years were investigated. There were 299 males and 301 females.
The prevalence of otitis media was found to be 14.7%. This comprises of acute
otitis media (AOM) in 11.8%, chronic suppurative otitis media (CSOM) in 2.5%,
while Otitis media with effusion (OME) was diagnosed in less than 1%. The peak
age of incidence was found to be in the age group 1-4 years 55 (9.2%), while the 
least age of occurrence was found to be in the age group less than 1 year 10
(1.7%). There was no statistical association between the duration of
breastfeeding practice and occurrence of otitis media among the subject (P>0.05).
There was no statistical association between the occurrence of otitis media and
immunization (p>0.05). However there were 3 children who had otitis media
associated with measles infection. A highly significant association was shown
between exposure to household cooking fuel (wood smoke) and the occurrence of
otitis media (P<0.05). Mother's educational status, number of children sleeping
in the same room greater than four was found to demonstrate a strong association 
with the occurrence of Otitis media (p<0.05). CONCLUSION: Otitis media is
prevalent among Nigeria children and it is found to occur more in children of
mothers with lower educational status and in number of children greater than 4
sleeping in the same room. A strong association was found between exposure to
wood smoke in the living environment and the occurrence of otitis media.

PMID: 16276700 [PubMed - indexed for MEDLINE]

900: Am J Otolaryngol. 2005 Nov-Dec;26(6):393-7.

Tympanic membrane changes in central tympanic membrane perforations.

Oktay MF, Cureoglu S, Schachern PA, Paparella MM, Kariya S, Fukushima H.

Department of Otolaryngology, Otitis Media Research Center, University of
Minnesota, Minneapolis, MN 55455, USA.

PURPOSE: The objective of this study was to evaluate the histopathological
changes in central tympanic membrane perforations caused by chronic otitis media 
without cholesteatoma. MATERIALS AND METHODS: Twenty-nine temporal bones from 25 
patients (13 male patients and 12 female patients) with central tympanic membrane
perforations-18 chronic otitis media with perforation and 11 chronic otitis media
with perforation caused by ventilation tubes-and 30 aged-matched normal temporal 
bones were included in this study. A scale was used to evaluate the extension of 
the migration of stratified squamous epithelium in the inner surface of the
tympanic membrane. The thickness of tympanic membranes was measured halfway
between the annular ligament and the perforation and compared with that of the
normal bones. The presence of tympanosclerosis and papillary projections of
squamous epithelium was also noted. RESULTS: The extension of the migration of
stratified squamous epithelium in the inner surface of the tympanic membrane was 
observed in 11 of the 29 perforations (38%). The thickness of tympanic membranes 
was significantly different between the perforation groups and the control group.
Of the 29 tympanic membranes, 13 (44%) had tympanosclerosis and 8 (28%) revealed 
papillary projections of squamous epithelium. CONCLUSIONS: Our study shows that a
central tympanic perforation should not merely be considered as a simple defect. 
Most of the tympanic membranes showed one or more signs of sequelae or persistent
abnormalities such as tympanosclerosis, papillary projections, thickening, and
ingrowth without significant differences between the 2 central perforation
groups.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16275408 [PubMed - indexed for MEDLINE]

901: J Allergy Clin Immunol. 2005 Nov;116(5):1129-35. Epub 2005 Sep 28.

Role of mast cells in otitis media.

Ebmeyer J, Furukawa M, Pak K, Ebmeyer U, Sudhoff H, Broide D, Ryan AF, Wasserman 
S.

Department of Surgery, Division of Otolaryngology; Department of
Otorhinolaryngology-Head and Neck Surgery, Julius-Maximilian University of
Würzburg, Germany.

BACKGROUND: New pathophysiologic concepts are needed to explain the clinically
observed connection between the allergic diathesis and otitis media. Although
mast cells, unlike lymphocytes, are common in the normal middle ear mucosa, their
potential role in innate immunity of the middle ear and in the expression of
inflammatory responses in that space to bacterial challenge, as opposed to
allergy, has received relatively little attention. OBJECTIVE: In the current
study, we examine the contributions of mast cells to the pathogenesis of
bacterially induced inflammation in the middle ear and thus to otitis media.
METHODS: Wild-type mice, mast cell-deficient mice, and mast cell-deficient mice
whose mast cell populations were restored by transplantation of bone
marrow-derived mast cells were challenged by using models of bacterial and
allergic middle ear inflammation. RESULTS: Our results indicate that mast cells
account for a substantial proportion of the innate immune response to bacteria in
the middle ear. CONCLUSION: This mechanism may link responses to allergy and
infection in the middle ear mucosa, and thus the mast cell may be a critical
control element in the pathogenesis of otitis media.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16275387 [PubMed - indexed for MEDLINE]

902: Otolaryngol Head Neck Surg. 2005 Nov;133(5):791-4.

Detection of Helicobacter pylori in the middle ear fluid of patients with otitis 
media with effusion.

Morinaka S, Tominaga M, Nakamura H.

Department of Otolaryngology, Kobe Japanpost Hospital, Kamitsutsui-dori, Kobe,
Japan. smorinakaent@yahoo.co.jp

OBJECTIVES: In patients with otitis media with effusion (OME), colonization of
the middle ear effusion (MEE) by Helicobacter pylori (HP) was investigated. STUDY
DESIGN: A prospective nonrandomized study with nonpaired, nonmatched controls.
Smear preparations were immunostained with anti-HP antibody and were subjected to
Gram staining and Giemsa staining. The rapid urease test (CLO) was done. RESULTS:
Twelve of 15 smears for MEE were positive for HP by immunohistochemistry and 14
by Giemsa that were Gram-negative. In 3 with positive immunohistochemistry, the
CLO was positive. CONCLUSION: The results suggest that HP may exist in the MEE of
some patients with OME.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16274811 [PubMed - indexed for MEDLINE]

903: Otol Neurotol. 2005 Nov;26(6):1125-7.

Possible role of Helicobacter pylori in the etiopathogenesis of chronic otitis
media.

Kutluhan A, Yurttaş V, Akarca US, Aydn A, Tuncer I, Uğraş S.

Department of Otorhinolaryngology, School of Medicine, Yüzüncü Yil University,
Van, Turkey. ahkutluhan@hotmail.com

OBJECTIVE: To investigate a possible contribution from Helicobacter pylori to the
etiopathogenesis of chronic otitis media. STUDY DESIGN: Prospective clinical
trial. METHODS: Tympanomastoidectomy, radical mastoidectomy, and modified radical
mastoidectomy procedures were performed according to the pathology of ear
disease. Biopsy specimens were taken from middle ear, mastoid antrum, and
tympanic orifice of eustachian tube. Helicobacter pylori DNA was extracted from
these biopsy specimens by using nested polymerase chain reaction. RESULTS:
Helicobacter pylori DNA was detected in 3 (7.9%) of 38 chronic otitis media
patients. CONCLUSION: Even though it is possible to detect Helicobacter pylori in
middle ear cleft in chronic otitis media, its role in the etiopathogenesis of the
issue is controversial.

PMID: 16272928 [PubMed - indexed for MEDLINE]

904: Otol Neurotol. 2005 Nov;26(6):1118-21.

Ultrastructural analysis of the chorda tympani nerve in chronic suppurative
otitis media.

Uygur K, Bayramoglu I, Nazikoğlu A, Yilmaz M, Bayazit Y, Muftuoglu S.

Gazi University Faculty of Medicine, ENT Department, Ankara, Turkey.
uygur@gazi.edu.tr

OBJECTIVE: To compare ultrastructure of the chorda tympani nerve by light and
electron microscopy in patients with otosclerosis and chronic suppurative otitis 
media. STUDY DESIGN: Comparative prospective study. SETTING: Tertiary care,
referral medical center. PATIENTS: The tympanic segments of chorda tympani nerves
were collected for ultrastructural investigation in 20 cases with chronic
suppurative otitis media and 10 cases with otosclerosis that underwent middle ear
surgery. RESULTS: Histopathologic examinations of the suppurative group showed
that unmyelinated fibers were almost totally lost and replaced by collagen
fibers. The thickness of the myelin sheaths was very slender, whereas some of
them were atrophic. A substantial increase was encountered in the endoneural
collagen substance and connective tissue, whereas inflammatory elements and edema
were present occasionally. Degenerative alterations of the myelinated fibers
mainly occurred in the form of adaxonal vacuoles. There was disorganization and
separation of parallel lamellae of Schmidt-Lanterman clefts. CONCLUSION: The
chorda tympani nerve should be preserved in otologic surgery. However,
inadvertent dissection of the chorda tympani nerve in chronic suppurative otitis 
media surgery will not possibly cause a postoperative disturbance in light of
ultrastructural changes that occur in the nerve.

Publication Types: 
    Comparative Study

PMID: 16272926 [PubMed - indexed for MEDLINE]

905: J Fam Pract. 2005 Nov;54(11):961-8.

Acute otitis media: influence of the PCV-7 vaccine on changes in the disease and 
its management.

Brunton S, Pichichero ME.

Carbarrus Family Medicine Residency Program, Charlotte, North Carolina, USA.

Studies have shown that most cases of acute otitis media (AOM) are of viral or
"no bacteria isolated" origin. In these cases, watchful waiting may be
appropriate. This publication addresses presumed bacterial causes of AOM for
which antibiotic use may be efficacious.

PMID: 16266602 [PubMed - indexed for MEDLINE]

906: Ear Nose Throat J. 2005 Sep;84(9):567-8, 570-4, 576 passim.

Erratum in:
    Ear Nose Throat J. 2005 Oct;84(10):614.

Nonsurgical home treatment of middle ear effusion and associated hearing loss in 
children. Part I: clinical trial.

Arick DS, Silman S.

Department of Otolaryngology-Head and Neck Surgery, New York Eye & Ear Infirmary,
New York City, USA.

We conducted a randomized, controlled clinical trial to investigate the efficacy 
of treatment of persistent middle ear effusion (MEE) and associated hearing loss 
with a modified Politzer device used in the home setting over a 7-week period.
Efficacy was determined by comparing pre-and posttherapy air-conduction
thresholds, tympanometric peak pressures, and otoscopic findings. The study group
was made up of 94 children (174 ears), aged 4 to 11 years, who had at least a
2-month history of MEE and associated hearing loss. At study's end, patients in
the treatment group experienced statistically significant improvements in all
measured outcomes; no significant improvements were seen in the control group in 
all measured outcomes. At study's end, the hearing sensitivity of 73.9% of the
treated ears was within normal limits, compared with only 26.7% of the control
ears. These findings demonstrate that home treatment of children with persistent 
MEE and associated hearing loss with the modified Politzer device is highly
efficacious.

Publication Types: 
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 16261757 [PubMed - indexed for MEDLINE]

907: J Laryngol Otol. 2005 Oct;119(10):816-8.

Pseudomonas cervical osteomyelitis with retropharyngeal abscess: an unusual
complication of otitis media.

Paul CA, Kumar A, Raut VV, Garhnam A, Kumar N.

Department of Orthopaedics, New Cross Hospital, Royal Wolverhampton NHS Trust,
Wolverhampton, UK.

We present the unusual case of a 54-year-old diabetic man with chronic
suppurative otitis media, presenting with cervical osteomyelitis and
retropharyngeal abscess. This was treated with decompression, debridement and
fusion from C2 to C4 with external halo-frame stabilization. Pseudomonas
aeruginosa was cultured from the ear and the osteomyelitis specimen. Exploration 
of the left ear showed evidence of mucosal disease, with granulations in the
middle ear and oedematous mucosa in the mastoid antrum, but no evidence of
dural-plate dehiscence. Haematogenous spread probably led to cervical
osteomyelitis and retropharyngeal abscess formation. Cervical osteomyelitis may
develop as a rare complication and present as a cause of severe neck pain in
patients with otitis media.

Publication Types: 
    Case Reports

PMID: 16259661 [PubMed - indexed for MEDLINE]

908: J Laryngol Otol. 2005 Oct;119(10):774-8.

Outcome of bacterial culture from mastoid granulations: is it relevant in chronic
ear disease?

Albert RR, Job A, Kuruvilla G, Joseph R, Brahmadathan KN, John A.

Department of ENT, Christian Medical College & Hospital, Vellore, Tamil Nadu,
India.

OBJECTIVE: To detect the presence of bacteria in mastoid granulations and compare
its prevalence in both types of chronic suppurative otitis media (CSOM). To find 
out if stage of disease activity, age, duration of disease, and aditus patency
relate to obtaining positive cultures. STUDY DESIGN AND SETTING: A prospective,
parallel group study done at a tertiary care referral centre. Mastoid
granulations from 79 patients with CSOM undergoing mastoidectomy were processed
for anaerobic and aerobic bacteria. RESULTS: Aerobes were isolated from 57.55 per
cent of the tubotympanic and 74.4 per cent of atticoantral disease (p=0.18).
Anaerobic cultures were positive in one case from each group. Monomicrobial
growth was detected in 37.5 per cent of tubotympanic and 48.5 per cent of
atticoantral disease. Polymicrobial growth occurred in 20 per cent and 25.6 per
cent in the tubotympanic and atticoantral groups, respectively. The predominant
aerobic isolate was coagulase negative Staphylococcus, followed by Pseudomonas
aeruginosa, Staphylococcus aureus, non-fermenting Gram-negative bacteria,
Enterobacter and Enterococcus, Proteus species, Citrobacter, non-pathogenic
Neisseria, aerobic spore formers were grown only in atticoantral disease. A
single isolate of Aspergillus was grown. Correlating the state of disease
activity of the ears with positive mastoid granulation cultures, six out of the
eight inactive ears were culture positive along with seven out of the nine active
and 10 out of the 23 quiescent ears. Positive mastoid granulation cultures were
obtained in 60 per cent of those with blocked aditus and 42.9 per cent with
patent aditus. CONCLUSION AND SIGNIFICANCE: In this study, we found that mastoid 
granulations are not sterile but harbour polymicrobial pathogens. Positive
cultures were obtained irrespective of stage of disease activity, age, duration
of disease and aditus patency. The pattern of organisms cultured from safe and
unsafe CSOM and also from ears in active, quiescent and inactive stages, were
similar. These findings suggest that these organisms may be responsible for
mastoid granulations. We also noted that positive cultures had no statistical
correlation with aditus patency and duration of disease. We suggest further
studies to evaluate the significance of asymptomatic mastoid granulations
harbouring organisms and whether opening the mastoid antrum and achieving aditus 
patency, irrespective of the stage of disease activity, will help improve the
long-term surgical outcome and also prevent recurrence of ear discharge.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16259653 [PubMed - indexed for MEDLINE]

909: Bangladesh Med Res Counc Bull. 2004 Dec;30(3):95-104.

Prevalence of chronic suppurative otitis media among the children living in two
selected slums of Dhaka City.

Kamal N, Joarder AH, Chowdhury AA, Khan AW.

Lalkuthi Maternity and Child Health Sub Center, Dhaka.

Chronic Suppurative Otitis Media (CSOM) is one of the important health problems
in our country. Serious complications may arise from it. As such the study was
aimed to find out the prevalence of CSOM among the children of two-selected slum 
dwellers in Dhaka City. This was a descriptive type of cross-sectional study. A
total of 203 samples were interviewed and examined. Altogether 7.39% of children 
were observed to have CSOM. Among CSOM cases, 60% had hearing impairment. Ear
discharge and perforation were observed in 26.7% in right ear, 46.7% in left ear 
and 26.7% in both ears. Central perforation was present in 93% cases.
Cholesteatoma was present in 6.7% cases. Among CSOM cases, 53.3% children were in
2-5 years age group, 80% were dependent, 53.3% cleaned ear by cotton buds, 93.3% 
lived in Kutcha house, 73.3% had a monthly income of TK. 1001-2000 and 46.7%
belonged to families having 6 members. Out of 15 CSOM, 11 cases were seen among
children of 141 illiterate mothers. Four cases of CSOM were found among children 
of 62 literate mothers. Among the 203 mothers, 65.52% were found aware, and
34.48% were not aware about the disease and sequel of CSOM. Here 39.9% mothers
had knowledge and 60.01% had no knowledge about the treatment of CSOM. Among the 
CSOM cases 46.67% cases did not receive any treatment. In treatment receiving
group, only 3(20%) children received it from MBBS doctor or Hospital.

PMID: 16240980 [PubMed - indexed for MEDLINE]

910: Vet Dermatol. 2005 Oct;16(5):299-307.

A comparative study of two antimicrobial/anti-inflammatory formulations in the
treatment of canine otitis externa.

Rougier S, Borell D, Pheulpin S, Woehrlé F, Boisramé B.

Vétoquinol Research Centre, Magny Vernois, BP 189, 70204 Lure Cedex, France.
sandrine.rougier@vetoquinol.com

The efficacy and tolerability of a marbofloxacin-clotrimazole-dexamethasone otic 
suspension (MCD) was compared with a standard topical treatment using a phase III
clinical trial protocol. In a total of 140 dogs with clinical signs of acute or
subacute otitis externa, Staphylococcus, Pseudomonas, Enterobacteriaceae and
Malassezia were isolated from samples taken at inclusion to identify the
causative pathogen; a further sample was collected in the event of failure or
relapse, and from dogs (at day 14) for which Pseudomonas species had been
isolated at inclusion. One group received MCD (10 drops per affected ear) once
daily and a second received Surolan (containing polymyxin B, miconazole and
prednisolone) (5 drops per affected ear), twice daily. Each group received
treatment for 7 or 14 days according to the clinical outcome on day 7. Efficacy
and tolerability were evaluated on days 7, 14 and, if necessary, 28 for dogs
treated for 14 days. The trial demonstrated equivalence of both treatments in
terms of efficacy, with a cure rate of 58.3% for MCD and 41.2% for Surolan. Both 
medications were equally well tolerated by dogs, but MCD was superior in terms of
pain relief, decrease in pus quantity and smell, response rate and investigator's
assessment on day 14.

Publication Types: 
    Clinical Trial, Phase III
    Comparative Study
    Randomized Controlled Trial

PMID: 16238809 [PubMed - indexed for MEDLINE]

911: Clin Exp Allergy. 2005 Oct;35(10):1370-6.

Eosinophil chemoattractants in the middle ear of patients with eosinophilic
otitis media.

Iino Y, Kakizaki K, Katano H, Saigusa H, Kanegasaki S.

Department of Otolaryngology, Teikyo University School of Medicine, Tokyo, Japan.
yiorl@med.teikyo-u.ac.jp

BACKGROUND: Patients with intractable otitis media associated with bronchial
asthma have an extensive accumulation of eosinophils in the effusion and mucosa
of the middle ear; this condition is called eosinophilic otitis media (EOM). It
remained to be determined how eosinophils accumulate in the middle ear.
OBJECTIVES: To clarify the pathogenesis of middle ear diseases, we measured the
concentration of eosinophil chemoattractants in middle ear effusion (MEE), and
carried out immunohistochemical studies of middle ear mucosa specimens to
demonstrate the expression of eosinophil chemoattractants. METHODS: Middle ear
effusion samples were obtained from 15 EOM patients with bronchial asthma and
from six controls for the measurement of eosinophil cationic protein (ECP), IL-5,
eotaxin and regulated on activation, normal T expressed and secreted
concentrations. Middle ear mucosa samples were also taken from 14 EOM patients
and 16 controls for immunohistochemical study. In 10 EOM patients, the numbers of
immunoreactive cells as well as apoptotic cells were determined before and after 
the topical application of triamcinolone acetonide into the middle ear. RESULTS: 
In EOM, significantly higher ECP and IL-5 concentrations were detected in MEE
than in serum, and ECP, IL-5 and eotaxin concentrations in MEE were higher in the
EOM patients than in the controls. ECP concentration positively correlated with
that of IL-5. Immunohistochemically, the numbers of cells positive for EG2 and
ecalectin were significantly higher in the EOM patients than in the controls.
After the topical application of triamcinolone acetonide, the numbers of
infiltrating cells and immunoreactive cells distinctly decreased, whereas the
number of apoptotic cells significantly increased. CONCLUSION: In EOM, locally
produced IL-5 may play a crucial role in the accumulation of eosinophils in the
middle ear. Chemokines such as ecalectin and eotaxin are also produced in the
middle ear, and help activate and enhance the survival of eosinophils to induce
the intractable condition in the middle ear. The topical application of
triamcinolone acetonide induces the apoptosis of not only eosinophils but also
eosinophil chemoattractant-producing cells, thereby improving the middle ear
condition.

PMID: 16238798 [PubMed - indexed for MEDLINE]

912: Cochrane Database Syst Rev. 2005 Oct 19;(4):CD004618.

Topical antibiotics without steroids for chronically discharging ears with
underlying eardrum perforations.

Macfadyen CA, Acuin JM, Gamble C.

Liverpool School of Tropical Medicine, International Health Research Group,
Pembroke Place, Liverpool, UK L3 5QA. carolynm@liv.ac.uk

BACKGROUND: Chronic suppurative otitis media (CSOM) causes ear discharge and
impairs hearing. OBJECTIVES: Assess topical antibiotics (excluding steroids) for 
treating chronically discharging ears with underlying eardrum perforations
(CSOM). SEARCH STRATEGY: The Cochrane Ear, Nose and Throat Disorders Group Trials
Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The
Cochrane Library Issue 1, 2005), MEDLINE (January 1951 to March 2005), EMBASE
(January 1974 to March 2005), LILACS (January 1982 to March 2005), AMED (1985 to 
March 2005), CINAHL (January 1982 to March 2005), OLDMEDLINE (January 1958 to
December 1965), PREMEDLINE, metaRegister of Controlled Trials (mRCT), and article
references. SELECTION CRITERIA: Randomised controlled trials; any topical
antibiotic without steroids, versus no drug treatment, aural toilet, topical
antiseptics, or other topical antibiotics excluding steroids; participants with
CSOM. DATA COLLECTION AND ANALYSIS: One author assessed eligibility and quality, 
extracted data, entered data onto RevMan; two authors inputted where there was
ambiguity. We contacted investigators for clarifications. MAIN RESULTS: Fourteen 
trials (1,724 analysed participants or ears). CSOM definitions and severity
varied; some included otitis externa, mastoid cavity infections and other
diagnoses. Methodological quality varied; generally poorly reported, follow-up
usually short, handling of bilateral disease inconsistent. Topical quinolone
antibiotics were better than no drug treatment at clearing discharge at one week:
relative risk (RR) was 0.45 (95% confidence interval (CI) 0.34 to 0.59) (two
trials, N = 197). No statistically significant difference was found between
quinolone and non-quinolone antibiotics (without steroids) at weeks one or three:
pooled RR were 0.89 (95% CI 0.59 to 1.32) (three trials, N = 402), and 0.97 (0.54
to 1.72) (two trials, N = 77), respectively. A positive trend in favour of
quinolones seen at two weeks was largely due to one trial and not significant
after accounting for heterogeneity: pooled RR 0.65 (0.46 to 0.92) (four trials, N
= 276) using the fixed-effect model, and 0.64 (95% CI 0.35 to 1.17) accounting
for heterogeneity with the random-effects model. Topical quinolones were
significantly better at curing CSOM than antiseptics: RR 0.52 (95% CI 0.41 to
0.67) at one week (three trials, N = 263), and 0.58 (0.47 to 0.72) at two to four
weeks (four trials, N = 519). Meanwhile, non-quinolone antibiotics (without
steroids) compared to antiseptics were more mixed, changing over time (four
trials, N = 254). Evidence regarding safety was generally weak. AUTHORS'
CONCLUSIONS: Topical quinolone antibiotics can clear aural discharge better than 
no drug treatment or topical antiseptics; non-quinolone antibiotic effects
(without steroids) versus no drug or antiseptics are less clear. Studies were
also inconclusive regarding any differences between quinolone and non-quinolone
antibiotics, although indirect comparisons suggest a benefit of topical
quinolones cannot be ruled out. Further trials should clarify non-quinolone
antibiotic effects, assess longer-term outcomes (for resolution, healing,
hearing, or complications) and include further safety assessments, particularly
to clarify the risks of ototoxicity and whether quinolones may result in fewer
adverse events than other topical treatments.

Publication Types: 
    Meta-Analysis
    Review

PMID: 16235370 [PubMed - indexed for MEDLINE]

913: Arch Otolaryngol Head Neck Surg. 2005 Oct;131(10):868-73.

Methicillin-resistant Staphylococcus aureus otorrhea after tympanostomy tube
placement.

Coticchia JM, Dohar JE.

Department of Otolaryngology, Wayne State University School of Medicine, Detroit,
Mich, USA.

OBJECTIVE: To compare a retrospective cohort of nonhospitalized children with
methicillin-resistant Staphylococcus aureus (MRSA) otorrhea with those with
methicillin-sensitive S aureus (MSSA) otorrhea to determine the risk factors
predisposing to MRSA otorrhea and the treatments used. DESIGN: Retrospective
case-controlled series. SETTING: Tertiary pediatric care facility. PATIENTS:
Seventeen children with MRSA otorrhea after bilateral myringotomy with
tympanostomy tube insertion (BM&T) and 19 age- and sex-matched control subjects
who demonstrated MSSA otorrhea. The average age at culture in MRSA patients was
52 months; in MSSA patients, 54 months. There were 8 boys and 3 girls in the MRSA
group and 8 boys and 4 girls in the MSSA group. INTERVENTIONS: Oral, topical, and
intravenous antimicrobial agents. MAIN OUTCOME MEASURES: Antibiotic exposure and 
history of otitis media and routine antibiotic administration (topical, oral, or 
intravenous). RESULTS: The following findings were statistically significant (P <
or = .06, Mann-Whitney test): (1) longer duration of antibiotic treatment after
BM&T for patients with MRSA vs those with MSSA; (2) increased number of episodes 
of acute otitis media before BM&T in patients with MRSA vs those with MSSA; and
(3) increased number of courses of antibiotics after BM&T in patients with MRSA
vs those with MSSA. CONCLUSIONS: Methicillin-resistant S aureus otorrhea is
commonly seen as a community-acquired infection in otherwise healthy pediatric
outpatients. Risk factors for development of MRSA otorrhea include the number of 
episodes of acute otitis media before BM&T and number of treatment courses and
duration of antibiotic therapy after BM&T.

PMID: 16230588 [PubMed - indexed for MEDLINE]

914: Int J Pediatr Otorhinolaryngol. 2006 Apr;70(4):711-5. Epub 2005 Oct 11.

Long-term follow-up evaluation of mastoidectomy in children with
non-cholesteatomatous chronic suppurative otitis media.

Rickers J, Petersen CG, Pedersen CB, Ovesen T.

ENT Department, Aarhus University Hospital, DK-8000 Aarhus C, Denmark.
jrickers@dadlnet.dk

OBJECTIVE: In spite of declining prevalence chronic suppurative otitis media
without cholesteatoma (CSOM) still poses a significant health problem. Randomized
clinical trials comparing medical and surgical intervention are not available.
Hence, the treatment of CSOM is almost exclusively based on empirical experience.
The purpose of the present study was to evaluate the long-term effects of
mastoidectomy combined with myringotomy and exploration of the middle ear in
children with CSOM. METHODS: 47 children with CSOM underwent surgery including
mastoidectomy. Ear status was investigated peri-operatively and at a long-term
follow-up (5-21 years post-operatively). MAIN OUTCOME MEASURES: Final success
rate, FS (dry ears for several years) and the optimal final success rate, OFS
(dry ears for several years without re-operations and without
retractions/perforations) were estimated. RESULTS: No serious surgical
complications occurred. Post-operatively re-mastoidectomy was performed in 13%
and re-myringoplasty/tympanoplasty in 21%. At the long-term follow-up the FS rate
was 94% and the OFS rate was 61%. CONCLUSIONS: Surgery alone did not entirely
cure CSOM which may justify randomized studies comparing conservative treatment
and myringoplasty with/without mastoidectomy. Finally, mastoidectomy in these
patients must be considered as a last resort when intense conservative treatment 
fails.

Publication Types: 
    Clinical Trial

PMID: 16225934 [PubMed - indexed for MEDLINE]

915: Laryngoscope. 2005 Oct;115(10):1734-40.

Canal wall reconstruction tympanomastoidectomy with mastoid obliteration.

Gantz BJ, Wilkinson EP, Hansen MR.

Department of Otolaryngology--Head and Neck Surgery, University of Iowa Hospitals
and Clinics, Iowa City, 52242, USA. bruce-gantz@uiowa.edu

OBJECTIVES: This study was designed to evaluate the authors' experience with
canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration in
the treatment of chronic otitis media with cholesteatoma. STUDY DESIGN:
Institutional review board approved retrospective case review. METHODS:
Retrospective review was performed of all patients undergoing CWR
tympanomastoidectomy with mastoid obliteration from 1997 to 2004. Data included
pre- and postoperative audiometry, findings at second look surgery with
ossiculoplasty, and postoperative complications including wound infection and
canal wall displacement. RESULTS: One hundred thirty ears in 127 adults and
children underwent the procedure. Mean time postoperative was 48 (range 2-94)
months. A second look ossiculoplasty was performed in 102 (78%). Percentage of
ears that remain safe without evidence of recurrence was 98.5. The postoperative 
infection rate decreased from an initial rate of 14.3% to 4.5% for the last 88
ears after protocol modification. Recurrence occurred in two (1.5%) patients,
requiring conversion to a canal wall down mastoidectomy. CONCLUSIONS: A CWR
technique can provide improved intraoperative exposure of the middle ear and
mastoid without creating a mastoid bowl and reduces the incidence of recurrent
disease. A single procedure is used for all patients with acquired cholesteatoma,
including children.

PMID: 16222186 [PubMed - indexed for MEDLINE]

916: Ear Nose Throat J. 2005 Aug;84(8):488, 490, 492 passim.

Tuberculous otitis media: report of 2 cases on Long Island, N.Y., and a review of
all cases reported in the United States from 1990 through 2003.

Chirch LM, Ahmad K, Spinner W, Jimenez VE, Donelan SV, Smouha E.

Department of Medicine, School of Medicine, State University of New York at Stony
Brook, USA. lisa.chirch@stonybrook.edu

We report 2 cases of tuberculous otitis media that were diagnosed at Stony Brook 
University Hospital in New York since 1999. Both patients were women, aged 30 and
31 years. One patient had grown up in Russia, the other was a native-born
American who had never left the East Coast region of the United States. Both
patients had been symptomaticfor many months; one complainedof chronic otorrhea, 
and the other reported otorrhea, hearing loss, and discomfort. Neither patient
responded to medical management, and both ultimately underwent surgery. One was
diagnosed after surgical pathology revealed acid-fast bacilli on frozen-section
analysis. In the other, pathology revealed chronic inflammation and granulomata, 
butstains were negative and her diagnosis was delayed for almost 2 years. We also
review 9 other cases of tuberculous otitis media in the United States that have
been reported in the literature since 1990. Our review suggests that the number
of cases is rising in areas where tuberculosis is most common--that is, in major 
U.S. cities. Although 3 of these 9 cases occurred as reactivation disease in
immigrants, most might have occurred as a result of local transmission.
Clinicians should maintain a high degree of suspicion for tuberculosis in
patients with chronic otitis symptoms, particularly those who are at higher risk 
of exposure to tuberculosis.

Publication Types: 
    Case Reports
    Review

PMID: 16220854 [PubMed - indexed for MEDLINE]

917: Int J Pediatr Otorhinolaryngol. 2006 Apr;70(4):703-10. Epub 2005 Oct 7.

Hearing loss as a sequel of secretory and acute otitis media as reflected by
audiometric screening of Swedish conscripts.

Augustsson I, Engstrand I.

Department of Otorhinolaryngology, Orebro University Hospital, S-70185 Orebro,
Sweden. ingrid.augustsson@orebroll.se

OBJECTIVE: Many authors have shown a small effect on hearing from middle ear
disease even a long time after active disease has subsided. We wanted to see to
what extent those who have had otitis media in childhood in our district have
normal hearing at the age of 18 years. The aim of the present study is to find
out if a history of secretory otitis media (SOM) up to 14 years of age or acute
otitis media (AOM) up to 4 years of age affects hearing at conscription in an age
cohort of Swedish boys. METHODS: For a cohort of 951 boys we have good knowledge 
of their ear diseases up to 14 years of age from previous studies. The prevalence
of elevated thresholds in audiometric screening at conscription was compared for 
the group of boys who had been treated with tympanostomy tubes and the group of
boys with no history of ear disease. Similarly, boys with a history of ear
disease but no treatment with tubes were compared to boys without history of ear 
disease. We also compared the prevalence of elevated thresholds for boys with a
history of at least four episodes of AOM up to the age of four to those who had
had no episodes up to that age. RESULTS: Those who had been treated with
tympanostomy tubes because of longstanding SOM had a significantly higher
prevalence of elevated thresholds for solitary frequencies. Two treated boys had 
a pure tone average greater than 25 dB, one unilaterally, one bilaterally. No
difference could be seen between those who had had episodes of ear disease but no
treatment with tympanostomy tubes and those who had had no documented ear
disease. The prevalence of elevated thresholds was not correlated to more than
three treated episodes of acute otitis media up to the age of 4 years.
CONCLUSIONS: Boys who had been treated with tympanostomy tubes had a higher
prevalence of having a hearing threshold above 20 dB for at least one frequency
at the age of 18. Hearing handicap was not a common sequel to SOM. We can show no
relation between more than three treated episodes of AOM before the age of four
and screening results at the age of 18.

PMID: 16214225 [PubMed - indexed for MEDLINE]

918: Otolaryngol Head Neck Surg. 2005 Oct;133(4):601-4.

Laser-assisted tympanostomy in pediatric patients with serous otitis media.

Prokopakis EP, Lachanas VA, Christodoulou PN, Velegrakis GA, Helidonis ES.

Department of Otolaryngology, University of Crete School of Medicine, Heraklion, 
Crete, Greece. epro@med.uoc.gr

OBJECTIVES: To evaluate prognostic factors related with cure rate, in pediatric
patients with serous otitis media treated with laser-assisted tympanostomy
without ventilation tubes, in a single institution. PATIENTS AND METHOD: The
procedure was performed on 124 ears in 88 individuals, from 3 to 14 years old.
External auditory canal anatomy, type of anesthesia, tympanic membrane and middle
ear fluid characteristics, myringotomy size, and laser parameters, in relation to
cure rate, were accordingly studied. RESULTS: The overall cure rate by ear at the
end of the 2-month follow-up period was 54.83%, whereas 45.17% still suffered
from otitis media. Multivariate statistical analysis demonstrated that the
presence of a thick tympanic membrane is significantly correlated with pure
outcome in children with serous otitis media, when laser-assisted tympanostomy
without ventilation tubes is performed favoring a worse cure rate (P < 0.023).
Other parameters did not statistically correlate with the outcome. A 41% parental
dissatisfaction rate was noticed. CONCLUSION: This study addresses selection bias
for children with serous otitis media, candidates for laser-assisted
tympanostomy. These are related to the duration of serous otitis media, the
condition of middle ear mucosa, the thickness of the tympanic membrane, the type 
of anesthesia, and the cost of laser apparatus. There is likely to be a causal
relationship between outcome and tympanic membrane appearance in children
undergoing laser-assisted tympanostomy.

PMID: 16213936 [PubMed - indexed for MEDLINE]

919: Otolaryngol Head Neck Surg. 2005 Oct;133(4):596-600.

Experimental and clinical experience of albumin coating of tympanostomy tubes.

Kinnari TJ, Jero J.

Department of Otolaryngology, Helsinki University Central Hospital, Helsinki,
Finland. teemu.j.kinnari@helsinki.fi

OBJECTIVE: Otorrhea and tube occlusion are typical problems with tympanostomy
tubes (TT). The purpose of this study was to test glue protein, fibronectin
adhesion on albumin-coated and uncoated TT surfaces and to show the effect of
this method on TT sequelae in vivo. STUDY DESIGN AND SETTINGS: Fibronectin
binding on TT surface was tested in two in vitro experiments. Thereafter 170
patients were randomized in a prospective clinical trial to test the effect of
the method in vivo. The extruded TTs that could be collected from ears of some
study patients were imaged with scanning electron microscopy (SEM). RESULTS:
Marked binding inhibition of fibronectin on albumin-coated TTs was found. Fewer
tube sequelae were found in ears with albumin-coated TTs. SEM revealed thick
crusts on uncoated tube surface. CONCLUSION: Albumin coating of TTs can reduce
unwanted adhesion on the tube surface in vitro and tube occlusions in vivo.
SIGNIFICANCE: TT sequelae can be reduced by surface coating with albumin.

Publication Types: 
    In Vitro
    Randomized Controlled Trial

PMID: 16213935 [PubMed - indexed for MEDLINE]

920: Otolaryngol Head Neck Surg. 2005 Oct;133(4):585-95.

Microbiology of acute otitis media with tympanostomy tubes.

Roland PS, Parry DA, Stroman DW.

Department of Otolaryngology, UT Southwestern Medical Center, Dallas, TX 75390,
USA. peter.roland@utsouthwestern.edu

OBJECTIVE: The objective was to determine the types of organisms which cause
acute otitis media with a tympanostomy tube and to ascertain their frequency
distribution. STUDY DESIGN AND SETTING: Prospective, randomized,
multi-institutional clinical trials. Both private and academic sites were
included. RESULTS: 1309 isolates were recovered from 956 draining ears.
Streptococcus pneumonia was recovered from 17%, Staphylococcus aureus from 13%, H
flu from 18% and Pseudomonas aeruginosa from 12%. Fungal organisms were recovered
from 5% of total isolates and 4% from single isolates. CONCLUSIONS: AOMT is
microbiologically different than AOM with an intact TM. There is no evidence that
resistance develops as result of topical treatment. SIGNIFICANCE: The study
demonstrates that AOMT is frequently caused by organisms not susceptible to oral 
antibiotics approved for children, but which are sensitive to topical ear drops.

PMID: 16213934 [PubMed - indexed for MEDLINE]

921: Clin Pediatr (Phila). 2005 Oct;44(8):693-7.

Does crying turn tympanic membranes red?

Yamamoto LG, Sumida RN, Yano SS, Derauf DC, Martin PE, Eakin PJ.

Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, 
Kapiolani Medical Center For Women and Children, Honolulu, Hawaii, USA.

The diagnosis of acute otitis media is based on several clinical factors. One of 
these factors is the color of the tympanic membrane (TM). Crying can cause
flushing and hyperemia of the face. The purpose of this study is to determine
whether crying affects the color of tympanic membranes. Infants and toddlers (age
30 months or less) evaluated in an outpatient clinic or primary care
pediatrician's office for routine well-baby checks who received at least 2
parenteral immunizations were enrolled on a convenience basis. Ill children were 
excluded. The initial physician assessed crying and TM color/visibility.
Following immunizations, a second physician assessed crying and the TM
color/visibility. Color differences were stratified by the degree of crying. One 
hundred twenty-one study subjects received 2-5 parenteral immunizations. TM
colors were most often in the pink range or less. Only 2 TMs were assessed as
light red and none were assessed as red. Twenty-eight percent of the TMs with
greater crying on the second exam were noted to be redder on the second exam
compared to the first exam versus 11% for the comparison group (p=0.0007); 19% of
the TMs with greater crying on the second exam were noted to be redder by 2 or
more increment levels compared to the first exam versus 5% for the comparison
group (p=0.0004); 31% of the TMs with greater crying on the second exam at the 3+
and 4+ level were noted to be redder on the second exam compared to the first
exam versus 14% for the comparison group (p=0.003). Our data indicate that, in
some instances, crying can result in an increase in pinkness of the TM. Crying in
well children does not result in a red tympanic membrane.

PMID: 16211193 [PubMed - indexed for MEDLINE]

922: Expert Rev Anti Infect Ther. 2005 Oct;3(5):707-17.

Single-dose azithromycin for the treatment of children with acute otitis media.

Soley CA, Arguedas A.

Instituto de Atención Pediátrica, Universidad de Ciencias Médicas, San José,
Costa Rica.

Azithromycin is an azalide with in vitro activity against otitis media pathogens,
good middle ear penetration and a prolonged half-life. A total of four clinical
trials have evaluated the clinical success rate, safety and compliance of
single-dose azithromycin (30 mg/kg) in the treatment of children with otitis
media. Among all the patients treated with single-dose azithromycin (30 mg/kg),
and presented previously in four published clinical trials, end-of-treatment
clinical success was 88% (544 out of 619) and maintained clinical success at the 
end-of-study was 82% (498 out of 610). Three of the four studies included a
mandatory baseline tympanocentesis. The overall end-of-treatment and end-of-study
clinical success rates among all culture-positive patients was 84% (222 out of
263) and 80% (210 out of 263), respectively. Per pathogen end-of-treatment
clinical success rates observed were 91% (125 out of 137) among patients with
Streptococcus pneumoniae, 77% (75 out of 97) among patients with Haemophilus
influenzae, 100% (14 out of 14) among patients with Moraxella catarrhalis, 64%
(seven out of 11) among patients with baseline Streptococcus pyogenes and 25%
(one out of four) among patients with a S. pneumoniae and H. influenzae mixed
infection. Clinical success was observed in 90% (106 out of 118) of patients with
baseline macrolide-susceptible S. pneumoniae and in 67% (14 out of 21) among
patients with baseline macrolide-resistant S. pneumoniae (p = 0.01). Adverse
events were uncommon, mostly mild and transitory gastrointestinal complaints, and
in the two larger comparative trials, were less frequent than the rates observed 
with the comparator agents. Compliance was excellent (99-100%). Single-dose
azithromycin (30 mg/kg) represents an alternative for the treatment of pediatric 
patients with uncomplicated acute otitis media, particularly in those geographic 
regions where high-level S. pneumoniae macrolide resistance is uncommon, and for 
those patients that require directly observed therapy or when compliance may be a
problem.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 16207162 [PubMed - indexed for MEDLINE]

923: Int J Pediatr Otorhinolaryngol. 2006 Apr;70(4):647-54. Epub 2005 Sep 27.

Presence of viral and bacterial pathogens in the nasopharynx of otitis-prone
children. A prospective study.

Pitkäranta A, Roivainen M, Blomgren K, Peltola J, Kaijalainen T, Räty R, Ziegler 
T, Rönkkö E, Hatakka K, Korpela R, Poussa T, Leinonen M, Hovi T.

Department of Otorhinolaryngology, Helsinki University Central Hospital, POB 220,
FIN-00029 Helsinki, Finland. anne.pitkaranta@hus.fi

OBJECTIVE: The purpose of the present study was to examine and follow up the
presence of respiratory viral and bacterial pathogens in the nasopharynx of
otitis-prone children during the cold season and compare the findings with the
child's respiratory symptoms. METHODS: We enrolled 121 otitis-prone children,
aged 10 months to 4 years for a prospective study. The nasopharyngeal swab (NPS) 
were studied at the baseline and after 12 and 24 weeks for respiratory viruses
and at the baseline and after 24 weeks for bacteria. Presence of
picorna(rhino-entero-parecho)-, influenza-, adenoviruses and Mycoplasma
pneumoniae was detected by PCR. NPS specimens were cultured for Haemophilus
influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Clinical data
(the rate of respiratory symptom days, otitis media, tympanometry findings,
day-care attendance and the number of siblings) were compared with
microbiological data. RESULTS: Rhinovirus was found in 30% of the samples at the 
baseline, in 8% and in 19% of the samples after 12 and 24 weeks, respectively.
Enterovirus was detected in 19% of the samples, in 21% and in 12% of samples
after 12 and 24 weeks, respectively. Picornavirus positivity correlated with the 
respiratory symptoms but not with the number of otitis media or with abnormal
tympanometry. Two samples were adeno- and three samples influenzavirus positive. 
Parechovirus and M. pneumoniae were negative in all samples. Rhinovirus
positivity correlated with that of M. catarrhalis and S. pneumonia but not with
H. influenzae. Microbiological positivity was not significantly associated with
the type of day-care. CONCLUSIONS: Picornaviruses as well as bacteria were
commonly found in the nasopharynx of otitis-prone children during the cold
season, even in the absence of clinical symptoms.

PMID: 16198005 [PubMed - indexed for MEDLINE]

924: Int J Pediatr Otorhinolaryngol. 2006 Jan;70(1):1-12. Epub 2005 Sep 27.

Chronic suppurative otitis media: a review.

Verhoeff M, van der Veen EL, Rovers MM, Sanders EA, Schilder AG.

Department of Otorhinolaryngology (KE04.140.5), Wilhelmina Children's Hospital,
University Medical Centre Utrecht, P.O. Box 85090, 3508 AB Utrecht, The
Netherlands.

OBJECTIVES: Chronic suppurative otitis media (CSOM) remains one of the most
common childhood chronic infectious diseases worldwide. Although microbial,
immunological, and genetically determined factors, as well as Eustachian tube
characteristics, are supposed to be involved in the pathogenesis of CSOM, many
aspects of the pathogenesis of CSOM still need to be clarified. Optimal treatment
strategy has not been established yet. The objective of this review is to present
and evaluate the current state of knowledge of CSOM. DESIGN: Systematic narrative
review. METHODS: A PubMed search (1966-January 2005) was performed for studies on
epidemiology, pathogenesis, clinical management, and complications of CSOM. All
included articles were categorized according to level of evidence. RESULTS: Five 
hundred and fifty papers were identified, of which 79 were found to be relevant
for this review. The definition of CSOM was found to vary. CSOM is a
multifactorial disease. Regarding management of CSOM, there is no consensus as to
what the optimal management strategy should entail. No convincing evidence is
available for most medical and surgical therapies. Topical quinolones have proven
effective, but need further monitoring regarding adverse effects. CONCLUSIONS AND
RECOMMENDATIONS: Important goals in research of CSOM should be achieving
consensus about the definition of CSOM and gaining more in-depth knowledge of the
pathogenesis of CSOM, especially the role of innate and adaptive immunity. There 
is also a need for further well-designed studies on the effectiveness of various 
management strategies for CSOM.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 16198004 [PubMed - indexed for MEDLINE]

925: J Am Vet Med Assoc. 2005 Sep 15;227(6):928-31.

Isolation of Staphylococcus schleiferi from healthy dogs and dogs with otitis,
pyoderma, or both.

May ER, Hnilica KA, Frank LA, Jones RD, Bemis DA.

Department of Small Animal Clinical Sciences, College of Veterinary Medicine,
University of Tennessee, Knoxville, TN 37996-4544, USA.

OBJECTIVE: To determine the frequency of isolation and susceptibility patterns of
Staphylococcus schleiferi from healthy dogs and dogs with otitis, pyoderma, or
both that had or had not received antimicrobial treatment. DESIGN: Prospective
study. ANIMALS: 50 dogs. PROCEDURE: Dogs were allocated to 1 of 4 groups: healthy
dogs (n=13), dogs without otitis but with pyoderma (10), dogs with otitis but
without pyoderma (11), and dogs with otitis and pyoderma (16). Bacteriologic
culture of ear swab specimens was performed in all dogs. Bacteriologic culture of
skin swab specimens was also performed in dogs with concurrent pyoderma. Isolates
were identified as S schleiferi subsp schleiferi or S schleiferi subsp coagulans 
on the basis of growth and biochemical characteristics. RESULTS: S schleiferi was
not isolated from any dogs with pyoderma only. Staphylococcus schleiferi subsp
schleiferi was isolated from the ears of 2 healthy dogs, and the skin and ears of
2 dogs and the skin of 1 dog with otitis and pyoderma. Staphylococcus schleiferi 
subsp coagulans was isolated from the ears of 3 dogs with otitis only, and the
ears of 6 dogs and the skin of 2 dogs with otitis and pyoderma. One of the S
schleiferi subsp schleiferi isolates from ears, 2 of the S schleiferi subsp
coagulans isolates from ears, and 1 of the S schleiferi subsp coagulans isolates 
from the skin were resistant to methicillin. One methicillin-resistant isolate
from the ears and 1 from the skin were also resistant to fluoroquinolones.
CONCLUSIONS AND CLINICAL RELEVANCE: S schleiferi subsp schleiferi was detected in
healthy dogs and dogs with otitis and pyoderma. Methicillin-resistant and
-susceptible S schleiferi subsp schleiferi and S schleiferi subsp coagulans were 
detected as the predominant organisms in dogs with otitis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16190591 [PubMed - indexed for MEDLINE]

926: Ann Otol Rhinol Laryngol. 2005 Aug;114(8):652-5.

Effect of climate on the bacteriology of chronic suppurative otitis media.

Yildirim A, Erdem H, Kilic S, Yetiser S, Pahsa A.

Department of Otolaryngology-Head and Neck Surgery, Cumhuriyet University Medical
Faculty, Sivas , Turkey.

OBJECTIVES: We evaluated the correlation between the microbial content of chronic
suppurative otitis media (CSOM) and regional climatic parameters. METHODS: We
assessed the interrelations between monthly mean records of temperature, maximum 
temperature, atmospheric pressure, and humidity and the aerobic microbial flora
in CSOM. RESULTS: Forty-three bacteria of Enterobacteriaceae, 67 staphylococcal
spp, 51 Pseudomonas aeruginosa, 9 Streptococcus pneumoniae, 1 alpha-hemolytic
Streptococcus, 1 Enterococcus sp, and 2 Edwardsiella tarda strains were recovered
from 173 patients with CSOM. There was a good relationship between enteric
bacteria and monthly mean temperature (r = 0.501) and significant colonization
rates due to increasing monthly mean temperature (p = .040) and monthly mean
maximum temperature values (p = .048). CONCLUSIONS: When the weather warmed, the 
frequency of isolation of enteric bacteria increased significantly. Temperature
changes may affect the enteric bacterial colonization of CSOM.

PMID: 16190100 [PubMed - indexed for MEDLINE]

927: Int J Pediatr Otorhinolaryngol. 2006 Apr;70(4):655-62. Epub 2005 Sep 26.

Meconium contaminated amniotic fluid and infant otitis media. Is it a risk factor
in children surviving aspiration and initial distress of respiration?

Lilja M, Palva T, Ramsay H, Laitinen K, Andersson S.

Department of Otolaryngology, Helsinki University Central Hospital,
Haartmaninkatu 4E, FIN-00290 Helsinki, Finland. Markus.Lilja@hus.fi

OBJECTIVE: Histological studies show that amniotic fluid cellular content (AFCC) 
causes in the middle ear a foreign body reaction, the extent and severity of
which depends upon the massiveness of contamination. We studied how factors
related to birth and environment affect proneness to acute otitis media (AOM) in 
infants born through meconium contaminated amniotic fluid. METHODS: From the
birth records of infants born from 1996 to 2000 a list was made of those born
through meconium contaminated amniotic fluid with pulmonary aspiration and
tracheal suctioning, followed by treatment in a neonatal intensive care unit.
Thirty-seven such children formed the study group, 43 children matching the study
cases but born through clear fluids formed the control group. Birth and
environmental factors together with the frequency and number of episodes of AOM
were analyzed in all, based on a verified questionnaire. In addition, 27 children
in the study group and 21 in the control group received a specialist ENT
examination, hearing tests and tympanometry. RESULTS: The events at delivery were
highly significantly different between the two groups, manifested by the lower
Apgar points in the study group (p<0.001) while other birth and environmental
factors appeared equalized. The first episode of AOM in the study group came
earlier than in the control group and their frequency was significantly higher
during the 1st and 2nd year of life and during the entire observation period
(p<0.001). Tympanostomy was performed more often in the study group. Tympanometry
showed more cases of reduced static admittance and negative pressure than in the 
control group and hearing was poorer. CONCLUSIONS: Cases with compromised
delivery through meconium contaminated fluids, resulting in pulmonary aspiration 
and in need of intensive care treatment, form a risk group, which should be
closely followed. Early nasopharyngeal suctioning of AFCC may reduce its entry
into the middle ear. A prolonged episode of AOM suggests mucosal involvement of
several middle ear compartments, shown by histological studies to occur in all
cases of massive contamination. Placement of a ventilation tube after the first
prolonged AOM allows regression of the granulation tissue in the air spaces
together with the secretory elements in the mucosa.

PMID: 16188327 [PubMed - indexed for MEDLINE]

928: J Otolaryngol. 2005 Oct;34(5):312-6.

Subannular ventilation tubes: retrospective study.

Cloutier JF, Arcand P, Martinez J, Abela A, Quintal MC, Guerguerian AJ.

Otolaryngology Program, University of Montreal, Montreal, QC.

OBJECTIVE: To evaluate the efficiency of a subannular tube insertion technique in
a group of pediatric patients with adhesive otitis or severe atelectasis of the
tympanic membrane. DESIGN: Retrospective nonrandomized case series. Setting:
Tertiary referral centre. MAIN OUTCOME MEASURES: The main outcomes of this study 
are tube duration according to the type of tube used, the complication rate, and 
the audiometric gain associated with this procedure. RESULTS: The study group
consisted of 190 patients (316 tubes) aged between 3 and 19 years (average 9
years old) and operated on between 1993 and 1999 by four pediatric
otolaryngologists. The average follow-up was 53 months. The tubes remained in
place for an average of 21.8 months, with fluoroplastic tubes lasting 17.8 months
and Goode T tubes lasting 23.8 months. When used in children between 5 and 9
years of age and in cases of adhesive otitis, Goode T tubes showed statistically 
significantly better results than fluoroplastic tubes. The complications of this 
technique were otorrhea (17.7%), perforation (7.9%), a plugged tube (7.0%), and
cholesteatoma (1.6%). The 5- to 9-year-old group and the reintervention group of 
patients showed statistically higher complication rates compared with all other
groups. Sixty-four patients (128 tubes) were eligible for audiogram analysis,
which showed a gain of 13.4 dB (speech reception threshold). CONCLUSIONS: The
technique of subannular tube insertion is a safe and effective method for
long-term middle ear ventilation in cases of adhesive otitis or severely
atelectatic tympanic membrane or for patients with pathology related to
dysfunction of the eustachian tube. It offers an alternative to repeated
short-term tube insertions for otitis media with effusion or recurrent acute
otitis media.

PMID: 16181592 [PubMed - indexed for MEDLINE]

929: Am J Audiol. 2005 Jun;14(1):3-13.

The use of tympanometry and pneumatic otoscopy for predicting middle ear disease.

Harris PK, Hutchinson KM, Moravec J.

Midwest Ear, Nose and Throat Clinic, Herrin, IL, USA.

PURPOSE: Otitis media is the most common condition diagnosed by pediatricians and
is estimated to affect approximately 70% of the pediatric population. The goal of
this study was to evaluate the effectiveness of otoscopy and multifrequency
tympanometry (MFT) for diagnosis of otitis media in children. METHOD: Twenty-one 
children, age 1 to 10 years, who were seeking medical treatment for suspected
middle ear disease were selected to participate. Data were collected prior to
myringotomy to determine the sensitivity and specificity rates of the following
otologic and audiologic measures: (a) pneumatic otoscopy, (b) conventional
tympanometry, and (c) MFT. For this study, the "gold standard," myringotomy, was 
used along with pneumatic otoscopy to determine the effectiveness, sensitivity,
and specificity of conventional 226-Hz tympanometry, 678-Hz tympanometry, and
1000-Hz tympanometry to predict middle ear disease. RESULTS: The diagnoses
provided with pneumatic otoscopy and tympanometry were both similar, agreeing in 
diagnosis 80%-100% of the time. The diagnoses from 678-Hz and 1000-Hz
tympanometry were nearly equal and proved to detect abnormality at a higher rate.
CONCLUSIONS: MFT is recommended on a routine basis with children having a history
of otitis media, or else abnormal or notched 226-Hz tympanograms. Further
research with a larger sample size will illuminate the possible predictive
potential of MFT in otitis media.

Publication Types: 
    Evaluation Studies

PMID: 16180966 [PubMed - indexed for MEDLINE]

930: J Am Vet Med Assoc. 2005 Sep 1;227(5):748-55.

Effect of tympanic cavity evacuation and flushing on microbial isolates during
total ear canal ablation with lateral bulla osteotomy in dogs.

Hettlich BE, Boothe HW, Simpson RB, Dubose KA, Boothe DM, Carpenter M.

Department of Veterinary Small Animal Medicine, College of Veterinary Medicine,
Texas A&M University, College Station, TX 77843, USA.

OBJECTIVE: To evaluate differences in bacterial numbers, identity, and
susceptibility in samples obtained from the tympanic cavity on entry (preflush)
and after evacuation and lavage (postflush) and assess perioperative and empiric 
antimicrobial selection in dogs that underwent total ear canal ablation (TECA)
with lateral bulla osteotomy (LBO) or reoperation LBO. DESIGN: Prospective
clinical study. ANIMALS: 34 dogs. PROCEDURE: TECA with LBO or reoperation LBO was
performed on 47 ears. Pre- and postflush aerobic and anaerobic samples were
obtained from the tympanic cavity. Isolates and antimicrobial susceptibility
patterns were compared. RESULTS: Different isolates (31/44 [70%] ears) and
susceptibility patterns of isolate pairs (6/44 [14%] ears) were detected in pre- 
and postflush samples from 84% of ears. Evacuation and lavage of the tympanic
cavity decreased the number of bacterial isolates by 33%. In 26% of ears,
bacteria were isolated from post-flush samples but not preflush samples. Only 26%
of isolates tested were susceptible to cefazolin. At least 1 isolate from 53% of 
dogs that received empirically chosen antimicrobials postoperatively was
resistant to the selected drugs. Anaerobic bacteria were recovered from 6 ears.
CONCLUSIONS AND CLINICAL RELEVANCE: Accurate microbiologic assessment of the
tympanic cavity should be the basis for selection of antimicrobials in dogs
undergoing TECA with LBO. Bacteria remain in the tympanic cavity after evacuation
and lavage. Cefazolin was a poor choice for dogs that underwent TECA with LBO, as
judged on the basis of culture and susceptibility testing results.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16178396 [PubMed - indexed for MEDLINE]

931: Br J Radiol. 2005 Oct;78(934):948-51.

CT, MRI and gallium SPECT in the diagnosis and treatment of petrous apicitis
presenting as multiple cranial neuropathies.

Lee YH, Lee NJ, Kim JH, Song JJ.

Department of Radiology, Head and Neck Surgery, Korea University College of
Medicine, Seoul.

We present a rare case of petrous apicitis initiated by middle ear inflammation
in a diabetic patient with multiple cranial neuropathies for early diagnosis of
this potentially life-threatening condition. The lesion appeared as opacification
of middle ear, petrous apex with aggressive bony destruction on CT and diffuse
petrosal T(1) hypointensity with adjacent soft tissue propagation on MRI.
Gallium-67 single-photon emission computed tomography (SPECT) scan also
contributed to evaluate response to therapy.

Publication Types: 
    Case Reports

PMID: 16177020 [PubMed - indexed for MEDLINE]

932: J Laryngol Otol. 2005 Jul;119(7):524-8.

Acute otitis media in children--there are guidelines but are they followed?

Woolley SL, Smith DR.

Emergency Department, Bristol Royal Infirmary/Bristol Children's Hospital,
Bristol, UK. woolley_s@hotmail.com

AIMS: To determine whether guidelines relating to the diagnosis and treatment of 
acute otitis media (AOM) in children are followed in a tertiary paediatric
emergency department (ED). METHODS: A literature search was undertaken to
identify national and international guidelines relating to the diagnosis and
management of AOM in children. The guidelines were assessed for their
applicability to UK practice. A retrospective case note audit was undertaken.
Children presenting to the ED with a discharge diagnosis of AOM over a two month 
period were identified from the ED computer discharge system. The notes were
analysed for compliance with the identified guidelines. RESULTS: 50 children were
identified (age range three months to 11 years). Eighty-six per cent of children 
received antibiotics. Fifty-two per cent of children had documented signs of AOM.
Twenty-five of these children received antibiotics (22 in accordance with
guidelines, three not in accordance with guidelines, antibiotic not documented in
one case). Thirty-nine per cent of children received antibiotics inappropriately.
In all cases, the antibiotic dosage was below the dose recommended in all
guidelines. CONCLUSION: There is poor compliance with national (and
international) guidelines for the management of AOM in this ED. National
guidelines must be introduced into the department by direct teaching at senior
house officer and middle grade level, a re-audit must be carried out and regular 
reviews of the notes of patients diagnosed with AOM must be undertaken to ensure 
compliance with guidelines is maintained.

Publication Types: 
    Review

PMID: 16175976 [PubMed - indexed for MEDLINE]

933: Ann Pharmacother. 2005 Nov;39(11):1879-87. Epub 2005 Sep 20.

Otitis media: review of the 2004 treatment guidelines.

Cober MP, Johnson CE.

Pediatric Surgery, University of Michigan Hospitals and Health Centers, Ann
Arbor, MI, USA.

OBJECTIVE: To review the 2004 treatment guidelines provided by the American
Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) 
regarding the treatment of otitis media in pediatric patients. DATA SOURCES: A
MEDLINE search, restricted to English-language articles about pediatric patients,
was conducted (1966-May 2005) using the key words acute otitis media (AOM),
guideline, observation therapy, and vaccination. Additional references were
located through review of the bibliographies of cited articles. STUDY SELECTION
AND DATA EXTRACTION: Studies related to the fundamental basis of the updated
guidelines and articles addressing current issues related to otitis media
infection were included. DATA SYNTHESIS: Otitis media affects many children in
the US. Concerns have been raised about the proper treatment of AOM in the face
of increasing drug resistance among primary pathogens responsible for infection. 
Some countries have chosen to observe patients for a designated period of time
prior to initiation of antibiotic therapy. The AAP and AAFP have updated the
treatment guidelines for otitis media to include the option of observation
therapy, recommendations for dosing of various antibiotic regimens and their
place in therapy, and the importance of initial pain management. CONCLUSIONS:
Updated treatment guidelines for otitis media have been developed in an effort to
properly treat children while decreasing current resistance rates for common
organisms that cause AOM. In the future, the therapeutic outcomes of observation 
therapy related to both the incidence of drug resistance and the possibility of
increased complications related to otitis media will need to be evaluated in the 
US.

Publication Types: 
    Review

PMID: 16174784 [PubMed - indexed for MEDLINE]

934: Arch Otolaryngol Head Neck Surg. 2005 Sep;131(9):785-7.

Effects of amoxicillin and cefdinir on nasopharyngeal bacterial flora.

Brook I, Gober AE.

Department of Pediatrics, Georgetown University School of Medicine, Washington,
DC, USA. ib6@georgetown.edu

OBJECTIVE: To compare the effects of cefdinir (14 mg/kg per day) and amoxicillin 
(90 mg/kg per day) antimicrobial therapy on the nasopharyngeal flora of children 
with acute otitis media. DESIGN: Nasopharyngeal cultures for aerobic and
facultative bacteria were obtained before therapy and 2 to 4 days after
completion of therapy. SETTING: Outpatient clinic. PATIENTS: Fifty children, aged
7 months to 5 years 4 months. MAIN OUTCOME MEASURES: After completion of therapy,
22 (88%) of the 25 patients treated with cefdinir and 16 (64%) of the 25 patients
treated with amoxicillin were considered clinically cured (P<.05). A significant 
reduction in the number of all isolates occurred following therapy in those
treated with cefdinir (36 vs 71, P<.01) or with amoxicillin (56 vs 73, P<.05).
However, the total number of isolates recovered after therapy was significantly
lower in those treated with cefdinir (36) compared with those treated with
amoxicillin (56) (P<.01). RESULTS: The recovery of potential pathogenic organisms
(eg, Streptococcus pneumoniae, Staphylococcus aureus, beta-hemolytic
streptococci, Haemophilus species, and Moraxella catarrhalis), as well as
penicillin-resistant bacteria, was lower following completion of therapy in the
cefdinir group (6 pathogens, including 5 that were penicillin resistant),
compared with the amoxicillin group (27 pathogens, including 16 that were
penicillin resistant) (P<.01). CONCLUSION: This study illustrates the greater
ability of cefdinir compared with amoxicillin to reduce the number of potential
nasopharyngeal pathogens as well as penicillin-resistant bacteria in children
with acute otitis media.

Publication Types: 
    Comparative Study

PMID: 16172355 [PubMed - indexed for MEDLINE]

935: Arch Otolaryngol Head Neck Surg. 2005 Sep;131(9):782-4.

Trimethoprim-sulfamethoxazole plus topical antibiotics as therapy for acute
otitis media with otorrhea caused by community-acquired methicillin-resistant
Staphylococcus aureus in children.

Al-Shawwa BA, Wegner D.

Department of Pediatrics, Ottumwa Regional Health Center, IA 52501, USA.
balshawwa@hotmail.com

OBJECTIVE: To report our experience in identification and treatment of acute
otitis media (AOM) with otorrhea secondary to community-acquired
methicillin-resistant Staphylococcus aureus (CA-MRSA), which is seen in children 
at increasing rates. DESIGN: Clinical and laboratory records were retrospectively
reviewed between January 2003 and December 2003. SETTING: Primary pediatric
clinic. PATIENTS: Six pediatric patients who had AOM with otorrhea caused by
CA-MRSA. MAIN OUTCOME MEASURES: Clinical resolution of AOM with otorrhea.
RESULTS: All patients had acute-onset otorrhea associated with their AOM. Five
patients had tympanostomy tubes and 1 had perforation of the tympanic membrane.
None of the patients were responding to treatment with oral antibiotics
(amoxicillin sodium-clavulanate potassium, cefpodoxime proxetil, and cefprozil)
or fluoroquinolone ear drops (ofloxacin, ciprofloxacin). Specimens were obtained 
from the ears for cultures, and MRSA was present in the cultures. The organisms
were resistant to levofloxacin and erythromycin in all patients and resistant to 
clindamycin hydrochloride in 2 patients. The cultures were sensitive to
trimethoprim-sulfamethoxazole, gentamicin sulfate, rifampin, and vancomycin
hydrochloride. All patients were treated successfully with oral
trimethoprim-sulfamethoxazole and ear drops (gentamicin sulfate or polymyxin B
sulfate-neomycin sulfate-hydrocortisone [Cortisporin]). CONCLUSIONS: The rising
rate of CA-MRSA as a cause for many pediatric infections is a major concern. It
is very important to obtain cultures from patients with nonresponsive or
persistent otorrhea with AOM to look for MRSA and determine the sensitivity of
the pathogen to antibacterial therapy. Trimethoprim-sulfamethoxazole is a good
choice for initial, empirical therapy when combined with a topical agent for AOM 
with otorrhea if CA-MRSA is suspected. Further studies are needed to determine
whether there is a link between the overuse of topical fluoroquinolones in
pediatric patients and the recent rising rate of CA-MRSA.

PMID: 16172354 [PubMed - indexed for MEDLINE]

936: Arch Otolaryngol Head Neck Surg. 2005 Sep;131(9):777-81.

The effect of otitis media in childhood on the development of middle ear
admittance on reaching adulthood.

de Beer B, Snik A, Schilder AG, Graamans K, Zielhuis GA.

Department of Otorhinolaryngology, Radboud University Nijmegen Medical Center,
Nijmegen, the Netherlands. b.debeer@kno.umcn.nl

OBJECTIVES: To determine the long-term change in static admittance values of
subjects with a positive or negative history of otitis media (OM) and ventilation
tube (VT) insertion; and to investigate the association between static admittance
values and tympanic membrane abnormalities. DESIGN: Prospective follow-up study. 
SUBJECTS: A total of 358 subjects with or without a history of OM (OM+ or OM-)
and VT insertion (VT+ or VT-) derived from a birth cohort that had been observed 
from preschool to adulthood. MAIN OUTCOME MEASURES: Otomicroscopic and
tympanometric data obtained at subject ages 8 and 18 years. RESULTS: Static
admittance values generally increased with age. At age 8 years, static admittance
values were highest in OM+VT+ ears and lowest in OM- ears. At age 18 years, the
difference between OM+VT+ and OM+VT- ears was larger, while the difference in
static admittance values between OM+VT- and OM- ears had disappeared. In the
group of VT+ subjects, the proportion of extreme static admittance values
increased from 16% to 35% between ages 8 and 18 years. Correlation coefficients
of individual static admittance values at 8 and 18 years were high in all groups 
and ranged from 0.61 to 0.85. We could not demonstrate an intermediate role of
tympanic membrane abnormalities in the relation between VTs and static admittance
at young adult age, except for atrophy. CONCLUSIONS: The static admittance value 
at age 8 years was a strong predictor for the value at age 18 years. A VT+ status
was associated with a larger increase in static admittance than can be explained 
on the basis of age alone.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16172353 [PubMed - indexed for MEDLINE]

937: Arch Otolaryngol Head Neck Surg. 2005 Sep;131(9):771-6.

Immune status and eustachian tube function in recurrence of otitis media with
effusion.

Straetemans M, van Heerbeek N, Sanders EA, Engel JA, Schilder AG, Rijkers GT,
Graamans K, Straatman H, Zielhuis GA.

Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical
Centre, the Netherlands.

OBJECTIVE: To study the combined role of immune status and eustachian tube
function in the development of recurrent bilateral otitis media with effusion
(OME). DESIGN: Prospective cohort study. SETTING: Three academic and general
hospitals. PATIENTS: Children aged 2 to 7 years with a first clinical episode of 
bilateral OME that persisted for at least 3 months; 136 (81%) of 168 eligible
children participated. All children received bilateral tympanostomy tubes at
study entry. MAIN OUTCOME MEASURE: Recurrence of bilateral OME within 6 months
after tube extrusion. RESULTS: Univariate analyses of various immunologic factors
(IgA, IgG1, IgG2, IgG3, IgG4, mannose-binding lectin, and the FcgammaRIIa-H/R131 
genotype) and eustachian tube function (forced response test) did not show any
significant associations with bilateral OME recurrence. Multivariate analyses
showed that children with closing pressures higher than the 75th percentile and
IgA or IgG2 levels below the 50th percentile of the cohort were more likely to
develop recurrent OME than children with closing pressures higher than the 75th
percentile and IgA or IgG2 levels above the 50th percentile. The corresponding
risk ratios were 6.3 (95% confidence interval [CI], 1.0-40.1) for IgA level and
3.0 (95% CI, 1.1-8.2) for IgG2 level. The multivariate analyses also revealed
that increasing serum levels of functional mannose-binding lectin were associated
with decreasing probabilities of developing recurrent OME (odds ratio, 0.7; 95%
CI, 0.6-1.0). CONCLUSION: Recurrence of bilateral OME after tympanostomy tube
placement is more likely in children with a combination of low IgA or low IgG2
levels with poor eustachian tube function and decreased levels of mannose-binding
lectin.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16172352 [PubMed - indexed for MEDLINE]

938: Mycopathologia. 2005 Sep;160(2):143-9.

Occurrence and population size of Malassezia spp. in the external ear canal of
dogs and cats both healthy and with otitis.

Cafarchia C, Gallo S, Capelli G, Otranto D.

Dipartimento di Sanità e Benessere Animale, Facoltà di Medicina Veterinaria,
Valenzano, Bari, Italy.

Malassezia yeasts are commensal organisms of human and animal skin that
occasionally act as pathogens; lipid-dependent species are associated with human 
skin disorders. The aim of this work was to evaluate the occurrence, risk factors
and population size of different species of Malassezia in the external ear canal 
of dogs and cats with and without otitis externa. Between 2001 and 2003, 107
healthy animals (25 cats and 82 dogs) and 123 animals with chronic otitis
exteirna (48 cats and 75 dogs) were clinically examined. Sterile cotton swabs
were used to collect specimens from the external ear canal and culture tests and 
cytological examinations were performed to detect the presence and population
size of Malassezia yeasts. Malassezia yeasts were isolated from 72.9% and 40% of 
the cats and from 57.3% and 28.0% of the dogs, with and without otitis externa,
respectively. Malassezia was frequently isolated from animals under 5 years of
age. The highest prevalence of positive samples was reported in winter for cats
and in autumn for dogs. Dogs with pendulous ears showed a higher incidence of
infection than dogs with erect ears. More Malassezia yeasts were recovered from
animals with otitis (i.e. 59.6 colony forming units - CFUs - for cats and 66.0
CFUs for dogs) than healthy animals. Out of the 413 isolates obtained from
animals with and without otitis, 403 (97.6%) were identified as M. pachydermatis 
and 10 (2.4%) as M. globosa. A statistical evaluation of the occurrence of
Malassezia yeasts in dogs and cats revealed that predisposing factors for
Malassezia infections are sampling period for cats, and type of ear for dogs. The
largest population of Malassezia yeasts was detected in animals with otitis,
suggesting a role in the occurrence of lesions.

PMID: 16170610 [PubMed - indexed for MEDLINE]

939: Int J Pediatr Otorhinolaryngol. 2006 Apr;70(4):639-45. Epub 2005 Sep 16.

Comment in:
    Int J Pediatr Otorhinolaryngol. 2007 Feb;71(2):358; author reply 359-60.

The role of topical nasal steroids in the treatment of children with otitis media
with effusion and/or adenoid hypertrophy.

Cengel S, Akyol MU.

Hacettepe University, Faculty of Medicine, Otorhinolaryngology Head-Neck Surgery,
06100 Ankara, Turkey. senemcengel@hotmail.com

OBJECTIVES: Topical steroid treatment can be a powerful alternative to surgery in
controlling adenoid hypertrophy and otitis media with effusion (OME). METHODS: A 
prospective, controlled, randomized, clinical study in an academic tertiary care 
center. A total of 122 children (3-15-year-old) on the waiting list for an
adenoidectomy and/or ventilation tube placement were enrolled into the study and 
control groups. The study group (67 patients with adenoid hypertrophy, 34 of them
with otitis media with effusion) received intranasal mometasone furoate
monohydrate 100 mcg/day, and the control group (55 patients with adenoid
hypertrophy, 29 of them with otitis media with effusion) was followed up without 
any treatment. All patients were evaluated at 0 and 6 weeks. The assessment of
each patient included history, a symptom questionnaire, a skin prick test, a
tympanogram, if possible a pure tone audiogram, and otoscopic and endoscopic
examinations. The size of adenoid tissue was graded as a percentage according to 
obliteration of the choanae. The adenoid/choana ratio (A/C) was recorded for each
patient. Symptoms were scored as 0 (absent), 1 (intermittent/periodic), or 2
(continuous). The data were analyzed with the "Statistical Package for the Social
Sciences" (SPSS 9.0) using the appropriate nonparametric tests for nominal and
ordinal data. RESULTS: Resolution of otitis media with effusion in the study
group (42.2%) was significantly higher than that in the control group (14.5%)
(p<0.001). Forty-five patients (67.2%) with adenoid hypertrophy in the study
group showed a significant decrease in adenoid size according to the endoscopic
evaluation compared to the control group (p<0.001). A significant improvement in 
obstructive symptoms was seen in the study group (p<0.001). The endoscopically
measured adenoid/choana ratio and degree of obstructive symptoms showed a
significant correlation (r=0.838 p<0.001, r=0.879 p<0.001, r=0.838 p<0.001,
r=0.879 p<0.001). The adenoid/choana ratio improved significantly in atopic
patients in the study group (p<0.05), whereas in atopic patients in the control
group there was no change (p=0.221). CONCLUSION: Nasal mometasone furoate
monohydrate treatment can significantly reduce adenoid hypertrophy and eliminate 
obstructive symptoms. It is a useful alternative to surgery, at least in the
short term, for otitis media with effusion.

Publication Types: 
    Randomized Controlled Trial

PMID: 16169093 [PubMed - indexed for MEDLINE]

940: Int J Pediatr Otorhinolaryngol. 2005 Nov;69(11):1497-502. Epub 2005 Sep 15.

A comparison assessment of videotelescopy for diagnosis of pediatric otitis media
with effusion.

Shiao AS, Guo YC.

Department of Otolaryngology, Taipei Veterans General Hospital, National
Yang-Ming University School of Medicine, No. 201 Shih-Pai Road, Sec. 2, Taipei
112, Taiwan, ROC. asshiao@vghtpe.gov.tw

OBJECTIVES: A correct diagnosis of pediatric otitis media with effusion (OME) is 
imperative for instituting an appropriate treatment. The aim of this study was to
compare the diagnostic efficacies of videotelescopy, pneumatic otoscopy, and
tympanometry for detecting the presence or absence of pediatric OME, and thereby,
to recommend a standardized procedure for assessing possible OME in the
outpatient setting of a referral center. STUDY DESIGN: Prospective study.
METHODS: Between November 1999 and May 2002, 104 children were enrolled in this
comparison study of diagnostic methods for OME. Based on a presumptive diagnosis 
of OME or atelectasis of the eardrum, patients under 12 years of age were
admitted to the ward for ventilation-tube insertion. In the 2 days prior to
surgery, videotelescopy, pneumatic otoscopy, and tympanometry were performed.
Myringotomies were subsequently conducted under general anesthesia to confirm the
presence or absence of OME. Type B tympanograms were accepted as positive results
for ears with effusion. RESULTS:: Of the 201 ears assessed in the study,
middle-ear effusion was detected in 179, while the remaining 22 ears were found
to be dry on myringotomy. It was demonstrated that videotelescopy had the highest
sensitivity (97.8%), specificity (100%), and accuracy (98.0%), reflecting
significantly better results than those for pneumatic otoscopy and tympanometry. 
CONCLUSIONS: In our study, videotelescopy seemed to be better than pneumatic
otoscopy and tympanometry for diagnosis of pediatric OME. It may be has the
potential to become the standard diagnostic and teaching procedure for pediatric 
OME in the outpatient setting of a referral center, and for validation of
pneumatic otoscopy.

Publication Types: 
    Clinical Trial

PMID: 16168494 [PubMed - indexed for MEDLINE]

941: Int J Syst Evol Microbiol. 2005 Sep;55(Pt 5):1871-6.

Gordonia otitidis sp. nov., isolated from a patient with external otitis.

Iida S, Taniguchi H, Kageyama A, Yazawa K, Chibana H, Murata S, Nomura F,
Kroppenstedt RM, Mikami Y.

Research Center for Pathogenic Fungi and Microbial Toxicoses, Chiba University,
Chuo-ku, Chiba 260-8673, Japan.

The taxonomic positions of two clinically isolated actinomycetes were established
using a polyphasic approach. The two strains, IFM 10032(T), isolated from ear
discharge of a 28-year-old Japanese female patient with external otitis, and IFM 
10148, isolated from pleural fluid of a 60-year-old Japanese male patient with
bronchitis, possessed meso-diaminopimelic acid as the diagnostic amino acid,
MK-9(H(2)) as the predominant menaquinone and mycolic acids ranging from 58 to 64
carbons. The 16S rRNA gene sequences of the two strains were most closely related
to those of Gordonia aichiensis, Gordonia sputi and 'Gordonia jacobaea'.
Differences in several phenotypic characteristics together with genotypic
distinctiveness distinguish strains IFM 10032(T) and IFM 10148 from these three
species. DNA-DNA hybridization results and the combination of genotypic and
phenotypic data showed that the two strains belong to a single species, and merit
recognition of a novel species within the genus Gordonia. The name proposed for
this taxon is Gordonia otitidis sp. nov.; the type strain is IFM 10032(T) (=DSM
44809(T)=JCM 12355(T)=NBRC 100426(T)).

PMID: 16166681 [PubMed - indexed for MEDLINE]

942: Int J Pediatr Otorhinolaryngol. 2006 Mar;70(3):481-5. Epub 2005 Sep 13.

The computed tomographical and tympanometrical evaluation of mastoid
pneumatization and attic blockage in patients with chronic otitis media with
effusion.

Görür K, Ozcan C, Talas DU.

University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology,
Mersin 33079, Turkey. kgorur@mersin.edu.tr

OBJECTIVE: To assess the relation between mastoid size and attic blockage in COME
patients treated with ventilation tube insertion and prognosis regarding
tympanometric compliance and computed tomography findings of temporal bones.
MATERIAL AND METHODS: Twenty-four ears of 15 patients with chronic otitis media
with effusion were selected prospectively. The ages of patients were between 5
and 13 years old and eight of them were females. All patient received medical
treatment for 10 days. Ventilation tubes were inserted with or without
adenoidectomy or adenotonsillectomy to the unimproved patients. Postoperative
compliances were measured on first day, first week, and first month and the
tympanometric results were compared each one with others and with mastoid
pneumatization degree using computerized tomographic findings. RESULTS: The
hearing thresholds were between 23 and 43 dB in left ears and between 22 and 45
dB in right ears. Mastoid pneumatization and aditus were normal and open in three
(12.6%); sclerotic and open in eight (33.3%); sclerotic and blocked in 13
patients (54.1%), when the temporal bones assessed by computerized tomography.
The mean compliance values of patients elevated postoperatively in regard with
time and this increase was significant. There was a significant statistical
relation between mastoid pneumatization and compliance of the ears. CONCLUSION:
Tympanometric assessment may be considered as a valuable and cost-effective
method rather than CT in the evaluation of aditus blockage and residual soft
tissue of the tympanomastoid region.

PMID: 16165223 [PubMed - indexed for MEDLINE]

943: Scand J Prim Health Care. 2005 Sep;23(3):184-91.

Otitis media, tympanostomy tube placement, and use of antibiotics.
Cross-sectional community study repeated after five years.

Arason VA, Sigurdsson JA, Kristinsson KG, Getz L, Gudmundsson S.

Department of Family Medicine, University of Iceland, Solvangur, Hafnarfjordur,
Iceland. vaa@hgsolvangur.is

OBJECTIVE: To investigate potential links between antimicrobial drug use for
acute otitis media (AOM) and tympanostomy tube placements, and the relationship
between parental views and physician antimicrobial prescribing habits. DESIGN:
Cross-sectional community study repeated after five years. SUBJECTS:
Representative samples of children aged 1-6 years in four well-defined
communities in Iceland, examined in 2003 (n = 889) and 1998 (n = 804). MAIN
OUTCOME MEASURES: Prevalence of antimicrobial treatments for AOM, tympanostomy
tube placements, and parental expectations of antimicrobial treatment. Results.
Tympanostomy tubes had been placed at some time in 34% of children in 2003, as
compared with 30% in 1998. A statistically significant association was found
between tympanostomy tube placement rate and antimicrobial use for AOM in 2003.
In the area where antimicrobial use for AOM was lowest in 1998, drug use had
further diminished significantly. At the same time, the prevalence of
tympanostomy tube placements had diminished from 26% to 17%. Tube placements had 
increased significantly, from 35% to 44%, in the area where antimicrobial use for
AOM was highest. Parents in the area where antimicrobial consumption was lowest
and narrow spectrum antimicrobials were most often used were less likely to be in
favour of antimicrobial treatment. CONCLUSIONS: Comparison between communities
showed a positive correlation between antimicrobial use for AOM and tympanostomy 
tube placements. The study supports a restrictive policy in relation to
prescriptions of antibiotics for AOM. It also indicates that well-informed
parents predict a restrictive prescription policy.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16162472 [PubMed - indexed for MEDLINE]

944: Pediatr Emerg Care. 2005 Sep;21(9):606-9.

Sigmoid sinus thrombosis following mastoiditis: early diagnosis enhances good
prognosis.

Ozdemir D, Cakmakci H, Ikiz AO, Demir K, Yilmaz S, Dirik E, Anal O.

Department of Pediatrics, Dokuz Eylul University, Medical School, Izmir, Turkey. 
durgul.ozdemir@deu.edu.tr

Sigmoid sinus thrombosis following mastoiditis is a rare, but potentially
life-threatening, condition. Its treatment usually consists of systemic
antibiotics and mastoidectomy. In this report, we describe a pediatric case of
sigmoid sinus thrombosis following mastoiditis, presenting with nonspecific
symptoms such as fever, otalgia, and headache. Diagnosis was based on magnetic
resonance imaging. The patient responded very well to intravenous antibiotics
with a rapid clinical improvement and complete recanalization of the thrombosed
sigmoid sinus. In conclusion, mastoiditis may present few clinical symptoms. In
case of treatment failure or new-onset neurologic deficit in children with acute 
otitis media, life-threatening complications associated with mastoiditis should
be considered. Early diagnosis is important, as favorable prognosis can be
achieved with conservative management without performing any surgical
intervention.

Publication Types: 
    Case Reports

PMID: 16160668 [PubMed - indexed for MEDLINE]

945: Medicina (Kaunas). 2005;41(8):661-7.

Development of myringosclerosis during acute otitis media caused by Streptococcus
pneumoniae and non-typeable Haemophilus influenzae: a clinical otomicroscopical
study using the rat model.

Raustyte G, Hermansson A.

Department of Otorhinolaryngology, Kaunas University of Medicine, Kaunas,
Lithuania. g.raustyte@takas.lt

OBJECTIVE: The present study was performed in order to study development of
myringosclerosis during acute otitis media caused by different bacteria in
myringotomized and non-myringotomized ears. MATERIAL AND METHODS: A rat model of 
acute otitis media caused by Streptococcus pneumoniae type 3 and non-typeable
Haemophilus influenzae was used. A sample consisted of 42 animals. Four days
following middle ear inoculation, a myringotomy was performed in 10 animals from 
the Streptococcus pneumoniae group and 6 from the non-typeable Haemophilus
influenzae group. Another group of 24 animals was inoculated only. On day 4, 7,
14 and 28 after inoculation the status of the drum was inspected under the
otomicroscope for vascular reaction, effusion, perforation, myringosclerosis and 
scarring. RESULTS: On day 4 after inoculation all infected ears had typical signs
of acute otitis media. Tympanic membranes healed with scar formation in most
cases of myringotomized Streptococcus pneumoniae type 3 infection and deposition 
of sclerotic plaques was observed by day 14. Otomicroscopically visible
myringosclerosis was not found after non-typeable Haemophilus influenzae induced 
acute otitis media neither in myringotomized nor in non-myringotomized animals.
We conclude that Streptococcus pneumoniae type 3 provokes a severe clinical
course of acute otitis media that healed with scarring and myringosclerosis
formation in the tympanic membrane. Clinically visible myringosclerosis develops 
after middle ear infection caused by Streptococcus pneumoniae type 3, but not in 
cases caused by non-typeable Haemophilus influenzae.

Publication Types: 
    Comparative Study

PMID: 16160414 [PubMed - indexed for MEDLINE]

946: Int J Pediatr Otorhinolaryngol. 2006 Mar;70(3):529-39. Epub 2005 Sep 12.

Calcium deposition and expression of bone modelling markers in the tympanic
membrane following acute otitis media.

Raustyte G, Cayé-Thomasen P, Hermansson A, Andersen H, Thomsen J.

Department of Ear, Nose and Throat Diseases, Kaunas University of Medicine,
Lithuania.

BACKGROUND AND OBJECTIVES: In accordance with clinical findings, myringosclerosis
develops after otitis media (OM) and paracentesis in an experimental setting. The
pathogenesis of this phenomenon of calcification is poorly understood. As the
calcification process and the sclerotic plaques of the drum mimics features of
bone tissue, this study explores tympanic membrane calcium deposition in
association with the expression of three bone modelling markers: osteopontin
(OPN), osteoprotegerin (OPG) and osteonectin (ON). OPN is secreted by osteoblasts
and is found at calcification sites, e.g. during pathological calcification in
chronic OM. The cytokine OPG is an inhibitor of bone resorption and consequently 
bone remodelling. ON is a calcium binding glycoprotein necessary for the
maintenance of bone mass and remodelling. It is found in bone matrix and
synthesized by osteoblasts. METHOD: A rat model of acute otitis media (AOM)
caused by non-typeable Haemophilus influenzae was used. Four days following
middle ear inoculation, a myringotomy was performed in six animals. Another group
of ten animals was inoculated only. The drum was dissected in two animals from
each group on day 4, 7, 14 and 28 post-inoculation, and the expression of OPN,
OPG and ON was determined by immunohistochemistry. von Kossa staining determined 
the deposition of calcium and immune staining for CD68 identified macrophages.
RESULTS: Calcium depositions were initially accumulated in the cytoplasm of
macrophages and dispersed in the connective tissue layers of the pars flaccida
and tensa. Late accumulation occurred in the lamina propria of pars tensa, more
extensively in myringotomized ears. OPN expression was found early in
inflammatory cells including especially macrophages and late in pars tensa
fibrocytes. OPG expression was initially located to inflammatory cells and late
to pars tensa fibrocytes and the inner basal membrane of pars flaccida. Some ears
displayed a marked pars flaccida expression of ON in the connective tissue matrix
on early days and at the inner basal membrane on later days. The latter cases
were from myringotomized ears. Otherwise, no apparent differences of marker
expression occurred between myringotomized and non-myringotomized animals.
CONCLUSION: We conclude that osteopontin, osteoprotegerin and osteonectin are
expressed by different cell types in the tympanic membrane during calcification
in association with AOM, with or without myringotomy. These molecules may
accordingly play a role in the pathogenesis of myringosclerosis, in which
macrophages and fibrocytes appear as potential major players.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16159670 [PubMed - indexed for MEDLINE]

947: Acta Otolaryngol. 2005 Aug;125(8):819-22.

Otogenic intracranial complications: a review of 28 cases.

Migirov L, Duvdevani S, Kronenberg J.

Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel
Aviv, Israel. smigirov@leumit.co.il

CONCLUSIONS: Antibiotic treatment does not absolutely prevent the development of 
otogenic intracranial complications (ICC); however, their incidence is relatively
low (0.36%).Various pathogens can be isolated in cultures of patients with these 
complications, but combinations of third- or fourth-generation cephalosporins
with chloramphenicol, vancomycin, metronidazole or aminoglycosides can provide
good results. Underlying cholesteatoma is common and is usually associated with
intracranial abscess or sinus thrombosis. High morbidity rates warrant long-term 
follow-up. OBJECTIVE: To evaluate the cause and nature of otogenic ICC in
patients treated at 1 medical center over an 18-year period. MATERIAL AND
METHODS: This was a retrospective chart review of 28 patients admitted to Sheba
Medical Center, Israel with otogenic ICC between 1984 and 2002. RESULTS:
Meningitis was the commonest complication (46.4%), followed by brain abscess,
epidural abscess, sigmoid sinus thrombosis, subdural empyema, perisinus abscess
and transverse and cavernous sinus thrombosis. Twelve patients (42.9%) had
received antibiotic treatment prior to admission. Chronic otitis media,
cholesteatoma and brain abscess were diagnosed mainly in adults, while acute
otitis media and epidural abscess were more frequent in children. Twenty-one
patients underwent mastoidectomy to eradicate the source of infection. The
commonest finding at surgery was granulations (81%). Cholesteatoma was seen in
38.1% of cases. Cholesteatoma and brain abscess were usually associated with
Gram-negative bacterial infection. Meningitis, however, was caused by
Streptococcus pneumoniae in 40% of cases. CT showed a sensitivity of 92.75% for
diagnosing otogenic ICC. There was no mortality. The morbidity rate was high
(71.4%) and included hearing impairment, hemiparesis, hydrocephalus, mental
retardation, polyneuropathy and epilepsy.

PMID: 16158527 [PubMed - indexed for MEDLINE]

948: J Laryngol Otol. 2005 Sep;119(9):699-703.

Early post-operative morbidity after tympanostomy tube insertion.

Allen J, Morton RP, Ahmad Z.

Department of Otorhinolaryngology, South Auckland Health, New Zealand.

Insertion of ventilation tubes is regarded as a simple, effective and safe
treatment for recurrent otitis media or prolonged middle-ear effusions. We
conducted a prospective observational study of 112 children to ascertain what
early post-operative complications were experienced. Our findings were consistent
with previously published figures for post-surgical otorrhoea and obstruction
rates, at 13.5 per cent and 4 per cent (by ear), respectively, using
intra-operative administration of antibiotic/steroid ear drops. We identified
unique characteristics of differing ethnic groups with regard to findings at
surgery and post-operative outcomes. There was a tendency for grommets placed in 
the left ear to be extruded early and Maori and Pacific Islanders were
significantly more likely to have a non-functioning tube (blocked or extruded) in
the early post-operative period. Overall, one in four children developed a
post-operative complication (otorrhoea or non-functioning tube) suggesting that
early and close follow up may allow timely identification and intervention where 
required.

PMID: 16156910 [PubMed - indexed for MEDLINE]

949: Vet J. 2006 Nov;172(3):544-8. Epub 2005 Sep 12.

Malassezia pachydermatis isolated from normal and diseased external ear canals in
dogs: a comparative analysis.

Girão MD, Prado MR, Brilhante RS, Cordeiro RA, Monteiro AJ, Sidrim JJ, Rocha MF.

Faculty of Veterinary, Post-Graduation Program in Veterinary Science, State
University of Ceará, Fortaleza-CE, Brazil.

To investigate the role of Malassezia pachydermatis as a pathogenic agent in
canine otitis, a comparative analysis of isolates from normal and diseased
external ear canals in dogs was undertaken. Specimens were collected from the
ears of dogs with unilateral or bilateral otitis and from healthy dogs.
Mycological analysis was by direct microscopy and fungal culture on Sabouraud's
dextrose agar and Dixon's agar. Of the otitis specimens, 63.7% showed typical
Malassezia cells on cytological examination. In samples taken from the healthy
ears of dogs with unilateral otitis, only 21.43% (P<0.05) showed evidence of
Malassezia. M. pachydermatis was identified cytologically and culturally in
57.53% (P<0.05), 14.29% and 30.0% of samples from the ears of dogs with otitis,
from the healthy ears of dogs with unilateral otitis and from the ears of healthy
dogs with no otitis. In the group with otitis associated with M. pachydermatis,
the poodle was the most common breed (39.29%; P<0.05), whereas in the group
without otitis, the German Shepherd breed was prominent (although this
observation was not statistically significant). In both groups, the majority of
dogs with M. pachydermatis were aged between 1 and 3 years (P<0.05). The higher
incidence of M. pachydermatis isolated from the ears of dogs with otitis externa 
suggests a putative pathogenic role of this yeast in this condition.

PMID: 16154787 [PubMed - indexed for MEDLINE]

950: Int J Pediatr Otorhinolaryngol. 2006 Apr;70(4):613-7. Epub 2005 Sep 9.

Acute otitis media in infants less than three months of age: clinical
presentation, etiology and concomitant diseases.

Sakran W, Makary H, Colodner R, Ashkenazi D, Rakover Y, Halevy R, Koren A.

Pediatric Department B, Ha'Emek Medical Center, Afula 18101, Israel.
sakran_w@clalit.org.il

OBJECTIVE: Acute otitis media (AOM) in the neonatal period can be difficult to
diagnose. This infection can be isolated and localized, or it may be associated
with serious bacterial infections or other illnesses. The objectives of this
study were to determine the clinical presentation, etiology, susceptibility
pattern, and frequency of bacteremia, meningitis and other serious bacterial
infections associated with the first episode of AOM in young infants. METHODS:
From July 2002 to August 2004, infants less than 12 weeks of age with confirmed
AOM underwent tympanocentesis with culture of the middle ear fluid. Sepsis
work-up was performed in all infants, and they were admitted to the pediatric
department. Parenteral antibiotic therapy with a combination of ampicillin and
gentamicin was initiated. RESULTS: Sixty-eight infants were diagnosed with AOM.
The median age was 43+/-17 days, 17 infants (25%) were less than 4 weeks of age. 
Fever was present in 45 (66%) of the patients. Meningitis or bacteremia was not
diagnosed in any of the cases. Concomitant urinary tract infection was diagnosed 
in six (8.8%) cases and broncholitis in seven (10.4%). Forty-seven bacterial
pathogens were isolated from the middle-ear fluid. Streptococcus pneumoniae was
the leading pathogen with 18 isolates (38%), followed by non-typable Haemophilus 
influenzae with nine (19%). Fourteen of the S. pneumoniae (78%) isolates were
susceptible to penicillin and the other four (22%) were intermediately resistant.
Three (33%) of the nine H. influenzae isolates were beta-lactamase producers.
CONCLUSIONS: In our study, AOM in infants less than 3 months of age is a
localized infection and it is not associated with severe bacterial infections. S.
pneumoniae and H. influenzae are the leading pathogens. In our region, most of S.
pneumoniae strains are still susceptible to penicillin. Although only small
number of patients were under 4 weeks of age, the results of the present study
raise the question of whether the current policy of a full sepsis work-up in
neonates with AOM is relevant.

PMID: 16154644 [PubMed - indexed for MEDLINE]

951: Clin Pediatr (Phila). 2005 Sep;44(7):575-8.

Preferred antibiotics for treatment of acute otitis media: comparison of
practicing pediatricians, general practitioners, and otolaryngologists.

Pichichero ME.

Elmwood Pediatric Group, University of Rochester Medical Center, 601 Elmwood
Avenue, Box 672, Rochester, NY 14642, USA.

The antibiotic preferences of 2,190 pediatricians (peds) 360 general
practitioners (GPs), and 273 otolaryngologists (ENTs) in the United States and
concurrence with treatment guideline recommendations for acute otitis media (AOM)
for suspected drug-resistant Streptococcus pneumoniae (DRSP) and
beta-lactamase-producing Haemophilus influenzae before and after an educational
workshop were compared. Peds and GPs preferred amoxicillin/clavulanate high-dose,
whereas ENTs preferred higher generation cephalosporins. Before the workshop,
endorsement of guideline-recommended antibiotics for treatment of AOM caused by
DRSP by Peds, GPs, and ENTs was 80%, 75%, and 78%, respectively, and for
Haemophilus influenzae was 73%, 63%, and 84%, respectively. After the workshop
concurrence with AOM guideline recommendations for DRSP increased to 96%, 95%,
and 97% and for H. influenzae increased to 93%, 94%, and 96% for Peds, GPs, and
ENTs, respectively (p<0.0001 for all comparisons). Peds, GPs, and ENTs select
appropriate antibiotics for AOM 63-84% of the time. After instruction that
provides the rationale for guideline-recommended agents based on
pharmacokinetics/pharmacodynamics and double tympanocentesis trials, endorsement 
of recommended antibiotics significantly improved to >90%.

Publication Types: 
    Comparative Study

PMID: 16151562 [PubMed - indexed for MEDLINE]

952: Otol Neurotol. 2005 Sep;26(5):1016-21.

Natural course of tympanic membrane pathology related to otitis media and
ventilation tubes between ages 8 and 18 years.

De Beer BA, Schilder AG, Zielhuis GA, Graamans K.

Department of Otorhinolaryngology, Radboud University Nijmegen Medical Center,
Nijmegen, The Netherlands. b.debeer@kno.umcn.nl

OBJECTIVE: To present the course of tympanic membrane pathology in childhood and 
young adulthood after otitis media (OM) in early life. STUDY DESIGN: Prospective 
follow-up study. SETTING: Community study of a birth cohort. PATIENTS: Three
hundred fifty-eight subjects with a positive and negative history of OM (OM+ or
OM-) or ventilation tube insertion (VT+ or VT-) derived from a birth cohort that 
had been followed-up from preschool to adult age. METHODS: Standardized
otomicroscopic examination performed at ages 8 and 18 years. MAIN OUTCOME
MEASURES: Tympanic membrane abnormalities (i.e., tympanosclerosis, atrophy,
atelectasis and retraction pockets of the pars tensa, and retraction of the pars 
flaccida). RESULTS: At the age of 8 years, tympanic membrane pathology was highly
prevalent in the both OM+ subcohorts (OM+VT+, 92% and OM+VT-, 46%), whereas in
the OM- ears (11%), tympanic membrane abnormalities were rare. In the subsequent 
10-year period, many tympanic membrane abnormalities disappeared spontaneously,
although the prevalence of tympanosclerosis remained substantial in the OM+VT+
cohort. CONCLUSION: The natural course of most tympanic membrane pathology
associated with OM in early life is favorable over time, suggesting an intrinsic 
repair capacity of the tympanic membrane. Tympanosclerosis, the most prevalent
sequelae of OM and treatment with VT, however, shows little tendency of
resolution.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16151352 [PubMed - indexed for MEDLINE]

953: Otol Neurotol. 2005 Sep;26(5):1011-5.

Quantitative experimental assessment of the factors contributing to hearing loss 
in serous otitis media.

Jeselsohn Y, Freeman S, Segal N, Sohmer H.

Department of Physiology, Hebrew University, Hadassah Medical School, Jerusalem, 
Israel.

OBJECTIVE: This study was designed to quantitatively assess the contribution of
various factors to the conductive hearing loss in otitis media. BACKGROUND: In
the conductive hearing loss seen in cases of serous otitis media, various volumes
of fluid of different viscosities along with subatmospheric (negative) pressure
are found in the middle ear. METHODS: To evaluate the contribution of each of
these factors to hearing loss, various volumes of saline, whole blood, or
glycerol were applied to the open middle ear cavity of guinea pigs for short
periods of time and auditory function was evaluated by recording the threshold of
auditory nerve-brainstem evoked responses. In some of the saline experiments, the
bulla cavity was also sealed, allowing a subatmospheric (negative) pressure to
develop in the cavity as water was osmotically absorbed because of the gradient
in colloid osmotic pressure between saline and blood in the vessels lining the
middle ear cavity. In other experiments, a thoracic drainage system was connected
to the middle ear cavity to induce desired negative middle ear pressures.
RESULTS: The degree of hearing loss increased as larger volumes of fluid were
introduced into the middle ear, reaching a maximum of 15 to 16 dB. There was no
difference in the degree of hearing loss induced by saline or by fluids with
viscosities up to 1,000 times greater than that of water (glycerol). A
subatmospheric pressure in the middle ear contributed only a small additional
(1-2 dB) threshold elevation. CONCLUSION: The major factor contributing to
hearing loss in serous otitis media is the volume of fluid in the middle ear,
irrespective of its viscosity. The contribution of negative middle ear pressure
is much smaller.

PMID: 16151351 [PubMed - indexed for MEDLINE]

954: Otol Neurotol. 2005 Sep;26(5):842-5.

Reevaluation of bilateral same-day surgery for bilateral perforated chronic
otitis media.

Katsura H, Sakagami M, Tsuji K, Muto T, Okunaka M, Mishiro Y, Fukazawa K.

Department of Otolaryngology, Hyogo College of Medicine, 1-1 Mukogawa-cho,
Nishinomiya, Hyogo, Japan. katsurahirokazu@yahoo.co.jp

OBJECTIVE: To evaluate the results of bilateral same-day surgery for bilateral
perforated chronic otitis media in comparison with our previous report. STUDY
DESIGN: Prospective study. PATIENTS: Seventeen patients ranging in age from 5 to 
70 years (mean, 52.5 yr), with bilateral perforated chronic otitis media.
METHODS: Two hundred cases of chronic otitis media were operated on at the
Department of Otolaryngology, Hyogo College of Medicine from December 1998 to
November 2002. Fifty-nine patients (29.5%) had bilateral disease and 17 patients 
(8.5%) underwent bilateral same-day surgery. RESULTS: The postoperative air-bone 
gap was less than 10 dB on both sides in 5 of 17 (29%) and less than 20 dB in 15 
of 17 (88%). The postoperative hearing level was less than 20 dB in both ears in 
4 of 17 (24%), less than 30 dB in 7 of 17 (41%), and less than 40 dB in 10 of 17 
(59%). The rate of closure of the ear drum was 20 of 22 (91%) in the simple
underlay myringoplasty series and 9 of 12 (75%) in the conventional
myringoplasty/tympanoplasty series. The rate of closure of the ear drum on both
sides was successful in 4 of 5 (80%) that underwent simple underlay
myringoplasty/simple underlay myringoplasty and 8 of 12 (67%) that underwent
simple underlay myringoplasty/conventional myringoplasty/tympanoplasty, whereas
that on at least one side was successful in 100%. CONCLUSION: Bilateral same-day 
surgery for bilateral perforated chronic otitis media is possible if operative
indications are considered. Furthermore, it will help patients save time and
money.

PMID: 16151326 [PubMed - indexed for MEDLINE]

955: Otol Neurotol. 2005 Sep;26(5):834-7.

Evaluation of attic retraction pockets by microendoscopy.

Kakehata S, Hozawa K, Futai K, Shinkawa H.

Department of Otorhinolaryngology, Hirosaki University School of Medicine,
Hirosaki, Japan. seijik@cc.hirosaki-u.ac.jp

OBJECTIVE: Attic retraction pockets (RPs) are one of the important sequelae of
otitis media with effusion and are classified on the basis of the findings of
otoscopy or otomicroscopy. It is unclear when and how RPs turn into
cholesteatomas. We compared the findings of RPs obtained with the use of a
microendoscope with those from an otomicroscope to determine the extension of
RPs. STUDY DESIGN: Comparative study. PATIENTS: Twenty-seven attic RPs (Tos type 
III or IV) and 10 precholesteatomas previously classified under an otomicroscope 
were reexamined. MAIN OUTCOME MEASURES: A high-resolution, fine, rigid
microendoscope with an outer diameter of 1.0 mm was used to observe the extension
of a retraction. In addition, to confirm the extent of the RP, computed
tomography (CT) scans using water as the contrast media were performed in
representative cases. RESULTS: Endoscopy with the microendoscope revealed that in
59%, the RP was deeper than indicated by the initial otomicroscopic estimation,
suggesting that the extension of the RP was underestimated. The findings of
water-enhanced CT scans were comparable with the endoscopic findings. The bottom 
was observable with the microendoscope and the otomicroscope in 20 (74%) and 11
(41%) of 27 RPs, respectively. Seven ears had a deeper RP, which extended beyond 
the incudomallear joint. Of the 10 precholesteatoma cases, in which the bottoms
were not visible with an otomicroscope or conventional endoscopes, the
microendoscope revealed the bottom in 5 (50%). CONCLUSION: On the basis of the
observations of our study, we suggest that reexamination of cases of RP
classified as Tos type III or IV, preferably with a microendoscope, if available,
and assessment of the depth of the RP using water-enhanced CT, would be useful
and that careful follow-up is necessary for deep RPs because of a potential risk 
of development into cholesteatoma.

Publication Types: 
    Comparative Study

PMID: 16151324 [PubMed - indexed for MEDLINE]

956: Otol Neurotol. 2005 Sep;26(5):830-3.

Fistula of the cochlear labyrinth in noncholesteatomatous chronic otitis media.

de Zinis LO, Campovecchi C, Gadola E.

Department of Otolaryngology, Head and Neck Surgery, University of Brescia,
Brescia, Italy. redaelli@med.unibs.it

OBJECTIVE: To discuss the clinical aspects and management of promontory fistula
of the cochlear labyrinth. STUDY DESIGN: Case report and review of the
literature. SETTING: University hospital, tertiary referral center. PATIENT,
INTERVENTION, AND RESULTS: The authors describe an unusual case of cochlear
fistula localized to the promontory discovered during tympanoplasty for
noncholesteatomatous chronic otitis media in a 59-year-old woman. Bone conduction
was slightly impaired after operation and hearing improved after a revision
myringoplasty performed for reperforation. CONCLUSION: Erosion of the bone of the
labyrinth can also be observed in noncholesteatomatous otitis media. The presence
of a fistula is not always associated with profound hearing loss. Overlying
pathologic tissue can be removed without damaging the membranous labyrinth.

Publication Types: 
    Case Reports

PMID: 16151323 [PubMed - indexed for MEDLINE]

957: J Pineal Res. 2005 Oct;39(3):283-6.

Effect of melatonin on lipid peroxidation, glutathione and glutathione-dependent 
enzyme activities in experimental otitis media with effusion in guinea pigs.

Taysi S, Ucuncu H, Elmastas M, Aktan B, Emin Buyukokuroglu M.

Department of Biochemistry, Nenehatun Obstetric and Gynecology Hospital, Erzurum,
Turkey. seytaysi@hotmail.com

Melatonin plays a role in the prevention of oxidative damage. In the present
study, we investigated whether the increased oxidative stress in experimental
otitis media with effusion (OME) induced by histamine is reflected in
erythrocytes and middle ear effusion fluid. Lipid peroxidation in effusion fluid 
was measured to determine the effects of melatonin on oxidative stress.
Erythrocyte and middle ear effusion malondialdehyde (MDA) levels, erythrocyte
glutathione (GSH) levels and glutathione peroxidase (GPx), glutathione reductase 
(GRd) and glutathione-S-transferase (GST) activities were measured in three
groups of six guinea pigs each at 3 hr after the injection of 0.1 mL of histamine
(or saline) into the middle ear. In erythrocyte and middle ear effusion samples, 
MDA levels showed a significant increase in guinea pigs with experimental OME
group when compared with the control animals. Erythrocyte GPx, GST, GRd
activities and GSH levels significantly reduced in experimental OME guinea pigs
when compared with the control and melatonin-treated animals. Erythrocyte GPx
activity also significantly increased after melatonin treatment when compared
with the control group. These findings suggest that reactive oxygen species play 
a role in histamine-induced OME. Pretreatment with melatonin increases
antioxidant enzyme activities and reduced formation of MDA, an indicator of lipid
peroxidation, in histamine-induced OME.

PMID: 16150109 [PubMed - indexed for MEDLINE]

958: Pediatr Infect Dis J. 2005 Sep;24(9):801-6.

Pneumococcal acute otitis media in relation to pneumococcal nasopharyngeal
carriage.

Syrjänen RK, Auranen KJ, Leino TM, Kilpi TM, Mäkelä PH.

Department of Vaccines, National Public Health Institute, Helsinki, Finland.
ritva.syrjanen@ktl.fi

BACKGROUND: Acute otitis media (AOM) is closely associated with viral upper
respiratory tract infections, but the most common microbial agent found in the
middle ear fluid during AOM is Streptococcus pneumoniae (Pnc). Pnc is also a
common colonizer of the nasopharynx, and its prevalence is further increased
during the viral infection. The aim of this study was to investigate the
interplay between viral infection, pneumococcal acquisition and carriage in the
development of Pnc AOM. METHODS: Pnc carriage was assessed in a longitudinal
study of 329 infants at scheduled visits at 3, 6, 9, 12, 15 and 18 months of age 
(N = 1715). The clinical outcome of the first episode of respiratory infection
("sick visit," N = 774) in the following 3-month period was recorded. The
occurrence and timing of Pnc AOM in relation to serotype specific carriage at the
start of the observation period were assessed. RESULTS: The occurrence, timing
and duration of symptoms of the sick visits or the frequency of overall AOM were 
not associated with preceding pneumococcal carriage. Pnc AOM was in each case
associated with concurrent carriage and 3.8 times (95% confidence interval,
1.4-10.0) more often with carriage acquired after the start of the observation
period than with carriage already present at the scheduled visit. In all, 79% (55
of 70) of Pnc AOM events were caused by a serotype acquired after the start of
the period. CONCLUSION: The majority of Pnc AOM events develop in association
with newly acquired carriage of pneumococcus.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16148847 [PubMed - indexed for MEDLINE]

959: Clin Diagn Lab Immunol. 2005 Sep;12(9):1130-4.

Difference in cytokine production and cell activation between adenoidal
lymphocytes and peripheral blood lymphocytes of children with otitis media.

Harimaya A, Tarkkanen J, Mattila P, Fujii N, Ylikoski J, Himi T.

Department of Otolaryngology, Sapporo Medical University School of Medicine,
Sapporo, Hokkaido 060-8543, Japan. harimaya@sapmed.ac.jp

We evaluated the immunological potential of adenoidal lymphocytes from children
with recurrent otitis media. Interleukin-4 release and CD69 expression were lower
in adenoidal lymphocytes than in peripheral blood lymphocytes (PBL). Our results 
suggest that there may be a difference between the immunological potential of
adenoidal lymphocytes and that of PBL in children with otitis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16148185 [PubMed - indexed for MEDLINE]

960: J Antimicrob Chemother. 2005 Oct;56(4):783-6. Epub 2005 Sep 6.

Effect of erythromycin treatment delay on therapeutic outcome of experimental
acute otitis media caused by Streptococcus pneumoniae.

Martínez-Marín C, Huelves L, del Prado G, García-Cía JI, Cenjor C, Ponte C,
Granizo JJ, Soriano F.

Unit for Research in Medical Microbiology and Antimicrobial Chemotherapy,
Otolaryngology, and Epidemiology, Fundación Jiménez Díaz--UTE, Avenida de Reyes
Católicos 2, 28040 Madrid, Spain.

OBJECTIVE: To evaluate the effect of delayed administration of erythromycin in
the course of acute otitis media caused by an erythromycin-susceptible
Streptococcus pneumoniae strain in the gerbil model. METHODS: The bacterium was
inoculated by transbullar challenge in the middle ear (ME) and antibiotic
treatment at different doses was administered at various times thereafter.
RESULTS: When 2.5 mg/kg of erythromycin was administered as a single dose 2, 5,
18 or 21 h post-inoculation (pi) the bacterial eradication rate was 55, 40, 0 and
0%, respectively. A higher dose (5 mg/kg) administered also as a single dose 2,
5, 18 and 21 h pi achieved bacterial eradication rates of 62.5, 43.8, 0 and 0%,
respectively. Using a very high dose (50 mg/kg) repeated three times at 3 h
intervals (total dose 150 mg/kg) and starting the treatment 21 h pi only achieved
bacterial eradication in 25% of cases. The concentration of erythromycin achieved
in the ME 90 min after administration of 5 mg/kg 5 or 21 h pi was very similar
(0.74 and 0.79 mg/L) but the ME half-life was longer (98.2 min) with the early
administration as compared with the delayed form (47.5 min), which could
partially explain the different results. Further experiments showed that the
failures observed with the delayed administration were not related to the time
elapsed from antibiotic administration to ME sampling or selection of
antibiotic-resistant mutants. CONCLUSION: Bacteriological and clinical efficacies
were significantly diminished if antibiotic administration was delayed.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16144869 [PubMed - indexed for MEDLINE]

961: Int J Pediatr Otorhinolaryngol. 2006 Apr;70(4):597-602. Epub 2005 Sep 6.

The reliability of self-reported childhood otitis media by adults.

Kvestad E, Kvaerner KJ, Røysamb E, Tambs K, Harris JR, Magnus P.

Division of Epidemiology, Norwegian Institute of Public Health, Pb 4404 Nydalen, 
N-0403 Oslo, Norway. ellen.kvestad@fhi.no

OBJECTIVE: To estimate reliability of retrospective questionnaire data on
childhood recurrent otitis media, and to identify factors influencing
inconsistency in self-report. METHODS: Retrospective questionnaire data from a
population-based sample of 4430 Norwegian twins who participated in two
questionnaire surveys, 6 years apart, containing identical questions on otitis
media. Main outcome measure was individual consistency in reporting of otitis
media. The tetrachoric correlation and Cohen's Kappa were used to measure
reliability. Inconsistent and consistent responders were compared on medical
history and mental distress. The use of twin data made it possible to test
whether inconsistent responders represent a group with intermediate levels of
otitis media severity. RESULTS: The test-retest tetrachoric correlation was 0.82 
and Kappa was 0.53. Inconsistency in response was not associated with mental
distress, but related to reported number of otitis media episodes per year, use
of medical services and history of ear surgery. CONCLUSION: Retrospective
self-reported otitis media is a relatively reliable measure. The study suggests
that reporting inconsistency is likely to be associated with less severe disease.
The finding that reporting pattern is related to disease severity is in
accordance with the proposed need for a uniform agreement on the definition of
the term "recurrent otitis media" for research purposes.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Twin Study

PMID: 16143406 [PubMed - indexed for MEDLINE]

962: Otolaryngol Head Neck Surg. 2005 Sep;133(3):357-61.

Association of reflux with otitis media in children.

Lieu JE, Muthappan PG, Uppaluri R.

Department of Otolaryngology--Head and Neck Surgery, Washington University School
of Medicine, St. Louis, MO 63110, USA. lieuj@ent.wustl.edu

OBJECTIVES: To confirm the finding of pepsin/pepsinogen in middle ear fluid of
children with chronic or recurrent otitis media (OME or ROM), and to ask parents 
about symptoms associated with gastroesophageal reflux (GER). METHODS: Middle ear
fluid was collected from children undergoing tympanostomy tube placement. We
tested this fluid for pepsin/pepsinogen using a proteolytic enzyme assay and an
ELISA. Parents completed questionnaires about symptoms of GER in their children. 
RESULTS: We collected 36 samples from 22 children; 16 of 22 children (73%) were
positive with the proteolytic assay; 17 (77%) were positive with ELISA.
Questionnaires did not show increased GER symptoms. CONCLUSIONS: We replicated
the finding of pepsin/pepsinogen in middle ear fluid of children with OME or ROM,
but did not find any increase in GER symptoms. Further research is needed to
establish a causative link between GER and OM.

PMID: 16143181 [PubMed - indexed for MEDLINE]

963: Otolaryngol Head Neck Surg. 2005 Sep;133(3):352-6.

Cost-utility analysis of tympanomastoidectomy for adults with chronic suppurative
otitis media.

Wang PC, Jang CH, Shu YH, Tai CJ, Chu KT.

Department of Otolaryngology, Cathay General Hospital, Fu Jen Catholic University
School of Medicine, Taipei, Taiwan.

OBJECTIVE: To undertake cost-utility analysis for tympanomastoid surgery to
analyze its cost-effectiveness in treating adult chronic suppurative otitis media
(CSOM). METHODS: Seventy-seven patients with CSOM were evaluated with the Chronic
Ear Survey (CES) before and 1 year after tympanomastoid surgery. Direct health
care cost data during the 1st year after operation were retrieved. The utility
gain was defined as change in the CES total score. The cost-utility ratio (CUR)
was defined as cost per utility gain. Patients were stratified by disease type
into wet-ear and dry-ear groups. RESULTS: The average total direct cost
attributable to tympanomastoid surgery is (in New Taiwan dollars) 45,716.3 in the
1st postoperative year, and the average CUR is 1850.9 New Taiwan dollars. The
lower CUR of 1280.9 New Taiwan dollars for the wet-ear group is due to the
greater utility gain (37.6 +/- 3.4 versus 24.4 +/- 6.8, P < 0.05) despite its
higher cost (48,163.2 New Taiwan dollars versus 38,419.7 New Taiwan dollars, P < 
0.05). CONCLUSIONS: Treating continuously or intermittently draining ears is more
cost-effective, as compared with managing a quiescent infection, because of its
favorable utility gain.

PMID: 16143180 [PubMed - indexed for MEDLINE]

964: Otolaryngol Head Neck Surg. 2005 Sep;133(3):347-51.

Bacteriemia during mastoidectomy and/or tympanoplasty.

Keleş E, Kizirgil A, Kaygusuz I, Karlidag T, Yalçin S, Alpay HC, Demir YS.

Firat Universitesi Firat, Elazig, Turkey. keleserol@yahoo.com

OBJECTIVE: To investigate the risk of bacteriemia development during surgery in
patients who underwent mastoidectomy and/or tympanoplasty for chronic otitis
media. PATIENTS AND METHODS: A total of 59 patients with chronic otitis media who
were undergoing tympanoplasty operation with or without mastoidectomy were
enrolled in this study. Smear cultures were obtained from outer ear canal and/or 
middle ears of all patients before the operation. Venous blood samples were
obtained before and after the operation for bacteriologic analysis. Smear
cultures were also obtained from the pressure dressing material that was applied 
during the operation for retrieval of the outer ear canal pressure. RESULTS:
There was a 13.5% difference between the outer ear canal and/or middle ear smear 
cultures and ear pressure dressing smear cultures of the same case. There was no 
growth in the blood cultures obtained before tympanoplasty in any of the involved
cases, however, in 5 (8.4%) of the culture samples obtained immediately after the
tympanoplasty operation, there was bacteriemia. In the pressure dressing smear
cultures obtained after the operation, 11 patients had microbial growth.
CONCLUSION: Risk of bacteriemia should be considered in the preoperative period
for the patients undergoing mastoidectomy especially in patients with
cardiovascular diseases, this is of importance for the dramatic consequences that
might arise after the operation. We also think that bacteriemia is also one of
the factors that influences graft success rate.

PMID: 16143179 [PubMed - indexed for MEDLINE]

965: Int J Pediatr Otorhinolaryngol. 2006 Feb;70(2):275-85. Epub 2005 Sep 2.

Pneumococcal conjugate vaccination in children with recurrent acute otitis media:
a therapeutic alternative?

van Kempen MJ, Vermeiren JS, Vaneechoutte M, Claeys G, Veenhoven RH, Rijkers GT, 
Sanders EA, Dhooge IJ.

Department of Otorhinolaryngology, Ghent University Hospital, Belgium.

BACKGROUND: Based on two clinical trials in healthy infants the American Academy 
of Pediatrics (AAP) advices immunization with a 7-valent pneumococcal conjugate
vaccine in children with recurrent acute otitis media (AOM). OBJECTIVE: To study 
the efficacy of a 7-valent pneumococcal conjugate vaccine on acute otitis media
recurrences, its immunogenicity and impact on nasopharyngeal Streptococcus
pneumoniae carriage in children with a history of frequent acute otitis media.
METHODS: In this double-blind, randomized study, 74 Belgian children, aged 1-7
years, with at least 2 clinically diagnosed episodes of acute otitis media in the
previous year were enrolled. Children were immunized with either a 7-valent
pneumococcal conjugate vaccine followed by a 23-valent pneumococcal
polysaccharide booster or a control hepatitis A vaccine. Total follow-up was 26
months. RESULTS: Despite adequate serum IgG responses to all conjugate vaccine
pneumococcal serotypes, no reduction of acute otitis media episodes was observed 
in the pneumococcal vaccine group as compared to the control group (rate ratio:
1.16; 95% CI: 0.69-1.96). Overall nasopharyngeal pneumococcal carriage remained
stable. However, a transient shift from conjugate vaccine related S. pneumoniae
serogroups to non-vaccine related serogroups was noted following conjugate
vaccination. CONCLUSION: Clinically no protective effect of pneumococcal
conjugate vaccination on acute otitis media recurrences was found in children
with a history of frequent AOM.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16140397 [PubMed - indexed for MEDLINE]

966: J Chin Med Assoc. 2005 Aug;68(8):347-52.

Ear problems in swimmers.

Wang MC, Liu CY, Shiao AS, Wang T.

Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan.

Acute diffuse otitis externa (swimmer's ear), otomycosis, exostoses, traumatic
eardrum perforation, middle ear infection, and barotraumas of the inner ear are
common problems in swimmers and people engaged in aqua activities. The most
common ear problem in swimmers is acute diffuse otitis externa, with Pseudomonas 
aeruginosa being the most common pathogen. The symptoms are itching, otalgia,
otorrhea, and conductive hearing loss. The treatment includes frequent cleansing 
of the ear canal, pain control, oral or topical medications, acidification of the
ear canal, and control of predisposing factors. Swimming in polluted waters and
ear-canal cleaning with cotton-tip applicators should be avoided. Exostoses are
usually seen in people who swim in cold water and present with symptoms of
accumulated debris, otorrhea and conductive hearing loss. The treatment for
exostoses is transmeatal surgical removal of the tumors. Traumatic eardrum
perforations may occur during water skiing or scuba diving and present with
symptoms of hearing loss, otalgia, otorrhea, tinnitus and vertigo. Tympanoplasty 
might be needed if the perforations do not heal spontaneously. Patients with
chronic otitis media with active drainage should avoid swimming, while patients
who have undergone mastoidectomy and who have no cavity problems may swim. For
children with ventilation tubes, surface swimming is safe in a clean, chlorinated
swimming pool. Sudden sensorineural hearing loss and some degree of vertigo may
occur after diving because of rupture of the round or oval window membrane.

Publication Types: 
    Review

PMID: 16138712 [PubMed - indexed for MEDLINE]

967: J Vet Diagn Invest. 2005 Jul;17(4):316-22.

Frequency, body distribution, and population size of Malassezia species in
healthy dogs and in dogs with localized cutaneous lesions.

Cafarchia C, Gallo S, Romito D, Capelli G, Chermette R, Guillot J, Otranto D.

Department of Animal Health and Welfare, Faculty of Veterinary Medicine,
University of Bari, Bari, Italy.

Malassezia species are commensal organisms of human and animal skin that
occasionally act as opportunistic pathogens. The lipid-dependent species are
associated with human skin disorders, whereas the non-lipid-dependent species
(Malassezia pachydermatis) is considered as an opportunistic secondary pathogen
affecting the canine skin surface and ear canal. This study evaluated the
relationship between Malassezia yeasts, their population size, and the occurrence
of skin lesions from healthy and skin-diseased dogs. The efficiency of
cytological examination and fungal culture for Malassezia detection was also
evaluated. From March 2002 to July 2003, 33 healthy dogs and 54 dogs with
pruritic localized skin diseases were examined; skin swabs (1218) were collected 
from 7 anatomical sites for culture and cytological examination. Malassezia
prevalence according to anatomical site and the agreement between cytological
results and fungal cultures were statistically analyzed. Differences in mean
colony forming unit counts between positive healthy and diseased dogs were
evaluated using the Bonferroni test for post hoc pair-wise comparisons. In
healthy dogs, Malassezia yeasts were most frequently isolated in the perianal and
perioral areas. The frequency of isolation and population size of Malassezia
species were higher in dogs with localized dermatitis, especially in affected
areas, indicating a role for Malassezia in the occurrence of skin lesions.
Malassezia pachydermatis was the species most commonly cultured from the skin and
external ear canal of healthy and diseased dogs; isolation of lipid-dependent
yeasts from healthy dogs was less frequent. Using fungal culture as the gold
standard, cytological examination showed good relative specificity (95%) but very
low relative sensitivity (30%).

PMID: 16130988 [PubMed - indexed for MEDLINE]

968: Int J Pediatr Otorhinolaryngol. 2006 Feb;70(2):311-7. Epub 2005 Aug 24.

Disease severity in patients referred to pediatric otolaryngologists with a
diagnosis of otitis media.

Poetker DM, Ubell ML, Kerschner JE.

Department of Otolaryngology and Communication Sciences, Medical College of
Wisconsin, Milwaukee, WI 53226, USA.

OBJECTIVE: This study evaluated disease severity of children referred to a
pediatric otolaryngology practice with a diagnosis of otitis media (OM) before
and after tympanostomy tube (TT) placement. METHODS: A retrospective review was
conducted of patients referred to a pediatric otolaryngology practice from
January 2000 to April 2004, with the chief complaint of middle ear effusion (MEE)
and/or OM. Patients who underwent TT placement had pre- and post-operative
hearing levels (HL) and bilaterality of disease analyzed. RESULTS: A total of 286
patients who underwent TT placement were included. Recurrent OM (ROM) was the
most common diagnosis (42.6%), followed by OM with effusion (OME) plus ROM (ROM +
OME) (31.7%) and then OME (25.7%) alone. The mean improvement in the pure tone
average (PTA) hearing level was 14.8 dB in patients with OME, 9.5 dB in patients 
with ROM + OME and 6.3 dB in patients with ROM alone. The hearing improvements in
OME and ROM + OME were statistically larger than the ROM group (P < or =0.0004). 
Hearing levels at 500, 1000, 2000 Hz and PTA showed statistically significant
improvements in HL after tube placement in each group (P < 0.0001). Of the
patients presenting with OME or ROM + OME, 70% had pre-operative findings
demonstrating bilateral MEE. CONCLUSION: Most children referred for consideration
of surgical management of OM have a diagnosis of ROM, or ROM in conjunction with 
OME, with only a small percentage having the diagnosis of OME alone. In addition,
the majority of children have bilateral disease, suggesting a more severely
affected patient population treated by the pediatric otolaryngologist. The
results also demonstrate a significant improvement in hearing after the placement
of TT. However, the long-term impact of this hearing improvement on a child's
development is not known and an additional prospective study of children in this 
population group is warranted.

PMID: 16125250 [PubMed - indexed for MEDLINE]

969: J Am Acad Audiol. 2005 May;16(5):301-11.

Measuring the ability of school children with a history of otitis media to
understand everyday speech.

Keogh T, Kei J, Driscoll C, Cahill L, Hoffmann A, Wilce E, Kondamuri P, Marinac
J.

Division of Audiology, University of Queensland, Brisbane, Australia.
t.keogh@uq.edu.au

The present study compared the ability of school-aged children with and without a
history of otitis media (OM) to understand everyday speech in noise using the
University of Queensland Understanding of Everyday Speech Test (UQUEST).
Participants were 484 children (246 boys, 238 girls) attending Grade 3 (272, mean
age = 8.25 yr., SD = 0.43) and Grade 4 (212, mean age = 9.28 yr., SD = 0.41) at
19 primary schools in Brisbane metropolitan and Sunshine Coast schools. Children 
selected for inclusion were native speakers of English with normal hearing on the
day of testing and had no reported physical or behavioral impairments. The
children were divided into three groups according to the number of episodes of OM
since birth. The results showed no significant differences in speech scores
across the participant groups. However, a significant difference in mean speech
scores was found across the grades and the noise conditions. Although children
with a history of OM performed equally well at a group level when compared to the
controls, they exhibited a large range of abilities in speech comprehension
within the same group.

Publication Types: 
    Comparative Study

PMID: 16119257 [PubMed - indexed for MEDLINE]

970: Clin Ther. 2005 Jun;27(6):786-94.

A comparison of 5 days of therapy with cefdinir or azithromycin in children with 
acute otitis media: a multicenter, prospective, single-blind study.

Block SL, Cifaldi M, Gu Y, Paris MM.

Kentucky Pediatric/Adult Research, Bardstown, 40004, USA. slblock@pol.net

BACKGROUND: Short-course therapy for acute otitis media (AOM) improves adherence 
and may reduce secondary bacterial resistance. METHODS: In this multicenter,
prospective, investigator-blinded study, patients between the ages of 6 months
and 6 years with a clinical diagnosis of AOM were randomized to receive cefdinir 
oral suspension 7 mg/kg q12h for 5 days or azithromycin oral suspension 10 mg/kg 
once daily on day 1 and 5 mg/kg once daily on days 2 through 5. Clinical response
was assessed at the end-of-therapy (EOT) visit (days 7-9) and the follow-up visit
(days 20-25). RESULTS: Three hundred fifty-seven patients were enrolled in the
study. The treatment groups were similar at baseline with respect to demographic 
characteristics (mean [SD] age, 3.0 [1.7] years; 55% male), incidence of
bilateral AOM (45%), and presenting signs and symptoms. The majority of evaluable
children (77%) had previously received conjugated heptavalent pneumococcal
vaccine (PCV7) against Streptococcus pneumoniae. At the EOT visit, clinical cure 
rates were comparable for cefdinir and azithromycin (87% [151/174] and 85%
[149/176], respectively; 95% CI, -5.5 to 9.8). In addition, clinical cure rates
at the EOT visit in the children who had been vaccinated with PCV7 were
comparable between cefdinir and azithromycin (86% vs 83%; 95% CI, -6.5 to 11.8). 
No significant difference in clinical cure rates was observed at the follow-up
visit (76% and 86%; 95% CI, -18.9 to 0.0). Parental satisfaction was similar
between treatment groups with regard to ease of use, taste, compliance, health
care resource utilization, and missed days of work and day-care. Both antibiotics
were well tolerated; diarrhea and abnormal stools were the most common
antibiotic-related adverse events (< or = 7% each). CONCLUSIONS: Short courses (5
days) of therapy with cefdinir or azithromycin were comparable in these children 
with AOM based on clinical end points, parental preferences, and health care
utilization.

Publication Types: 
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial

PMID: 16117986 [PubMed - indexed for MEDLINE]

971: Am J Manag Care. 2005 Aug;11(6 Suppl):S202-10.

Improving acute otitis media outcomes through proper antibiotic use and
adherence.

Brixner DI.

Department of Pharmacotherapy, Pharmacotherapy Outcomes Research Center, Salt
Lake City, UT, USA.

This article will discuss how therapy adherence may have an impact on acute
otitis media (AOM) outcomes. Although the relationship between therapy adherence 
and treatment failures in AOM has not been proved beyond question, many believe
that adherence with antibiotic therapy plays a key role in patient outcomes. Poor
adherence may contribute to treatment failures; treatment failures are known to
result in poorer health outcomes, higher total costs of care, and an increased
potential for bacterial resistance. As such, managed care organizations should
consider strategies for achieving better patient adherence with antibiotic
regimens for AOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16111443 [PubMed - indexed for MEDLINE]

972: Am J Manag Care. 2005 Aug;11(6 Suppl):S192-201.

Evolving shifts in otitis media pathogens: relevance to a managed care
organization.

Pichichero ME.

University of Rochester Medical Center, Rochester, NY, USA.

The microbiological landscape of acute otitis media (AOM) has been relatively
constant over the past half century. Because of this stability, empiric
management of AOM was a common and efficient practice. Recently, there has been a
proportional shift in the microbiology of AOM, bringing the choices for empiric
therapy into question. Because of this shift, managed care organizations should
review their formularies to ensure that they are structured to include and
promote the use of appropriate antibiotics. This article explores the background 
and events leading up to the shift in AOM microbiology; discusses the clinical
consequences and the future implications of the shift, such as increased costs
associated with treatment failures, its impact on new vaccines and new-onset AOM 
and related disease states, such as sinusitis; and describes why these factors
should be considered by managed care decision makers in their formulary
deliberations.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16111442 [PubMed - indexed for MEDLINE]

973: Clin Otolaryngol. 2005 Jun;30(3):258-65.

The impact of recurrent acute otitis media on the quality of life of children and
their caregivers.

Brouwer CN, Rovers MM, Maillé AR, Veenhoven RH, Grobbee DE, Sanders EA, Schilder 
AG.

Department of Pediatrics, Spaarne Hospital Haarlem, The Netherlands.

OBJECTIVE: To assess the quality of life of 384 Dutch children aged 1-7 years
with recurrent acute otitis media (AOM), and compare it with that of children
from four reference populations: (i) children from a general population; (ii)
children with mild-to-moderate asthma, (iii) children with mild-to-moderately
severe chronic illness, and (iv) US children with persistent or recurrent otitis 
media. DESIGN: Survey. SETTING: A general and an academic hospital (study
population of children with recurrent AOM, n = 384); general population (n = 225 
and 117); primary care (children with asthma, n = 64); community care (children
with chronic illness, n = 82); and a general hospital (children with persistent
or recurrent otitis media, n = 169). PARTICIPANTS: A total of 384 children aged
1-7 years who had experienced at least two episodes of AOM in the preceding year 
and their caregivers. MAIN OUTCOME MEASURES: Generic and disease-specific quality
of life as judged by the children's caregivers. Age-adjusted total and subscale
scores were compared with those of the reference populations. RESULTS: For all
generic questionnaires, children with recurrent AOM had poorer scores than
children from the general population. Quality of life of children with four or
more episodes of AOM in the preceding year was poorer than that of children with 
two to three episodes. Children with recurrent AOM scored lower on the
health-related questionnaire than children with mild-to-moderately severe chronic
illness. Quality of life of the present study population was similar to those of 
children with asthma and US children with chronic otitis media with effusion or
recurrent AOM. CONCLUSION: Recurrent AOM has a considerable negative impact on
the quality of life of children and causes concern to their caregivers. These
effects are proportional to the severity of the condition. Professionals involved
in the care of children with OM should be aware that OM not only affects physical
functioning but also general well-being of the child and its family. These
outcomes should therefore be included in the evaluation of the child with otitis 
media both in the clinical and research setting.

Publication Types: 
    Comparative Study

PMID: 16111423 [PubMed - indexed for MEDLINE]

974: Fam Pract. 2006 Feb;23(1):40-5. Epub 2005 Aug 17.

Long-term prognosis of acute otitis media in infancy: determinants of recurrent
acute otitis media and persistent middle ear effusion.

Damoiseaux RA, Rovers MM, Van Balen FA, Hoes AW, de Melker RA.

Julius Center of Health Sciences and Primary Care, University Medical Center
Utrecht, The Netherlands.

OBJECTIVES: Children under 2 years of age with acute otitis media are known to
have a relatively poor prognosis. The objective of this study was to assess
whether known determinants for recurrent acute otitis media and persistent middle
ear effusion after an episode of acute otitis media during childhood also apply
to children under 2 years. METHODS: Study design: prospective study of 210
children under 2, with identification of potential prognostic determinants.
Univariate and multivariate logistic regression analyses were applied to evaluate
which parameters independently contributed to the prediction of both outcome
measures (recurrent acute otitis media and persistent middle ear effusion). A
prognostic function was developed, and the area under the receiving operating
characteristic (ROC) was used to estimate the predictive ability of the
prognostic models. Population: children under 2 years of age with an episode of
acute otitis media in family practice. Outcomes measured: recurrent acute otitis 
media and persistent middle ear effusion. RESULTS: For the outcome recurrent
acute otitis media data from 210 children were used and winter season, male sex, 
passive smoking and persistent symptoms for more than 10 days at presentation
were independent prognostic determinants. For the outcome persistent middle ear
effusion data from 190 children were used and winter season, bilateral disease at
entry, a sibling history of recurrent acute otitis media, and a previous episode 
of acute otitis media independently predicted the outcome. No sufficiently
discriminatory prognostic model could be constructed for either outcome measure. 
CONCLUSION: Prediction of recurrent acute otitis media or persistent middle ear
effusion in individual young children remains poor.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16107490 [PubMed - indexed for MEDLINE]

975: Int J Pediatr Otorhinolaryngol. 2006 Feb;70(2):267-73. Epub 2005 Aug 15.

Adherence to therapeutic guidelines for acute otitis media in children younger
than 2 years.

Reuveni H, Asher E, Greenberg D, Press J, Bilenko N, Leibovitz E.

Department of Health Care Policy and Management, Ben-Gurion University of the
Negev, Beer-Sheva, Israel. reuvenil@bgu.ac.il

OBJECTIVES: to analyze adherence to therapeutic guidelines for AOM. METHODS:
Descriptive retrospective study of community primary care providers in southern
Israel. Study population (n = 590) included all children aged 0-48 months
diagnosed with AOM in PED during the year 2000 who had a referral letter from a
community physician and an AOM diagnosis confirmed by tympanocentesis. AOM
antibiotic treatment was considered appropriate when in accord with CDC and local
therapeutic guidelines. RESULTS: Referral letter data allowing characterization
of AOM by category were available in 471 (79.8%) children, 320 (68%) with simple 
AOM and 151(32%) with complicated AOM. AOM diagnosis made by the primary care
physician was in accord with PED diagnosis in 365/590 (62%) patients. Three
hundred and fifty-five (60.2%) patients did not receive antibiotics in the
community. Of 365 (62%) children diagnosed with AOM in the community, 235 (64.4%)
were treated with antibiotics prior to arrival to PED. Amoxicillin was prescribed
to 109 (46.4%), cefuroxime axetil to 48 (20.4%), amoxicillin/clavulanate to 31
(13.2%) and i.m. ceftriaxone to 20 (8.5%) of the patients. Eighty-three (25.9%)
patients with simple AOM were treated with antibiotics in the community and only 
46 (55.4%) received amoxicillin according to the therapeutic guidelines.
Eighty-one (53.6%) patients with complicated AOM were treated with antibiotics in
the community and only 41 (50.6%) of them received antibiotics according to AOM
therapeutic guidelines. More antibiotics were prescribed in the community to
patients with complicated AOM than to patients with simple AOM (81/151, 53.6%
versus 83/320, 25.9%, respectively, p < 0.001). Adherence to therapeutic
guidelines was similar between the simple and the complicated AOM groups (46/83, 
55.4% versus 41/81, 50.6%, respectively, p = 0.5). CONCLUSION: We found partial
adherence to AOM therapeutic guidelines among primary care providers in the
community in Southern Israel.

PMID: 16102848 [PubMed - indexed for MEDLINE]

976: Pediatr Infect Dis J. 2005 Aug;24(8):731-2.

Epidemiologic study of conjunctivitis-otitis syndrome.

Bingen E, Cohen R, Jourenkova N, Gehanno P.

Service de Microbiologie, Hôpital Robert Debré, Paris, France.
edouard.bingen@rdb.ap-hop-paris.fr

We conducted a prospective cross-sectional epidemiologic study of
conjunctivitis-otitis syndrome during two 3-week periods of consecutive winters. 
A representative sample of 184 pediatricians and ear, nose and throat specialists
in the Paris area recruited 2901 children from 6 to 36 months of age presenting
with acute otitis media, of whom 465 (16%) also had purulent conjunctivitis. In
sampled children, the culture of the conjunctival exudate yielded bacterial
pathogens in 419 patients: Haemophilus influenzae, 371 (89%); Streptococcus
pneumoniae, 72 (17%); and Branhamella catarrhalis, 23 (5%). Pulsed field gel
electrophoresis analysis of paired H. influenzae isolates from the conjunctival
exudate and middle ear fluid of 21 patients showed identical strains in each
patient.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16094231 [PubMed - indexed for MEDLINE]

977: Laryngoscope. 2005 Aug;115(8):1512-6.

Long-term clinical, audiologic, and radiologic outcomes in palate cleft children 
treated with early tympanostomy for otitis media with effusion: a controlled
prospective study.

Valtonen H, Dietz A, Qvarnberg Y.

Department of Otorhinolaryngology, Kuopio University Hospital, PO Box 1277,
FIN-70211 Kuopio, Finland. hannu.valtonen@kuh.fi

OBJECTIVES: The role of tympanostomy in the treatment of otitis media with
effusion (OME) in children with palate cleft with regard to the otologic and
audiologic outcome is controversial. Little is known about the development of the
mastoid air cell system (MACS) in these children. STUDY DESIGN: Controlled,
prospective. METHODS: All children born in the hospital district area of the
Central Hospital of Central Finland during the years 1983 to 1993 with palate
cleft were reviewed at the age of 6 months. A total of 39 patients were followed 
up for 6 years after primary tympanostomy. Otologic and audiologic data were
collected, and the MACS size was planimetrically measured. The control group
consisted of age-matched children without palate cleft suffering from OME and
were identically reviewed. RESULTS: The otologic outcome was similar in the study
group, 64.1%, and among the controls, 60.6% were healed. There were no serious
otologic complications in the study group. The audiologic outcome was also
similar, with a mean pure-tone average (0.5-2 kHz) of 10.5 dB and 10.9 dB for the
corresponding groups. The initial size and growth of the MACS did not
significantly differ between the groups. CONCLUSIONS: The prognosis of children
with palate cleft treated with early tympanostomy is favorable and does not
differ from children without palate cleft. Active treatment ensures normal
hearing during the critical years of language, speech, and cognitive development 
and maintains the development of an aerated mastoid. We believe that early
tympanostomy is the treatment of choice of OME in palate cleft children.

Publication Types: 
    Clinical Trial
    Comparative Study

PMID: 16094135 [PubMed - indexed for MEDLINE]

978: Laryngoscope. 2005 Aug;115(8):1469-72.

Mucosal biofilm formation on middle-ear mucosa in a nonhuman primate model of
chronic suppurative otitis media.

Dohar JE, Hebda PA, Veeh R, Awad M, Costerton JW, Hayes J, Ehrlich GD.

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 3705
5th Avenue, Pittsburgh, PA 15213, USA. Joseph.Dohar@hp.edu

BACKGROUND: An increased awareness of bacterial biofilms and their formation has 
led to a better understanding of bacterial infections that occur in the middle
ear. Perhaps the best studied pathogen for its propensity toward biofilm
formation is Pseudomonas aeruginosa, also the primary pathogen in chronic
suppurative otitis media (CSOM). OBJECTIVE: The aim of this study was to
determine whether P. aeruginosa forms a biofilm in the middle ear in the setting 
of CSOM in a nonhuman primate model. METHODS: Cynomolgus monkeys underwent
perforation of the tympanic membrane and inoculation of the middle ear with a
known biofilm-forming strain of P. aeruginosa. The contralateral ear was used as 
an internal control and was neither perforated nor infected. At the end of the
study period, both ears were irrigated to remove planktonic bacteria, and the
middle ear mucosa was removed and examined ultrastructurally using scanning
electron microscopy (SEM) for determination of the presence or absence of biofilm
formation. MAIN OUTCOME MEASURE: The identification of middle ear biofilm
containing rod-shaped bacteria. RESULTS: SEM revealed that P. aeruginosa formed
bacterial biofilm in vivo on the middle ear mucosal surface, seen only in the
infected ear. Interestingly, biofilm formation caused by cocci was also seen in
both the experimental as well as the control ear. CONCLUSION: P. aeruginosa forms
biofilms in the middle ear in CSOM in primates. To our knowledge, this is the
first report of disease-associated bacterial biofilm in a nonhuman primate model 
of CSOM. Such a model lays a foundation for much needed study into the role of
biofilms in the pathophysiology of CSOM. Should CSOM be caused by biofilms, which
is uncertain at this time, development of novel strategies for treatment and
prevention may be possible. The finding of both rods and cocci forming biofilms
also warrants further investigation.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 16094127 [PubMed - indexed for MEDLINE]

979: N Engl J Med. 2005 Aug 11;353(6):576-86.

Comment in:
    J Pediatr. 2006 Jan;148(1):144.

Developmental outcomes after early or delayed insertion of tympanostomy tubes.

Paradise JL, Campbell TF, Dollaghan CA, Feldman HM, Bernard BS, Colborn DK,
Rockette HE, Janosky JE, Pitcairn DL, Kurs-Lasky M, Sabo DL, Smith CG.

Department of Pediatrics, School of Medicine, University of Pittsburgh,
Pittsburgh, USA. jpar@pitt.edu

BACKGROUND: To prevent later developmental impairments, myringotomy with the
insertion of tympanostomy tubes has often been undertaken in young children who
have persistent otitis media with effusion. We previously reported that prompt as
compared with delayed insertion of tympanostomy tubes in children with persistent
effusion who were younger than three years of age did not result in improved
developmental outcomes at three or four years of age. However, the effect on the 
outcomes of school-age children is unknown. METHODS: We enrolled 6350 healthy
infants younger than 62 days of age and evaluated them regularly for middle-ear
effusion. Before three years of age, 429 children with persistent middle-ear
effusion were randomly assigned to have tympanostomy tubes inserted either
promptly or up to nine months later if effusion persisted. We assessed
developmental outcomes in 395 of these children at six years of age. RESULTS: At 
six years of age, 85 percent of children in the early-treatment group and 41
percent in the delayed-treatment group had received tympanostomy tubes. There
were no significant differences in mean (+/-SD) scores favoring early versus
delayed treatment on any of 30 measures, including the Wechsler Full-Scale
Intelligence Quotient (98+/-13 vs. 98+/-14); Number of Different Words test, a
measure of word diversity (183+/-36 vs. 175+/-36); Percentage of Consonants
Correct-Revised test, a measure of speech-sound production (96+/-2 vs. 96+/-3);
the SCAN test, a measure of central auditory processing (95+/-15 vs. 96+/-14);
and several measures of behavior and emotion. CONCLUSIONS: In otherwise healthy
children younger than three years of age who have persistent middle-ear effusion 
within the duration of effusion that we studied, prompt insertion of tympanostomy
tubes does not improve developmental outcomes at six years of age. Copyright 2005
Massachusetts Medical Society.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 16093466 [PubMed - indexed for MEDLINE]

980: Acta Paediatr. 2005 Apr;94(4):423-8.

Accuracy of acute otitis media diagnosis in community and hospital settings.

Asher E, Leibovitz E, Press J, Greenberg D, Bilenko N, Reuveni H.

Department of Health Care Policy and Management, Ben-Gurion University of the
Negev, Beer-Sheva, Israel.

AIM: To evaluate the accuracy rates of acute otitis media (AOM) diagnosis in the 
community by analyzing the initial AOM diagnosis (according to information from
the referral letters to the Pediatric Emergency Department [PED]) among children 
with AOM diagnosis confirmed by tympanocentesis at PED. METHODS: A descriptive,
retrospective study conducted during the year 2000, including 590 children aged
0-48 mo diagnosed with AOM at PED. AOM was confirmed by tympanocentesis. We
defined: (1) simple AOM as < 3 or < 4 episodes during the last 6 or 12 mo,
respectively; (2) complicated AOM as > or = 3 or > or = 4 episodes during the
last 6 or 12 mo, respectively, and/or not improving with antibiotics. RESULTS:
571 (96.8%) were < 24 mo of age; 355 (60%) were Arab Bedouins and 235 (40%) Jews.
Seventy-three pediatricians, 57 general practitioners and 27 family practitioners
provided referral letters. Information on disease severity was available in
471/590 (79.8%) patients, of whom 320 (68%) had simple and 151 (32%) complicated 
AOM. Three hundred and sixty-five (62%) of 590 patients were accurately diagnosed
by referring physicians, more frequently in patients with complicated than simple
AOM (p < 0.001). Diagnostic accuracy was similar among physician specialties (p =
0.33) and ethnic groups (p = 0.11). Multivariable logistic regression analysis
showed that complicated AOM, adjusted for age, sex, ethnic origin, and physician 
specialty, was the only predictive factor for accurate AOM diagnosis (odds ratio 
4.0, p < 0.001). CONCLUSIONS: Inaccurate diagnosis of AOM in community settings
is common, occurring more frequently in simple than in complicated AOM, and is
unrelated to physician specialty and children's ethnicity.

PMID: 16092455 [PubMed - indexed for MEDLINE]

981: J Otolaryngol. 2005 Jun;34 Suppl 1:S33-9.

Complications of otitis media: an evolving state.

Agrawal S, Husein M, MacRae D.

Department of Otolaryngology-Head and Neck Surgery, University of Western
Ontario, London Health Sciences Centre, London, ON.

The advent of antibiotics in the 1930s and 1940s has led to a decline in the
incidence of otitis media complications. However, otitis media and its
complications are continuing to evolve owing to the emergence of antibiotic
resistance and the introduction of pneumococcal vaccines. Modern high-resolution 
computed tomographic scans have allowed for earlier diagnosis when signs and
symptoms are present, but a high index of suspicion must be maintained because
the clinical presentation may be quite subtle. The intent of this article is to
discuss the intracranial and extracranial complications of acute and chronic
otitis media. The clinical presentation, work-up, and management of the
individual complications are presented.

Publication Types: 
    Review

PMID: 16089238 [PubMed - indexed for MEDLINE]

982: J Otolaryngol. 2005 Jun;34 Suppl 1:S24-32.

Otitis media and the new guidelines.

Kenna MA.

Department of Otolaryngology and Communication Disorders, Children's Hospital
Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
margaret.kenna@childrens.haward.edu

Otitis media, including recurrent acute otitis media (AOM) and otitis media with 
effusion (OME), is one of the most common reasons for an illness-related visit to
the primary care clinician. Until recently, antibacterial therapy was the
standard treatment for most episodes of AOM and often for OME. However, in 1994, 
a clinical practice guideline on OME was developed by the Agency for Healthcare
Policy and Research (now the Agency for Healthcare Research and Quality) and
applied to normal children aged 1 to 3 years. The recommendations in the 1994
guideline were evidence based, widely discussed, and somewhat controversial but
also acted as a starting point for some ideas about standardization of management
of this very common disease. In 2004, revised clinical practice guidelines were
published for OME that applied to children aged 2 months to 12 years and included
children with developmental disabilities and underlying conditions that
predispose them to OME. In addition, a new evidence-based clinical practice
guideline for AOM was published in 2004. This guideline recognized that many
episodes of AOM will resolve on their own without antimicrobial therapy, and on
that basis, one of the recommendations for initial treatment of AOM in specified 
situations was watchful waiting without antibacterial therapy. This article
briefly discusses the current knowledge about AOM and OME and then addresses the 
new AOM and OME guidelines point by point. It is important to remember that
although important, these clinical practice guidelines are just guidelines and
that actual management of the patient with otitis media depends on clinical
judgement, the severity of the illness, other underlying medical conditions,
ready access to adequate follow-up care, and other features, such as cultural
differences. Surgical recommendations were not included in the AOM guidelines but
were addressed in the OME guidelines. Further information about the efficacy and 
effectiveness of both sets of guidelines will likely include the results of
prospective studies using the guidelines in both normal children and those with
underlying medical conditions.

Publication Types: 
    Review

PMID: 16089237 [PubMed - indexed for MEDLINE]

983: J Otolaryngol. 2005 Jun;34(3):149-59.

Inflammatory chronic otitis media and the anterior epitympanic recess.

Mansour S, Nicolas K, Naim A, Yamine F, Moukarzel N, Nehme A.

Division of Otolaryngology, Sacré-Coeur Hospital, Lebanese University, Hazmieh,
Baabada, Lebanon.

OBJECTIVE: To demonstrate the important role of the anterior epitympanic recess
(AER) in the surgery of noncholesteatomateous chronic inflammatory middle ear
disorders. To establish selective criteria as to the indication of surgical
intervention on the AER, aiming to create a permanent anterior aeration pathway
for the attic. In addition, to point out the mandatory role of preoperative
temporal bone computed tomography (CT) demonstrating whether the AER is involved 
and thus contributing, within the clinical context, to the indication for this
surgery and its appropriate approach. STUDY DESIGN: Prospective study on patients
with persistent or recurring chronic inflammatory middle ear disease for at least
3 years, after failure of conventional medical or surgical treatments. SETTING:
Tertiary referral university centre. PATIENTS: Between November 2002 and July
2003, every patient presenting with clinical findings suggestive of an AER
pathology was included in this study. SURGERY: Surgical approach of the AER
during a mastoatticotomy and tympanoplasty with excision of the Cog and the
tensor tympani fold, preserving the ossicular chain in almost all cases. OUTCOME 
MEASURES: Absence of postoperative otorrhea, satisfactory otoscopic examination, 
and improvement in the air-bone gap postoperatively in case the presurgery
hearing level was abnormal and not due to an ossicular chain abnormality.
RESULTS: Eight patients were included in the study. The preoperative CT scan
showed AER opacities in all patients that were either isolated or associated with
a diseased meso- or hypotympanum or the mastoid cavity. The measurement of the
relevant transverse diameter of the AER is proposed to evaluate preoperatively
the distance between the Cog laterally and the facial nerve canal medially to
minimize the risk of a perioperative injury. During the operation, we found
granulation tissue and adhesions in the AER in all cases A clinical follow-up 3
months after the intervention showed good local control in all patients, absence 
of otorrhea, and almost complete closure of the air-bone gap at audiometric
evaluation. The last clinical follow-up in August 2004, a mean of 18 months after
our intervention, did not reveal any relapse of symptoms in any case. CT control 
could be obtained in five of eight cases, within 13 to 21 months after the
intervention, showing a reaerated tympanic cavity and AER. CONCLUSION: The AER
plays a major role in sustaining some noncholesteatomateous chronic or recurrent 
inflammatory middle ear disorders that do not respond to conventional medical
treatment. Definitive control of this pathology will be obtained by approaching
the AER through an excision of the Cog and the tensor tympani fold, exenterating 
the inflammatory tissues, and creating a sufficient and permanent anterior
atticomesotympanic communication. The indication for such a surgical approach is 
highly dependent on clinical findings correlated to temporal bone CT. Familiarity
with the AER and its critical role should become part of every resident's
training program in otology.

PMID: 16089217 [PubMed - indexed for MEDLINE]

984: Otolaryngol Head Neck Surg. 2005 Aug;133(2):206-10.

Penicillin reduces eustachian tube gland tissue changes in acute otitis media.

Andersen H, Thomsen J, Cayé-Thomasen P.

Department of Oto-rhino-laryngology, Head and Neck Surgery, Gentofte University
Hospital of Copenhagen, Copenhagen, Denmark.

OBJECTIVE: The volume of the mucous paratubal glands and the number of the
mucus-producing goblet cells in the middle ear and Eustachian tube (ET) are
increased after experimental acute otitis media (AOM). The present investigation 
examines a potential effect of penicillin on the changes in goblet cell density
and gland structures of the ET during and after AOM. STUDY DESIGN: Middle ear
inoculation of Streptococcus pneumoniae in 50 rats. Two days later, 25 rats were 
given penicillin V as one daily dose for 5 days. Twenty-five rats received no
treatment. Five animals from each group were sacrificed on days 4, 8, 16, 90, and
180. The ET was dissected and decalcified, followed by paraffin embedding, serial
transverse sectioning, and PAS/alcian blue staining. The goblet cell density and 
the paratubal gland composition and volume were determined in every 20th section,
using a light microscope. RESULTS: Penicillin reduced the increase of goblet cell
density from day 8 and through 6 months, whereas the increase of the paratubal
mucous gland volume was unaffected by treatment. CONCLUSION: We conclude that
penicillin reduces the increase of ET goblet cell density during and after acute 
otitis media, whereas the paratubal gland volume remains unaffected. An increased
mucosal secretory capacity and indicated excessive secretion of mucus may
contribute to the deteriorated ET function found after AOM and thus predispose,
sustain, or aggravate middle ear disease. This may be prevented by penicillin
treatment.

Publication Types: 
    Comparative Study

PMID: 16087016 [PubMed - indexed for MEDLINE]

985: Indian Pediatr. 2005 Jul;42(7):686-91.

Identification of Chlamydia trachomatis with polymerase chain reaction in middle 
ear fluid in otitis media with effusion.

Keles E, Bulut Y, Kaygusuz I, Karlidag T, Yalçin S, Ozdarendeli A, Alpay HC.

University Medical Faculty Otorhinolaryngology, Department Elazig, Turkey.
keleserol@yahoo.com

In this study, 78 middle ear aspiration samples from 59 children between the ages
of 2 14 who have undergone myringotomy under general anesthesia were included.
The presence of DNA genome of Chlamydia trachomatis was analyzed with polymerase 
chain reaction in the aspiration material. The relationship between the nature of
the effusion fluid and the presence of Chlamydia trachomatis was investigated. Of
the seventy eight middle ear effusions, 26 (33.3%) were serous, 31 were (39.7%)
mucoid and 21 (26.9%) were sero mucoid in nature. Chlamydia trachomatis DNA
genome was identified in seven (8.9%) effusion samples. Of these, three were
mucoid (42.8%), three were serous (42.8%) and one was sero mucoid (14.2%) in
character. We think that during the bacteriological analyses carried out for the 
cases of otitis media with effusion, Chlamydia trachomatis should be taken into
consideration both at the time of diagnosis and the treatment.

PMID: 16085970 [PubMed - indexed for MEDLINE]

986: Rev Laryngol Otol Rhinol (Bord). 2005;126(1):15-8.

Mast cells in chronic inflammation of the middle ear mucosa.

Sankovic S, Dergenc R, Bojic P.

ORL Clinic, Clinic Hospital Centre Zvezdara, Belgrade. sreckob@1100imp.bg.ac.yu

AIM OF THE STUDY: The number, distribution and degranulation frequency of mast
cells have been studied in the middle ear mucosa biopsies of patients with
chronic otitis media. MATERIALS AND METHODS: The pathohistological analysis has
been performed on 115 biopsy specimens, taken intraoperatively from the different
regions of the middle ear cleft in 27 patients with chronic otitis media and in
15 children with otomastoiditis which occurred during the treatment of secretory 
otitis media. Mast cells were identified on the basis of metachromatic staining
for histamine and heparin granules. RESULTS: The findings of this study confirm
that the number of mast cells is increased in all areas of middle ear cleft in
chronic inflammation of the middle ear mucosa. Mast cells were identified in 108 
out of 115 analysed samples. In chronic otitis media of atticoantral and
tubotympanic type mast cells were present in 91.5% of samples, the cells with
heparin granules were present in 62.2% and degranulation frequency was 37.8%. In 
secretory otitis media 33 mucosal samples were analysed and all samples contained
mast cells with predominance of histamine granules and with de granulation
frequency of 81.8%. CONCLUSION: These findings indicate that mast cells have
complex function in pathophysiology of chronic inflammation of the middle ear
mucosa: it may take part in amplification of inflammation as well as in its
limitation. Further studies are needed to clarify the role of histamine and
heparin in chronic inflammatory reactions of the middle ear mucosa.

PMID: 16080642 [PubMed - indexed for MEDLINE]

987: Acta Otolaryngol. 2005 Jun;125(6):580-4.

Squamous cell metaplasia of the nasopharyngeal epithelium and its association
with adult-onset otitis media with effusion.

Doğru H, Yasan H, Candir O, Tüz M, Ciriş M.

Department of Ear Nose and Throat-Head and Neck Surgery, School of Medicine,
Süleyman Demirel University, Isparta, Turkey.

CONCLUSION: The common association between adult-onset otitis media with effusion
(AO-OME) and squamous cell metaplasia (SCM) of the epithelium of Rosenmüller's
fossa, which is near the Eustachian tube orifice, implies the predictive role of 
metaplasia, which probably compromises the drainage function of the middle ear.
OBJECTIVE: To determine the effects of nasopharyngeal epithelial changes (SCM) on
AO-OME. AO-OME is a multifactorial and insidious disease that may necessitate
detailed investigation, i.e. biopsy of the nasopharynx, because of possible
underlying nasopharyngeal malignancy. MATERIAL AND METHODS: Fifty-two patients
with AO-OME (study group) and 29 with a unilateral neck mass in the posterior
triangle without AO-OME (control group) were enrolled. Nasopharyngeal biopsies
taken from all subjects were evaluated with regard to surface epithelial changes 
of the nasopharynx. RESULTS: Nasopharyngeal biopsies revealed SCM in 34/52
patients (65%) in the study group and 9/29 (31%) in the control group (p<0.05).
During the follow-up period, recurrence of effusion occurred in 56% of the group 
with SCM and 22% of the group without it.

PMID: 16076705 [PubMed - indexed for MEDLINE]

988: J Otolaryngol. 2005 Aug;34 Suppl 2:S64-9.

Medical management of middle ear disease in children less than 2 years of age
with sensorineural hearing loss.

Westerberg BD, Morzaria S, Kozak FK, Price D.

Division of Otolaryngology, University of British Columbia, Vancouver, BC,
Canada. BWesterberg@providencehealth.bc.ca

OBJECTIVE: With emerging early hearing detection and communication development
programs, physicians are increasingly requested to review young children with
sensorineural hearing loss (SNHL) and associated conductive hearing loss (CHL).
The purpose of this critical review is to develop an evidence-based approach to
the management of the child less than 2 years of age with fluctuating CHL and
coexisting SNHL. METHODS: A critical review of the 1966-2002 MEDLINE database was
performed to address the diagnosis, natural history, and management of otitis
media with effusion (OME) and the management of acute otitis media (AOM) in the
child under 2 years of age with underlying SNHL. RESULTS: Pneumatic otoscopy
should be used to diagnose middle ear effusion. Clearance of OME may be prolonged
in children with craniofacial abnormalities. Antibiotics provide a small
short-term increase in the resolution of OME and may be warranted in children
with coexisting SNHL and OME for 4 to 6 weeks. If OME persists for 8 to 12 weeks,
bilateral myringotomy and tube placement (BM&T) with short-term tubes will
improve hearing and help resolve OME. AOM in children less than 2 years of age
should be treated with a 10-day course of antibiotics. Prophylactic antibiotics
may be useful in avoiding tube placement in children less than 2 years of age
with recurrent AOM. BM&T with short-term tubes are recommended if recurrent AOM
persists. Pneumococcal vaccination can decrease episodes of AOM by 6 to 7%.
CONCLUSIONS: An evidence-based algorithm for the management of fluctuating CHL in
children less than 2 years of age with an underlying SNHL is presented.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 16076419 [PubMed - indexed for MEDLINE]

989: J Otolaryngol. 2005 Aug;34 Suppl 2:S60-3.

Guidelines for the treatment of tympanostomy tube otorrhea.

Daniel SJ, Kozak FK, Fabian MC, Hekkenberg R, Hruby LE, Harjee KS, Rana R, Lubell
RF, Hawke M; Expert round table of pediatric and general otolaryngologists,
pediatricians, and family physicians.

Division of Otolaryngology, Montreal Children's Hospital, Montreal, QC, Canada.
sam.daniel@muhc.mcgill.ca

Treatment of tympanostomy tube otorrhea has evolved with numerous studies
demonstrating the superiority of topical therapy in the form of eardrops over
systemic antibiotic therapy. Many physicians have been concerned about
ototoxicity with antibiotic eardrops because several ototopical agents have a
risk of vestibular and cochlear damage, which may be permanent. An expert round
table of pediatric and general otolaryngologists, pediatricians, and family
physicians met in Quebec City in May 2004 to develop practical Canadian
guidelines for the safe treatment of tympanostomy tube otorrhea. The
recommendations and guidelines are outlined.

Publication Types: 
    Consensus Development Conference
    Guideline
    Practice Guideline
    Research Support, Non-U.S. Gov't
    Review

PMID: 16076418 [PubMed - indexed for MEDLINE]

990: J Otolaryngol. 2005 Aug;34 Suppl 2:S52-5.

Topical treatment for otorrhea: issues and controversies.

Bance M, Rutka JA.

Division of Otolaryngology, Dalhousie University, Halifax, NS, Canada.
m.bance@dal.ca

Otorrhea is a symptom and not a diagnosis. It can be caused by many disease
processes. There are several reasons to consider topical treatment of otorrhea.
Two are that greater concentrations can be reached locally of pharmacologically
active agents and there is less risk of systemic complications and side effects. 
One factor that might prevent their efficacy is the formation of biofilms by
pathogenic organisms. Topical treatments usually include antimicrobial agents.
There is evidence that aminoglycoside-containing drops can cause ototoxicity,
particularly insidious vestibular ototoxicity. Nonaminoglycosides are recommended
if there is access to the middle ear. There is some evidence that the addition of
steroids hastens resolution. There is little evidence on which to estimate the
risk reduction of serious complications of otitis media from treatment with
topical therapy. In some causes of otorrhea, nonmicrobial treatments might be
just as effective. Individualized therapy is recommended.

Publication Types: 
    Review

PMID: 16076416 [PubMed - indexed for MEDLINE]

991: Int J Pediatr Otorhinolaryngol. 2005 Sep;69(9):1225-33.

Amoxicillin-sulbactam versus amoxicillin-clavulanic acid for the treatment of
non-recurrent-acute otitis media in Argentinean children.

Casellas JM Jr, Israele V, Marín M, Ishida MT, Heguilen R, Soutric J, Arenoso H, 
Sibbald A, Stamboulian D.

Pediatric Infectious Diseases, Hospital de Niños de San Isidro, French 3085, 1425
Buenos Aires, Argentina. javier_casellas@yahoo.com.ar

Streptococcus pneumoniae (Sp) and Haemophilus influenzae (Hi) are the leading
bacterial cause of acute otitis media (AOM), having the nasopharynx (NP) as their
reservoir. In October 2001 we began a prospective, multicenter, randomized,
evaluator blind study, comparing the efficacy of amoxicillin-sulbactam (Ax/S) and
amoxicillin-clavulanic acid (Ax/C) for the treatment of non-recurrent AOM
(nr-AOM). Both antimicrobial susceptibility (AS) to Ax/S and Ax/C from Sp and Hi 
carried by study children (aged 6-48 months with nr-AOM) and, clinical outcome
after treatment with high dose of either Ax/C (7:1) or Ax/S (4:1) (amoxicillin
dose: 80 mg/(kg day), b.i.d. for 10 days) were assessed. Nasal cultures (NCs)
were taken at Day 0. Follow-up NCs, were done only for Sp carriers. On final
analysis 247/289 pts (85.5%) were fully evaluable (120 Ax/S and 127 Ax/C). NP
carriage rate of Hi and Sp at Day 0 was 32.2% (93/289 pts) and 28.7% (83/289
pts), respectively. Persistent Sp carriage was detected only in 2 pts. Hi
betalactamase positive rate was 13% (12/93). MICs for Ax/S and Ax/C were
identical when tested against Sp and Hi isolates (range < or = 0.016-1.0 and < or
= 0.016-0.25 mg/L, respectively). Clinical efficacy at Days 12-14 and 28-42 were 
98.3% (115/117) and 94.2% (97/103) for Ax/S; and 98.3% (115/117) and 95.1%
(98/103) for Ax/C, respectively (pNS). We conclude, that Sp and Hi isolated from 
NCs of nr-AOM pts were highly sensitive to both drugs and correlated with high
clinical efficacy rate.

Publication Types: 
    Multicenter Study
    Randomized Controlled Trial

PMID: 16061111 [PubMed - indexed for MEDLINE]

992: Mymensingh Med J. 2005 Jul;14(2):152-5.

Prevalence of CSOM among rural school going children.

Biswas AC, Joarder AH, Siddiquee BH.

Department of Otolaryngology and Head-Neck Surgery, BMC, Dhaka.

A prospective study was carried out from January 2001 to December 2002 to find
the prevalence of CSOM among rural school going children. Altogether 225 students
aged 4-13 years from five primary schools and junior high schools of Magura
district were interviewed and examined. 28 (12.44%) children were found to have
CSOM. Out of these 28 cases, 25 came from lower and 3 from middle income group
families. No case of CSOM was found in higher income group family. In this study 
73.33% mothers were not aware of CSOM. 60% mothers had no knowledge about
treatment and sequelae of CSOM. Only (5.78%) people use cotton bud to clean ear
while majority use unhygienic materials like matchstick, cloth with stick and
chicken feathers. Treatment seeking pattern was observed in our study. 10.71%
cases did not receive any treatment and remaining 89.29% received treatment of
which 25% from MBBS doctor or Hospital and 7.14%, 35.71%, 10.71%, 10.71% received
it from Kabiraj, Quack, Homeopathy doctor, and salesman of pharmacy respectively.

PMID: 16056201 [PubMed - indexed for MEDLINE]

993: Kulak Burun Bogaz Ihtis Derg. 2004;13(3-4):51-6.

The role of allergy in the etiology of otitis media with effusion; immune system 
and cytokines.

Keleş E, Yalçin S, Bulut V, Kaygusuz I, Karlidağ T, Alpay HC.

Department of Otolaryngology, Medicine Faculty of Firat University, Elaziğ,
Turkey. keleserol@yahoo.com

OBJECTIVES: Otitis media with effusion (OME) is one of the major causes of
hearing loss in childhood. In this study, the role and the importance of allergy 
in the etiology of OME was evaluated with reference to the immune system and the 
cytokines. PATIENTS AND METHODS: Seventy-eight ears of 59 patients who had
undergone myringotomy with the diagnosis of OME were included in this study.
Serum samples of 26 healthy children who were in the same age group and were
living in the same region under similar socioeconomic circumstances were examined
as the control group. RESULTS: Interferon (IFN)-gamma levels were significantly
lower and IL-4 and IgE levels were significantly higher in the serum samples of
the patient group when compared with those of the control group (p<0.05). A
positive correlation was found between IL-4 and IgE in the serum samples of
patients (p<0.01). However, there were negative correlations between IFN-gamma
and both IgE and IL-4 levels, that were not statistically significant.
CONCLUSION: T-helper polarization suggests that allergy may have a role in the
etiology of OME. Therefore, it should be kept in mind in the treatment of OME.

PMID: 16055981 [PubMed - indexed for MEDLINE]

994: Vet Radiol Ultrasound. 2005 May-Jun;46(3):205-9.

A comparison of the rostrocaudal open mouth and rostro 10 degrees
ventro-caudodorsal oblique radiographic views for imaging fluid in the feline
tympanic bulla.

Hammond GJ, Sullivan M, Weinrauch S, King AM.

Institute of Comparative Medicine, Faculty of Veterinary Medicine, Glasgow
University, Glasgow, UK. g.hammond@vet.gla.ac.uk

Fluid within the tympanic bulla is an indication of middle ear disease.
Radiography has a relatively low accuracy for the detection of soft tissue
opacification in the tympanic bulla, and the most useful radiographic projection,
the rostrocaudal open mouth (RCd (open mouth)), is technically difficult to
perform in dogs and cats. An alternative projection for the feline tympanic
bulla, the rostro 10 degrees ventro-caudodorsal oblique (R10 degrees V-CdDO), was
compared to the RCd (open mouth) in 41 feline cadaver heads with the tympanic
bullae randomly filled with KY jelly. Computed tomography was used as the gold
standard. Each tympanic bulla was recorded as being positive or negative for soft
tissue opacification. Although there was no significant difference between the
accuracy of the two views, the R10 degrees V-CdDO was subjectively more accurate 
and easier to perform, and in a live patient may be performed without the need
for general anesthesia. The R10 degrees V-CdDO projection is a good alternative
to the RCd (open mouth) projection for detecting otitis media in the cat.

Publication Types: 
    Comparative Study
    Evaluation Studies

PMID: 16050277 [PubMed - indexed for MEDLINE]

995: B-ENT. 2005;1(2):57-62.

Chronic suppurative otitis media and related complications at the University
Clinic of Kinshasa.

Matanda RN, Muyunga KC, Sabue MJ, Creten W, Van de Heyning P.

Service d'Oto-Rhino-Laryngologie, Cliniques Universitaires de Kinshasa,
Université de Kinshasa. B.P. 123 Kinshasa XI. République Démocratique du Congo.
rmatanda@yahoo.fr

During the five-year period from 1998 to 2002, the ENT department of the
University Clinic of Kinshasa treated 343 patients suffering from chronic
suppurative otitis media (CSOM) and complications. Two hundred and seven patients
had simple, 28 had cholesteatomatous form of CSOM, and 108 patients presented
with intratemporal or intracranial complications. Roughly half of the patient
group consisted of children younger than 10 years. The simple form of CSOM
affects men and women equally, but the cholesteatomatous form was more prevalent 
among men. Otorrhoea and hearing loss were the major presenting symptoms. Hearing
loss was moderate to severe in 2/3 and slight in 1/3 of the audiometrically
tested ears. A mastoidectomy was performed on 55% of the patients. Roughly 1/3 of
the patients presented with complications, the majority of which (69) were
subperiostal abscesses. Complications other than subperiostal abscesses were
associated with a high morbitidy and a few patients even died. Our data suggest
that the prevalence of CSOM in the Kinshasa area is at least 4% and, in fact, has
not declined over the last 20 years.

PMID: 16044735 [PubMed - indexed for MEDLINE]

996: Int J Pediatr Otorhinolaryngol. 2006 Jan;70(1):137-41. Epub 2005 Jul 25.

Immediate repair of the tympanic membrane to prevent persistent perforation after
intentional removal of long-lasting tubes.

Yilmaz M, Kemaloğlu YK, Aydil U, Bayramoğlu I, Göksu N, Ozbilen S.

Gazi University, Faculty of Medicine, Department of ENT-HNS, Yalim Sokak 2/13K.
Esat, Ankara 06660, Turkey.

OBJECTIVE: Our purpose was to evaluate efficiency of immediate repair of the
tympanic membrane perforation after intentional removal of the long-lasting
tubes. METHODS: This study was done in 36 ears of 27 patients who had either
Goode-T or Paparella-II silicone tube insertion due to chronic OME or ROM and
tube removal. Only the ears in which tube removal was performed due to no longer 
need for middle ear ventilation were included to the study. After removal of the 
tube, the perforation edges were refreshed and Steri-Strip (3M) patch was adhered
on the perforation site. Otoscopic, tympanometric and audiologic data were
reported. RESULTS: Mean duration of the tube persistence was 49.58+/-11.94
months. It was found that there were two subgroups in the study group: those
under regular follow-up (20 ears), and the ears which were out of regular
follow-up (16 ears). Mean tube persistence times were 34.10 and 52.11 months in
these subgroups, respectively (chi2-test, p=0.056). In six ears (16.67%),
persistent perforation (PP) was found. PP rate (PPR) was higher in group-B (25%) 
than in group-A (10%) (chi2-test, p>0.1). The rest perforation was anteriorly
marginal in five of six PP (83.33%). The PPR in the ears in which rest
perforation was anteriorly marginal was 35.71% (5/14) while it was 4.54% (1/22)
in the ears with central rest perforation (chi2-test, p<0.02). CONCLUSIONS: Even 
immediate repair of the perforation after removal of the long-lasting tubes
resulted in a high PPR. The data in this study documented that this high PPR was 
associated with type and localisation of rest perforation and tube persistence
time. Anteriorly, marginal perforations had about eight times higher risk of PP
and longer tube persistence caused higher anterior marginal perforations after
tube removal.

PMID: 16043232 [PubMed - indexed for MEDLINE]

997: J Infect. 2005 Aug;51(2):E49-51.

Pneumococcal meningitis and etanercept--chance or association?

Killingley B, Carpenter V, Flanagan K, Pasvol G.

Department of Infection and Tropical Medicine, Lister Unit, Northwick Park
Hospital, Watford Road, London HA1 3UJ, UK. bkillingley@hotmail.com

Rheumatoid arthritis is a severe deforming chronic disease which has major
implications for mortality and quality of life. Agents with anti-tumour necrosis 
factor alpha (TNFalpha) activity are a new modality of therapy, which can
significantly reduce the acute inflammation in this condition. However, TNFalpha 
is a cytokine involved in initiating the protective immune response;
consequently, patients receiving this therapy are at increased risk of infection.
Etanercept is a recombinant form of the p75 TNF receptor (TNF-RII) dimerised by
fusion with a portion of the human IgG1 Fc tail with anti-TNFalpha activity. We
report the first case of a patient with rheumatoid arthritis who developed
pneumococcal meningitis whilst on etanercept, suggesting a possible association
between etanercept and this severe life threatening infection.

Publication Types: 
    Case Reports

PMID: 16038750 [PubMed - indexed for MEDLINE]

998: Child Neuropsychol. 2005 Apr;11(2):121-33.

Impaired auditory attention skills following middle-ear infections.

Asbjørnsen AE, Obrzut JE, Boliek CA, Myking E, Holmefjord A, Reisaeter S, Klausen
O, Møller P.

Department of Psychosocial Sciences, University of Bergen, Bergen, Norway.

The present study investigated auditory attention skills in a sample of children 
with non-chronic otitis media with effusion (OME). Twenty children with repeated 
episodes of OME but not found in the need for myringotomy and insertion of
ventilating tubes were compared to 20 control children with no known episodes of 
OME based on parental reports and medical records. Mean age during assessment was
9 years, and none of the children showed signs of impaired language functions and
with normal general cognitive abilities. They were assessed with dichotic
listening CV-syllables (DLCV-108) free recall and directed attention tasks. The
control children showed the expected right ear advantage during free recall and
the directed right condition, and demonstrated a shift toward a left ear
advantage during the directed left. The children with a history of OME showed a
predominant right ear advantage across all three tasks. Although some change in
ear accuracy occurred across tasks, impaired auditory attention skills were found
following a history of middle ear infections. These results replicate those
reported earlier from a sample of children with persistent otitis media with
effusion, and suggest that treatment with ventilating tubes does not appear to
make any difference in the development of auditory attention skills, whereas
occurrence of OME must be considered when testing auditory attentional skills as 
a part of a neuropsychological assessment.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16036440 [PubMed - indexed for MEDLINE]

999: J Antimicrob Chemother. 2005 Sep;56(3):569-74. Epub 2005 Jul 20.

Analysis of under- and overprescribing of antibiotics in acute otitis media in
general practice.

Akkerman AE, Kuyvenhoven MM, van der Wouden JC, Verheij TJ.

Julius Center for Health Sciences and Primary Care, University Medical Center
Utrecht, Location Stratenum, 3508 AB Utrecht, The Netherlands.
A.Akkerman-2@umcutrecht.nl

OBJECTIVES: To assess clinical determinants of under- and overprescribing of
antibiotics according to the Dutch national guideline for patients with acute
otitis media (AOM) in general practice. PATIENTS AND METHODS: A total of 146
general practitioners (GPs) from the Netherlands included all patients with AOM
during a 4 week period in winter, and recorded patient characteristics, clinical 
presentation and management. Under- and overprescribing of antibiotics in AOM was
assessed using the Dutch national guideline. RESULTS: A total of 458 AOM
consultations were recorded. In seven out of 10 consultations (310/439; excluding
19 consultations in which patients were referred to secondary care), antibiotic
prescribing decisions were according to the national guideline. In 11% of all
consultations (50/439), there was underprescribing and in 18% (79/439) there was 
overprescribing. Patients with an antibiotic indication but without an antibiotic
prescription (underprescribing; n=50) had more short-term symptoms (OR: 0.93),
relatively few inflammation signs (OR: 0.47) and were less severely ill (OR:
0.30), compared with patients with an antibiotic indication and an antibiotic
prescription (n=167). Patients without an antibiotic indication but with an
antibiotic prescription (overprescribing; n=79) were more often younger than 24
months (OR: 0.34), more severely ill (OR: 3.30) and expected more often an
antibiotic as perceived by their GP (OR: 2.11), compared with patients without an
antibiotic indication and without an antibiotic prescription (n=143).
CONCLUSIONS: Clinical determinants which are stated as criteria for antibiotic
treatment of AOM in the Dutch national guideline were recognized by GPs as
important items, but were frequently given too much weight.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16033803 [PubMed - indexed for MEDLINE]

1000: BMC Pediatr. 2005 Jul 20;5:27.

Otitis media in young Aboriginal children from remote communities in Northern and
Central Australia: a cross-sectional survey.

Morris PS, Leach AJ, Silberberg P, Mellon G, Wilson C, Hamilton E, Beissbarth J.

Ear Health and Education Unit, Menzies School of Health Research, Darwin,
Australia. peterm@menzies.edu.au

BACKGROUND: Middle ear disease (otitis media) is common and frequently severe in 
Australian Aboriginal children. There have not been any recent large-scale
surveys using clear definitions and a standardised middle ear assessment. The aim
of the study was to determine the prevalence of middle ear disease (otitis media)
in a high-risk population of young Aboriginal children from remote communities in
Northern and Central Australia. METHODS: 709 Aboriginal children aged 6-30 months
living in 29 communities from 4 health regions participated in the study between 
May and November 2001. Otitis media (OM) and perforation of the tympanic membrane
(TM) were diagnosed by tympanometry, pneumatic otoscopy, and video-otoscopy. We
used otoscopic criteria (bulging TM or recent perforation) to diagnose acute
otitis media. RESULTS: 914 children were eligible to participate in the study and
709 were assessed (78%). Otitis media affected nearly all children (91%, 95%CI
88, 94). Overall prevalence estimates adjusted for clustering by community were: 
10% (95%CI 8, 12) for unilateral otitis media with effusion (OME); 31% (95%CI 27,
34) for bilateral OME; 26% (95%CI 23, 30) for acute otitis media without
perforation (AOM/woP); 7% (95%CI 4, 9) for AOM with perforation (AOM/wiP); 2%
(95%CI 1, 3) for dry perforation; and 15% (95%CI 11, 19) for chronic suppurative 
otitis media (CSOM). The perforation prevalence ranged from 0-60% between
communities and from 19-33% between regions. Perforations of the tympanic
membrane affected 40% of children in their first 18 months of life. These were
not always persistent. CONCLUSION: Overall, 1 in every 2 children examined had
otoscopic signs consistent with suppurative ear disease and 1 in 4 children had a
perforated tympanic membrane. Some of the children with intact tympanic membranes
had experienced a perforation that healed before the survey. In this high-risk
population, high rates of tympanic perforation were associated with high rates of
bulging of the tympanic membrane.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16033643 [PubMed - indexed for MEDLINE]

1001: Clin Infect Dis. 2005 Aug 15;41(4):470-8. Epub 2005 Jul 13.

Comment in:
    Clin Infect Dis. 2005 Aug 15;41(4):479-80.

Safety and efficacy of gatifloxacin therapy for children with recurrent acute
otitis media (AOM) and/or AOM treatment failure.

Pichichero ME, Arguedas A, Dagan R, Sher L, Saez-Llorens X, Hamed K, Echols R.

Elmwood Pediatric Group, University of Rochester Medical Center, Rochester, New
York 14642, USA. michael_pichichero@urmc.rochester.edu

BACKGROUND: Because of concerns about arthrotoxicity, fluoroquinolones are
restricted for use in children. This study describes the safety and efficacy of
gatifloxacin when used for treatment of children with recurrent acute otitis
media (ROM) or acute otitis media (AOM) treatment failure (AOMTF). METHODS: We
performed an analysis of 867 children included in 4 clinical trials who had ROM
and/or AOMTF and were treated with gatifloxacin (10 mg/kg once daily for 10
days). RESULTS: Gatifloxacin had adverse event rates that were similar overall to
those of a comparator antibiotic (amoxicillin-clavulanate), except for increased 
diarrhea in children <2 years old receiving amoxicillin-clavulanate. There was no
evidence of arthrotoxicity, hepatotoxicity, alteration of glucose homeostasis, or
central nervous system toxicity acutely or during 1 year follow-up in any child. 
Regarding efficacy, in 2 noncomparative trials, the gatifloxacin cure rate of AOM
was 89% (95% confidence interval [CI], 83%-95%) at the test of cure (TOC) visit, 
3-10 days after completion of therapy. In 2 comparative trials of gatifloxacin
versus amoxicillin-clavulanate, the efficacy of gatifloxacin was 88% (95% CI,
82%-94%). Gatifloxacin led to better clinical outcomes than
amoxicillin-clavulanate for AOMTF (91% vs. 81%; P=.029), for AOMTF and age <2
years old (89% vs. 69%; P=.009), and for severe AOM in children <2 years old (90%
vs. 75%; P=.012). Among children with AOMTF previously treated with
amoxicillin-clavulanate or ceftriaxone injections, gatifloxacin cure rates were
high (88% and 75%, respectively). CONCLUSIONS: Gatifloxacin appears to be safe
for children, with no evidence of producing arthrotoxicity in 867 children
exposed to the antibiotic when used as treatment for ROM and AOMTF.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 16028153 [PubMed - indexed for MEDLINE]

1002: Auris Nasus Larynx. 2005 Dec;32(4):403-6. Epub 2005 Jul 18.

Malignant external otitis: treatment with prolonged usage of antibiotics and
Burow's solution.

Shimizu T, Ishinaga H, Seno S, Majima Y.

Department of Otorhinolaryngology, Shiga University of Medical Science and Mie
University School of Medicine, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan.
shimizu@belle.shiga-med.ac.jp

Malignant external otitis is a severe infection of the external auditory canal,
generally caused by Pseudomonas aeruginosa in elderly diabetics patients. We
describe a case of malignant external otitis in a 63-year-old man with severe
otalgia, purulent otorrhea and polypoid granulation of the external auditory
canal. Local debridement, insulin treatment and 6-week intravenous antibiotic
therapy with carbapemens were very effective and the granulation tissue
disappeared completely. However, the patient readmitted for recurrent disease 3
weeks later, despite the oral and ear drop administration with new quinolone. No 
recurrence has been noted after 4-week additional treatment with intravenous
carbapenems followed by 3-week treatment with Burow's solution as ear drops.

Publication Types: 
    Case Reports

PMID: 16026955 [PubMed - indexed for MEDLINE]

1003: Australas Radiol. 2005 Aug;49(4):312-4.

Ultrasound detection of a subperiosteal abscess secondary to coalescent
otomastoiditis.

Grant RL, Piotto L.

Department of Medical Imaging, Women's and Children's Hospital, Adelaide, South
Australia 5006, Australia. drrobyngrant@hotmail.com

We report the unusual ultrasound appearance of coalescent otomastoiditis with
subperiosteal abscess in a 3-month-old boy with a 1-week history of an enlarging 
lump behind the left ear. Ultrasound examination of the lump revealed
subcutaneous oedema with an abscess extending from a defect in the cranial vault 
as a result of extension of the inflammatory process. We believe that this
sonographic appearance has not been previously described in the published
literature.

Publication Types: 
    Case Reports

PMID: 16026438 [PubMed - indexed for MEDLINE]

1004: Otolaryngol Head Neck Surg. 2005 Jul;133(1):139-46.

The role of bacterial interference in otitis, sinusitis and tonsillitis.

Brook I.

Department of Pediatrics, Georgetown University, USA. ib6@georgetown.edu

Bacterial interactions that include antagonism (interference) and synergism help 
maintain balance between the members of the normal endogenous flora.
Alpha-streptococci that predominate in the normal respiratory tract flora
attracted most attention in studies of bacterial interference. Other organisms
that possess interfering characteristics in upper respiratory tract infections
(URTIs) are nonhemolytic streptococci, and Prevotella and Peptostreptococcus spp.
The production of bacteriocins by some microorganisms is one of the important
mechanisms of interference. The role of bacterial interference in the development
of URTI and its effect on the eradication of these infections is discussed. These
infections include pharyngo-tonsillitis, otitis media, and sinusitis. Treatment
with various antimicrobial agents can affect the balance between members of the
oro-pharyngeal bacterial flora and interfering organisms. Implantation into the
indigenous microflora of low virulence bacterial strains that are potentially
capable of interfering with colonization and infection with other more virulent
organisms has been used in preliminary studies as a means of coping with the
failure of antimicrobials in the treatment of several URTI.

Publication Types: 
    Review

PMID: 16025067 [PubMed - indexed for MEDLINE]

1005: Otolaryngol Head Neck Surg. 2005 Jul;133(1):121-5.

Skull base osteomyelitis: diagnostic and therapeutic challenges in atypical
presentation.

Singh A, Al Khabori M, Hyder MJ.

Department of Otorhinolaryngology-Head and Neck Surgery and Communication
Disorder, Al Nahdha Hospital, Muscat, Sultanate of Oman. ankit@omantel.net.om

OBJECTIVE: We sought to document the diagnostic and management difficulties in
masked skull base osteomyelitis secondary to malignant otitis externa, with
emphasis on establishing diagnostic criteria in recurrence. STUDY DESIGN:
Retrospective analysis of 3 cases of inadequately treated malignant otitis
externa in elderly diabetic individuals leading to recurrence and atypical
manifestations of skull base osteomyelitis on contralateral side with or without 
multiple cranial nerve involvement. RESULTS: Two of the 3 cases died of the
disease despite aggressive treatment. One case was treated successfully with
combination of antipsuedamonal microbial drugs for 8 to 12 weeks and hyperbaric
oxygen therapy. Major complications such as thrombosis of lateral sinus and
internal jugular vein, meningitis, ophthalmoplegia, blindness, cervical spine
erosion and paralysis of all cranial nerves with exception of Ist cranial nerve
were observed. CONCLUSION: There is high morbidity and mortality associated with 
skull base osteomyelitis. In partially treated cases of malignant otitis externa,
atypical symptoms and findings of unilateral severe otalgia, unremitting
headache, and presence of high ESR, unilateral OME, constitute diagnostic clues
of skull base osteomyelitis. Such cases require further investigation with CT,
MRI, Technetium 99 and gallium 67 scintigraphy and aggressive management.

Publication Types: 
    Case Reports

PMID: 16025065 [PubMed - indexed for MEDLINE]

1006: Int J Pediatr Otorhinolaryngol. 2006 Feb;70(2):213-9. Epub 2005 Jul 14.

Risk factors for otitis media with effusion in Chinese schoolchildren: a nested
case-control study and review of the literature.

Tong MC, Yue V, Ku PK, Lo PS, Wong EM, van Hasselt CA.

Division of Otorhinolaryngology, Department of Surgery, The Chinese University of
Hong Kong, Prince of Wales Hospital, SAR, China. mtong@cuhk.edu.hk

OBJECTIVE: To identify the risk factors for otitis media with effusion (OME) in
Chinese schoolchildren and analyse the results with reference to the review of
the literature. METHODS: The study subjects were 6-7-year-old children drawn from
a school-screening program for OME in Hong Kong. Both positive and negative
screens attended a hospital clinic for further assessment with repeated otoscopic
examination and tympanometry as well as pure tone audiometry within 3 weeks after
the initial school-screening. During the visit, parents were interviewed to
provide information with regard to the children's birth history, neonatal
history, socio-economic background, otological history, past health, and medical 
history. These data formed the basis in the estimation of potential risk factors 
for OME. RESULTS: In the univariate analysis of 127 cases and 173 controls,
significantly elevated odds ratios (OR) for OME were detected on the symptoms of 
atopy (OR = 2.21, p = 0.04), hearing loss (OR = 4.13, p = 0.001), nasal
obstruction (OR = 1.94, p = 0.005), rhinorrhoea (OR = 1.61, p = 0.04),
tonsillitis in the past 12 months (OR = 1.82, p = 0.02), and previous history of 
acute otitis media (OR = 6.89, p < 0.001). However, only three of them were found
to be significant in the multivariate logistic regression model: nasal
obstruction (OR = 1.67, 95% CI: 1.01-2.75); acute tonsillitis (OR = 1.68, 95% CI:
1.00-2.80), and previous acute otitis media episodes (OR = 5.75, 95% CI:
2.60-12.69). CONCLUSIONS: Risk factors identified in the Chinese schoolchildren
for OME were comparable with previous western reports. A previous attack of acute
otitis media was a major determinant for middle ear effusion.

Publication Types: 
    Review

PMID: 16023224 [PubMed - indexed for MEDLINE]

1007: Otol Neurotol. 2005 Jul;26(4):762-6.

Otologic manifestations of malignant osteopetrosis.

Dozier TS, Duncan IM, Klein AJ, Lambert PR, Key LL Jr.

Department of Otolaryngology-Head and Neck Surgery, Medical University of South
Carolina, Charleston, South Carolina 29425, USA. dozierts@musc.edu

OBJECTIVE: To determine the incidence of hearing loss and describe the
neurotologic manifestations over time in a large series of patients with
malignant osteopetrosis. STUDY DESIGN: Longitudinal study. SETTING: Tertiary care
referral center. PATIENTS: Thirty-two patients, including 19 infants (< 1 yr of
age at initial visit) and 13 children (aged 1-7.6 yr at initial visit), with
autosomal recessive osteopetrosis were followed-up during a 10-year period from
1991 to 2001. The average length of follow-up was 2.5 years (range, 0-9.1 yr).
INTERVENTIONS: Patients underwent annual otologic evaluations including clinical 
examination, audiologic evaluation (auditory brainstem response, pure-tone
thresholds, speech discrimination scores, and tympanograms), and high-resolution 
computed tomography of the temporal bone. MAIN OUTCOME MEASURES: Incidence of
hearing loss, otitis media, and facial paralysis. Serial changes in temporal bone
anatomy by computed tomographic scan. RESULTS: Twenty-six percent of infants'
ears demonstrated hearing loss during the first year of life, and 78% of
children's ears demonstrated hearing loss during the study period. Of the
children's ears with hearing loss, 100% had a conductive component and 26% had an
additional sensorineural component (mixed hearing loss); VIIIth nerve conduction 
was normal in 100% of infants and 78% of children. Five patients (16%) had
unilateral facial nerve palsy. Common temporal bone findings included thickening 
and sclerosis of the calvarium; poor pneumatization of the mastoid bone; and
narrowing of the external auditory canal, eustachian tube, and internal auditory 
canal. CONCLUSION: Otologic manifestations are common in malignant osteopetrosis 
secondary to the formation of dense, brittle bone. Frequent findings include
external auditory canal stenosis, otitis media, conductive and sensorineural
hearing loss, and facial nerve paralysis.

PMID: 16015181 [PubMed - indexed for MEDLINE]

1008: Otol Neurotol. 2005 Jul;26(4):741-7.

Significance of a glenoid fossa approach for management of extensive lesions in
the lateral skull base.

Zixiang Y, Rong Z, Jinmei C, Chang L, Gongbiao L.

Otolaryngology Institute of Fujian Province and First Affiliated Hospital of
Fujian Medical University, Fuzhou, China.

OBJECTIVE: This article is designed to relate our experiences with a glenoid
fossa approach for exposing the outer border of extensive lesions in the lateral 
skull base. MATERIALS AND METHODS: In this series, there were five large
paragangliomas with the longest diameter of 6.5 cm in length, one large jugular
schwannoma with extratemporal components, and one severe case of petromastoiditis
with otogenic pachymeningitis, edema of the temporal lobe, and mental disorder.
All lesions of these cases were treated via a glenoid fossa approach combined
with other reasonable approaches. RESULTS: The glenoid fossa approach resulted in
crucial advantages: 1) it effectively exposes the outer border of extensive
lesions in the lateral skull base; 2) it provides safe distal control of the
facial nerve and internal carotid artery in the skull base; 3) it obviates the
need for anterior transposition or rerouting of the facial nerve; and 4) it
obviates sacrifice of the intact middle ear or section the mandibular condyle.
There is no postoperative mandibular dysfunction because the mandibular articular
capsule and articular tubercle are kept intact. CONCLUSION: On the basis of our
experiences, the glenoid fossa approach is a safe, quick, and useful design for
adequate exposure of the outer border of extensive lesions in lateral skull base 
surgery.

Publication Types: 
    Case Reports

PMID: 16015178 [PubMed - indexed for MEDLINE]

1009: Otol Neurotol. 2005 Jul;26(4):567-71.

Lymphocyte subpopulations in middle ear effusions: flow cytometry analysis.

Skotnicka B, Stasiak-Barmuta A, Hassmann-Poznanska E, Kasprzycka E.

Department of Pediatric Otolaryngology, Medical University, Białystok, Poland.
pedorl@amb.edu.pl

OBJECTIVE: The aim of this study was to identify lymphocyte subpopulations in
middle ear effusions, peripheral blood, and adenoids in children suffering from
otitis media with effusion. SETTING: Tertiary referral center. PATIENTS:
Thirty-three children (55 ears) undergoing myringotomy for otitis media with
effusion. METHODS: CD3, CD4, CD8, CD19, and natural killer cell populations were 
investigated in middle ear effusion, peripheral blood, and adenoids using a
three-color monoclonal antibody and flow cytometry method for quantitative
estimation. RESULTS: T cells (CD3) are dominating lymphocytes in middle ear
effusion. Among T lymphocytes, the majority are those of the helper type (CD4).
The dominating isoform among CD4 lymphocytes are memory cells (CD4CD45RO); among 
CD8 lymphocytes, naive cells (CD8CD45RA). The percentage of CD4 cells, CD8 cells,
and the CD4/CD8 ratio was significantly higher in middle ear effusions than in
blood. The percentage of memory CD4 lymphocytes and naive CD8 lymphocytes was
significantly lower in the middle ear effusion. Lymphocyte subsets were compared 
between 22 pairs of effusions from each patient. The percentage of each type of
cell did not differ significantly. CONCLUSION: The results of this study indicate
local regulation of the lymphocyte profile in middle ear effusions and the same
phase of immune response in two ears of the same patient.

PMID: 16015148 [PubMed - indexed for MEDLINE]

1010: Kulak Burun Bogaz Ihtis Derg. 2004;12(3-4):55-9.

The efficacy of CO2 laser myringotomy in serous otitis media.

Bozkurt MK, Calgüner M.

Department of Otolaryngology, Medicine Faculty of Ankara University, Ankara,
Turkey. bozkurtmetekaan@hotmail.com

OBJECTIVES: We evaluated the efficacy of CO2 laser myringotomy combined with
adenoidectomy in children with serous otitis media (SOM) unresponsive to medical 
therapy and compared the recurrences in the follow-up period with the control
group who underwent adenoidectomy and ventilation tube (VT) insertion. PATIENTS
AND METHODS: The CO2 laser myringotomy group included 25 children with a mean age
of 5.6 years and there were 10 children with a mean age of 6.3 years in the VT
control group. The laser used was a Sharplan 1030 CO2 laser, attached to Zeiss
Universal S3 operation microscope with a 300 mm objective, using a Microspot
optical delivery system. RESULTS: The mean (+/-SD) healing time was 13 (+/-2.16) 
days in 4 ears with myringotomies less than 2 mm in diameter, and 25 (+/-2.34)
days in 46 ears with myringotomies with 2 mm in diameter. During the 6-month
follow-up period, there were 11 recurrences (22%) in the CO2 laser group and 4
recurrences (20%) in the control group, which was not statistically significant
(p>0.05). CONCLUSION: We prefer laser myringotomy in SOM cases who do not need
long-time middle ear ventilation; we use the ventilation tubes in cases with
thick mucoid effusion and recurrent effusion after laser myringotomy.

Publication Types: 
    Clinical Trial
    Controlled Clinical Trial

PMID: 16010101 [PubMed - indexed for MEDLINE]

1011: FEMS Microbiol Lett. 2005 Aug 15;249(2):207-9.

Moraxella catarrhalis is only a weak activator of the mannose-binding lectin
(MBL) pathway of complement activation.

Hays JP, Ott A, Verduin CM, van Belkum A, Kuipers S.

Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Dr.
Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. j.hays@erasmusmc.nl

A hemolytic bystander assay was used to assess the functional serum
mannose-binding lectin (MBL) activating capacity of five isolates of Moraxella
catarrhalis obtained from children who suffered recurrent acute otitis media
episodes. Results showed that this organism is only a poor activator of the
lectin pathway of complement activation, with subsequent consequences for the
etiology of otitis media by this organism.

PMID: 16006058 [PubMed - indexed for MEDLINE]

1012: Int J Pediatr Otorhinolaryngol. 2005 Aug;69(8):1071-6. Epub 2005 Mar 20.

Tympanoplasty type I in children--an evaluative study.

Singh GB, Sidhu TS, Sharma A, Singh N.

Department of ENT and HNS, Institute of Medical Sciences and S.S Hospital, BHU,
Varanasi, India. gbsnit@yahoo.co.in

OBJECTIVE: A considerable controversy surrounds the subject of paediatric
tympanoplasty type I. Conflicting views regarding timing of surgery and various
other factors like Eustachian tube, status of contralateral ear, site and type of
perforation etc. are presented by various published case series in medical
literature. However, very few prospective studies address the issue. Thus, a
prospective study was planned to evaluate the success rate of paediatric
tympanoplasty type I and analyse the factors suggested to influence the outcome
of the said surgery. METHOD: A cohort study with control was carried out in 40
patients of chronic suppurative otitis media-mucosal disease in a tertiary care
teaching hospital. Patients were divided into two groups of 20 cases each, one
comprising of paediatric patients (8-14 years) and other comprising of adult
patients (more than 14 years of age). All the patients underwent tympanoplasty
type I by post auricular inlay technique. An intact graft at the end of 6th month
was considered a success and a minimum hearing improvement of 10 db in two
consecutive frequencies was regarded as an audiological success. Results were
tabulated and statistically analysed using chi2-test (with Yates correction).
RESULTS: A success rate of 80% in terms of graft uptake and hearing improvement
of 61% was seen in paediatric cases, compared to 85% graft uptake and 65% hearing
improvement in adult cases. Statistically, on applying chi2-test, the value of P 
is >0.05 which is insignificant was obtained, indicating that age does not
influence paediatric tympanoplasty type I. Also, the data for evaluating the
correlation between Eustachian tube and paediatric tympanoplasty type I showed no
statistical significance. In addition, no association between site and type of
perforation and paediatric tympanoplasty type I was observed when results were
compared to adult patients. However, anteriorly placed perforations were found to
give poor results in both adult and paediatric group. CONCLUSIONS: The results of
this cohort study mitigates against delaying tympanoplasty type I in paediatric
population. This study also elucidates that Eustachian tube, contralateral ear
pathology, site and type of perforation do not influence the outcome of the said 
surgery. However, anteriorly placed perforations require vigilance while repair
in view of high failure rate. We recommend the age of 8 years for the paediatric 
tympanoplasty type I, but in view of redundancy of eustachian tube factor, the
criteria for delineating minimum age for success of the said surgery is open to
debate. More prospective studies are required in this direction.

Publication Types: 
    Comparative Study
    Evaluation Studies
    Research Support, Non-U.S. Gov't

PMID: 16005349 [PubMed - indexed for MEDLINE]

1013: Int J Pediatr Otorhinolaryngol. 2005 Aug;69(8):1031-41. Epub 2005 Apr 20.

Health-related quality of life in children with otitis media.

Brouwer CN, Maillé AR, Rovers MM, Grobbee DE, Sanders EA, Schilder AG.

Department of Paediatrics, Spaarne Hospital Hoofddorp, Postbus 770, 2130 AT
Hoofddorp, The Netherlands. carol2b_workit@hotmail.com

BACKGROUND: Growing interest in health-related quality of life (HRQoL) in
children with otitis media has brought the need to study the currently available 
HRQoL instruments with respect to their results and their applicability in
clinical practice and research of otitis media. OBJECTIVE: To review existing
literature on health-related quality of life research in children with otitis
media with respect to: (1) the measured impact of otitis media on HRQoL; and (2) 
the applicability of HRQoL instruments used in research and clinical practice
based on their characteristics and contents. METHODS: A search was performed in
EMBASE (1988-November 2004) and on NLM Gateway (1966-November 2004) for studies
assessing health-related quality of life or functional health status by means of 
disease-specific or generic questionnaires in children aged 0-18 years with
chronic or recurrent otitis media with effusion or acute otitis media. The
bibliographies of the selected articles were searched manually. RESULTS: Only 13 
of the 141 retrieved articles retrieved fulfilled the criteria for inclusion. In 
these studies, physical suffering (pain, high fever, etc.), difficulties with
hearing or speech, behavioural problems, or emotional distress were reported to
be the most important problems experienced by children with otitis media. Almost 
all instruments applied in these studies measure functional health status instead
of health-related quality of life. Data on validity and reliability of these
instruments are incomplete. CONCLUSIONS: Recurrent or chronic otitis media is
reported to have a substantial and negative effect on various domains of
functional health status and health-related quality of life of children. The OM-6
appears to be the best available instrument to assess functional health status in
children with OM in a research setting. However, the lack of true HRQoL
instruments as well as incomplete data on their reliability and validity, limit
both our current knowledge of HRQoL in OM and the application of current
instruments in both research and clinical practice.

Publication Types: 
    Review

PMID: 16005345 [PubMed - indexed for MEDLINE]

1014: J Clin Microbiol. 2005 Jul;43(7):3140-4.

Genetic relatedness between pneumococcal populations originating from the
nasopharynx, adenoid, and tympanic cavity of children with otitis media.

Tonnaer EL, Rijkers GT, Meis JF, Klaassen CH, Bogaert D, Hermans PW, Curfs JH.

Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen,
The Netherlands. e.tonnaer@kno.umcn.nl

Previous studies have shown that Streptococcus pneumoniae exists in both middle
ear effusions and the upper respiratory region from children with otitis media
with effusion (OME), but it remains unclear whether these strains represent
genetically identical clones. Therefore, it cannot be determined whether these
bacteria originate from a common source. To determine the presence of pneumococci
at different anatomical locations of OME patients, conventional culture and PCR
techniques were used. To analyze the possible genetic relatedness between
pneumococci from different anatomical sites, molecular typing by amplified
fragment length polymorphism was utilized. The percentage of middle ear effusions
of OME patients that are positive for pneumococci after PCR analysis (13%) was
higher than after conventional culture (5%). Molecular fingerprints from
pneumococci derived from two different anatomic sites within patients were very
similar in 80% of OME patients and in 90% of acute otitis medium patients,
indicating their genetic relatedness. Biofilm formation or pneumococcal L-forms
probably play a role in OME, since culture-negative effusions prove to contain
pneumococcal DNA. Bacteria involved in this process most likely originate from
the nasopharynx since they show a close genetic relatedness with their
nasopharyngeal counterparts.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16000426 [PubMed - indexed for MEDLINE]

1015: Pediatr Infect Dis J. 2005 Jul;24(7):655-7.

Detection of human metapneumovirus from children with acute otitis media.

Suzuki A, Watanabe O, Okamoto M, Endo H, Yano H, Suetake M, Nishimura H.

Virus Research Center, Sendai Medical Center, Sendai, Japan.

Nasal and middle ear specimens collected from children with acute otitis media
were subjected to viral isolation and bacteria culture. All virus-negative
specimens underwent reverse transcription polymerase chain reaction to detect
human metapneumovirus. Three of 126 middle ear specimens were positive by this
assay.

PMID: 15999017 [PubMed - indexed for MEDLINE]

1016: Pediatr Infect Dis J. 2005 Jul;24(7):631-4.

Middle ear fluid Streptococcus pneumoniae serotype distribution in Costa Rican
children with otitis media.

Arguedas A, Dagan R, Guevara S, Porat N, Soley C, Pérez A, Brilla R.

Instituto de Atención Pediátrica, San José, Costa Rica. aarguedas@iped.net

BACKGROUND: Streptococcus pneumoniae conjugate vaccine became available in Costa 
Rica in 2004. Previous S. pneumoniae middle ear fluid (MEF) data obtained during 
the period 1999-2001 from Costa Rican children indicated that serotype 19F was
the most common type (75%), but more recently other serotypes have become more
prevalent. OBJECTIVES: To establish the most common S. pneumoniae serotypes
present in the MEF of Costa Rican children with otitis media (OM) and to analyze 
serotype distribution by demographic factors, disease distribution and
antimicrobial susceptibility patterns and assess the potential protection
provided by the new conjugated heptavalent S. pneumoniae vaccine in Costa Rican
children with OM. METHODS: During 2002 and 2003, 69 S. pneumoniae isolates were
obtained from the MEF of Costa Rican children, ages 3-49 months, with OM.
Serotyping was performed by the quellung reaction with antisera from Statens
Serum Institute, Copenhagen, Denmark. RESULTS: The most common S. pneumoniae
serotypes isolated were 19F (26.1%), 6B (14.5%), 9V (8.7%), 16F (8.7%), 14
(5.8%), 23F (5.8%), 3 (5.8%) and 6A (5.8%). Serotype distribution was similar
among children younger than 24 months of age or 24 months of age or older and by 
disease distribution. There was a tendency towards more penicillin- and
trimethoprim-sulfamethoxazole-nonsusceptible isolates among vaccine-type strains 
than among non-vaccine type strains. CONCLUSIONS: The serotype distribution of S.
pneumoniae causing pediatric OM in Costa Rica is similar to those reported from
developed countries. The current heptavalent pneumococcal conjugate vaccine
covers 74% of OM episodes in Costa Rican children.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15999006 [PubMed - indexed for MEDLINE]

1017: Niger Postgrad Med J. 2005 Jun;12(2):73-6.

Adult onset otitis media with effusion in Lagos.

Somefun AO, Adefuye SA, Danfulani MA, Afolabi S, Okeowo PA.

Otolaryngology unit, Department of surgery, CMUL/LUTH, Lagos, Nigeria.

BACKGROUND/AIM: The documented reports on adult onset OME is scanty world wide,
this study was prompted by the increasing trend of OME in our adult patients with
the aim of determining the prevalence, predisposing factors and treatment outcome
of the disease. PATIENTS AND METHODS: A prospective study was carried out over a 
two year period at the Otolaryngology Clinic of Lagos University Teaching
Hospital Lagos Nigeria, on 195 patients referred to the clinic with provisional
diagnosis of OME. The patients had clinical evaluation, pure tone audiometry,
tympanometry while a few had fibre optic nasopharyngoscopy and biopsy done.
RESULTS: A hospital based prevalence of 2.6% was recorded in the Otolaryngology
clinic during the study period, with infective and allergic sinusitis as the
major predisposing factors to OME in adult patients. Majority 58 (92.06%)
patients were treated conservatively and recurrence was seen in 8 (12.7%) of the 
patients without any untoward effects. OME, though recognised as a childhood
disease may be as prevalent in adult as in childhood but with less complication. 
CONCLUSION: OME as a single clinical feature or in association with allergy or
sinusitis is most unlikely to habour NPC therefore nasopharyngoscopy and biopsy
are likely to give a low yield of positive biopsy in isolated OME in adult and
the cost implication of this must be borne in mind.

PMID: 15997251 [PubMed - indexed for MEDLINE]

1018: Arch Pediatr Adolesc Med. 2005 Jul;159(7):679-84.

Delayed prescription may reduce the use of antibiotics for acute otitis media: a 
prospective observational study in primary care.

Marchetti F, Ronfani L, Nibali SC, Tamburlini G; Italian Study Group on Acute
Otitis Media.

Department of Pediatrics and Epidemiology Unit, Institute of Child Health, IRCCS 
Burlo Garofolo, Trieste, Italy.

OBJECTIVES: To evaluate the applicability and the effectiveness of practice
guidelines based on a wait-and-see strategy for children with acute otitis media 
(AOM). POPULATION: Children from 1 to 14 years old having AOM who were referred
to primary care pediatric practices. STUDY DESIGN: Prospective observational
study. MAIN OUTCOME MEASURE: Proportion of children having a diagnosis of AOM and
eligible for symptomatic treatment who, at 72 hours from enrollment, recovered
from their symptoms (fever and earache) without receiving antibiotic treatment.
RESULTS: One hundred sixty-nine pediatricians participated in the study and
enrolled 1672 children. One thousand two hundred seventy-seven children were
included in the analysis. One hundred seventy-eight children received antibiotic 
treatment at first contact according to the practice guidelines criteria
(presence of otorrhea or recurrent AOM). Of the 1099 children who were eligible
for symptomatic treatment only, 743 (67.6%) recovered without antibiotic
treatment at 3 days and 716 (65.1%) at 30 days. No complications were observed.
Coexistence of a high fever (temperature > or = 38.4 degrees C) and red and
bulging tympanic membrane as well as male sex were significantly associated with 
antibiotic use. CONCLUSIONS: Practice guidelines based on a wait-and-see strategy
for children with AOM are applicable and effective in primary care. This strategy
was able to avoid the administration of antibiotic treatment in 2 of 3 children.

PMID: 15997003 [PubMed - indexed for MEDLINE]

1019: Laryngoscope. 2005 Jul;115(7):1262-5.

Detection of Helicobacter pylori in children with otitis media with effusion: a
preliminary report.

Karlidag T, Bulut Y, Keles E, Kaygusuz I, Yalcin S, Ozdarendeli A, Dabak H.

Department of Otorhinolaryngology, Firat University Medical Faculty, Elazig,
Turkey. turgut_karlidag@yahoo.com

OBJECTIVE: To determine the presence of Helicobacter pylori in the middle ear
effusion of patients with otitis media with effusion (OME) by polymerase chain
reaction (PCR). STUDY DESIGN: A prospective study in patients with OME. METHODS: 
The study was performed in 38 patients with OME who were admitted to the ENT
Clinic, Firat University from June 2003 to April 2004. In all cases, a
myringotomy operation (with or without placement of a ventilation tube) was
carried out. The effusion samples aspirated from the middle ear were analyzed
with PCR assay. RESULTS: A total of 55 aspiration samples collected from 38
children ranging in age from 2 to 12 were included in the study. Fifteen of the
subjects were girls, and 23 were boys. In 17 patients, both ears demonstrated
effusions, whereas in 21 patients, only one ear had effusions. Nine (16.3%) of 55
the middle ear effusion samples were shown to be H. pylori positive by PCR.
CONCLUSIONS: H. pylori was detected in the middle ear effusion of some patients
with OME. These results may have interesting implications for a possible role of 
H. pylori in OME. In addition, these results suggest that further studies are
needed to investigate the role of H. pylori in the etiology of OME.

PMID: 15995518 [PubMed - indexed for MEDLINE]

1020: Laryngoscope. 2005 Jul;115(7):1256-61.

Management of brain herniation and cerebrospinal fluid leak in revision chronic
ear surgery.

Wootten CT, Kaylie DM, Warren FM, Jackson CG.

Otology Group of Vanderbilt, Nashville, Tennessee 37203, USA.

OBJECTIVES/HYPOTHESIS: Brain herniation and cerebrospinal fluid (CSF) leakage
into the middle ear and mastoid are rare but described complications of chronic
ear disease. This paper will discuss the presentation and management of brain
herniation and/or CSF leak encountered in revision chronic ear surgery. STUDY
DESIGN: Retrospective chart review. METHODS: Twelve of 1,130 cases of revision
chronic ear surgery in which brain herniation or CSF leak was diagnosed were
identified and analyzed. RESULTS: Ten (83%) patients' initial diagnosis was
tympanic membrane (TM) perforation with cholesteatoma and two (17%) with TM
perforation without cholesteatoma. Initial revision procedures included one
(8.3%) tympanoplasty with canal-wall-up mastoidectomy maintaining ossicular
continuity, two (17%) tympanoplasties with canal-wall-down (CWD) mastoidectomies 
with ossicular chain reconstruction (OCR), and nine (75%) tympanoplasties with
CWD mastoidectomies without OCR. Three (25%) required a second procedure, two
(17%) a third, and one (8.3%) a fourth, finally resulting in four (33%) with an
ossicular reconstruction and eight (67%) without. Brain herniation and/or CSF
leak were repaired by way of transmastoid and middle fossa approaches.
Preoperative and postoperative pure-tone average air-bone gaps were statistically
similar (33.1 and 28.1 dbHL, respectively; P = .464). CONCLUSIONS: Brain
herniation and/or CSF leak appear to be rare complications of surgery for
revision chronic ear disease. Their management require adherence to the
principles of establishing a safe ear with hearing restoration as a secondary
goal.

Publication Types: 
    Case Reports

PMID: 15995517 [PubMed - indexed for MEDLINE]

1021: Pediatrics. 2005 Jul;116(1):185-9.

Comment in:
    Pediatrics. 2005 Nov;116(5):1257; author reply 1258.

Adenoidectomy does not significantly reduce the incidence of otitis media in
conjunction with the insertion of tympanostomy tubes in children who are younger 
than 4 years: a randomized trial.

Hammarén-Malmi S, Saxen H, Tarkkanen J, Mattila PS.

Department of Otorhinolaryngology, University of Helsinki and Helsinki University
Central Hospital, Helsinki, Finland.

OBJECTIVE: To evaluate the efficacy of adenoidectomy in reducing the incidence of
otitis media among children who are younger than 4 years and receive tympanostomy
tubes. METHODS: A randomized trial was conducted at a tertiary center clinic. A
total of 217 children who were aged 12 to 48 months and had recurrent acute
otitis media (>3 episodes during the past 6 months) or chronic otitis media with 
effusion, no obstructive symptoms as a result of adenoid enlargement, and no
previous surgical intervention were enrolled in the study. Adenoidectomy in
conjunction with the insertion of tympanostomy tubes or insertion of tympanostomy
tubes without adenoidectomy was studied. The number of otitis media episodes
during the follow-up period of 12 months was measured. RESULTS: During the
follow-up, the mean number of otitis media episodes was 1.7 among children who
underwent adenoidectomy with concurrent insertion of tympanostomy tubes and 1.4
among children who received tympanostomy tubes only. The risk for recurrent
otitis media (>or=3 episodes) could not be reduced by adenoidectomy (odds ratio: 
1.66; 95% confidence interval: 0.80-3.46). CONCLUSION: Adenoidectomy does not
significantly reduce the incidence of acute otitis media in otitis prone children
who are younger than 4 years and receive tympanostomy tubes.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15995051 [PubMed - indexed for MEDLINE]

1022: J Infect. 2006 Mar;52(3):181-7. Epub 2005 Jun 29.

Is there any specific association between respiratory viruses and bacteria in
acute otitis media of young children?

Kleemola M, Nokso-Koivisto J, Herva E, Syrjänen R, Lahdenkari M, Kilpi T, Hovi T.

Department of Microbiology, National Public Health Institute, Helsinki, Finland.

BACKGROUND: Respiratory viral infections are usually preceding or coinciding with
acute otitis media (AOM) in children. It is not known if a given viral infection 
would facilitate invasion of bacterial pathogens into the middle ear in a
species-specific way. We reanalysed the microbiological results of the two
prospective Finnish Otitis Media (FinOM) studies for this purpose. METHODS: The
children had been followed from 2 months to 2 years of age in specific study
clinics and all referred AOM events were analysed. Combined results of virus
detection tests from middle ear fluid and nasopharyngeal aspirate and those of
bacterial culture from middle ear fluid were cross-tabulated for 529 AOM events
in the FinOM Cohort Study and for 364 events in the FinOM Vaccine Trial. RESULTS:
In both studies the main bacterial pathogens were Streptococcus pneumoniae,
Haemophilus influenzae and Moraxella catarrhalis while the main viruses detected 
were rhinoviruses and respiratory syncytial virus (plus enteroviruses in the
Vaccine Trial). No distinct species-specific associations were observed between
the viral and bacterial findings. CONCLUSION: We did not find support to the
theory that respiratory infection caused by a given viral species would favour
growth of a certain bacterial pathogen in the MEF more than another.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15992930 [PubMed - indexed for MEDLINE]

1023: J Laryngol Otol. 2005 Jun;119(6):443-7.

Scintigraphic evaluation of nasal mucociliary activity in unilateral chronic
otitis media.

Cingi C, Altin F, Cakli H, Entok E, Gurbuz K, Cingi E.

Department of Otorhinolaryngology, Osmangazi University Medical Faculty,
Eskisehir, Turkey. ccingi@ogu.edu.tr

Mucociliary clearance is a key defence mechanism in human upper and lower
airways. Although mucociliary activity is present in both ears of the patients,
most cases of chronic otitis media are unilateral.In this study, we aim to
evaluate the difference between nasal mucociliary activity of the affected and
non-affected sides in patients with unilateral chronic otitis media. Both nasal
transport times of 36 patients with unilateral chronic otitis media were compared
statistically with each other and with the control group by independent samples
t-test. The nasal mucociliary transport times of the nasal cavity at the same
side as the affected ear and as the non-affected ear are significantly different,
in the same patients. Our study shows that impaired or decreased nasal
mucociliary activity may result in dysfunction of the eustachian tube and
middle-ear ciliary activity, which plays an important role in the
aetiopathogenesis of chronic otitis media.

PMID: 15992469 [PubMed - indexed for MEDLINE]

1024: Am J Otolaryngol. 2005 Jul-Aug;26(4):226-9.

Labyrinthitis secondary to experimental otitis media.

Trinidad A, Ramírez-Camacho R, García-Berrocal JR, Verdaguer JM, Daza R.

Department of Oto-Rhino-Laryngology, Hospital Puerta de Hierro, Autonoma
University of Madrid, Spain. atrinid@yahoo.es

PURPOSE: Analysis of labyrinthitis in a model of otitis media. MATERIALS AND
METHODS: Morphologic study in 20 Wistar rats in which otitis media was induced by
transbullar inoculation of Pseudomonas aeruginosa with obstruction of the
eustachian tube. RESULTS: Seventy percent of rats showed vestibular signs.
Histologic changes ranged from nonaffected labyrinths to suppurative
labyrinthitis. CONCLUSIONS: Dissemination of infection probably occurs through
round window membrane. A thinner round window membrane typical of rodents would
be the reason for a more severe clinical and morphologic picture in rats when
compared to human beings.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15991087 [PubMed - indexed for MEDLINE]

1025: Antimicrob Agents Chemother. 2005 Jul;49(7):3056-8.

In vitro activities of levofloxacin and comparable agents against middle ear
fluid, nasopharyngeal, and oropharyngeal pathogens obtained from Costa Rican
children with recurrent otitis media or failing other antibiotic therapy.

Soley C, Arguedas A, Porras W, Guevara S, Loaiza C, Pérez A, Rincón G, Schultz M,
Arguedas J, Brilla R.

Instituto de Atención Pediátrica, P.O. Box 607-1150, San José, Costa Rica.

This study analyzes the in vitro activities of levofloxacin and other commonly
used antimicrobials against middle ear fluid, nasopharyngeal, and oropharyngeal
pathogens obtained from children with otitis media at risk of having a resistant 
pathogen. Levofloxacin proved to be very active against these pathogens and had
intermediate activity against Streptococcus pyogenes.

Publication Types: 
    Clinical Trial
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15980399 [PubMed - indexed for MEDLINE]

1026: Hear Res. 2005 Sep;207(1-2):110-6.

The role of Fas-mediated apoptosis in otitis media: observations in the lpr/lpr
mouse.

Rivkin AZ, Palacios SD, Pak K, Bennett T, Ryan AF.

Department of Surgery, Division Otolaryngology, UCSD School of Medicine and VA
Medical Center, 9500 Gilman Drive number 0666, Fir Building, Room 106, La Jolla, 
CA 92093, USA.

Apoptosis, or programmed cell death, is a critical regulatory mechanism involved 
in the function, homeostasis and stimulus response of many organ systems. In the 
middle ear, apoptosis could participate in mucosal remodeling or leukocyte
clearance during otitis media (OM). Fas is a death receptor that can contribute
to apoptosis in a variety of cell types. To assess the role of Fas signaling in
OM, we probed for expression of Fas and Fas ligand (FasL) by polymerase chain
reaction (PCR) during bacterial OM in the rat. In addition, we assessed the
response of the middle ear to endotoxin, an inflammatory bacterial product that
has been used as a model for otitis media in the mouse, in normal and Fas
deficient mice. We saw evidence of increased expression of Fas and Fas ligand
during bacterial OM. Moreover, the intensity of the mucosal response to endotoxin
was significantly greater and the resolution of the response was prolonged in Fas
deficient mice. Prolonged resolution of mucosal hyperplasia may reflect reduced
apoptosis of the hyperplastic mucosal cells. Elucidation of the pathways that
regulate the mucosal hyperplastic response during otitis media brings us closer
to manipulating them in the interest of reducing the chronic complications of
this disease.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 15978756 [PubMed - indexed for MEDLINE]

1027: J Otolaryngol. 2004 Dec;33(6):345-51.

Evidence of allergic inflammation in the middle ear and nasopharynx in atopic
children with otitis media with effusion.

Nguyen LH, Manoukian JJ, Tewfik TL, Sobol SE, Joubert P, Mazer BD, Schloss MD,
Taha R, Hamid QA.

Department of Otolaryngology, McGill University, Montreal, Quebec, Canada.

BACKGROUND: Otitis media with effusion (OME) occurs in the setting of eustachian 
tube (ET) dysfunction. Previous studies have demonstrated a predominance of T
helper 2 (Th2) mediators in the middle ear effusions (MEEs) of atopic children,
suggesting that allergy plays a role in the pathogenesis of OME. Given that the
middle ear is contiguous with the upper airway, the allergic inflammation seen in
the middle ear of atopic patients with OME may also have been observed in the
nasopharynx. OBJECTIVE: We hypothesize that atopic children have different
cellular and cytokine profiles in MEE compared with nonatopic patients and that
this allergic inflammation occurs in both the middle ear and the nasopharynx.
METHODS: Forty-five patients undergoing both ventilation tube placement for OME
and adenoidectomy for adenoid hypertrophy were recruited. The atopic status was
determined for each patient using standard skin testing. The cellular and
cytokine profiles of the MEEs and the torus tubarius and adenoid tissues were
investigated using immunocytochemistry and in situ hybridization. RESULTS: Our
results indicate that, within the atopic patient, there is a similar cellular and
cytokine profile within the three regions sampled, with a predominant expression 
of interleukin-4 (a Th2 cytokine) and an increased infiltration of eosinophils
compared with the nonatopic patient. CONCLUSION: These findings confirm the
association of allergy with MEE and support the hypothesis that the middle ear
may be an integral part of the United Airway Concept.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 15971648 [PubMed - indexed for MEDLINE]

1028: J Child Neurol. 2005 May;20(5):452-4.

Facial nerve palsy with acute otitis media during the first 2 weeks of life.

Rizk EB, El-Bitar MA, Matae GM, Saad K, Mikati MA.

Department of Pediatrics, American University of Beirut Medical Center, Lebanon.

A full-term male newborn presented to us at the age of 2 weeks with left facial
weakness that had started at the age of 4 days and steadily progressed over a
10-day period. Physical examination revealed a complete unilateral left
peripheral facial nerve paralysis, with an erythematous dull and bulging left
tympanic membrane. Computed tomography and magnetic resonance imaging were
normal. The patient underwent left myringotomy and placement of a pneumatic
equalization tube within 24 hours of presentation. He also received a 5-day
course of prednisone and a 2-week course of antibiotics and acyclovir.
Improvement of the facial paralysis was rapid, with near-complete resolution at
the time of discharge home and complete resolution 6 weeks later. To our
knowledge, this is the only reported case of acute otitis media with associated
facial nerve palsy in a newborn during the first 2 weeks of life.

Publication Types: 
    Case Reports

PMID: 15968933 [PubMed - indexed for MEDLINE]

1029: J Bacteriol. 2005 Jul;187(13):4627-36.

Genomic sequence of an otitis media isolate of nontypeable Haemophilus
influenzae: comparative study with H. influenzae serotype d, strain KW20.

Harrison A, Dyer DW, Gillaspy A, Ray WC, Mungur R, Carson MB, Zhong H, Gipson J, 
Gipson M, Johnson LS, Lewis L, Bakaletz LO, Munson RS Jr.

Center for Microbial Pathogenesis, Columbus Children's Research Institute, Ohio
State University College of Medicine and Public Health, Columbus, Ohio 43205,
USA.

In 1995, the Institute for Genomic Research completed the genome sequence of a
rough derivative of Haemophilus influenzae serotype d, strain KW20. Although
extremely useful in understanding the basic biology of H. influenzae, these data 
have not provided significant insight into disease caused by nontypeable H.
influenzae, as serotype d strains are not pathogens. In contrast, strains of
nontypeable H. influenzae are the primary pathogens of chronic and recurrent
otitis media in children. In addition, these organisms have an important role in 
acute otitis media in children as well as other respiratory diseases. Such
strains must therefore contain a gene repertoire that differs from that of strain
Rd. Elucidation of the differences between these genomes will thus provide
insight into the pathogenic mechanisms of nontypeable H. influenzae. The genome
of a representative nontypeable H. influenzae strain, 86-028NP, isolated from a
patient with chronic otitis media was therefore sequenced and annotated. Despite 
large regions of synteny with the strain Rd genome, there are large
rearrangements in strain 86-028NP's genome architecture relative to the strain Rd
genome. A genomic island similar to an island originally identified in H.
influenzae type b is present in the strain 86-028NP genome, while the mu-like
phage present in the strain Rd genome is absent from the strain 86-028NP genome. 
Two hundred eighty open reading frames were identified in the strain 86-028NP
genome that were absent from the strain Rd genome. These data provide new insight
that complements and extends the ongoing analysis of nontypeable H. influenzae
virulence determinants.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 15968074 [PubMed - indexed for MEDLINE]

1030: Arch Otolaryngol Head Neck Surg. 2005 Jun;131(6):509-12.

Recovery of potential pathogens and interfering bacteria in the nasopharynx of
otitis media-prone children and their smoking and nonsmoking parents.

Brook I, Gober AE.

Department of Pediatrics, Georgetown University School of Medicine, Washington,
DC, USA. ib6@georgetown.edu

OBJECTIVE: To study the frequency of isolation of potential pathogens and
interfering bacteria in the posterior nasopharynx of otitis media-prone (OMP)
children and their smoking and nonsmoking parents to possibly explain why active 
and passive exposure to smoking is associated with carriage of potentially
pathogenic bacteria and an increased risk of respiratory tract infection in both 
adults and children. SETTING: Outpatient clinic. PARTICIPANTS: Twenty OMP
children and their smoking parents (smoking group) and 20 OMP children and their 
nonsmoking parents (nonsmoking group). INTERVENTIONS: Posterior nasopharynx
cultures were taken from 20 OMP children and their smoking parents and 20 OMP
children and their nonsmoking parents. MAIN OUTCOME MEASURE: Potential pathogens 
and aerobic and anaerobic bacteria with interfering capabilities against these
organisms were identified. RESULTS: Fourteen potential pathogens were isolated
from smoking parents, and 17 were recovered from their children. Concordance in
isolation of a pathogen between a parent and child was noted in 11 instances.
Three potential pathogens were isolated from nonsmoking parents (P<.001 compared 
with the parents and children in the smoking group and children in the nonsmoking
group), and 16 were recovered from their children. Bacterial interference by
normal flora isolates against potential pathogens was noted in 58 instances in
smoking parents and in 55 instances in their children (P<.05). Bacterial
interference was noted in 129 instances in nonsmoking parents (P<.05 compared
with the parents and children in the smoking group and children in the nonsmoking
group) and in 55 instances in their children. CONCLUSIONS: A high recovery rate
of potential pathogens and a low number of interfering organisms were observed in
OMP children. This was not related to their parents' smoking habits. The
posterior nasopharynx flora of smoking parents contained more potential pathogens
similar to the ones recovered from OMP children and fewer interfering organisms
than nonsmoking parents.

PMID: 15967884 [PubMed - indexed for MEDLINE]

1031: Curr Allergy Asthma Rep. 2005 Jul;5(4):313-8.

Complementary and alternative medicine in allergy, otitis media, and asthma.

Blazek-O'Neill B.

Allegheny General Hospital, Integrated Medicine Program, 320 E. North Avenue,
Pittsburgh, PA 15212, USA. boneill@wpahs.org

There is growing interest on the part of both patients and providers in the use
of complementary and alternative medicine (CAM) therapies to treat allergy,
otitis media, and asthma. Research efforts investigating CAM are increasing in
frequency and quality. Studies suggest possible efficacy for some vitamin and
mineral supplements for allergic diseases; results are less clear in asthmatic
patients. The use of polyunsaturated fatty acids appears particularly promising
for treatment and even prevention of allergy and asthma conditions. Studies also 
suggest that probiotic preparations have a role in the treatment of allergic
conditions. Xylitol gum, syrup, and lozenges have shown efficacy in treatment of 
acute otitis media, as have some naturopathic herbal remedies. Preliminary
results with studies of yoga and various relaxation therapies for treatment of
asthmatics suggest that these therapies may have a role, but further work would
be needed to document efficacy and delineate the specific types of interventions 
most appropriate for particular asthmatic populations.

Publication Types: 
    Review

PMID: 15967074 [PubMed - indexed for MEDLINE]

1032: Curr Allergy Asthma Rep. 2005 Jul;5(4):308-12.

Complications of acute otitis media in children.

Leskinen K.

Department of Otolaryngology, Helsinki University Central Hospital,
Haartmaninkatu 4 E, PO Box 220, FIN-00029 Huch, Finland. kimmo.leskinen@hus.fi

The clinical picture and the treatment of acute otitis media (AOM) and its
complications have changed during the past decades. The availability of
antibiotics has decreased the incidence of complications of AOM significantly.
The treatment of complications of AOM is conservative in most cases.
Mastoidectomy is needed when abscess-forming mastoiditis or intracranial
complications develop. Although intratemporal and intracranial complications of
AOM are rare today, they still cause morbidity, and need prompt treatment.
Occasionally, permanent damage of the ear leads to hearing loss, vertigo, and
sometimes, facial weakness. Antibiotic treatment has decreased the mortality
associated with the complications of AOM, but it is still high in countries with 
developing health care systems. Early diagnosis and effective treatment of the
complications are the bases for a good prognosis.

Publication Types: 
    Review

PMID: 15967073 [PubMed - indexed for MEDLINE]

1033: Curr Allergy Asthma Rep. 2005 Jul;5(4):302-7.

Immunologic screening of children with recurrent otitis media.

Wiertsema SP, Veenhoven RH, Sanders EA, Rijkers GT.

Department of Immunology, University Medical Center Utrecht, Wilhelmina
Children's Hospital, KC03.063.0, Lundlaan 6, 3584 EA Utrecht, The Netherlands.

Some 5% to 10% of all infants and toddlers suffer from four or more episodes of
otitis per year. Usually, this is a temporary problem that resolves with
increasing age. In a minority of cases, otitis episodes are frequent or have an
abnormal course, with complications such as mastoiditis. In these cases,
immunologic screening is indicated, to exclude an immunodeficiency.
Agammaglobulinemia or hypogammaglobulinemia is rare among these patients. Other
immune defects that occur more often are deficient or lowered immunoglobulin
(Ig)A or decreased levels of one or more IgG subclass, in particular IgG2. The
specific antibody response to bacterial capsular polysaccharides often is
disturbed. These findings can give direction to the treatment of children with
frequent, recurrent otitis.

Publication Types: 
    Review

PMID: 15967072 [PubMed - indexed for MEDLINE]

1034: Acta Otolaryngol. 2005 Mar;125(3):266-9.

Pseudomonas aeruginosa infection in the hypoventilated middle ear: an
experimental model.

Trinidad A, Ramírez-Camacho R, García-Berrocal JR, Verdaguer JM, Vicente J,
Pinilla MT.

Department of Otorhinolaryngology, Hospital Puerta de Hierro, Madrid, Spain.
atrinid@yahoo.es

CONCLUSION: This is a suitable model for studying different aspects of the
pathophysiology of chronic suppurative otitis media. OBJECTIVE: To analyze the
methodological features of an animal model of chronic suppurative otitis media
induced by intratympanic inoculation of Pseudomonas aeruginosa. MATERIAL AND
METHODS: Otitis media was induced by inoculation of P. aeruginosa through the
inferior aspect of the rat bulla and cauterization of the Eustachian tube via a
transpalatal approach. Inspection of the tympanic membrane, culturing of middle
ear effusion and processing of the temporal bones for light microscopy were
performed. RESULTS: Abnormal otomicroscopic findings and persistence of infection
were correlated with the histopathological changes found in middle ear tissues.

PMID: 15966695 [PubMed - indexed for MEDLINE]

1035: Acta Otolaryngol. 2005 Mar;125(3):256-9.

Effect of recombinant vascular endothelial growth factor on experimental otitis
media with effusion.

Kim TH, Chae SW, Kim HJ, Jung HH.

Department of Otolaryngology--Head and Neck Surgery, Korea University College of 
Medicine, Sungbuk-Ku, Seoul, South Korea.

CONCLUSION: This study demonstrates that rVEGF in the middle ear cavity
contributes significantly to the development of OME by increasing the vascular
permeability of the middle ear mucosa. OBJECTIVE: Vascular endothelial growth
factor (VEGF) has been detected in otitis media with effusion (OME). It has a
very strong effect on increasing vascular permeability, and is much more potent
than platelet-activating factor, arachidonic acid metabolites or histamine. The
purpose of this study was to investigate whether recombinant VEGF (rVEGF) can
increase vascular permeability in the middle ear mucosa of rats. MATERIAL AND
METHODS: rVEGF was injected transtympanically at doses of 0.01, 0.1 and 1.0
microg in the experimental groups; normal saline was injected in the control
group. Twenty-four h after the injection of rVEGF, middle ear fluid was aspirated
and the vascular permeability of the middle ear mucosa was measured by means of
the Evans Blue vital dye technique. RESULTS: Extravasation of Evans Blue dye was 
found in all specimens injected with rVEGF, and was quantified using a
spectrophotometer. Middle ear fluid developed in all ears injected with 0.1 or
1.0 microg of rVEGF and histopathology of the middle ear mucosa revealed severe
inflammatory cellular infiltration, subepithelial edema and vascular dilatation. 
Rats injected with 1.0 microg of rVEGF showed a significant increase in middle
ear vascular permeability in comparison with the control group (p < 0.05).

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15966693 [PubMed - indexed for MEDLINE]

1036: Acta Otolaryngol. 2005 Mar;125(3):250-5.

Hearing loss after "refractory" secretory otitis media.

Ryding M, Konradsson K, White P, Kalm O.

Department of Otorhinolaryngology, Hospital of Ostersund, Ostersund, Sweden.
marie.ryding@jll.se

CONCLUSIONS: The results indicate that SOM of extreme duration, and maybe also
the treatment of SOM, are risk factors for developing permanent hearing loss,
both conductive and sensorineural. OBJECTIVE: Fluctuating or persisting hearing
loss of varying degrees is known to accompany secretory otitis media (SOM). The
aim of this study was to detect possible hearing sequelae in young adults who had
suffered from "refractory" SOM during childhood. MATERIAL AND MEDTHODS: A total
of 33 subjects (age 16-25 years) with previous SOM that had persisted for a mean 
of 11 years (range 6-19 years) were retrospectively examined at a mean of 18
years after their first myringotomy or tube insertion and compared to 15 healthy 
controls. The follow-up included audiometric examinations (pure-tone audiometry, 
distorted speech and impedance audiometry), otomicroscopy and scrutiny of medical
records. RESULTS: The SOM group had poorer hearing at all frequencies with the
exception of 1.5 kHz in the range 0.125-16 kHz. Those with the greatest number of
myringotomies and tube insertions and those with the longest duration of SOM had 
significantly poorer hearing at high frequencies (8-16 kHz) than those with fewer
tube insertions and a shorter duration of SOM. The SOM group scored lower on
distorted speech tests than the controls.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15966692 [PubMed - indexed for MEDLINE]

1037: Clin Pediatr (Phila). 2005 Jun;44(5):437-41.

Paroxysmal non-epileptic events resembling seizures in children with otitis
media.

Soman TB, Krishnamoorthy KS.

Department of Neurology, The Hospital for Sick Children, Toronto, ON M5G 1X8,
Canada.

Children may frequently present with recurrent spells, which are often thought to
be seizures. However, there are several benign non-epileptic conditions that
mimic seizures. A group of 8 children is described who were diagnosed with otitis
media and presented with recurrent, stereotypic spells suggestive of seizures. A 
paroxysmal phenomenon, in association with otitis media, resembling seizures, has
not been previously described. These paroxysmal phenomena resembling seizures may
be related to acute otitis media and should be included in the differential
diagnosis of paroxysmal non-epileptic events in infants and young children.

Publication Types: 
    Comparative Study

PMID: 15965551 [PubMed - indexed for MEDLINE]

1038: Eur Arch Otorhinolaryngol. 2005 Oct;262(10):847-51. Epub 2005 Jun 15.

Comment in:
    Eur Arch Otorhinolaryngol. 2006 Apr;263(4):394.

Intracranial abscesses associated with chronic suppurative otitis media.

Seven H, Coskun BU, Calis AB, Sayin I, Turgut S.

Department of Otolaryngology, Sisli Etfal Training and Research Hospital,
Istanbul, Turkey.

Intracranial abscesses are serious complications of chronic suppurative otitis
media (COM). This study included 32 patients presenting with intracranial
abscesses from 780 patients hospitalized for treatment of COM. The 32 patients
had 59 intracranial complications. Perisinus abscess (13 of 32) was the most
common intracranial abscess, followed by temporal lobe abscess (8 of 32),
epidural abscess (7 of 32), cerebellar abscess (6 of 32) and subdural empyema (2 
of 32). Headache (93%), fever (87%) and altered mental status (62%) were the most
common presenting symptoms and signs, along with symptoms of COM. All patients
were treated with intravenous antibiotics and canal wall down mastoidectomy.
Cholesteatoma with granulation tissue and bony defects at the sinus plate and/or 
dural plate were seen in most of the patients. Gram negative bacilli and
anaerobes were the most common organisms cultured from the abscesses. Three
patients had neurological sequels. One patient died. The early diagnosis of these
complications requires a high index of suspicion and imaging studies. A
multidisciplinary and coordinated approach is important for the management of
these patients.

PMID: 15959795 [PubMed - indexed for MEDLINE]

1039: Int J Pediatr Otorhinolaryngol. 2005 Oct;69(10):1311-9.

Acute otitis media-diagnosis and treatment in the era of antibiotic resistant
organisms: updated clinical practice guidelines.

Segal N, Leibovitz E, Dagan R, Leiberman A.

Department of Otolaryngology - Head & Neck Surgery, Soroka University Medical
Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev,
P.O. Box 151, Beer-Sheva 84101, Israel.

The treatment of children with AOM has to rely on an accurate diagnosis and a
clear discrimination between AOM and serous otitis media. The last decade has
seen major changes in the epidemiology of AOM with an earlier onset of disease
and a greater proportion of children with recurrent/complicated AOM. The
processes of changing susceptibility of bacterial pathogens added a major problem
in treatment selection. Tastier, more efficient, safe and conveniently-dosing as 
well as cost effective drugs are required to achieve adherence to therapy. The
recent published guidelines for the treatment of AOM in the present era of
pneumoccocal resistance represent a major step forward in the approach to the
management of this disease by establishing a clear hierarchy among the various
therapeutic agents. A 48-72 h observation option without use of antibacterial
therapy in selected children with uncomplicated AOM should be promoted.
Immunization against S. pneumoniae with the heptavalent pneumococcal conjugated
vaccines was showed to result in a decrease in the frequency of AOM caused by
this pathogen, including AOM caused by antibiotic-resistant S. pneumoniae.

Publication Types: 
    Review

PMID: 15955573 [PubMed - indexed for MEDLINE]

1040: BMC Pediatr. 2005 Jun 14;5(1):16.

The clinical course of acute otitis media in high-risk Australian Aboriginal
children: a longitudinal study.

Gibney KB, Morris PS, Carapetis JR, Skull SA, Smith-Vaughan HC, Stubbs E, Leach
AJ.

Department of Medicine, Royal Darwin Hospital, Australia.
katherinegibney@hotmail.com

BACKGROUND: It is unclear why some children with acute otitis media (AOM) have
poor outcomes. Our aim was to describe the clinical course of AOM and the
associated bacterial nasopharyngeal colonisation in a high-risk population of
Australian Aboriginal children. METHODS: We examined Aboriginal children younger 
than eight years who had a clinical diagnosis of AOM. Pneumatic otoscopy and
video-otoscopy of the tympanic membrane (TM) and tympanometry was done every
weekday if possible. We followed children for either two weeks (AOM without
perforation), or three weeks (AOM with perforation), or for longer periods if the
infection persisted. Nasopharyngeal swabs were taken at study entry and then
weekly. RESULTS: We enrolled 31 children and conducted a total of 219
assessments. Most children had bulging of the TM or recent middle ear discharge
at diagnosis. Persistent signs of suppurative OM (without ear pain) were present 
in most children 7 days (23/30, 77%), and 14 days (20/26, 77%) later. Episodes of
AOM did not usually have a sudden onset or short duration. Six of the 14 children
with fresh discharge in their ear canal had an intact or functionally intact TM. 
Perforation size generally remained very small (<2% of the TM). Healing followed 
by re-perforation was common. Ninety-three nasophyngeal swabs were taken. Most
swabs cultured Streptococcus pneumoniae (82%), Haemophilus influenzae (71%), and 
Moraxella catarrhalis (95%); 63% of swabs cultured all three pathogens.
CONCLUSION: In this high-risk population, AOM was generally painless and
persistent. These infections were associated with persistent bacterial
colonisation of the nasopharynx and any benefits of antibiotics were modest at
best. Systematic follow up with careful examination and review of treatment are
required and clinical resolution cannot be assumed.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15955251 [PubMed - indexed for MEDLINE]

1041: South Med J. 2005 May;98(5):577-8.

Mastoiditis in an immunocompetent adult.

Rathbun KC, Kendall MS.

Ochsner Clinic Foundation, Baton Rouge, LA 70809, USA. krathbun@ochsner.org

A 20-year-old white male presented to the family practice department with a
1-month history of right ear pain and loss of hearing. During the month, he had
been seen in emergency rooms twice and also by his dentist. He had been treated
with pain medications, tooth extraction, and finally, antibiotics. On
presentation to the clinic, his right mastoid area showed erythema, tenderness,
and swelling that displaced the pinna. He was immediately referred to the
otolaryngology department. Imaging studies confirmed coalescent mastoiditis and
subperiosteal abscess. He was taken to surgery, where he underwent cortical
mastoidectomy and right pressure equalization tube placement. Intraoperative and 
postoperative intravenous cefotaxime was given. Recovery was complete and
uneventful.

Publication Types: 
    Case Reports

PMID: 15954521 [PubMed - indexed for MEDLINE]

1042: J Commun Disord. 2005 Nov-Dec;38(6):473-98. Epub 2005 Jun 13.

A quantitative and qualitative assessment of verbal short-term memory and
phonological processing in 8-year-olds with a history of repetitive otitis media.

Majerus S, Amand P, Boniver V, Demanez JP, Demanez L, Van der Linden M.

Department of Cognitive Sciences/Cognitive Psychopathology Sector, University of 
Liege, Belgium. smajerus@ulg.ac.be

Language outcome in children experiencing fluctuant hearing loss due to otitis
media (OME) remains highly equivocal. In the current study, we assessed
performance on highly sensitive verbal short-term memory (STM), new word learning
and phonological processing tasks in 8-year-old children who had suffered from
recurrent OME before the age of 3. Relative to a control group with no history of
OME, we observed strictly normal performance for different STM and new word
learning tasks. Performance on these tasks was also normally influenced by
phonotactic, lexical and semantic variables. However, at the level of
phonological processing, a small but significant decrease of performance was
found in a speeded nonword identification task and a rhyme judgment task. The
results of this study suggest that outcome of OME is characterized by subtle
impairments at the level of perceptual-phonological analysis, but there is no
significant impact on verbal STM and new word learning abilities. LEARNING
OUTCOMES: As a result of this activity, the participant will be able to (1)
explain the outcome of recurrent OME before age 3 on later language and verbal
STM development, (2) be aware of the complex relationships that link language
development and verbal STM, (3) explain how fluctuant hearing loss during infancy
and early childhood could affect verbal STM development and learning capacity for
new phonological information, (4) describe different verbal STM measures that
distinguish retention capacities for phonological and lexico-semantic
information, and (5) explain the influence of phonotactic frequency on nonword
processing in language and verbal STM tasks.

PMID: 15950984 [PubMed - indexed for MEDLINE]

1043: Eur J Radiol. 2005 Jul;55(1):102-7. Epub 2004 Dec 7.

MR of 2270 TMJs: prevalence of radiographic presence of otomastoiditis in
temporomandibular joint disorders.

Orhan K, Nishiyama H, Tadashi S, Shumei M, Furukawa S.

Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Ankara
University, 06500 Besevler, Ankara, Turkey. call53@yahoo.com

OBJECTIVE: The purpose of this study is to determine the prevalence of
radiographic presence of otomastoiditis while examining temporomandibular joint
(TMJ) disorders in magnetic resonance images (MRI) in a series of 2270
temporomandibular joint magnetic resonance images and to examine the relationship
between otomastoiditis and TMJ disorders. MATERIALS AND METHODS: 2270
temporomandibular joint magnetic resonance images and patients' data were
retrospectively investigated. Magnetic resonance images were obtained from the
patients who referred to Osaka University Dental Hospital Outpatient Clinic with 
TMJ complaints for the last four years (from January 1998 to January 2003). The
patients, who were diagnosed as otomastoiditis based on their temporomandibular
joint magnetic resonance images, were sent to Osaka University Hospital
Department of Otolaryngology for a medical consultation in order to have their
pathologies certified following their MR process. Age and sex were recorded for
all patients and for otomastoiditis cases; location of the disease, symptoms of
patients and TMJ findings were noted as well. RESULTS: Seven patients were
diagnosed as acute otomastoiditis and one patient diagnosed as chronic active
otitis media with cholesteatoma in the series of 2270 MR, which were representing
a prevalence of 0.39%. Neurilemoma diagnosed in left mastoid process in one
patient. The final diagnoses of all patients were made after medical
consultation. CONCLUSION: While examining temporomandibular joint magnetic
resonance images; it is not only important to examine just the TMJ structures,
but also to look at the nearby anatomical features to check evidence for
inflammatory disease.

PMID: 15950106 [PubMed - indexed for MEDLINE]

1044: Int J Pediatr Otorhinolaryngol. 2005 Dec;69(12):1659-65. Epub 2005 Jun 8.

Middle ear total pressure measurement as a useful parameter for outcome
prediction in pediatric otitis media with effusion.

Uchimizu H, Utahashi H, Hamada Y, Aoki K.

The Jikei University School of Medicine, Department of Otorhinolaryngology,
3-25-8, Nishi-shinbashi, Tokyo 105-8461, Japan. uchimizu@jikei.ac.jp

OBJECTIVE: For the effective treatment of pediatric otitis media with effusion
(OME) with a ventilation tube, routine evaluation of the condition of the middle 
ear mucosa after tube placement is critical. For this purpose, we monitored the
changes in the middle ear total pressure (METP) associated with the transmucosal 
gas exchanges. We also evaluated the function of the eustachian tube by
sonotubometry. The present study aimed to examine the temporal changes in the
maximum METP after tube placement and to assess the association between the
maximum METP and subsequent outcome. We also investigated the predictive value of
METP measurement and sonotubometry on tube removal. METHODS: To study the
temporal changes in the maximum METP after tube placement and the association
between the maximum METP and outcome after tube removal, 78 patients were
enrolled, who underwent ventilation tube placement between April 1991 and May
2002 and were followed up for at least a year after tube removal. Of these 78
patients, 54 patients who underwent the METP measurement on tube removal and 39
patients who underwent sonotubometry on tube removal were included in a
retrospective analysis of the predictive value of these tests. The patients were 
divided into 4 groups according to the outcome after tube removal, graded as
"excellent", "good", "persistent perforation" and "recurrence". RESULTS: The
maximum METP exhibited a tendency to increase after 18 months or longer of tube
placement. The comparisons of the maximum METP across the patient groups revealed
that the maximum METP in patients with "excellent" was significantly higher than 
that in patients with "recurrence" (Student's t-test, P<0.05). As for the
prediction of outcomes on tube removal, 32.4 and 57.1% of patients were predicted
to have a good outcome by sonotubometry and the METP measurement, respectively
(chi2 test, P<0.05). Among patients with a maximum METP higher than 31 mm H2O,
93.3% exhibited no recurrence after tube removal. CONCLUSIONS: Favorable outcome 
after tube removal was associated with more active transmucosal gas exchange. The
maximum METP best reflected the outcome after tube removal, indicating a superior
predictive value of the METP measurement over sonotubometry.

Publication Types: 
    Evaluation Studies

PMID: 15949851 [PubMed - indexed for MEDLINE]

1045: J Laryngol Otol. 2005 May;119(5):342-7.

A group III steroid solution without antibiotic components: an effective cure for
external otitis.

Emgård P, Hellström S.

ENT Clinic, Ystad Hospital, Ystad, Sweden. per.emgard@skane.se

The present study was undertaken to compare the clinical benefits of prescribing 
ear drops containing 0.05% solution of betamethasone dipropionate (BD), and ear
drops containing hydrocortisone with oxytetracycline hydrochloride and polymyxin 
B (HCPB), for topical treatment of external otitis. Fifty-one patients were
enrolled in this open randomized, parallel-group, multicentre study, performed in
eight different ENT departments. The patients were randomly assigned to one of
the two treatment groups: BD (n = 26) and HCPB (n = 25). Only ENT specialists
investigated the patients. Bacterial and fungal cultures were raised on days 1
and 11, using swabbed material from ear canals. Twice daily the patients recorded
their symptoms during the acute phase, using special diary cards.BD proved a
significantly more effective cure than HCPB during the acute phase of external
otitis and afforded a lower relapse frequency during a six-month follow-up
period. The patients of the BD group were significantly less troubled by itching 
(p < 0.01) than those in the HCPB group. On day 11, at the end of the acute
phase, growth of bacteria (p = 0.03) and fungi (p < 0.01) was less frequent in
the BD group than in the HCPB group. No serious adverse events occurred, and
those minor events observed were comparable between the two groups.Our conclusion
is that the group III steroid solution, BD, cured the external otitis more
effectively than did the HCPB solution, whether infected by bacteria or by fungi.
No difference was evident regarding adverse effects. Furthermore, price favours a
solution without any antibiotic component. In view of these observations, a group
III steroid solution ought to be the preferred remedy for external otitis,
whether infected or not.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15949095 [PubMed - indexed for MEDLINE]

1046: J Laryngol Otol. 2005 Apr;119(4):325-9.

Gradenigo's syndrome: successful conservative treatment in adult and paediatric
patients.

Burston BJ, Pretorius PM, Ramsden JD.

Department of Otolaryngology, Northampton General Hospital, Northampton, UK.

A triad of retro-ocular pain, discharging ear and abducens nerve palsy, as
described by Gradenigo, has been recognized for 150 years. It has traditionally
been treated with surgery, but recent advances in imaging, allied with improved
antibiotic treatment, allow conservative management of these cases. We present
two cases of Gradenigo's syndrome: a 6-year-old child and a 70-year-old man, both
without cholesteatoma, who were managed without mastoidectomy. They both had full
recovery of abducens nerve function, although this took 6 and 12 weeks,
respectively. In order to manage patients with Gradenigo's syndrome safely,
accurate diagnostic radiology is essential, and our findings are presented and
discussed. With changing medical technology, a review of the diagnostic and
treatment options for this rare but serious condition, is timely.

Publication Types: 
    Case Reports

PMID: 15949093 [PubMed - indexed for MEDLINE]

1047: J Laryngol Otol. 2005 Apr;119(4):308-10.

Genetically-induced deep venous thrombosis presenting as acute mastoiditis.

Barbara M, Consagra C, Buongiorno G, Monini S, Bandiera G, Filipo R.

Department of Otorhinolaryngology, Second Medical School, University La Sapienza,
Rome, Italy. maurizio.barbara@uniroma1.it

Sigmoid sinus thrombosis (SST) usually follows acute as well as chronic otitis
media with coalescent mastoiditis. A singular case of noncoalescent mastoiditis
complicated with thrombosis of deep cerebral sinuses occurring in a young child
is presented. A genetic thrombophilic disorder (prothrombin G20210A allele
mutation) was identified as the predisposing factor for this unusual
complication. Particular emphasis is placed on the course of the disease, which
showed regression only after surgical exploration and additional anticoagulant
therapy. We conclude that a thorough and early assessment of coagulation factors 
should always be performed, especially in the population at risk, in order to
rule out unusual aetiologies of these rare but still life-threatening
pathological processes.

Publication Types: 
    Case Reports

PMID: 15949088 [PubMed - indexed for MEDLINE]

1048: J Laryngol Otol. 2005 Apr;119(4):306-7.

A simple method for preparing an ear wick.

Badran K, Karkos PD.

Department of Otolaryngology, The Countess of Chester Health Park, Liverpool
Road, Chester CH2 1UL, UK.

We present a simple method for preparing an ear wick for treating otitis externa 
in ENT outpatient clinics. In our experience, this method is efficient,
economical and clean, and ensures an equal distribution of the medication along
the wick.

PMID: 15949087 [PubMed - indexed for MEDLINE]

1049: Otolaryngol Head Neck Surg. 2005 Jun;132(6):924-7.

Laser myringotomy for otitis media with effusion in nasopharyngeal carcinoma
patients.

Hwang CF, Chien CY, Lin HC, Peng JP, Chang HW, Su CY.

Department of Otolaryngology, Chang Gung University, Kaohsiung Chang Gung
Memorial Hospital, Taiwan. cfhwang@seed.net.tw

OBJECTIVE: To evaluate the effectiveness of laser myringotomy in otitis media
with effusion (OME) in patients with nasopharyngeal carcinoma (NPC). STUDY DESIGN
AND SETTING: Laser myringotomy was performed with a CO 2 laser otoscope in 53 NPC
patients (68 ears) and 32 non-NPC patients (37 ears). All patients had a history 
of OME. RESULTS: In the NPC group, 40% of ears developed persistent perforation, 
37% had recurrent OME, and 23% were free of disease. In the non-NPC group, only
3% of ears developed persistent perforation, and 43% were free of disease.
Significant differences in perforation and disease-free state were evident
between the 2 groups. Tumor stage was found to be a significant determining
factor for clinical outcome in NPC group. CONCLUSION: Laser myringotomy for NPC
group carries a significantly higher risk of persistent perforation and lower
rate of cure. This procedure may be considered for early staging NPC patients
with serious OME symptoms.

PMID: 15944565 [PubMed - indexed for MEDLINE]

1050: Otolaryngol Head Neck Surg. 2005 Jun;132(6):896-901.

Preoperative antibiotic and steroid therapy and hearing loss caused by
semicircular canal transection in pseudomonas otitis media.

Lee JC, Remtulla RA, Stevens GR, Zhang M, Antonelli PJ.

Department of Otolaryngology, University of Florida, Gainesville 32610-0264, USA.

OBJECTIVE: The purpose of this experiment was to determine whether preoperative
administration of antibiotics and corticosteroids can attenuate the severity of
hearing loss (HL) with semicircular canal (SC) transection in a guinea pig model 
of Pseudomonas aeruginosa (PA) otitis media (OM). Study design and setting
Prospective and controlled. METHODS: OM was induced in 64 pigmented guinea pigs
by bilateral, transtympanic injection of PA. Two to 4 days later, 1 horizontal SC
was randomly transected. In the 1st series, antibiotic therapy was initiated
either immediately before or after surgery. In the 2nd series, all animals
received preoperative antibiotics, and half received dexamethasone before
surgery. Hearing was tested before and after surgery. RESULTS: PA was recovered
in all ears. SC transection was associated with significant HL. HL was better in 
animals given antibiotics preoperatively (clicks, 16 versus 32 dB, P = 0.0220).
Addition of preoperative steroids did not significantly further reduce HL (7
versus 14 dB for clicks, P = 0.6919). CONCLUSIONS: HL caused by SC transection in
PA OM may be attenuated with preoperative antibiotic therapy in the guinea pig.

PMID: 15944561 [PubMed - indexed for MEDLINE]

1051: Int J Pediatr Otorhinolaryngol. 2005 Dec;69(12):1641-7. Epub 2005 Jun 6.

Factors influencing the presence of otitis media with effusion 16 months after
initial diagnosis in a cohort of school-age children in rural Greece: a
prospective study.

Xenellis J, Paschalidis J, Georgalas C, Davilis D, Tzagaroulakis A, Ferekidis E.

Academic Department of Otolaryngology - Head and Neck Surgery, Ippokration
Hospital, National University of Athens, Athens, Greece.

OBJECTIVE: Few studies have specifically assessed the risk factors for
persistence or recurrence of OME in a cohort of school-age children. The
generally accepted etiological factors for OME occurrence may not apply in the
same way when the presence of OME over a year from original diagnosis is
assessed. METHODS: A cohort of 250 school-age children with unilateral or
bilateral OME, identified through screening of 5121 asymptomatic children was
re-examined 16 months later. All were assessed for a variety of demographic,
family and medical factors. Measures included tympanometry, acoustic reflexes and
a complete otolaryngologic examination. RESULTS: At 16 months after initial
confirmation of OME, 56 out of 250 children (22.4%) suffered from OME, 21
bilateral and 31 unilateral. Presence of OME at 16 months was not associated with
gender, blood group, gestational age and weight, history of breast feeding,
paternal education level and smoking history, history of allergy, previous use of
antibiotics, or with surgery (myringotomy, insertion of ventilation tubes or
adenotonsillectomy). In multiple backward-eliminating logistic regression, the
only factors associated with OME presence after 16 months were episodes of AOM
during the study period (odds ratio 2.75 (95% CI: 1.13-8.17), p=0.04) and younger
age (odds ratio 0.53 (95% CI: 0.32-0.79), p=0.002 for each 2 years of increase in
age). CONCLUSION: Seventy-eight percent of school-age children identified with
OME through screening will be free of disease 16 months later. The threshold for 
referral, or surveillance could however justifiably be lower in children who (a) 
have once been identified with OME and (b) are (relatively) younger, or have
experienced an episode of acute otitis media.

PMID: 15941593 [PubMed - indexed for MEDLINE]

1052: Clin Infect Dis. 2005 Jul 1;41(1):35-41. Epub 2005 May 26.

Comment in:
    Clin Infect Dis. 2005 Jul 1;41(1):42-4.

Acute otitis media caused by Streptococcus pyogenes in children.

Segal N, Givon-Lavi N, Leibovitz E, Yagupsky P, Leiberman A, Dagan R.

Department of Otorhinolaryngology, Ben-Gurion University of the Negev,
Beer-Sheva, Israel.

BACKGROUND: Streptococcus pyogenes, or group A beta -hemolytic Streptococcus
(GAS), is an important causative agent of bacterial pharyngotonsillititis and
skin, soft-tissue, and invasive infections. Although it is also an important
pathogen in acute otitis media (AOM), its exact role has not been determined.
METHODS: Patients aged 0-18 years with AOM, from whom a specimen of middle-ear
fluid was obtained and cultured during 1999-2003, were enrolled. Streptococcus
pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and GAS were
considered pathogens. Information collected included demographic characteristics,
clinical history, and signs and symptoms. RESULTS: GAS otitis was observed in 350
(3.1%) of 11,311 episodes (of which 117 were also culture-positive for other
pathogens). The other 10,961 episodes involved H. influenzae only (n = 2507), S. 
pneumoniae only (n = 2131), dual infection with H. influenzae and S. pneumoniae
(n = 1290), M. catarrhalis only (n = 129), and other combinations of pathogens (n
= 271). Increased age and Jewish ethnicity were independent, significant,
positive risk factors for GAS AOM, and fall season was a negative risk factor.
Episodes of GAS infection were less frequently bilateral, febrile, and
accompanied by other systemic findings than were other episodes of other types of
infection. Most patients with GAS AOM presented with acute drainage from the
ears. A lower proportion of cases of AOM were due to GAS in children with
recurrent AOM and in patients recently treated with antibiotics, compared with
patients with AOM who did not have these factors. The risk for mastoiditis was
highest among patients with GAS AOM, compared with patients infected with other
pathogens: 11.6 episodes per 1000 episodes of GAS AOM, compared with 2.2, 0.3,
and 0 episodes of mastoiditis per 1000 episodes of AOM due to S. pneumoniae, H.
influenzae, and M. catarrhalis, respectively. CONCLUSION: Compared with AOM
caused by pathogens other than GAS, GAS AOM is characterized by older age and
higher local aggressiveness manifested by lower rates of fever and respiratory
symptoms and higher rates of tympanic perforation and mastoiditis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15937760 [PubMed - indexed for MEDLINE]

1053: Ann Acad Med Singapore. 2005 May;34(4):330-4.

Infections of the external ear.

Ong YK, Chee G.

Department of Otolaryngology--Head and Neck Surgery, National University
Hospital, Singapore.

Otitis externa is one of the most common conditions seen in the otolaryngology
practice. It encompasses a wide range of conditions, from those that cause mild
inflammation and discomfort to those that are life-threatening. The management of
these conditions requires a clear understanding of the anatomy and physiology of 
the ear canal, the microbiology of pathogens and familiarity with the clinical
presentation.

Publication Types: 
    Review

PMID: 15937574 [PubMed - indexed for MEDLINE]

1054: Int J Pediatr Otorhinolaryngol. 2005 Oct;69(10):1399-405.

Acute mastoiditis and osteomyelitis of the temporal bone.

Dudkiewicz M, Livni G, Kornreich L, Nageris B, Ulanovski D, Raveh E.

Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Sackler
Faculty of Medicine, Tel Aviv University, Tel Aviv, Petah Tiqwa, Israel.

OBJECTIVE: Acute mastoiditis becomes clinically significant when infection
spreads through the periosteum and induces periosteitis. This study describes an 
atypical complication of acute mastoiditis: osteomyelitis of the temporal bone.
PATIENTS AND METHODS: The study sample included all patients admitted for acute
mastoiditis between September 2001 and December 2003 who had symptoms, signs and 
imaging findings of osteomyelitis of the temporal bone beyond the mastoid area.
The files were reviewed for diagnosis, work-up, radiographic findings and
treatment. RESULTS: The study group included 6 of the 120 patients treated for
acute mastoiditis. In four children (66%), the diagnoses of acute otitis media
and acute mastoiditis were made simultaneously at admission. Ear cultures yielded
coagulase-positive Staphylococcus in three patients, Bacteroides in two, multiple
organisms in two, S. pneumoniae in one, and no growth in two. Complications were 
suspected if there was a lack of improvement in symptoms and signs, or in cases
of skin involvement over the temporal bone beyond the area of the mastoid in
accordance with imaging findings. Computerized tomography demonstrated temporal
bone absorption beyond the mastoid area (squama and/or petrous bones) in all
children, suspected sinus vein thrombosis in two, and suspected epidural abscess 
in one. All children were treated with at least cortical mastoidectomy and
insertion of ventilation tubes. Revision mastoidectomy was performed in three
children in whom no improvement was noted and imaging suggested other
complications. CONCLUSION: The present study describes an unusual complication of
acute mastoiditis-osteomyelitis of the temporal bone beyond the mastoid
framework. The disorder is characterized by a failure to respond both locally and
systemically to accepted medical and surgical therapy, persistent fever and high 
levels of inflammatory markers, and computerized tomography findings of temporal 
bone destruction. Treatment includes broad-spectrum antibiotics and at least
cortical mastoidectomy. Prognosis is good.

PMID: 15935482 [PubMed - indexed for MEDLINE]

1055: Pediatr Infect Dis J. 2005 Jun;24(6):525-32.

Large dosage amoxicillin/clavulanate, compared with azithromycin, for the
treatment of bacterial acute otitis media in children.

Hoberman A, Dagan R, Leibovitz E, Rosenblut A, Johnson CE, Huff A, Bandekar R,
Wynne B.

Children's Hospital of Pittsburgh, PA 15213, USA. hoberman@chp.edu

BACKGROUND: A large dosage pediatric formulation of amoxicillin/clavulanate with 
an improved pharmacokinetic/pharmacodynamic profile was developed to eradicate
many penicillin-resistant strains of Streptococcus pneumoniae and Haemophilus
influenzae (including beta-lactamase-producing strains). METHODS: This
randomized, investigator-blinded, multicenter trial examined treatment of
bacterial acute otitis media (AOM) in children 6-30 months of age with
amoxicillin/clavulanate (90/6.4 mg/kg/d in 2 divided doses for 10 days) versus
azithromycin (10 mg/kg for 1 day followed by 5 mg/kg/d for 4 days).
Tympanocentesis was performed at entry for bacteriologic assessment, at the
on-therapy visit (day 4-6) to determine bacterial eradication and at any time
before the end-of-therapy visit (day 12-14) if the child was categorized as
experiencing clinical failure. Clinical assessments were performed at the
on-therapy, end-of-therapy and follow-up (day 21-25) visits. RESULTS: We enrolled
730 children; AOM pathogens were isolated at baseline for 249 of the
amoxicillin/clavulanate group and 245 of the azithromycin group. For children
with AOM pathogens at baseline, clinical success rates at the end-of-therapy
visit were 90.5% for amoxicillin/clavulanate versus 80.9% for azithromycin (P <
0.01), and those at the on-therapy and follow-up visits were 94.9% versus 88.0%
and 80.3% versus 71.1%, respectively (all P < 0.05). At the on-therapy visit,
pretherapy pathogens were eradicated for 94.2% of children receiving
amoxicillin/clavulanate versus 70.3% of those receiving azithromycin (P < 0.001).
Amoxicillin/clavulanate eradicated 96.0% of S. pneumoniae (92.0% of fully
penicillin-resistant S. pneumoniae) and 89.7% of H. influenzae (85.7% [6 of 7
cases] of beta-lactamase-positive H. influenzae). Corresponding rates for
azithromycin were 80.4% (54.5%) for S. pneumoniae and 49.1% (100% [1 of 1 case]) 
for H. influenzae (all P < 0.01 for between-drug comparisons). CONCLUSION:
Amoxicillin/clavulanate was clinically and bacteriologically more effective than 
azithromycin among children with bacterial AOM, including cases caused by
penicillin-resistant S. pneumoniae and beta-lactamase-positive H. influenzae.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15933563 [PubMed - indexed for MEDLINE]

1056: Laryngoscope. 2005 Jun;115(6):1124-7.

Gustatory function in chronic inflammatory middle ear diseases.

Landis BN, Beutner D, Frasnelli J, Hüttenbrink KB, Hummel T.

Department of Otorhinolaryngology, Smell and Taste Clinic, University of Dresden 
Medical School, Dresden, Germany. Basile.Landis@hcuge.ch

HYPOTHESIS: Changes of gustatory function after ear surgery have been studied
extensively. However, little is known on the influence of repeated/chronic
inflammation within the middle ear on taste. STUDY DESIGN: Prospective study.
MATERIALS AND METHODS: Forty-six patients suffering from either cholesteatoma (n 
= 25) or chronic otitis media mesotympanalis (n = 21) received quantitative
gustatory tests. None of these patients had been operated on before these
investigations. RESULTS: Side by side comparison showed a significantly lower
taste function on the anterior two thirds of the tongue ipsilateral to the site
of inflammation, regardless of the diagnosis. Further analyses exhibited a trend 
toward greater impairment in relation to the severity of the inflammatory
process. CONCLUSION: These data are proof that taste function changes in relation
to chronic middle ear diseases. It further shows that many of these alterations
go unnoticed by the patients.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15933535 [PubMed - indexed for MEDLINE]

1057: Laryngoscope. 2005 Jun;115(6):1065-9.

Novel use of a swimming pool biocide in the treatment of a rare fungal
mastoiditis.

Chang CY, Schell WA, Perfect JR, Hulka GF.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke
University Medical Center, Durham, North Carolina 27710, USA.

OBJECTIVE: To describe an extremely rare fungal mastoiditis caused by
Lecythophora hoffmannii, its recalcitrant behavior to therapy, and eventual
successful treatment with adjunctive therapy using polyhexamethylene biguanide (a
common swimming pool biocide). STUDY DESIGN: Case report and review of literature
of human Lecythophora hoffmannii infections. METHODS: Medline database was
searched using the keywords Lecythophora and hoffmannii. All articles that
described Lecythophora hoffmannii as the cause of human infection at any site
were identified. Literature and patient's records were considered for complete
data review and extraction. RESULTS: We present the second known case in the
literature of a human infection with Lecythophora hoffmannii. We also present the
process to definitively identify and then to successfully eradicate this unusual 
fungal infection using polyhexamethylene biguanide as adjunctive treatment.
CONCLUSIONS: Successful treatment of a chronic Lecythophora hoffmannii fungal
mastoiditis involved a combination of radical surgical removal of all apparent
infected tissue along with local treatments with polyhexamethylene biguanide, a
common swimming pool biocide agent under the brand name Baquacil (Avecia,
Manchester, United Kingdom). Given the prolonged course of treatment, this report
particularly stresses the importance of concurrent surgery combined with creative
local antimicrobial therapy to eliminate an unusual fungal infection in an
immunocompetent host.

Publication Types: 
    Case Reports

PMID: 15933522 [PubMed - indexed for MEDLINE]

1058: Pediatrics. 2005 Jun;115(6):1466-73.

Watchful waiting for acute otitis media: are parents and physicians ready?

Finkelstein JA, Stille CJ, Rifas-Shiman SL, Goldmann D.

Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard 
Pilgrim Health Care, Boston, Massachusetts, USA.
jonathan_finkelstein@harvardpilgrim.org

OBJECTIVE: To assess the current use of initial observation ("watchful waiting") 
of acute otitis media among community physicians and the acceptability of this
option to parents of young children. SETTING: Sixteen nonoverlapping
Massachusetts communities enrolled in a community intervention study on
appropriate antibiotic use. DESIGN: Pediatricians, family physicians, and a
random sample of parents of children <6 years old were surveyed. Parents
predicted what their satisfaction would be with initial observation of an ear
infection without antibiotics if suggested by their physician and concerns they
would have regarding this watchful-waiting approach. Physicians reported the
frequency with which they use this approach in children > or =2 years and those
<2 years old. Separate multivariable models identified factors independently
associated with parental satisfaction and with frequency of self-reported use by 
physicians. All models accounted for clustering of responses within communities. 
RESULTS: Two thousand fifty-four (40%) parents and 160 (58%) physicians
responded. Of the parents, 34% would be somewhat or extremely satisfied if
initial observation was recommended, another 26% would be neutral, and the
remaining 40% would be somewhat or extremely dissatisfied. The multivariable
model showed lower parental education (odds ratio [OR]: 0.50; 95% confidence
interval [CI]: 0.35, 0.71, for high school education or less compared with
college graduation) and Medicaid enrollment (OR: 0.77; CI: 0.57, 1.0) was
associated with lower predicted satisfaction. Higher antibiotic-related knowledge
(OR: 1.2; CI: 1.1, 1.3, per question correct), belief that antibiotic resistance 
is a serious problem (OR: 2.3; CI: 1.8, 2.8), and reporting feeling included in
medical decisions (OR: 1.4; CI: 1.1, 1.7) all were independently associated with 
higher predicted satisfaction. Thirty-eight percent of physicians treating
children > or =2 years old never or almost never reported using initial
observation, 39% reported use occasionally, 17% sometimes, and 6% most of the
time. In a multivariable model, only more years in practice (OR: 0.96; CI: 0.93, 
0.99) was associated with a decreased likelihood of occasional or more-frequent
use of watchful waiting (compared with those who never use initial observation). 
However, a secondary model that combined occasional users with nonusers (compared
with those reporting use sometimes or more often) identified several correlates
of use of observation: years in practice (OR: 0.95; CI: 0.91, 0.99), family
medicine specialization (OR: 4.5; CI: 1.9, 11), belief that antibiotic resistance
is a significant problem (OR: 4.3; CI: 1.3, 14.5), and practice in a community
receiving a judicious antibiotic-use intervention (OR: 3.5; CI: 1.3, 9.1).
CONCLUSIONS: A majority of physicians reported at least occasionally using
initial observation, but few use it frequently. Many parents have concerns
regarding this option, but acceptability is increased among those with more
education and those who feel included in medical decisions. Substantial change in
both parental and provider views would be needed to make initial observation a
widely used alternative for acute otitis media.

Publication Types: 
    Multicenter Study
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 15930205 [PubMed - indexed for MEDLINE]

1059: Pediatrics. 2005 Jun;115(6):1455-65.

Comment in:
    J Fam Pract. 2005 Sep;54(9):754.

Nonsevere acute otitis media: a clinical trial comparing outcomes of watchful
waiting versus immediate antibiotic treatment.

McCormick DP, Chonmaitree T, Pittman C, Saeed K, Friedman NR, Uchida T, Baldwin
CD.

Division of General Academic Pediatrics, University of Texas Medical Branch, 301 
University Blvd, Galveston, TX 77555-1119, USA. david.mccormick@utmb.edu

OBJECTIVE: The widespread use of antibiotics for treatment of acute otitis media 
(AOM) has resulted in the emergence of multidrug-resistant pathogens that are
difficult to treat. However, it has been shown that most children with nonsevere 
AOM recover without ABX. The objective of this study was to evaluate the safety, 
efficacy, acceptability, and costs of a non-ABX intervention for children with
nonsevere AOM. METHODOLOGY: Children 6 months to 12 years old with AOM were
screened by using a novel AOM-severity screening index. Parents of children with 
nonsevere AOM received an educational intervention, and their children were
randomized to receive either immediate antibiotics (ABX; amoxicillin plus symptom
medication) or watchful waiting (WW; symptom medication only). The investigators,
but not the parents, were blinded to enrollment status. Primary outcomes included
parent satisfaction with AOM care, resolution of symptoms, AOM
failure/recurrence, and nasopharyngeal carriage of Streptococcus pneumoniae
strains resistant to ABX. Secondary outcomes included medication-related adverse 
events, serious adverse events, unanticipated AOM-related office and emergency
department visits and telephone calls, the child's absence from day care or
school resulting from AOM, the parent's absence from school or work because of
their child's AOM, and costs of treatment. Subjects were defined as failing (days
0-12) or recurring (days 13-30) if they experienced a higher AOM-severity score
on reexamination. RESULTS: A total of 223 subjects were recruited: 73% were
nonwhite, 57% were <2 years old, 47% attended day care, 82% had experienced prior
AOM, and 83% had not been fully immunized with heptavalent pneumococcal vaccine. 
One hundred twelve were randomized to ABX, and 111 were randomized to WW.
Ninety-four percent of the subjects were followed to the 30-day end point. Parent
satisfaction with AOM care was not different between the 2 treatment groups at
either day 12 or 30. Compared with WW, symptom scores on days 1 to 10 resolved
faster in subjects treated with immediate ABX. At day 12, among the immediate-ABX
group, 69% of tympanic membranes and 25% of tympanograms were normal, compared
with 51% of normal tympanic membranes and 10% of normal tympanograms in the WW
group. Parents of children in the ABX group gave their children fewer doses of
pain medication than did parents of children in the WW group. Subjects in the ABX
group experienced 16% fewer failures than subjects in the WW group. Of the
children in the WW group, 66% completed the study without needing ABX. Immediate 
ABX resulted in eradication of S pneumoniae carriage in the majority of children,
but S pneumoniae strains cultured from children in the ABX group at day 12 were
more likely to be multidrug-resistant than strains from children in the WW group.
More ABX-related adverse events were noted in the ABX group, compared with the WW
group. No serious AOM-related adverse events were observed in either group.
Office and emergency department visits, phone calls, and days of work/school
missed were not different between groups. Prescriptions for ABX were reduced by
73% in the WW group compared with the ABX group. Costs of ABX averaged $47.41 per
subject in the ABX group and $11.43 in the WW group. CONCLUSIONS: Sixty-six
percent of subjects in the WW group completed the study without ABX. Parent
satisfaction was the same between groups regardless of treatment. Compared with
WW, immediate ABX treatment was associated with decreased numbers of treatment
failures and improved symptom control but increased ABX-related adverse events
and a higher percent carriage of multidrug-resistant S pneumoniae strains in the 
nasopharynx at the day-12 visit. Key factors in implementing a WW strategy were
(a) a method to classify AOM severity; (b) parent education; (c) management of
AOM symptoms; (d) access to follow-up care; and (e) use of an effective ABX
regimen, when needed. When these caveats are observed, WW may be an acceptable
alternative to immediate ABX for some children with nonsevere AOM.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 15930204 [PubMed - indexed for MEDLINE]

1060: J Ayub Med Coll Abbottabad. 2005 Jan-Mar;17(1):75-7.

Frequency of intra cranial complications in Chronic Otitis Media.

Hussain A, Khan AR.

Department of ENT, PGMI, Lady Reading Hospital, Peshawar, Pakistan.

BACKGROUND: Chronic Otitis Media can lead to intracranial complications, which
were more common in pre-antibiotic era as compared to the present antibiotic era.
Patients of Chronic Otitis Media with intracranial complications usually present 
very late due to ignorance and lack of primary health care. The aim of this study
was to investigate, the frequency, mortality and morbidity of intracranial
complications of chronic otitis media admitted in Ear Nose and Throat Unit of
Lady Reading Hospital Peshawar. METHODS: This study was conducted in Government
Lady Reading Hospital Peshawar for a period of two years from October 2001 to
October 2003. All the patients diagnosed as intracranial complications of chronic
otitis media were included in the study. RESULT: The total number of patients
reporting with intracranial complication due to chronic Otitis media (Unsafe ear)
was 20. Meningitis and brain abscess were present in 8 cases each (40%). In 3
cases (15%) extradural abscess was found while 1 (5%) had lateral sinus
thrombosis. CONCLUSION: Chronic Otitis media is a common disease in our part of
the world.

PMID: 15929536 [PubMed - indexed for MEDLINE]

1061: Ear Nose Throat J. 2005 Apr;84(4):219-22.

Mastoidectomy for acute otomastoiditis: our experience.

Migirov L, Kronenberg J.

Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel
Aviv. smigirov@leumit.co.il

We conducted a retrospective study of 53 mastoidectomies in 51 patients with
acute otomastoiditis. In 26 cases (49.1%), surgery had been performed within 48
hours of the development of symptoms. The most common complication of acute
otomastoiditis was subperiosteal abscess, which occurred in 37 cases (69.8%).
Intracranial complications were seen in 6 cases (11.3%). The most common
pathogens isolated from subperiosteal abscesses, the mastoid cavity, and
intracranial collections were Streptococcus spp and Staphylococcus aureus. In 14 
cases (26.4%), conservative treatment failed to cure acute otomastoiditis; such
cases should raise a suspicion of a subperiosteal abscess, an underlying
cholesteatoma, or an infection caused by gram-negative bacteria. Upon hospital
admission, patients should receive antibiotics that are effective against both
gram-positive and gram-negative organisms. Patients with intracranial
complications or facial nerve paralysis may require a combination of two or more 
antibiotics. Long-term follow-up is highly recommended.

PMID: 15929321 [PubMed - indexed for MEDLINE]

1062: Int J Pediatr Otorhinolaryngol. 2005 Nov;69(11):1503-8. Epub 2005 May 31.

Fungal causes of otitis externa and tympanostomy tube otorrhea.

Martin TJ, Kerschner JE, Flanary VA.

Department of Otolaryngology and Communication Sciences, Division of Pediatric
Otolaryngology, Medical College of Wisconsin, 9000 West Wisconsin Avenue,
Milwaukee, WI 53226, USA.

OBJECTIVE: To describe the occurrence of fungal organisms in the setting of
otitis externa and tympanostomy tube otorrhea, review the treatment course,
timing of diagnosis, organism identified and time to resolution with fungal
infections. DESIGN: Retrospective review. SETTING: Pediatric otolaryngology
clinic within a tertiary care hospital. PATIENTS: One hundred and sixty-six
patients (ages 16 days to 18 years) with fungal organisms on ear culture. OUTCOME
MEASURES: Number of prior therapies, number of office visits, time to resolution 
and anti-fungal therapy. RESULTS: Ear cultures positive for fungal organisms were
found in 166 patients seen between 1 January 1996 and 30 September 2003 from a
total of 1242 patients undergoing ear culture. Comparing the 3-year period
(1996-1998) prior to the availability of fluoroquinolone ototopical drops to the 
3-year period after (1999-2001), there is a statistically significant increase in
the incidence of positive fungal culture (p<0.001). Otitis media was diagnosed in
72% of these children, with otitis externa comprising 25%. Approximately 3%
carried a diagnosis of both otitis externa and otitis media. Candida albicans was
identified in 43% of fungal organism-positive cultures. Candida parapsilosis was 
found in 24% of and Aspergillus fumigatus in 13%. The remainder of the cultures
yielded three other Candida and three other Aspergillus species, each at less
than 5%. Time to resolution ranged from 1 week to 9 months, with a median of 3.8 
weeks for symptom resolution. Patients were treated with an average of 1.7 oral
antibiotics and 1.1 ototopical agent before a culture was taken. CONCLUSIONS:
Otorrhea due to fungal organisms occurs in the setting of refractory infection
and is often discovered after multiple oral and ototopical antibacterial
medications. Due to the extended treatment period required to clear fungal
organism, timely diagnosis with culture for bacteria and fungus is required in
patients with persistent otorrhea. An increase in incidence of fungal infections 
of the ear was found in the period after widespread use of ofloxacin began.

PMID: 15927274 [PubMed - indexed for MEDLINE]

1063: Wien Klin Wochenschr. 2005 Apr;117(7-8):256-68.

Comment in:
    Wien Klin Wochenschr. 2005 Apr;117(7-8):239-40.    Wien Klin Wochenschr. 2005 Apr;117(7-8):241-2.    Wien Klin Wochenschr. 2005 Jul;117(13-14):500-1.

Anthroposophic vs. conventional therapy of acute respiratory and ear infections: 
a prospective outcomes study.

Hamre HJ, Fischer M, Heger M, Riley D, Haidvogl M, Baars E, Bristol E, Evans M,
Schwarz R, Kiene H.

Institute for Applied Epistemology and Medical Methodology, Freiburg, Germany.
harald.hamre@ifaemm.de

CONTEXT: Acute respiratory and ear symptoms are frequently treated with
antibiotics. Anthroposophic treatment of these symptoms relies primarily on
anthroposophic medications. OBJECTIVE: To compare anthroposophic treatment to
conventional treatment of acute respiratory and ear symptoms regarding clinical
outcome, medication use and safety, and patient satisfaction. DESIGN:
Prospective, non-randomised comparison of outcomes in patients self-selected to
anthroposophic or conventional therapy under real-world conditions. SETTING: 29
primary care practices in Austria, Germany, Netherlands, UK, and USA.
PARTICIPANTS AND THERAPY: 1016 consecutive outpatients aged > or = 1 month,
consulting an anthroposophic (n = 715 A-patients) or conventional physician (n = 
301 C-patients) with a chief complaint of acute (< or = 7 days) sore throat, ear 
pain, sinus pain, runny nose or cough. Patients were treated according to the
physician's discretion. PRIMARY OUTCOME: Patients' self-report of treatment
outcome (complete recovery/major improvement/slight to moderate improvement/no
change/deterioration) at Day 14. RESULTS: Most common chief complaints were cough
(39.9% of A-patients vs. 33.9% of C-patients, p = 0.0772), sore throat (26.3% vs.
23.3%, p=0.3436), and ear pain (20.0% vs. 18.9%, p=0.7302). Baseline chief
complaint severity was severe or very severe in 60.5% of A-patients and 53.3% of 
C-patients (p=0.0444), mean severity (0-4) of complaint-related symptoms was 1.3 
+/- 0.7 vs. 1.2 +/- 0.6 (p=0.5197). During the 28-day follow-up antibiotics were 
prescribed to 5.5% of A-patients and 33.6% of C-patients (p<0.0001),
anthroposophic medicines were prescribed to all A-patients and no C-patient.
OUTCOMES: Improvement within 24 hours occurred in 30.9% (221/715) of A-patients
and 16.6% (50/301) of C-patients (p<0.0001), improvement within 3 days in 73.1%
and 57.1% (p<0.0001). At Day 7 complete recovery or major improvement was
reported by 77.1% of A-patients and 66.1% of C-patients (p=0.0004), at Day 14 by 
89.7% and 84.4% (p=0.0198). Complete recovery rates at Day 7 were 30.5% and 23.3%
(p<0.0001); at Day 14 they were 64.2% and 49.5% (p<0.0001). 69.9% of A-patients
and 60.5% of C-patients were very satisfied with their physician (p=0.0043);
95.7% and 83.4% would choose the same therapy again for their chief complaint
(p<0.0001). After adjustment for country, gender, age, chief complaint, duration 
of complaint, previous episode of complaint within last year, and baseline
symptom severity, odds ratios favoured the A-group for all these outcomes.
Adverse drug reactions were reported in 2.7% of A-patients and 6.0% of C-patients
(p=0.0157). CONCLUSION: Compared to conventional treatment, anthroposophic
treatment of primary care patients with acute respiratory and ear symptoms had
more favourable outcomes, lower antibiotic prescription rates, less adverse drug 
reactions, and higher patient satisfaction.

Publication Types: 
    Comparative Study
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 15926617 [PubMed - indexed for MEDLINE]

1064: Pediatr Clin North Am. 2005 Jun;52(3):711-28, v-vi.

Otitis media: re-evaluation of diagnosis and treatment in the era of
antimicrobial resistance, pneumococcal conjugate vaccine, and evolving morbidity.

Pelton SI.

Departments of Pediatrics and Epidemiology, Boston University Schools of Medicine
and Public Health, Boston, MA 02118, USA. spelton@bu.edu

The changing susceptibility of bacterial otopathogens is only one aspect of the
evolving concepts regarding pathogenesis, immunoprophylaxis, pharmacodynamics,
and sequelae of acute otitis media that mandates new insights for achieving a
successful outcome. 2004 guidelines by the American Academy of Pediatrics for the
treatment of acute otitis media provide one perspective that proposes a
rethinking of the routine use of antimicrobial therapy with the hope of
preventing further increases in bacterial resistance among otopathogens. The
goals of this article are to incorporate the advances in diagnosis, treatment,
prevention, and management of sequelae into strategies that optimize the outcome 
of acute otitis media and limit further emergence of resistant otopathogens.

Publication Types: 
    Review

PMID: 15925659 [PubMed - indexed for MEDLINE]

1065: Int J Pediatr Otorhinolaryngol. 2005 Oct;69(10):1383-93.

Gene expression profiles of early pneumococcal otitis media in the rat.

Chen A, Li HS, Hebda PA, Zeevi A, Swarts JD.

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, and
Department of Otolaryngology, University of Pittsburgh Medical School,
Pittsburgh, PA 15213, USA.

OBJECTIVE: To define the gene expression patterns during the early phases of a
bacterial middle ear infection in the rat model. METHOD: Using cDNA gene array
technology, we profiled the mRNA expression of 1176 genes in a rat model of acute
otitis media. We identified changes in gene expression two-fold or greater 12 and
48 h after bilateral ME inoculation with either tryptic soy broth (TSB) or
Streptococcus pneumoniae in TSB. RESULTS: Transcripts of cytokines and cell
adhesion molecules were up-regulated by 12 h, but returned to placebo
transcription levels by 48 h. Three of six stress-response genes, including
inducible nitric oxide synthase, GADD45 and heat shock protein 27 (HSP27) were
up-regulated by 12 h, with HSP27 transcription levels continuing to rise through 
48 h. All assayed transcription factors were up-regulated by 12 h, but only c-fos
and c-jun up-regulation persisted to the 48-h time point. Up-regulation of
apoptosis-related genes, except for bcl-x, was not evident until 48 h. These gene
expression patterns reflected an early proinflammatory response consisting of
cytokines, cell adhesion and stress-response molecules at 12 h followed by an
up-regulation of apoptosis-related genes at 48 h. CONCLUSION: Downstream targets 
of several transcription factors, up-regulated transiently at 12 h, control
secondary effects of S. pneumoniae infection, including apoptosis of neutrophils 
and mucosal epithelial cells, bone proliferation and promotion of leukocyte
differentiation. These observations lead to a greater understanding of the early 
events in the pathogenesis of an AOM episode and highlight therapeutic targets,
which may play a roll in the sequelae of AOM.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15922460 [PubMed - indexed for MEDLINE]

1066: J Feline Med Surg. 2005 Jun;7(3):141-5.

Isolation of Malassezia species from healthy cats and cats with otitis.

Nardoni S, Mancianti F, Rum A, Corazza M.

Dipartimento di Patologia Animale, Profilassi ed Igiene degli Alimenti,
University of Pisa, Viale delle Piagge, 2, I 56100 Pisa, Italy.
snardoni@vet.unipi.it

Lipid-dependent Malassezia species have recently been cultured from veterinary
specimens. The identification of Malassezia species isolates from animals is
important to clarify the epidemiology of these lipophilic yeasts. Malassezia
species were cultured from the external ear canals of 63 out of 99 cats with
otitis and 12 of 52 (23%) healthy control cats. The rate of isolation in affected
animals versus controls was highly significant (P<0.01). Malassezia pachydermatis
was isolated as a pure culture in 33 (45.2%) cats, associated with Malassezia
globosa and Malassezia furfur in 20 (50%) and 17 (42.5%) animals, respectively.
Three different species were isolated simultaneously in three cats (two cats with
M pachydermatis, M globosa and M furfur, one subject with M pachydermatis, M
furfur and Malassezia sympodialis). M globosa was isolated as the sole species in
two animals. The present work confirms the presence of some lipid-dependent
species of Malassezia in both healthy and otitic cats.

Publication Types: 
    Comparative Study

PMID: 15922220 [PubMed - indexed for MEDLINE]

1067: BMC Infect Dis. 2005 May 27;5:41.

Salivary antibodies induced by the seven-valent PncOMPC conjugate vaccine in the 
Finnish Otitis Media Vaccine Trial.

Nurkka A, Lahdenkari M, Palmu AA, Käyhty H; FinOM Study Group.

Department of Vaccines, National Public Health Institute (KTL), Helsinki,
Finland. anu.nurkka@ktl.fi

BACKGROUND: Mucosal antibodies have been suggested to have a role in defence
against pneumococcal infections. We investigated here the ability of a
seven-valent pneumococcal conjugate vaccine, PncOMPC, to induce mucosal immune
response. METHODS: Healthy Finnish children (n = 111), a subcohort of the Finnish
Otitis Media Vaccine Trial, were recruited and 56 of them were immunised with the
PncOMPC at the age of 2, 4, and 6 months. At 12 months of age, 49 of them
received the PncOMPC and 7 were vaccinated with the pneumococcal polysaccharide
vaccine (PncPS) as a booster. The control group of 55 children received a
hepatitis B vaccine at the same ages. Salivary anti-Pnc IgG, IgA, IgA1, and IgA2 
antibodies to serotypes 6B, 14, 19F, and 23F were measured in both groups at the 
age of 7 and 13 months. RESULTS: Salivary anti-Pnc IgG and IgA were detected more
often in the PncOMPC than in the control group. However, the difference between
groups was significant only for 19F and 23F IgA concentrations at the age of 7
months. At the age of 13 months, antibody concentrations did not differ between
PncOMPC and control groups. The rises in IgA concentrations between 7 and 13
months of age were mainly of subclass IgA1. Further, there is a clear trend that 
PncPS booster induces higher salivary anti-Pnc PS antibody concentrations than
the PncOMPC. CONCLUSION: We found that PncOMPC can induce a mucosal IgA response.
However, the actual impact of mucosal antibodies in protection against
pneumococcal infections is not clear.

Publication Types: 
    Controlled Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 15921511 [PubMed - indexed for MEDLINE]

1068: Hosp Med. 2005 May;66(5):268-72.

Otitis media in children.

Clarke RW, De S.

Ear Nose and Throat Department, Alder Hey Hospital, Liverpool L12 2AP.

Otitis media is the term used for a group of conditions characterized by
inflammation of the middle-ear cleft. These conditions are particularly common in
children where they present important diagnostic and therapeutic dilemmas.

Publication Types: 
    Review

PMID: 15920855 [PubMed - indexed for MEDLINE]

1069: Int J Pediatr Otorhinolaryngol. 2005 Jul;69(7):965-71. Epub 2005 Mar 16.

Diagnostic value of tympanometry using subject-specific normative values.

Palmu AA, Syrjänen R.

National Public Health Institute, Helsinki, Finland; Tampere School of Public
Health, University of Tampere, Finland. arto.palmu@ktl.fi

OBJECTIVE: Tympanometry has proven valuable in the diagnosis of otitis media in
infants. The classification used in the Finnish otitis media studies has resulted
in high specificity yet only moderate sensitivity. We aimed to explore the
benefit of using each subject's individual previous test results (obtained at
previous visits of the children when diagnosed healthy) as normative values.
Specific aim was to assess this approach in increasing sensitivity in the
diagnosis of otitis media. METHODS: We used tympanometric (GrasonStadler GSI 38) 
results of children in the Finnish otitis media vaccine trial obtained at
pre-scheduled 7-month visits (if ears found healthy) and at the first subsequent 
sick visit with respiratory infections and potential otitis media within a 90-day
period after the 7-month visit. Children with recent otitis media within the
previous month and tympanometric tests with documented interfering factors were
excluded. Pneumatic otoscopy was used as the reference method for the diagnosis
of otitis media. RESULTS: Altogether 2476 children at the 7-month visits were
examined; after exclusions data on 1759 children were available for analysis. Of 
these children, 630 were brought to at least one sick visit defined above.
Finally, data on 906 ears were available for analysis. Entirely flat type B
tympanograms predicted otitis media accurately; also high-peaked tympanograms
were accurate in predicting normal middle ear status. For the moderate-peaked
curves in-between, absolute and relative changes in the tympanometric variables
from the 7-month visit to the sick visit were explored for accurate prediction of
otitis media; decrease in curve height by at least 2/3 was found most valuable.
Sensitivity of the type B tympanogram was 61% and specificity 99% at the sick
visit. The sensitivity increased to 67% with a specificity of 98%, if results
with the ratio of static acoustic admittance (height of the curve) at the sick
visit compared to the previous healthy visit <0.35 were also considered abnormal 
together with type B curve in indicating otitis media. CONCLUSIONS: The
subject-specific normative values were not found especially useful, although a
slight increase in sensitivity was achieved without compromizing specificity.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15911016 [PubMed - indexed for MEDLINE]

1070: Int J Pediatr Otorhinolaryngol. 2005 Jul;69(7):959-63. Epub 2005 Apr 7.

Investigation about the homogeneity of nasopharyngeal microflora at the different
location of nasopharynx of children with acute otitis media.

Kaieda S, Yano H, Okitsu N, Hosaka Y, Okamoto R, Inoue M, Takahashi H.

Division of Otorhinolaryngology, Department of Translational Medical Science,
Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501,
Japan. tetsuumi@aol.com

OBJECTIVE: Nasopharynx is thought to be a very important site as becterial
reservoir for acute otitis media (AOM). In this study, we investigated on the
homogeneity of nasopharyngeal microflora at the different location of nasopharynx
of children with AOM. METHODS: Thirty nasopharyngeal samples of 15 children with 
AOM, two samples harvested from both nostrils of each child, were cultured and
analyzed by patterns of antibiotic susceptibility and pulsed-field gel
electrophoresis analysis (PFGE). RESULTS: A total of 30 nasopharyngeal samples
were cultured and 19 isolates of Streptococcus pneumoniae from 10 children
(66.7%), 8 isolates of Haemophilus influenzae from 4 children (26.7%), and 12
isolates of Moraxella catarrhalis from 7 children (46.7%) were obtained. In all
children except three, the nasopharyngeal microflora at right and left orifice of
the eustachian tubes showed no obvious differences in the bacterial species and
quantities. Furthermore, in children with the same species of were cultured from 
right and left orifice of the eustachian tubes at the same time, all nine couples
of S. pneumoniae isolates, four couples of H. influenzae isolates, and five
couples of M. catarrhalis isolates showed about the same susceptibility and PFGE 
patterns. CONCLUSION: These results suggest that the microflora at the different 
location of nasopharynx of children with AOM is almost homogeneous, irrespective 
of the clinical signs.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15911015 [PubMed - indexed for MEDLINE]

1071: Int J Pediatr Otorhinolaryngol. 2005 Jul;69(7):943-51. Epub 2005 Apr 11.

Functional tubal therapy for persistent otitis media with effusion in children:
myth or evidence?

Kouwen H, van Balen FA, Dejonckere PH.

Institute of Phoniatrics, University Medical Center Utrecht, AZU F.02.504, P.O.
Box 85500, NL-3508 GA Utrecht, The Netherlands.

Otitis media with effusion (OME), a form of inflammatory middle ear disease, is a
common reason for young children to visit their family doctor and to have
surgery. Tubal dysfunction plays a major role in the pathogenesis. In case of
persistent OME, there seems to be a logical rationale for a favourable effect on 
the tubal dysfunction of a functional active motoric approach combined with
behavioral changes (hygiene), and as a consequence for a therapeutic effect on
the middle ear disease. The basic principles of this functional treatment are:
active ventilation of the middle ear, correction of immature and undesirable
deviant mouth habits, increasing swallowing frequency, activating jaw and palate 
movements, and encouraging the use of chewing gum. The bases for this functional 
therapy are critically analysed, and it may be concluded that all of these
principles rely upon evidence based physiological mechanisms. However, the
limited available clinical data from the literature are reviewed, and appear as
methodologically weak. The results of an own prospective randomized pilot study
comparing functional treatment with watchful waiting may be considered
encouraging, since a borderline significance level was reached with a small
amount of subjects.

Publication Types: 
    Review

PMID: 15911013 [PubMed - indexed for MEDLINE]

1072: Clin Infect Dis. 2005 Jun 15;40(12):1738-44. Epub 2005 May 11.

Comment in:
    Clin Infect Dis. 2005 Jun 15;40(12):1745-7.

Acute otitis media due to penicillin-nonsusceptible Streptococcus pneumoniae
before and after the introduction of the pneumococcal conjugate vaccine.

McEllistrem MC, Adams JM, Patel K, Mendelsohn AB, Kaplan SL, Bradley JS, Schutze 
GE, Kim KS, Mason EO, Wald ER.

Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213-2582, USA.
mcellistremc@msx.dept-med.pitt.edu

BACKGROUND: The impact of the 7-valent pneumococcal conjugate vaccine (PCV7
[Prevnar]) on penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) recovered
from children with acute otitis media (AOM) is unclear. METHODS: At 5 hospitals, 
505 pneumococcal isolates were collected from children with AOM between 1 January
1999 and 31 December 2002. Molecular subtyping was performed on 158 isolates.
RESULTS: Overall, the percentage of AOM cases due to non-PCV7 serogroups
(including serotype 3) increased over time (from 12% in 1999 to 32% in 2002; P < 
.01) and according to the number of PCV7 doses received (18% [< or = 1 dose] vs. 
35% [2-4 doses]; P < .01). The percentage of cases due to vaccine-related
serotypes (including serotype 19A) increased according to the number of PCV7
doses received (10% [< or = 1 dose] vs. 19% [2-4 doses]; P = .05) but not over
time, whereas the percentage of cases due to serotype 19F remained unchanged both
over time and according to the number of PCV7 doses received. The frequency of
penicillin nonsusceptibility among PCV7 serotypes (range, 65%-75%) and non-PCV7
serogroups (range, 11%-27%) did not significantly change overall. Although no
change was detected among isolates collected from children with spontaneous
drainage, the percentage of pneumococci recovered at the time of myringotomy
and/or tympanostomy tube placement that were nonresistant to penicillin decreased
over time (from 73% in 1999 to 53% in 2002; P = .03). All of the serotype 3
strains were genetically related, whereas 88% of the isolates that were either
serotype 19F or serotype 23F were related to 1 of 3 international clones.
CONCLUSIONS: Among children with AOM, the proportion of cases due to non-PCV7
serogroups increased, vaccine-related serotypes increased, and serotype 19F
remained unchanged. Although a decrease in the proportion of cases due to PNSP
occurred among children who required myringotomy and/or tympanostomy tube
placement, the proportion of PNSP remained unchanged overall and among children
with spontaneous drainage. Because future trends in the susceptibility patterns
of pneumococcal isolates recovered from children with AOM are not easy to
predict, continued surveillance is essential.

Publication Types: 
    Multicenter Study
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15909260 [PubMed - indexed for MEDLINE]

1073: Int J Pediatr Otorhinolaryngol. 2005 Nov;69(11):1529-33.

Mastoid subperiosteal abscess: a review of 51 cases.

Migirov L, Yakirevitch A, Kronenberg J.

Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center,
52621 Tel Hashomer, Israel. smigirov@leumit.co.il

OBJECTIVE: To present a large study on subperiosteal abscess (SA) that represents
the most frequent complication of acute mastoiditis. METHOD: A retrospective
study was conducted on 49 patients who underwent mastoidectomy for SA. RESULTS:
The patients ranged in age from 8 months to 21 years. Two patients were re
operated on the same side due to recurrent abscess. Forty-five percent of the
patients were treated using antibiotics at home and 58.8% of patients had no
history of middle ear infection prior to admission. CT underestimated abscess in 
two patients who were operated on based on their clinical signs. Perisinus
abscess was drained during mastoidectomy in one child. Purulent discharge was
obtained from the abscess in 41 cases. The most common isolated pathogens were
Streptococcus pyogenes and Staphylococcus aureus. Cholesteatoma was found during 
mastoidectomy in six patients (11.3%). Twenty-four patients (49%) developed
postoperative sequela including various middle ear infections, mastoiditis,
recurrent SA and impaired hearing. CONCLUSIONS: Mastoid SA is a unilateral mainly
children's disease that can recur. Cholesteatoma can associate the abscess and
could be found in older children and recurrent abscess. High morbidity rate
requires long-term follow-up for these patients.

PMID: 15908017 [PubMed - indexed for MEDLINE]

1074: Ann Otol Rhinol Laryngol. 2005 Apr;114(4):323-7.

Postauricular needle aspiration of subperiosteal abscess in acute mastoiditis.

Lahav J, Handzel O, Gertler R, Yehuda M, Halperin D.

Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, PO Box
1, Rehovot, Israel. yonatan_L@clalit.org.il

To test the hypothesis that subperiosteal abscess, a complication of acute
mastoiditis, can be treated equally well by needle aspiration as by cortical
mastoidectomy, we performed a retrospective analysis of 78 pediatric patients
hospitalized between 1995 and 2003 and performed an analysis of published data on
types and outcomes of treatment approaches for acute mastoiditis. Postauricular
pus aspiration resolved the subperiosteal abscess in 14 of 17 patients. The
length of the hospital stay of patients who underwent aspiration was shorter than
that of patients who underwent cortical mastoidectomy. We conclude that
postauricular pus aspiration, a simple and minimally invasive procedure, is an
effective treatment modality for subperiosteal abscess. Mastoidectomy should be
reserved for nonresponsive cases or those with more serious complications.
Broad-spectrum antibiotics, myringotomy with daily toilet of the ear, and
postauricular aspiration, when required, minimize the indications for surgery and
reduce the hospital stay.

Publication Types: 
    Comparative Study

PMID: 15895789 [PubMed - indexed for MEDLINE]

1075: Homeopathy. 2005 Apr;94(2):125-31.

Sanicula aqua: three clinical cases and a heuristic.

Sevar R.

Raymondsevar@aol.com

The cases presented are of three children who responded well to Sanicula aqua. I 
have used the exact words of the patients or their mothers. All 3 are: firstborn 
girls, tall and very thin with blue-green eyes. Two with recurrent otitis media
with perforated tympanic membrane and smell of rotting fish, the third atopic
eczema and asthma. The case analyses, materia medica of Sanicula aqua and the
creation of a remedy heuristic, are discussed.

Publication Types: 
    Case Reports

PMID: 15892494 [PubMed - indexed for MEDLINE]

1076: Otol Neurotol. 2005 May;26(3):438-41.

Ventilation tubes and cochlear implants: what do we do?

Kennedy RJ, Shelton C.

Division of Otolaryngology, University of Utah, Salt Lake City, Utah 84132, USA.

OBJECTIVE: To determine current practice management with respect to ventilation
tubes and cochlear implants. STUDY DESIGN: Questionnaire. SETTING: All members of
the American Neurotology Society were sent questionnaires. MAIN OUTCOME MEASURES:
Members were asked a series of questions including how they deal with ventilation
tubes before cochlear implantation, how they manage serous otitis media in
patients undergoing cochlear implantation, and how they manage otitis prone
children with cochlear implants. RESULTS: Two hundred and twenty members returned
questionnaires. Surgeons who replied perform an average of 25 implants per year: 
15 in adults and 10 in children. Analysis of the data revealed a wide practice
variation between surgeons. Fifty-six percent of surgeons will place a cochlear
implant in a patient with a clean, dry ventilation tube in place. More than half 
the surgeons will place a ventilation tube in a child with serous otitis media,
let the ear settle down, and perform the cochlear implant at a second operation. 
Wide variation in the management of otitis prone children with cochlear implants 
exists with respect to placement of ventilation tubes. Only 5% of surgeons
reported any complications with cochlear implants that they attributed to
ventilation tubes. There were a number who suggested their practice had changed
since the recent identification of issues involving meningitis in implantees.
CONCLUSION: Wide practice variation exists with the management of ventilation
tubes in cochlear implant patients. On the basis of the results of this survey,
it is acceptable to place cochlear implants in patients with clean, dry
ventilation tubes. It also acceptable to place ventilation tubes in otitis prone 
children with cochlear implants. Despite theoretic concerns, the reported
incidence of complications is low.

PMID: 15891646 [PubMed - indexed for MEDLINE]

1077: Otol Neurotol. 2005 May;26(3):364-7.

Bone cement ossiculoplasty: incus to stapes versus malleus to stapes cement
bridge.

Bayazit YA, Ozer E, Kanlikama M, Durmaz T, Yilmaz M.

Department of Otolaryngology, Faculty of Medicine, University of Gaziantep,
Turkey.

OBJECTIVE: In this study, our purpose was to evaluate results of our experience
with bone cement repair of ossicular discontinuity between the incus and stapes
and between the malleus and stapes. METHODS: Medical records of patients who
underwent surgery for chronic otitis media between March 2000 and December 2002
were evaluated retrospectively. Fifty-seven patients who underwent bone cement
ossiculoplasty and had appropriate follow-up data were included in the study.
Bone cement reconstruction of the ossicular chain was performed 1) from incus to 
stapes (I-S) in the absence of long arm or lenticular process of the incus and 2)
from malleus to stapes (M-S) in the absence of the incus. The clinical data of
the patients were evaluated by otoscopic examination and audiometry. RESULTS: The
graft take rate was 84.1%. I-S procedure was performed in 42 and M-S in 8
patients. Pre- and postoperative PTAs of all patients were compared, which showed
a significant improvement in air PTA (p < 0.001) while bone PTA did not change (p
> 0.05). In I-S and M-S groups, successful hearing restoration could be achieved 
in 78.6.1% and 87.5% of the patients, respectively. Hearing results of different 
aural pathologies (chronic otitis media and conductive hearing loss) and
surgeries (tympanotomy and tympanoplasty with or without mastoidectomy) were not 
significantly different (p > 0.05). CONCLUSION: Bone cement ossiculoplasty offers
cost effective and significant improvement in conductive hearing loss.

Publication Types: 
    Evaluation Studies

PMID: 15891635 [PubMed - indexed for MEDLINE]

1078: Otol Neurotol. 2005 May;26(3):361-3.

Implications of laser assisted tympanostomy in adults.

Prokopakis EP, Lachanas VA, Christodoulou PN, Bizakis JG, Karatzanis AD,
Velegrakis GA.

Department of Otolaryngology, University of Crete School of Medicine, Heraklion, 
Crete, Greece. epro@med.uoc.gr

OBJECTIVES: To assess outcome in adult individuals undergoing laser-assisted
tympanostomy without ventilation tube placement. STUDY DESIGN: Case series with
2-month follow-up. SETTING: Faculty practice, research protocol, tertiary care
academic medical center. PATIENTS AND METHOD: Laser-assisted tympanostomy was
performed on a total of 142 ears (108 individuals). Indications included serous
otitis media with effusion (66 ears/47 patients), functional eustachian tube
dysfunction (48 ears/36 patients), acute otitis media (19 ears/16 patients), and 
endoscopic visualization of the middle ear (9 ears/9 patients). INTERVENTION: The
laser-assisted tympanostomy procedure is performed with a CO2 laser under local
anesthesia on an outpatient basis. MAIN OUTCOME MEASURES: Patency time of the
tympanostomy, presence of fluid after the closure of the tympanostomy,
tympanometry and tone audiometry findings, relief of symptoms. RESULTS: Middle
ear disease was resolved after the closure of tympanostomy in 47.9% of patients
with serous otitis media with effusion. In 79.1% of patients with functional
eustachian tube dysfunction, symptoms were diminished. All patients with acute
otitis media had a satisfactory outcome. Laser-assisted tympanostomy was found to
be quite helpful in patients undergoing middle ear endoscopy. CONCLUSIONS:
Laser-assisted tympanostomy without ventilation tubes provides a safe alternative
surgical option in adult patients in certain cases. The selection criteria for
this procedure are addressed in detail.

Publication Types: 
    Clinical Trial

PMID: 15891634 [PubMed - indexed for MEDLINE]

1079: Otol Neurotol. 2005 May;26(3):355-60.

The effect of radiofrequency and mitomycin C on the closure rate of human
tympanostomy.

Ragab SM.

Tanta Faculty of Medicine and University Hospitals, Tanta, Egypt.
sragab@doctors.org.uk

OBJECTIVES: To conduct a prospective, randomized, controlled trial determining
the feasibility of radiofrequency with or without topical mitomycin C application
in delaying the closure time of human tympanostomy and screening its efficacy in 
management of recurrent acute otitis media and otitis media with effusion.
METHODS: From November 2002 to January 2004, 96 patients (180 ears) who were to
undergo surgical intervention for recurrent acute otitis media or otitis media
with effusion were included in this study. Sixty ears with a diagnosis of
recurrent acute otitis media were equally randomized to three procedures: cold
knife myringotomy (Group A), radiofrequency tympanostomy (Group B), and
radiofrequency tympanostomy with topical mitomycin C application (Group C). One
hundred twenty ears diagnosed as having otitis media with effusion were equally
randomized to the last two procedures only. Patients were followed-up every week 
in the first month, every 2 weeks in the second month, and monthly after that
until closure of the tympanostomy. A special follow-up setting was designed 3
months after tympanostomy closure where tympanograms and pure-tone audiograms
were obtained. RESULTS: Groups B and C showed a significantly slower rate of
closure than Group A. At the same time, Group C demonstrated a slower rate when
compared with Group B. The mean closure time of Group B was 3.5 weeks, with no
difference between recurrent acute otitis media and otitis media with effusion.
In contrast, the mean closure times for Group C were 5.3 and 7 weeks in cases of 
otitis media with effusion and recurrent acute otitis media, respectively, with
the latter demonstrating a significantly slower closure rate. No recurrence of
acute otitis media was reported in 10, 45, and 80% of Groups A, B, and C,
respectively. Fifty-nine percent of Group C showed no clinical or tympanometric
signs of otitis media with effusion 3 months after closure of tympanostomy. In
contrast, Group B reported a lower cure rate (28%), with a statistically
significant difference between both groups. Absence of recurrence and improvement
in tympanometry signs correlated significantly with the duration of patency of
tympanostomy (p < 0.01). The success rate was higher in patients who underwent
adenoidectomy, but this did not reach statistical significance except in Group C 
(p < 0.01). CONCLUSION: Radiofrequency and mitomycin C delay the closure rate of 
human tympanostomy. The efficacy of mitomycin C seems to be amplified in the
presence of an inflamed tympanic membrane. Radiofrequency-assisted
mitomycin-enhanced tympanostomy is a precise, safe, and cost-effective procedure 
that provides a viable approach in the management of recurrent acute otitis media
and otitis media with effusion, especially when used in conjunction with
adenoidectomy.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 15891633 [PubMed - indexed for MEDLINE]

1080: Otol Neurotol. 2005 May;26(3):344-50.

Early and late effects of capsaicin pretreatment in otitis media with effusion.

Basak S, Dikicioglu E, Turkutanit S, Sarierler M.

Department of Oto-Rhino-Laryngology, Adnan Menderes University, Faculty of
Medicine, Turkey. obasak@superonline.com.tr

PURPOSE: Discovery of the role of the neurogenic inflammation in the formation of
otitis media with effusion has led to the investigation of the place of some
neuropeptide antagonists in the treatment. In the current study, we investigated 
the effect of capsaicin (CP) pretreatment on the inflammation and proliferation
in the middle ear mucosa and on the nerve fibers containing substance P,
vasoactive intestinal polypeptide, and calcitonin gene-related peptide. METHODS: 
Seventeen Wistar rats were used in the study. Ten rats were given CP on 3
consecutive days, and seven rats were given isotonic saline solution. Seven days 
after the third injection, animals were operated on, and their eustachian tubes
were occluded. On the seventh day after the operation, five rats from the test
group and three from the control group were killed. The others were killed 21
days after the operation. In the histopathologic examination of the sections,
acute inflammation and proliferation scores were determined. Gland degeneration, 
goblet cell hyperplasia, and the density of mast cells were evaluated. Neural
elements were stained immunohistochemically. RESULTS: The acute inflammation
score in the test group was lower, but the difference was insignificant (p >
0.05). The proliferation score in the test group was lower, and the difference
was significant (p = 0.02). In the control group, gland degeneration was
significantly higher (p = 0.044). Goblet cell hyperplasia demonstrated no
difference between two groups (p > 0.05). Mast cell density was higher in the
control group, but the difference was not significant (p > 0.05). Substance P
immunoreactivity (IR) was significantly higher in the control group (p = 0.015). 
calcitonin gene-related peptide-IR and vasoactive intestinal polypeptide-IR were 
limited in both groups. CONCLUSIONS: That CP pretreatment reduces inflammatory
proliferative findings, and gland degeneration leads us to consider that it could
be effective in both treatment of experimental otitis media with effusion and
prevention of its complications.

PMID: 15891631 [PubMed - indexed for MEDLINE]

1081: Otol Neurotol. 2005 May;26(3):337-43.

Pars flaccida displacement pattern in otitis media with effusion in the gerbil.

Larsson C, Dirckx JJ, Bagger-Sjöbäck D, von Unge M.

Department of Otorhinolaryngology, Karolinska Hospital and Karolinska Institute, 
Stockholm, Sweden. larsson_christina@hotmail.com

HYPOTHESIS: Our hypothesis is that otitis media with effusion causes stiffness
loss in the pars flaccida of the tympanic membrane. This loss of stiffness may be
persistent and may trigger the development of retraction pockets and
cholesteatoma. BACKGROUND: Otitis media with effusion is a very common disease in
childhood. It can cause minor to moderate hearing loss and delayed speech
development. Otitis media with effusion is a risk factor for retraction pocket
formation. METHODS: Otitis media with effusion was induced unilaterally in 15
gerbils by obstructing the eustachian tube with glue. The contralateral ears
served as normal controls. As a measure of mechanical stiffness, pars flaccida
peak displacement versus pressure was used. The displacement measurements were
made with moire interferometry. This is a noncontacting optical technique with
which the displacement of an object can be measured in real time. RESULTS: The
mean peak displacement of the pars flaccida in the group with otitis media with
effusion was increased threefold as compared with normal controls. This
difference was statistically significant. CONCLUSION: There was a loss of
mechanical stiffness in the pars flaccida caused by otitis media with effusion.
This loss of stiffness may be persistent and may predispose for retraction pocket
formation and cholesteatoma development.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15891630 [PubMed - indexed for MEDLINE]

1082: Med J Malaysia. 2004 Dec;59(5):688-9.

Nocardia infection of the mastoid in an immunocompromised patient.

Subha ST, Raman R.

Department of Surgery/Otolaryngology, Faculty of Medicine and Health Sciences,
University Putra Malaysia, Hospital Kuala Lumpur, Jalan Masjid, Kuala Lumpur.

A rare case of Nocardia infection of mastoid is presented in an immunocompromised
patient.

Publication Types: 
    Case Reports

PMID: 15889577 [PubMed - indexed for MEDLINE]

1083: J Med Microbiol. 2005 Jun;54(Pt 6):553-6.

Long-term effects on the nasopharyngeal flora of children following antimicrobial
therapy of acute otitis media with cefdinir or amoxycillin-clavulanate.

Brook I, Gober AE.

Department of Pediatrics, Georgetown University School of Medicine, Washington DC
20016, USA. ib6@georgetown.edu

The effect on the nasopharyngeal bacterial flora of 10 days of
amoxycillin-clavulanate or cefdinir antimicrobial therapy was studied in 50
children with acute otitis media. Before therapy, 17 potential pathogens
(Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis) were
isolated from the nasopharynx of 14 (56%) of those treated with
amoxycillin-clavulanate, and 20 potential pathogens were recovered from 15 (60%) 
of those treated with cefdinir. Following therapy, at days 12-15, the number of
potential pathogens was reduced to a similar extent with both therapies, to three
in those treated with amoxycillin-clavulanate and two in those treated with
cefdinir. However, the number of potential pathogens rebounded faster in those
treated with amoxycillin-clavulanate as compared with cefdinir in the two
subsequent specimens taken at days 30-35 and 60-65 (12 and 18 in the
amoxycillin-clavulanate group, and six and nine in the cefdinir group, P < 0.01
and P < 0.001, respectively). Differences between the groups were also noted in
the recovery of organisms with interfering capability. Immediately following
amoxycillin-clavulanate therapy, the number of interfering organisms declined
from 54 to 13, while following cefdinir treatment their number was reduced from
59 to 39 (P < 0.001). The differences between the two therapy groups persisted in
the two later specimens taken at days 30-35 and 60-65 (25 and 38 in the
amoxycillin-clavulanate group, and 52 and 51 in the cefdinir group, P < 0.001 and
P < 0.05, respectively). This study illustrates the potential beneficial effect
of using a narrow-spectrum antimicrobial that selectively spares the interfering 
organisms while eliminating pathogens. The benefit of such therapy is the
prevention of reacquisition of pathogenic bacteria in the nasopharynx. In
contrast, utilization of a broad-spectrum antimicrobial is associated with
prolonged absence of inhibitory organisms and rapid recolonization with
pathogens.

Publication Types: 
    Clinical Trial
    Comparative Study

PMID: 15888464 [PubMed - indexed for MEDLINE]

1084: Int J Pediatr Otorhinolaryngol. 2005 Jun;69(6):823-7. Epub 2005 Feb 17.

Oxidant and antioxidant levels in children with acute otitis media and
tonsillitis: a comparative study.

Cemek M, Dede S, Bayiroğlu F, Caksen H, Cemek F, Yuca K.

Department of Chemistry (Biochemistry Division), Faculty of Science, Afyon
Kocatepe University, Afyon, Turkey. mcemek@yahoo.com

OBJECTIVE: Recurrent episodes of acute otitis media (AOM) and acute tonsillitis
(AT) are a common problem in infectious disorders during childhood and are major 
cause of morbidity in children. The organism maintains defense systems including 
nonenzymatic antioxidants such as Vitamins A, E and C and reduced glutathione
(GSH) against reactive oxygen species (ROS). In the present study, lipid
peroxidation status and nonenzymatic antioxidant capacity were investigated in
children with AOM and AT. Our aim was to compare the lipid peroxidation and
responses of the body's antioxidant status in the closely associated infections
such as AOM and acute tonsillitis. METHODS: The study included 23 (14 males, 9
females) children with AOM, 27 (14 males, 13 females) with AT and 29 (16 males,
13 females) healthy control subjects. The ages of the study and control subjects 
were between 2 and 7 years. Serum beta-carotene, retinol, Vitamin E, Vitamin C,
and whole blood malondialdehyde (MDA) (as an indicator of lipid peroxidation) and
GSH levels were studied in all subjects. RESULTS: There was a statistically
significant difference between the groups for all parameters (P<0.05). All of the
antioxidant vitamins such as beta-carotene, retinol, Vitamin E, and Vitamin C
levels were observed to be significantly decreased in the both patient groups.
Nevertheless, GSH levels were also decreased in the patient groups. MDA levels
were found to be higher in children with AOM and AT than in the healthy control
subjects. When compared the AOM and AT groups, there was statistically
significant difference between the groups for whole blood MDA (P<0.05).
CONCLUSION: Even though they seem to react in a similar way against ROS, in the
cases of AOM and AT, it is possible to see the different approaches in these
tissues for the oxidative stress.

Publication Types: 
    Comparative Study

PMID: 15885336 [PubMed - indexed for MEDLINE]

1085: Int J Pediatr Otorhinolaryngol. 2005 Jun;69(6):799-804. Epub 2005 Feb 16.

Microbiology of middle ear effusions from 292 patients undergoing tympanostomy
tube placement for middle ear disease.

Poetker DM, Lindstrom DR, Edmiston CE, Krepel CJ, Link TR, Kerschner JE.

Division of Pediatric Otolaryngology, Department of Otolaryngology and
Communication Sciences, Medical College of Wisconsin, 9200 West Wisconsin Avenue,
Milwaukee, WI 53226, USA.

OBJECTIVE: Otitis media is one of the most commonly diagnosed childhood
illnesses. Ideally, culture directed therapy for otitis media would be available,
however, the common approach is to treat infections with antibiotics that cover
the most common pathogens. The objective of this study is to describe the
pathogens cultured from the middle ear effusions (MEE) of patients that underwent
tympanostomy tube placement for middle ear disease, compare these results with
previous studies, and assess for trends suggestive of changes in the microbiology
of these patients. METHODS: Patients were invited to participate after the
decision to place ventilation tubes had been made. A standard anterior-inferior
myringotomy was made for placement of the ventilation tube. After myringotomy,
patients had their ears suctioned and all effusions were collected for
microbiologic analysis. RESULTS: A total of 292 patients were enrolled in the
study, a total of 270 MEE samples were taken. Haemophilus influenzae and
Moraxella catarrhalis were seen in 24 of 148 (16.2%) and 15 of 148 (10.1%),
respectively. Neisseria meningitidis, Staphylococcus aureus and Corynebacterium
species were each identified in 11 of the 148 pathogens isolated (7.4%).
Streptococcus pneumoniae was identified in 6 of the 148 isolated pathogens
(4.1%). CONCLUSION: Despite a high number of non-pathogenic bacteria, and a high 
number of culture negative effusions, we demonstrated pathogen rates consistent
with other reports in the literature. Future directions include using more
specific techniques such as PCR to better understand the microbiology of middle
ear effusions.

PMID: 15885332 [PubMed - indexed for MEDLINE]

1086: Int J Pediatr Otorhinolaryngol. 2005 Jun;69(6):757-69. Epub 2005 Feb 23.

Effects of otitis media with effusion on auditory temporal resolution.

Hartley DE, Moore DR.

University Laboratory of Physiology, Parks Road, Oxford OX1 3PT, UK.
douglas.hartley@physiol.ox.ac.uk

OBJECTIVE: There is mounting evidence to suggest that otitis media with effusion 
(OME) is associated with auditory processing deficits that persist beyond the
resolution of the peripheral hearing loss. This study investigated the residual
effects of OME on auditory temporal resolution. EXPERIMENT 1: METHODS: Experiment
1 measured detection thresholds for a brief tone presented either before
(backward masking) or during (simultaneous masking) a masking noise, in 6- and
8-year-old children. Six-year-olds were selected from a prospectively studied
group with a lifetime known history of OME. Eight-year-old children, with a
retrospectively determined history of OME, were also recruited. All children were
free of OME at the time of testing. RESULTS: Regardless of OME history,
6-year-old children had similar tone thresholds on all masking tasks. In
contrast, 8-year-olds with a history of recurrent OME had 18 and 4dB higher mean 
thresholds for the backward and simultaneous masking conditions, respectively,
compared with age-matched controls. Possible explanations for these results
included (i) recruitment bias, rather than OME, contributed to differences in
auditory processing abilities amongst 8-year-old children, or (ii) OME impaired
performance at both ages, but this was not seen in 6-year-olds due to 'ceiling'
effects. EXPERIMENT 2: METHODS: To distinguish between these possibilities,
Experiment 2 measured temporal resolution, using backward masking and amplitude
modulation detection, in the prospectively studied group of children when they
were 8 years old. RESULTS: Regardless of OME history, these 8-year-olds had
similar auditory temporal processing abilities. Results from Experiment 2
suggested that recruitment bias was the most likely explanation for the
difference in auditory processing abilities between 8-year-old children with and 
without a history of OME found in Experiment 1. Consistent with previous data,
associations were found between backward masking, age and cognitive ability.
CONCLUSION: There is no evidence to suggest that OME effects temporal resolution 
after the recovery of normal pure-tone thresholds.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15885328 [PubMed - indexed for MEDLINE]

1087: Int J Pediatr Otorhinolaryngol. 2005 Jun;69(6):745-9. Epub 2005 Feb 16.

Does Helicobacter pylori have role in development of otitis media with effusion?

Yilmaz MD, Aktepe O, Cetinkol Y, Altuntaş A.

Afyon Kocatepe University, Faculty of Medicine, Department of Otolaryngology,
03200 Afyon, Turkey. denizy@aku.edu.tr

OBJECTIVE: Recently, it was suggested that tonsil and adenoid tissues may act as 
a reservoir for Helicobacter pylori (HP). A connection between chronic
tubotympanal disorders and gastroesophageal reflux is well recognized, but the
mechanism underlying this relationship is unclear. In this study, we investigated
possible presence of HP in adenoid tissue and middle ear effusions in patients
with chronic otitis media with effusion (OME) and we compared the data with the
results of the children who had adenoid hypertrophy without OME. METHODS: The
study was comprised of 38 consecutive children with adenoid hypertrophy and/or
chronic OME. The patients were divided into two groups. The first group included 
18 subjects having OME+adenoid hypertrophy and the second group included 20
subjects having solely adenoid hypertrophy. Each patient underwent the
appropriate surgical procedure; myringotomy, placement of tympanostomy tubes
and/or adenoidectomy. After myringotomy, the middle ear effusions were collected 
in a suction and collection device and a core biopsy specimen was taken from each
adenoid tissue following adenoidectomy. DNA extracted from these samples was used
for the amplification of 23S ribosomal RNA gene of HP by real-time polymerase
chain reaction (RT-PCR). RESULTS: In the first group 34 effusion samples were
obtained from ears of 18 patients (two had unilateral OME). HP was found to be
positive in 12 children (67%) and 16 of 34 ears (47%) with RT-PCR. In eight
children HP was positive in only one ear and in four children in both ears. No
positive reaction was seen in tissue samples obtained from adenoids of these
patients. In the second group a positive reaction was seen in adenoid tissue of
only one patient. CONCLUSIONS: This study showed that there is HP presence in
middle ears of the children with chronic OME, indicating HP having a possible
role in OME pathogenesis. In addition, we demonstrated HP presence in only 1 of
38 adenoid specimens supporting the idea that adenoid tissue does not act as a
reservoir for HP.

PMID: 15885326 [PubMed - indexed for MEDLINE]

1088: Scand J Immunol. 2005 May;61(5):466-74.

Childhood levels of immunoglobulins and mannan-binding lectin in relation to
infections and allergy.

Thórarinsdóttir HK, Lúdvíksson BR, Víkingsdóttir T, Leópoldsdóttir MO, Ardal B,
Jónsson T, Valdimarsson H, Arason GJ.

Department of Immunology, Institute for Medical Laboratory Sciences, Landspitali 
University Hospital, Hringbraut, Reykjavik, Iceland.

Respiratory tract infections, allergies and otitis media are common problems in
early childhood. Our aim was to evaluate in a longitudinal community-based cohort
study the association between maturation of immunoglobulin (Ig) and
mannan-binding lectin (MBL) responses and disease manifestations in the first 4
years of life. Sustained low levels of IgA proved the strongest single indicator 
of susceptibility for recurrent otitis media (P = 0.008) and respiratory tract
infections (P = 0.02), and this condition was also associated with low production
of IgG subclasses. About 7% of the cohort had sustained low levels of MBL (<0.4
mg/l). Low MBL did not predispose to any ailments studied, but children with low 
IgA and recurrent otitis media had relatively low MBL at birth, which failed to
increase during the study period and was significantly reduced at the age of 4
years (P = 0.04). MBL levels increased from birth to 2 years (P < 0.0001) and
were higher in children than in adults (P = 0.001). The increase was 1.9-fold in 
children with no recorded clinical events and 1.7-fold in children with asthma or
infections, but significantly lower, 1.2-fold, in children with recurrent otitis 
media. Low levels of IgA within the normal range may reveal disease
susceptibility not detected by conventional criteria. Slow maturation of Ig
appears to be the main factor of susceptibility during childhood, but a strong
corollary role for MBL is indicated by the high levels produced during childhood 
as well as the precipitation of disease in children with low levels of MBL and
Ig.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15882439 [PubMed - indexed for MEDLINE]

1089: Acta Otolaryngol. 2005 Feb;125(2):180-3.

Evaluation of mutations in penicillin binding protein-3 gene of non-typeable
Haemophilus influenzae isolated from the nasopharynx of children with acute
otitis media.

Sakai A, Hotomi M, Billal DS, Yamauchi K, Shimada J, Tamura S, Fujihara K,
Yamanaka N.

Department of Otolaryngology--Head and Neck Surgery, Wakayama Medical University,
Wakayama, Japan.

CONCLUSION: Younger children tend to harbor more resistant strains because they
are exposed to these pathogens more often through contacts with siblings or
attendance at day-care centers and are frequently treated with antibiotics. The
high prevalence of BLNAR strains should be taken into account in the treatment of
AOM in young children. OBJECTIVE: Non-beta-lactamase-producing
ampicillin-resistant (BLNAR) strains with mutations in penicillin-binding protein
(PBP) genes of Haemophilus influenzae have been prevalent recently among younger 
children. MATERIAL AND METHODS: We investigated mutations in the ftsI gene
encoding PBP-3 of H. influenzae isolated from the nasopharynx of children with
acute otitis media (AOM) using polymerase chain reaction (PCR). RESULTS: Strains 
containing the bla gene (beta-lactamase-producing ampicillin-resistant) were
identified in 4.7% of cases. Strains with mutations in the ftsI gene (BLNAR) were
identified in 23.3% of cases. Strains without mutations in the ftsI gene and that
did not contain the bla gene (non-beta-lactamase-producing
ampicillin-susceptible) were identified in 70.7% of cases. Strains with both
expression of the bla gene and mutations in the ftsI gene
(beta-lactamase-producing amoxicillin clavulanate-resistant) were identified in
1.3% of cases. The MICs of ampicillin against the strains evaluated in this study
were 0.5-2.0 microg/ml. Cefditoren-pivoxil had the lowest MIC90 against the
strains (0.06 microg/ml). Strains with mutations in the ftsI gene (BLNAR) were
broadly identified among young children.

PMID: 15880950 [PubMed - indexed for MEDLINE]

1090: Acta Otolaryngol. 2005 Feb;125(2):130-3.

Substance P upregulates osteoclastogenesis by activating nuclear factor kappa B
in osteoclast precursors.

Sohn SJ.

Department of Otolaryngology, Catholic University of Daegu School of Medicine,
Daegu, South Korea. sjsohn@cu.ac.kr

CONCLUSION: SP upregulates osteoclastogenesis by activating NF-kappaB in
osteoclast precursors. OBJECTIVE: Osteoclastic bone resorption is a common
finding of otitis media with or without cholesteatoma. Factors upregulating
osteoclastogenesis are implicated in bone resorption. The aim of this study was
to investigate the effect of substance P (SP) on mouse osteoclastogenesis in
vitro. MATERIAL AND METHODS: The SP dose response was analyzed in a mouse
osteoclast culture induced by macrophage colony-stimulating factor and receptor
activator for nuclear factor kappa B (NF-kappaB) ligand. Western blot analysis
was performed to elucidate the subcellular target of SP in osteoclastogenesis.
RESULTS: Treatment with SP significantly increased osteoclastogenesis compared to
control. SP activated nuclear translocation of NF-kappaB, which is an essential
event in osteoclastogenesis in osteoclast precursors (bone marrow macrophages).

PMID: 15880941 [PubMed - indexed for MEDLINE]

1091: Pediatr Infect Dis J. 2005 May;24(5):423-8.

Streptococcus pneumoniae and noncapsular Haemophilus influenzae nasal carriage
and hand contamination in children: a comparison of two populations at risk of
otitis media.

Stubbs E, Hare K, Wilson C, Morris P, Leach AJ.

Menzies School of Health Research and the Institute of Advanced Studies, Charles 
Darwin University, Darwin, Australia.

BACKGROUND: Australian Indigenous children living in remote areas have rates of
tympanic membrane perforation as high as 60%, almost 100 times the prevalence in 
urban child care settings (<1%). Relative rates of pneumococcal nasal carriage do
not reflect this difference in disease risk. METHODS: Cross-sectional comparison 
of nasal carriage and hand contamination in children younger than 4 years of age 
from urban child-care centers and Indigenous children 3-7 years of age from a
remote community. Almost identical methods of nasal swab collection, transport
and culture were used. Data on pneumococcal antimicrobial susceptibility patterns
and serotypes are also reported. RESULTS: For Indigenous children compared with
children in child care, the relative risk of nasal carriage of either
pneumococcus or noncapsular Haemophilus influenzae was <2-fold [relative risk,
1.7; 95% confidence interval (CI), 1.5, 1.9], the risk of simultaneous nasal
carriage was almost 3-fold (78% versus 28%; relative risk, 2.9; 95% CI 2.3, 3.5),
and the risk of pneumococcal hand contamination was 8-fold higher (37% versus 4%;
relative risk, 8.4; 95% CI 4.6, 15.2). For simultaneous hand contamination, the
risk was 23-fold (8% versus 0.3%; relative risk, 23.1; 95% CI 2.9, 185.4). Remote
Indigenous children also had a more diverse serotype distribution (25 versus 14
serotypes identified). CONCLUSIONS: Simultaneous nasal carriage of Streptococcus 
pneumoniae and H. influenzae and hand contamination are simple indicators of risk
for use in studies of otitis media in populations at risk for tympanic membrane
perforation.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15876941 [PubMed - indexed for MEDLINE]

1092: J Infect Dis. 2005 Jun 1;191(11):1876-80. Epub 2005 Apr 29.

Effective treatment of experimental acute otitis media by application of volatile
fluids into the ear canal.

Kristinsson KG, Magnusdottir AB, Petersen H, Hermansson A.

Department of Clinical Microbiology, Landspitali University Hospital, Reykjavik, 
Iceland. karl@landspitali.is

Essential oils are volatile and can have good antimicrobial activity. We compared
the effects of oil of basil (Ocimum basilicum) and essential oil components
(thymol, carvacrol, and salicylaldehyde) to those of a placebo when placed in the
ear canal of rats with experimental acute otitis media caused by pneumococci or
Haemophilus influenzae. Progress was monitored by otomicroscopic examination and 
middle ear cultures. The treatment with oil of basil or essential oil components 
cured or healed 56%-81% of rats infected with H. influenzae and 6%-75% of rats
infected with pneumococci, compared with 5.6%-6% of rats in the placebo group.
Essential oils or their components placed in the ear canal can provide effective 
treatment of acute otitis media.

Publication Types: 
    Comparative Study
    Evaluation Studies
    Research Support, Non-U.S. Gov't

PMID: 15871121 [PubMed - indexed for MEDLINE]

1093: J Infect Dis. 2005 Jun 1;191(11):1869-75. Epub 2005 Apr 28.

Erratum in:
    J Infect Dis. 2005 Aug 1;192(3):549.

Comment in:
    J Infect Dis. 2005 Jun 1;191(11):1790-2.

Nasopharyngeal carriage of Streptococcus pneumoniae at the completion of
successful antibiotic treatment of acute otitis media predisposes to early
clinical recurrence.

Libson S, Dagan R, Greenberg D, Porat N, Trepler R, Leiberman A, Leibovitz E.

Pediatric Infectious Disease Unit, Soroka University Medical Center, Ben-Gurion
University of the Negev, Beer-Sheva, Israel.

OBJECTIVE: We sought to investigate the role of Streptococcus pneumoniae (SP)
nasopharyngeal (NP) colonization after successful antibiotic treatment (Rx) of
acute otitis media (AOM) in recurrent AOM (RAOM). PATIENTS AND METHODS: NP
cultures were obtained from 494 (93%) of 530 patients at the end of antibiotic
treatment (EOT). RESULTS: At enrollment, middle ear fluid (MEF) cultures in 418
(79%) of 530 patients were positive for pathogens. At EOT, NP cultures in 208
(42%) of 494 patients were positive for SP. RAOM was found in 130 (26%) of 494
patients: 66 (32%) of 208 with SP-positive NP and 64 of 286 (22%) without
SP-positive NP at EOT (P=.026). MEF was positive for SP during RAOM in 34 (61%)
of 56 patients with SP-positive NP and 17 (36%) of 47 patients without
SP-positive NP at EOT (P=.022). The same serotype was identified in 24 (80%) of
30 SP pairs; complete identity was found between isolates in 22 (96%) of 23 SP
pairs. CONCLUSIONS: Early RAOM was more commonly caused by SP if the organism was
present in NP at EOT during the initial AOM episode. Most SP-RAOM episodes were
caused by SP isolates present in NP at EOT during the previous AOM episode.

PMID: 15871120 [PubMed - indexed for MEDLINE]

1094: J Virol. 2005 May;79(10):6035-42.

Chinchilla and murine models of upper respiratory tract infections with
respiratory syncytial virus.

Gitiban N, Jurcisek JA, Harris RH, Mertz SE, Durbin RK, Bakaletz LO, Durbin JE.

Columbus Children's Research Institute, Rm. W591, The Ohio State University
College of Medicine & Public Health, Department of Pediatrics, 700 Children's
Drive, Columbus, OH 43205-2696, USA.

Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract
infections in infants and the elderly. While the primary infection is the most
serious, reinfection of the upper airway throughout life is the rule. Although
relatively little is known about either RSV infection of the upper respiratory
tract or host mucosal immunity to RSV, recent literature suggests that RSV is the
predominant viral pathogen predisposing to bacterial otitis media (OM). Herein,
we describe mouse and chinchilla models of RSV infection of the nasopharynx and
Eustachian tube. Both rodent hosts were susceptible to RSV infection of the upper
airway following intranasal challenge; however, the chinchilla proved to be more 
permissive than the mouse. The chinchilla model will likely be extremely useful
to test the role of RSV in bacterial OM and the efficacy of RSV vaccine
candidates designed to provide mucosal and cytotoxic T-lymphocyte immunity.
Ultimately, we hope to investigate the relative ability of these candidates to
potentially protect against viral predisposal to bacterial OM.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 15857989 [PubMed - indexed for MEDLINE]

1095: Arch Dis Child. 2005 May;90(5):480-5.

Grommets in otitis media with effusion: an individual patient data meta-analysis.

Rovers MM, Black N, Browning GG, Maw R, Zielhuis GA, Haggard MP.

Julius Center for Health Sciences and Primary Care and Department of Pediatrics, 
University Medical Center Utrecht, Netherlands. mrovers@umcutrecht.nl

AIMS: To identify subgroups of children with otitis media with effusion (OME)
that might benefit more than others from treatment with ventilation tubes.
METHODS: An individual patient data (IPD) meta-analysis on seven randomised
controlled trials (n = 1234 children in all), focusing on interactions between
treatment and baseline characteristics--hearing level (HL), history of acute
otitis media, common colds, attending day-care, gender, age, socioeconomic
status, siblings, season, passive smoking, and history of breast feeding. Outcome
measures that could be studied were mean time spent with effusion (n = 557), mean
hearing levels (n = 557 in studies that randomised children, and n = 180 in
studies that randomised ears), and language development (n = 381). RESULTS: In
the trials that treated both ears the only significant interaction was between
day-care and surgery, occurring where mean hearing level was the outcome measure.
None of the other baseline variables showed an interaction effect with treatment 
that would justify subgrouping. In the trials that treated only one ear, the
baseline hearing level showed a significant but not pervasive interaction with
treatment-that is, only with a cut-off of 25 dB HL. CONCLUSIONS: The effects of
conventional ventilation tubes in children studied so far are small and limited
in duration. Observation (watchful waiting) therefore seems to be an adequate
management strategy for most children with OME. Ventilation tubes might be used
in young children that grow up in an environment with a high infection load (for 
example, children attending day-care), or in older children with a hearing level 
of 25 dB HL or greater in both ears persisting for at least 12 weeks.

Publication Types: 
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review

PMID: 15851429 [PubMed - indexed for MEDLINE]

1096: Arch Med Res. 2005 Mar-Apr;36(2):154-8.

Role of glucocorticoids in ototopical antibiotic-steroid preparations in the
treatment of chronic suppurative otitis media.

Indudharan R, Valuyeetham KA, Raju SS.

Department of Otorhinolaryngology, School of Medical Sciences, Universiti Sains
Malaysia, Malaysia.

BACKGROUND: It is conventional to use antibiotic-steroid combination eardrops,
although the advantage of steroid combination has not been substantiated. The
present prospective randomized comparative study is designed to assess the role
of glucocorticoids in ototopical antibiotic-steroid preparations in the treatment
of chronic suppurative otitis media (CSOM). METHODS: Pre-treatment clinical
assessment, bacteriology of the middle ear discharge and pure tone audiogram were
done. CSOM with organisms sensitive to gentamicin were treated either with plain 
gentamycin (GM) or gentamycin steroid combination (GM-S) eardrops for a period of
3 weeks. Post-treatment clinical, bacteriological and audiogram response was
recorded 1 week after discontinuing the eardrops. The post-treatment clinical
improvement, bacteriologic improvement and changes in hearing threshold at speech
frequencies were analyzed by using unpaired Student's t test and chi(2) tests.
RESULTS: The most common organism associated with CSOM was Pseudomonas aeruginosa
(33.92%). Clinical improvement was seen in 87.7 and 86.5% cases but
bacteriological improvement in only 82.5 and 75% of cases treated with GM and
GM-S (p >0.05), respectively. On comparing the pre- and post-treatment pure tone 
audiograms in 95 patients, 28.9% treated with GM and 30% with GM-S showed
deterioration in bone conduction threshold above 5 dB (p >0.05) at speech
frequencies. The mean increase in bone conduction in the two groups was 7.7 and
8.57 dB (p >0.05), respectively. CONCLUSIONS: Our results indicate that there is 
no difference in the clinical and bacteriological improvement or ototoxicity
either with topical GM or GM-S. Hence, we conclude that it is unnecessary to
combine steroids with topical antibiotic preparations for the management of CSOM.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15847949 [PubMed - indexed for MEDLINE]

1097: Cochrane Database Syst Rev. 2005 Apr 18;(2):CD004617.

Hyperbaric oxygen as an adjuvant treatment for malignant otitis externa.

Phillips JS, Jones SE.

Department of Otolaryngology, Norfolk and Norwich University Hospital, Colney
Lane, Norwich, Norfolk, UK, NR4 7UY. john.phillips@mac.com

BACKGROUND: Malignant, or necrotising, otitis externa is a potentially fatal
infection of the external ear canal and surrounding soft tissue and bone. It may 
be complicated by involvement of cranial nerves, principally the facial nerves
and the contents of the jugular foramen. It is an uncommon condition mainly found
in the elderly or in diabetics. OBJECTIVES: To assess the effectiveness of
adjunctive hyperbaric oxygen treatment for malignant otitis externa. SEARCH
STRATEGY: We searched the Cochrane Central Register of Controlled Trials
(CENTRAL) (The Cochrane Library Issue 4, 2003), MEDLINE (January 1966 to April
2004) and EMBASE (January 1985 to April 2004) with pre-specified terms. The date 
of the last search was 5th April 2004. SELECTION CRITERIA: Randomised controlled 
trials, involving adults, undergoing hyperbaric oxygen therapy in malignant
otitis externa. DATA COLLECTION AND ANALYSIS: No identified articles described
randomised controlled trials of hyperbaric oxygen therapy in the treatment of
malignant otitis externa. MAIN RESULTS: Due to the lack of data no results could 
be presented. AUTHORS' CONCLUSIONS: No clear evidence exists to demonstrate the
efficacy of hyperbaric oxygen therapy when compared to treatment with antibiotics
and/or surgery. No data were found to compare rates of complication between the
different treatment modalities. Further research is required.

Publication Types: 
    Review

PMID: 15846724 [PubMed - indexed for MEDLINE]

1098: Infect Immun. 2005 May;73(5):2805-11.

Genomic subtraction followed by dot blot screening of Streptococcus pneumoniae
clinical and carriage isolates identifies genetic differences associated with
strains that cause otitis media.

Pettigrew MM, Fennie KP.

Yale University School of Medicine, Department of Epidemiology and Public Health,
60 College Street, P. O. Box 208034, New Haven, CT 06520-8034, USA.
melinda.pettigrew@yale.edu

Streptococcus pneumoniae strains are the leading cause of bacterial otitis media,
yet little is known about specific bacterial factors important for this disease. 
We utilized a molecular epidemiological approach involving genomic subtraction of
the S. pneumoniae serogroup 19 middle ear strain 5093 against the laboratory
strain R6. Resulting subtraction PCR (sPCR) products were used to screen a panel 
of 93 middle ear, 90 blood, 35 carriage, and 58 cerebrospinal fluid isolates from
young children to identify genes found more frequently among middle ear isolates.
Probe P41, similar to a hypothetical protein of Brucella melitensis, occurred
among 41% of middle ear isolates and was found 2.8 (95% confidence interval [CI],
1.32 to 6.5), 3.3 (95% CI, 1.9 to 5.7), and 1.8 (95% CI, 1.1 to 3.0) times more
frequently among middle ear strains than carriage, blood, or meningitis strains, 
respectively. sPCR fragment H10, similar to an unknown Streptococcus agalactiae
protein, was present in 31% of middle ear isolates and occurred 3.6 (95% CI, 1.2 
to 11.2), 2.8 (95% CI, 1.5 to 5.4), and 2.6 (95% CI, 1.2 to 5.5) times more often
among middle ear isolates than carriage, blood, or meningitis strains,
respectively. These studies have identified two genes of potential importance in 
otitis media virulence. Further studies are warranted to outline the precise role
of these genes in otitis media pathogenesis.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 15845484 [PubMed - indexed for MEDLINE]

1099: J Laryngol Otol. 2005 Mar;119(3):198-201.

Tea tree oil: in vitro efficacy in otitis externa.

Farnan TB, McCallum J, Awa A, Khan AD, Hall SJ.

Department of Otolaryngology, Craigavon Area Hospital, Northern Ireland, UK.
t.farnan@ntlworld.com

OBJECTIVE: The purpose of this study was to determine the susceptibility of
organisms causing otitis externa (OE) to the essential oil of Melaleuca
alternifolia, or tea tree oil (TTO). METHODS: Fifty-seven swabs were taken from
the ears of 52 patients with OE for culture and sensitivity. A broth
microdilution method was used to determine the minimum inhibitory concentration
(MIC) of TTO for each organism. RESULTS: In 51 percent of the swabs taken,
pathogenic organisms were cultured. Of these cultures 71 percent, both bacteria
and yeast, were susceptible to TTO 2 percent or less. The only organism showing
resistance to TTO was Pseudomonas aeruginosa; however 25 percent of these
bacteria were sensitive. CONCLUSION: Tea tree oil may have a role to play in the 
treatment of OE. However, more work needs to be done to enhance the
anti-pseudomonal effect and to assess ototoxicity.

Publication Types: 
    In Vitro

PMID: 15845191 [PubMed - indexed for MEDLINE]

1100: J Otolaryngol. 2004 Jun;33(3):155-9.

Reconstruction of old radical cavities and long-term results.

Magliulo G, D'Amico R, Fusconi M.

Department of Otorhinolaryngology, Audiology and Phoniatrics, G. Ferreri,
University La Sapienza, Rome, Italy. giuseppemagliulo@yahoo.com

Various techniques and materials have been proposed to deal with the problems
that concern radical cavities, such as recurrence of the inflammatory process,
the need for regular medication, and social inconvenience (eg, inability to
practice water sports, working in an adverse enviroment). This article provides a
detailed report of the results of revalidation of old radical cavities using
hydroxyapatite granules as a filling. The material was incorporated with fibrin
adhesive to fill the mastoid cavity and was covered with a sheet of bone pate
sealant. Twenty-eight patients with chronic discharging old radical cavities were
selected for this study (mean follow-up 11.4 years; range 10-14 years). At the
6-month follow-up, grafting was successful in 25 patients, whereas the functional
outcomes showed an air-bone gap below 30 dB in 18 patients. No postoperative
sensorineural hearing loss was observed. The long-term follow-up demonstrated a
slight worsening of the initial findings; four other patients had reperforation
of the tympanic membrane, and hearing deteriorated in five patients to above 30
dB air-bone gap. These results could be a consequence of an alteration in the
function of the eustachian tube and of the severity of the preoperative
pathologic processes.

PMID: 15841992 [PubMed - indexed for MEDLINE]

1101: Clin Otolaryngol. 2005 Apr;30(2):105-11.

Relative humidity of the external auditory canal in normal and abnormal ears, and
its pathogenic effect.

Gray RF, Sharma A, Vowler SL.

Department of Otolaryngology, Addenbrookes Hospital, Cambridge, UK.

OBJECTIVE: To find the relative humidity of the normal external ear canal and to 
demonstrate that the relative humidity of the external auditory canal was higher 
in abnormal ears, i.e. ears commonly associated with chronic discharge. SETTING: 
Secondary health care within the ENT departments of Addenbrooke's and
Hinchingbrooke hospitals. DESIGN: A clinical observational study. PARTICIPANTS:
Volunteers seen in ENT outpatients. Inclusion criteria for the normal ear group, 
was a normal ear with no history of infection or previous ear disease. Inclusion 
criteria for abnormal ear group commonly associated with chronic discharge.
Exclusion criteria were the presence of pus or infection within the ear canal.
METHOD: The relative humidity of the external ear canal was measured in normal
and abnormal ears. Abnormal ears were grouped as those commonly associated with
chronic discharge, mastoid cavities, tympanic perforations, recurrent otitis
externa and hearing-aided ears. RESULTS: The range of relative humidity of normal
ears is 40-70%. The humidity in abnormal ears was found to be significantly
higher than the humidity in normal ears (P < 0.0001). CONCLUSION: The raised
relative humidity in the external canal may explain the predisposition of certain
abnormal ears to chronic discharge and infection. If the humidity of the canal
could be brought down to a normal level, this could offer a new therapeutic
treatment.

PMID: 15839860 [PubMed - indexed for MEDLINE]

1102: J AAPOS. 2005 Apr;9(2):192-4.

Success of simple probing and irrigation in patients with nasolacrimal duct
obstruction and otitis media.

Lee DH, Fudemberg SJ, Davitt BV, Cruz OA.

University Eye Institute, Saint Louis University School of Medicine, St. Louis,
MO, USA.

PURPOSE: To examine whether, as has been reported in the literature, a history of
otitis media (OM) affects the success of probing and irrigation (P&I) for
nasolacrimal duct obstruction (NLDO). METHODS: All patients who underwent P&I at 
the Saint Louis University Eye Institute between 2001 and 2002 were prospectively
studied. A preoperative questionnaire assessed the laterality of NLDO and history
and laterality of OM. Intraoperatively, site of NLDO and recovery of fluorescein 
were recorded. The success of the probing was determined by follow-up interview 6
months postoperatively. RESULTS: Overall success of initial P&I was 86.2%.
Patients with OM did not have a statistically significant decrease in success of 
P&I ( P = 1.00, RR 0.920, 95% CI 0.298-2.736 by Yates-corrected chi-square). The 
failure rate of initial P&I was not statistically different regardless of
fluorescein recovery. NLDO occurred most frequently at the valve of Hasner
(45.8%). CONCLUSIONS: OM was not a risk factor for initial P&I failure. Omission 
of fluorescein irrigation to assess patency may save time and cost.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15838451 [PubMed - indexed for MEDLINE]

1103: Arch Otolaryngol Head Neck Surg. 2005 Apr;131(4):299-303.

A 14-year prospective follow-up study of children treated early in life with
tympanostomy tubes: Part 2: Hearing outcomes.

Valtonen H, Tuomilehto H, Qvarnberg Y, Nuutinen J.

Author Affiliations: Department of Otorhinolaryngology, Kuopio University
Hospital, Kuopio, Finland. hannu.valtonen@kuh.fi

OBJECTIVE: To determine hearing outcomes in young children receiving early and
repeated tympanostomy tube insertion for recurrent acute otitis media or otitis
media with effusion. DESIGN: Prospective 14-year follow-up. SETTING: Central
Hospital of Central Finland, a tertiary care hospital.Patients Three hundred five
consecutive infants and young children with otitis media received initial
tympanostomy tube insertion at the age of 5 to 16 months. The final study group
comprised 237 patients (77.7%) attending the 14-year checkups. MAIN OUTCOME
MEASURES: At the 14-year checkups, children received clinical examinations and
audiometric testing for the determination of bone and air conduction pure-tone
thresholds. RESULTS: The mean pure-tone average of 177 healed ears was 4.3 dB.
The mean pure-tone average of all ears was 5.8 dB, with significantly poorer
results in ears with abnormal outcomes such as grade II or higher pars tensa
retraction, otitis media with effusion, and tympanic membrane perforation.
Thirteen (5.5%) of 237 ears had a hearing level worse than 15 dB, and the better 
ear hearing level was poorer than 15 dB in 3 patients. CONCLUSIONS: The hearing
level of healed ears was comparable to that of age-matched normal ears. Hearing
losses were infrequent, of slight grade, and, when present, almost exclusively
conductive and related to unsuccessful otological outcomes. From the hearing
point of view, repeated tympanostomy tube insertion for recurrent acute otitis
media or otitis media with effusion early in life is a safe treatment.

PMID: 15837896 [PubMed - indexed for MEDLINE]

1104: Arch Otolaryngol Head Neck Surg. 2005 Apr;131(4):293-8.

A 14-year prospective follow-up study of children treated early in life with
tympanostomy tubes: Part 1: Clinical outcomes.

Valtonen H, Tuomilehto H, Qvarnberg Y, Nuutinen J.

Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland.
hannu.valtonen@kuh.fi

OBJECTIVE: To determine 14-year otological outcomes in young children treated
with early insertion of ventilation tubes (VTs) for recurrent acute otitis media 
or otitis media with effusion (OME). DESIGN: Prospective 14-year follow-up.
SETTING: Central Hospital of Central Finland, a tertiary care hospital.Patients
Three hundred five consecutive infants and young children aged 5 to 16 months
with otitis media were enrolled for early initial tympanostomy tube insertion.
The final study group comprised 237 patients (77.7%) attending the 14-year
checkup. MAIN OUTCOME MEASURES: At the 14-year checkups, abnormal otological
findings were recorded and results compared with those of the 5-year checkups.
RESULTS: From 5 to 14 years' follow-up, the number of healed ears increased from 
156 (65.8%) to 177 (74.7%), while the number healed of ears with abnormal
outcomes decreased from 81 (34.2%) to 60 (25.3%). Of 156 healed ears, 142 (91.0%)
remained healed, and 35 (43.2%) of 81 ears with abnormal outcomes healed. The
proportion of abnormal outcomes was higher among ears with OME (P = .02) and with
3 or more VT insertions (P<.001). Repeated tympanostomy tube insertion was
performed in 141 ears (59.5%), more often in those with OME (P = .003), and ear
surgery was performed in 9 ears (3.8%), 8 with OME. CONCLUSIONS: Early VT
treatment is recommended for young children with recurrent acute otitis media or 
persistent OME. Parents should be informed of the long follow-up, of the possible
need for repeated VT insertion, and of potential sequelae that sometimes
necessitate surgical intervention. Patients healed after 5 years do not need
further follow-up.

Publication Types: 
    Comparative Study

PMID: 15837895 [PubMed - indexed for MEDLINE]

1105: J Fam Pract. 2005 Apr;54(4):313-22.

Acute otitis media: making sense of recent guidelines on antimicrobial treatment.

Pichichero ME, Casey JR.

University of Rochester Medical Center, Elmwood Pediatric Group, 601 Elmwood
Avenue, Box 672, Rochester, NY 14642, USA. michael_pichichero@urmc.rochester.edu

High-dose amoxicillin (80 to 90 mg/kg/d divided twice daily) remains the drug of 
choice for treatment of acute otitis media despite increasing antimicrobial
resistance. For persistent or recurrent acute otitis media, guidelines recommend 
high-dose amoxicillin/clavulanate (90/6.4 mg/kg/d), cefdinir, cefprozil,
cefpodoxime, cefuroxime, or ceftriaxone. Increasing the dose of amoxicillin does 
not cover infection with beta-lactamase-producing pathogens; add the
beta-lactamase inhibitor clavulanate to amoxicillin, or choose a cephalosporin
with good activity against S pneumoniae and good beta-lactamase stability. Key
factors for enhancing compliance are taste of suspension, dosing frequency, and
duration of therapy.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 15833221 [PubMed - indexed for MEDLINE]

1106: J Laryngol Otol. 2005 Feb;119(2):113-8.

Course and long-term outcome of 'refractory' secretory otitis media.

Ryding M, White P, Kalm O.

Department of Otorhinolaryngology, Hospital of Ostersund, Ostersund, Sweden.
marie.ryding@jll.se

OBJECTIVE: The course and the long-term outcome of 'refractory' secretory otitis 
media (SOM), defined as continuous SOM for more than 6 years, were studied in 52 
young patients. They had during childhood been treated for bilateral SOM on
average for 12 years (range 6 to 26 years). The mean interval between resolution 
of SOM and examination was 7 years. METHODS: At follow up the patients' medical
records were scrutinized with regards to transmyringeal ventilation tubes,
adenoidectomy, sequelae and complications, and a questionnaire was filled in to
document other diseases. RESULTS: The onset of SOM showed two peaks, one at the
age of one year and one at the age of 3.5 years. Patients whose onset of SOM was 
related to an episode of acute otitis media (AOM) were younger at SOM onset than 
those who had no such relation. Otorrhoea and AOM episodes were more frequent
during the SOM periods, with blocked or expelled tubes, than during periods with 
patent tubes. Cholesteatoma were seen in 3 per cent and perforations in 5 per
cent of patients. CONCLUSIONS: Extremely long-standing SOM does not necessarily
result in myringeal perforation or cholesteatoma to a greater extent than that
seen in patients with shorter durations of SOM. However, at follow up one-third
of the patients reported hearing impairment and a majority felt discomfort when
flying or diving.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15829063 [PubMed - indexed for MEDLINE]

1107: Acta Otolaryngol. 2005 Apr;125(4):346-52.

External otitis caused by infection with Pseudomonas aeruginosa or Candida
albicans cured by use of a topical group III steroid, without any antibiotics.

Emgård P, Hellström S, Holm S.

ENT Clinic, Ystad Hospital, Ystad, Sweden. per.emgard@skane.se

CONCLUSIONS: Irrespective of the microbial agent, group III steroid solution
cured external otitis efficiently in a rat model. The addition of antibiotic
components to steroid solutions for the treatment of external otitis is of
questionable validity. OBJECTIVE: External otitis, caused by infection with
either Pseudomonas aeruginosa or Candida albicans, was established in a rat model
and the treatment efficacy of a group III steroid solution was studied. MATERIAL 
AND METHODS: Three treatments were studied: (i) a group III steroid solution;
(ii) a group I steroid combined with two antibiotic components; and (iii) a
saline solution. A scoring scale was used to evaluate the characteristics of the 
ear canal skin. Bacteriological and fungal samples were collected for culturing
and ear canal skin biopsies were taken for structural analyses. RESULTS: It was
possible to cause P. aeruginosa and C. albicans infections in an animal model. In
the P. aeruginosa-infected animals, only the group III steroid treatment cured
all the animals. In the C. albicans-infected animals, group III steroid treatment
resolved external otitis faster than the other treatment modalities.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15823803 [PubMed - indexed for MEDLINE]

1108: Neuropathology. 2005 Mar;25(1):99-102.

Chronic calcified subdural empyema occurring 46 years after surgery.

Kaspera W, Bierzyńska-Macyszyn G, Majchrzak H.

Department of Neurosurgery, Medical University of Silesia in Katowice, Sosnowiec,
Poland. wkaspera@wss5.pl

The authors present a case of a 47-year-old female in whom there was diagnosed a 
chronic calcified subdural empyema 46 years after the removal of an acute
subdural empyema resulting from complications after otitis media. The patient had
suffered from grand mal convulsions and partial epileptic seizures occurring 3-4 
times a month. A large frontotemporoparietal craniotomy was carried out and the
subdural empyema filled with numerous brownish-black, uncharacteristic tissue
fragments together with the partially calcified and ossified capsule was removed.
The empyema mass was found to be sterile for bacteria. After the operation,
mental disability symptoms began to withdraw and the number of epileptic seizures
decreased.

Publication Types: 
    Case Reports

PMID: 15822825 [PubMed - indexed for MEDLINE]

1109: Pediatr Infect Dis J. 2005 Apr;24(4):301-8.

Randomized, investigator-blinded, multicenter, comparative study of gatifloxacin 
versus amoxicillin/clavulanate in recurrent otitis media and acute otitis media
treatment failure in children.

Sher L, Arguedas A, Husseman M, Pichichero M, Hamed KA, Biswas D, Pierce P,
Echols R.

Peninsula Research Associates, Rolling Hills Estates, CA, USA.

BACKGROUND: Recurrent otitis media and acute otitis media treatment failure are
commonly encountered in the pediatric population. OBJECTIVE: To compare the
clinical efficacy of gatifloxacin with amoxicillin/clavulanate for the treatment 
of acute otitis media treatment failure and recurrent otitis media. METHODS:
Three hundred fifty-four children 6 months-7 years with recurrent otitis media
and/or acute otitis media failure were stratified according to age (younger than 
2 years versus 2 years or older) and then randomly assigned to 10 days of
treatment with gatifloxacin 10 mg/kg once daily or amoxicillin/clavulanate 90
mg/6.4 mg in 2 divided doses. Tympanocentesis was performed in 116 children with 
acute otitis media treatment failure and 52 with recurrent otitis media at study 
entry to validate the clinical diagnosis and provide microbiologic data. The
primary outcome measure was clinical resolution of infection at the test-of-cure 
visit 3-10 days after completing treatment. RESULTS: Clinical resolution of acute
otitis media was observed in 79.0% (49 of 62) of clinically evaluable children
younger than 2 years and 90.3% (56 of 62) of those 2 years or older who were
treated with gatifloxacin as compared with 77.6% (45 of 58) of children younger
than 2 years and 79.7% (47 of 59) of children 2 years or older treated with
amoxicillin/clavulanate. In patients with acute otitis media treatment failure,
clinical response rates for children younger than 2 years and those 2 years or
older were 87.5% (21 of 24) and 97.0% (32 of 33) with gatifloxacin versus 63.6%
(14 of 22) and 83.9% (26 of 31) with amoxicillin/clavulanate. The corresponding
clinical response rates in patients with recurrent otitis media were 79.2% (19 of
24) and 85.7% (18 of 21) with gatifloxacin and 90.5% (19 of 21) and 76.0% (19 of 
25) with amoxicillin/clavulanate. Clinical success in those subjects having
pretreatment middle ear fluid pathogens was similar for the 2 regimens [80.0% (24
of 30) gatifloxacin, 77.1% (27 of 35) amoxicillin/clavulanate]. Emergence of
fluoroquinolone-resistant strains was not observed. Both drugs were generally
well-tolerated. Diarrhea was the most common drug-related adverse event (10%
gatifloxacin, 18% amoxicillin/clavulanate). No evidence of abnormal joint or gait
findings was found during a 12-month follow-up. CONCLUSIONS: Gatifloxacin once
daily is at least as effective and well-tolerated as amoxicillin/clavulanate
twice daily in children with acute otitis media treatment failure or recurrent
otitis media. There was no evidence of arthrotoxicity or emergence of
fluoroquinolone-resistant bacteria in gatifloxacin-treated children.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15818288 [PubMed - indexed for MEDLINE]

1110: Indian J Pediatr. 2005 Mar;72(3):233-8.

Comparative efficacy and safety evaluation of cefaclor vs amoxycillin +
clavulanate in children with Acute Otitis Media (AOM).

Aggarwal M, Sinha R, Murali MV, Trihan P, Singhal PK.

Pediatric Department, B.Y. Nair Hospital, Mumbai, India.
ashok.moharana@ranbaxy.com

Acute Otitis Media (AOM) is the most frequent respiratory tract infection of
infancy and childhood that is treated with antimicrobial agents. The most common 
causative pathogens include Streptococcus pneumoniae, Hemophilus influenzae and
Moxarella catarrhalis, and therefore antibacterial management should target
against these isolates. Cefaclor, a congener of cephalexin monohydrate, is a
semisynthetic cephalosporin antibiotic. It is an orally active cephalosporin
which has demonstrated activity against a wide range of organisms in vitro.
Present study is designed as a multicentric prospective trial to study and
compare the efficacy and safety of cefaclor versus amoxicillin + clav in children
with acute otitis media. One hundred and sixty seven patients were evaluated for 
efficacy endpoints in the cefaclor arm comprised of 104 males and 63 females with
a mean age of 5.74+/-2.80 years and 185 patients in the amoxy-clav group
comprised of 118 males and 67 females with a mean age of 4.93+/-2.92 years. Both 
cefaclor and amoxy-clav caused a significant improvement in all the signs and
symptoms after a 10-day treatment period. However, between-the-group comparisons 
showed that the reduction in most of the symptoms was significantly more in
cefaclor arm as compared to amoxicillin-clav arm. The clinical success (clinical 
cure + improvement) at the end of therapy was significantly more in cefaclor arm:
98% with cefaclor versus 85% with amoxicillin + clav, p<0.05 Table 3. Failure
cases were prescribed other antibiotics according to the culture sensitivity
reports, as rescue medication. Bacterial eradication rates were largely
consistent with clinical responses. Bacteriological eradication was seen in 95%
of patients in cefaclor group and 78% of patients in amoxicillin + clav group. In
conclusion, cefaclor is a well tolerated and effective antibacterial option for
acute otitis media in children and it is superior to the combination of
amoxicillin + clav in efficacy and tolerability in acute AOM. Moreover, its
expanded spectrum of activity, ability to achieve adequate concentrations in
tissues, suitability for twice-daily dosing, and proven tolerability suggest that
it is a good alternative to agents traditionally used in acute otitis media.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study

PMID: 15812119 [PubMed - indexed for MEDLINE]

1111: J Laryngol Otol. 2005 Jan;119(1):71-5.

Radiological and radionuclide investigation of malignant otitis externa.

Okpala NC, Siraj QH, Nilssen E, Pringle M.

ENT Department, Queen Alexandra Hospital, Portsmouth, UK.

This study looks at case series of malignant otitis externa, outlines detailed
structural (radiological) and functional (radionuclide) investigations, and
discusses their utility in the initial diagnosis, patient management and follow
up of this condition. Patients were investigated by computerized tomography (CT),
magnetic resonance imaging (MRI), two-phase planar and single-photon emission
tomography (SPECT), technetium-99m methylenediphosphonate bone scans, gallium-67 
planar and SPECT scans, and indium-111 or technetium-99m labelled WBC planar and 
SPECT scintigraphy. We discuss example case reports with the various radiological
and scintigraphic findings and outline a protocol for rational investigation. It 
is concluded that CT and/or MRI should be supported by routine SPECT bone imaging
for initial diagnosis of malignant otitis externa. Routine SPECT bone imaging
further supplemented by gallium scintigraphy should be the investigation of
choice in the follow up of these cases for assessing response to treatment and
disease recurrence.

Publication Types: 
    Case Reports

PMID: 15807974 [PubMed - indexed for MEDLINE]

1112: J Laryngol Otol. 2005 Jan;119(1):61-3.

Malignant (invasive) otitis externa involving the temporomandibular joint.

Dobbyn L, O'Shea C, McLoughlin P.

Department of Oral and Maxillofacial Surgery, Ninewells Hospital and Medical
School, Tayside University Hospital Trust, Dundee DD1 9SY, UK.
lornadobbyn@hotmail.com

Malignant (invasive) otitis externa (MOE) is an infection involving the external 
auditory meatus (EAM), most often found in elderly diabetics, which carries a
high morbidity and mortality. In advanced cases it may give rise to osteomyelitis
and cranial neuropathies. This is a case ofMOE, which invaded the posterior wall 
of the right temporomandibular joint (TMJ), resulting in severe trismus and pain.
Subsequently, this required treatment by replacement of the glenoid fossa with a 
Silastic prosthesis.

Publication Types: 
    Case Reports

PMID: 15807971 [PubMed - indexed for MEDLINE]

1113: J Laryngol Otol. 2005 Jan;119(1):36-7.

An easier way of inserting the Shah permavent grommet.

Tahery J, Saeed SR.

University Department of Otolaryngology and Head and Neck Surgery, Manchester
Royal Infirmary, Manchester M13 9WL, UK. jtahery@aol.com

Ventilation tube insertion plays an important role in the management of otitis
media with effusion. In selected cases, repeated grommet insertion due to
persistent eustachian tube dysfunction necessitates the need for longer-term
ventilation. Insertion of such tubes can however occasionally be more difficult
than insertion of standard grommets. One such long-term ventilation tube is the
Shah permavent grommet. This paper describes a simple modification of the
technique that is less time-consuming and less traumatic.

PMID: 15807962 [PubMed - indexed for MEDLINE]

1114: Otolaryngol Head Neck Surg. 2005 Apr;132(4):647-52.

Measuring quality of life in preschool children with sore throats and otitis
media using the TAPQOL questionnaire.

Kubba H, Swan IR, Gatehouse S.

MRC Institute for Hearing Research (scottish section), Glasgow Royal Infirmary,
Glasgow, Scotland. haytham@ihr.gla.ac.uk

OBJECTIVES: TNO-AZL Preschool Quality of Life Questionnaire (TAPQOL) is one of
the few instruments designed to assess health-related quality of life in
preschool children but its applicability to otolaryngology is unknown. STUDY
DESIGN AND SETTING: We studied a consecutive series of children aged 1 to 5 years
referred to hospital with recurrent sore throats, recurrent acute otitis media,
or otitis media with effusion. RESULTS: TAPQOL domain scores were not influenced 
by age, sex, or socio-economic class, but correlated with markers of disease
severity (frequency of sore throat or pyrexia, time off school), ear-related
handicap (assessed with the OM6 questionnaire), and other measures of
health-related quality of life (visual analogue scale, 5-point rating scale and
the Health Utilities Index mark III). Comparison with published data from healthy
children suggests that these common otolaryngologic problems have a large impact 
on a child's quality of life. CONCLUSIONS: TAPQOL seems to be appropriate for use
in this context. Marked ceiling effects in some domains, however, may limit their
sensitivity.

PMID: 15806062 [PubMed - indexed for MEDLINE]

1115: Otolaryngol Head Neck Surg. 2005 Apr;132(4):626-9.

Eustachian tube dysfunction in allergic rhinitis.

Lazo-Sáenz JG, Galván-Aguilera AA, Martínez-Ordaz VA, Velasco-Rodríguez VM,
Nieves-Rentería A, Rincón-Castañeda C.

Otorhinolaryngology Department, Speciality Hospital No 71, Social Security
Mexican Institute, Torreón, Coahuila, México. veromart@internetual.com.mx

OBJECTIVE: To assess eustachian tube function in patients with allergic rhinitis 
and compare them with a control group. STUDY DESIGN AND SETTING: Tympanometry was
performed in 130 patients (260 ears), divided into 2 groups: 80 cases with
allergic rhinitis and 50 healthy controls. Cases underwent skin hypersensitivity 
tests. RESULTS: Cases, age 21.1 +/- 14.9; Controls, age 23.9 +/- 15.6. Most
frequent skin hypersensitivity: Dermatophagoides pt (62%), Zea Maiz (44%), and
Cockroach (37%). Tympanometry of cases showed negative values of peak
tympanometric pressure in both children and adults (P < or = 0.05). Among
children under 11 years of age, 15.5% tympanograms showed abnormal curves (13% C 
curves and 3% B curves); among the control group only normal curves were found
(type A). CONCLUSION: Allergic rhinitis patients have a higher risk of eustachian
tube dysfunction, particularly during childhood. Tympanometry is a noninvasive,
readily available procedure that may be useful in these patients to prevent
chronic middle-ear disease.

PMID: 15806058 [PubMed - indexed for MEDLINE]

1116: Otolaryngol Head Neck Surg. 2005 Apr;132(4):523-6.

Gastric reflux is uncommon in acute post-tympanostomy otorrhea.

Antonelli PJ, Lloyd KM, Lee JC.

University of Florida, Department of Otolaryngology, Gainesville, FL 32610-0264, 
USA. antopj@ent.ufl.edu

OBJECTIVE: Acute post-tympanostomy otorrhea (APTO) is a common complication of
tympanostomy tube placement. APTO has been related primarily to viral upper
respiratory infections and external ear contamination. Elevated levels of gastric
enzymes have been found in a large proportion of chronic middle ear effusions,
implicating gastric reflux (GR) in its pathogenesis. Thus, our objective was to
determine whether GR may be a contributing factor in the development of APTO.
STUDY DESIGN AND SETTING: Prospective, nonrandomized design. Otorrhea samples
were collected from children with APTO. Total pepsinogen concentrations were
measured with a commercial ELISA, using a pepsinogen I-specific capture antibody 
and horseradish peroxidase detection antibody. RESULTS: Twenty-six samples from
24 patients were collected and analyzed. Eight samples demonstrated measurable
pepsinogen I, but the measured concentrations, 2-17 mg/L, were below the normal
serum reference ranges. CONCLUSIONS: GR does not play a major role in the
development of APTO in children.

PMID: 15806038 [PubMed - indexed for MEDLINE]

1117: Laryngoscope. 2005 Apr;115(4):731-4.

Effect of adenotonsillectomy on middle ear status in children.

Oomen KP, Rovers MM, van den Akker EH, van Staaij BK, Hoes AW, Schilder AG.

Department of Otorhinolaryngology, Wilhelmina Children's Hospital, University
Medical Center Utrecht, the Netherlands.

OBJECTIVE: To determine the effects of adenotonsillectomy as compared with
watchful waiting on the middle ear status of children. STUDY DESIGN: Randomized
controlled trial. METHODS: We recruited 300 children between 2 and 8 years of age
who were selected for adenotonsillectomy according to current medical practice.
Excluded from the trial were children with very frequent throat infections (more 
than 6 per year) or obstructive sleep apnea. Participants were randomly assigned 
to either adenotonsillectomy or watchful waiting. Main outcome measure was the
percentage of children with unilateral or bilateral otitis media diagnosed at the
scheduled follow-up visits according to an algorithm combining tympanometry and
otoscopy. RESULTS: The percentages of children in the adenotonsillectomy and
watchful waiting group diagnosed with otitis media at baseline and at 3, 6, 12,
18, and 24 months were 27.7 versus 30.5, 16.8 versus 25.2, 18.3 versus 21.2, 12.3
versus 15.2, 17.6 versus 15.5, and 14.7 versus 10.3%, respectively (P < .10). In 
the subgroup of children selected for adenotonsillectomy predominantly because of
recurrent or persistent otitis media, hearing loss, or recurrent upper
respiratory tract infections (n = 111) and in the subgroup of children diagnosed 
with otitis media at inclusion (n = 82), the occurrence of otitis media did not
differ significantly between the adenotonsillectomy and watchful waiting group
during the entire follow-up period. CONCLUSION: We conclude that in a large
proportion of children selected for adenotonsillectomy according to current
medical practice, including those with otitis media or related complaints, no
beneficial effect of adenotonsillectomy on middle ear status is to be expected.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15805889 [PubMed - indexed for MEDLINE]

1118: Laryngoscope. 2005 Apr;115(4):651-4.

Inflammatory proteases in chronic otitis externa.

Antonelli PJ, Schultz GS, Cantwell JS, Sundin DJ, Pemberton PA, Barr PJ.

Department of Otolaryngology, University of Florida, Gainesville, Florida
32610-0264, USA. antonpj@ent.ufl.edu

OBJECTIVES: Proteases are known to contribute to the pathogenesis of chronic
inflammatory skin conditions such as atopic dermatitis and psoriasis. Inhibition 
of these proteases has shown promise in the treatment of these skin conditions.
The purpose of this study was to measure the matrix metalloproteinases (MMP) and 
human neutrophil elastase (HNE) activities in chronic otitis externa (COE) and to
determine whether administration of protease inhibitors recombinant alpha
1-antitrypsin (rAAT) and ilomastat might reduce these protease activities. STUDY 
DESIGN: Prospective and ex vivo. METHODS: Twenty-five ear canals with COE and 34 
with no pathology (i.e., controls) were debrided and filled with saline. After a 
tragal pump and 1 to 2 minutes, the washes were collected and analyzed for MMP
and HNE activities and the inhibitory activity of rAAT and ilomastat on these
proteases, respectively. RESULTS: MMP and HNE levels were significantly higher (P
= .0057 and .0112) in ears with COE than normal ears. MMP activity greater than 3
mAU/minute was observed in 30% of COE and 0% of controls (P = .0270). HNE
activity greater than 3 mAU/minute was found in 77% of COE versus 7% of controls 
(P < .0001). Ilomastat and rAAT inhibited 60% of MMP and 98% of HNE activity,
respectively, in COE ears. CONCLUSIONS: Elevated levels of proteases found in
COE, MMP, and HNE may be inhibited with ilomastat and rAAT. The therapeutic
potential of these protease inhibitors warrants investigation.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15805875 [PubMed - indexed for MEDLINE]

1119: J Vet Med Sci. 2005 Mar;67(3):263-8.

Isolation and characterization of staphylococci from external auditory meatus of 
dogs with or without otitis externa with special reference to Staphylococcus
schleiferi subsp. coagulans isolates.

Yamashita K, Shimizu A, Kawano J, Uchida E, Haruna A, Igimi S.

Department of Microbiology and Immunology, Faculty of Agriculture, Kobe
University, Kobe, Hyogo 657-8501, Japan.

Staphylococci were isolated from the external auditory meatus in 14 (48.3%) of 29
dogs affected with otitis externa (OE dogs) and 28 (68.3%) of 41 dogs without OE 
(non-OE dogs). Twenty-two OE isolates were identified as belonging to 12 species,
and 42 non-OE isolates were identified as belonging to 13 species. The
predominant species found in both OE and non-OE isolates were S. intermedius, and
S. epidermidis. Thirty-eight (59.4%) of 64 isolates were resistant to one or more
of the 17 antimicrobial agents tested. Resistance to PCG and ABPC was most
frequent. S. schleiferi subsp. coagulans, a recent etiologic agent of canine OE, 
was isolated from OE and non-OE dogs. All of the 5 S. schleiferi subsp. coagulans
isolates showed typical characteristics. No clear difference in the extracellular
enzyme or toxin profiles, nor in the PFGE patterns, was demonstrated between the 
OE and non-OE isolates of S. schleiferi subsp. coagulans. A new PCR primer set
specific for 16S rDNA was designed to identify strains of S. schleiferi subsp.
coagulans. The amplified fragment was detected in all of the 5 isolates as well
as the type strain GA 211 (=JCM 7470) and a reference strain GA 11, but was not
detected in any strains of the related species, S. aureus, S. intermedius and S. 
hyicus. The PCR may allow a simple, rapid and precise identification of S.
schleiferi subsp. coagulans, in addition to the standard tube test for free
coagulase.

Publication Types: 
    Comparative Study

PMID: 15805728 [PubMed - indexed for MEDLINE]

1120: Pediatrics. 2005 Apr;115(4):1048-57.

A review of evidence supporting the American Academy of Pediatrics recommendation
for prescribing cephalosporin antibiotics for penicillin-allergic patients.

Pichichero ME.

University of Rochester Medical Center, Elmwood Pediatric Group, 601 Elmwood Ave,
Box 672, Rochester, NY 14642, USA. michael_pichichero@urmc.rochester.edu

The American Academy of Pediatrics, evidence-based guidelines endorse the use of 
cephalosporin antibiotics for patients with reported allergies to penicillin, for
the treatment of acute bacterial sinusitis and acute otitis media. Many
physicians, however, remain reluctant to prescribe such agents. Although such
concern is understandable, lack of consistent data regarding exactly what
constitutes an initial penicillin-allergic reaction and subsequent
cross-sensitivity to cephalosporins may be preventing many patients from
receiving optimal antibiotic therapy. This article reviews evidence in support of
the American Academy of Pediatrics recommendation. Included is an examination of 
the types and incidence of reactions to penicillins and cephalosporins; the
frequency of cross-reactivity between these 2 groups of agents; experimental and 
clinical studies that suggest that side chain-specific antibodies predominate in 
the immune response to cephalosporins, thereby explaining the lack of
cross-sensitivity between most cephalosporins and penicillins; the role of skin
testing; and the risks of anaphylaxis. Specific recommendations for the treatment
of patients on the basis of their responses to previously prescribed agents are
summarized.

Publication Types: 
    Review

PMID: 15805383 [PubMed - indexed for MEDLINE]

1121: Ethn Health. 2005 May;10(2):91-111.

'We are not just participants--we are in charge': the NACCHO ear trial and the
process for Aboriginal community-controlled health research.

Couzos S, Lea T, Murray R, Culbong M.

National Aboriginal Community Controlled Health Organisation, Western Australia. 
scouzos@tpgi.com.au

OBJECTIVE: Methodological criteria that characterise ethically sound
community-based studies are often described in overviews but are rarely
documented in clinical studies. Research investigating the health of Aboriginal
Australians is often small-scale, descriptive and largely driven by
non-Indigenous people. The 'community-controlled' model of research relating to
Aboriginal peoples health is a form of 'participatory' research that shifts the
balance of control towards those being researched. This paper describes the
methodological issues and principles that underpin community-controlled health
research; their practical application; and encourages their adoption in research 
involving Indigenous populations. DESIGN: Descriptive report of the methods used 
to conduct the landmark Aboriginal community-controlled multi-centre double-blind
randomised controlled clinical ear trial investigating ototopical treatments for 
chronic suppurative otitis media. RESULTS: The characteristics of the
community-controlled research model are illustrated under the headings of:
setting the research agenda; research project planning and approval; conduct of
research; and analysis, dissemination and application of findings. CONCLUSION:
The 22 methodological elements which defined the community-controlled design of
the ear trial may assist community groups, external research bodies and funding
agencies to improve the acceptability, quality and scope of research involving
Indigenous peoples. Aboriginal community-controlled organisations are well placed
to lead research, which can be interventional and of a high scientific standard
without compromising the values and principles of those being researched. With
over 120 Aboriginal community-controlled health services (ACCHSs) across
Australia, the potential exists for these services to engage in multi-centre
research to realise solutions to health problems faced by Indigenous Australians.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15804658 [PubMed - indexed for MEDLINE]

1122: J Radiat Res (Tokyo). 2005 Mar;46(1):75-81.

Effects of high linear energy transfer radiation on the cochlea of C3H/He mouse
during postnatal developmental course.

Nitta Y, Araki N, Nitta K, Harada T, Ishizaki F, Ando J.

International Radiation Information Center, Research Institute for Radiation
Biology and Medicine, Hiroshima University, Kasumi, Hiroshima, Japan.
yumiko@hiroshima-u.ac.jp

To investigate the biological effectiveness of neutrons at energies below 1MeV
with regard to ear toxicity, we exposed mice to 1.0 Gy of monoenergetic neutrons 
(1.026 MeV) or 137Cs gamma rays at 7 days of age, and observed subsequent
morphological changes in the inner ear with light and scanning electron
microscopes. Monoenergetic neutrons, but not gamma rays, caused acute changes in 
the ear. The epithelium of the greater epithelial ridge in the organ of Corti
showed degeneration around 6 hours and disappeared by 72 hours post-irradiation. 
The apoptotic cell death of the epithelium of the greater epithelial ridge was
inducible by the radiation at 3 or 4 days of age. The hair cells formed the
protrusion structures of the surface by 72 hours post-irradiation.
Neutron-irradiation also caused acute otitis media until 10 weeks of age.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15802862 [PubMed - indexed for MEDLINE]

1123: Acta Otolaryngol. 2005 Jan;125(1):43-7.

Expression of Clara cell secretory protein in experimental otitis media in the
rat.

Kim SJ, Jung HH.

Department of Biomedical Sciences--Head and Neck Surgery, Korea University
College of Medicine, Seoul, South Korea.

CONCLUSION: These results suggest that CCSP is upregulated in OME and may play a 
protective role in the pathogenesis of OME. OBJECTIVE: Clara cell secretory
protein (CCSP) is an abundant 16-kDa homodimeric protein and is secreted by
non-ciliated secretory epithelial cells in the lung. It has an important
protective role against the intrapulmonary inflammatory process. The aim of this 
study was to investigate the expression of CCSP in endotoxin-induced otitis media
with effusion (OME) in the rat. MATERIAL AND METHODS: We instilled endotoxin and 
saline (control) into the middle ear cavity of the rat. Middle ear mucosa were
taken at 0, 1, 3, 6 and 12 h and 1, 3, 7 and 14 days, and the expression of both 
CCSP mRNA and protein were then evaluated using semi-quantitative reverse
transcriptase polymerase chain reaction (RT-PCR), Western blotting and
immunohistochemistry. RESULTS: RT-PCR revealed that the expression of CCSP was
first identified at 1 h after endotoxin instillation, was dramatically increased 
between 1 h and Day 1, with maximal expression at 12 h, and then decreased after 
Day 3. The expression pattern of CCSP protein identified by means of Western
blotting was similar to the CCSP mRNA patterns observed using RT-PCR. Expression 
of CCSP at both mRNA and protein levels was not detected in either normal middle 
ear mucosa or saline-instilled middle ear mucosa. Immunohistochemistry revealed
that some epithelial cells in the middle ear mucosa were stained.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15799573 [PubMed - indexed for MEDLINE]

1124: Acta Otolaryngol. 2005 Jan;125(1):9-15.

Round window membrane and labyrinthine pathological changes: an overview.

Cureoglu S, Schachern PA, Rinaldo A, Tsuprun V, Ferlito A, Paparella MM.

Department of Otolaryngology, University of Minnesota, Minneapolis, MN, USA.

The round window membrane is considered the most likely pathway from the middle
to the inner ear. Various substances placed in the middle ear have been seen to
pass through the round window membrane. Once toxic substances or inflammatory
mediators such as cytokines and nitric oxide enter the inner ear, various inner
ear sequelae such as labyrinthitis, endolymphatic hydrops, sensorineural hearing 
loss or more insidious diseases can occur.

Publication Types: 
    Review

PMID: 15799567 [PubMed - indexed for MEDLINE]

1125: Ear Nose Throat J. 2005 Feb;84(2):94-6.

Fibromatosis presenting as acute mastoiditis: a case report.

Kaberos A, Balatsouras DG, Vasilakaki T, Economou NC, Leontiadis A.

ENT Department, Tzanion General Hospital, Piraeus, Greece.

We describe the case of a middle-aged man who presented with manifestations of
acute mastoiditis caused by fibromatosis of the mastoid region. A lesion of the
right mastoid bone had eroded its wall and extended toward the middle and
posterior cranial fossae. The macroscopic and microscopic appearance of an
excised portion of the lesion established the diagnosis of mastoid fibromatosis. 
After a more detailed work-up, a second procedure involving extensive removal of 
the tumor was performed, and the diagnosis was confirmed. The patient's
postoperative period was uneventful, and he showed no evidence of recurrence
during 3 years of follow-up.

Publication Types: 
    Case Reports

PMID: 15794545 [PubMed - indexed for MEDLINE]

1126: Arch Otolaryngol Head Neck Surg. 2005 Mar;131(3):256-8.

Helicobacter pylori in children who are prone to upper respiratory tract
infections.

Pitkäranta A, Kolho KL, Rautelin H.

Department of Otorhinolaryngology, Helsinki University Central Hospital,
University of Helsinki, Helsinki, Finland. anne.pitkaranta@hus.fi

OBJECTIVE: To examine the presence of Helicobacter pylori infection in children
with recurrent upper respiratory infections, including acute otitis media.
DESIGN: A prospective clinical trial. SETTING: Tertiary referral center.
PATIENTS: A total of 20 children who were prone to upper respiratory infections
and acute otitis and who were admitted for elective adenoidectomy and/or
tympanostomy were included in the study. MAIN OUTCOME MEASURES: Samples of
adenoid tissue and middle ear fluid were cultured for H pylori. Serologic
analysis and fecal antigen detection testing were also carried out to determine
the presence of H pylori. RESULTS: The results of serologic and antigen detection
tests were positive for H pylori in 4 children (20%), but cultures of adenoid
tissue and middle ear fluid samples were negative for H pylori in all children.
CONCLUSION: An association between H pylori infection and recurrent upper
respiratory infections and otitis media could not be established.

Publication Types: 
    Clinical Trial
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15781769 [PubMed - indexed for MEDLINE]

1127: Vaccine. 2005 Apr 15;23(21):2696-702.

Vaccines for otitis media: proposals for overcoming obstacles to progress.

Murphy TF, Bakaletz LO, Kyd JM, Watson B, Klein DL.

Division of Infectious Diseases, Department of Medicine, University at Buffalo,
SUNY, USA. murphyt@buffalo.edu

Otitis media is a common problem with enormous morbidity worldwide. The
development of vaccines to prevent otitis media would have an important human and
economic impact. A striking lack of progress in the development, production and
clinical testing of vaccines to prevent otitis media has occurred in the past
decade. This review outlines a series of specific proposals intended to advance
vaccine development for otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 15780715 [PubMed - indexed for MEDLINE]

1128: Vaccine. 2005 Apr 8;23(20):2607-13.

Pneumococcal conjugate vaccination does not induce a persisting mucosal IgA
response in children with recurrent acute otitis media.

Bogaert D, Veenhoven RH, Ramdin R, Luijendijk IH, Rijkers GT, Sanders EA, de
Groot R, Hermans PW.

Laboratory of Pediatrics, Department of Pediatrics, University Medical Center
Rotterdam, Erasmus MC-Sophia Rotterdam, Room Ee 1500, Dr. Molewaterplein 50, 3015
GE Rotterdam, The Netherlands.

AIM: In a prospective controlled study in young children with a history of
recurrent acute otitis media, we analyzed the salivary IgA and IgG antibody
titers upon vaccination with a 7-valent pneumococcal conjugate vaccine (PCV)
given once or twice, followed by a 23-valent polysaccharide booster vaccination. 
METHODS: Salivary IgA and IgG antibody concentrations to vaccine serotype 6B, 14,
18C and 19F were measured by enzyme immunoassay in 38 samples of children
vaccinated with PCV and 45 control samples. In the PCV group, 12 samples were
taken prior to vaccination, 12 samples 4 weeks after the polysaccharide booster
(8 months after the first conjugate vaccination) and 14 samples 7 months after
the last vaccination (14 months after the first conjugate vaccination). In the
control group 15 children were sampled at each of these three time points.
RESULTS: We observed an increase in salivary IgG antibody concentrations against 
serotype 6B, 14, and 18C 14 months after the primary vaccination in children
vaccinated with PCV twice, although this was significant for serotype 14 only.
There was no increase in salivary IgG antibody in children vaccinate with PCV
once nor in control children. IgA antibody titers increased significantly after 8
and after 14 months in both the pneumococcal vaccine recipients and the controls.
However, the observed increase in mean antibody titers was significantly higher
in control children compared to the PCV group. CONCLUSION: We suggest that
repeated pneumococcal conjugate vaccination is necessary to induce an increase in
salivary IgG antibodies and effectuate clearance of S. pneumoniae from the
nasopharyngeal mucosa of children with recurrent acute otitis media. We
hypothesize that the increase in salivary IgA is caused by the local boosting of 
the mucosal immune response by carriage and recurrent infections, which occurs
less often in the PCV group compared to the control children.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15780443 [PubMed - indexed for MEDLINE]

1129: Int J Circumpolar Health. 2005 Feb;64(1):5-15.

Comment in:
    Int J Circumpolar Health. 2005 Feb;64(1):2-3.

Otitis media: health and social consequences for aboriginal youth in Canada's
north.

Bowd AD.

Centre of Excellence for Children and Adolescents with Special Needs, Lakehead
University, Thunder Bay, Canada. alan.bowd@lakeheadu.ca

OBJECTIVES. Otitis media is endemic among Inuit, First Nations and Métis children
in northern Canada, with prevalence rates in some communities as high as 40 times
that found in the urban south. Hearing impairment, much of it attributable to
chronic otitis media, is the most common health problem in parts of the arctic,
and conductive hearing loss among children may affect as many as two-thirds.
STUDY DESIGN AND METHODS: There is a need for systematic data based on consistent
disease definitions and measures, and taking account of cross-cultural
methodological issues and sampling. RESULTS: Otitis media is most likely to
develop in infancy. Susceptibility has been linked to immune defects and to a
variety of environmental factors. Among the most significant are diet, the
decline in initiation and maintenance of breastfeeding, and exposure to cigarette
smoke. Hearing loss has been related to difficulties in language acquisition, and
to subsequent issues with literacy and school achievement, including learning
disabilities and attention deficits. The economic and social costs of otitis
media are substantial. CONCLUSION: Approaches to treatment and prevention have
enjoyed limited success. Public health and medical practice need to be informed
by the traditional knowledge and practices of indigenous peoples.

Publication Types: 
    Review

PMID: 15776988 [PubMed - indexed for MEDLINE]

1130: Acta Otolaryngol. 2004 Dec;124(10):1178-81.

Pharyngeal reflux in children with chronic otitis media with effusion.

Keleş B, Oztürk K, Günel E, Arbağ H, Ozer B.

Departments of Otolaryngology, Meram Medical Faculty, Selçuk University, Konya,
Turkey. baharkeles@hotmail.com

OBJECTIVE: To investigate whether there is an association between chronic otitis 
media (COM) with effusion and pharyngeal reflux in children by using 24-h pH
monitoring with a dual probe. MATERIAL AND METHODS: This was a prospective study.
The study group consisted of 25 children with COM with effusion and the control
group comprised 12 healthy children. All children underwent 24-h esophageal pH
monitoring with a dual probe (distal and proximal esophageal pH monitoring).
RESULTS: In the study group, the frequencies of pharyngeal and gastroesophageal
reflux (GER) were 48% and 64%, respectively, and the corresponding values in the 
control group were 8.3% and 25%. Both of these differences were significant (p
<0.05). In the study group, 28% of patients were positive for at least 1 symptom 
of GER; 72% of the patients did not have any symptoms but 56% of these patients
had silent GER. CONCLUSIONS: These findings indicate that pharyngeal reflux may
play an important role in the etiology of COM with effusion. If patients have
typical symptoms of GER, such as pyrosis, regurgitation, dysphagia and emesis,
the presence of GER should be considered. The presence of silent GER and
pharyngeal reflux should also be considered.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15768814 [PubMed - indexed for MEDLINE]

1131: Int J Pediatr Otorhinolaryngol. 2005 Apr;69(4):555-9.

Zygomatic abscess with temporal myositis - a rare extracranial complication of
acute otitis media.

Kuczkowski J, Narozny W, Stankiewicz C, Mikaszewski B, Izycka-Swieszewska E.

Department of Otolaryngology, Medical University of Gdańsk, Poland ul. Debinki 7,
Building 16, 80-211 Gdańsk, Poland. jerzyk@amg.gda.pl

Acute mastoiditis is the most common complication of acute otitis media (AOM) and
its early recognition and management still poses a challenge due to potentially
serious consequences. The incidences of extracranial and intracranial suppurative
complications of AOM in children have decreased significantly, yet they remain a 
serious clinical problem, especially when caused by bacteria resistant to
antibiotics. The authors presented a case of rare AOM complication - zygomatic
abscess with temporal myositis. A 6-year-old boy was admitted to the ENT
Department with 4 weeks of ear pain, treated for AOM with cefuroxime axetyl and
amoxicilline, with acute mastoiditis and subsequent abscess formation in
zygomatic and preauricular region. The inflammatory process spread through
anterior air cells to the zygomatic cells leading to a fistula formation in the
zygomatic bone and breakthrough into the temporal muscle. The surgical procedures
applied were: myringotomy with drainage, cortical mastoidectomy and revision of
zygomatic area and treatment with antibiotics (ceftriaxon). Enterococcus faecalis
and Streptococcus viridans were found in the culture of middle ear and mastoid
effusion. After half a year of follow-up the child had a normal hearing. Severe
complications of AOM are rare today. An early diagnosis in order to promote
adequate management and prevent inherently suppurative complications is
essential.

PMID: 15763297 [PubMed - indexed for MEDLINE]

1132: Int J Pediatr Otorhinolaryngol. 2005 Apr;69(4):533-40. Epub 2005 Jan 22.

Birth characteristics and recurrent otitis media with effusion in young children.

Engel JA, Straetemans M, Zielhuis GA.

Department of Otorhinolaryngology, Canisius-Wilhelmina Hospital, P.O. Box 9015,
6500 GS Nijmegen, The Netherlands. jamengel@wxs.nl

OBJECTIVE: To study the association between birth characteristics and the
recurrence of otitis media with effusion (OME). METHODS: Prospective cohort study
on 136 children aged 2-7 years, who received tympanostomy tubes for bilateral
otitis media with effusion. Checkups were planned 1 week after tube insertion and
once every 3 months thereafter. An otologist examined the ear status to assess
tube extrusion and otitis media with effusion recurrence. Outcome measure was the
recurrence of otitis media with effusion within 6 months after documentation of
spontaneous tube extrusion. Birth characteristics were investigated in relation
with the recurrence of otitis media with effusion in 90 children with known
clinical outcome. RESULTS: No statistically significant associations were found
between various birth characteristics and the recurrence of otitis media with
effusion. Multivariate analyses showed positive but fairly weak associations
between recurrence of otitis media with effusion and low birth weight (<2500 g)
and/or low gestational age (<37 weeks) and/or a history of incubator care (odds
ratio (OR) 1.95, 95% confidence interval (CI): 0.21-18.2), male sex (OR 1.85, 95%
CI: 0.56-6.13) and maternal medication use during pregnancy (OR 4.80, 95% CI:
0.57-40.72). A remarkable finding was the asymmetrical distribution of certain
birth characteristics within the group of children with recurrence of otitis
media with effusion: children with unilateral recurrence had a relatively lower
gestational age, lower birth weight, lower 'birth length to birth weight' ratio
than the children with bilateral recurrence. CONCLUSION: These findings suggest
that determination of birth characteristics cannot help us in the treatment
strategy for recurrent otitis media with effusion in childhood.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15763293 [PubMed - indexed for MEDLINE]

1133: Int J Pediatr Otorhinolaryngol. 2005 Apr;69(4):487-91. Epub 2004 Dec 29.

Acute otitis media and season of birth.

Homøe P, Christensen RB, Bretlau P.

Department of Otolaryngology, Head and Neck Surgery, Rigshospitalet, University
Hospital of Copenhagen, Blegdamsvej 9, Copenhagen DK-2100 Ø, Denmark. phom@rh.dk

INTRODUCTION: This study examines the question whether season of birth is
associated with acute otitis media (AOM) and recurrent AOM (rAOM) and whether
season of birth is associated with early age of AOM onset. METHODS: This was done
in a population-based survey of 591 unselected Greenlandic children aged 3-5 and 
8 years, living in the two largest towns in Greenland. The overall attendance
rate was 86%. Information of AOM episodes was obtained from the parents and
cross-checked in medical records available for 95% of the children. In total, 67%
reported AOM at least once and 30% of those had rAOM. RESULTS: According to
season of birth, the frequency of history of AOM in general varied between 63%
and 70% lowest for birth in the autumn and highest for birth in the spring but
without any significant statistical difference (p=0.51). The similar variation in
rAOM according to season of birth was between 21% and 35%, highest for children
born in autumn and winter and lowest for children born in the spring (p=0.09).
Additionally, there was no difference in age at onset of the first AOM episode
according to season of birth. However, AOM children born in the summer and autumn
periods have a significantly higher relative risk (RR=1.44, CI=1.04-1.99) of
attracting rAOM than AOM children born in the winter and spring periods. This may
be due to a higher risk of being quickly reinfected in the late autumn and winter
period with another episode of upper respiratory tract infection. CONCLUSION:
Season of birth do not seem to be a predictor of AOM episodes or early onset of
AOM but children born in the summer and autumn periods who attracts AOM have a
higher risk of developing rAOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15763285 [PubMed - indexed for MEDLINE]

1134: Expert Rev Anti Infect Ther. 2005 Feb;3(1):117-29.

Otitis media with effusion: an effort to understand and clarify the
uncertainties.

Chantzi FM, Bairamis T, Papadopoulos NG, Kafetzis DA.

University of Athens, Second Department of Pediatrics, and the ENT department, P 
and A Kyriakou Children's Hospital, Athens 115 27, Greece.

Otitis media with effusion--defined as the accumulation of middle-ear effusion
behind an intact tympanic membrane without signs or symptoms of acute
infection--is one of the most common causes of hearing loss in children in
developed countries, potentially leading to language deficits. Although treatment
of chronic or relapsing otitis media with effusion is considered imperative, none
of the preventative or nonsurgical management measures currently available have
proven effective. Tympanostomy tube placement remains the recommended treatment
option for high-risk children or for cases of unresponsive otitis media with
effusion. This can be attributed to the uncertainties surrounding its
pathogenesis. Multiple factors and several possible pathogenetic models have been
proposed to explain the production and persistence of middle-ear effusion; only a
few of them are supported by sufficient evidence. In this review, the authors
will present current knowledge on the pathogenesis, consequences, diagnosis and
management of otitis media with effusion. An effort will be made to clarify those
aspects sufficiently supported by evidence-based studies, and to underline those 
that remain unfounded.

Publication Types: 
    Review

PMID: 15757462 [PubMed - indexed for MEDLINE]

1135: Ann Otol Rhinol Laryngol. 2005 Feb;114(2):161-6.

Fine structure histopathology of labyrinthitis ossificans in the gerbil model.

Tinling SP, Nabili V, Brodie HA.

Department of Otolaryngology, University of California, Davis, School of
Medicine, Davis, California, USA.

Labyrinthitis ossificans (LO) is the pathological deposition of new bone within
the lumen of the cochlea and labyrinth. This process occurs most commonly as a
result of infection or inflammation affecting the otic capsule. Trauma and
vascular compromise can also lead to neo-ossification within the otic capsule.
The mechanism that regulates this process remains unestablished. This study
details the end-stage histopathology in high-resolution plastic thin sections.
Twenty Mongolian gerbils were infected by intrathecal injection of Streptococcus 
pneumoniae type 3 followed by subcutaneous penicillin G procaine (8 days) and
were painlessly sacrificed 3 months later. The cochleas were serially divided and
sectioned for light and electron microscopy. Sixteen of 20 animals (27 of 40
cochleas) demonstrated LO. Cochlear damage was most extensive in the vestibule
and basal turn and decreased toward the apex, which often appeared normal. The
histopathologic findings consisted of 1) new bone, calcospherites, osteoid, and
fibrosis without dense connective tissue or osteoblasts extending from the
endosteal wall into the lumen of the vestibule and scala tympani; 2) areas of
dense connective tissue and osteoid enclosed by epithelial cells conjoined with
the organ of Corti, stria vascularis, spiral ligament, and vestibular
(Reissner's) membrane; and 3) partial to complete loss of the organ of Corti,
spiral ligament cell bodies, stria vascularis, and spiral ganglion cells.
Osteoblastic activity was not demonstrated in end-stage ossification in LO in the
gerbil model. Neo-ossification appears to occur by calcospherite deposition along
collagen-like fibrils within osteoid. The destruction of the organ of Corti,
spiral ganglion cells, stria vascularis, and cells of Reissner's membrane and the
spiral ligament occurs even in the absence of ossification of the cochlear duct.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15757198 [PubMed - indexed for MEDLINE]

1136: Ann Otol Rhinol Laryngol. 2005 Feb;114(2):147-52.

Comment in:
    Ann Otol Rhinol Laryngol. 2005 Nov;114(11):895; author reply 896.

Complications of mastoiditis in children at the onset of a new millennium.

Oestreicher-Kedem Y, Raveh E, Kornreich L, Popovtzer A, Buller N, Nageris B.

Department of Otolaryngology, Schneider Children's Medical Center of Israel,
Petah Tiqva.

The aim of the present study was to review our recent experience in the diagnosis
and treatment of acute mastoiditis and its complications in a single
tertiary-care, university-affiliated pediatric center. Ninety-eight children with
101 episodes of acute mastoiditis were included in the study. The mean interval
from onset of illness to mastoiditis was 4.5 days. Ear cultures most often grew
Streptococcus pneumoniae and Pseudomonas aeruginosa (23.7% each). Complications
occurred in 15.8% of episodes. The only factor differentiating children with and 
without complications was white blood cell count. These findings indicate that
acute mastoiditis not only is a complication of prolonged infection of the middle
ear, but may also present as an acute infection of the mastoid bone that can
progress within 48 hours. The complication rate remains high, and antibiotic
treatment at the onset of symptoms does not prevent complications. A high white
blood cell count on admission may serve as a predictive factor of complicated
cases.

PMID: 15757196 [PubMed - indexed for MEDLINE]

1137: Eur J Epidemiol. 2005;20(1):23-8.

Bayes' theorem: a negative example of a RCT on grommets in children with glue
ear.

Rovers MM, van der Wilt GJ, van der Bij S, Straatman H, Ingels K, Zielhuis GA.

Julius Centre for Health Sciences and Primary Care, University Medical Centre,
Utrecht, The Netherlands. mrovers@umcutrecht.nl

Bayesian inference presupposes that practitioners' belief in the effectiveness of
medical intervention is the product of prior belief and recent evidence from
studies. Although increasingly used, up to now the posterior belief calculated
according to the theorem has not been compared with an empirically measured
posterior belief. We conducted a RCT, which was preceded by elicitation of prior 
beliefs among ENT-surgeons, and which was followed by elicitation of posterior
beliefs among ENT-surgeons, 1 year after completion of the trial. We compared the
posterior beliefs of ENT-surgeons about the effect of grommets in children with
glue ears, as predicted by Bayes' theorem with actual measured posterior beliefs.
The distribution of the measured posterior beliefs was not in line with the
calculated posterior, but almost identical to the distribution of the measured
prior beliefs. The results showed that our trial had little or no impact on the
beliefs of the ENT-surgeons, i.e. they did not adjust their belief to the extent 
that was expected according to Bayes' theorem.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial

PMID: 15756901 [PubMed - indexed for MEDLINE]

1138: Eur Arch Otorhinolaryngol. 2005 Oct;262(10):852-5. Epub 2005 Mar 9.

Cochlear implantation and management of chronic suppurative otitis media: single 
stage procedure?

Basavaraj S, Shanks M, Sivaji N, Allen AA.

Crosshouse Hospital, Scottish Cochlear Implant Centre, Kilmarnock, Scotland, UK. 
sbbki@yahoo.com

In a series of 360 patients who underwent cochlear implantation at our center,
four patients (five procedures) had cochlear implantation with obliteration of
the mastoid cavity and management of cholesteatoma as a single-staged procedure. 
Three patients were bilaterally deaf secondary to CSOM and had bilateral mastoid 
cavities, and in one patient congenital cholesteatoma was identified during
cochlear implantation. A mastoidectomy or revision mastoidectomy with
obliteration of the mastoid cavity and cochlear implantation was performed as a
single stage procedure. Cholesteatoma reoccurred in one patient 9 years after
cochlear implantation. Surgical procedures, complications, follow-up and outcomes
are discussed.

Publication Types: 
    Case Reports

PMID: 15756568 [PubMed - indexed for MEDLINE]

1139: Vaccine. 2005 Mar 18;23(17-18):2304-10.

Bacterial otitis media: a vaccine preventable disease?

Cripps AW, Otczyk DC, Kyd JM.

School of Medicine, Griffith University, Gold Coast Campus, PMB 50, Gold Coast
MC, Qld 9726, Australia. allan.cripps@griffith.edu.au

Otitis media (OM) is the most common childhood illness for which medical advice
is sought. Whilst the disease rarely results in death, there is a significant
level of morbidity and economic burden on the community. Although the causes of
OM are multifactoral, bacterial and viral infections are the single most
important cause. Bacteria responsible for infections of the middle ear are
predominantly, nontypeable Haemophilus influenzae, Streptococcus pneumoniae and
Moraxella catarrhalis. Antibiotics have been widely used to treat children who
present to a medical clinic with OM. However, given the high prevalence of this
disease and the increasing incidence of microbial resistance to antibiotics,
there is a need to develop alternative therapeutic strategies such as
vaccination. Pneumococcal polysaccharide vaccination has produced disappointing
results for effectiveness in preventing OM and there is evidence of an increased 
incidence of disease due to non-vaccine serotypes. An efficacious vaccine for
bacterial OM would require combining protective protein antigens from all three
causative bacteria. A combined bacterial-viral vaccine formulation would produce 
the most profound and sustained impact on reducing the global incidence of OM.

Publication Types: 
    Review

PMID: 15755616 [PubMed - indexed for MEDLINE]

1140: Clin Otolaryngol. 2005 Feb;30(1):29-34.

A blinded in-vitro study to compare the efficacy of five topical ear drops in
clearing grommets blocked with thick middle ear effusion fluid.

Uppal S, Sharma R, Nadig SK, Back G, England RJ, Coatesworth AP.

Department of Otolaryngology, Head and Neck Surgery, York Hospital, York, UK.
uppalsandeep@yahoo.com

OBJECTIVE: To compare the efficacy of 5% NaHCO3, 3% H2O2, Sofradex (dexamethasone
sodium metasulphobenzoate 0.05%, framycetin sulphate 0.5%, gramicidin 0.005%),
0.33% acetic acid and 0.9% NaCl eardrops in clearing grommets blocked with
harvested thick middle ear effusion fluid. STUDY DESIGN: A blinded in-vitro
study. SETTING: District general hospital. PARTICIPANTS: A total of 473 grommets 
were blocked with freshly harvested unpooled thick middle ear effusion fluid
obtained from 68 patients. MAIN OUTCOME MEASURES: Patency of the grommets before 
and 7 days after intervention was ascertained by tympanometry and close visual
inspection. Results: Instillation of eardrops leads to a statistically
significant increase in the clearance of grommets as compared with not using any 
drops (chi2 = 14.3, d.f. = 5, P = 0.006). The numbers needed to treat were 2.8
for NaHCO3, 3.2 for 0.9% NaCl, 3.9 for 0.33% acetic Acid, 4.4 for Sofradex and
9.5 for H2O2 eardrops. Pair-wise comparison was only significant for comparison
between 5% NaHCO3 and 3% H2O2 eardrops (Bonferroni corrected P = 0.01, odds ratio
= 4.3, CI = 1.9-9.9). CONCLUSIONS: Use of eardrops leads to a clinically and
statistically significant increase in the clearance of blocked grommets. Of the
five drops used, 5% NaHCO3 was the most efficacious and 3% H2O2 the least
efficacious. Limitations of this in-vitro study are recognized and a prospective 
in-vivo double blind randomized controlled trial is planned.

Publication Types: 
    In Vitro

PMID: 15748186 [PubMed - indexed for MEDLINE]

1141: Cleft Palate Craniofac J. 2005 Mar;42(2):197-201.

Morphology of the auditory tube and palatal muscles in a case of bilateral cleft 
palate.

Arnold WH, Nohadani N, Koch KH.

Department of Anatomy, Faculty of Dental Medicine, University of Witten/Herdecke,
Witten, Germany. wolfa@uni-wh.de

OBJECTIVE: There is an increased incidence of otitis media in children with cleft
palate, which may be related to the pathology of the auditory tube and palatal
muscles. In the present study, the head of a human on term born fetus with
bilateral palatal cleft was serially sectioned and the anatomy of the auditory
tube and palatal muscles were studied by computer-aided three-dimensional
reconstruction. RESULTS: The results showed a nearly horizontal course of the
auditory tube. The tensor veli palatini muscle had a bony attachment on either
side. The levator veli palatini muscle also showed an abnormal course.
CONCLUSIONS: This abnormal course may result in obstruction of the auditory tube 
during contraction. These pathological findings may explain the higher frequency 
of otitis media in children with cleft palate.

PMID: 15748112 [PubMed - indexed for MEDLINE]

1142: Otolaryngol Head Neck Surg. 2005 Mar;132(3):495-9.

Reading performance in children with otitis media.

Golz A, Netzer A, Westerman ST, Westerman LM, Gilbert DA, Joachims HZ, Goldenberg
D.

Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center and
Bruce Rappaport Faculty of Medicine-The Technion, Haifa, Israel.
golz@netvision.net.il

OBJECTIVE: To examine whether middle ear diseases and the associated hearing loss
in early childhood affect reading performance later at school. STUDY DESIGN AND
SETTING: One hundred and sixty children, 6.5 to 8 years of age, were enrolled in 
this study: 80 children with a history of recurrent infections and/or prolonged
periods of effusions of the middle ear before the age of 5 years, and 80 healthy 
children without any history of middle ear disease. Data were collected from the 
medical records of the children. Every child underwent a complete otological and 
audiological evaluation, followed by special reading tests. RESULTS: The study
group performed more poorly, in all reading tests, as compared to the controls ( 
P < 0.001). CONCLUSION: Children with recurrent or prolonged middle ear diseases 
during the first five years of life tend to be at greater risk for delayed
reading than aged-matched controls with no previous middle ear diseases.

PMID: 15746869 [PubMed - indexed for MEDLINE]

1143: Yonsei Med J. 2005 Feb 28;46(1):161-5.

A case of tympanogenic labyrinthitis complicated by acute otitis media.

Jang CH, Park SY, Wang PC.

Department of Otolaryngology, Chonnam National University Hospital, 8 Hak- dong, 
Dong-gu, Gwangju, Chonbuk 570-711, Korea. chulsavio@hanmail.net

Widespread use of antimicrobial drugs in the management of otitis media has
significantly reduced the incidence of labyrinthitis nowadays. Cases of
tympanogenic labyrinthitis following acute otitis media have rarely been reported
in recent literature on otolaryngology. We report an unusual case of tympanogenic
labyrinthitis that presented with sudden sensorineural hearing loss (SNHL)
following acute otitis media in an adult who had no previous otological
complaints. An audiogram revealed SNHL with pure tone threshold of 43.7 dB in the
left ear. MRI was helpful to identify the inflammatory change of the membranous
labyrinth. The patient's hearing returned to normal after treatment. The definite
diagnosis of serous labyrinthitis was established retrospectively.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 15744821 [PubMed - indexed for MEDLINE]

1144: Pediatr Emerg Care. 2005 Mar;21(3):170-2.

Reaction toward a new treatment paradigm for acute otitis media.

Fischer TF, Singer AJ, Gulla J, Garra G, Rosenfeld R.

Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, USA.
tomfxf@aol.com

OBJECTIVE: Recent evidence suggests that oral antibiotics may not be required in 
all children with acute otitis media (AOM). We determined whether parents and
pediatricians were aware of and comfortable with a policy of selective use of
antibiotics for AOM. METHODS: DESIGN: Descriptive survey. SETTINGS: Suburban
academic emergency department, urgent care center, and private pediatric
practices. PARTICIPANTS: Parents of children presenting to an emergency
department and urgent care center and pediatricians in faculty and private
practice. INTERVENTIONS AND OUTCOMES: Parents were asked whether they were aware 
of any side effects associated with antibiotic use or of research that supports
selective use of antibiotics for AOM. Physicians were queried regarding the
methods used to diagnose AOM and their patterns of prescribing antibiotics for
AOM. Parents and physicians were questioned regarding their comfort with
withholding antibiotics for AOM using a 6-point Likert scale ranging from very
uncomfortable to very comfortable. RESULTS: Six hundred fifty-four parents and 84
physicians were surveyed. Sixty-one percent of parents were unaware of the
potential side effects of antibiotics, and 72% were unaware of research
supporting selective use of antibiotics. Fifty-three percent of parents and 73%
of physicians were somewhat comfortable to very comfortable with an observation
option for AOM. Half of all pediatricians stated that they always prescribe
antibiotic for AOM. CONCLUSIONS: Although most parents are unaware of selective
use of antibiotics and half of all surveyed pediatricians stated that they always
prescribed antibiotics for AOM, many parents and pediatricians felt comfortable
with selective use of antibiotics.

PMID: 15744195 [PubMed - indexed for MEDLINE]

1145: Am J Otolaryngol. 2005 Mar-Apr;26(2):123-7.

Preventive therapy for postoperative purulent otorrhea after ventilation tube
insertion.

Kocaturk S, Yardimci S, Yildirim A, Incesulu A.

Otolaryngology Head and Neck Surgery Department, Medical Faculty, Cumhuriyet
University, Sivas, Turkey.

OBJECTIVE: Treatment modalities which are intraoperative irrigation of the middle
ear with isotonic saline, postoperative oral antibiotic treatment, and
postoperative topical antibiotic use have been compared with each other and with 
control group regarding their efficiency in preventing postoperative purulent
otorrhea after ventilation tube insertion. Moreover, the costs of the treatment
modalities were analyzed. STUDY DESIGN: Each group consisted of 70 patients, and 
a total of 280 patients were followed up for purulent otorrhea 2 weeks after the 
surgery. The study was a single-blind randomized clinical trial. RESULTS: Ten
(14.28%) patients in the oral antibiotic group, 11 (15.71%) patients in the
isotonic saline irrigation group, 6 (8.57%) patients in the topical antibiotic
drops group, and 21 (30%) patients in the control group had postoperative
purulent otorrhea. Statistical analysis determined a significant difference
between each treatment modalities and control group but did not show any
significant difference between the treatment groups. When the treatment options
were compared according to their cost, however, the cost per successfully treated
patient was significantly lower in the saline irrigation group. CONCLUSION:
Intraoperative saline irrigation of the middle ear provides an effective, easy,
and cheap treatment in preventing postoperative purulent otorrhea.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 15742266 [PubMed - indexed for MEDLINE]

1146: Am J Otolaryngol. 2005 Mar-Apr;26(2):118-22.

The relationship between the protective effect of amifostine and decreased
intercellular adhesion molecule 1 expression.

Wang SZ, Chen ZC, McNamar JP, Wang SY, Cheng QF.

Department of Radiotherapy and Oncology Eye, Ear, Nose and Throat Hospital of
Fudan University, Shanghai, P.R. China. shengziwang@fudan.edu.cn

PURPOSE: The objective of our study was to characterize the relationship between 
the protective effect of amifostine and decreased intercellular adhesion molecule
1 (ICAM-1) expression in early-phase, radiation-induced otitis media and to
illustrate the possible mechanism of early-phase radiation-induced otitis media. 
MATERIALS AND METHODS: A comparison study of middle ear tissue was performed by
the expression of ICAM-1 and the electron microscope from total 38 guinea pigs.
Group A, consisting of 2 pigs, was used as control, and these pigs were not
irradiated. Groups B, C, D, and E, consisting of 9 pigs each, were irradiated.
Sterile saline was administered intraperitoneally to the pigs in groups B and D
before irradiation, and amifostine was administered intraperitoneally as an
aqueous solution 30 minutes before irradiation to the pigs in groups C and E. The
pigs in groups B and C were killed on the second day after irradiation, and the
pigs in groups D and E were killed 30 days after irradiation. RESULTS:
Intercellular adhesion molecule 1 was strongly expressed in the middle ear mucosa
of the irradiated pigs after a 45-Gy dose of radiation was administered. Enhanced
ICAM-1 expression was accompanied by pathomorphologic changes in the middle ear
tissue. Scanning electron microscopy demonstrated the changes. Intercellular
adhesion molecule 1 expression in the mucosa of the groups killed on the second
day was stronger than that in the mucosa of the groups killed 30 days after
irradiation. Amifostine protected the middle ear from radiation injury, and we
found that the expression of ICAM-1 in the middle ear mucosa was down-regulated. 
However, slight expression of ICAM-1 remained 30 days after irradiation.
CONCLUSIONS: Irradiation increased the expression of ICAM-1 in the middle ear
mucosa. Amifostine protected the middle ear from early irradiation injury. There 
was a relationship between oxygen free radicals derived from irradiation and
up-regulation of ICAM-1 expression. Continuous ICAM-1 expression might be related
to stenosis of the eustachian tube.

PMID: 15742265 [PubMed - indexed for MEDLINE]

1147: J Clin Immunol. 2005 Jan;25(1):78-86.

Immunological status in the aetiology of recurrent otitis media with effusion:
serum immunoglobulin levels, functional mannose-binding lectin and Fc receptor
polymorphisms for IgG.

Straetemans M, Wiertsema SP, Sanders EA, Rijkers GT, Graamans K, van der Baan B, 
Zielhuis GA.

Department of Epidemiology and Biostatistics, University Medical Centre Nijmegen,
Nijmegen, The Netherlands.

The objective was to study the role of serum immunoglobulin levels,
mannose-binding lectin (MBL), and Fc gamma receptor (FcgammaR) polymorphisms on
the development of recurrent otitis media with effusion (OME). Children aged
between two and seven years with persisting OME received bilateral tympanostomy
tubes and immunological parameters were investigated in relation with OME
recurrence within six months after tube extrusion. No statistically significant
differences in serum immunoglobulin levels were present between children with and
without OME recurrence. In children with bilateral recurrence (n = 56), median
levels of MBL were 1.39 mg/L compared to 2.48 mg/L in children with OME
recurrence (n = 17) (p = 0.29). In addition, 34% of the children with bilateral
recurrence were homozygous for the genotype FcgammaRIIa-R/R131, whereas less than
20% of the children with unilateral recurrence or those without recurrence were
homozygous for this Fcgamma receptor (p = 0.26). Serum mannose-binding lectin and
FcgammaRIIa-R/R131 polymorphism may play a role in the aetio-pathogenesis of
recurrent OME.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15742161 [PubMed - indexed for MEDLINE]

1148: Int J Circumpolar Health. 2004;63 Suppl 2:312-4.

Otitis media and hearing loss among 12-16-year-old Inuit of Inukjuak, Quebec,
Canada.

Ayukawa H, Bruneau S, Proulx JF, Macarthur J, Baxter J.

Hearing and Otitis Program, Tulattavik Health Centre, Kuujjuaq, Quebec.
hannah.ayukawa@muhc.mcgill.ca

OBJECTIVES: Chronic otitis media (COM) and associated hearing loss is a frequent 
problem for many Inuit children in Canada. In this study, we evaluated
individuals aged 12-16 years living in Inukjuak, to determine the prevalence of
middle ear disease and hearing loss, and the effect of hearing loss on academic
performance. METHODS: Otological examination, hearing test, medical and school
file review were performed in November 1997. 88 individuals were seen. RESULTS:
Otological examination revealed maximal scarring in 1.8%, minimal scarring in
34.9%, normal eardrums in 49.1% and chronic otitis media in 16.9%. There were 62 
individuals whose ear exams could be directly compared with a previous exam done 
in 1987. Of those, there were three ears that had developed COM and 4/13 ears
with COM in 1987 that had healed. Hearing tests found bilateral normal hearing in
80% (PTA <20dB), unilateral loss in 15% and bilateral loss in 5%. Hearing loss
was associated with poorer academic performance in Language (p<.05). A similar
trend was found in Mathematics but not in Inuttitut. CONCLUSION: Chronic otitis
media remains a significant problem among the Inuit, with a prevalence of 16.9%
in individuals aged 12-16 years. One in five in this age group has hearing loss, 
and this hearing loss impacts on academic performance.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15736675 [PubMed - indexed for MEDLINE]

1149: Int J Pediatr Otorhinolaryngol. 2005 Mar;69(3):393-7. Epub 2004 Dec 30.

Failed newborn hearing screens as presentation for otitis media with effusion in 
the newborn population.

Boone RT, Bower CM, Martin PF.

Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for
Medical Sciences, 4301 West Markham, MS 543, Little Rock, AR 72205-7199, USA.

OBJECTIVES: Evaluate the prevalence of middle ear disease in infants failing a
newborn hearing screening program. Review the outcomes of those infants diagnosed
with or without middle ear disease after failed hearing screen. DESIGN:
Retrospective chart review of 76 patients referred to a tertiary care institution
for evaluation of a failed newborn hearing screening test. SETTING: Arkansas
Children's Hospital, Little Rock, Arkansas. RESULTS: Seventy-six patients were
referred for failed OAEs and complete otolaryngology evaluation. Mean age at the 
time of referral was 3 months (0.25 years) old. OME was identified in 64.5% of
the patients. ABR confirmed a suspected hearing loss in 15 patients (78.9%)
without middle ear disease. Effusion resolved without surgical intervention in
65.3% of infants, while 17 (34.7%) of the infants required tubes. SNHL was
subsequently identified in 11% of infants after resolution of the effusion.
CONCLUSIONS: OME is a common cause of failed infant hearing screens, and should
be looked for prior to definitive diagnostic hearing testing. OME resolves in the
majority of infants, but tube insertion is necessary to allow for diagnostic
testing in nearly one third of infants. The majority of infants without OME had
SNHL confirmed. SNHL was also identified in 11% of infants with OME after
resolution of the effusion.

PMID: 15733600 [PubMed - indexed for MEDLINE]

1150: Int J Pediatr Otorhinolaryngol. 2005 Mar;69(3):361-6. Epub 2004 Dec 21.

Comparison of performance by otolaryngologists, pediatricians, and general
practioners on an otoendoscopic diagnostic video examination.

Pichichero ME, Poole MD.

Elmwood Pediatric Group, University of Rochester Medical Center, 601 Elmwood
Avenue, Box 672, Rochester, NY 14642, USA. michael_pichichero@urmc.rochester.edu

OBJECTIVE: To compare the performance of United States, South African, and Greek 
otolaryngologists, pediatricians, and general practitioners in recognizing the
otoscopic examination findings of acute otitis media (AOM) and otitis media with 
effusion (OME) as presented in an otoendoscopic video evaluation test.
DESIGN/SUBJECTS: Otolaryngologists, pediatricians, and general practitioners from
the United States (n = 273, 2190, and 360 respectively), South Africa (n = 36,
36, and 206), and Greece (n = 58, 115, and 126) viewed nine different
video-recorded otoscopic examinations, including pneumatic otoscopy of tympanic
membranes. The ability to differentiate AOM, OME, and normal was ascertained.
RESULTS: Overall, the average +/- standard deviation correct diagnosis on the
otoscopic video exam by otolaryngologists was superior to pediatricians and
general practitioners in all three countries: from the United States, it was 74
+/- 16% for otolaryngologists versus 51 +/- 11% for pediatricians (p < 0.000l)
and 46+/-21% for general practitioners (p < 0.0001); from South Africa, it was 72
+/- 16% versus 53 +/- 21% (p = 0.16) and 47 +/- 19% (p = 0.002); and from Greece,
it was 61 +/- 15% versus 36 +/- 12% (p < 0.003) and 39 +/- 10% (p = 0.009).
CONCLUSIONS: A video-based otoscopy examination test may be a useful tool for
evaluation of otoscopy-based diagnostic skills. Otolaryngologists performed
significantly better than pediatricians in differentiating AOM, OME, and normal
in such a test described here. However, all specialists who examine patients with
AOM or OME may benefit from viewing video otoscopies to improve diagnostic
accuracy.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15733595 [PubMed - indexed for MEDLINE]

1151: Int J Pediatr Otorhinolaryngol. 2005 Mar;69(3):295-9. Epub 2004 Nov 24.

Current challenges in diagnosis of acute otitis media.

Blomgren K, Pitkäranta A.

Department of Otorhinolaryngology, Helsinki University Hospital, P.O. Box 220,
Fi-00029 Helsinki, Finland. karin.blomgren@fimnet.fi

Diagnosis of acute otitis media is difficult: circumstances and equipment for
diagnosis are often compromised, the child may be uncooperative, signs and
symptoms of acute otitis media and those of the common cold are mostly the same, 
and parents appear to have strong opinions concerning correct diagnosis and
treatment. Many clinicians have received inadequate pre- and postgraduate
education about diagnosis. On the other hand, they are aware of the worldwide
problem of antimicrobial resistance resulting from antibiotics unwisely
prescribed for viral infections. We performed a systematic search to summarize
what is known about diagnosis of acute otitis media and suggest ways to improve
one's diagnostic skills. With the combination of appropriate and well-maintained 
diagnostic equipment for tympanometry and pneumatic otoscopy, strict diagnostic
criteria, and open communication with each child's parents it is possible to
increase accuracy in acute otitis media diagnosis. Recent public health campaigns
both among clinicians and parents, plus increased knowledge of diagnostics reveal
the possibility of significantly decreasing the number of acute otitis media
diagnoses in children which will lead to reduced prescription of antibiotics.

Publication Types: 
    Review

PMID: 15733586 [PubMed - indexed for MEDLINE]

1152: J Immunol. 2005 Mar 1;174(5):3006-14.

Identification of a peptide derived from vaccinia virus A52R protein that
inhibits cytokine secretion in response to TLR-dependent signaling and reduces in
vivo bacterial-induced inflammation.

McCoy SL, Kurtz SE, Macarthur CJ, Trune DR, Hefeneider SH.

National Center for Rehabilitative Auditory Research and Department of
Immunology, Veterans Affairs Medical Center, Portland, OR 97239, USA.

TLRs recognize and respond to conserved motifs termed pathogen-associated
molecular patterns. TLRs are characterized by an extracellular leucine-rich
repeat motif and an intracellular Toll/IL-1R domain. Triggering of TLRs by
pathogen-associated molecular patterns initiates a series of intracellular
signaling events resulting in an inflammatory immune response designed to contain
and eliminate the pathogen. Vaccinia virus encodes immunoregulatory proteins,
such as A52R, that can effectively inhibit intracellular Toll/IL-1R signaling,
resulting in a diminished host immune response and enhancing viral survival. In
this study, we report the identification and characterization of a peptide
derived from the A52R protein (sequence DIVKLTVYDCI) that, when linked to the
nine-arginine cell transduction sequence, effectively inhibits cytokine secretion
in response to TLR activation. The peptide had no effect on cytokine secretion
resulting from cell activation that was initiated independent of TLR stimulation.
Using a mouse model of otitis media with effusion, administration of
heat-inactivated Streptococcus pneumoniae into the middle ears of BALB/c mice
resulted in a significant inflammatory response that was dramatically reduced
with peptide treatment. The identification of this peptide that selectively
targets TLR-dependent signaling may have application in the treatment of chronic 
inflammation initiated by bacterial or viral infections.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 15728514 [PubMed - indexed for MEDLINE]

1153: Arch Otolaryngol Head Neck Surg. 2005 Feb;131(2):118-23.

Eustachian tube function before recurrence of otitis media with effusion.

Straetemans M, van Heerbeek N, Schilder AG, Feuth T, Rijkers GT, Zielhuis GA.

Department of Epidemiology, University Medical Centre Nijmegen, 6500 HB Nijmegen,
the Netherlands.

OBJECTIVE: To study the role of eustachian tube function in the development of
recurrent otitis media with effusion (OME) in children treated with tympanostomy 
tubes for OME. DESIGN: Prospective cohort study. SETTING: Three academic and
general hospitals. PATIENTS: Children aged 2 to 7 years with a first clinical
episode of OME that persisted for at least 3 months; 136 (81%) of 168 eligible
children participated. All children received tympanostomy tubes for bilateral OME
at study entry. MAIN OUTCOME MEASURE: Recurrence of OME within 6 months of tube
extrusion. RESULTS: No statistically significant differences were present in
eustachian tube function test results between ears that developed recurrent OME
and those that did not. The difference in passive ventilatory function between
ears with and without OME recurrence was 10 daPa (95% confidence interval, -24 to
43 daPa) for opening pressure and -3 daPa (95% confidence interval, -18 to 11
daPa) for closing pressure. The overall difference in the proportion of ears with
and without OME recurrence that could not equilibrate positive and negative
applied pressures was 12% (95% confidence interval, -2% to 26%). The proportions 
of ears with and without OME recurrence that induced negative pressure in the
middle ear by forcefully sniffing were 22% and 31%, respectively (P = .75).
CONCLUSION: Measurement of ventilatory and protective eustachian tube function
using the forced response test, the pressure equilibration test, and the sniff
test has no value in predicting whether children have an increased risk of OME
recurrence.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 15723942 [PubMed - indexed for MEDLINE]

1154: Neurol Med Chir (Tokyo). 2005 Feb;45(2):82-5, discussion 86.

Combined approach for otogenic brain abscess.

Ozkaya S, Bezircioglu H, Sucu HK, Ozdemir I.

Neurosurgery Department, Izmir Atatürk Training and Research Hospital, 35361
Izmir, Turkey.

Otogenic intracranial infections usually require both neurosurgical and
otolaryngological surgery. This prospective, non-randomized study investigated
the value of combining both surgical procedures. Thirteen patients with otogenic 
intracranial abscess were treated by mastoidectomy and abscess removal through
the same incision between 1993 and 2002. Another 12 patients underwent abscess
removal or mastoidectomy followed by the other procedure within 7 days. The
clinical features of the patients were compared. Four patients died in our
series. All four patients had Glasgow Coma Scale (GCS) scores of 7 or less. The
preoperative GCS score was the main factor in mortality. One patient had
recurrence after the combined approach compared to nine patients with recurrence 
after separate procedures. The surgical procedure was the main factor affecting
the recurrence rate. The combined approach and total capsule excision of the
abscess may reduce the risk of recurrence of otogenic intracranial abscess.

Publication Types: 
    Clinical Trial

PMID: 15722605 [PubMed - indexed for MEDLINE]

1155: Physiol Meas. 2004 Dec;25(6):1473-83.

Diffuse reflectance spectroscopy of the human tympanic membrane in otitis media.

Sundberg M, Peebo M, Oberg PA, Lundquist PG, Strömberg T.

Department of Biomedical Engineering, Linköpings Universitet, SE-581 85
Linköping, Sweden. miksu@imt.liu.se

We have investigated if features in the diffuse reflectance spectra from in vivo 
spectroscopic measurements of the tympanic membrane could aid the diagnosis of
otitis media in children. Diffuse reflectance spectroscopy, in the visible
wavelength range, was used in 15 ears from children with otitis media with
effusion before and after myringotomy and in 15 healthy ears as a reference. Two 
previously published erythema detection algorithms yielded numerical quantities
of haemoglobin content. With a combination of the algorithms, induced erythema
(after myringotomy) was distinguished from healthy ears using Student's t-test (p
< 0.01). Otitis media with mucous effusion was distinguished from (1) otitis
media with serous effusion, (2) induced erythema and (3) healthy ears, (p < 0.05)
using Student's t-test for independent groups and the paired t-test for dependent
groups. Our results imply that reflectance spectroscopy is a promising technique 
to be used for the diagnosis of otitis media.

Publication Types: 
    Clinical Trial
    Controlled Clinical Trial
    Research Support, Non-U.S. Gov't
    Validation Studies

PMID: 15712725 [PubMed - indexed for MEDLINE]

1156: Rev Laryngol Otol Rhinol (Bord). 2004;125(4):203-9.

Mucus physiopathology, update and new therapeutic tendencies.

Sanabria J, Márquez F, Gutiérrez R, Cenjor C.

Fundación Jiménez Díaz, Ear, Nose and Throat Department, Avda. Reyes Católicos 2,
28040 Madrid, Spain. Jsanabria@fjd.es

The knowledge of mucous secretions has advanced considerably with respect to
their altered physiological properties in various ear, nose and throat disorders.
We review the physicochemical properties of normal mucus and abnormal mucus
present in the airways during sinusitis, otitis media with effusion, etc. We have
adapted the mucoactive drugs classification to the up-to-date european situation,
presenting a bibliographic review. We have attempted to reconcile the agreed
findings in the literature with the most recent advances in research that have
resulted in new therapeutic strategies for the treatment of pathological
hypersecretion in the airways.

Publication Types: 
    Review

PMID: 15712689 [PubMed - indexed for MEDLINE]

1157: FEMS Immunol Med Microbiol. 2005 Mar 1;43(3):385-92.

Induction of CD69 expression and Th1 cytokines release from human peripheral
blood lymphocytes after in vitro stimulation with Alloiococcus otitidis and three
middle ear pathogens.

Harimaya A, Himi T, Fujii N, Tarkkanen J, Carlson P, Ylikoski J, Mattila P.

Department of Otolaryngology, Sapporo Medical University School of Medicine, S-1,
W-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan. harimaya@sapmed.ac.jp

Alloiococcus otitidis is a recently discovered pathogen of otitis media. However,
only a limited number of studies are available about the pathogenic and
immunological role of A. otitidis. The aim of this study was to investigate the
activation and the cytokine production of human peripheral blood lymphocytes at
the early immune response after stimulation with A. otitidis. After stimulation
of whole human peripheral blood lymphocytes for 18 h with whole killed A.
otitidis or the three major middle ear pathogens (Streptococcus pneumoniae,
Haemophilus influenzae and Moraxella catarrhalis), the expression of CD69 and the
production of cytokines were analyzed. The expression of CD69 on T cells and B
cells was dose-dependently enhanced after stimulation with A. otitidis. The
release of interleukin (IL)-12 was induced after stimulation with A. otitidis,
whereas the release of IL-4 was not induced after stimulation with A. otitidis.
In addition, the release of interferon (IFN)-gamma was induced after stimulation 
with A. otitidis. Although the release of IFN-gamma started within 18 h after
stimulation with A. otitidis, intracellular production of IFN-gamma was not
observed in either CD4+ T cells or CD8+ T cells within 18 h upon stimulation. The
patterns of CD69 expression and T helper-type 1 (Th1)-promoting cytokines
production were similarly shown when human peripheral blood lymphocytes were
stimulated with the other three major pathogens. Our results suggest that A.
otitidis has sufficient immunogenic potential to modulate a host immune response,
like the other three major middle ear pathogens, and also suggest that the
immunogenicity of A. otitidis is very similar, at the early immune response, to
that of the three major middle ear pathogens.

Publication Types: 
    In Vitro

PMID: 15708312 [PubMed - indexed for MEDLINE]

1158: Folia Microbiol (Praha). 2004;49(5):601-4.

Otomycoses of candidal origin in eastern Slovakia.

Dorko E, Jenca A, Orencák M, Virágová S, Pilipcinec E.

Department of Epidemiology, Faculty of Medicine, Safárik University, 041 80
Kosice, Slovakia. erikdorco@pobox.sk

Mycological analysis of swabs and scraping samples from the external ear canals
of 40 patients with clinically diagnosed otomycosis (10 neonates, 30 adults)
revealed the presence of fungi as etiological agents. They were investigated
microscopically using 20 % potassium hydroxide, and by cultivation on Sabouraud's
glucose agar. The Candida species were identified using the germ-tube test,
micromorphology observations of colonies on rice agar, and particularly by the
commercial kit AUXAcolor. The following Candida species were identified in the
aural material examined: C. albicans (n = 21; 52.5 %), C. parapsilosis (11;
27.5), C. tropicalis (3; 7.5), C. krusei (3; 7.5), C. guilliermondii (2; 5.0).
The above yeasts were present in samples together with Staphylococcus epidermidis
(31), S. aureus (16), alpha-hemolytic streptococci (14), Neisseria spp. (14),
Proteus mirabilis (3), Pseudomonas aeruginosa (3), Escherichia coli (1) and
Haemophilus influenzae (1). The most frequent predisposing factors for otomycosis
were swimming in public pools and/or bath, spa and diabetes mellitus.

PMID: 15702553 [PubMed - indexed for MEDLINE]

1159: Pediatr Infect Dis J. 2005 Feb;24(2):153-61.

A randomized, multicenter, double blind, double dummy trial of single dose
azithromycin versus high dose amoxicillin for treatment of uncomplicated acute
otitis media.

Arguedas A, Emparanza P, Schwartz RH, Soley C, Guevara S, de Caprariis PJ,
Espinoza G.

Instituto de Atención Pediátrica, San José, Costa Rica. aarguedas@iped.net

BACKGROUND: High dose amoxicillin is recommended for the initial treatment of
children with acute otitis media (AOM), particularly patients at risk for having 
drug-resistant Streptococcus pneumoniae. Single dose azithromycin (30 mg/kg) is
considered an alternative agent for the treatment of AOM. OBJECTIVE: To compare
the clinical efficacy and safety of single dose azithromycin with that of high
dose amoxicillin among children with uncomplicated AOM. METHODS: This was a
double blind, double dummy, multinational, clinical trial in which children (6-30
months of age) with AOM were randomized to treatment with single dose
azithromycin (30 mg/kg) or high dose amoxicillin (90 mg/kg/d, in 2 divided doses)
for 10 days. Tympanocentesis was performed at baseline and clinical responses
were assessed at days 12-14 (end of therapy) and at days 25-28 (end of study).
RESULTS: The study enrolled 313 patients, and 83% of the patients were < or =2
years of age. A total of 158 patients in the azithromycin group and 154 in the
amoxicillin group were considered clinical modified intent-to-treat patients. A
middle ear pathogen was detected for 212 patients (68%). Haemophilus influenzae
was the most common pathogen (isolated for 96 patients), followed by S.
pneumoniae (92 patients), Moraxella catarrhalis (23 patients) and Streptococcus
pyogenes (23 patients). beta-Lactamase production was observed for 17% of H.
influenzae isolates and 100% of M. catarrhalis isolates. Thirty-five (38%) S.
pneumoniae isolates were penicillin-nonsusceptible and 24 (26%) isolates were
macrolide-resistant. At the end of therapy, clinical success rates for
azithromycin and amoxicillin were comparable for all patients (84 and 84%,
respectively) and for children < or =2 years of age (82 and 82%, respectively).
At the end of therapy and end of study, clinical efficacies among all
microbiologic modified intent-to-treat evaluable subjects were comparable for
patients treated with azithromycin (80%) and patients treated with amoxicillin
(83%). The rates of treatment-related adverse events for azithromycin and
amoxicillin were 20% and 29%, respectively (P = 0.064). Diarrhea was more common 
in the amoxicillin group than in the azithromycin group (17.5 and 8.2%,
respectively) (P = 0.017). Compliance, defined as completion of > or =80% of the 
study medication, was higher in the azithromycin group (100%) than in the
amoxicillin group (90%) (P = 0.001). CONCLUSIONS: In this study, single dose
azithromycin was as effective as high dose amoxicillin for the treatment of
children with AOM, whereas rates of adverse events were lower and compliance
improved with the simplified single dose regimen.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15702045 [PubMed - indexed for MEDLINE]

1160: Pediatr Infect Dis J. 2005 Feb;24(2):115-20.

Penicillin susceptibility of pneumococcal isolates causing acute otitis media in 
children: seasonal variation.

Hoberman A, Paradise JL, Greenberg DP, Wald ER, Kearney DH, Colborn DK.

Department of Pediatrics, University of Pittsburgh School of Medicine, Children's
Hospital of Pittsburgh, Pittsburgh, PA 15213, USA. hoberman@chp.edu

BACKGROUND: During the past decade, the prevalence of nonsusceptible
Streptococcus pneumoniae strains that cause acute otitis media (AOM) has
increased to approximately 30%, and the proportion of fully resistant strains has
also increased. The purpose of this study was to determine whether seasonal
variation in resistance exists among pneumococcal isolates from children with
AOM. METHODS: Between 1991 and 2003, children 2 months-8 years of age diagnosed
with AOM according to stringent criteria underwent tympanocentesis in various
clinical trials. RESULTS: Cultures from 567 of 794 tympanocenteses (71.4%)
performed between 1991 and 2003 yielded AOM pathogens. During 1991-1995, only 1
of 43 S. pneumoniae isolates recovered (2%) was nonsusceptible to penicillin. The
present analysis focuses on the 691 cultures obtained during 1996-2003; of these,
491 (71.1%) yielded AOM pathogens, of which 165 (33.6%) were S. pneumoniae. Of
the pneumococcal isolates, 52 (31.5%) were nonsusceptible to penicillin. The
proportion of nonsusceptible strains of S. pneumoniae increased over time: 0 of 3
(0%) in 1996; 2 of 11 (18%) in 1997; 14 of 40 (35%) in 1998; 3 of 34 (9%) in
1999; 11 of 25 (44%) in 2000; 11 of 22 (50%) in 2001; 4 of 18 (22%) in 2002; and 
7 of 12 (58%) in 2003 (Cochran Armitage trend test, P = 0.03). AOM caused by
nonsusceptible S. pneumoniae was more likely to occur as the winter progressed (P
= 0.03); a similar trend was noted for the proportion of nonsusceptible strains
that were fully resistant. CONCLUSIONS: In children with AOM, an increase in the 
proportion of episodes caused by nonsusceptible S. pneumoniae as the winter
months progress may serve as a potential factor in guiding antimicrobial therapy 
for such children.

PMID: 15702038 [PubMed - indexed for MEDLINE]

1161: Otol Neurotol. 2005 Jan;26(1):19-26.

Cochlear microperfusion: experimental evaluation of a potential new therapy for
severe hearing loss caused by inflammation.

Barkdull GC, Vu C, Keithley EM, Harris JP.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery,
University of California, San Diego, School of Medicine, 92103-8895, USA.

HYPOTHESIS: Cochlear microperfusion will be a useful treatment of severe
sensorineural hearing loss caused by inflammation. BACKGROUND: Viruses, bacteria,
and autoimmunity can initiate inflammation in the inner ear. The acute phase is
associated with elevations in cytokines, nitrous oxide, and cellular infiltrates 
and the breakdown of the blood-labyrinthine barrier. The chronic phase leads to
irreversible ossification of the labyrinth. METHODS: The authors developed
cochlear microperfusion to facilitate removal of inflammatory cells and their
byproducts during the acute phase of inflammation. Using a ventral approach to
the guinea pig cochlea, the authors displaced resident perilymph by delivering
perfusate into the scala vestibuli and collecting the effluent from the scala
tympani. The authors evaluated the benefit of the procedure in an animal model of
severe hearing loss caused by inflammation. RESULTS: Healthy controls undergoing 
cochlear microperfusion with phosphate-buffered saline incurred a mean hearing
loss of 16 dB (n=4). This hearing loss was associated with the creation of two
cochleostomies and not the perfusion itself. Sterile labyrinthitis (n=5)
generated by perfusion of the cochlea with antigen consistently produced severe
hearing loss over the initial 48 hours, and this hearing loss persisted for the
subsequent 7 days. Therapeutic cochlear microperfusion, performed within the
first 24 hours of developing severe hearing loss (n=9), immediately restored on
average 24 dB (p <0.007) of hearing. CONCLUSION: Cochlear microperfusion is a
promising new technique for treating severe deafness caused by inflammation. The 
benefit may be sustained when combined with local delivery of immunosuppressive
agents to the inner ear.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 15699715 [PubMed - indexed for MEDLINE]

1162: Otol Neurotol. 2005 Jan;26(1):12-8.

Diode laser myringotomy for chronic otitis media with effusion in adults.

Zanetti D, Piccioni M, Nassif N, Campovecchi C, Redaelli de Zinis LO.

Otorhinolaryngologic Department, University of Brescia, Italy.
diego_zanetti@iol.it

OBJECTIVE: To analyze the closure time of diode laser-assisted myringotomies, the
incidence of complications, and the hearing results in comparison with the "cold"
procedure in adults with otitis media with effusion (OME). STUDY DESIGN:
Prospective case-control study. SETTING: Tertiary referral center, university
hospital. PATIENTS: Twenty-eight adult patients (39 ears), 13 men and 15 women,
age 13 to 76 years (mean, 51.9). Inclusion criteria included 3 months (or more)
history of OME resistant to medical therapy. Twenty-two control patients (34
ears) underwent cold myringotomies with knife and ventilation tubes (VT).
INTERVENTION: Diode laser myringotomy performed in an office setting under local 
anesthesia with topical EMLA ointment. MAIN OUTCOME MEASURES: Timing of closure
of the myringotomy, hearing results, incidence of complications, recurrence of
OME. RESULTS: No intra- or postoperative pain nor complications were observed.
Otomicroscopic daily monitoring documented the healing patterns of the
tympanostomies, which remained patent for 7 to 25 days (average, 15.6 +/- 4.8
days). Immediate improvement of hearing was achieved in every patient. Recurrence
of OME was observed in 36 ears (92.3%) within 1 month from healing. In the
control group with VTs, healing of the eardrum was observed between 126 and 301
days (average, 183.2 +/- 44.8 days), and recurrence of OME was observed in 8 ears
(23.5%) (p < 0.001). One month after healing, the air-bone gap was retained
within 10 dB in 10.3% (4/39) of the diode laser group and in 50% (17/34) of the
standard procedure group (p=0.0001). CONCLUSIONS: Diode laser myringotomy is a
straightforward, painless procedure simplified by the thin fiberoptic cables
available. Functional benefit is comparable to conventional tympanostomies plus
VTs, but the duration of patency is too short to achieve long-term clearance of
the effusion in "glue" ears of adult patients. Selected indications could be
acute or recurrent otitis media or the prevention of barotraumas in tubal
dysfunction.

Publication Types: 
    Clinical Trial

PMID: 15699714 [PubMed - indexed for MEDLINE]

1163: Otol Neurotol. 2005 Jan;26(1):5-11.

Accuracy of tympanometric middle ear pressure determination in secretory otitis
media: dose-dependent overestimation related to the viscosity and amount of
middle ear fluid.

Gaihede M, Bramstoft M, Thomsen LT, Fogh A.

Department of Otolaryngology, Head and Neck Surgery, Aalborg Hospital, Aarhus
University Hospital, Aalborg, Denmark. mgaihede@aas.nja.dk

HYPOTHESIS: Tympanometric measurements of middle ear pressure in children with
secretory otitis media are overestimated in a dose-response manner because of
increased hysteresis explained by the viscosity and amount of middle ear fluid.
BACKGROUND: Tympanometric middle ear pressure is important in evaluating children
with secretory otitis media. These measurements are influenced by hysteresis
appearing as a peak pressure difference in bidirectional tympanometry. This
represents an inaccuracy of 0.5 x peak pressure difference, which is only 5 to 25
daPa in normal ears. However, previous experiments found increased hysteresis,
suggesting an inaccuracy of 225 daPa in secretory otitis media ears. MATERIALS
AND METHODS: In 56 patients with secretory otitis media, bidirectional
tympanometry was performed; Type B curves were excluded. The middle ear fluid was
semiquantified subsequently at surgery according to viscosity (serous,
seromucoid, or mucoid) and amount (small, medium, or large). A control group
included 28 normal children. Peak pressure difference was calculated by the
difference between middle ear pressure determined by a positive and negative
pressure sweep. RESULTS: Mean peak pressure difference was 10 and 69 daPa in the 
normal and secretory otitis media groups, respectively (p <0.001). However, peak 
pressure difference ranged to 205 daPa in the secretory otitis media group and
showed a significant positive correlation to viscosity and amount of the fluid
(both p <0.0001). CONCLUSION: Peak pressure difference is significantly increased
in secretory otitis media because of additional damping explained by the
viscosity and amount of the fluid. The mean error was 5 daPa in normal ears and
35 daPa in secretory otitis media ears, but ranged to greater than 100 daPa.
These results were only a low estimate of the inaccuracy, because patients with
Type B tympanograms could not be included, and errors of more than 100 daPa can
be anticipated.

PMID: 15699713 [PubMed - indexed for MEDLINE]

1164: Otolaryngol Head Neck Surg. 2005 Feb;132(2):327-9.

Facial palsy associated with acute otitis media.

Popovtzer A, Raveh E, Bahar G, Oestreicher-Kedem Y, Feinmesser R, Nageris BI.

Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, ENT
Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
bennyn@clalit.org.il

OBJECTIVE: Facial palsy secondary to acute otitis media is rarely encountered
today. The aim of the present study was to review the characteristics of the
disease and propose the proper management. STUDY DESIGN: File review. Setting
University-affiliated tertiary referral center. MAIN OUTCOME MEASURES: Disease
course, management and outcome were recorded. RESULTS: Sixty-five children with
facial palsy were identified, of whom 13 (20%) had acute otitis media. The otitis
media preceded the facial palsy in all cases by 1 to 21 days (average 5 days).
House-Brackmann grade ranged from 2 to 5 (average 3.5). The recovery period was
varied and unpredictable, ranging in duration from 1 to 180 days (average 68
days). Treatment was conservative, except for insertion of a ventilation tube in 
2 cases. CONCLUSIONS: Considering that all the patients recovered, conservative
treatment, including myringotomy and intravenous antibiotics, may be the correct 
approach to facial palsy associated with acute otitis media.

PMID: 15692549 [PubMed - indexed for MEDLINE]

1165: Otolaryngol Head Neck Surg. 2005 Feb;132(2):180-8.

The Cooperative Outcomes Group for ENT: a multicenter prospective cohort study on
the outcomes of tympanostomy tubes for children with otitis media.

Witsell DL, Stewart MG, Monsell EM, Hadley JA, Terrell JE, Yueh B, Rosenfeld RM, 
Hannley MT, Holzer SS.

Duke University Medical Center, Divison of Otolaryngology-Head and Neck Surgery, 
Durham Veterans Administration Medical Center, NC 27710, USA.
witse001@mc.duke.edu

OBJECTIVE: Outcomes for patients with otitis media were assessed in this
prospective, multicenter study. STUDY DESIGN AND SETTING: Thirty-one
otolaryngologists enrolled 272 pediatric patients with otitis media; caregivers
completed surveys at 3-month intervals, and clinical and treatment data was also 
collected. The Otitis Media 6 (OM-6) was the primary outcome measure. RESULTS:
One hundred seventy-seven patients (mean age 2.0 years) completed 3-month
follow-up. One hundred thirty-seven patients underwent tympanostomy tube
placement. Large improvements in disease-specific quality of life (QOL) were seen
up to 9 months of follow-up. Baseline OM-6 score was the best predictor of
clinical success in regression modeling. CONCLUSIONS: Patients referred to an
otolaryngologist for treatment of otitis media see large improvements in
disease-specific QOL regardless of treatment rendered. SIGNIFICANCE: The study
demonstrates the feasibility of multicenter outcomes studies and confirms
appropriate triage of patients with otitis media into surgical versus medical
interventions. EBM rating: C.

Publication Types: 
    Multicenter Study

PMID: 15692524 [PubMed - indexed for MEDLINE]

1166: Laryngoscope. 2005 Feb;115(2):363-5.

Comment in:
    Laryngoscope. 2005 Jul;115(7):1321-3; author reply 1323.

Oxymetazoline is equivalent to ciprofloxacin in preventing postoperative otorrhea
or tympanostomy tube obstruction.

Kumar VV, Gaughan J, Isaacson G, Szeremeta W.

Departments of Otolaryngology-Head and Neck Surgery , Temple University School of
Medicine, Philadelphia, PA 19140, USA.

OBJECTIVE: To compare the effectiveness of ciprofloxacin and oxymetazoline
solutions instilled after tympanostomy tube placement in the prevention of
postoperative otorrhea and tube occlusion. STUDY DESIGN: Prospective
cross-sectional series. METHODS: We reviewed all bilateral myringotomy and tube
placement operations performed by two full-time attending pediatric
otolaryngologists during a 9 month period. Data from 488 patients who underwent
surgery for otitis media were collected. Demographic and clinical variables
including age, sex, number of tube insertions in the past, previous
adenoidectomy, type of effusion present at surgery, and type of drop prescribed
postoperatively were recorded. All patients were evaluated in the office 2 to 4
weeks postoperatively. Multivariate logistic regression analysis was used to
estimate the relationship of these variables with the occurrence of otorrhea and 
tube patency. Odds ratios were calculated. RESULTS: No significant differences in
postoperative otorrhea or tube patency were found between ciprofloxacin (Ciloxan)
and oxymetazoline solutions (Afrin, Visine LR). CONCLUSION: Oxymetazoline and
ciprofloxacin solutions are equivalent in the prevention of postoperative
otorrhea and tube occlusion after tympanostomy tube placement. The implications
for medication cost and potential adverse reactions are discussed.

Publication Types: 
    Comparative Study

PMID: 15689767 [PubMed - indexed for MEDLINE]

1167: Laryngoscope. 2005 Feb;115(2):317-20.

Increase of macrolide-resistant Streptococcus pneumoniae-expressing mefE or ermB 
gene in the nasopharynx among children with otitis media.

Hotomi M, Billal DS, Shimada J, Suzumoto M, Yamauchi K, Fujihara K, Yamanaka N.

Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, 
Wakayama 641-0012, Japan.

OBJECTIVE: To evaluate prevalence of macrolide resistant strains and the
genotypes of the resistance among Streptococcus pneumoniae isolated from the
nasopharynx of children with otitis media. STUDY DESIGN: Retrospective review.
METHODS: A total of 858 S. pneumoniae isolates were collected from the
nasopharynx of pediatric patients with acute otitis media at the clinics of
Otolaryngology-Head and Neck Surgery, Wakayama Medical University Hospital and
six affiliated hospitals in Wakayama prefecture between January 1998 and December
2002. The antibiotic susceptibility patterns were analyzed for penicillin,
erythromycin, and clindamycin according to the National Committee for Clinical
Laboratory Standards. Macrolide resistance genes of mefE and ermB were determined
by polymerase chain reaction of all S. pneumoniae. RESULTS: Of 858 clinical
isolates, 259 (30.1%) were strains without ermB or mefE gene, 279 (32.5%)
carrying mefE, 292 (34.0%) carrying ermB, and 28 (3.4%) carrying both genes.
There was a strong correlation between phenotypes and the presence of macrolide
resistance genes. The macrolide resistance genes were especially frequently
identified among penicillin-resistant S. pneumoniae. Strains carrying ermB gene
gradually increased from 25% in 1998 to 45% in 2002, with a concurrent decrease
in strains carrying mefE from 36% in 1998 to 1999 to 19% in 2002. Strains having 
mefE were frequently identified among children younger than 2 years old. The
current finding suggested that high-level ermB-mediated macrolide resistance in
S. pneumoniae is increasing at an alarming rate in pediatric patients with otitis
media, especially among young children. Physicians should pay close attention to 
such macrolide-resistant bacterial pathogens in the antimicrobial treatment of
pediatric patients with otitis media.

PMID: 15689758 [PubMed - indexed for MEDLINE]

1168: Laryngoscope. 2005 Feb;115(2):268-73.

Development of mastoid air cell system in children treated with ventilation tubes
for early-onset otitis media: a prospective radiographic 5-year follow-up study.

Valtonen HJ, Dietz A, Qvarnberg YH, Nuutinen J.

Department of Otorhinolaryngology, Kuopio University Hospital, FIN-70211 Kuopio, 
Finland. hannu.valtonen@kuh.fi

OBJECTIVES/HYPOTHESIS: Although most studies have agreed that small mastoid air
cell systems correlate with long-standing otitis media, the extent to which the
environmental factors affect the development of MACS remains undetermined. We
investigated the radiographic development of mastoid air cell systems in children
with recurrent acute otitis media or otitis media with effusion who were treated 
with ventilation tubes early in life. STUDY DESIGN: Prospective follow-up.
METHODS: Of 305 consecutive patients aged less than 17 months with recurrent
acute otitis media or otitis media with effusion who received primary
tympanostomy in the Central Hospital of Central Finland, 281 (92.1%) were
followed for 5 years. Mastoid radiographic films were obtained preoperatively and
at the 5-year end-point examination. Mastoid air cell system size was
planimetrically measured. RESULTS: Small baseline mastoid air cell system size
was associated with young age at the time of first diagnosis of otitis media and 
small size of the child. Slow growth and small final size of mastoid air cell
system related significantly with female gender and with slow overall growth of
the child. Slow mastoid air cell system growth was observed in children who
required several ventilation tubes during the follow-up period. Small final
mastoid air cell system size correlated significantly with unfavorable otological
outcome. CONCLUSION: The genetically determined development of mastoid air cell
system is arrested in varying degree by environmental factors, particularly by an
early onset of otitis media, a long-standing disease, and an unfavorable
otological outcome. On the other hand, poor pneumatization seems to be a risk
factor for chronic and recurrent infections and, ultimately, for a deficient
otological outcome. However, in a vast majority of patients, this untoward
development may be reversed by an early and, if needed, repeated tympanostomy.

PMID: 15689748 [PubMed - indexed for MEDLINE]

1169: Pediatr Neurosurg. 2004 Sep-Oct;40(5):226-9.

Intracranial complications following mastoidectomy.

Migirov L, Eyal A, Kronenberg J.

Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel
Hashomer 52621, Israel.

Mastoidectomy is a common surgical procedure in otology. However, postoperative
complications of various degrees of severity may occur. We present 4 children who
underwent mastoidectomy for middle ear and mastoid disease and developed
postoperative intracranial complications. One child was operated on for brain
abscess 1 week after the initial mastoidectomy. Another child appeared with
seizures 5 days after the initial mastoidectomy and a subdural empyema was
drained during revision surgery. Large bone defects with exposed middle cranial
fossa dura were found at revision surgery in both cases and Proteus vulgaris and 
methicillin-resistant Staphylococcus aureus were isolated from the mastoid and
abscess cavities in these children. A small epidural collection was diagnosed in 
the third patient 2 days after initial mastoid surgery and was managed with
intravenous antibiotics only. The other child was found to have sigmoid sinus
thrombosis the day after mastoidectomy that was performed for nonresponsive acute
mastoiditis. This child received both intravenous antibiotics and anticoagulants.
Timely revision surgery, combinations of third- or fourth-generation
cephalosporins with vancomycin or metronidazole and the addition of
anticoagulants in cases of sinus thrombosis can lead to full recovery. Copyright 
(c) 2004 S. Karger AG, Basel.

Publication Types: 
    Case Reports

PMID: 15689642 [PubMed - indexed for MEDLINE]

1170: Pediatrics. 2005 Feb;115(2):273-9.

Comment in:
    J Pediatr. 2005 Jul;147(1):124-5.

Effect of pneumococcal vaccination on quality of life in children with recurrent 
acute otitis media: a randomized, controlled trial.

Brouwer CN, Maillé AR, Rovers MM, Veenhoven RH, Grobbee DE, Sanders EA, Schilder 
AG.

Department of Pediatrics, Spaarne Hospital Haarlem, Haarlem, Netherlands.

BACKGROUND: Limited effectiveness of current treatment strategies for recurrent
acute otitis media (RAOM) and increasing antibiotic resistance have diverted
attention to prevention of AOM by vaccination. Pneumococcal vaccination for AOM
seems to have only modest clinical efficacy. Thus far, the effects on
health-related quality of life (HRQoL) or functional health status (FHS) have not
been studied. OBJECTIVE: To assess the effect of vaccination on HRQoL or FHS.
METHODS: In a double-blind, randomized, controlled trial, 383 children 1 to 7
years old with RAOM were vaccinated with either heptavalent pneumococcal
conjugate vaccine followed by pneumococcal polysaccharide vaccine (pneumococcal
group: n = 190) or with hepatitis A or B vaccines (control group: n = 193).
Parents completed validated Dutch versions of 8 HRQoL and FHS instruments
assessing generic FHS (Rand, Functional Status Questionnaire specific, and
Functional Status Questionnaire generic), otitis media-specific FHS (OM-6),
otitis media-specific child HRQoL (Numerical Rating Scale for Child), family
functioning (Family Functioning Questionnaire), and otitis media-specific
caregiver HRQoL (Numerical Rating Scale for Caregiver). Scores were compared at
baseline and at 14 and 26 months' follow-up. RESULTS: At baseline, the average
AOM incidence in the pneumococcal and control group was 5.0 (SD: 2.8) and 4.9
(SD: 2.6) episodes per year, respectively, with 38.4% and 36.8% having suffered
from > or =6 episodes per year. AOM frequency decreased 4.4 episodes per year in 
both groups, with a considerable and comparable improvement in HRQoL and FHS. No 
substantial differences in HRQoL or FHS were found between the pneumococcal and
the control group at baseline or at 14 or 26 months' follow-up. CONCLUSION:
Pneumococcal vaccination has no beneficial effect compared with control
vaccination on either HRQoL or FHS in children 1 to 7 years old with RAOM.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15687432 [PubMed - indexed for MEDLINE]

1171: CMAJ. 2005 Feb 1;172(3):335-41.

Comment in:
    CMAJ. 2005 Aug 2;173(3):235; author reply 236.    CMAJ. 2005 Aug 2;173(3):235; author reply 236.    CMAJ. 2005 Aug 2;173(3):235; author reply 236.    CMAJ. 2005 Aug 2;173(3):236; author reply 236.    CMAJ. 2005 Mar 1;172(5):657-8.

A randomized, double-blind, placebo-controlled noninferiority trial of
amoxicillin for clinically diagnosed acute otitis media in children 6 months to 5
years of age.

Le Saux N, Gaboury I, Baird M, Klassen TP, MacCormick J, Blanchard C, Pitters C, 
Sampson M, Moher D.

Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ont.
lesaux@cheo.on.ca

OBJECTIVES: Debate continues with respect to a "watch and wait" approach versus
immediate antibiotic treatment for the initial treatment of acute otitis media.
In this double-blind noninferiority trial, we compared clinical improvement rates
at 14 days for children (6 months to 5 years of age) with acute otitis media who 
were randomly assigned to receive amoxicillin or placebo. METHODS: We enrolled
healthy children who presented to clinics or the emergency department with a new 
episode of acute otitis media during the fall and winter months in Ottawa (from
December 1999 to the end of March 2002). The children were randomly assigned to
receive amoxicillin (60 mg/kg daily) or placebo for 10 days. Telephone follow-up 
was performed on each of days 1, 2 and 3 and once between day 10 and day 14. The 
primary outcome was clinical resolution of symptoms, defined as absence of
receipt of an antimicrobial (other than the amoxicillin in the treatment group)
at any time during the 14-day period. Secondary outcomes were the presence of
pain and fever and the activity level in the first 3 days, recurrence rates, and 
the presence of middle ear effusion at 1 and 3 months. RESULTS: According to
clinical scoring, 415 of the 512 children who could be evaluated had moderate
disease. At 14 days 84.2% of the children receiving placebo and 92.8% of those
receiving amoxicillin had clinical resolution of symptoms (absolute difference
-8.6%, 95% confidence interval -14.4% to -3.0%). Children who received placebo
had more pain and fever in the first 2 days. There were no statistical
differences in adverse events between the 2 groups, nor were there any
significant differences in recurrence rates or middle ear effusion at 1 and 3
months. INTERPRETATION: Our results did not support the hypothesis that placebo
was noninferior to amoxicillin (i.e., that the 14-day cure rates among children
with clinically diagnosed acute otitis media would not be substantially worse in 
the placebo group than the treatment group). Nevertheless, delaying treatment was
associated with resolution of clinical signs and symptoms in most of the
children.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15684116 [PubMed - indexed for MEDLINE]

1172: Trop Med Int Health. 2005 Feb;10(2):190-7.

Topical quinolone vs. antiseptic for treating chronic suppurative otitis media: a
randomized controlled trial.

Macfadyen C, Gamble C, Garner P, Macharia I, Mackenzie I, Mugwe P, Oburra H,
Otwombe K, Taylor S, Williamson P.

International Health Research Group, Liverpool School of Tropical Medicine,
Pembroke Place, Liverpool L3 5QA, UK. cmacfadyenuk@yahoo.co.uk

OBJECTIVE: To compare a topical quinolone antibiotic (ciprofloxacin) with a
cheaper topical antiseptic (boric acid) for treating chronic suppurative otitis
media in children. DESIGN: Randomized controlled trial. SETTING AND PARTICIPANTS:
A total of 427 children with chronic suppurative otitis media enrolled from 141
schools following screening of 39 841 schoolchildren in Kenya. Intervention
Topical ciprofloxacin (n = 216) or boric acid in alcohol (n = 211);
child-to-child treatment twice daily for 2 weeks. MAIN OUTCOME MEASURES:
Resolution of discharge (at 2 weeks for primary outcome), healing of the tympanic
membrane, and change in hearing threshold from baseline, all at 2 and 4 weeks.
RESULTS: At 2 weeks, discharge was resolved in 123 of 207 (59%) children given
ciprofloxacin, and in 65 of 204 (32%) given boric acid (relative risk 1.86; 95%
CI 1.48-2.35; P < 0.0001). This effect was also significant at 4 weeks, and
ciprofloxacin was associated with better hearing at both visits. No difference
with respect to tympanic membrane healing was detected. There were significantly 
fewer adverse events of ear pain, irritation, and bleeding on mopping with
ciprofloxacin than boric acid. CONCLUSIONS: Ciprofloxacin performed better than
boric acid and alcohol for treating chronic suppurative otitis media in children 
in Kenya.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15679563 [PubMed - indexed for MEDLINE]

1173: Cochrane Database Syst Rev. 2005 Jan 25;(1):CD001801.

Comment in:
    Otolaryngol Head Neck Surg. 2006 Oct;135(4):507-10.

Grommets (ventilation tubes) for hearing loss associated with otitis media with
effusion in children.

Lous J, Burton MJ, Felding JU, Ovesen T, Rovers MM, Williamson I.

Institute of Public Health, General Practice, University of Southern Denmark,
Winsløwparken 19, 3, DK-5000 Odense C, Denmark. jlous@health.sdu.dk

BACKGROUND: Otitis media with effusion (OME), or 'glue ear', is very common in
children, especially between the ages of one and three years with a prevalence of
10% to 30% and a cumulative incidence of 80% at the age of four years. OME is
defined as middle ear effusion without signs or symptoms of an acute infection.
OME may occur as a primary disorder or as a sequel to acute otitis media. The
functional effect of OME is a conductive hearing level of about 25 to 30 dB
associated with fluid in the middle ear. Both the high incidence and the high
rate of spontaneous resolution suggest that the presence of OME is a natural
phenomenon, its presence at some stage in childhood being a normal finding.
Notwithstanding this, some children with OME may go on to develop chronic otitis 
media with structural changes (tympanic membrane retraction pockets, erosion of
portions of the ossicular chain and cholesteatoma), language delays and
behavioural problems. It remains uncertain whether or not any of these findings
are direct consequences of OME. The most common medical treatment options include
the use of decongestants, mucolytics, steroids, antihistamines and antibiotics.
The effectiveness of these therapies has not been established. Surgical treatment
options include grommet (ventilation or tympanostomy tube) insertion,
adenoidectomy or both. Opinions regarding the risks and benefits of grommet
insertion vary greatly. The management of OME therefore remains controversial.
OBJECTIVES: To assess the effectiveness of grommet insertion compared with
myringotomy or non-surgical treatment in children with OME. The outcomes studied 
were (i) hearing level, (ii) duration of middle ear effusion, (iii) well-being
(quality of life) and (iv) prevention of developmental sequelae possibly
attributable to the hearing loss (for example, impairment in impressive and
expressive language development (measured using standardised tests), verbal
intelligence, and behaviour). SEARCH STRATEGY: We searched the Cochrane Central
Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2003),
MEDLINE (1966 to 2003), EMBASE (1973 to 2003) and reference lists of all
identified studies. The date of the last systematic search was March 2003, and
personal non-systematic searches have been performed up to August 2004. SELECTION
CRITERIA: Randomised controlled trials (RCTs) evaluating the effect of grommets
on hearing, duration of effusion, development of language, cognition, behaviour
or quality of life. Only studies using common types of grommets (mean function
time of 6 to 12 months) were included. DATA COLLECTION AND ANALYSIS: Data from
studies were extracted by two reviewers and checked by the other reviewers. MAIN 
RESULTS: Children treated with grommets spent 32% less time (95% confidence
interval (CI) 17% to 48%) with effusion during the first year of follow-up.
Treatment with grommets improved hearing levels, especially during the first six 
months. In the randomised controlled trials that studied the effect of grommet
insertion alone, the mean hearing levels improved by around 9 dB (95% CI 4 dB to 
14 dB) after the first six months, and 6 dB (95% CI 3 dB to 9 dB) after 12
months. In the randomised controlled trials that studied the combined effect of
grommets and adenoidectomy, the additional effect of the grommets on hearing
levels was improvement by 3 to 4 dB (95% CI 2 dB to 5 dB) at six months and about
1 to 2 dB (95% CI 0 dB to 3 dB) at 12 months. Ears treated with grommets had an
additional risk for tympanosclerosis of 0.33 (95% CI 0.21 to 0.45) one to five
years later. In otherwise healthy children with long-standing OME and hearing
loss, early insertion of grommets had no effect on language development or
cognition. One randomised controlled trial in children with OME more than nine
months, hearing loss and disruptions to speech, language, learning or behaviour
showed a very marginal effect of grommets on comprehensive language. AUTHORS'
CONCLUSIONS: The benefits of grommets in children appear small. The effect of
grommets on hearing diminished during the first year. Potentially adverse effects
on the tympanic membrane are common after grommet insertion. Therefore an initial
period of watchful waiting seems to be an appropriate management strategy for
most children with OME. As no evidence is yet available for the subgroups of
children with speech or language delays, behavioural and learning problems or
children with defined clinical syndromes (generally excluded from the primary
studies included in this review), the clinician will need to make decisions
regarding treatment for such children based on other evidence and indications of 
disability related to hearing impairment.This review does not resolve the
discrepancy between parental and clinical observation of a beneficial treatment
effect and the results in the reviewed RCT showing only a short-term effect on
hearing and virtually no effect on development. Is the perceived, often dramatic,
effect of grommets only a short-term one? Are some children more sensitive to
OME-related hearing loss than others? If so, how do we identify them?Further
research should focus upon indications. Studies should use sufficiently large
sample sizes to show significant interactions. There is a need to determine the
most suitable variables and appropriate "softer" outcomes to be the subject of
these interaction tests. Interesting options include measures of speech-in-noise 
and binaural hearing.The generally modest results in the trials which are
included in this review should make it easier to justify randomisation of more
severely affected and higher-risk children in appropriately constructed trials.
Randomised controlled trials are necessary in these children before more detailed
conclusions about the effectiveness of grommets can be drawn.

Publication Types: 
    Meta-Analysis
    Review

PMID: 15674886 [PubMed - indexed for MEDLINE]

1174: Brain Dev. 2005 Mar;27(2):155-9.

Acute onset of abducens nerve palsy in a child with prior history of otitis
media: a misleading sign of Gradenigo syndrome.

Villa G, Lattere M, Rossi A, Di Pietro P.

Emergency Department of Paediatrics G. Gaslini Children's Hospital Largo G.
Gaslini, 5 16147 Genova, Italy. ninnivilla@yahoo.it

Gradenigo syndrome in children during otitis media is a very rare complication
since the use of antibiotics: nevertheless, it must be taken into account in case
of otitis media, abducens nerve paralysis and facial pain in regions innervated
by the first and second division of trigeminal nerve. We report the case of a
4-year-old boy whose neurological signs and clinical history prompted us to
entertain a diagnosis of Gradenigo syndrome, which was not confirmed by CT and
MRI findings, revealing otomastoiditis and sinus thrombosis.

Publication Types: 
    Case Reports

PMID: 15668058 [PubMed - indexed for MEDLINE]

1175: J Laryngol Otol. 2004 Dec;118(12):933-6.

Long-term ventilation of the middle ear using a subannular tympanotomy technique:
a follow-up study.

Jassar P, Coatesworth A, Strachan DR.

Department of Otolaryngology Head & Neck Surgery, Bradford Royal Infirmary,
Bradford, UK. pjassar@yahoo.co.uk

The results of a nine-year series of patients who underwent long-term middle ear 
ventilation using a tympanotomy technique are presented. The original series of
26 cases was published in 1995. The same series has now expanded to 37 cases,
which form the basis of this follow-up study. In contrast to the original series 
we found a high spontaneous extrusion rate (68 per cent) and in 27 per cent of
cases complications necessitated removal of the subannular T tube. In favour of
the technique was a low perforation rate after extrusion or removal (eight per
cent). Although only nine per cent underwent re-ventilation this is unlikely to
represent resolution of the middle ear effusion in the remaining cases. We
conclude that the adverse effects of the subannular tympanotomy technique for
long-term ventilation of the middle ear outweigh the benefits when compared with 
the traditional technique of placing a T tube through a myringotomy incision.

Publication Types: 
    Evaluation Studies

PMID: 15667678 [PubMed - indexed for MEDLINE]

1176: Pediatr Infect Dis J. 2005 Jan;24(1):24-8.

Impact of amoxicillin on pneumococcal colonization compared with other therapies 
for acute otitis media.

Toltzis P, Dul M, O'Riordan MA, Toltzis H, Blumer JL.

Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western
Reserve University School of Medicine, Cleveland, OH, USA.

BACKGROUND: This study compared the effects of 4 outpatient antibiotic regimens
on colonization by penicillin-susceptible and -nonsusceptible pneumococci to
assess their relative potential to promote colonization with Streptococcus
pneumoniae with reduced susceptibility to penicillin. METHODS: Children
presenting with acute otitis media were randomized to receive amoxicillin,
cefprozil, ceftriaxone or azithromycin. Nasopharyngeal specimens were collected
on days 0, 3-5, 10-14 and 28-30 and assessed for the presence of S. pneumoniae.
At each visit, the proportions of penicillin-susceptible and -nonsusceptible
pneumococci were compared among treatment groups. RESULTS: Among 1009 enrollees, 
the prevalence of colonization by S. pneumoniae at baseline was 23.5%, of which
41.1% were penicillin-nonsusceptible. Colonization by nonsusceptible pneumococci 
was unaltered during the observation period in all treatment groups, with no
detectable differences among groups at each visit. By contrast, there was a
substantial reduction in the prevalence of colonization by penicillin-susceptible
organisms, most notably in subjects treated with amoxicillin. This resulted in a 
proportional shift toward resistant organism colonization in all groups, with
this shift being significantly more pronounced among amoxicillin recipients than 
in the other groups at 10-12 days (P < 0.02 for each comparison with
amoxicillin). CONCLUSIONS: Treatment with amoxicillin for acute otitis media
resulted in a larger shift toward nonsusceptible organism colonization among
those children still colonized postexposure than did treatment with 3 comparison 
agents. This phenomenon raises theoretical concerns that at the population level,
amoxicillin produces conditions that promote the dissemination of the
nonsusceptible phenotype more readily than other outpatient antibiotics.
Confirmation of these results requires further study.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15665706 [PubMed - indexed for MEDLINE]

1177: Int J Pediatr Otorhinolaryngol. 2005 Feb;69(2):209-14.

Pure tone audiometry in children.

Kemaloğlu YK, Gündüz B, Gökmen S, Yilmaz M.

Department of ENT-HNS, Ankara, Turkey. yusufk@gazi.edu.tr

OBJECTIVE: Our purpose was to evaluate performance of the children on pure tone
audiometry (PTA), and role of age, concentration level (CL) and otitis media with
effusion (OME) in testing process. METHODS: This study was prospectively
performed on 100 consecutive children referred for PTA between 24 and 120 months 
of age. After the audiologists' decision on test technique, the followings were
noted: CL (by using a visual analog scale), test duration, test convenience (TC) 
and the problems (interruption, delay, crying) during the test. By using pure
tone averages (PTAv), mean hearing level (MHL) and mean gap (MG) were calculated.
RESULTS: PTA was achieved in 90% of the children and PTAv of bone and air
conduction in the both ears were obtained in 86% (play audiometry with earphones 
(PAE): 73%, conventional audiometry (CA): 22%). These ratios were not different
between the children with and without OME. About 55% of the younger children than
36 months were failed in PTA, while this ratio was 4.5% in the children between
36 and 120 months. Only difference between PAE and CA tests was in MHL. In OME
group, only TC was found to be lower. Correlation analysis showed that CL was
correlated with age. Test duration was correlated with MG and MHL, but found to
be dependent on only MG. Further, it was found that test choice of the
audiologist was correlated with age and CL, but dependent on only CL.
CONCLUSIONS: PTA is available in children depending on their age and particularly
CL; hence, performance in PTA is directly related with audiologists' assessment
the children and cooperation before starting the test. Meanwhile, test duration
appears to be directly associated with the work on detection of the gap between
air and bone conduction thresholds.

PMID: 15656954 [PubMed - indexed for MEDLINE]

1178: Curr Opin Allergy Clin Immunol. 2005 Feb;5(1):1-4.

Genetic susceptibility to otitis media.

Casselbrant ML, Mandel EM.

ENT Research Center, Children's Hospital of Pittsburgh, Pennsylvania, USA.
margaretha.casselbrant@chp.edu

PURPOSE OF REVIEW: Otitis media is a disease that is prevalent in the pediatric
population, and recent twin and triplet studies have confirmed that there is a
strong genetic component to susceptibility. Here, we summarize the status of
current efforts to identify the specific genes underlying otitis media
susceptibility and presentation. RECENT FINDINGS: Recent studies have focused on 
identifying candidate genes. For example, IFN-gamma polymorphisms, allotypes of
the leukocyte IgG (FcgammaR) receptors and certain haplotypes of surfactant genes
were linked in pilot studies to otitis media susceptibility. The pattern of gene 
expression during an episode of otitis media is also being elucidated with the
overall goal of providing clues as to which of these modulated genes are
polymorphic and thus potentially capable of affecting otitis media
susceptibility. Mucin and cathepsin protease genes were shown to exhibit these
characteristics. SUMMARY: In addition to the simple searches for linkages between
known genes and otitis media, work is progressing within the context of
genome-wide linkage studies. These efforts promise to answer some of the many
questions remaining in otitis media susceptibility and pathogenesis.

Publication Types: 
    Review

PMID: 15643336 [PubMed - indexed for MEDLINE]

1179: Infect Control Hosp Epidemiol. 2004 Dec;25(12):1083-9.

An outbreak of Pseudomonas aeruginosa pneumonia and bloodstream infection
associated with intermittent otitis externa in a healthcare worker.

Zawacki A, O'Rourke E, Potter-Bynoe G, Macone A, Harbarth S, Goldmann D.

Children's Hospital, Boston, Massachusetts, USA.

OBJECTIVES: To investigate an outbreak of Pseudomonas aeruginosa pneumonia and
bloodstream infection among four neonates, determine risk factors for infection, 
and implement preventive strategies. DESIGN: Retrospective case finding;
prospective surveillance cultures of patients, personnel, and environmental
sites; molecular typing by pulsed-field gel electrophoresis; and a matched
case-control study. PATIENTS AND SETTING: Neonates in the level-III neonatal
intensive care unit of a tertiary-care pediatric institution. INTERVENTIONS:
Cohorting of patients with positive results for P. aeruginosa, work restrictions 
for staff with positive results, implementation of an alcohol-based hand product,
review of infection control policies and procedures, and closure of the unit
until completion of the investigation. RESULTS: Seven (4%) of 190 environmental
cultures and 5 (3%) of 178 cultures of individual healthcare workers' hands grew 
P. aeruginosa. All four outbreak isolates and one previous bloodstream isolate
were genotypically identical, as were the P. aeruginosa isolates from the hands
and external auditory canal of a healthcare worker with intermittent otitis
externa. Four of 5 case-patients versus 5 of 15 matched control-patients had been
cared for by this healthcare worker (P = .05). The healthcare worker was treated 
and no further cases occurred. CONCLUSIONS: These findings suggest that a
healthcare worker with intermittent otitis externa may have caused this cluster
of fatal P. aeruginosa infections, adding the external ear to the list of
colonized body sites that may serve as a source of potentially pathogenic
organisms.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 15636297 [PubMed - indexed for MEDLINE]

1180: J Clin Microbiol. 2005 Jan;43(1):74-83.

Molecular epidemiology of pneumococcal colonization in response to pneumococcal
conjugate vaccination in children with recurrent acute otitis media.

Bogaert D, Veenhoven RH, Sluijter M, Wannet WJ, Rijkers GT, Mitchell TJ, Clarke
SC, Goessens WH, Schilder AG, Sanders EA, de Groot R, Hermans PW.

Department of Pediatrics, Erasmus MC-Sophia Rotterdam, The Netherlands.

A randomized double-blind trial with a 7-valent pneumococcal conjugate vaccine
was conducted in The Netherlands among 383 children, aged 1 to 7 years, with a
history of recurrent acute otitis media. No effect of vaccination on the
pneumococcal colonization rate was found. However, a shift in serotype
distribution was clearly observed (R. Veenhoven et al., Lancet 361:2189-2195,
2003). We investigated the molecular epidemiology of 921 pneumococcal isolates
retrieved from both the pneumococcal vaccine (PV) and control vaccine (CV) groups
during the vaccination study. Within individuals a high turnover rate of
pneumococcal restriction fragment end labeling genotypes, which was unaffected by
vaccination, was observed. Comparison of the genetic structures before and after 
completion of the vaccination scheme revealed that, despite a shift in serotypes,
there was clustering of 70% of the pneumococcal populations. The remaining
isolates (30%) were equally observed in the PV and CV groups. In addition, the
degree of genetic clustering was unaffected by vaccination. However, within the
population genetic structure, nonvaccine serotype clusters with the serotypes 11,
15, and 23B became predominant over vaccine-type clusters after vaccination.
Finally, overall pneumococcal resistance was low (14%), and, albeit not
significant, a reduction in pneumococcal resistance as a result of pneumococcal
vaccination was observed. Molecular surveillance of colonization in Dutch
children shows no effect of pneumococcal conjugate vaccination on the degree of
genetic clustering and the genetic structure of the pneumococcal population.
However, within the genetic pneumococcal population structure, a clear shift
toward nonvaccine serotype clusters was observed.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15634953 [PubMed - indexed for MEDLINE]

1181: J Am Anim Hosp Assoc. 2005 Jan-Feb;41(1):12-21.

Efficacy of boric-complexed zinc and acetic-complexed zinc otic preparations for 
canine yeast otitis externa.

Mendelsohn CL, Griffin CE, Rosenkrantz WS, Brown LD, Boord MJ.

Animal Dermatology Clinics, Tustin, California 92780, USA.

The purpose of this 2-week, double-blinded, controlled clinical trial was to
evaluate the efficacy of topical amino acid-complexed zinc gluconate formulated
with boric acid (ZGB) or acetic acid (ZGA) versus a topical placebo in the
treatment of yeast otitis externa in dogs. Included in the study were dogs with
otitis externa and a cytopathological finding of yeast organisms in the affected 
ear. Ears were treated with the placebo, ZGA, or ZGB medications. Yeast counts as
well as clinical appearance of the ears were monitored. Results revealed that ZGB
significantly reduced the number of yeast organisms in cases of otitis externa.

Publication Types: 
    Randomized Controlled Trial

PMID: 15634862 [PubMed - indexed for MEDLINE]

1182: Ann Otol Rhinol Laryngol. 2004 Dec;113(12):975-9.

Management of hemorrhagic high jugular bulb with adhesive otitis media in an only
hearing ear: transcatheter endovascular embolization using detachable coils.

Kondoh K, Kitahara T, Mishiro Y, Okumura S, Kubo T.

Department of Otorhinolaryngology and Sensory Organ Surgery, Osaka University
Graduate School of Medicine Osaka, Japan.

A 51-year-old woman had a hemorrhagic high jugular bulb protruding into the
posterosuperior part of the tympanic cavity in her left ear. This (only hearing) 
ear had severe adhesive otitis media resulting in repetitive hemorrhage from the 
jugular bulb. Therefore, treatment to stop the bleeding was required. Since
invasive middle ear surgery in an only hearing ear would involve a high risk of
hearing loss and massive bleeding, transcatheter endovascular embolization using 
detachable coils was selected for this special case; it safely blocked the blood 
flow and preserved the patient's hearing level. This is the first such report in 
the otosurgical field, showing that transcatheter endovascular embolization using
detachable coils was quite effective in a difficult case of a hemorrhagic high
jugular bulb with severe adhesive otitis media in an only hearing ear.

Publication Types: 
    Case Reports

PMID: 15633900 [PubMed - indexed for MEDLINE]

1183: Otolaryngol Head Neck Surg. 2005 Jan;132(1):37-42.

Intracranial complications of otitis media: 15 years of experience in 33
patients.

Penido Nde O, Borin A, Iha LC, Suguri VM, Onishi E, Fukuda Y, Cruz OL.

Department of Otorhinolaryngology-Head and Neck Surgery, Federal University of
São Paulo, Escola Paulista De Medicina, Brazil. gomessampa@uol.com.br

OBJECTIVES: Complications in the central nervous system (CNS) from acute otitis
media (AOM) and chronic otitis media (COM) are becoming fewer, although they
still represent a challenge for early recognition, adequate treatment, and
satisfactory results. This retrospective study analyzed clinical data and
therapeutic options in 33 patients with intracranial involvement resulting from
otitis media. Important clinical features of intracranial complications and the
sequence of the most efficient therapeutic maneuvers are discussed. METHODS:
Charts of six patients with AOM and 27 patients with COM associated with CNS
complications were analyzed for clinical presentation, imaging, and therapeutic
approach. RESULTS: Ages ranged from 6 months to 79 years, with no gender
predilection. Persistent fever, headache, and purulent otorrhea were the main
symptoms. Proteus mirabilis , Enterococcus , and Pseudomonas aeruginosa were the 
most common microorganisms in COM, and Pneumococcus and Haemophilus were the most
common microorganisms in AOM. Nineteen patients (58%) presented with more than 1 
CNS complication, resulting in a total of 56 complications, including 26 cases of
otogenic brain abscess, 21 cases of meningitis, 5 cases of lateral sinus
thromboses, two cases of subdural empyemas, 1 case of epidural empyema, and 1
case of meningocele. Surgical interventions included craniotomy and drainage of
the abscess (n = 17), open mastoidectomy with abscess drained through the mastoid
(n = 10), open mastoidectomy alone (n = 8), and closed mastoidectomy (n = 2).
Twelve patients who underwent craniotomy had subsequent mastoidectomy for
recurrent abscess. At the 6-month, 66% of patients presented without sequelae,
24% presented with sequelae, and 9% died. CONCLUSION: Early identification and
prompt clinical and surgical intervention with mandatory drainage of the middle
ear (primary disease), was essential for better outcome.

Publication Types: 
    Review

PMID: 15632907 [PubMed - indexed for MEDLINE]

1184: Otolaryngol Head Neck Surg. 2005 Jan;132(1):25-9.

Hearing loss and extent of labyrinthine injury in Pseudomonas otitis media.

Malaty J, Lee JC, Zhang M, Stevens G, Antonelli PJ.

Department of Otolaryngology, University of Florida, Gainesville 32610-0264, USA.

OBJECTIVES: To determine if the severity of hearing loss due to semicircular
canal transection (SCT) in Pseudomonas otitis media (POM) is a function of the
extent of the labyrinthine injury. METHODS: POM was induced bilaterally in 45
guinea pigs. After 2 to 4 days, SCT was performed in one 1 on the horizontal
canal, the superior canal, or both the horizontal and the superior canals.
Auditory-evoked brainstem responses were measured before and after SCT. RESULTS: 
POM was induced bilaterally in all animals. Elevation of click thresholds was
found in almost all SCT ears of all 3 groups; however, there were no significant 
differences between groups. Comparing the SCT ear to the contralateral, control
ear, mean hearing losses in the horizontal, superior, and horizontal + superior
SCT groups were 23 dB, 27 dB, and 24 dB, respectively. CONCLUSIONS: Hearing loss 
does not correlate with extent of labyrinthine injury in POM in the guinea pig.
EBM rating: B-2.

PMID: 15632905 [PubMed - indexed for MEDLINE]

1185: Int J Pediatr Otorhinolaryngol. 2005 Jan;69(1):117-22.

A case of the otogenic variant of Lemierre's syndrome with atypical sequelae and 
a review of pediatric literature.

Masterson T, El-Hakim H, Magnus K, Robinson J.

Department of Pediatrics, The Stollery Children's Hospital, Edmonton, Alta.,
Canada.

We report a case of an 8-year-old girl who presented with the clinical picture of
Lemierre's syndrome (LS) secondary to bilateral mastoiditis. She developed
unilateral sensorineural hearing loss (SNHL) along with internal jugular vein
(IJV) thrombosis, septic arthritis of her ankle and cervical fasciitis. Combined 
antimicrobial, anticoagulant and surgical treatment helped reverse all the
effects of the sequelae, including nearly all the hearing loss. This is a unique 
case of this uncommon variant of the syndrome and with an uncommonly reported
complication. The literature indicates that pediatric cases are a minority and
enforces that successful management rests on awareness of the condition, vigil
and promptness of communication of a multidisciplinary pediatric team.

Publication Types: 
    Case Reports
    Review

PMID: 15627459 [PubMed - indexed for MEDLINE]

1186: Int J Pediatr Otorhinolaryngol. 2005 Jan;69(1):61-4.

Effect of myringotomy on prognosis in pediatric acute otitis media.

Nomura Y, Ishibashi T, Yano J, Ichikawa T, Shinogami M, Monobe H, Hirai R, Kaga
K.

Department of Otolaryngology, University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo
113-8655, Japan. ikehara-tky@umin.ac.jp

OBJECTIVE: In children with acute otitis media (AOM), we compared clinical
outcomes between groups with and without myringotomy to elucidate the effect of
this procedure on long-term clinical course and prognosis. METHODS: Fifty-nine
children (29 male, 30 female) with tympanic membrane bulging or middle ear fluid 
(MEF) at initial presentation were assigned to one of two treatment groups. Group
A received oral antibiotics and also underwent myringotomy at initial enrollment 
(36 cases), while group B received oral antibiotics without myringotomy (23
cases). Clinical outcomes were evaluated by otolaryngologic specialists using
pneumatic otoscopy and tympanometry at 5, 10, 15, 30 days and 12 weeks and then
every 2 weeks after the initial treatment. Otitis media with effusion (OME),
early recurrence and recurrent AOM were used as the evaluation criteria for the
prognosis. RESULTS: In group A, 6 children (16.7%) showed transition to OME, 11
(30.6%) showed early recurrence of AOM, and 9 (25.0%) developed recurrent AOM. In
group B 10, 8, and 3 (43.5%, 34.8%, and 13.0%) showed these respective adverse
outcomes. While early recurrence rates and recurrent AOM rates did not differ
significantly between groups, progression of OME was significantly less frequent 
in group A than group B (P = 0.036). CONCLUSIONS: Lower rates of progression to
OME in the group undergoing myringotomy suggested that myringotomy might be
effective in preventing this outcome.

Publication Types: 
    Clinical Trial
    Comparative Study
    Controlled Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 15627448 [PubMed - indexed for MEDLINE]

1187: Int J Pediatr Otorhinolaryngol. 2005 Jan;69(1):57-60.

Gelfoam plug tympanoplasty concomitant with removal of retained ventilation
tubes.

Puterman M, Leiberman A.

Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical
Center, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
puterman@netvision.net.il

OBJECTIVE: To review the charts of patients treated using a gelfoam plug and to
determine the efficacy of its use as a grafting material for prevention of
perforation when removing retained ventilation tubes. METHOD: Following removal
of the retained tube, excision and debridement of the rim of the perforation, the
perforation was plugged with gelfoam material. Between February 1998 and July
2002, we used this procedure in 27 patients aged 15 years and younger, on a total
of 36 ears. RESULTS: In all 27 cases, complete healing of the perforation was
attained. CONCLUSION: A minimal tympanoplastic procedure using gelfoam graft
concomitantly with tube removal is effective in prevention of perforation
resulting from delayed spontaneous extrusion.

PMID: 15627447 [PubMed - indexed for MEDLINE]

1188: Int J Pediatr Otorhinolaryngol. 2005 Jan;69(1):49-56.

Comparison of caregiver otitis media risk factor knowledge in suburban and urban 
primary care environments.

Kerschner JE, Lindstrom DR, Pomeranz A, Rohloff R.

Children's Hospital of Wisconsin, Department of Otolaryngology and Communication 
Sciences, Medical College of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI
53226, USA. kersch@mcw.edu

OBJECTIVE: There are many risk factors for otitis media. Some of these, such as
passive tobacco smoke exposure and childcare arrangements; have the potential to 
be modified. The purpose of this study is to assess caregiver knowledge deficits 
about risk factors associated with otitis media and their willingness to modify
behaviors associated with those risks. RESEARCH DESIGN AND METHODS: This study is
a prospective survey study investigating knowledge deficits of parents or
guardians of children ages 6-36 months about the risk factors of otitis media.
The patients were consecutively drawn from a suburban and an urban pediatric
practice. Any difference in survey results between these two groups was also
assessed. Participants completed a survey of 21 questions with content including 
demographic and OM risk factor data. RESULTS: A total of 401 caregivers completed
surveys, with 213 from an urban pediatric practice and 188 from a suburban
practice. There was a significant difference in the ethnic distributions of the
two populations. The suburban population had a significantly greater family
history of ear infections, number of ear infections in the past 12 months, and
number of previous ventilation tubes placed. The urban population had a
significantly greater number of smokers in the household and decreased knowledge 
about day care as a risk for OM. The urban population's question responses
suggested a greater willingness to change day care arrangements to reduce the
risk of otitis media. CONCLUSIONS: Both populations demonstrated knowledge
deficits regarding risk factors associated with OM and both populations exhibited
willingness to modify behaviors to reduce risk. These findings demonstrate that
there are opportunities for improving education regarding OM risk factors and
that this education could potentially reduce risk for OM and in turn reduce the
incidence of OM in children.

Publication Types: 
    Comparative Study

PMID: 15627446 [PubMed - indexed for MEDLINE]

1189: Pediatr Infect Dis J. 2004 Dec;23(12):1142-52.

Haemophilus influenzae: a significant pathogen in acute otitis media.

Leibovitz E, Jacobs MR, Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center and the
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,
Israel.

Haemophilus influenzae is a major pathogen in acute otitis media (AOM) causing
disease that is not clinically distinguishable from that caused by Streptococcus 
pneumoniae. AOM caused by H. influenzae is particularly associated with older age
and recurrent disease. Antibiotics differ in their ability to eradicate H.
influenzae from the middle ear space. In the United States, widespread
pneumococcal vaccination has increased the importance of H. influenzae as a major
therapeutic challenge in the treatment of AOM.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 15626953 [PubMed - indexed for MEDLINE]

1190: Infect Immun. 2005 Jan;73(1):609-11.

Development of a chinchilla model to allow direct, continuous, biophotonic
imaging of bioluminescent nontypeable Haemophilus influenzae during experimental 
otitis media.

Novotny LA, Mason KM, Bakaletz LO.

Center for Microbial Pathogenesis, Columbus Children's Research Institute, The
Ohio State University College of Medicine and Public Health, Rm. W591, 700
Children's Dr., Columbus, OH 43205-2696, USA.

We transformed a nontypeable Haemophilus influenzae clinical isolate with a
plasmid containing the luxCDABE operon driven by the H. influenzae outer membrane
protein P2 promoter. Herein, we demonstrate the ability to detect bioluminescence
and to monitor infection within the nasopharynges, eustachian tubes, and middle
ears of chinchillas after intranasal and transbullar challenges.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15618201 [PubMed - indexed for MEDLINE]

1191: Infect Immun. 2005 Jan;73(1):599-608.

A mutation in the sap operon attenuates survival of nontypeable Haemophilus
influenzae in a chinchilla model of otitis media.

Mason KM, Munson RS Jr, Bakaletz LO.

Department of Pediatrics, Center for Microbial Pathogenesis, Columbus Children's 
Research Institute, The Ohio State University College of Medicine and Public
Health, Columbus, OH 43205-2696, USA.

Bacteria have evolved strategies to resist killing by antimicrobial peptides
(APs), important effectors of innate immunity. The sap (sensitivity to
antimicrobial peptides) operon confers resistance to AP-mediated killing of
Salmonella. We have recently shown that sapA gene expression is upregulated in
the middle ear in a chinchilla model of nontypeable Haemophilus influenzae
(NTHI)-induced otitis media. Based on these findings, we constructed an NTHI
strain containing a Lux reporter plasmid driven by the sapA promoter and
demonstrated early yet transient expression of the sap operon within sites of the
chinchilla upper airway upon infection. We hypothesized that the sap operon
products mediate NTHI resistance to APs. In order to test this hypothesis, we
constructed a nonpolar mutation in the sapA gene of NTHI strain 86-028NP, a
low-passage-number clinical isolate. The sapA mutant was approximately eightfold 
more sensitive than the parent strain to killing by recombinant chinchilla
beta-defensin 1. We then assessed the ability of this mutant to both colonize and
cause otitis media in chinchillas. The sapA mutant was significantly attenuated
compared to the parent strain in its ability to survive in both the nasopharynx
and the middle ear of the chinchilla. In addition, the mutant was impaired in its
ability to compete with the parent strain in a dual-strain challenge model of
infection. Our results indicate that the products of the sap operon are important
for resisting the activity of APs and may regulate, in part, the balance between 
normal carriage and disease caused by NTHI.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15618200 [PubMed - indexed for MEDLINE]

1192: Infect Immun. 2005 Jan;73(1):369-77.

Kinetics and avidity of antibodies evoked by heptavalent pneumococcal conjugate
vaccines PncCRM and PncOMPC in the Finnish Otitis Media Vaccine Trial.

Ekström N, Ahman H, Verho J, Jokinen J, Väkeväinen M, Kilpi T, Käyhty H.

Vaccine Immunology Laboratory, National Public Health Institute, Mannerheimintie 
166, 00300 Helsinki, Finland. nina.ekstrom@ktl.fi

The licensure of new pneumococcal conjugate vaccines (PCVs) relies on
immunogenicity data. When defining correlates of protection, vaccine efficacy
data must be included. In the FinOM Vaccine Efficacy Trial, the PncOMPC vaccine
showed an efficacy profile similar to that of the licensed PncCRM vaccine despite
different antibody responses after primary and booster vaccinations. We
determined antibody kinetics and avidities in a subgroup of infants participating
in the FinOM trial. A total of 166 infants in three vaccine groups were immunized
at 2, 4, 6, and 12 months of age with 7-valent PCV, PncCRM or PncOMPC, or
hepatitis B vaccine. Concentrations of serum immunoglobulin G (IgG) against
pneumococcal capsular polysaccharides were determined at 2, 4, 6, 7, 12, 13, and 
24 months of age, and the avidity index (AI) to serotypes 6B, 19F, and 23F were
determined at 7, 12, 13, and 24 months of age by enzyme immunoassay. Both PCVs
were highly immunogenic, but they demonstrated different kinetics of antibody
response; the concentration of IgG against serotypes 6B, 19F, and 23F declined
faster after the third and fourth doses of vaccine in the PncCRM group than in
the PncOMPC group. For both PCVs, the mean AI of anti-6B and -23F, but not of
anti-19F, increased during the follow-up, which is in line with serotype-specific
protection in the FinOM trial. Our data suggest that the kinetics and avidities
of antibodies should be considered, in addition to antibody responses, when
defining correlates of protection.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 15618174 [PubMed - indexed for MEDLINE]

1193: Pediatr Ann. 2004 Dec;33(12):843-53.

Management of the draining ear in children.

Schroeder A, Darrow DH.

Department of Otolaryngology--Head & Neck Surgery, Portsmouth Naval Medical
Center, Portsmouth, VA, USA.

There are a variety of causes of otorrhea in children. The most important factor 
in reaching the proper diagnosis and providing relief of the problem is aural
toilet. Once adequate debridement has been performed, the diagnosis is usually
clearer, and treatment with ototopicals is significantly more effective. Most
cases of otorrhea are due to infection or granulation tissue and can be managed
initially with appropriately selected ototopical medication, thereby avoiding the
risks and side effects of systemic therapy and the need for referral to a
specialist. However, otorrhea in children that is refractory to medical therapy
may be due to retained tympanostomy tubes or insidious pathology such as
cholesteatoma or malignancy. In such cases, prompt referral to the
otolaryngologist can facilitate accurate diagnosis and successful management.

Publication Types: 
    Review

PMID: 15615311 [PubMed - indexed for MEDLINE]

1194: Clin Infect Dis. 2005 Jan 1;40(1):52-7. Epub 2004 Dec 6.

Association of clinical signs and symptoms with pneumococcal acute otitis media
by serotype--implications for vaccine effect.

Palmu AA, Jokinen JT, Kaijalainen T, Leinonen M, Karma P, Kilpi TM.

National Public Health Institute, Helsinki, Finland. arto.palmu@ktl.fi

BACKGROUND: Clinical symptoms and signs in acute otitis media (AOM) may differ
depending on the various pneumococcal serotypes causing the disease. Alteration
in clinical presentation of AOM could be expected after wide-scale pneumococcal
vaccinations if there were considerable differences between vaccine serotypes and
nonvaccine serotypes. METHODS: In this study, data from 831 children in the
control arm of the Finnish Otitis Media Vaccine Trial were used. The children
were followed up prospectively in 8 study clinics from 2 to 24 months of age. If 
AOM was diagnosed, myringotomy was done, and middle ear fluid was aspirated for
bacterial culture. Clinical symptoms and signs of AOM were routinely recorded on 
structured case report forms. RESULTS: Consistent with previous studies, 60% of
pneumococcal episodes were caused by vaccine serotypes. There were no major
differences between the clinical presentations of AOM due to different serotypes 
or serotype categories. However, earache was more often associated with AOM
caused by vaccine and cross-reactive serotypes, compared with AOM caused by
non-vaccine-related serotypes (42% vs. 29%; odds ratio, 1.66; 95% confidence
interval, 1.02-2.70). CONCLUSIONS: Introduction of the currently available
pneumococcal conjugate vaccine is unlikely to result in a remarkable alteration
in the clinical presentation of pneumococcal AOM in infants.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15614692 [PubMed - indexed for MEDLINE]

1195: Paediatr Drugs. 2004;6(6):387-93.

Parent-reported outcomes for treatment of acute otitis media with cefdinir or
amoxicillin/clavulanate oral suspensions.

Cifaldi MA, Paris MM, Devcich KJ, Bukofzer S.

Health Economics and Outcomes Research, Abbott Laboratories, Abbott Park,
Illinois 60064-6124, USA. Mary.Cifaldi@abbott.com

OBJECTIVE: To compare parent-reported outcomes (satisfaction, tolerability,
compliance, and work/daycare missed) for children (aged 6 months to 6 years)
receiving either cefdinir or amoxicillin/clavulanate for acute otitis media.
METHOD: In a phase IV, investigator-blinded, parallel-group, randomized,
multicenter study, parents or legal guardians were asked to complete the Otitis
Parent Questionnaire (OPQ) 12-14 days after the first dose of cefdinir or
amoxicillin/clavulanate oral suspensions. Responses in each of the outcome
domains were analyzed using non-parametric statistical analysis. RESULTS: Of 367 
parents/guardians who completed the questionnaire, better ease of use (p = 0.009)
and taste (p < 0.0001) were associated with cefdinir versus
amoxicillin/clavulanate treatment, and children were significantly more likely to
experience vomiting with amoxicillin/clavulanate (16% vs 8%; p = 0.016). Parents 
also reported that their children were much more likely to take all of their
medication if receiving cefdinir (68% vs 53% for amoxicillin/clavulanate; p =
0.005). There were no statistically significant differences between groups in
work/daycare missed. CONCLUSION: Based on parents' assessment using the OPQ,
cefdinir was easier to administer and tasted better than amoxicillin/clavulanate.
Children who received cefdinir also experienced less vomiting and had greater
compliance than children who received amoxicillin/clavulanate.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15612839 [PubMed - indexed for MEDLINE]

1196: Arch Otolaryngol Head Neck Surg. 2004 Dec;130(12):1407-10.

Ultrasonic detection of middle ear effusion: a preliminary study.

Discolo CM, Byrd MC, Bates T, Hazony D, Lewandowski J, Koltai PJ.

Section of Pediatric Otolaryngology, Head and Neck Institute, The Cleveland
Clinic Foundation, Cleveland, Ohio, USA.

OBJECTIVE: To assess the ability to detect and characterize middle ear effusion
in children using A-mode ultrasonography. DESIGN: Prospective nonblinded
comparison study. SETTING: Tertiary children's hospital. PATIENTS: Forty children
(74 ears) scheduled to undergo bilateral myringotomy with pressure equalization
tube placement. INTERVENTIONS: Before myringotomy, ultrasound examination of the 
tympanic membrane and middle ear space was performed on each ear. Afterward,
myringotomy was performed and the type of effusion (serous, mucoid, or purulent) 
was recorded. Pressure equalization tubes were then placed. MAIN OUTCOME MEASURE:
Comparison of ultrasound findings with the visual assessment of the type of
middle ear effusion present. RESULTS: Of the 74 ears tested, 45 (61%) had
effusion on direct inspection. The effusion was purulent in 8 ears (18%), serous 
in 9 ears (20%), and mucoid in 28 ears (62%). Ultrasound identified the presence 
or absence of effusion in 71 cases (96%) (P = .04). Ultrasound distinguished
between serous and mucoid effusion with 100% accuracy (P = .04). The probe did
not distinguish between mucoid and purulent effusion. CONCLUSIONS:
Ultrasonography is an accurate method of diagnosing middle ear effusion in
children. Moreover, it can distinguish thin from mucoid fluid. Further
refinements in probe design may further improve the sensitivity of fluid
detection and allow differentiation of sterile vs infectious effusion.

Publication Types: 
    Comparative Study

PMID: 15611400 [PubMed - indexed for MEDLINE]

1197: Int J Technol Assess Health Care. 2004 Fall;20(4):488-92.

Policy relevance of Bayesian statistics overestimated?

van der Wilt GJ, Rovers M, Straatman H, van der Bij S, van den Broek P, Zielhuis 
G.

Department of Medical Technology Assessment, University Medical Centre Nijmegen, 
The Netherlands. G.vanderwilt@mta.umcn.nl

OBJECTIVES: The observed posterior probability distributions regarding the
benefits of surgery for otitis media with effusion (OME) with expected
probability distributions, using Bayes' theorem are compared. METHODS: Postal
questionnaires were used to assess prior and posterior probability distributions 
among ear-nose-throat (ENT) surgeons in the Netherlands. RESULTS: In their prior 
probability estimates, ENT surgeons were quite optimistic with respect to the
effectiveness of tube insertion in the treatment of OME. The trial showed no
meaningful benefit of tubes on hearing and language development. Posterior
probabilities calculated on the basis of prior probability estimates and trial
results differed widely from those, elicited empirically 1 year after completion 
of the trial and dissemination of the results. CONCLUSIONS: ENT surgeons did not 
adjust their opinion about the benefits of surgical treatment of glue ears to the
extent that they should have done according to Bayes' theorem. Users of the
results of Bayesian analyses, notably policy-makers, should realize that Bayes'
theorem is prescriptive and not necessarily descriptively correct. Health policy 
decisions should not be based on the untested assumption that health-care
professionals use new evidence to adjust their subjective beliefs in a Bayesian
manner.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15609800 [PubMed - indexed for MEDLINE]

1198: J Vet Med B Infect Dis Vet Public Health. 2004 Dec;51(10):449-54.

Microbiological features of Staphylococcus schleiferi subsp. coagulans, isolated 
from dogs and possible misidentification with other canine coagulase-positive
staphylococci.

Zdovc I, Ocepek M, Pirs T, Krt B, Pinter L.

Veterinary Faculty, Institute of Microbiology and Parasitology, University of
Ljubljana, Gerbiceva 60, 1115 Ljubljana, Slovenia. irena.zdovc@vf.uni-lj.si

Staphylococcus schleiferi subsp. coagulans has only rarely been isolated and
identified from the external auditory meatus of dogs suffering from external
otitis. Its morphological and basic biochemical characteristics are of relatively
little value for identification, as it phenotypically resembles another
coagulase-positive staphylococci (CPS) and, consequently, may be easily
misidentified as S. intermedius or even as S. aureus. In the present work,
differentiation of S. schleiferi ssp. coagulans was therefore based on specific
biochemical and genetic methods. All the strains were evaluated with the
following commercial methods: Api Staph System (bioMérieux, Marcy l'Etoil,
France), BBL Crystal Identification Systems (Gram-Positive ID Kit and Rapid
Gram-Positive ID Kit; Becton Dickinson), and GEN-PROBE AccuProbe, Staphylococcus 
aureus identification test (bioMérieux). Gram-Positive ID System/GP database
includes the broadest range of staphylococcal species and correctly identifies
the majority of strains important in veterinary medicine. Therefore, it is an
acceptable alternative to conventional methods for identification of canine
staphylococcal isolates. Reliable differentiation of S. aureus from S. schleiferi
ssp. coagulans and S. intermedius was feasible with AccuProbe for S. aureus,
which gave positive results only for S. aureus; all other CPS tested were
negative.

Publication Types: 
    Evaluation Studies

PMID: 15606869 [PubMed - indexed for MEDLINE]

1199: Rev Laryngol Otol Rhinol (Bord). 2004;125(3):171-3.

Tuberculous acute mastoiditis--a rare diagnosis. A case report.

Mustafa A, Wiorowski M, Schultz P, Debry Ch.

University Clinical Centre, ENT-Head and Neck Surgery Clinic, Prishtina, Kosovo, 
UNMIK. aziz_mustafa2000@yahoo.com

Tuberculous acute mastoiditis (TAM) is a rare inflammatory infective condition of
the mastoid process that can be difficult to diagnose. We presente the case of a 
65-year-old women with earache, ear purulent discharge and tenderness of the
mastoid tip after long time of medical therapy. Mastoidectomy with
attico-antrotomy revealed chronic granulations with an osteitic process of
mastoid and tympanic cavity with intact ossicular chain. Standard medical therapy
resulted with prompt healing. Despite its rarity, diagnosis of TAM is often
delayed, with potentially danger for severe complications.

Publication Types: 
    Case Reports

PMID: 15602861 [PubMed - indexed for MEDLINE]

1200: Rev Laryngol Otol Rhinol (Bord). 2004;125(3):165-9.

Treatment of acute mastoiditis: report of 31 cases over a ten year period.

Mustafa A, Debry Ch, Wiorowski M, Martin E, Gentine A.

University Clinical Centre, ENT-Head and Neck Surgery Clinic, Prishtina, Kosovo, 
UNMIK. aziz_mustafa2000@yahoo.com

OBJECTIVE: With possible extracranial and intracranial complications, acute
mastoiditis is the leading complication of acute otitis media (AOM). The goal of 
this study is to assess the clinical features, pathogens, complications and
especially management of acute mastoiditis in the ENT service, University
Hospital of Strasbourg, France. METHODS: Systematic review of all medical records
of patients who were admitted with acute mastoiditis from January 1993 to April
2003. RESULTS: 31 patients, 18 male (58%) and 13 female (42%) fulfilled inclusion
criteria. The average age was 16, going from 6 months to 70 years, with 55%
between 0 to 5 years. Most common symptom was otalgia (84%), 58% of patients had 
history of past AOM and 61% were under antibiotic therapy during admission.
Twenty-three patients (74%) presented retroauricular swelling and erythema. 18
(58%) had a displaced pinna. Cultures taken from pus isolated Streptococcus
pneumoniae in 12 cases (38.7%), Pseudomonas aeruginosa in 2 cases (6.4%),
Streptococcus beta-haemolyticuis 1 case, Staphylococcus coagulase-positive 1 case
and Mycobacterium tuberculosis hominis 1 case (3%). Complications of acute
mastoiditis occurred in 3 cases (10%): Meningitis 2 cases and facial nerve
paralysis 1 case. Surgery therapy was periformed in 84% of cases (mastoidectomy
only or in combination with myringotomy with tube insertion) and medical therapy 
only in 16% of cases. CONCLUSION: Despite use of antibiotics, acute mastoiditis
remains still a threat for patients with AOM, especially for children under 5
years of age. Great care is required from clinicians to make an early diagnosis
in order to promote adequate management and prevent complications.

PMID: 15602860 [PubMed - indexed for MEDLINE]

1201: J Med Microbiol. 2005 Jan;54(Pt 1):83-5.

Antimicrobial resistance in the nasopharyngeal flora of children with acute
otitis media and otitis media recurring after amoxicillin therapy.

Brook I, Gober AE.

Department of Pediatrics, Georgetown University School of Medicine, 4431
Albemarle St NW, Washington DC 20016, USA. ib6@georgetown.edu

The objective of this study was to investigate the antimicrobial susceptibility
of the organisms isolated from the nasopharynx of children who presented with
acute otitis media (AOM) or otitis media that recurred after amoxicillin therapy.
Nasopharyngeal cultures obtained from 72 patients, 40 with AOM and 32 with
recurrent otitis media (ROM), were analysed. Thirty-six potentially pathogenic
organisms were recovered in 34 (85 %) of the children from the AOM group, and 42 
were isolated from 29 (91 %) of the children from the ROM group. The organisms
isolated were Streptococcus pneumoniae (n = 26), Haemophilus influenzae non-type 
b (n = 22), Moraxella catarrhalis (n = 13), Streptococcus pyogenes (n = 8) and
Staphylococcus aureus (n = 9). Resistance to the eight antimicrobial agents used 
was found in 37 instances in the AOM group as compared to 99 instances in the ROM
group (P < 0.005). The difference between AOM and ROM was significant with
Streptococcus pneumoniae resistance to amoxicillin (P < 0.005), to
amoxicillin/clavulanate (P < 0.005), to trimethoprim/sulfamethoxazole (P < 0.01),
to cefixime (P < 0.01) and to azithromycin (P < 0.01), and for H. influenzae
resistance to amoxicillin (P < 0.025). These data illustrate the higher recovery 
rate of antimicrobial-resistant Streptococcus pneumoniae and H. influenzae from
the nasopharynx of children who had otitis media that recurred after amoxicillin 
therapy than those with AOM.

PMID: 15591260 [PubMed - indexed for MEDLINE]

1202: ORL J Otorhinolaryngol Relat Spec. 2004;66(5):233-40.

Genotyping of Streptococcus pneumoniae and Haemophilus influenzae isolated from
paired middle ear fluid and nasopharynx by pulsed-field gel electrophoresis.

Hotomi M, Yamanaka N, Billal DS, Sakai A, Yamauchi K, Suzumoto M, Takei S, Yasui 
N, Moriyama S, Kuki K.

Department of Otolaryngology - Head and Neck Surgery, Wakayama Medical
University, Kimiidera 811-1, Wakayama-shi, Wakayama, Japan.
mhotomi@wakayama-med.ac.jp

Twenty-eight isolates of Streptococcus pneumoniae and 30 isolates of Haemophilus 
influenzae from paired nasopharynx and middle ear fluids of 21 children with
acute otitis media (AOM) were evaluated to determine genotypes by polymerase
chain reaction and pulsed-field gel electrophoresis (PFGE). Among the 28 isolates
of S. pneumonaie, 21 isolates (75.0%) possessed mutations in the pbp1a,pbp2x, and
pbp2b genes, and 7 isolates (25%) had mutations in the pbp2x gene. Nineteen
isolates (67.9%) expressed the mefE gene, and 5 isolates (17.9%) possessed the
ermB gene. Among the 30 isolates of H. influenzae, 5 isolates (16.7%) had
mutations in pbp3 genes, 3 isolates (10.0%) produced beta-lactamase, and 2 (6.7%)
isolates possessed mutations both in the pbp3 gene and the beta-lactamase gene.
Ten out of the 14 pairs (71.4%) of the restriction fragment patterns of S.
pneumoniae from paired nasopharynx and middle ear fluids were indistinguishable
following PFGE analysis. The same patterns were identified among 5 children of
unrelated families. The restriction fragment patterns of H. influenzae isolated
by PFGE were also indistinguishable in 13 out of the 15 pairs (86.7%) of
nasopharynx and middle ear fluids. The genetic similarity between nasopharyngeal 
and middle ear isolates suggests that the causative bacteria migrate from the
nasopharynx into the middle ear cavity via the Eustachian tube. Some resistant
strains might be prevalent. In children with AOM, the nasopharynx could have been
colonized by a virulent strain of bacteria that replaced the benign, commensal
bacteria and then progressed to the middle ear, where they caused AOM. Copyright 
2004 S. Karger AG, Basel.

PMID: 15583436 [PubMed - indexed for MEDLINE]

1203: Otolaryngol Head Neck Surg. 2004 Dec;131(6):917-20.

Diagnosis of middle ear disease using tympanograms and digital imaging.

Aronzon A, Ross AT, Kazahaya K, Ishii M.

Department of Otolaryngology--Head and Neck Surgery, University of Pennsylvania
Medical Center, Philadelphia, USA.

OBJECTIVE: The study investigates the ability of physicians with different levels
of training to accurately identify middle ear (ME) pathology using tympanograms
and tympanic membrane (TM) digital photographs. STUDY DESIGN AND SETTING: Groups 
of medical students, internal medicine residents, and attending and resident
otolaryngologists were presented with a set of 50 matched tympanograms and
photographs of TMs. The physicians were asked to differentiate between a normal
and an abnormal-appearing TM. The sensitivity and specificity of diagnosis of ME 
pathology by physicians were compared with the gold standard, examining the ME
cavity for pathology during myringotomy. RESULTS: The sensitivity did not vary
among physicians with different levels of training; however, specificity improved
with an increase in physician experience. CONCLUSIONS AND SIGNIFICANCE: This
study establishes a baseline for accuracy of diagnosis of ME pathology using
tympanograms and photographs of TMs as compared with binocular otomicroscopy and 
the gold standard, myringotomy. EBM RATING: B-2.

Publication Types: 
    Comparative Study

PMID: 15577789 [PubMed - indexed for MEDLINE]

1204: Otolaryngol Head Neck Surg. 2004 Dec;131(6):797-803.

The role of oxidants and antioxidants in otitis media with effusion in children.

Yilmaz T, Koçan EG, Besler HT, Yilmaz G, Gürsel B.

Department of Otolaryngology--Head and Neck Surgery, Hacettepe University Faculty
of Medicine, Ankara, Turkey. tyilmaz@hacettepe.edu

OBJECTIVE: Determine the possible role of oxidants and antioxidants in the
pathogenesis of otitis media with effusion in children. STUDY DESIGN AND SETTING:
Randomized controlled trial, tertiary referral center. The study group was made
up of children with otitis media with effusion who were to undergo bilateral
ventilation tube insertion and adenoidectomy. The control group was comprised of 
otherwise healthy children. The blood levels of antioxidants (retinol,
beta-carotene, alpha-tocopherol, laycopene, ascorbic acid, superoxide dismutase, 
glutathione peroxidase, GSH) and oxidation products (malondialdehyde) were
determined before and 1 month after the operation in the study group and once
only in the control group. These substances were also measured in the adenoid
tissue and middle ear fluids. RESULTS: In the study group, the blood levels of
antioxidants and oxidants before and after the operation were significantly
different when compared with the control group (P < 0.05). In the study group,
the blood antioxidant levels increased and oxidant levels decreased significantly
after the operation (P < 0.05). The levels after the operation never reached
those of the control group. CONCLUSIONS AND SIGNIFICANCE: Oxidants and
antioxidants played a significant role in the pathogenesis of otitis media with
effusion in children. These children are under significant oxidative stress.
Insertion of a ventilation tube and adenoidectomy significantly decreased the
oxidative stress in these patients, but could not normalize it completely.
Additional studies are necessary in the clinical use of antioxidants in otitis
media with effusion.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15577771 [PubMed - indexed for MEDLINE]

1205: Auris Nasus Larynx. 2004 Dec;31(4):361-8.

The effects of hypoxia, premature birth, infection, ototoxic drugs, circulatory
system and congenital disease on neonatal hearing loss.

Yoshikawa S, Ikeda K, Kudo T, Kobayashi T.

Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University
Graduate School of Medicine, Aoba-ku, Sendai 980-8575, Japan. yoshikaway@aol.com

OBJECTIVES: To investigate the incidence of neonatal hearing loss in well-baby
populations and in a neonatal intensive care unit and to identify potential risk 
factors for hearing loss in a neonatal intensive care unit which the Joint
Committee on Infant Hearing (JCIH) had not recommended. METHODS: Auditory
screening was conducted in 226 infants (452 ears) born in Tohoku University from 
2000 to 2001. The cases included 124 healthy newborn infants (248 ears), and 102 
newborn infants (204 ears) treated in the neonatal intensive care unit (NICU).
Hearing impairment was confirmed through a primary screening of the automated
auditory brainstem response (AABR) and a secondary test of the auditory brainstem
response (ABR) with otolaryngologic evaluation. Based on these examinations, we
divided infants into two groups, 'Pass' and 'Refer'. RESULTS: Nine patients (15
ears) in Refer group were identified through our protocol. The incidence of the
Refer group was 0.8% (1 out of 124) in the well-baby nursery, 7.8% (8 out of 102)
in the NICU populations. The infants in Refer group were shown to have a higher
incidence of congenital infection (P < 0.01), high C-reactive protein (CRP) (> or
=10 mg/dl), chromosomal aberration, and central nervous system abnormality (P <
0.05). On the other hand, there were no statistical differences between the Pass 
and Refer groups in NICU, birth weight (<2200 g), gestational age, the values of 
total serum bilirubin, the values of arterial blood gases (pH, PaCO2 , PaO2 ),
percutaneous oxygen saturation (SpO2), hemodynamics (blood pressure and heart
rate) (P > 0.1). Respiratory status such as the Apgar score (the abbreviation for
appearance, pulse, grimace, activity, respiration) (1 min; < or =4), (5 min; < or
=6), Silverman retraction score, ototoxic drug use, respiratory distress syndrome
(RDS), Meconium aspiration syndrome (MAS), and persistent pulmonary hypertension 
of newborn (PPHN) were also not statistically related to hearing loss (>0.999).
CONCLUSION: Even in a small number of infants, there are positive relationships
between hearing loss and congenital infection, high CRP (> or =10 mg/dl),
chromosomal aberration and central nervous system abnormality. The CRP (> or =10 
mg/dl) variable are not listed in the high-risk register published by the JCIH,
but we can say that the variable may predict hearing impairment in our patient
population. The possibility of autosomal recessive inheritance of genes for
deafness is supposed when newborns have no other risk factors for hearing loss.
This leads us to conclude that hearing screening is an effective way to find out 
hearing loss population.

PMID: 15571908 [PubMed - indexed for MEDLINE]

1206: Auris Nasus Larynx. 2004 Dec;31(4):341-5.

Relationship between respiratory syncytial virus infection and acute otitis media
in children.

Sagai S, Suetake M, Yano H, Yoshida M, Ohyama K, Endo H, Takayanagi R, Nishimura 
H, Kobayashi T.

Department of Otolaryngology, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku,
Sendai 981-8563, Japan.

BACKGROUND: Respiratory syncytial virus (RSV) is among the major causes of
respiratory tract infection in infants and young children, and concomitant acute 
otitis media (AOM) often develops. However, there are only a few reports about
AOM associated with RSV infection. METHODS: Two hundred and thirty children who
were diagnosed as having RSV infection were studied by enzyme immunoassay
(Testpack RSV) at the Department of Pediatrics of Tohoku Rosai Hospital from 1
November 2001 to 31 October 2002. In the patients with AOM, bacterial culture and
detection of RSV antigen in the middle ear fluid (MEF) by enzyme immunoassay were
performed, and the outcome was investigated. RESULTS: Among the 230 children, 120
(52.2%) were found to have AOM. In children under 2 years of age, the incidence
of AOM was significantly higher (73.1%) than in the older children (29.7%). RSV
antigen was positive in the MEF of 36 out of 52 patients with AOM (69.2%). In 24 
of the 46 patients in whom both RSV antigen detection and bacterial culture of
MEF were performed, RSV antigen was detected and bacterial culture was negative. 
Although the outcome of the first episode of AOM following RSV infection was
favorable, relapse was observed in 31% of the patients. CONCLUSION: These results
confirm that patients with RSV infection have a high risk of AOM, especially
children younger than 2 years of age, and suggest that RSV may be a direct cause 
of AOM at least in the early stage of infection with this virus. The necessity of
performing careful follow-up of AOM after resolution of symptoms is suggested
because relapse is common.

PMID: 15571905 [PubMed - indexed for MEDLINE]

1207: Ann Otol Rhinol Laryngol. 2004 Nov;113(11):872-6.

Anatomic and functional long-term results of canal wall-down mastoidectomy.

Kos MI, Castrillon R, Montandon P, Guyot JP.

Department of Otolaryngology-Head and Neck Surgery, University Hospital, 24, Rue 
Micheli-du-Crest, 1211 Geneva 14, Switzerland.

The objective of this study was to evaluate, over the long-term, the anatomic and
functional outcome of canal wall-down mastoidectomy performed for chronic otitis 
media with cholesteatoma and chronic otomastoiditis resistant to all conservative
treatment. The study was made through a retrospective review of 338 cases of
consecutive primary canal wall-down mastoidectomies performed between 1974 and
1998. Included were 259 cases with sufficient data. In all cases, functional
reconstruction was performed at the same time as the mastoidectomy. Demographic
and clinical data were collected from each file. From the clinical data, the
surgical techniques, complications, the number of follow-up visits necessary to
ensure cavity cleanliness, details of care provided over the period 1 to 24 years
(mean, 7 years) after the operation, and audiometric data from admission and from
the latest postoperative follow-up were retained. Canal wall-down mastoidectomies
were followed up an average of 10 times during the first 6 months after
operation, twice a year over the 6-year period following surgery, and less than
twice a year beyond the 6-year period. Care was dispensed for meatal stenosis,
scars, infections, polyps, and beads of cholesteatoma. Surgical revisions were
performed because of residual or recurrent cholesteatoma in 6.1% of the cases,
because of perforation of the tympanic membrane in 7.3% of the cases, and to
improve hearing in 12.2% of the cases. At the last consultation, 1 to 24 years
after surgery, cavities were found to be dry and self-cleaning in 95% of the
cases, and still humid, with otorrhea, in 5% of the cases. Over the long-term,
the hearing threshold remained unchanged in 41.3% of the cases. It was improved
after surgery by 10 to 19 dB in 15.4% of the cases, by 20 to 29 dB in 11.5% of
the cases, and by more than 29 dB in 3.8% of the cases. The hearing threshold was
thus improved or at least remained unchanged in 72.0% of cases. Hearing losses
occurred in 28% of the cases: by 10 to 19 dB in 11.9%, by 20 to 29 dB in 6.5%,
and by more than 29 dB in 9.2% of the cases. A sensorineural hearing loss of more
than 60 dB at all frequencies occurred immediately after the operation in 2 cases
(0.7%).There was 1 case of facial paralysis (0.3%). Four patients (1.5%)
complained of persistent vertigo. Canal wall-down mastoidectomy is an adequate
treatment for chronic otitis with cholesteatoma or chronic otomastoiditis. The
anatomic and functional results are satisfactory, and the rate of complications
is acceptably low. A tympanoplasty can be performed simultaneously. Thus, for the
large majority of patients, only a single intervention is required; however, a
small minority can benefit from a revision tympanoplasty. In order to obtain
these results, both the patient and the surgeon should engage in a long-term
follow-up.

PMID: 15562896 [PubMed - indexed for MEDLINE]

1208: Am Fam Physician. 2004 Nov 1;70(9):1713-20.

Tympanometry.

Onusko E.

Clinton Memorial Hospital, Wilmington, Ohio, USA.

Tympanometry provides useful quantitative information about the presence of fluid
in the middle ear, mobility of the middle ear system, and ear canal volume. Its
use has been recommended in conjunction with more qualitative information (e.g., 
history, appearance, and mobility of the tympanic membrane) in the evaluation of 
otitis media with effusion and to a lesser extent in acute otitis media. It also 
can provide useful information about the patency of tympanostomy tubes.
Tympanometry is not reliable in infants younger than seven months because of the 
highly compliant ear canals of infants. Tympanogram tracings are classified as
type A (normal), type B (flat, clearly abnormal), and type C (indicating a
significantly negative pressure in the middle ear, possibly indicative of
pathology). According to the Agency for Healthcare Research and Quality
guidelines on otitis media with effusion, the positive predictive value of an
abnormal (flat, type B) tympanogram is between 49 and 99 percent. A type C curve 
may be useful when correlated with other findings, but by itself it is an
imprecise estimate of middle ear pressure and does not have high sensitivity or
specificity for middle ear disorders.

Publication Types: 
    Review

PMID: 15554489 [PubMed - indexed for MEDLINE]

1209: J Laryngol Otol. 2004 Oct;118(10):827-9.

Preoperative evaluation of bone destruction using three-dimensional computed
tomography in cholesteatoma.

Jang CH, Wang PC.

Department of Otolaryngology, Wonkwang Medical School, Iksan, 570-711, South
Korea. chul@wonkwang.ac.kr

This study investigated the usefulness of three-dimensional computed tomography
(3DCT) in the evaluation of bony defects caused by cholesteatoma. Fifteen
patients with chronic otitis media with cholesteatoma who showed bony destruction
or suspicious destruction in two-dimensional CT were examined using 3DCT. The CT 
data were transferred to a workstation with a real-time image processor. We used 
three-dimensional reconstruction software enabling image processing. In all
patients, 3DCT clearly delineated the destruction of bony structures by
cholesteatoma. The 3DCT-generated images provided spatial relationships, which
were not easily appreciated on two-dimensional CT. Intraoperative bony
destruction findings correlated with 3DCT findings. From these results, 3DCT
could be useful to evaluate the invasiveness of cholesteatoma to the cranial
base. It could also be helpful in planning reconstruction during surgery.

PMID: 15550196 [PubMed - indexed for MEDLINE]

1210: Eur J Pediatr. 2005 Jan;164(1):3-8. Epub 2004 Nov 10.

Comment in:
    Eur J Pediatr. 2005 Jan;164(1):1-2.

Treatment and outcome of severe and non-severe acute otitis media.

Hotomi M, Yamanaka N, Samukawa T, Suzumot M, Sakai A, Shimada J, Ikeda Y, Faden
H.

Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, 
Wakayama, Japan.

To determine outcomes in acute otitis media (AOM) according to severity of
disease and to assess different initial treatment regimens, 308 with AOM were
enrolled and divided into severe (n = 277; 89.9%) and non-severe (n = 31; 10.1%) 
groups based on symptoms and tympanic membrane changes. Children in the severe
group were initially managed with amoxicillin (AMPC) whereas children in the
non-severe group were initially managed without antibiotics. Children were
monitored on days 1, 5, 10, 14 and 28. Five outcome measures were assessed:
disappearance of symptoms at day 5, resolution of tympanic membrane changes by
day 28, disappearance of middle ear effusions by day 28, recurrence of acute
symptoms prior to day 28, and need to change treatment regimens. Children with
severe disease were more often male (57% versus 36%, P < 0.05) and more often
colonized with pathogens (77% versus 55%, P < 0.05 than children with non-severe 
disease. The two groups were similar with respect to age and day care attendance.
Despite differences in initial treatment regimens between the two groups,
symptoms improved at the same rate for severe and non-severe disease, 94% by day 
5. In contrast, tympanic membranes returned to normal in 69% of the severe and
81% of the non-severe groups by day 28; however, as early as day 5, 10% of the
severe and 55% of the non-severe groups demonstrated normal tympanic membranes.
Middle ear effusions similarly disappeared more slowly in the severe group, 52%
versus 74% by day 14 and 76% versus 84% by day 28. Recurrence rates of acute
symptoms occurred with equal frequency in the severe, 15%, and non-severe groups,
10%. Failure of the symptoms or the tympanic membranes to improve led to
antibiotic changes in 59.9% of the severe group and to the addition of
antibiotics in 51.6% of the non-severe group. Children in the severe group who
failed to improve with an initial course of amoxicillin were younger (40.2 months
versus 45.8 months, P < 0.05), had higher tympanic membrane scores (4.5 versus
4.1, P < 0.05), and were more often colonized with penicillin-resistant
Streptococcus pneumoniae (33.8% versus 6.5%, P < 0.01) than children who
responded to AMPC. In a similar manner, children with non-severe disease who
failed to improve without antibiotics were younger (40.7 months versus 54.8
months, P < 0.05) and more often colonized with pathogens (75.0% versus 33.4%, P 
< 0.05). CONCLUSION: Severe disease occurred more often among males and among
children colonized with pathogens. Response to treatment was impaired in younger 
children and in children colonized with pathogens, especially
penicillin-resistant Streptococcus pneumoniae.

PMID: 15549378 [PubMed - indexed for MEDLINE]

1211: Curr Opin Pediatr. 2004 Dec;16(6):706-22.

Medical home, obesity, acute otitis media, and otitis media with effusion.

Spector ND, Kelly SF.

Drexel University College of Medicine and St. Christopher's Hospital for
Children, Philadelphia, Pennsylvania 19134, USA. nds24@EXCHANGE1.DREXEL.EDU

Four areas of pediatric office practice are reviewed: the medical home concept,
obesity, acute otitis media, and otitis media with effusion. The concept of the
medical home in the care of children with special health care needs, its effect
on health care outcomes, and its application to office practice are discussed.
The epidemiology and causes of obesity are covered along with options for obesity
screening and prevention. Diagnosis and therapy of acute otitis media and otitis 
media with effusion are reviewed along with discussion of recent practice
guidelines for both entities.

Publication Types: 
    Review

PMID: 15548936 [PubMed - indexed for MEDLINE]

1212: Curr Opin Otolaryngol Head Neck Surg. 2004 Dec;12(6):488-94.

The potential effect of widespread use of pneumococcal conjugate vaccines on the 
practice of pediatric otolaryngology: the case of acute otitis media.

Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center and the
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,
Israel. rdagan@bgumail.bgu.ac.il

PURPOSE OF REVIEW: This review provides the otolaryngologist with the evolving
understanding of various aspects of pneumococcal conjugate vaccines (PCVs) that
are related to their effect on the respiratory tract RECENT FINDINGS: The
efficacy of PCVs against invasive pneumococcal disease and pneumonia is well
established and is documented in several well-conducted studies. However, the
effect of PCVs on otitis media is less obvious and more complex. PCVs clearly
reduce diseases caused by vaccine-type (VT) pneumococci, but replacement of VT
serotypes by non-VT serotypes in nasopharyngeal carriage of Streptococcus
pneumoniae is responsible for the increase in acute otitis media (AOM) caused by 
non-VT serotypes. Furthermore, an increased rate of AOM caused by Haemophilus
influenzae and Moraxella catarrhalis was found. Since most antibiotic-resistance 
in S. pneumoniae is confined to VT serotypes, vaccine use also reduces antibiotic
resistance. The reduction of carriage by PCVs is responsible for the reduction of
spread of VT pneumococci (herd immunity). Thus a modification of AOM rather than 
just a simple reduction is seen with the widespread use of PCV. SUMMARY: Acute
otitis media in the era of widespread use of PCV is modified. A disease with
reduced VT serotypes, reduced antibiotic resistance, and a lower rate of sequelae
is to be expected. However, replacement with potential virulent organisms and
development of antibiotic resistance in non-VT pneumococci is a possibility that 
needs careful monitoring.

Publication Types: 
    Review

PMID: 15548905 [PubMed - indexed for MEDLINE]

1213: Am J Otolaryngol. 2004 Nov-Dec;25(6):442-6.

Rapid evolution of acute mastoiditis: three case reports of otogenic meningitis
in adults.

Felisati G, Di Berardino F, Maccari A, Sambataro G.

Ear, Nose, and Throat Department, University of Milan, Italy.

Otogenic meningitis is the most common intracranial complication of neglected
otitis media. In the western world, such complications seldom occur in children
and young adults and are extremely rare in adults and elderly people. The current
use of antibiotics and of more sophisticated surgery has greatly diminished the
incidence of otogenic meningitis in comparison with the past. This has resulted
in physicians having less experience concerning diagnosis and treatment of this
complication. The authors reported 3 consecutive cases of otogenic meningitis in 
adults, which occurred in the space of 3 months after a 6-year absence of such
pathology at their institution. In all 3 cases, conventional antibiotic therapy
proved ineffective; the course of the disease worsened rapidly in contrast with
the lack of symptoms during the period before treatment. Emergency surgical
treatment was mandatory.

Publication Types: 
    Case Reports

PMID: 15547816 [PubMed - indexed for MEDLINE]

1214: Otol Neurotol. 2004 Nov;25(6):885-90.

The Yung percutaneous mastoid vent: results of a multicenter trial.

Yung MW, Bowdler D, Swan IR.

Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK. yung@doctors.org.uk

OBJECTIVE: The primary goal of the study was to find out whether the Yung vent
would remain patent long-term. The secondary goal was to find out whether mastoid
ventilation could overcome permanent ventilation disorder within the middle ear. 
STUDY DESIGN: The study was an open prospective investigation. SETTING: The study
was a multicenter study involving three tertiary referral centers. PATIENTS:
Twenty-three subjects older than 12 years were included. The inclusion criteria
were complete atelectasis, failed tympanoplasty because of persistent eustachian 
tube dysfunction, and persistent otitis media with effusion in spite of repeated 
ventilation tube insertion. INTERVENTION: Tympanoplasty with insertion of the
Yung percutaneous mastoid vent. MAIN OUTCOME MEASURES: Patency of the vent,
adverse effects, patient acceptance, hearing results, and appearance of the
tympanic membrane were assessed every 3 months up to 18 months postoperatively.
RESULTS:: At 18 months, 20 of 23 vents were still patent. Overall, there had been
no unacceptable adverse effect on any patient. Eighteen of 23 ears had improved
hearing. The tympanic membrane had returned from a collapsed state to near normal
in 13 of 17 completely atelectatic ears. There were five patients who had no
benefit from the vent because of blockage within the epitympanum or middle ear
effusion. CONCLUSION: The Yung percutaneous mastoid vent can maintain long-term
patency. It is effective in the treatment of complete atelectasis as an adjunct
to tympanoplasty.

Publication Types: 
    Multicenter Study

PMID: 15547416 [PubMed - indexed for MEDLINE]

1215: Otol Neurotol. 2004 Nov;25(6):873-8.

Postauricular periosteal-pericranial flap for mastoid obliteration and canal wall
down tympanomastoidectomy.

Ramsey MJ, Merchant SN, McKenna MJ.

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard
Medical School, Boston, Massachusetts 02114, USA.

OBJECTIVE: To describe an effective technique for mastoid cavity obliteration in 
canal wall down tympanomastoidectomy for chronic otitis media and review its
efficacy in producing a dry, low-maintenance, small mastoid cavity. DESIGN::
Retrospective clinical study of a consecutive series of procedures from 1995 to
2000. SETTING: Tertiary referral center and institutional academic practice in
otology and neurotology. PATIENTS: Sixty consecutive procedures for active
chronic otitis media with a minimum follow-up of 12 months (mean, 31 mo; range,
12-80 mo). INTERVENTION: All patients had canal wall down mastoidectomy with
simultaneous tympanoplasty including split-thickness skin grafting. An inferiorly
pedicled, periosteal-pericranial flap was used in conjunction with autologous
bone pate to obliterate the mastoid cavity. The additional length provided by the
pericranial extension of the flap permitted it to reach superior to the lateral
canal and into the sinodural angle, with improved coverage of bone pate and
better reduction of cavity size. OUTCOME MEASURES: The primary outcome measure
was control of suppuration and creation of a dry, low-maintenance mastoid cavity,
which was assessed using a previously developed semiquantitative scale. This
scale includes a temporal dimension to assess control of infection. Secondary
outcome measures included postoperative complications (i.e., hematoma, infection,
flap necrosis, and meatal stenosis) and incidence of recurrent or residual
cholesteatoma. RESULTS: Forty-nine ears (82%) maintained a small, dry, healthy
mastoid cavity. Five ears (8%) had intermittent otorrhea easily controlled by
topical treatment. Six ears (10%) had suboptimal control of otorrhea, of which
four had meatal stenosis. There were no residual or recurrent cholesteatomas.
Outcomes remained stable over progressively longer follow-up, up to 80 months.
CONCLUSION: Obliteration of a canal wall down mastoid cavity by a postauricular
periosteal-pericranial flap with autologous bone pate is a reliable and effective
technique that results in a dry, trouble-free mastoid cavity in 90% of patients
with active chronic otitis media.

PMID: 15547414 [PubMed - indexed for MEDLINE]

1216: Pediatr Infect Dis J. 2004 Nov;23(11):1030-4.

Comment in:
    Pediatr Infect Dis J. 2006 Oct;25(10):960-1; author reply 961-2.

Otoscopic and tympanometric findings in acute otitis media yielding dry tap at
tympanocentesis.

Saeed K, Coglianese CL, McCormick DP, Chonmaitree T.

Department of Pediatrics, University of Texas Medical Branch at Galveston,
Galveston, TX, USA.

BACKGROUND: The value of tympanometry in detection of middle ear effusion (MEE)
has been widely studied in otitis media with effusion. There has been no direct
comparison of tympanometric and tympanocentesis (TAP) findings in acute otitis
media (AOM). We compared otoscopic, tympanometric and TAP findings in AOM
including cases of AOM without effusion. METHODS: In a study of AOM treatment of 
90 children, a tympanogram was obtained, and TAP was performed before and after 5
days of treatment. Subjects were followed with otoscopy and tympanometry every 2 
weeks for 3 months or until the MEE cleared. RESULTS: In 130 AOM ears, otoscopic,
tympanometric and TAP findings were available; MEE was obtained from 110 ears. Of
20 ears with a dry tap, 18 had abnormal tympanogram and otoscopic findings. With 
TAP findings as the standard, sensitivity and positive predictive value of type B
tympanogram were 97 and 87%, respectively. Of 18 AOM ears yielding dry tap, 2
yielded MEE 5 days later, and 8 continued with evidence of MEE 5 days-12 weeks
later. Five subjects with 8 AOM ears yielding dry tap were lost to follow-up; all
had short duration of clinical symptoms. CONCLUSIONS: Although otoscopic and
tympanometric findings suggested the presence of MEE in AOM, MEE was unobtainable
by TAP in 14% of cases. Dry tap cases likely represent early AOM before
accumulation of detectable MEE. However, technical difficulty in obtaining small 
amounts of or highly viscous MEE could not be excluded. Sensitivity and positive 
predictive value of abnormal tympanograms in detection of MEE in AOM cases are
comparable with those in otitis media with effusion.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

PMID: 15545858 [PubMed - indexed for MEDLINE]

1217: Eur Radiol. 2005 Apr;15(4):755-8. Epub 2004 Oct 22.

Comment in:
    Eur Radiol. 2006 Mar;16(3):762-3.

Mastoid effusion associated with dural sinus thrombosis.

Agid R, Farb RI.

Department of Medical Imaging, Division of Neuroradiology, Toronto Western
Hospital, University Health Network, University of Toronto, 399 Bathurst St.,
Toronto, ON, Canada, M5T 2S8. ronitagid@hotmail.com

We present a series of three patients with mastoid air cell effusions associated 
with adjacent lateral sinus thrombosis. In all of these cases, the findings
support the hypothesis that the mastoid effusion is secondary to sinus thrombosis
rather then the other way around. Also shown is the chronology and natural
evolution of mastoid air cell effusion secondary to sinus thrombosis as seen on
planar imaging.

PMID: 15538581 [PubMed - indexed for MEDLINE]

1218: J Allergy Clin Immunol. 2004 Nov;114(5):1110-5.

Similar allergic inflammation in the middle ear and the upper airway: evidence
linking otitis media with effusion to the united airways concept.

Nguyen LH, Manoukian JJ, Sobol SE, Tewfik TL, Mazer BD, Schloss MD, Taha R, Hamid
QA.

Department of Otolaryngology, McGill University, Montreal, Quebec, Canada.

BACKGROUND: Otitis media with effusion (OME) is a chronic inflammatory disease of
the middle ear space characterized by the accumulation of fluid. Previous
investigations have suggested that the immunopathologic mechanism underlying the 
development of middle ear effusion in patients with allergy is largely due to the
effects of T(H)2 mediators. The composition of the inflammatory substrate in the 
effusions of allergic otitis media is similar to the late-phase allergic response
seen elsewhere in the respiratory tract, such as in asthma and in allergic
rhinitis. OBJECTIVE: To determine whether the middle ear compartment may be a
component of the united airways in allergic disease by comparing the inflammatory
profiles of the middle ear to the upper airway. METHODS: Middle ear effusions,
torus tubaris (Eustachian tube mucosa at the nasopharyngeal orifice), and
adenoidal tissue biopsies were obtained from 45 patients undergoing simultaneous 
tympanostomy tube placement for OME and adenoidectomy for adenoid hypertrophy.
The cellular and cytokine profiles of each site were investigated by using
immunocytochemistry (elastase, CD3, major basic protein) and in situ
hybridization (IL-4, IL-5, IFN-gamma mRNA). Atopic status was determined for each
patient by using skin prick testing. RESULTS: Eleven of the 45 patients with OME 
(24%) were atopic. The middle ear effusions of atopic patients had significantly 
higher levels of eosinophils, T lymphocytes, and IL-4 mRNA + cells ( P < .01) and
significantly lower levels of neutrophils and IFN-gamma mRNA + cells ( P < .01)
compared with nonatopic patients. The nasopharyngeal tissue biopsies revealed
similar cellular and cytokine profiles. CONCLUSION: In atopic patients with OME, 
the allergic inflammation occurs on both sides of the Eustachian tube, both in
the middle ear and in the nasopharynx. The results of this study support the
concept that the middle ear may be part of the united airway in atopic
individuals.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15536418 [PubMed - indexed for MEDLINE]

1219: Paediatr Perinat Epidemiol. 2004 Nov;18(6):441-7.

Association of early-onset otitis media in infants and exposure to household
mould.

Pettigrew MM, Gent JF, Triche EW, Belanger KD, Bracken MB, Leaderer BP.

Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department
of Epidemiology and Public Health, Yale University School of Medicine, New Haven,
CT 06520-8034, USA. melinda.pettigrew@yale.edu

Otitis media is one of the most common infections of early childhood. Children
who first experience acute otitis media at an early age (before 6 months) are at 
increased risk for recurrent otitis media. This prospective study investigated
exposure to measured levels of airborne household mould and the risk of early
otitis media in the first 6 months of life among a cohort of infants at high risk
for asthma. Between September 1996 and December 1998, women were invited to
participate if they had at least one other child with physician-diagnosed asthma.
Mothers were given a standardised questionnaire within 4 months of their infant's
birth. Airborne mould samples were also taken at this time, and culturable fungi 
were categorised into four levels according to the report of the Commission of
European Communities: 0 (undetectable), 1-499 colony forming units (CFU)/m(3)
(low), 500-999 CFU/m(3) (medium), > or =1000 CFU/m(3) (high). Infant respiratory 
symptoms were collected during quarterly telephone interviews at 6, 9 and 12
months of age. Of the 806 children in the study, 27.8% experienced otitis media
before six months of age. Household levels of Penicillium and Cladosporium were
modestly associated with the number of otitis media episodes (P = 0.056 and 0.081
respectively). After controlling for potential confounders, Penicillium and
Cladosporium were not associated with early otitis media. High levels of 'other' 
mould (defined as total spore count minus counts for Penicillium, Cladosporium,
and yeast) were associated with early otitis media (OR 3.49; 95% CI [1.38,
8.79]). We also found associations between day-care outside of the home and birth
during the summer or fall season with early otitis media. This study is
suggestive of a relationship between otitis media and mould that warrants further
study.

Publication Types: 
    Multicenter Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 15535820 [PubMed - indexed for MEDLINE]

1220: Ann Otol Rhinol Laryngol. 2004 Oct;113(10):846-52.

Factors associated with clinical outcomes in acute otitis media.

Hotomi M, Yamanaka N, Shimada J, Ikeda Y, Faden H.

Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, 
Wakayama, Japan.

Acute otitis media (AOM) is a common disease in childhood. If predictors of
outcome in AOM were known, it would be possible to individualize therapy. Our aim
was to identify factors that predict the outcome in AOM. We enrolled 368 children
with AOM (ages, 10 to 86 months). The severity of symptoms and the severity of
tympanic membrane changes were graded with a scoring system. Nasopharyngeal
colonization with middle ear pathogens was determined on day 1. Three outcomes
were assessed: persistence of symptoms at day 5, persistence of tympanic membrane
changes at day 28, and recurrence of acute symptoms prior to day 28. Persistence 
of symptoms at day 5 was associated with younger age (35 versus 44 months; p <
.001), higher symptom score on day 1 (3.5 versus 2.9; p < .05), and colonization 
with Streptococcus pneumoniae (61% versus 41%; p < .05). Persistence of tympanic 
membrane changes at day 28 was associated with younger age (39 versus 45 months; 
p < .01), higher tympanic membrane score on day 1 (4.1 versus 3.6; p < .01), and 
nasopharyngeal colonization with S. pneumoniae, especially drug-resistant S.
pneumoniae (33% versus 13%; p < .05). Recurrence of acute symptoms prior to day
28 occurred in 14% of the children. Streptococcus pneumoniae was the only
pathogen associated with an increased recurrence rate (23%) as compared to the
group without pathogens (7%; p < .05). Age, severity of disease at presentation, 
and nasopharyngeal colonization patterns were proven to be important determinants
of outcome in AOM.

PMID: 15535151 [PubMed - indexed for MEDLINE]

1221: Ann Otol Rhinol Laryngol. 2004 Oct;113(10):843-5.

Bezold's abscess following chronic mastoiditis in a newborn.

Schöndorf HJ, Roth B, Streppel M.

Department of Otorhinolaryngology, University of Cologne, Cologne, Germany.

Despite the availability of antibiotics, acute otitis media can still lead to
major complications. Bezold's abscesses are very rare complications and are
usually found only in adults with well-pneumatized mastoid bones. We present the 
case of a 10-week-old newborn with a Bezold's abscess. It is stressed that acute 
otitis media can be silent and undetected in infants and can lead to major
complications such as Bezold's abscess.

Publication Types: 
    Case Reports

PMID: 15535150 [PubMed - indexed for MEDLINE]

1222: Int J Pediatr Otorhinolaryngol. 2004 Dec;68(12):1489-92.

Pediatric middle ear infections and gastroesophageal reflux.

Karkos PD, Assimakopoulos D, Issing WJ.

Department of Otolaryngology, The Freeman Hospital, Newcastle Upon Tyne, UK.
pkarkos@aol.com

OBJECTIVES: The pathogenesis of middle ear infections in children is
multifactorial and includes infection, anatomical factors, impaired immunologic
status, allergy, familial predisposition, male sex, method of feeding and
environmental factors. Glue ear remains the commonest cause of deafness in
childhood. Gastroesophageal reflux (GOR) is a common problem in the newborn and
preschool periods. Recent research suggests that it may be related to eustachian 
tube dysfunction and otitis media. METHODS: We review the literature and discuss 
the possible relationship between Gastroesophageal reflux and otitis media in
children. CONCLUSIONS: The current data are not enough to support antireflux
treatment in children with refractory middle ear infections. More prospective
randomised placebo-controlled studies are needed.

Publication Types: 
    Review

PMID: 15533559 [PubMed - indexed for MEDLINE]

1223: Clin Otolaryngol Allied Sci. 2004 Dec;29(6):606-11.

Outcomes of myringoplasty in Australian Aboriginal children and factors
associated with success: a prospective case series.

Mak D, MacKendrick A, Bulsara M, Coates H, Lannigan F, Lehmann D, Leidwinger L,
Weeks S.

Kimberley Public Health Unit, Derby, and School of Population Health, The
University of Western Australia, Perth, Australia. makho@bigpond.com

The objective of this study was to assess the outcomes of myringoplasties in
Aboriginal children and to identify factors associated with a successful outcome 
with the use of prospective case series from primary health care clinics and
hospitals in four rural and remote regions of Western Australia. All 58
Aboriginal children, aged 5-15 years, who underwent 78 myringoplasties between 1 
January 2000 and 30 June 2001 were included in the study. Complete postoperative 
(post-op) follow-up was achieved following 78% of myringoplasties. The main
outcome measures were (a) success, i.e. an intact tympanic membrane and normal
hearing six or more months post-op in the operated ear, (b) closure of the
perforation, (c) Post-op hearing improvement. Forty-nine per cent of
myringoplasties were successful, 72% resulted in closure or reduction in the size
of the perforation and 51% resulted in hearing improvement. After controlling for
age, sex, clustering and number of previous myringoplasties, no association was
observed between success or hearing improvement and perforation size, or the
presence of serous aural discharge at the time of surgery. Myringoplasty resulted
in hearing improvement and/or perforation closure in a significant proportion of 
children. Thus, primary school-aged Aboriginal children in whom conservative
management of chronic suppurative otitis media has been unsuccessful should have 
access to myringoplasty because of the positive impact on their socialization,
language and learning that results from improved hearing.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15533146 [PubMed - indexed for MEDLINE]

1224: Clin Otolaryngol Allied Sci. 2004 Dec;29(6):595-7.

Does ENT outpatient review at 1-week post ventilation tube insertion improve
outcome at 1 month in paediatric patients?

Wallace HC, Newbegin CJ.

Department of Otolaryngology, Huddersfield Royal Infirmary, Huddersfield, UK.
hcwallace@lycos.co.uk

The aims of this study were to see if ENT review at 1 week following ventilation 
tube insertion in paediatric patients reduced the complication rate and the
number of consultations with the general practitioner in the first postoperative 
month. Sixty-six children were prospectively randomized into two follow-up
groups: group A was reviewed at 1 week and 1 month and group B at 1 month only.
There was no statistically significant difference in postoperative otorrhoea (P =
0.59), ventilation tube patency (P = 0.44), ventilation tube extrusion rate (P = 
0.64) and number of consultations with the general practitioners (GP) for
postoperative otorrhoea (P = 0.19) between the two groups at 1 month. In
conclusion, there seems to be no advantage with early postventilation tube
insertion review as it does not reduce complications or decrease the GP
consultation rate.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 15533143 [PubMed - indexed for MEDLINE]

1225: Vaccine. 2004 Dec 2;23(3):298-304.

Salivary antibodies induced by the seven-valent PncCRM conjugate vaccine in the
Finnish Otitis Media Vaccine Trial.

Nurkka A, Lahdenkari M, Palmu A, Käyhty H; FinOM Study Group.

Department of Vaccines, National Public Health Institute, Mannerheimintie 166,
FIN-00300 Helsinki, Finland. anu.nurkka@ktl.fi

We studied salivary antibodies induced by a seven-valent pneumococcal conjugate
vaccine (PncCRM). Healthy Finnish children (n=115), a subcohort of the Finnish
Otitis Media (FinOM) Vaccine Trial, were immunised either with the PncCRM or a
control vaccine (hepatitis B) at the age of 2, 4, 6, and 12 months. Salivary IgG,
IgA, IgA1, IgA2 and sIg for serotypes 6B, 14, 19F, and 23F were measured at 7 and
13 months of age, and IgG and IgA also at 4-5 years of age. The PncCRM could
induce both salivary anti-Pnc polysaccharide IgG and IgA. However, by the age of 
4-5 years IgA concentrations had increased in both groups and were similar. The
increases in IgA concentrations were mostly of IgA1 subclass. The difference
between the PncCRM and the control group was more notable for serotypes 6B, 14
and 23F than for serotype 19F. We could not find evidence for the development of 
mucosal immunologic memory after vaccination with the PncCRM.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15530671 [PubMed - indexed for MEDLINE]

1226: Ear Nose Throat J. 2004 Sep;83(9):625-6, 628, 630 passim.

Ototopical ciprofloxacin in a glycerin vehicle for the treatment of acute
external otitis.

Olivera ME, Bistoni A, Anun HE, Salinas A, Manzo RH.

Departamento de Farmacia, Facultad de Ciencias Químicas, Universidad Nacional de 
Córdoba, Argentina.

We conducted a prospective, randomized, controlled, double-blind study of 33
patients to compare the efficacy and tolerability of a new glycerin formulation
of ototopical 0.3% ciprofloxacin with that of a conventional aqueous formulation 
of ciprofloxacin for the treatment of acute external otitis. Outcomes measures
were resolution of discharge, swelling, pain, and redness and the incidence of
adverse side effects. Patients were examined on three occasions: on the day of
enrollment (visit 1), 48 to 72 hours later (visit 2), and 7 days after enrollment
(visit 3). At visit 2, the patients in the glycerin group showed a significantly 
greater resolution of discharge. We observed the same pattern with respect to
swelling, pain, and redness, which resolved more quickly in the glycerin group,
although not significantly so. All patients were cured by visit 3, and the two
treatments were equally well tolerated. On the basis of our findings, we conclude
that the glycerin formulation of ototopical 0.3% ciprofloxacin appears to be at
least as effective as the aqueous form in the treatment of acute external
otitis--and in the case of otorrhea, more so.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15529649 [PubMed - indexed for MEDLINE]

1227: Ear Nose Throat J. 2004 Sep;83(9):622-4.

Modern acoustic reflectometry: accuracy in diagnosing otitis media with effusion.

Babb MJ, Hilsinger RL Jr, Korol HW, Wilcox RD.

Department of Head and Neck Surgery, Kaiser Permanente Medical Center, Oakland,
CA 94611-5693, USA.

We conducted a study of 80 patients to evaluate the accuracy of a commercially
available acoustic reflectometer in identifying the presence or absence of otitis
media with effusion (OME). This device assesses bilateral tympanic membrane
mobility and, by inference, middle ear status. We found that it was most accurate
in patients with normal and grossly fluid-filled ears. We recommend screening
with this acoustic reflectometer to rule out OME in adult and pediatric patients.

Publication Types: 
    Evaluation Studies

PMID: 15529648 [PubMed - indexed for MEDLINE]

1228: Am J Hum Genet. 2004 Dec;75(6):988-97. Epub 2004 Oct 22.

Chronic and recurrent otitis media: a genome scan for susceptibility loci.

Daly KA, Brown WM, Segade F, Bowden DW, Keats BJ, Lindgren BR, Levine SC, Rich
SS.

Department of Otolaryngology, School of Public Health, University of Minnesota
School of Medicine, Minneapolis, MN, USA.

Otitis media (OM) is the most common childhood disease. Almost all children
experience at least one episode, but morbidity is greatest in children who
experience chronic/recurrent OM (COME/ROM). There is mounting evidence that
COME/ROM clusters in families and exhibits substantial heritability. Subjects who
had tympanostomy tube surgery for COME/ROM (probands) and their families were
recruited for the present study, and an ear examination was performed, without
knowledge of the subject's history, to determine presence of OM sequelae. In
addition, tympanometric testing was performed at three frequencies (226, 630 or
710, and 1,400 Hz) to detect abnormal middle-ear mechanics, and hearing was
screened at 20 dB for the speech frequencies. Of these families, 121 had at least
two individuals who had received the diagnosis of COME/ROM (364 affected and
genotyped individuals), of whom 238 affected and informative relative pairs were 
used for analyses. Single-point nonparametric linkage analysis provided evidence 
of linkage of COME/ROM to chromosome 10q at marker D10S212 (LOD 3.78; P=3.0 x
10(-5)) and to chromosome 19q at marker D19S254 (LOD 2.61; P=5.3 x 10(-4)).
Analyses conditional on support for linkage at chromosomes 10q and 19q resulted
in a significant increase in LOD score support on chromosome 3p (between markers 
D3S4545 and D3S1259). These results suggest that risk of COME/ROM is determined
by interactions between genes that reside in several candidate regions of the
genome and are probably modulated by other environmental risk factors.

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 15514890 [PubMed - indexed for MEDLINE]

1229: Laryngoscope. 2004 Nov;114(11 Pt 3 Suppl 105):1-26.

Studies in otitis media: Children's Hospital of Pittsburgh-University of
Pittsburgh progress report--2004.

Bluestone CD.

Department of Pediatric Otolaryngology, University of Pittsburgh School of
Medicine-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.

OBJECTIVES/HYPOTHESIS: The present Progress Report has summarized the key otitis 
media clinical trials and laboratory studies conducted since 1969 by
investigators at the Children's Hospital of Pittsburgh-University of Pittsburgh
(Pittsburgh, PA). STUDY DESIGN: Review. METHODS: Included in the discussion are
the following: 1) studies of the epidemiology and risk factors; 2) anatomy and
pathology of the eustachian tube-middle ear from human temporal bone
histopathological specimens; 3) physiology and pathophysiology of the eustachian 
tube-middle ear in humans and animal models; 4) pathogenesis; 5) otitis media in 
special populations (e.g., patients with cleft palate, Native Americans, patients
with Down syndrome); 6) microbiology; 7) diagnosis; 8) outcomes of randomized
clinical trials that evaluated efficacy of nonsurgical and surgical methods of
treatment and prevention; 9) studies of certain complications and sequelae (e.g.,
effect of middle-ear effusion on hearing, early child development, and the
vestibular system; chronic suppurative otitis media). Also included are relevant 
summary tables and 256 references.

Publication Types: 
    Review

PMID: 15514559 [PubMed - indexed for MEDLINE]

1230: Acta Otolaryngol. 2004 Nov;124(9):1033-8.

Cochlear implantation in patients with a history of chronic otitis media.

Kim CS, Chang SO, Lee HJ, Shim WS, Oh SH, Kim YH.

College of Medicine, Seoul National University, South Korea.
chongkim@plaza.snu.ac.kr

OBJECTIVE: To propose management options for cochlear implantation in chronic
otitis media based on our experiences. MATERIAL AND METHODS: A retrospective
review of 418 cochlear implantations performed by the 2 senior authors between
November 1988 and February 2004 was conducted. Nine patients who had chronic
otitis media in the ear to be implanted were included. Of these, three showed
active inflammation at presentation; the other six cases had undergone previous
tympanomastoidectomy surgery and did not show active inflammation at
presentation. RESULTS: Five patients with active inflammation or without an
adequate soft tissue layer in the mastoid bowl underwent a two-stage procedure.
Four cases who showed inactive inflammation and had an adequate tissue layer to
protect the electrode array underwent a single-stage technique, although two of
them showed dry tympanic membrane perforation. No local or intracranial
inflammation recurred. The electrode was exposed in the mastoid bowl in one case,
who was managed with revisional mastoid obliteration with soft tissue.
CONCLUSION: Complete eradication of inflammation and the securing of a strong
protective soft tissue layer over the electrode are prerequisites for cochlear
implantation in ears with chronic otitis media.

Publication Types: 
    Case Reports

PMID: 15513546 [PubMed - indexed for MEDLINE]

1231: Acta Otolaryngol. 2004 Nov;124(9):1008-14.

Acute otitis media caused by drug-resistant bacteria: correlation with antibiotic
treatment.

Sakakura K, Chikamatsu K, Furukawa M, Shibasaki M, Takegoshi T, Takahashi K,
Furuya N.

Department of Otolaryngology--Head and Neck Surgery Gunma University Graduate
School of Medicine, Japan.

OBJECTIVE: Although acute otitis media (AOM) is the commonest infectious disease 
of childhood, the emergence of drug-resistant bacteria has dramatically changed
its clinical outcome. Here, we report the trend of AOM due to drug-resistant
Staphylococcus pneumoniae (DRSP) and beta-lactamase-negative ampicillin-resistant
Haemophilus influenzae (BLNAR), and the relation between antibiotics used for the
management of AOM and the isolation of bacterial pathogens. MATERIAL AND METHODS:
Bacterial isolation and susceptibility tests were performed on specimens from
children with AOM. Clinical information, including antibiotic treatment within
the previous 30 days, was analyzed. RESULTS: DRSP was detected in 59.3% of
Pneumococci isolates and BLNAR in 26.0% of H. influenzae isolates. As expected,
the incidence of AOM caused by such drug-resistant bacteria has been increasing
year on year, and 32% of cases have been treated with inappropriate antibiotics. 
In contrast, 32% of cases of AOM caused by DRSP and 50% caused by BLNAR were
given antibiotics with high susceptibility to drug-resistant bacteria.
CONCLUSION: In order to ensure the most appropriate use of antibiotics,
clinicians should consider performing tympanocentesis or myringotomy, with
subsequent submission of the middle ear fluid for susceptibility testing.
Furthermore, these results suggest that, as well as the selection of antibiotics,
the dosage and period of dosing should also be considered in the management of
AOM. In addition, other factors, in particular horizontal transmission from other
infants in day care or nursery school, may affect the rapid spread of such
drug-resistant bacteria.

PMID: 15513542 [PubMed - indexed for MEDLINE]

1232: Acta Otolaryngol. 2004 Oct;124(8):914-7.

Gastroesophageal reflux and sequelae of chronic tubotympanal disorders in
children.

Velepic MM, Velepic MS, Starcevic R, Manestar D, Rozmanic V.

Otorhinolaryngology, Rijeka University Medical School, Rijeka, Croatia.
marko.velepic@ri.htnet.hr

OBJECTIVE: To compare sequelae of chronic tubotympanal disorders in children with
and without gastroesophageal reflux (GER). MATERIAL AND METHODS: In 32 patients
with chronic tubotympanal disorders GER was studied by means of 24-h continuous
esophageal pH monitoring. After a period of 2-6 years (mean 4 years) sequelae of 
the tubotympanal disorders were examined, together with the clinical status of
the ears and hearing status. The criteria for classification into mild, moderate 
and severe sequelae were based on the clinical status of the ear. Hearing was
determined using tonal audiograms. Conductive hearing loss was classified as
either slight (< or = 35 dB hearing loss in speech frequencies) or severe (>35 dB
hearing loss in speech frequencies). RESULTS: In the group of 16 patients (mean
age 6.1 years) with GER, sequelae were observed in 29 ears (mild, n=11; moderate,
n=5; severe, n=13). Hearing impairment was determined in 20 ears (mild, n=8;
severe, n=12). In the group of 16 patients (mean age 7.1 years) without GER,
sequelae were observed in 17 ears (mild, n=11; moderate, n=1; severe, n=5).
Hearing impairment was determined in 10 ears (mild, n=6; severe, n=4).
CONCLUSION: The total number of ears with sequelae and the total number of ears
with conductive hearing impairment were significantly higher in patients with
GER.

Publication Types: 
    Comparative Study

PMID: 15513526 [PubMed - indexed for MEDLINE]

1233: Acta Otolaryngol Suppl. 2004 Oct;(554):38-44.

Application of modified transmastoid approach methods to congenital atresia of
the external ear canal with middle ear infection.

Yamane H, Sunami K, Takayama M, Tochino R, Konishi K, Iguchi H, Sakashita T,
Kusuki M.

Department of Otolaryngology and Head & Neck Surgery, Osaka City University
Graduate School of Medicine, Osaka, Japan. ent-yamane@med.osaka-cu.ac.jp

OBJECTIVE: To present our surgical technique for congenital atresia of the
external ear canal with middle ear infection. METHODS: A modified transmastoid
approach to congenital atresia of the external ear canal with middle ear
infection was applied. Our method is to visualize the landmarks of the mastoid
cavity such as the antrum, sinodural angle and digastric ridge by the canal-open 
method to avoid facial nerve injury and then prepare a relatively large external 
ear canal with reconstruction of the posterior wall of the external ear canal.
RESULTS AND CONCLUSION: This method is suitable not only for treating congenital 
atresia of the external ear canal with middle ear infection, but also for
avoiding facial nerve injury and postoperative complications such as re-stenosis 
of the new ear canal and postoperative middle ear infection.

Publication Types: 
    Case Reports

PMID: 15513509 [PubMed - indexed for MEDLINE]

1234: Laryngoscope. 2004 Nov;114(11):1967-72.

Cytokine expression in experimental chronic otitis media with effusion in mice.

Maeda K, Hirano T, Ichimiya I, Kurono Y, Suzuki M, Mogi G.

Department of Otolaryngology, Faculty of Medicine, Oita University, Japan.

OBJECTIVES: Although otitis media with effusion (OME) is still a common disease
in children and adults, the pathogenesis is not yet fully understood. We studied 
the effects of intratympanic injection with endotoxin purified from nontypeable
Haemophilus influenzae on the characteristics of middle ear effusion (MEE).
METHODS: Murine model of OME was developed by eustachian tube (ET) blockage
followed by intratympanic inoculation with endotoxin (endotoxin group) or saline 
(control group). The mice were decapitated and histological changes and the
production of inflammatory cytokines in MEEs were examined 3 days, 2 weeks, and 2
months after injection. RESULTS: All mice showed OME until 2 months after ET
blockage. Most MEEs in the control group were serous, and mucoid or pultaceous
MEEs were found only in the endotoxin group. Subepithelial space of middle ear
mucosa was severely thickened with the infiltration of a large number of
mononuclear cells in the endotoxin group. The levels of tumor necrosis
factor-alpha (TNF-alpha) in MEEs were significantly higher in the endotoxin group
than in the control group at all time points. Further, in situ hybridization
showed that TNF-alpha messenger RNA was expressed not only by leukocytes and
macrophages in MEEs but mononuclear cells present in the subepithelial space of
middle ear mucosa. CONCLUSIONS: These results indicate that ET blockage is
essential for the induction of serous MEE and additional administration of
endotoxin is associated with the production of mucoid MEE accompanied by
histological changes with inflammatory cell infiltration and cytokine production 
in the tympanic cavity.

PMID: 15510024 [PubMed - indexed for MEDLINE]

1235: Chang Gung Med J. 2004 Jul;27(7):475-88.

Acute otitis media in children: current epidemiology, microbiology, clinical
manifestations, and treatment.

Leibovitz E, Greenberg D.

Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, 
Israel. eugenel@bgumail.bgu.ac.il

An accurate differential diagnosis of AOM is essential for ensuring appropriate
treatment, since overdiagnosis of disease is common and antibiotics are not
indicated for otitis media with effusion. Although antibiotic therapy is required
in only 20-30% of all AOM cases (high rate of spontaneous recovery), most of the 
patients are treated since this small proportion cannot be quickly and easily
identified. The main determinant of the efficacy of antibiotics in AOM is the
time that drug concentration at the site of infection exceeds the minimal
inhibitory concentration for the pathogen. The major problems encountered in the 
antibiotic therapy of AOM are the tremendous increase in the resistance to
antibiotics of its main pathogens and the lack of tight criteria in the selection
of the appropriate antibiotic drugs for the treatment of this disease. The
recently published Center for Disease Control and Prevention (CDC) guidelines for
the treatment of AOM represent a major step forward in the rational approach to
the management of this disease by establishing a clear hierarchy among the
various therapeutic agents used in the treatment of simple and complicated AOM. A
seven-valent pneumococcal conjugate vaccine recently licensed in the United
States for universal immunization of infants <2 years has demonstrated efficacy
for prevention of serotype-specific pneumococcal AOM.

Publication Types: 
    Review

PMID: 15508870 [PubMed - indexed for MEDLINE]

1236: East Afr Med J. 2004 May;81(5):267-70.

Cervical spinal tuberculosis with tuberculous otitis media masquerading as otitis
externa malignans in an elderly diabetic patient: case report.

Aderibigbe A, Ologe FE.

Department of Medicine, University of Ilorin Teaching Hospital, P.M.B. 1459,
Ilorin 240001, Nigeria.

Extrapulmonary manifestation of tuberculosis (Tb), a medieval disease, occurs in 
every part of the body with varying degree of frequency but commonly in the
pleural and lymph nodes. When it occurs in bones thoracolumbar vertebrae is the
usual site of involvement. Other bones are less involved hence seldomly reported.
This is true for other organs and parts of the body including larynx, pharynx
nose and the middle ear. More importantly, isolated extrapulmonary tuberculosis
without pulmonary involvement is uncommon. The case of a 65 year old Nigerian
trader who presented with headache, chronic ear ache with otorrhoea, persistent
neck pain and found to be diabetic on further evaluation is presented. She was
hitherto managed as a case of otitis external malignans without any improvement
but rather her clinical condition worsened with evidence of cervical vertebra
destruction and multiple cranial nerve palsies without pulmonary tuberculosis.
Prompt and effective response to anti tuberculosis drugs informed the diagnosis
of tuberculosis of the cervical vertebra and tuberculous otitis media with
multiple cranial nerve palsies. This case underscores the value of high index of 
suspicion, thorough and complete clinical evaluation in any patient with chronic 
symptoms and signs unresponsive to conventional treatment.

Publication Types: 
    Case Reports

PMID: 15508343 [PubMed - indexed for MEDLINE]

1237: Ann Fam Med. 2004 Sep-Oct;2(5):429-33.

Opportunities, challenges, and lessons of international research in
practice-based research networks: the case of an international study of acute
otitis media.

Green LA, Fryer GE Jr, Froom P, Culpepper L, Froom J.

The Robert Graham Center, Washington, DC 22036, USA. Lgreen@aafp.org

The requirements of research become more complex and demanding in international
collaborations. The opportunity to study naturally occurring variation in
treatment prompted networking primary care research networks in the United
Kingdom, The Netherlands, and North America to study acute otitis media.
Additional challenges faced and addressed in this study included (1) differing
national requirements for protecting human subjects; (2) variation in data
collection processes in primary care practices; (3) data transmission among
participants; (4) duties and tariffs on necessary instruments; (5) fluctuation in
currency exchange rates; (6) incapacitation of coinvestigators; (7) complex
administration of funds; (8) financing the additional, legitimate costs of
collaboration; (9) sustaining strong personal relationships among
coinvestigators; and (10) accepting longer time frames than would otherwise be
expected. Overall, international practice-based research can be productive,
affect millions of people, and be extremely rewarding to investigators. It is
not, however, for the faint-hearted.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15506576 [PubMed - indexed for MEDLINE]

1238: Int J Pediatr Otorhinolaryngol. 2004 Nov;68(11):1455-8.

Vestibular neuritis in a child with otitis media with effusion; clinical
application of vestibular evoked myogenic potential by bone-conducted sound.

Monobe H, Murofushi T.

Department of Otolaryngology, University of Tokyo, Tokyo, Japan.

Vestibular evoked myogenic potential (VEMP) has been applied for patients with
vestibulo-cochlear disorders. The impairment of the sound transmission due to
middle ear pathology affects VEMP results. In children, otitis media with
effusion (OME) is well documented and it is difficult to apply conventional VEMP 
in such cases. To overcome the attenuation of stimulation due to middle ear
pathology, VEMP by bone-conducted sound has been developed. We report a
3-year-old girl with vestibular neuritis and OME as a representative case of
clinical application of VEMP by bone-conducted sound. VEMP by bone-conducted
sound can be an alternative method to elicit vestibular-dependent potential.

Publication Types: 
    Case Reports

PMID: 15488981 [PubMed - indexed for MEDLINE]

1239: Int J Pediatr Otorhinolaryngol. 2004 Nov;68(11):1435-9.

Acute mastoiditis in infancy: the Soroka experience: 1990-2000.

Niv A, Nash M, Slovik Y, Fliss DM, Kaplan D, Leibovitz E, Katz A, Dagan R,
Leiberman A.

Departments of Otolaryngology, Head and Neck Surgery, Soroka University Medical
Center, Ben Gurion University of the Negev, BeerSheva, Box 151, 84101 Israel.

Acute mastoiditis (AM) is an uncommon but serious complication of acute otitis
media (AOM). In the pre-antibiotic era, AM was seen more frequently than it is
today, but it was rare in infants. However, in the last two decades an increase
in the incidence of AM in infancy has been reported in the literature. During the
years 1990-2002, we treated 113 patients with 128 episodes of AM; of them, 24
were infants (median age 6 months; 18 males) who suffered from 26 episodes of AM.
Twenty developed AM as a complication of their first episode of AOM. One of the
four infants with a prior history of AOM suffered from common variable
immunodeficiency. A significant increase in the incidence of AM in infants was
recorded during the study period (P = 0.01). The most common presenting clinical 
signs were post-auricular swelling and fever >38 degrees C (77% and 77%,
respectively, of all patients). Seventeen episodes of AM were not treated with
prior antibiotics. Tympanocentesis was performed in all episodes of AM. Middle
ear fluid culture was positive in 17 (65%) of the 26 AM episodes. The most common
pathogens cultured were Streptococcus pneumoniae (10 infants, 58% of all
pathogens, 3/10 intermediately susceptible to penicillin) followed by
Streptococcus pyogenes (4, 23%), non-typable H. influenzae (2, 12%) and S. aureus
(1, 6%). Temporal bone CT showed bone destruction in 14 patients; 3 infants had
subperiosteal abscesses and 3 lateral sinus thrombosis. Ten infants underwent
mastoid surgery due to non-resolution of symptoms and signs with antibiotic
therapy. Eight underwent cortical mastoidectomy with two patients undergoing
ventilation tube introduction only. The remainder of the infants healed with
conservative treatment. Conclusions: (1) A significant increase in the incidence 
of AM in infants was recorded over the last decade, though a specific reason for 
this trend remains uncertain; (2) Most of the cases of AM followed the infant's
initial AOM episode, and most of the infants had not received prior antibiotic
therapy; (3) The clinical signs and symptoms of AM were more severe in infants
than in older patients; (4) While S. pneumonia was the most common pathogen
isolated in middle ear fluid cultures, the involvement of S. pyogenes in AM was
higher than that reported in AOM.

PMID: 15488977 [PubMed - indexed for MEDLINE]

1240: Int J Pediatr Otorhinolaryngol. 2004 Nov;68(11):1381-5.

Investigation of antioxidant status in children with acute otitis media and
tonsillitis.

Cemek M, Caksen H, Cemek F, Bayiroğlu F, Dede S, Dülger H, Ustün R.

Department of Biochemistry, Faculty of Science and Arts, Afyon Kocatepe
University, Afyon, Turkey. mcemek@yahoo.com

OBJECTIVE: Antioxidant enzymes status was investigated in children with acute
otitis media (AOM) and acute tonsillitis. The aim was to determine the effect of 
oxidative damage due to free radicals on the antioxidant enzymes status in
children with AOM and acute tonsillitis. METHODS: We measured erythrocyte levels 
of superoxide dismutase and glutathione peroxidase (GPx) and activity of serum
catalase, ceruloplasmin, albumin and total bilirubin in 23 children with AOM, 27 
with acute tonsillitis and 17 control subjects. RESULTS: There was statistically 
significant difference between the groups for all parameters. All antioxidant
activities except for albumin level were increased in the studies groups. When
the values of AOM and acute tonsillitis were compared, there was statistically
significant difference between the groups for erythrocyte GPx. CONCLUSION: Our
findings indicate that not only a few antioxidant enzymes but almost all
antioxidant activities showed a significant enhancement in children with AOM and 
acute tonsillitis.

PMID: 15488967 [PubMed - indexed for MEDLINE]

1241: Ann Clin Lab Sci. 2004 Summer;34(3):341-6.

Protective effect of melatonin on experimental otitis media with effusion in
guinea pigs.

Ucuncu H, Aktan B, Ozabacigil F, Buyukokuroglu ME, Akyuz M, Altas E.

Department of Otorhinolaryngology-Head and Neck Surgery, Medical Faculty, Atatürk
University, Erzurum, Turkey. hucuncu@atauni.edu.tr

The aims of this study were: (a) to assess whether the increased oxidative stress
in otitis media with effusion (OME) induced in guinea pigs by histamine injection
into the middle ear cavity is reflected by lipid peroxidation in erythrocytes,
plasma, and middle ear effusion fluid; (b) to survey the alterations of oxidant
and antioxidant enzyme activities in experimental OME; and (c) to determine the
effects of melatonin and methylprednisolone on this oxidative stress.
Malondialdehyde (MDA) level, erythrocyte total (enzymatic plus non-enzymatic)
superoxide scavenger activity (TSSA), non-enzymatic superoxide scavenger activity
(NSSA), superoxide dismutase (SOD), catalase (CAT), and xanthine oxidase (XO)
activities were measured in 4 groups of 7 guinea pigs at 3 hr after injection of 
0.1 ml of histamine (or saline) into the middle ear. Group I was the control
group, Group II was an experimental group with OME induced by histamine, Group
III was a melatonin-pretreated OME group, and Group IV was a
methylprednisolone-pretreated OME group. In erythrocyte, plasma, and middle ear
effusion samples, MDA levels were significantly increased in guinea pigs with OME
(Group II), compared to controls (Group I); erythrocyte TSSA and SOD activities
were lower and erythrocyte XO activity was increased in guinea pigs with OME
(Group II) compared to controls (Group I). No significant differences were found 
in erythrocyte NSSA and CAT activities. In Group III, pretreatment of guinea pigs
with i.p. melatonin at 1 hr prior to histamine induction of OME decreased the
erythrocyte, plasma, and effusion MDA levels, compared to Group II; erythrocyte
XO activity was diminished and erythrocyte TSSA, SOD, and CAT activities were
increased in Group III compared to Group II. In Group IV, pretreatment of guinea 
pigs with i.p. methylprednisolone at 1 hr prior to histamine induction of OME
decreased the plasma and effusion MDA levels and increased the erythrocyte TSSA
and SOD activities, compared to Group II. These results suggest that reactive
oxygen species (ROS) play a role in histamine-induced OME. Pretreatment with i.p.
melatonin or methylprednisolone both decrease the ROS generated by experimental
OME, but melatonin appears to be more effective than methylprednisolone.

PMID: 15487711 [PubMed - indexed for MEDLINE]

1242: J Korean Med Sci. 2004 Oct;19(5):739-43.

Clinical diagnostic accuracy of otitis media with effusion in children, and
significance of myringotomy: diagnostic or therapeutic?

Lee DH, Yeo SW.

Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The
Catholic University of Korea, Seoul, Korea. leedh0814@catholic.ac.kr.

The specific aims of this prospective survey were to determine the accuracy of
traditional diagnostic tools, such as pneumatic otoscopy, otomicroscopy, and
tympanometry, and evaluate the usefulness of myringotomy as a diagnostic method; 
also to determine the significance of myringotomy in treating otitis media with
effusion (OME). The status of middle ear of 51 children (85 ears) from November
2002 to February 2003 was examined using pneumatic otoscopy, otomicroscopy, and
tympanometry, and the presence/absence of middle ear effusion was confirmed by
myringotomy. The otomicroscopy was the most sensitive and specific one among
three diagnostic tools. But, it had some false positive cases. This study failed 
to show the therapeutic efficacy of myringotomy. Otomicroscopy seems to have the 
potential to become the standard for diagnosis of OME and for validation of
pneumatic otoscopy in children. However, when otoscopic, otomicroscopic findings 
and tympanogram of suspected ear show poor correlation, myringotomy can be used
to confirm the presence of OME, as the diagnostic modality. As the therapeutic
modality, we think that it is proper to limit indications of myringotomy to some 
selected cases.

Publication Types: 
    Clinical Trial

PMID: 15483354 [PubMed - indexed for MEDLINE]

1243: J Korean Med Sci. 2004 Oct;19(5):735-8.

Detection rates of bacteria in chronic otitis media with effusion in children.

Park CW, Han JH, Jeong JH, Cho SH, Kang MJ, Tae K, Lee SH.

Department of Otolaryngology, College of Medicine, Hanyang University, Seoul,
Korea.

This study was performed to investigate polymerase chain reaction-based detection
of bacterial DNA in middle ear fluid and assess the correlation between the
PCR-positive rate with several factors associated with middle ear effusion. The
purpose was to gain a further understanding of bacterial infection as a major
cause of otitis media with effusion. Of the 278 specimens of middle ear fluid, 39
(14%) tested positive by ordinary culture. The overall detection rate of
bacterial DNA using the PCR method was 36.7% for middle ear effusion, and
bacterial DNA detection rates of Hemophilus influenzae, Streptococcus pneumoniae,
Moraxella catarrhalis in the middle ear effusion were 29.1%, 4.7% and 10.8%,
respectively. The bacterial DNA detection rate was higher in ears with a history 
of acute otitis media than those without the history. High detection rates were
observed in patients younger than 48 months who have had a higher tendency to
present with acute otitis media. We concluded that PCR is a more sensitive method
for the detection of bacteria in middle ear effusion than ordinary culture, and
acute otitis media is a major contributor to the pathogenesis of otitis media
with effusion.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15483353 [PubMed - indexed for MEDLINE]

1244: Kaohsiung J Med Sci. 2004 Jan;20(1):31-5.

Fibro-osseous lesion of the external auditory canal: a case report.

Chi HP, Ho KY, Tsai KB, Lee KW, Ta CF, Wang LF, Kuo WR.

Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung,
Taiwan.

The aim of this study was to differentiate a novel type of benign circumscribed
bone lesion of the external auditory canal from lesions described previously,
such as exostoses and osteomas. We present a 43-year-old male patient who
suffered from ear discharge of the right ear. Local findings showed bloody
discharge from his right auditory canal, which was occupied by a mass-like
tissue. Computerized tomography (CT) carried out before resection of the lesion
disclosed the absence of a bony connection to the underlying structures. The
pathologic findings showed lesions consisting of an osteoma-like bone formation
with sparse osteoblastic areas. Mature lamellar bone and bone marrow containing
adipose tissue were also noted. There was no evidence of a relationship to the
cartilaginous tissue or bony structures of the external auditory canal.
Therefore, we present this rare case and review the reported literature in which 
clinical, CT, surgical, and pathologic findings suggest that this lesion was
unlike those previously known, and may be related to ossifying reactions in other
parts of the organism.

Publication Types: 
    Case Reports

PMID: 15481564 [PubMed - indexed for MEDLINE]

1245: J Commun Disord. 2005 Jan-Feb;38(1):29-63.

The role of early language experience in the development of speech perception and
phonological processing abilities: evidence from 5-year-olds with histories of
otitis media with effusion and low socioeconomic status.

Nittrouer S, Burton LT.

Boys Town National Research Hospital, 555 North 30th Street, Omaha, NE, USA.
nittrouer@cpd2.usu.edu

This study tested the hypothesis that early language experience facilitates the
development of language-specific perceptual weighting strategies believed to be
critical for accessing phonetic structure. In turn, that structure allows for
efficient storage and retrieval of words in verbal working memory, which is
necessary for sentence comprehension. Participants were forty-nine 5-year-olds,
evenly distributed among four groups: those with chronic otitis media with
effusion (OME), low socio-economic status (low-SES), both conditions (both), or
neither condition (control). All children participated in tasks of speech
perception and phonological awareness. Children in the control and OME groups
participated in additional tasks examining verbal working memory, sentence
comprehension, and temporal processing. The temporal-processing task tested the
hypothesis that any deficits observed on the language-related tasks could be
explained by temporal-processing deficits. Children in the three experimental
groups demonstrated similar results to each other, but different from the control
group for speech perception and phonological awareness. Children in the OME group
differed from those in the control group on tasks involving verbal working memory
and sentence comprehension, but not temporal processing. Overall these results
supported the major hypothesis explored, but failed to support the hypothesis
that language problems are explained to any extent by temporal-processing
problems. LEARNING OUTCOMES: As a result of this activity, the participant will
be able to (1) Explain the relation between language experience and the
development of mature speech perception strategies, phonological awareness,
verbal working memory, and syntactic comprehension. (2) Name at least three
populations of individuals who exhibit delays in the development of mature speech
perception strategies, phonological awareness, verbal working memory, and
syntactic comprehension, and explain why these delays exist for each group. (3)
Point out why perceptual strategies for speech are different for different
languages. (4) Describe Baddeley's model [A.D. Baddeley, The development of the
concept of working memory: implications and contributions of neuropsychology, in:
G. Vallar, T. Shallice (Eds.), Neuropsychological Impairments of Short-term
Memory, Cambridge University Press, New York, 1990, p. 54] of verbal working
memory.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15475013 [PubMed - indexed for MEDLINE]

1246: Clin Infect Dis. 2004 Oct 1;39(7):911-9. Epub 2004 Sep 1.

Nasopharyngeal pneumococcal carriage after combined pneumococcal conjugate and
polysaccharide vaccination in children with a history of recurrent acute otitis
media.

Veenhoven RH, Bogaert D, Schilder AG, Rijkers GT, Uiterwaal CS, Kiezebrink HH,
van Kempen MJ, Dhooge IJ, Bruin J, Ijzerman EP, de Groot R, Kuis W, Hermans PW,
Sanders EA.

Department of Pediatrics, Spaarne Hospital, Haarlem, The Netherlands.

BACKGROUND: We recently showed that vaccination with a 7-valent pneumococcal
conjugate vaccine (PCV7) followed by a 23-valent pneumococcal polysaccharide
vaccine (PPSV23) failed to prevent new episodes of acute otitis media (AOM) in
previously unvaccinated toddlers and children with a history of recurrent AOM. We
describe in detail the impact of pneumococcal vaccinations on nasopharyngeal
carriage of S. pneumoniae in this study population. METHODS: The impact of
vaccination with PCV7 followed by PPSV23 on pneumococcal nasopharyngeal carriage 
was studied in a prospective, randomized trial involving 383 children (age range,
1-7 years) with previous AOM. Nasopharyngeal swab specimens were collected at the
time of first vaccination and at 6-7-month intervals during the 26-month
follow-up period. RESULTS: Overall, pneumococcal carriage rates did not diminish,
remaining at approximately 50% in both PCV7/PPSV23 and control vaccinees. A
significant shift from conjugate vaccine- to nonconjugate vaccine-type
pneumococci was observed in children aged 1-2 years, who received the conjugate
vaccine twice before the polysaccharide vaccine was administered. Conjugate
vaccine serotype carriage was not influenced in older children, who received the 
conjugate vaccine once before receiving the polysaccharide booster. CONCLUSIONS: 
The administration of conjugate vaccines at least twice also after 2 years of age
may be mandatory for reducing the carriage of conjugate vaccine serotypes in
children with recurrent AOM. Polysaccharide booster vaccination did not affect
nasopharyngeal colonization with serotypes not included in the conjugate vaccine.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15472839 [PubMed - indexed for MEDLINE]

1247: J Clin Microbiol. 2004 Oct;42(10):4868-9.

Association between phospholipase production by Malassezia pachydermatis and skin
lesions.

Cafarchia C, Otranto D.

Department of Animal Health and Welfare, Faculty of Veterinary Medicine,
University of Bari, Valenzano, Italy.

An evaluation was made of the phospholipase activities of Malassezia
pachydermatis strains isolated from healthy dogs versus those from dogs with
dermatitis and otitis. A high percentage of strains of M. pachydermatis obtained 
from lesion sites (93.9%) produced phospholipase, compared to the strains
obtained from healthy skin of the same dog with localized lesions (41.4%) and
healthy dogs (10.6%).

PMID: 15472366 [PubMed - indexed for MEDLINE]

1248: Environ Health Perspect. 2004 Oct;112(14):1359-65.

Acute infections and environmental exposure to organochlorines in Inuit infants
from Nunavik.

Dallaire F, Dewailly E, Muckle G, Vézina C, Jacobson SW, Jacobson JL, Ayotte P.

Department of Social and Preventive Medicine, Laval University, and Public Health
Research Unit, CHUQ-Laval University Medical Center, 945 Wolfe Street,
Sainte-Foy, Québec G1V 5B3, Canada.

The Inuit population of Nunavik (Canada) is exposed to immunotoxic
organochlorines (OCs) mainly through the consumption of fish and marine mammal
fat. We investigated the effect of perinatal exposure to polychlorinated
biphenyls (PCBs) and dichlorodiphenyldichloroethylene (DDE) on the incidence of
acute infections in Inuit infants. We reviewed the medical charts of a cohort of 
199 Inuit infants during the first 12 months of life and evaluated the incidence 
rates of upper and lower respiratory tract infections (URTI and LRTIs,
respectively), otitis media, and gastrointestinal (GI) infections. Maternal
plasma during delivery and infant plasma at 7 months of age were sampled and
assayed for PCBs and DDE. Compared to rates for infants in the first quartile of 
exposure to PCBs (least exposed), adjusted rate ratios for infants in higher
quartiles ranged between 1.09 and 1.32 for URTIs, 0.99 and 1.39 for otitis, 1.52 
and 1.89 for GI infections, and 1.16 and 1.68 for LRTIs during the first 6 months
of follow-up. For all infections combined, the rate ratios ranged from 1.17 to
1.27. The effect size was similar for DDE exposure but was lower for the full
12-month follow-up. Globally, most rate ratios were > 1.0, but few were
statistically significant (p < 0.05). No association was found when postnatal
exposure was considered. These results show a possible association between
prenatal exposure to OCs and acute infections early in life in this Inuit
population.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15471725 [PubMed - indexed for MEDLINE]

1249: J Paediatr Child Health. 2004 Nov;40(11):627-32.

Increased rates of ENT surgery among young children: have clinical guidelines
made a difference?

Rob MI, Westbrook JI, Taylor R, Rushworth R.

Centre for Health Informatics, Faculty of Medicine, University of New South
Wales, Sydney, New South Wales, Australia.

OBJECTIVES: To examine the association between introduction of paediatric ear,
nose and throat (ENT) surgery guidelines and population procedure rates. To
determine changes in children's risk of undergoing ENT surgery. METHODS: Trend
analysis of incidence of myringotomy, tonsillectomy and adenoidectomy among New
South Wales (NSW) children aged 0-14 between 1981 and mid 1999. Poisson
regression models were used to estimate annual rates of change pre and
postguidelines introduction and age/gender specific rates, and lifetable methods 
to determine risk of undergoing an ENT procedure by age 15. RESULTS: ENT surgery 
rates increased by 21% over the study period. Children's risk of surgery
increased from 17.9% in 1981 to 20.2% in 1998/99. Guideline introduction was
associated with moderate short-term decreases in rates. For tonsillectomy, rates 
decreased between 1981 and 1983, but then rose continually until the introduction
of myringotomy guidelines in 1993, when they fell, only to recommence rising
until the end of the study period. For myringotomy, rates rose annually from 1981
to 1992/93 and fell in the 3 years following guideline introduction, after which 
they rose again. Increases were almost exclusively restricted to children aged
0-4 and correspond with increased use of formal childcare. The prevalence of
myringotomy by the age of 5 years rose from 5.6% of children born in 1988/89 to
6.4% of those born in 1994/95, and the prevalence of tonsillectomy from 2.4% to
2.7%. CONCLUSIONS: The risk of young Australian children undergoing ENT surgery
increased significantly over the last two decades despite the introduction of
guidelines and no evidence of an increase in otitis media, one condition
prompting surgery. Surgery increased most among the very young. We hypothesize
this is related to increasing use of childcare.

PMID: 15469532 [PubMed - indexed for MEDLINE]

1250: Acta Otorhinolaryngol Ital. 2004 Apr;24(2):63-7.

Rhinopharynx endoscopy in the diagnosis of chronic otitis media with effusion in 
infancy.

Neri G, Mennucci E, Ortore R, Leone O, Croce A.

Department of Experimental and Clinical Surgical Sciences, Otorhinolaryngoiatric 
Division, University G. D'Annunzio, Chieti, Pescara, Italy. giampieroneri@tin.it

Chronic otitis media with effusion is an inflammatory process of the mucosa of
the middle ear persisting for more than 3 months, being most frequent in infancy,
and is correlated with marked tube obstruction. In infancy, the most frequent
cause of this obstruction is adenoid hypertrophy and diagnosis, clinical or
radiological, is often not confirmed by rhinopharynx fiberendoscopy. Since, in
these cases, treatment is often surgical, it is possible that small patients may 
be submitted, unnecessarily, to adenoidectomy. In collaboration with the
Paediatric Clinic, the present study on an infant outpatient population with
nasal respiratory difficulty, associated with chronic otitis media with effusion,
was, therefore, aimed at standardizing the endoscopic diagnosis of patients with 
suspected adenoid hypertrophy. Between October and December 2002, 32 consecutive 
patients, aged between 4 and 11 years, all oral breathers with OME, were sent to 
our attention from the Paediatric Clinic. All those patients, with indication for
adenoidectomy, have been enrolled in the study and submitted to fiberendoscopic
examination of the external ear and nose. Nasal respiration was confirmed with
active anterior rhinomanometry. Endoscopic evaluation of the rhinopharynx, aimed 
at assessing adenoid dimensions and their relationship with the auditory tube,
has been expressed in four degrees of increasing severity and adenoidectomy was
indicated in those cases, classified, by us, as third and fourth degree. In our
experience, endoscopic examination of the rhinopharynx has, however, shown that
only 9 children (28.2%) presented an absolute need to undergo adenoidectomy since
they were carriers of massive adenoid hypertrophy with tubal obstruction and
consequent bilateral glue ear (3rd and 4th degree) while, in all other cases
(71.8%), the clinical and radiological findings did not correspond to endoscopic 
data. Diagnostic accuracy that characterizes rhinopharyngeal fiberendoscopy is,
therefore, in our opinion, of fundamental importance to avoid these errors, as
far as possible, and in establishing an appropriate therapeutic programme.

Publication Types: 
    Comparative Study

PMID: 15468993 [PubMed - indexed for MEDLINE]

1251: Arch Pediatr Adolesc Med. 2004 Oct;158(10):962-5.

Tympanocentesis for the management of acute otitis media in children: a survey of
Canadian pediatricians and family physicians.

Vayalumkal J, Kellner JD.

Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.

OBJECTIVE: To evaluate the current knowledge, practice patterns, skills, and
attitudes of Canadian pediatricians and family physicians regarding the role of
diagnostic tympanocentesis in the management of acute otitis media in children.
DESIGN: Survey. SETTING AND PARTICIPANTS: A self-completion questionnaire was
mailed to a random selection of 302 pediatricians and 196 family physicians
practicing in hospitals and community settings across Canada in 2002. A second
questionnaire was sent to those who did not respond to the first mailing. MAIN
OUTCOME MEASURES: The demographic features of respondents and their attitudes,
beliefs, and behaviors regarding tympanocentesis for acute otitis media were
collected via a 2-page questionnaire consisting of open-ended and multiple-choice
questions. RESULTS: The overall response rate was 56%. Only 4% of pediatricians
and family physicians surveyed received training in tympanocentesis, and none
currently perform the procedure. Higher proportions of those who learned to
perform tympanocentesis graduated from medical school before 1970 and received
postgraduate training outside of Canada compared with those who did not learn to 
perform tympanocentesis. Pediatricians were more likely than family physicians to
make referrals to otolaryngologists for tympanocentesis for acute otitis media
(62% vs 48%; P = .04). CONCLUSIONS: Few Canadian pediatricians and family
physicians in our survey learned to perform tympanocentesis, and none currently
perform the procedure. It is not clear whether current practices for
tympanocentesis in children with acute otitis media are adequate.

PMID: 15466683 [PubMed - indexed for MEDLINE]

1252: J Vet Diagn Invest. 2004 Sep;16(5):397-402.

Mycoplasma otitis in California calves.

Lamm CG, Munson L, Thurmond MC, Barr BC, George LW.

Department of Veterinary Pathology, Microbiology, and Immunology, School of
Veterinary Medicine, University of California, Davis, CA 95616, USA.

A retrospective study of Mycoplasma otitis in California calves submitted for
necropsy between 1993 and 2002 was conducted to characterize the demographic
features of the disease and the pathologic findings associated with infection.
Sixty-one confirmed cases of Mycoplasma otitis were identified among 20,525
necropsied cattle. All affected animals were calves, ranging in age from 2 weeks 
to 4 months and with a median age of 1.5 months. Ninety-two percent of the cases 
were dairy breeds. A higher percent of necropsied calves with Mycoplasma otitis
were males (0.45%) than females (0.23%). The proportion of cases that had
Mycoplasma otitis increased from 1993 to 2002, and there was a significant (P <
0.05) seasonal distribution, with the highest proportion in the spring and the
lowest in the summer months. Infections involved both the middle and inner ear
and were characterized by a suppurative inflammatory response with extensive bony
involvement. Three species of Mycoplasma were isolated from the ears: M. bovis,
M. bovirhinis, and M. alkalescens. Concurrent pneumonia occurred in 47 cases
(77%), and Mycoplasma was isolated from the lungs of 30 of those cases. The
increasing proportion of Mycoplasma otitis cases in the past 10 years emphasizes 
the importance of identifying risk factors that could be modified to lower the
incidence of this disease in calves.

PMID: 15460321 [PubMed - indexed for MEDLINE]

1253: Minerva Pediatr. 2004 Oct;56(5):481-95.

Antibiotics for otitis media with effusion.

Mandel EM, Casselbrant ML.

ENT Research Center, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213,
USA. mandele@pitt.edu

Otitis media with effusion (OME) is defined as asymptomatic middle-ear effusion, 
that is, without the signs and symptoms of acute otitis media (AOM), such as
fever, otalgia, or otorrhea. OME can occur after an episode of AOM or may occur
without any prior or concurrent symptoms and is often noted on a routine physical
examination or screening. Because children with OME are usually not ill, there is
a question of whether treatment is warranted for this condition. Also adding to
the complexity of this problem is the high spontaneous cure rate of OME. This
paper will review the many clinical trials of the efficacy of antimicrobial
therapy for OME. We have grouped the studies into 4 major categories: antibiotic 
vs no treatment, antibiotic vs placebo, antibiotic vs antibiotic, and antibiotic 
prophylaxis. While study designs, definitions, and quality vary widely, these
studies show a trend toward short-term efficacy of antimicrobial treatment, but
long-term efficacy is doubtful. In this age of antimicrobial resistance, coupled 
with the high natural cure rate, routine antimicrobial treatment of OME is not
warranted. It may be useful in selected patients, particularly those with chronic
OME (3 months or longer of bilateral effusion or 6 months or longer of unilateral
effusion) for whom surgery is being considered: a 1-time short course of
antibiotic may allow cancellation or at least postponement of a surgical
procedure, particularly in spring/summer when one would like to avoid placing
tubes in the ears and placing the child at risk for otorrhea due to water
exposure. Also, antimicrobial therapy may provide at least short-term relief for 
symptomatic children (hearing loss, developmental delay, etc.) for whom surgery
must be postponed or is contraindicated.

Publication Types: 
    Comparative Study
    Review

PMID: 15459573 [PubMed - indexed for MEDLINE]

1254: Microb Pathog. 2004 Oct;37(4):193-204.

Alteration of gene expression in human middle ear epithelial cells induced by
influenza A virus and its implication for the pathogenesis of otitis media.

Tong HH, Long JP, Li D, DeMaria TF.

Division of Otologic Research, Department of Otolaryngology, College of Medicine 
and Public Health, The Ohio State University, Room 4331 Cramblett, 456 W. 10th
Avenue, Columbus, OH 43210, USA.

Influenza A virus infection plays a significant role in the pathogenesis of
Streptococcus pneumoniae-induced acute otitis media in children. An understanding
of how influenza A virus modulates host cellular responses is critically
important in efforts to explore the molecular mechanisms of this synergism. We
used microarray technology to characterize the mRNA expression profile in human
middle ear epithelial cells induced by influenza A virus. Alterations of mRNA
expression in 142 out of approximately 12,600 genes were observed at 24h after
virus infection. Of these 142 genes with altered expression, interferon inducible
genes, chemokine and cytokine genes, pro- and antiapoptotic genes, signal
transduction and transcription factors, cellular immune response, cell cycle and 
metabolism genes were the most prominent. Our results reveal several previously
unknown alterations of host gene expression induced by influenza A virus which
may provide new targets for further analysis of its role in this particular
host-pathogen interaction.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15458780 [PubMed - indexed for MEDLINE]

1255: J Laryngol Otol. 2004 Aug;118(8):645-7.

Topical vancomycin for chronic suppurative otitis media with
methicillin-resistant Staphylococcus aureus otorrhoea.

Jang CH, Song CH, Wang PC.

Department of Otolaryngology, Wonkwang University Hospital, Wonkwang Medical
School, Iksan, Korea. chulsavio@hanmail.net

There has been a steady increase in the number of cases of methicillin-resistant 
Staphylococcus aureus (MRSA) otorrhoea; this is a growing concern. The purpose of
this study was to evaluate the efficacy of topical vancomycin treatment in
patients with MRSA otorrhoea. Fifty-five patients with MRSA otorrhoea were
prospectively enrolled into the study. Thirty-five patients were treated with
vancomycin eardrops as outpatients. The concentration of the locally prepared
vancomycin solution was 25 mg/ml. The dose of vancomycin was two drops three
times daily for 10 days. As a control group, 20 patients were treated with
gentamicin 0.3% solution. Data were analysed by the Mann-Whitney U test to
compare the efficacy of vancomycin eardrops and gentamicin eardrops. In the
vancomycin group, the otorrhoea was significantly reduced in 33 ears (94%); in
the gentamicin group, in four ears (20 per cent); this reduction was
statistically significant (P < 0.03). The use of topical vancomycin treatment was
effective for patients with MRSA otorrhoea refractory to conventional antibiotic 
treatment.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15453944 [PubMed - indexed for MEDLINE]

1256: Ann Otol Rhinol Laryngol. 2004 Sep;113(9):711-20.

Biphasic ceramics and fibrin sealant for bone reconstruction in ear surgery.

Bagot d'Arc M, Daculsi G, Emam N.

Department of Otolaryngology, Bachaumont Hospital, Paris, France.

Bone reconstruction is still a matter of concern in middle ear surgery despite
the large number of surgical techniques proposed. A composite made of biphasic
calcium phosphate ceramic granules mixed with human fibrin sealant, forming a
moldable material that is easy to set for bone reconstruction, has been used with
success over a 16-year period for reconstruction of the posterior canal wall or
for mastoid obliteration. In a retrospective series of 72 ears with long-term
follow-up (average follow-up of 46 months), regular microscopic examination, and 
computed tomographic controls, we have evaluated this bone reconstruction
technique for radical mastoidectomy cavities or the closed technique. The bone
reconstruction material provided an immediate anatomic reconstruction that
remains stable and is well tolerated over the long term. A slight leakage of
granules in the meatus was initially observed in several patients with transient 
aseptic otorrhea. Fifty-seven ears were followed up for 1 year or more.
Satisfactory clinical results with complete regression of the mucous membrane
disease were found in 82.4% of the patients, with perfect stability of the
material in 65%. We did not observe any cases of recurrent cholesteatoma in or
behind the filling material. Eighteen biopsies were performed between 8 and 84
months after surgery during a second surgical step performed for functional
purposes or for recurrent cholesteatoma; 17 of the 18 cases showed
osteointegration of the filling material. After a 16-year experiment, we consider
this technique to be a highly satisfactory procedure that could be extended to
other situations of bone reconstruction.

PMID: 15453528 [PubMed - indexed for MEDLINE]

1257: Saudi Med J. 2004 Sep;25(9):1199-203.

Otitis externa infection in Jordan. Clinical and microbiological features.

Battikhi MN, Ammar SI.

Hashemite University, Faculty of Allied Health Sciences, Department of Medical
Laboratory Sciences, Zarqa 13115, Jordan. m.nizar@hu.edu.jo

OBJECTIVE: Aims of this study were to investigate the clinical findings and to
identify causative microorganisms and their susceptibility to antibiotics in
otitis externa infection. METHODS: The symptoms and signs, as well as the
bacterial and fungal flora from the auditory canal of one hundred and eighty
patients (100 males and 80 females), age range from 6 month to 19-years old
suffering from acute otitis externa were studied from January 2001 to December
2002. One way ANOVA and Least Significant Difference (LSD) were carried out for
statistical analysis. RESULTS: Pain was the most common symptom (97.2%) while,
itching and difficulty in hearing were the least common (11.7 %). Pseudomonas
aeruginosa (P.aeruginosa) was isolated from (41.7%) which showed the best
susceptibility to ciprofloxacin (93.4%), aspergillus species from (19.4%),
candida albicans from (10.6%), staphylococcus aureus from (16.1%) which showed
the best susceptibility to amikacin and ciprofloxacin (96.5%), proteus mirabilis 
from (2.8%) which showed the best susceptibility (100%) to amikacin,
ciprofloxacin, imipenem and ofloxacin, anaerobic bacteria from (2.2%); and no
bacteria growth was observed in (7.2%). There was a significant variation
relating signs, symptoms and sex in favor of males (P=0.03). Significant seasonal
variation in otitis externa infection was observed (P <0.05). CONCLUSION:
Pseudomonas aeruginosa was the most frequently isolated pathogenic microorganism,
which showed the best susceptibility to ciprofloxacin. Pain was the most common
symptom.

Publication Types: 
    Comparative Study

PMID: 15448765 [PubMed - indexed for MEDLINE]

1258: J Emerg Med. 2004 Oct;27(3):253-6.

Gradenigo syndrome: a case report and review of a rare complication of otitis
media.

Sherman SC, Buchanan A.

Department of Emergency Medicine, Cook County Hospital, Chicago, Illinois 60612, 
USA.

Otitis media is a commonly seen condition in the Emergency Department. The
complications of otitis media that were seen frequently in the preantibiotic era 
are now rare today. We report a case of a diabetic man who presented with
otorrhea, retro-orbital pain, and diplopia secondary to a sixth cranial nerve
palsy--Gradenigo syndrome. This syndrome occurs as infection from the middle ear 
spreads medially to the petrous portion of the temporal bone. The emergency
physician should consider this condition in patients with chronic ear drainage or
pain not responsive to conventional treatment or in any patient with a cranial
nerve palsy in the setting of acute or chronic otitis. Work-up should include a
CT scan of the temporal bones. Otolaryngology consultation and admission for i.v.
antibiotics is recommended.

Publication Types: 
    Case Reports

PMID: 15388211 [PubMed - indexed for MEDLINE]

1259: Pharmacoepidemiol Drug Saf. 2005 Mar;14(3):163-70.

Effectiveness of amoxicillin, azithromycin, cefprozil and clarithromycin in the
treatment of acute otitis media in children: a population-based study.

Quach C, Collet JP, LeLorier J.

Infectious Diseases Division-MUHC: Montreal Children's Hospital, McGill
University, Montreal (QC), Canada.

Population-based studies may give results different from randomized clinical
trials assessing the efficacy of antibiotics.OBJECTIVE: To determine the
effectiveness of amoxicillin, azithromycin, cefprozil and clarithromycin in the
treatment of acute otitis media (AOM) in children. METHODS: Using Quebec Health
Insurance databases (RAMQ), we selected a cohort of children aged < or = 6 years,
with a first episode of AOM between 1999 and 2002. The index AOM was defined as a
medical service claim with a diagnosis of AOM and an antibiotic dispensation in
the following 72 hours. Failures were defined as a new antibiotic dispensation, a
hospitalization or outpatient visit for complications related to AOM in the 30
days after the index AOM. Data were analyzed using logistic regression. RESULTS: 
Overall, 12,693 failures occurred among 60,513 first episodes of AOM.
Azithromycin was the only antibiotic that was associated with a decreased risk of
failure overall, when compared to amoxicillin (OR 0.88, 95% CI: 0.82, 0.94).
However in the first 3 days of treatment (n = 680), azithromycin was more
associated with treatment failure (OR 1.6, 95% CI: 1.3, 2.0). Compared to
amoxicillin, post-therapy failures (n = 9387) were more likely to occur with
cefprozil (OR 1.2, 95%CI: 1.2, 1.3) but were less with azithromycin (OR 0.8 95%
CI: 0.8, 0.9). CONCLUSIONS: Azithromycin had the lowest risk of failure 30 days
after the onset of treatment but an increased risk of failure during the first
few days of treatment. Amoxicillin remains an effective first-line drug for
treating first AOM episodes. Copyright 2004 John Wiley & Sons, Ltd.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15386697 [PubMed - indexed for MEDLINE]

1260: Clin Pediatr (Phila). 2004 Sep;43(7):647-51.

Survey of parenting books for advice on the common cold, diarrhea, and otitis
media in infants and toddlers.

Holland PR, Mau MK, Yamamoto LG.

Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, 
Honolulu, Hawaii, USA.

Parenting books often provide advice for common medical ailments of infants and
toddlers. However, the accuracy of such advice has never been evaluated. The
purpose of this study is to survey the informational content of a sample of
parenting books. Fifty general parenting books were identified and reviewed for
the informational content on the following topics: common colds, diarrhea, and
otitis media. When covered by the book, accurate and consistent information was
generally provided in the following topic areas: non-medicated nose drops for
nasal congestion, upright positioning for children with colds, breastfeeding
infants with diarrhea, electrolyte solutions for diarrhea, and feeding practices 
as they relate to otitis media. The following topic areas displayed significant
inconsistency: the use of decongestants, antihistamines, expectorants, cough
suppressants, and decongestant nose drops for colds; antidiarrheal medications;
soft drinks and juice for diarrhea; home recipes for oral hydration solutions;
and the usefulness of pressure equalization tubes for refractory otitis media.
Practitioners should be aware that parents may be misinformed by some parenting
books and take measures to educate parents.

PMID: 15378153 [PubMed - indexed for MEDLINE]

1261: Curr Opin Otolaryngol Head Neck Surg. 2004 Oct;12(5):384-6.

Cochlear implantation in the chronically diseased ear.

El-Kashlan HK, Telian SA.

Department of Otolaryngology-Head and Neck Surgery, University of Michigan, 1500 
East Medical Center Drive, Ann Arbor, MI 48109-0312, USA. hussam@umich.edu

PURPOSE OF REVIEW: The presence of chronic ear disease in patients with profound 
SNHL presents a challenge to the otologic surgeon and was considered, in the
past, a contraindication to cochlear implantation. This review discusses options 
for cochlear implantation in patients with chronically diseased ears. RECENT
FINDINGS: Several management options are available for cochlear implantation in
patients with chronic suppurative otitis media (CSOM) and severe to profound
sensorineural hearing loss (SNHL). CONCLUSION: Cochlear implantation can be
safely achieved in patients with CSOM. The approach chosen should be
individualized based on clinical findings.

Publication Types: 
    Comparative Study
    Review

PMID: 15377948 [PubMed - indexed for MEDLINE]

1262: Clin Otolaryngol Allied Sci. 2004 Oct;29(5):553-7.

Long-term Paparella II grommet use in the management of persistent childhood
otitis media: a 5-year follow-up study.

Kim DS, Moore PL, Rockley TJ.

A comprehensive 5-year follow-up study of Paparella grommet use in UK. Study
group consists of children previously treated with short-term grommets and with
persistent glue ear. Mean functional period was 3.73 years with 52% being
retainde for the full 5 year duration of the study. Infection and perforation
rates increased with the duration of grommet in-situ and this was especially
marked after 36 months. We advise the elective removal of these long-term
grommets after 3 years of function to reduce compication rate.

Publication Types: 
    Letter

PMID: 15373873 [PubMed - indexed for MEDLINE]

1263: Clin Otolaryngol Allied Sci. 2004 Oct;29(5):497-504.

Speech reception in noise: an indicator of benefit from otitis media with
effusion surgery.

MRC Multicentre Otitis Media Study Group.

To determine possible selection criteria for ventilation tubes (VTs - grommets), 
in otitis media with effusion (OME), a randomized trial on 68 children was
undertaken. To provide both a baseline predictor and outcome measure in auditory 
disability, speech-in-noise thresholds were obtained with the IHR-McCormick
Automated Toy Test (SiN ATT). Children allocated to surgery (n = 32) and control 
(n = 36) were followed-up at 3 and 12 months postintervention. Baseline SiN ATT
score provided a significant by-treatment interaction in predicting the
performance at +3 months, establishing it as an evidence-based indicator.
Although average benefits on hearing level score (HL) were also shown, baseline
HL was not a valid indicator (no significant interaction). The 40% of the sample 
with worst baseline SiN experienced high benefit from VTs. In children over 3
years of age, baseline SiN performance can indicate those with OME most likely to
benefit from VTs.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 15373863 [PubMed - indexed for MEDLINE]

1264: Acta Otolaryngol. 2004 Sep;124(7):794-7.

Depletion of mucosal substance P in acute otitis media.

Cayé-Thomasen P, Schmidt PT, Hermansson A, Holst JJ, Thomsen J.

Department of Otorhinolaryngology, Head and Neck Surgery, Gentofte University
Hospital of Copenhagen, Hellerup, Denmark. percaye@dadlnet.dk

OBJECTIVE: The neuropeptide substance P (SP) is an inducer of neurogenic
inflammation and bone resorption in the middle ear. Resorption of the bone tissue
structures surrounding the middle ear cavity is a distinct feature of the initial
stage of acute otitis media (AOM), which may be due to nerve fiber release of SP.
MATERIAL AND METHODS: To investigate possible release of SP in the middle ear
mucosa during AOM, we used a well-established rat model of AOM caused by
Streptococcus pneumoniae. Following tissue extraction on Days 1, 3 and 6
post-inoculation, the mucosal concentration of SP was measured using a
radioimmunoassay. RESULTS: Compared to sham-inoculated control ears, the
concentration of SP was significantly reduced on Day 1 and even further reduced
on Day 3, whereas partial replenishment was found on Day 6. CONCLUSION: SP seems 
to be depleted in the rat middle ear mucosa in the hyperacute phase of AOM. This 
depletion is followed by replenishment and the concentration of SP approaches its
normal level 6 days post-inoculation. The release of SP may be the trigger of the
concurrent bone resorption and may further augment the inflammatory response to
the bacterial colonization.

PMID: 15370562 [PubMed - indexed for MEDLINE]

1265: Can Vet J. 2004 Aug;45(8):661-6.

Otitis media in dairy calves: a retrospective study of 15 cases (1987 to 2002).

Francoz D, Fecteau G, Desrochers A, Fortin M.

Département des sciences cliniques, Faculté de Médecine Vétérinaire, Université
de Montréal, Saint-Hyacinthe, Québec. david.francoz@umontreal.ca

Epidemiological data, clinical signs, complementary examination findings,
antimicrobial treatments, and outcome were reviewed in 15 calves diagnosed with
otitis media at the Centre hospitalier universitaire vétérinaire de l'Université 
de Montréal between 1987 and 2002. Age at presentation ranged from 2 to 18 weeks.
A purulent ear discharge and epiphora were seen in 8/12 and 6/15 cases,
respectively. Neurological signs observed were head tilt (13), eyelid ptosis (7),
paresis/paralysis of the pinna (8), ataxia (2), strabismus (2), and convulsions
(1). Concurrent pneumonia was frequently diagnosed (n = 11). A Mycoplasma sp. was
the principal pathogen isolated from ear discharge; 6 out of 6 samples submitted 
were positive for mycoplasma. Tympanic bullae radiographs were considered
abnormal in 12 out of 13 cases. Cerebrospinal fluid analysis was considered
abnormal in 2 out of 5 cases. The antibiotic most commonly used was enrofloxacin 
(n = 7). Average treatment duration was 19.6 days. Four out of 8 treated animals 
for which follow-up information was available completely recovered. These results
suggest that M. bovis is a major pathogen of otitis media in dairy calves and
effective antimicrobial therapy should be of long duration.

PMID: 15368739 [PubMed - indexed for MEDLINE]

1266: Asian Pac J Allergy Immunol. 2004 Mar;22(1):7-10.

Allergic contact dermatitis prevalence in patients with eczematous external
otitis.

Yariktas M, Yildirim M, Doner F, Baysal V, Dogru H.

Department of Otorhinolaryngology, Süleyman Demirel University, School of
Medicine, Isparta, Turkey.

Eczematous external otitis, because of its basic allergic nature, tends to be
chronic or recurrent. The purpose of our study was to investigate the association
between allergic contact dermatitis and chronic eczematous external otitis.
Sixty-six patients with eczematous external otitis and 48 healthy volunteers were
included in this study. All the patients were tested with an epicutaneous patch
test. In the study group, the average recurrent attack rate was 6.1+/-1.5
(between 4-9 times during the last year) in the patch test positive eczematous
external otitis patients, and 4.9+/-1.3 (between 4-8 times during the last year) 
in the patch test negative patients (p = 0.002). The epicutaneous patch test was 
positive in 19 (28.8%) out of 66 cases with chronic eczematous external otitis,
and in 3 (6.3%) out of 48 cases in the control group. The difference between the 
two groups was statistically significant (p = 0.003). The most common reactions
were due to neomycin sulfate and potassium dichromate in this study. These
results suggest that, in some cases eczematous external otitis may be considered 
as a form of delayed type hypersensitivity to allergen stimuli. Patients
suffering from eczematous external otitis symptoms should be investigated for
allergens.

PMID: 15366652 [PubMed - indexed for MEDLINE]

1267: Otolaryngol Head Neck Surg. 2004 Sep;131(3):280-7.

A new measure of placebo response and patient satisfaction in office encounters.

Ovchinsky A, Ovchinsky N, Rosenfeld RM.

Department of Otolaryngology, State University of New York Downstate Medical
Center, Brooklyn, New York, USA. aovchinsky@nyee.edu

OBJECTIVES: Placebo response is defined as a change in health status resulting
from the symbolic significance attributed by the patient or proxy to the
physician encounter. Our goals were to validate the PR12 survey as a measure of
placebo response and to analyze the placebo response as a discrete and measurable
component of everyday office encounters with the otolaryngologist. STUDY DESIGN: 
This was a prospective, before-and-after clinical outcomes study of 95 children
aged 6 months to 12 years conducted in an academic metropolitan pediatric
otolaryngology practice. Caregivers completed the PR-12 survey at entry and at
least 4 weeks later. The survey included 3 domains (4 questions each) reflecting 
the main components of the placebo response: meaningful explanation, care and
concern, and mastery and control. PR-12 was correlated with longitudinal change
in health status at least 1 to 2 months after the baseline visit. Outcome
measures included direct and indirect measures of change in disease-specific
quality of life and satisfaction with change. RESULTS: Test-retest reliability
was fair for most PR-12 survey items (R = 0.41 to 0.76) but was higher for
domains (0.60 to 0.66) and the overall survey score (0.66). PR-12 had excellent
internal consistency (Cronbach's alpha 0.91) and appropriate construct validity. 
Caregiver satisfaction change at follow-up correlated with the PR-12 (r = -.25, P
= 0.036). Conversely, no correlation was seen between the PR-12 and direct and
indirect measures of change in disease specific quality of life. CONCLUSION:
Placebo response is an important and potentially measurable aspect of clinical
encounters. PR-12 is a promising first step at creating a brief, reliable, and
valid instrument to assess the placebo response. SIGNIFICANCE: Reemphasizing the 
therapeutic potential of the doctor-patient relationship may improve quality of
care and disease outcomes.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15365548 [PubMed - indexed for MEDLINE]

1268: Otolaryngol Head Neck Surg. 2004 Sep;131(3):248-52.

Hearing loss with semicircular canal transection and Pseudomonas aeruginosa
otitis media.

Prevatt AR, Sedwick JD, Gajewski BJ, Antonelli PJ.

Department of Otolaryngology, University of Florida, Gainesville, Florida, USA.

OBJECTIVE: To determine if Pseudomonas aeruginosa (PA) otitis media (OM)
increases the risk of sensorineural hearing loss (SNHL) with semicircular canal
transection in the guinea pig model. METHODS: PA was injected transtympanically
into both middle ears of pigmented guinea pigs. Saline-injected animals served as
controls. Two to 4 days after injection, one horizontal semicircular canal was
transected and sealed. Hearing was tested using electrocochleography before and
after transection. RESULTS: PA-OM was induced in all PA-injected ears. Five days 
after semicircular canal transection, click-evoked thresholds were significantly 
elevated in ears with PA-OM (P = 0.00009) but not in saline-injected ears (P =
0.398). CONCLUSION: Violation of the inner ear in the presence of PA-OM is
associated with increased risk of SNHL in the guinea pig. SIGNIFICANCE: Factors
unique to PA infection may be responsible for SNHL with labyrinthine injury in
humans with chronic otitis media.

PMID: 15365544 [PubMed - indexed for MEDLINE]

1269: Int J Pediatr Otorhinolaryngol. 2004 Oct;68(10):1315-25.

Erratum in:
    Int J Pediatr Otorhinolaryngol. 2005 Jan;69(1):135.

Diagnostic accuracy and the observation option in acute otitis media: the Capital
Region Otitis Project.

Gurnaney H, Spor D, Johnson DG, Propp R.

School of Public Health, State University of New York at Albany, USA.
gurnaney@mailcity.com

OBJECTIVE: Studies of acute otitis media indicate that deferring antibiotics in
selected patients is a valid option. This study sought to determine the effects
of a multifaceted educational intervention on disease management and treatment
attitudes in practitioners caring for acute otitis media (AOM). METHODS: An
expert committee composed of clinical and public health practitioners was
convened which reviewed current evidence-based literature on diagnosis and
treatment of AOM. A survey instrument to measure attitudes was fashioned and
administered to 150 invited practitioners before and after a daylong educational 
intervention. The intervention was composed of two diagnostic otoscopy workshops;
a lecture on an antibiotic-centered approach to treatment, followed by a lecture 
on the Dutch "observation without antibiotic option" (OWAO), which in 1998
involved withholding antibiotic prescription for selected patients over the age
of 2 for up to 72 h; and a concluding "Miller Interactive Process"--small group
sessions on five key clinical management questions. RESULTS: Significant
short-term changes occurred in practitioners' attitudes in importance of ear
pulling as a diagnostic symptom (P = 0.034) and clinical findings in the tympanic
membrane for the diagnosis of AOM (P = 0.006). Significant changes towards
increased comfort of practitioners' management attitudes were found in managing
selected patients without antibiotics (P = 0.057), using shortened courses of
antibiotics (P = 0.001), and using high dose amoxicillin (80 mg/kg/day) as a
second line drug (P = 0.001). CONCLUSIONS: Practitioners' attitudes about
managing AOM can be modified in the short-term with an educational intervention
combining didactic, hands-on, and interactive learning that incorporates
evidence-based medicine.

Publication Types: 
    Consensus Development Conference
    Review

PMID: 15364504 [PubMed - indexed for MEDLINE]

1270: Int J Pediatr Otorhinolaryngol. 2004 Oct;68(10):1301-5.

Myringotomy and tympanostomy tube placement in children with sickle cell disease.

Tran KD, Koprowska IA, Rao S, Sundaram R, Goldstein NA.

Department of Otolaryngology, State University of New York Downstate Medical
Center, 450 Clarkson Avenue, Box 126, Brooklyn 11203-2098, USA.
kdtran2004@yahoo.com

OBJECTIVE: To assess the event rate of myringotomy and tube placement (M&T) in
the pediatric patient population with sickle cell disease (SCD). METHODS: Four
hundred and forty-nine children with confirmed SCD have been followed over a
period of 11.5 years at two hospital-based pediatric hematology and
otolaryngology offices, and three tertiary care hospitals. Children with SCD who 
had undergone M&T were identified via computer search of International
Classification of Diseases codes by the medical records departments of the three 
hospitals, and from two databases of the hematology offices. The inpatient and
outpatient medical records of all children identified were reviewed. RESULTS: For
the 449 patients, mean duration of SCD follow-up was 6.13 +/- 3.36 years. Of
these, eight patients (four boys, four girls, mean age 9 +/- 3.5 years; four
patients had hemoglobin SC disease, and four patients had sickle cell anemia type
SS) underwent M&T. Two children met criteria for severe SCD. The event rate for
M&T insertion was 0.29/100 person-years, 95% CI (0.15, 0.58). CONCLUSIONS: The
event rate for M&T in children with SCD, compared to a historical control group, 
is lower than that of the general population. Type and severity of SCD were not
predictive of the need for tube insertion. Children with sickle cell disease do
not have an increased rate of M&T insertion.

Publication Types: 
    Multicenter Study

PMID: 15364502 [PubMed - indexed for MEDLINE]

1271: Vet Surg. 2004 Sep-Oct;33(5):435-9.

Cosmetic results of a ventrally based advancement flap for closure of total ear
canal ablations in 6 cats: 2002-2003.

McNabb AH, Flanders JA.

Department of Clinical Sciences, College of Veterinary Medicine, Cornell
University, Ithaca, NY 14853, USA.

OBJECTIVE: To report the outcome of a modified total ear canal ablation (TECA)
technique to maintain normal ear carriage in cats. STUDY DESIGN: Case series.
ANIMALS: Six cats with external ear canal disease. METHODS: Medical records were 
reviewed to identify cats in which a modified TECA using a single pedicle
advancement flap was used to maintain normal ear carriage. Signalment,
histopathologic diagnosis, complications, and outcome were retrieved. Owners were
contacted to document long-term outcome. RESULTS: Modified TECA procedures (7)
were performed in 6 cats. Normal ear carriage was present immediately after
surgery and was preserved at follow-up interview. Owners were satisfied with
cosmetic appearance. Histopathologic diagnosis of excised ear masses included
ceruminous gland adenocarcinoma (2 cats), ceruminous gland adenoma (2 cats, 3
ears), and inflammatory polyp (2 cats). CONCLUSIONS: Modification of the TECA
skin incision preserved normal ear carriage in all cats. Owners were satisfied
with overall outcome and with cosmetic result. Rate and nature of complications
were similar to previously published data. CLINICAL RELEVANCE: A simple
modification of the TECA skin incision to create a single pedicle advancement
flap maintains normal ear carriage in cats.

Publication Types: 
    Evaluation Studies

PMID: 15362981 [PubMed - indexed for MEDLINE]

1272: Pediatr Infect Dis J. 2004 Sep;23(9):834-8.

Comparison of five-day cefdinir treatment with ten-day low dose
amoxicillin/clavulanate treatment for acute otitis media.

Block SL, Busman TA, Paris MM, Bukofzer S.

Kentucky Pediatric/Adult Research, Bardstown, KY, USA. sblock@pol.net

BACKGROUND: Short course beta-lactam antibiotic therapy for acute otitis media
(AOM) should improve patient adherence, but it has not been evaluated since the
heptavalent pneumococcal conjugate vaccine became routinely used in the United
States. METHODS: In a prospective, investigator-blinded, multicenter study, 425
patients, age 6 months-6 years, with a clinical diagnosis of nonrefractory AOM
were randomized to receive either 5 days of cefdinir therapy (14 mg/kg divided
twice daily) or 10 days of amoxicillin/clavulanate therapy (45/6.4 mg/kg divided 
twice daily). Clinical response was assessed at end of therapy (2-4 days
postantibiotic, respectively) and week 4 (study days 25-28). RESULTS: With no
difference in demographics between treatment groups, overall the mean age (+/-SD)
was 2.8 +/- 1.8 years, 65% had received conjugated pneumococcal vaccination and
48% had bilateral AOM. The satisfactory clinical response rate at end of therapy 
was comparable for cefdinir versus amoxicillin/clavulanate (88%, 170 of 194
versus 85%, 164 of 192; 95% CI -4.9, 9.3). Although this must be interpreted with
caution, cefdinir showed an apparent trend for higher efficacy than
amoxicillin/clavulanate (92%, 72 of 78 versus 77%, 55 of 71; P = 0.019) in a
subsample of patients 6-24 months old who had received conjugated pneumococcal
vaccination. The incidence of drug-related adverse events was less for cefdinir
than for amoxicillin/clavulanate (24%, 50 of 211 versus 38%, 82 of 214; P =
0.0018) CONCLUSION: For children with nonrefractory AOM, based only on clinical
endpoints, 5 days of therapy with cefdinir 14 mg/kg divided twice daily was
comparable overall with 10 days of therapy with low dose amoxicillin/clavulanate 
45/6.4 mg/kg divided twice daily.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15361722 [PubMed - indexed for MEDLINE]

1273: Pediatr Infect Dis J. 2004 Sep;23(9):829-33.

Comment in:
    Pediatr Infect Dis J. 2004 Sep;23(9):839-41.

Community-wide vaccination with the heptavalent pneumococcal conjugate
significantly alters the microbiology of acute otitis media.

Block SL, Hedrick J, Harrison CJ, Tyler R, Smith A, Findlay R, Keegan E.

Kentucky Pediatric Research, Inc., Bardstown, KY, USA.

BACKGROUND: Community-wide use of conjugated heptavalent pneumococcal vaccine
(PCV7) in children <2 years of age could affect the microbiology of acute otitis 
media (AOM) in vaccinees, particularly for penicillin-nonsusceptible
Streptococcus pneumoniae (PNSP). SETTING: Since Summer 2000, 94% of young
children cared for by this 7-clinician, pediatric practice in rural central
Kentucky received 3 or 4 doses of PCV7 in the first 18 months of life. OBJECTIVE:
To determine changes in microbiology of AOM before and after community-wide
routine implementation of PCV7. METHODS: Among children 7-24 months old with
severe or refractory AOM, we compared 336 AOM isolates from 1992-1998 with 83 AOM
isolates from 2000-2003 in children who had received 3 or 4 doses of PCV7.
RESULTS: Comparing each cohort (1992-1998 versus 2000-2003), the proportion of S.
pneumoniae decreased from 48% to 31% (P = 0.009; relative risk, 0.754; 95%
confidence interval, 0.628-0.906), and nontypable Haemophilus influenzae
increased from 41% to 56% (P = 0.01; relative risk, 1.87; 95% confidence
interval, 1.15-3.04; beta-lactamase-positive, 56% versus 64%, not significant).
The proportions of intermediate PNSP and resistant PNSP, respectively, were 16%
and 9% versus 13% and 6% pre- and post-PCV7, respectively. Vaccine and
vaccine-related serotypes, respectively, comprised 70% and 8% versus 36% and 32% 
of S. pneumoniae strains (P = 0.003). Post-PCV7, Gram-negative bacteria and
beta-lactamase-producing organisms accounted for two-thirds and one-half of all
AOM isolates, respectively. DISCUSSION: The overall proportion of S. pneumoniae
isolates and vaccine serotypes in AOM were significantly reduced by
community-wide use of PCV7 vaccine in our practice. The proportion of
Gram-negative bacteria became 2-fold more frequent than S. pneumoniae in AOM in
PCV7-vaccinated young children where PCV7 uptake was community-wide and supply
was adequate.

Publication Types: 
    Comparative Study

PMID: 15361721 [PubMed - indexed for MEDLINE]

1274: Pediatr Infect Dis J. 2004 Sep;23(9):824-8.

Comment in:
    Pediatr Infect Dis J. 2004 Sep;23(9):839-41.

Changes in frequency and pathogens causing acute otitis media in 1995-2003.

Casey JR, Pichichero ME.

Elmwood Pediatric Group, Department of Pediatrics, University of Rochester,
Rochester, NY, USA.

OBJECTIVE: This study was undertaken to determine whether a change in the
frequency or distribution of the causative pathogens in persistent acute otitis
media (AOM) and AOM treatment failure (AOMTF) occurred after publication of the
Centers for Disease Control and Prevention AOM treatment guidelines advocating
high dose amoxicillin in 1998 and the universal use of the pneumococcal conjugate
vaccine in 2000. METHODS: This was a 9-year prospective study in a suburban,
community-based private practice. To identify bacterial isolate(s), 551 children 
with AOM who had not responded after 1 or 2 empiric antimicrobial treatment
courses (termed persistent AOM) and those who were failures after 48 h on
treatment (AOMTF) underwent tympanocentesis. Three periods were compared: (1)
1995-1997 when all enrolled received standard dose amoxicillin (40-50 mg/kg/day
divided 3 times daily) as the initial empiric treatment; (2) 1998-2000 when all
received high dose amoxicillin (80-100 mg/kg/day divided twice daily); and (3)
2001-2003 when high dose amoxicillin and pneumococcal conjugate vaccinations were
used. RESULTS: Persistent AOM or AOMTF for which tympanocentesis was performed
occurred in 195 (16.2%) of 1,207, 204 (16.1%) of 1,278 and 152 (12.3%) of 1,232
AOM visits for 1995-1997, 1998-2000 and 2001-2003, respectively; the 24% decline 
in 2001-2003 in persistent AOM and AOMTF was significant (P = 0.007). Middle ear 
aspirates grew Streptococcus pneumoniae (48, 44 and 31%) and Haemophilus
influenzae (38, 43 and 57%) for time periods 1, 2 and 3, respectively. There was 
a significant decline in S. pneumoniae (P = 0.017) and increase in H. influenzae 
(P = 0.012) isolations and of H. influenzae that were beta-lactamase-producing (P
= 0.04) among middle ear fluid isolates. Also there was a trend for an increased 
proportion of S. pneumoniae in 2001-2003 that were penicillin-susceptible (P =
0.17). CONCLUSIONS: In our experience, persistent AOM and AOMTF has decreased in 
frequency since the introduction of high dose amoxicillin therapy and
pneumococcal conjugate vaccination. It appears that H. influenzae has become the 
predominant pathogen of persistent AOM and AOMTF since universal immunization
with the pneumococcal conjugate vaccine. Fewer S. pneumoniae AOM isolates are
penicillin-resistant and more H. influenzae are beta-lactamase-producing.

Publication Types: 
    Comparative Study

PMID: 15361720 [PubMed - indexed for MEDLINE]

1275: Clin Microbiol Infect. 2004 Sep;10(9):854-7.

Acute and chronic otitis media and Turicella otitidis: a controversial
association.

Gomez-Garces JL, Alhambra A, Alos JI, Barrera B, García G.

Servicio de Microbiología, Hospital de Mostoles, Instituto Madrileño de Salud,
28935 Móstoles, Madrid, Spain. jlgarces@microb.net

Turicella otitidis is a non-fermenting Gram-positive bacillus isolated almost
exclusively from ear exudates. Its significance in acute or chronic otitis media 
is controversial. Over a 12-month period, T. otitidis was isolated from nine ear 
exudates from seven patients. Most of these were cases of spontaneous drainage
following recurrence of otitis media after antimicrobial therapy that was
ineffective against T. otitidis. The MICs of penicillin, levofloxacin, linezolid 
and vancomycin were very low for all the isolates studied, but most isolates
displayed high resistance to macrolides and lincosamides.

PMID: 15355421 [PubMed - indexed for MEDLINE]

1276: J Am Vet Med Assoc. 2004 Aug 15;225(4):548-53.

Evaluation of outcome of otitis media after lavage of the tympanic bulla and
long-term antimicrobial drug treatment in dogs: 44 cases (1998-2002).

Palmeiro BS, Morris DO, Wiemelt SP, Shofer FS.

Department of Clinical Studies, School of Veterinary, Medicine, University of
Pennsylvania, Philadelphia, PA 19104, USA.

OBJECTIVE: To evaluate the outcome of otitis media in dogs after video-otoscopic 
lavage of the tympanic bulla and long-term antimicrobial drug treatment. DESIGN: 
Retrospective study. ANIMALS: 44 dogs with otitis media treated in an academic
referral practice. PROCEDURE: Medical records were reviewed for signalment,
duration of ear canal disease, previous medical treatments, dermatologic
diagnosis, results of cytologic examination and microbial culture of ear canal
exudate, findings during video-otoscopy, medical treatment, days to resolution,
and maintenance treatments prescribed. Four independent variables (age, duration 
of ear canal disease prior to referral, use of corticosteroids in treatment
regimens, and infection with Pseudomonas aeruginosa) were evaluated statistically
for potential influence on time to resolution. RESULTS: Mean +/- SD (range)
duration of ear canal disease prior to referral was 24.9 +/- 21.6 (3 to 84)
months. Otitis media in 36 dogs resolved after lavage of the tympanic bulla and
medical management; mean +/- SD (range) time to resolution was 117 +/- 86.7 (30
to 360) days. Time to resolution was not significantly influenced by any variable
evaluated. Three dogs were lost to follow-up, and 4 dogs eventually required
surgical intervention. Seven of 36 dogs in which otitis had resolved relapsed; 4 
required additional lavage procedures. CONCLUSIONS AND CLINICAL RELEVANCE:
Results indicate that lavage of the tympanic bulla combined with medical
management is an effective and viable option for treatment of otitis media in
dogs.

PMID: 15344362 [PubMed - indexed for MEDLINE]

1277: Pediatrics. 2004 Sep;114(3):755-61.

Population-based impact of pneumococcal conjugate vaccine in young children.

Poehling KA, Lafleur BJ, Szilagyi PG, Edwards KM, Mitchel E, Barth R, Schwartz B,
Griffin MR.

Department of Pediatrics, Vanderbilt University Medical Center, Nashville,
Tennessee 37232-2637, USA.

OBJECTIVE: To determine the population impact of pneumococcal conjugate vaccine
(PCV) on pneumococcal-related diseases, including pneumonia and otitis media.
METHODS: Using administrative data from Tennessee Medicaid and 3 commercial
insurance plans in upstate New York, we measured annual rates of medical visits
for pneumococcal-related diseases (pneumococcal and nonspecific pneumonia and
invasive disease; otitis media) and pneumococcal-unrelated diseases (other acute 
respiratory illnesses). Disease rates before (1995-2000 in Tennessee; 1998-2000
in New York) and after (2000-2002) PCV licensure were calculated for children
aged <2 years (eligible for PCV) and those 3 to 5 years (not routinely given
PCV). Because annual variations should affect both age groups similarly and
vaccine-related outcomes should preferentially decline in younger children,
ratios (<2:3-5 years) of disease rates before and after PCV licensure were
compared. Expected disease rates were calculated for children aged <2 years in
each postvaccine year. The difference between observed and expected disease rates
was the estimated vaccine effect. RESULTS: In 2001-2002, there were 67 380 and
9485 child-years of observation for Tennessee and New York children aged <2
years, respectively. We observed fewer visits for pneumonia and invasive disease 
per 1000 children than expected in both regions: 20 fewer emergency department or
outpatient visits in Tennessee and 33 fewer outpatient visits in New York. Otitis
media visits declined by 118 and 430 per 1000 children in Tennessee and New York,
respectively. CONCLUSIONS: Adding PCV to the childhood immunization schedule was 
associated with a 10-fold greater reduction in pneumonia and a 100-fold greater
reduction in otitis media than the previously reported reduction in
culture-confirmed invasive pneumococcal diseases of 1.3 episodes per 1000
children aged <2 years. Although additional studies are needed to confirm the
impact of routine immunization with PCV on pneumococcal-related disease, these
results suggest that its impact is substantially greater than the effects on
invasive disease alone.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15342850 [PubMed - indexed for MEDLINE]

1278: Int J Radiat Oncol Biol Phys. 2004 Sep 1;60(1):295-301.

Radiation-induced otitis media--study of a new test, vestibular-evoked myogenic
potential.

Yang TL, Young YH.

Department of Otolaryngology, National Taiwan University College of Medicine,
University Hospital, 1 Chang-te Street, Taipei, Taiwan.

PURPOSE: Excluding the radiation history, current physical examination and
audiovestibular function tests fail to differentiate radiation-induced otitis
media (ROM) from chronic otitis media (COM). This study applied the newly
developed vestibular-evoked myogenic potential (VEMP) test to investigate whether
the VEMP test can be of help in differentiating between them. METHODS AND
MATERIALS: Fourteen irradiated nasopharyngeal carcinoma (NPC) patients with ROM
(18 ears) and 14 age-matched, and gender-matched patients with COM (18 ears) were
enrolled. Each patient underwent stimulation with a short tone burst initially,
and then by tapping the forehead using a tendon hammer. To define the effect of
the neck soft tissue on the VEMP response further, an additional two groups (10
non-NPC patients with ROM but no neck fibrosis/edema and 10 non-NPC patients
without ROM but with neck fibrosis/edema) were included for comparison. RESULTS: 
The occurrence of normal VEMPs in the ROM ears (33%) did not differ significantly
from that in the COM ears (56%) by tone-burst stimulation. However, using tapping
evocation, most (89%) COM ears revealed normal VEMPs, and most (61%) ROM ears
demonstrated delayed VEMPs. Furthermore, most (90%) non-NPC patients with ROM but
no neck fibrosis/edema revealed delayed or absent VEMPs. In contrast, all non-NPC
patients with neck fibrosis/edema but no ROM demonstrated normal VEMPs
bilaterally, implying that the effect of neck soft tissue on the VEMP response is
less. CONCLUSION: Through tapping evocation, most COM ears revealed normal VEMPs,
and most ROM ears demonstrated delayed VEMPs, indicating that ROM is different
from COM because of the larger affected areas such as retrolabyrinthine or
brainstem involvement. This result can explain why grommet insertion or
tympanoplasty is not beneficial to postirradiated ears, possibly because both
operations spare the inflammation outside the middle ear cavity.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15337568 [PubMed - indexed for MEDLINE]

1279: Clin Ther. 2004 Jul;26(7):1168-78.

A cost threshold analysis of ciprofloxacin-dexamethasone versus ofloxacin for
acute otitis media in pediatric patients with tympanostomy tubes.

Roland PS, Pontius A, Michael Wall G, Waycaster CR.

Department of Otolaryngology, University of Texas Southwestern Medical Center,
Dallas, USA.

OBJECTIVE: The aim of this study was to determine the cost-effectiveness hreshold
of a ciprofloxacin 0.3% and dexamethasone 0.1% (CD) otic suspension relative to
olfloxacin otic solution (OFX) for the treatment of acute otitis media in
pediatric patients with tympanostomy tubes (AOMT). METHODS: This study used a
decision-analytic model to simulate the costs and consequences of the ototopical 
treatment of AOMT. The AOMT model consisted of 3 tiers of antimicrobial therapy. 
Each successive tier represented the repeat treatment of clinical failures from
the preceding tier. Patients were modeled for treatment until cured or until
third-tier therapy was complete, at which time patients were considered cured.
First-tier therapy modeled a comparison of CD and OFX using efficacy rates taken 
from a randomized clinical trial with a population of 599 patients. Second-tier
therapy modeled the use of amoxicillin and clavulanic acid using an efficacy rate
taken from the medical literature. Third-tier therapy was modeled as being
pathogen specific and could follow 1 of 3 possible clinical pathways: (1) PO
fluconazole, (2) IM ceftriaxone, or (3) IV antibiotics administered in a hospital
setting. Third-tier therapeutic pathway probabilities were based on the
microbiologic spectrum of the treatment failures from the clinical trial. Cost
information (in year-2003 US dollars) was taken from accepted cost reference
sources and presented from the perspective of a third-party payer. The economic
outcome of interest was the cost-effectiveness threshold of CD relative to OFX.
RESULTS: Given the model parameters, CD had a cost-effectiveness threshold value 
of 4.5 times the wholesale acquisition cost of OFX. Based on actual cost,
first-tier CD therapy was more cost-effective than OFX up to a threshold price of
US 152.64 dollars. CONCLUSION: In this decision-analytic model, CD was more
cost-effective than OFX for AOMT therapy in pediatric patients up to a threshold 
price of 4.5 times the price of OFX.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15336482 [PubMed - indexed for MEDLINE]

1280: Clin Ther. 2004 Jul;26(7):1046-54.

Efficacy of ofloxacin otic solution once daily for 7 days in the treatment of
otitis externa: a multicenter, open-label, phase III trial.

Torum B, Block SL, Avila H, Montiel F, Oliva A, Quintanilla W, Duncanson F,
Cantrell HF, Riefler J, Katz E, Lombardy E.

CIDAL, Guatemala City, Guatemala.

BACKGROUND: Otitis externa (OE) is an infection of the external auditory canal
that is typically treated with topically applied broad-spectrum antibiotics.
Twice-daily topical treatment with ofloxacin otic 0.3% solution for 10 days has
been reported to be as effective and well tolerated as the standard of care,
neomycin sulfate/polymyxin B sulfate/hydrocortisone solution administered 4 times
daily for 10 days. OBJECTIVE: This study evaluated the efficacy and safety
profile of 7 days of a once-daily regimen of ofloxacin otic 0.3% solution in the 
treatment of OE. METHODS: This multicenter, open-label, Phase III study was
conducted from June 12, 2002, to October 14, 2002. Eligible patients were aged > 
or = 6 months and had OE of <2 weeks' duration with moderate to severe edema and 
tenderness involving 1 or both ears and sufficient exudate for microbiologic
culture. Ofloxacin otic solution was instilled once daily for 7 days (5 drops for
children aged 6 months to <13 years, 10 drops for adolescents/adults aged > or = 
13 years). Assessments were conducted at the end-of-treatment visit and 7 to 10
days later (the test-of-cure visit). Medication was supplied free of charge to
study participants who incurred no costs for physician visits. RESULTS: Of 489
patients enrolled at 58 sites in 3 countries, 439 were clinically evaluable (173 
children, 266 adolescents/adults; 52 % males, 48% females; 47% Hispanic, 45%
white; 5% black, and 3% other). The cure rate among clinically evaluable patients
was 91% (95% of children, 88% of adolescents/adults); 68% of patients were cured 
within 7 days. Forty-three potentially pathogenic strains were isolated from 253 
microbiologically evaluable patients. Pseudomonas aeruginosa was isolated from
158 (62%) microbiologically evaluable patients and Staphylococcus aureus from 32 
(13%). Eradication rates were 96% overall. No serious adverse events were
observed. Minor adverse events were experienced by 15 (3%) of 489 patients
included in the safety population. The most common adverse events were pruritus
(5 patients), increased earache (4 patients), and application-site reactions (3
patients). Overall mean (SD) adherence to therapy was 98% (11.9). CONCLUSIONS:
Ofloxacin otic 0.3% solution administered once daily for 7 days was well
tolerated and effective in achieving clinical and microbiologic cure of OE. The
compliance rates in this study suggests that this regimen may be better accepted 
by patients than longer, more repetitive regimens.

Publication Types: 
    Clinical Trial
    Clinical Trial, Phase III
    Multicenter Study

PMID: 15336469 [PubMed - indexed for MEDLINE]

1281: Antimicrob Agents Chemother. 2004 Sep;48(9):3536-42.

Beta-lactamase-producing nontypeable Haemophilus influenzae fails to protect
Streptococcus pneumoniae from amoxicillin during experimental acute otitis media.

Westman E, Lundin S, Hermansson A, Melhus A.

Department of Oto-Rhino-Laryngology, Umeå University Hospital, Umeå, Sweden.
va.borjesdotter.westman@lvn.se

Acute otitis media (AOM) is the most common reason for outpatient antimicrobial
therapy. Mixed infections pose a potential problem, since the first-line drug
used for the treatment of AOM, amoxicillin, can be neutralized by
beta-lactamase-producing pathogens of the upper respiratory tract. To study the
effects of a 5-day course of amoxicillin on a mixed middle ear infection, rats
were challenged with Streptococcus pneumoniae alone or in combination with
beta-lactamase-producing nontypeable Haemophilus influenzae. Amoxicillin was
introduced at the clinical peak of the infection. Local and systemic changes were
monitored by otomicroscopy, bacterial culture, and analysis of histological
changes and the expression of the transforming growth factor beta (TGF-beta)
gene. beta-Lactamase-producing H. influenzae did not demonstrate an ability to
protect S. pneumoniae. Amoxicillin eradicated the pneumococci in all treated
animals but increased to some degree the ability of H. influenzae to persist at
the site of infection. Thus, only an insignificant acceleration of the resolution
of the AOM caused by a mixture of pathogens was observed during treatment.
Moderate to major morphological changes could not be avoided by treatment of the 
mixed infections, but a slight downregulation of TGF-beta expression was
observed. In contrast to infections caused by a single pathogen, the mixed
infections induced white plaques in the tympanic membrane at a remarkably high
frequency independent of treatment. These experimental findings constitute
support for further studies of antimicrobial drugs and AOM caused by bacteria
with and without mechanisms of antibiotic resistance.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15328122 [PubMed - indexed for MEDLINE]

1282: Curr Med Res Opin. 2004 Aug;20(8):1175-83.

Efficacy and safety of topical ciprofloxacin/dexamethasone versus
neomycin/polymyxin B/hydrocortisone for otitis externa.

Roland PS, Pien FD, Schultz CC, Henry DC, Conroy PJ, Wall GM, Garadi R, Dupre SJ,
Potts SL, Hogg LG, Stroman DW; Ciprodex Otic AOE Study Group.

Department of Otolaryngology, University of Texas Southwestern Medical Center,
Dallas, Texas 75390-9035, USA. peter.roland@utsouthwestern.edu

OBJECTIVES: To compare the efficacy and safety of ciprofloxacin
0.3%/dexamethasone 0.1% (CIP/DEX) otic suspension with that of neomycin
0.35%/polymyxin B 10,000 IU/mL/hydrocortisone 1.0% (N/P/H) otic suspension in
patients with acute otitis externa (AOE). STUDY DESIGN: Randomized,
observer-masked, parallel-group, multicenter study. Patients were randomized to 7
days treatment with either CIP/DEX 3-4 drops twice daily or N/P/H 3-4 drops three
times daily. POPULATION: Patients of either sex and older than 1 year, with a
clinical diagnosis of mild, moderate, or severe AOE and intact tympanic membranes
were recruited to participate. OUTCOMES MEASURED: Signs and symptoms of AOE,
including ear inflammation, tenderness, edema and discharge (assessed on Days 3, 
8 [End-of-Therapy] and 18 [Test-of-Cure]); microbiologic eradication (presumed or
documented); and frequency of adverse events. RESULTS: Patients enrolled numbered
468. In culture-positive patients who met the inclusion criteria (N = 396),
clinical cure rates at Day 18 were significantly higher with CIP/DEX than with
N/P/H (90.9% vs. 83.9%; p = 0.0375), as were microbiologic eradication rates
(94.7% vs. 86.0%; p = 0.0057). In addition, the clinical response was
significantly better with CIP/DEX than with N/P/H at Days 3 and 18 (p = 0.0279
and p = 0.0321, respectively), as was the reduction in ear inflammation at Day 18
(p = 0.0268). Both preparations were well tolerated in pediatric and adult
patients. CONCLUSIONS: 7 days treatment with CIP/DEX otic suspension administered
twice daily is clinically and microbiologically superior to N/P/H otic suspension
administered 3 times daily in the treatment of mild to severe AOE, and is equally
well tolerated.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15324520 [PubMed - indexed for MEDLINE]

1283: Eur J Pediatr. 2004 Sep;163(9):524-9. Epub 2004 Jun 15.

Antibiotic susceptibility of acute otitis media pathogens in otitis-prone Belgian
children.

van Kempen MJ, Vaneechoutte M, Claeys G, Verschraegen GL, Vermeiren J, Dhooge IJ.

Department of Otorhinolaryngology, Ghent University Hospital, De Pintelaan 185,
9000, Ghent, Belgium.

A regional surveillance study was carried out in children with recurrent acute
otitis media (AOM) to determine the antimicrobial susceptibility of three common 
AOM pathogens. Susceptibility to relevant antimicrobial agents was determined on 
149 Streptococcus pneumoniae, 246 Haemophilus influenzae and 119 Moraxella
catarrhalis strains isolated between January 1999 and January 2002, either from
the nasopharynx or middle ear of 74 children with recurrent AOM, the majority
(77%) being otitis-prone. Overall pneumococcal resistance to penicillin was 9.4% 
(6.7% penicillin-intermediate resistant, 2.7% penicillin-resistant), whereas
cotrimoxazole and erythromycin resistance accounted for 25.5% and 38.9%
respectively. The prevalence of antimicrobial-non-susceptible S. pneumoniae was
the highest in middle ear isolates (P<0.05) and in otitis-prone children
(P<0.01). Moreover, otitis-prone children harboured significantly more
pneumococci resistant to at least two antimicrobial agents (24.3% versus 7.4%;
P<0.01). No patient age related variation was observed. Five serogroups (6, 19,
23, 14 and 9) covered by the 7-valent pneumococcal conjugate vaccine, constituted
most of the antibiotic resistant pneumococci. Among nasopharyngeal and middle ear
H. influenzae isolates, 17.1% were resistant to ampicillin and 16.3% to
cotrimoxazole. For M. catarrhalis, 92.4% of all isolates was
ampicillin-resistant. CONCLUSION: This study confirms international and national 
differences in antimicrobial susceptibility profiles of three acute otitis media 
pathogens with relatively favourable antibiotic resistance rates in Belgian
children with frequent acute otitis media. This "at risk" population of
otitis-prone children is shown to harbour more antimicrobial resistant and
multidrug resistant pneumococci. If antimicrobial therapy in this group of
children is indicated, high dose amoxicillin is recommended whereas the use of
macrolides is obsolete.

Publication Types: 
    In Vitro

PMID: 15322870 [PubMed - indexed for MEDLINE]

1284: J Coll Physicians Surg Pak. 2004 Aug;14(8):459-61.

Comment in:
    J Coll Physicians Surg Pak. 2005 Jun;15(6):378-9; authors reply 379.

Microbiology and drug sensitivity patterns of chronic suppurative otitis media.

Aslam MA, Ahmed Z, Azim R.

Department of Otorhinolaryngology and Head & Neck Surgery, Foundation University 
Medical College, Rawalpindi. dr_azeemaslam@hotmail.com

OBJECTIVE: To identify the commonest microorganisms associated with chronic
discharging ears and their antimicrobial sensitivities. DESIGN: Descriptive
study. PLACE AND DURATION OF STUDY: This study was carried out from August 2003
to February 2004 at the Department of Otorhinolaryngology and Head and Neck
Surgery, Fauji Foundation Hospital, Rawalpindi. MATERIALS AND METHODS: A total of
124 patients with unilateral or bilateral active chronic suppurative otitis media
attending the outpatient clinic were included in the study. All patients were
evaluated through detailed history and clinical examination. Pus samples were
collected from the discharging ear(s) and sent to the hospital laboratory where
culture and sensitivity studies were done for aerobes, anaerobes and fungi and
antibiotic sensitivity patterns. RESULTS: Overall microbiology of 142 samples was
studied. Among them, 108 (76%) were pure cultures and 34 (23.9%) were mixed.
There were 186 isolates including 182 (97.8%) aerobes, nil anaerobes and only 4
(2.1%) fungi. Pseudomonas aeruginosa 94(50.5%) was the most common isolate,
followed by Staphylococcus aureus 44 (23.6%). Drug sensitivities pattern of
Pseudomonas aeruginosa showed that ciprofloxacin was active against majority
95.8% of isolates followed by amikacin 83.3%, gentamicin and tobarmycin 60% and
cefotaxime 41.6%. Staphylococcus aureus isolates were resistant to penicillin,
ampicillin and amoxicillin in 77.2% whereas majority was sensitive to coamoxiclav
81.8% and cephradine 86.3%. CONCLUSION: Commonest organisms isolated from chronic
discharging ears were Pseudomonas aeruginosa and Staphylococcus aureus. Majority 
of isolates of Pseudomonas aeruginosa were sensitive to ciprofloxacin. Majority
of strains of Staphylococcus aureus were resistant to penicillin. Cephradine and 
coamoxiclav were effective against most of the isolates of Staphylococcus aureus.

PMID: 15321034 [PubMed - indexed for MEDLINE]

1285: J Laryngol Otol. 2004 Jul;118(7):576-9.

Use of magnetic resonance imaging as the primary imaging modality in the
diagnosis and follow-up of malignant external otitis.

Ismail H, Hellier WP, Batty V.

Department of Otorhinolaryngology, Southampton General Hospital, UK.

Malignant external otitis (MEO) is a severe infection of the external auditory
meatus caused by Pseudomonas aeruginosa. Classical features include unrelenting
deep otalgia, otorrhoea and granulations in the floor of the ear canal. Treatment
is generally protracted antibiotic therapy and monitoring of inflammatory
markers; the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
Traditionally computed tomography (CT) has been the imaging modality of choice.
The authors present a case where magnetic resonance imaging (MRI) has been
crucial in the diagnosis and follow up of a patient with MEO.

Publication Types: 
    Case Reports

PMID: 15318971 [PubMed - indexed for MEDLINE]

1286: Water Sci Technol. 2004;50(1):63-7.

Poor-quality water in swimming pools associated with a substantial risk of otitis
externa due to Pseudomonas aeruginosa.

Hajjartabar M.

Faculty of Industrial Safety & Health, Sahel Park, Boulevard Sahel, Hakimyeh
Tehranpars, Tehran, Iran. f_i_s_h_edu@hotmail.com

There are many large and small public outdoor and indoor swimming pools in Tehran
that hundreds of people use, especially on hot summer days. The bacteriological
quality of the water of some of these pools was assayed over a period of about
one year (2001-2002). To assess if these swimming pools were a health risk to
users, eleven public swimming pools, in the east and northeast of the city, were 
examined, and the exposed people were monitored. Samples of swimming-pool waters 
were examined for colony counts, Escherichia coli and coliforms. In addition,
Pseudomonas aeruginosa was isolated from nine (81.8%) of those pools. P.
aeruginosa grew in seven (63.6%) of the swimming-pool water samples. In two
(18.2%) other samples, in addition to P. aeruginosa, high rates of total
bacterial count, total coliforms and faecal coliform counts were also found. At
the same time, users of the swimming pools were asked to complete a
questionnaire. Ear swabs were collected from 179 users with a history of ear
problems during the previous two weeks. An adequate control group was chosen
randomly from those who never used the investigated pools. P. aeruginosa was
isolated from the ear swabs of 142 (79.3%) of the cases, as well as from 4% of
the controls. Results were matched for age, sex, duration of time spent in the
pools, place of occurrence and other useful information. Investigation of the
contaminated swimming pools revealed that chlorination was often inadequate,
especially when high numbers of people led to overuse of the pools. Although the 
results of this research showed that otitis externa was strongly associated with 
the swimming pools, due to P. aeruginosa, an extensive follow-up study is needed 
to determine the other possible health risks associated with public pools.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15318488 [PubMed - indexed for MEDLINE]

1287: Adv Ther. 2004 Mar-Apr;21(2):87-95.

Amoxicillin tablets for oral suspension in the treatment of acute otitis media: a
new formulation with improved convenience.

Dhaon NA.

Marion Internal Medicine Associates, Ocala, Florida, USA.

Acute otitis media (AOM) is the most common cause of pediatric office visits in
the United States and the most frequent bacterial infection in children.
Antimicrobials are often prescribed and amoxicillin continues to be the
first-line treatment for AOM. Recently, amoxicillin tablets that disperse in
water to form an oral suspension have become available in the United States for
the treatment of AOM. This formulation retains the efficacy, safety, and
tolerability features of conventional amoxicillin formulations while providing
the additional potential benefits of improved portability, patient convenience
and compliance, and dosing accuracy.

Publication Types: 
    Review

PMID: 15310082 [PubMed - indexed for MEDLINE]

1288: Int J Pediatr Otorhinolaryngol. 2004 Sep;68(9):1199-201.

T-cell lymphoma presenting as acute mastoiditis with a facial palsy.

Ho TP, Carrie S, Meikle D, Wood KM.

Department of Otorhinolaryngology, Head and Neck Surgery, Freeman Hospital,
Newcastle-upon-Tyne NE7 7DN, UK. allantpho@hotmail.com

Isolated T-cell lymphomas affecting only the mastoid are extremely rare.
Presentation with oto-neurological signs prior to systemic involvement of a
lymphoproliferative disease is also unusual. This is the youngest reported
patient with a peripheral T-cell lymphoma with disease isolated only in the
mastoid who presented with acute mastoiditis and a complete seventh cranial nerve
palsy.

Publication Types: 
    Case Reports

PMID: 15302153 [PubMed - indexed for MEDLINE]

1289: Int J Pediatr Otorhinolaryngol. 2004 Sep;68(9):1175-9.

An evaluation of postural stability and the effects of middle-ear drainage on
vestibulo-spinal reflexes of children with chronic otitis media with effusion.

Gawron W, Pośpiech L, Orendorz-Fraczkowska K.

ENT Department, Faculty of Medicine, University of Wroclaw, ul. Chalubinskiego 2,
Wroclaw 50-368, Poland. wgawron@interia.pl

OBJECTIVE: Many authors agree that chronic otitis media with effusion (OME) are
the main causes of vertigo and balance disturbances in children. The aim of this 
work was the stabilometric evaluation of postural stability and the influence of 
middle ear drainage on vestibulo-spinal reflexes in children with OME. METHODS:
Fifteen children with OME (5-14 years old, 13 males and two females) were
selected for bilateral drainage of the middle ear after conservative treatment
proved ineffective. The control group consisted of 15 healthy children of an
analogous age range. Static and quasi-dynamic posturography was performed to
evaluate balance. The tests were performed three times: 1 day before drainage, 1 
day after drainage and 4 weeks after drainage. Parameters including the field of 
the developed area and the average velocity of body deflection were analysed.
RESULTS: There was statistically significant elevation of stabilogram parameters 
in almost all the tests in children with OME as compared to the control group.
The changes in the stabilogram parameters were analysed with reference to the
timing of the evaluation. Significant improvement was noted after the fluid was
removed from the ear, although recovery was not complete after 4 weeks.
CONCLUSIONS: The presence of fluid in the middle ear impairs the functioning of
the balance system in children. Postural stability and the quantity of
vestibulo-spinal reflexes seem to depend on the functional condition of the
middle ear. Prolonged cases of OME could potentially handicap a child's motor
development.

PMID: 15302148 [PubMed - indexed for MEDLINE]

1290: Int J Pediatr Otorhinolaryngol. 2004 Sep;68(9):1149-55.

Nasopharyngeal pathogens in children with acute otitis media in a low-antibiotic 
use country.

Nielsen HU, Konradsen HB, Lous J, Frimodt-Møller N.

Statens Serum Institut, National Center for Antimicrobials & Infection Countrol, 
Building 47, 5 Artillerivej, Copenhagen 2300S, Denmark. hun@ssi.dk

OBJECTIVE: Acute otitis media (AOM) is one of the most common diseases of
childhood. Knowledge, of which bacteria are the most common pathogens in AOM and 
their susceptibilities towards antibiotics, is essential for the reasonable
empiric treatment. With rapidly increasing frequencies of antibiotic resistance
surveillance of the common etiologic pathogens has become pertinent. The purpose 
of this paper is to present the bacteriological findings and antibiotic
susceptibilities, in cultures from nasopharyngeal swabs, in Danish children with 
AOM. METHODS: Children aged up to 10 years who had AOM diagnosed in general
practice in Denmark were swabbed in nasopharynx, cultures were incubated and
susceptibility testing was performed as tablet diffusion and minimal inhibitory
concentrations (MICs) were determined by E-test. RESULTS: We included 331
patients, in 257 bacteria were found, which could be classified as commonly ear
pathogenic. The most frequent bacteria found was Streptococcus pneumoniae
followed by Haemophilus influenzae and Moraxella catarrhalis. Ninety-six percent 
of the tested S. pneumoniae were susceptible towards penicillin and 99% towards
erythromycin. Eighty-nine percent of the H. influenzae were susceptible to
ampicillin and all tested M. catarrhalis were susceptible towards erythromycin.
In more than 30% of H. influenzae MIC of phenoxymethylpenicillin were above the
level that could be achieved in middle ear fluid. CONCLUSION: Antimicrobial
resistance is still infrequent in pathogens that might cause AOM in children in
Denmark; this is probably due to minimal use of antibiotics as well as the use of
phenoxymethylpenicillin as primary drug for treatment of AOM.
Phenoxymethylpenicillin and azithromycin are not efficient for treating the
majority of infections due to H. influenzae.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15302145 [PubMed - indexed for MEDLINE]

1291: J Investig Allergol Clin Immunol. 2004;14(2):154-8.

The role of allergy in recurrent otitis media with effusion.

Döner F, Yariktas M, Demirci M.

Süleyman Demirel University, Faculty of Medicine, Department of
Otorhinolaryngology, Isparta/Turkey. fehmidoner@hotmail.com

OBJECTIVE: To compare the OME groups that improved when treated with
adenoidectomy, VT and medication, and which of them recurred. METHODS: Twenty-two
consecutive children with recurrent OME (11%) were selected among 200 children
who had adenoidectomies and had been inserted a ventilation tube (VT) for OME.
The patients were selected for allergy evaluation because of recurrent OME not
responsive to medical therapy and adenoidectomy, requiring more than one
myringotomy with tubes. The control group consisted of 24 healthy children that
were treated with adenoidectomy and VT, and had no recurrence. RESULTS: Eight
(36.4%) patients had positive skin tests for inhalant and food allergens. Two
subjects of the control group (8.3%) had positive skin tests for inhalant and
food allergens. This was statistically significant (p:0.032). A pattern to
multiple positive nasal and food reactions was shown in the study group rather
than in the control subjects. CONCLUSIONS: The possibility of allergy should be
considered in OME cases that did not improve with drug treatment and
adenoidectomy and VT insertion but recurred, and a thorough search for allergen
was made for proper diagnostic and therapeutic management.

PMID: 15301306 [PubMed - indexed for MEDLINE]

1292: Pediatr Infect Dis J. 2004 Aug;23(8):774-8.

Fungal biofilm formation on cochlear implant hardware after antibiotic-induced
fungal overgrowth within the middle ear.

Cristobal R, Edmiston CE Jr, Runge-Samuelson CL, Owen HA, Firszt JB, Wackym PA.

Department of Otolaryngology and Communication Sciences, University of Wisconsin,
Milwaukee, Milwaukee, WI 53226-3596, USA.

Cochlear implantation in patients with chronic suppurative otitis media is
managed with perioperative antibiotics; however, fungal overgrowth can occur. We 
present a child who received oral cefdinir and topical ofloxacin (Floxin). After 
6 weeks, a fungal (Candida) biofilm was demonstrated on the implant surface. In
this clinical setting, an antimicrobial strategy using an oral antifungal to
prevent fungal overgrowth is a possibility.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 15295230 [PubMed - indexed for MEDLINE]

1293: Pediatr Infect Dis J. 2004 Aug;23(8):732-8.

The seven-valent pneumococcal conjugate vaccine reduces tympanostomy tube
placement in children.

Palmu AA, Verho J, Jokinen J, Karma P, Kilpi TM.

National Public Health Institute, Helsinki, Finland.

BACKGROUND: The novel pneumococcal conjugate vaccine, PncCRM, has been shown to
prevent acute otitis media caused by vaccine serotypes and to reduce otitis
surgery. Our aim was to assess long term efficacy of the vaccine on tympanostomy 
tube placements. METHODS: Children with complete follow-up in the Finnish Otitis 
Media Vaccine Trial up to 24 months of age and still living in the study area
(1490 of 1662 randomized at 2 months of age) were invited to a single visit at
4-5 years of age. The children had been vaccinated at 2, 4, 6 and 12 months of
age with PncCRM or hepatitis B vaccine (control). Tympanostomy tube placements
reported by parents at the visit were verified from hospital and private medical 
center records. Additionally, tympanostomy tube placements of all children were
verified from the hospital discharge registry. Vaccine efficacy (VE) was
estimated by comparing all events of tympanostomy tube placement between vaccine 
groups. RESULTS: During the vaccine trial (2-24 months of age), VE (95%
confidence interval) in preventing tympanostomy tube placement was only 4%
(-19-23%). Altogether 756 children were enrolled for the follow-up study. After
24 months of age, the rate of surgery was 3.5 per 100 person-years in the PncCRM 
and 5.7 per 100 person-years in the control children, giving VE of 39% (4-61%).
In the hospital-based data of all children (N = 1490), VE of 44% was obtained
(19-62%). CONCLUSIONS: Receipt of PncCRM vaccine at infancy was associated with a
reduction in tympanostomy tube placement from 2 to 4-5 years of age.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15295223 [PubMed - indexed for MEDLINE]

1294: Ear Hear. 2004 Aug;25(4):388-96.

Hearing loss associated with ear infections in Nord-Trøndelag, Norway.

Tambs K, Hoffman HJ, Engdahl B, Borchgrevink HM.

Epidemiology Section, Norwegian Institute of Public Health, N-0403 Oslo, Norway. 
kristian.tambs@fhi.no

OBJECTIVE: We have assessed the effect of recurrent childhood ear infections on
adult hearing. We also examined whether adult hearing is poorer with an early age
of onset of ear infections compared with later onset. DESIGN: A population-based 
cohort of 50,398 subjects, 20 yr of age or older, were examined with
air-conduction, pure-tone audiometry and reported if they had had recurrent ear
infections (EI) in childhood (or subsequently) with the age of onset. RESULTS:
There were poorer hearing thresholds associated with recurrent EI for all
frequency ranges from 0.25 kHz to 8 kHz, regardless of age or gender. The effect 
increased with age from approximately 2 dB among younger subjects (20 to 44 yr
old) to approximately 5 to 6 dB among older subjects (65 yr or older). Among
younger subjects, the effect of EI was somewhat stronger for men, whereas among
older subjects the effect was somewhat stronger for women. Early age of onset for
EI was associated with poorer hearing thresholds than late onset. The mean loss
was close to 9 to 10 dB for all frequency ranges among older subjects reporting
onset of EI before 2 yr of age. The mean loss was only about 4 dB among older
subjects reporting onset of EI after 7 yr of age. CONCLUSIONS: Reported EIs are
associated with similar consequences in terms of reduced hearing across
frequencies 0.25 to 8 kHz for male and female subjects. The observed effects are 
stronger among older than among younger subjects, perhaps because effects
increase with age or possibly because EI affected the hearing more before 1940
than during subsequent decades. Reported early age of onset of EI increases the
risk of a substantially reduced hearing level later in life.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15292778 [PubMed - indexed for MEDLINE]

1295: Dev Med Child Neurol. 2004 Aug;46(8):514-9.

Long-term prognosis of cerebral venous sinus thrombosis in childhood.

De Schryver EL, Blom I, Braun KP, Kappelle LJ, Rinkel GJ, Peters AC,
Jennekens-Schinkel A.

Department of Neurology, University Medical Center Utrecht, H.02.128, PO Box
85500, 3508 GA Utrecht, The Netherlands. e.deschryver@neuro.azu.nl

Cerebral venous sinus thrombosis (CVST) is a rare but potentially serious
disorder in children. There is no literature on the long-term neuropsychological 
and emotional sequelae and implications for quality of life. We studied 17
children who had CVST after the neonatal period, aged between 1 month and 16
years at the time of CVST (mean age at CVST was 6 years, median 4 years 8
months). Five children died during follow-up. The cause of death was related to
CVST in one child. Twelve children participated in a clinical follow-up
assessment. Mean follow-up was 2 years 8 months. One child had physical sequelae 
with impairment of skilled movement. All children had average or high
intelligence scores. Two children with CVST due to an uncomplicated mastoiditis
had mild cognitive deficits: one child had difficulty with written language; the 
other had diminished cognitive efficiency with concentration and attention
problems associated with decreased psychosocial functioning. Decreased physical
well-being was reported in three of 12 children. We conclude that children who
had survived CVST had a fair prognosis. Most had normal cognitive and physical
development, although mild cognitive deficits or decreased physical and
psychosocial well-being can occur.

PMID: 15287241 [PubMed - indexed for MEDLINE]

1296: Pediatrics. 2004 Aug;114(2):342-7.

Developing community-specific recommendations for first-line treatment of acute
otitis media: is high-dose amoxicillin necessary?

Garbutt J, St Geme JW 3rd, May A, Storch GA, Shackelford PG.

Division of General Medical Sciences, Washington University School of Medicine,
St Louis, Missouri, USA. jgarbutt@im.wustl.edu

OBJECTIVES: National recommendations are to use high-dose amoxicillin (80-90
mg/kg per day) to treat uncomplicated acute otitis media (AOM) in children who
are at high risk for infection with nonsusceptible Streptococcus pneumoniae
(NSSP). However, high-dose treatment may not be necessary if the local prevalence
of NSSP is low. The objective of this study was to estimate the local prevalence 
of NSSP in children with acute upper respiratory illnesses and to develop
community-specific recommendations for first-line empiric treatment of AOM.
METHODS: We conducted a cross-sectional prevalence study in the offices of 7
community pediatricians in St Louis, Missouri. S pneumoniae was isolated from
nasopharyngeal swabs collected from children who were younger than 7 years and
had AOM, nonspecific upper respiratory infection, cough, acute sinusitis, or
pharyngitis. Children were excluded from the study when they had received an
antibiotic in the previous 4-week period. Parents and providers completed a brief
questionnaire to assess risk factors for carriage of NSSP. On the basis of
National Clinical Chemistry Laboratory Standards, isolates with a penicillin
minimum inhibitory concentration > or =0.12 microg/mL were considered to be
nonsusceptible to penicillin (NSSP), and isolates with a penicillin minimum
inhibitory concentration >2 microg/mL were categorized as nonsusceptible to
standard-dose amoxicillin (35-45 mg/kg per day; NSSP-A). RESULTS: S pneumoniae
was isolated from the nasopharynx of 85 (40%) of 212 study patients (95%
confidence interval [CI]: 33%-47%); 41 (48%) of 85 isolates were NSSP (95% CI:
37%-59%), and 6 (7%) were NSSP-A (95% CI: 1.5%-13%). Among the 212 study
patients, the prevalence of NSSP was 19% (95% CI: 14%-25%), and the prevalence of
NSSP-A was 3% (95% CI: 0.6%-5%). Carriage of NSSP was increased in child care
attendees compared with nonattendees (29% vs 14%; odds ratio: 2.6; 95% CI:
1.3-5.2). CONCLUSIONS: In our community, although the prevalence of NSSP among
isolates of S pneumoniae identified from the nasopharynx of symptomatic children 
is high (48%), the probability of NSSP-A infection among symptomatic children is 
<5%. Our data support a recommendation to treat most children who have
uncomplicated AOM with standard-dose amoxicillin. Children who attend child care 
or have recently received an antibiotic may require treatment with high-dose
amoxicillin. Other communities may benefit from a similar assessment of the
prevalence of NSSP and NSSP-A.

Publication Types: 
    Multicenter Study

PMID: 15286214 [PubMed - indexed for MEDLINE]

1297: Infect Immun. 2004 Aug;72(8):4662-7.

Role of p38 mitogen-activated protein kinase in middle ear mucosa hyperplasia
during bacterial otitis media.

Palacios SD, Pak K, Rivkin AZ, Kayali AG, Austen D, Aletsee C, Melhus A, Webster 
NJ, Ryan AF.

Department of Surgery/Otolaryngology, University of California-San Diego, La
Jolla, 92037, USA.

Hyperplasia of the middle ear mucosa contributes to the sequelae of acute otitis 
media. Understanding the signal transduction pathways that mediate hyperplasia
could lead to the development of new therapeutic interventions for this disease
and its sequelae. Endotoxin derived from bacteria involved in middle ear
infection can contribute to the hyperplastic response. The p38 mitogen-activated 
protein kinase (MAPK) is known to be activated by endotoxin as well as cytokines 
and other inflammatory mediators that have been documented in otitis media. We
assessed the activation of p38 in the middle ear mucosa of an in vivo rat
bacterial otitis media model. Strong activity of p38 was observed 1 to 6 h after 
bacterial inoculation. Activity continued at a lower level for at least 7 days.
The effects of p38 activation were assessed using an in vitro model of rat middle
ear mucosal hyperplasia in which mucosal growth is stimulated by nontypeable
Haemophilus influenzae during acute otitis media. Hyperplastic mucosal explants
treated with the p38 alpha and p38 beta inhibitor SB203580 demonstrated
significant inhibition of otitis media-stimulated mucosal growth. The results of 
this study suggest that intracellular signaling via p38 MAPK influences the
hyperplastic response of the middle ear mucosa during bacterial otitis media.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 15271927 [PubMed - indexed for MEDLINE]

1298: Clin Otolaryngol Allied Sci. 2004 Aug;29(4):321-3.

Emergence of ciprofloxacin-resistant pseudomonas in chronic suppurative otitis
media.

Jang CH, Park SY.

Wonkwang Medical School, Iksan, South Korea. chul@wonkwang.ac.kr

The most frequently isolated organism in chronic suppurative otitis media (CSOM) 
is Pseudomonas aeruginosa. Ototopical ciprofloxacin has proven effectiveness
against P. aeruginosa. The purpose of this study is to evaluate the patients with
recurrent otorrhoea caused by CSOM that was unresponsive to topical
ciprofloxacin. Eighty-eight patients (18-77 years of age) with otorrhoea due to
CSOM were reviewed retrospectively. All of them were initially treated with
ciprofloxacin eardrops but the otorrhoea failed to resolve. Bacteriological
specimens were processed and identified with standard cultures. In vitro
antimicrobial susceptibility of these bacterial isolates was assessed by an agar 
disc diffusion method. Isolates were tested against 16 antibiotics.
Ciprofloxacin-resistant P. aeruginosa were isolated in all cases. Imipenem was
the most sensitive antibiotic agent with an overall susceptibility rate of 96.5%,
followed by amikacin (55.6%), piperacillin/tazobactam (37.5%) and ceftazidime
(31.8%). In our series, ciprofloxacin-resistant P. aeruginosa is increasing
recently. Continuous surveillance is necessary to monitor antimicrobial
resistance and to guide antibacterial therapy.

PMID: 15270816 [PubMed - indexed for MEDLINE]

1299: Clin Otolaryngol Allied Sci. 2004 Aug;29(4):318-20.

The effect of otitis media with effusions on balance in children.

Waldron MN, Matthews JN, Johnson IJ.

Department of Otolaryngology, Freeman Hospital, University of Newcastle,
Newcastle-upon-Tyne, UK. murray.waldron@newcastle.ac.uk

There is increasing interest in the effect, otitis media with effusions (OME) has
on the balance in children. The aim of our investigation was to determine whether
a universal effect on balance could be demonstrated in children with OME by using
sway posturography. Assessment was made in 20 children with proven OME before and
after the insertion of bilateral ventilation tubes. Sway posturography was
performed on each occasion in each of the four recording conditions in the
presence and absence of both reduced optic fixation and reduced proprioception.
The pathlength traversed during the recording interval was measured and analysed 
by a split-unit anova. The results demonstrate an overall improvement in mean
pathlength of 20% following treatment of the effusions (P < 0.001) (95% CI
14-25%). The effect of reduced optic fixation and of reduced proprioception were 
similar when increasing the mean pathlength by 22% (P < 0.001). These results
demonstrate that OME has a universal effect on balance in all recording
conditions.

PMID: 15270815 [PubMed - indexed for MEDLINE]

1300: Cochrane Database Syst Rev. 2004;(3):CD001727.

Update in:
    Cochrane Database Syst Rev. 2007;(2):CD001727.    Cochrane Database Syst Rev. 2008;(3):CD001727.

Update of:
    Cochrane Database Syst Rev. 2002;(1):CD001727.

Decongestants and antihistamines for acute otitis media in children.

Flynn CA, Griffin GH, Schultz JK.

Family Medicine, SUNY Upstate Medical University, Suite 200, 475 Irving Avenue,
Syracuse, NY 13210, USA. flynnc@upstate.edu

BACKGROUND: Acute otitis media (AOM) is a common and important source of
morbidity in children, although most cases resolve spontaneously. While
frequently recommended, decongestant and antihistamine therapy is of unclear
benefit. OBJECTIVES: To determine the efficacy of decongestant and antihistamine 
therapy in children with AOM on outcomes of AOM resolution, symptom resolution,
medication side effects, and complications of AOM. SEARCH STRATEGY: We searched
the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane
Library Issue 3, 2003); MEDLINE (January 1966 to December 2003), EMBASE (January 
1990 to July 2003) and reference lists of articles for this updated review. We
also contacted study authors and pharmaceutical companies. SELECTION CRITERIA:
Randomized controlled trials evaluating decongestant or antihistamine treatment
for children with AOM were included. Patient-oriented outcomes were considered
most relevant. There were no quality or language restrictions. DATA COLLECTION
AND ANALYSIS: Investigators independently evaluated studies for inclusion,
performed validity assessments, and completed data extraction. Dichotomous data
were pooled to generate relative risks; homogeneity was assessed using
approximate chi-square tests. MAIN RESULTS: Fifteen trials involving 2695 people 
were included. Only the combined decongestant-antihistamine group demonstrated
statistically lower rates of persistent AOM at the two week period (fixed
relative risk (RR) 0.76; 95% confidence interval (CI) 0.60 to 0.96; number needed
to treat (NNT) 10). No benefit was found for early cure rates, symptom
resolution, prevention of surgery or other complications. There was a five to
eight -fold increased risk of side effects for those receiving an intervention,
which reached statistical significance for all decongestant groupings. Validity
sub analyses demonstrated that lower quality studies found benefit, while
analysis of those studies with higher validity scores found no benefit of
treatment. REVIEWERS' CONCLUSIONS: Given lack of benefit and increased risk of
side effects, these data do not support the use of decongestant treatment in
children with AOM. There was a small statistical benefit from combination
medication use but the clinical significance is minimal and study design may be
biasing the results. Thus, the routine use of antihistamines for treating AOM in 
children cannot be recommended.

Publication Types: 
    Meta-Analysis
    Review

PMID: 15266451 [PubMed - indexed for MEDLINE]

1301: J Paediatr Child Health. 2004 Aug;40(8):483-6.

Comment in:
    J Paediatr Child Health. 2005 Apr;41(4):231; author reply 231-2.

Facial nerve paralysis secondary to acute otitis media in infants and children.

Gaio E, Marioni G, de Filippis C, Tregnaghi A, Caltran S, Staffieri A.

Department of Otolaryngology-Head and Neck Surgery, University of Padua, Italy.
gaio.elena@libero.it

Nowadays, facial paralysis is an uncommon complication of acute inflammation of
the middle ear, with an estimated incidence of 0.005%; it was not so rare in the 
pre-antibiotic era, occurring in 0.5-0.7% of middle ear inflammatory processes.
We would like to highlight this complication of acute otitis media, a common
paediatric complaint. We present three new cases of facial palsy in children with
acute otitis media and discuss the etiological mechanisms and different
approaches to the treatment; a flow chart for facial paralysis in acute otitis
media is also presented. Our three patients recovered completely after
mastoidectomy (first two cases) and myringotomy with antibiotic therapy (third
case). Facial paralysis is an uncommon complication of otitis media which
requires appropriate care. Following our experience and revision of literature on
the subject, antibiotic therapy and myringotomy are the first-line procedures.
Surgery should be employed in case of acute or coalescent mastoiditis,
suppurative complications and lack of clinical regression.

Publication Types: 
    Case Reports

PMID: 15265194 [PubMed - indexed for MEDLINE]

1302: Clin Pediatr (Phila). 2004 Jul-Aug;43(6):529-33.

The effect of montelukast sodium on the duration of effusion of otitis media.

Combs JT.

Department of Pediatrics, University of Connecticut School of Medicine, Meriden, 
CT 06450, USA.

This study tests the hypothesis that montelukast sodium, a selective leukotriene 
receptor antagonist, will decrease the duration of the effusion of otitis media. 
Tympanometry and spectral gradient acoustic reflectometry were used to confirm
the effusion of otitis media in patients between 2 and 12 years of age. Patients 
were treated with amoxicillin for 10 days and montelukast sodium or placebo for
30 days in a random, double-blind manner. Sixty patients completed the study: 31 
received placebo and 29 received montelukast sodium. At a 4-week follow-up visit,
5 ears (16%) were free of effusion in the placebo group and 17 (58%) in the
montelukast sodium group. The difference was significant. The efficacy of
montelukast sodium in clearing the effusion was 49%.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15248005 [PubMed - indexed for MEDLINE]

1303: Vaccine. 2004 Jul 29;22(21-22):2737-42.

Development of antibodies against pneumococcal proteins alpha-enolase,
immunoglobulin A1 protease, streptococcal lipoprotein rotamase A, and putative
proteinase maturation protein A in relation to pneumococcal carriage and Otitis
Media.

Adrian PV, Bogaert D, Oprins M, Rapola S, Lahdenkari M, Kilpi T, de Groot R,
Käyhty H, Hermans PW.

Laboratory of Pediatrics/Room Ee1500, Erasmus MC-Sophia, P.O. Box 1738, 3000 DR
Rotterdam, The Netherlands.

Surface associated pneumococcal proteins alpha-enolase (Eno), immunoglobulin A1
protease (Iga), streptococcal lipoprotein rotamase A (SlrA), and putative
proteinase maturation protein A (PpmA) have potential as candidates for future
protein-based anti-pneumococcal vaccines. The immunogenicity of these proteins
were studied in a cohort of 329 children during their first two years of life.
During the first recorded episode of otitis media, acute and convalescent phase
sera were available from 151 children. Concentrations of antibodies against Eno, 
Iga, SlrA and PpmA were measured by EIA and detected in 99% (300/302), 95%
(288/302), 95% (288/302), and 83% (251/302) of the sera, respectively. There were
no statistically significant differences between the groups of children with and 
without a history of pneumococcal contact or with respect to the type of
pneumococcal contact. Despite a mean overall decrease in the antibody titers in
the convalescent sera following AOM, several children were able to respond with a
more than twofold increase in antibody titer in response to AOM. The majority of 
the children with increased antibody concentrations appeared in the groups, which
were colonized with pneumococci at the time of serum collection, but were
recorded as having no prior contact with pneumococci. In conclusion, SlrA, PpmA, 
Eno and Iga are immunogenic proteins that elicit antibody responses early in
life. No significant correlation between antibody titers to these proteins and
pneumococcal carriage or infection was found. Presumably, this results from the
presence of cross-reactive epitopes on commensal bacteria.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15246605 [PubMed - indexed for MEDLINE]

1304: J Chin Med Assoc. 2004 Apr;67(4):200-3.

Nasopharyngeal carcinoma spreading along the eustachian tube: the imaging
appearance.

Yang MS, Chen CC, Cheng YY, Hung HC, Chen WH, Lee MC, Lee CW, Lee SK.

Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan,
ROC. yangming@vghtc.gov.tw

Nasopharyngeal cancer (NPC) is one of the most common cancers in Taiwan. It can
spread anteriorly, laterally, posteriorly, superiorly and inferiorly. Skull base 
invasion is the common presentation, in up to one-third of cases. We report a
rare spreading pathway of NPC, via the eustachian tube. A 44-year-old male
suffered from NPC and got radiotherapy about 2 years ago. He suffered from middle
ear effusion and facial nerve palsy on the right side recently. The computed
tomography and magnetic resonance image could clearly depict the infiltrating
tumor over the mastoid region and tympanic cavity on the right side, spreading
along the eustachian tube. It could result in eustachian tube dysfunction and
middle ear effusion. The nature of the right facial palsy was most likely due to 
tumor infiltration.

Publication Types: 
    Case Reports

PMID: 15244021 [PubMed - indexed for MEDLINE]

1305: J Infect Dis. 2004 Aug 1;190(3):545-50. Epub 2004 Jul 2.

Concentration of antipneumococcal antibodies as a serological correlate of
protection: an application to acute otitis media.

Jokinen JT, Ahman H, Kilpi TM, Mäkelä PH, Käyhty MH.

Department of Vaccines, National Public Health Institute, Helsinki, Finland.
jukka.jokinen@ktl.fi

BACKGROUND: For the licensing of new pneumococcal vaccines, it is vital to be
able to predict their protective efficacy on the basis of immunogenicity.
However, the serological correlates of protection have not been established for
pneumococcal diseases. METHODS: A total of 1666 children were immunized with the 
pneumococcal conjugate vaccine. Acute otitis media (AOM) events were identified, 
and middle-ear fluid was cultured for pneumococci. The association between the
concentration of antibodies against serotypes 6B, 19F, and 23F and the risk of
AOM caused by the homologous serotypes or by the cross-reactive serotype 6A was
assessed. An association model was used to predict efficacy at different
geometric mean concentrations (GMCs). RESULTS: An association between antibody
concentration and risk of AOM was found, but with large differences between
serotypes. On the basis of the association, the predicted efficacy for 19F was
negligible up to the highest GMC tested. In contrast, 6B was found to be highly
efficacious (>65%) at a GMC of 0.5 microg/mL. CONCLUSIONS: The results challenge 
the view that a new vaccine candidate should always induce antibody
concentrations that are not inferior to those produced by the licensed vaccine.
Furthermore, the differences between serotypes caution against defining a common 
correlate of protection that is applicable to all serotypes.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15243930 [PubMed - indexed for MEDLINE]

1306: J Am Acad Audiol. 2004 Apr;15(4):300-10; quiz 334-5.

Simulated conductive hearing loss in children.

Penn TO, Grantham DW, Gravel JS.

Vanderbilt University, USA. terrey.penn@vanderbilt.edu

Otitis media with effusion (OME) often results in hearing loss for children with 
the condition. In order to provide appropriate and effective audiologic
management, it is important to understand the impact of OME on speech recognition
ability when hearing loss is present. This study examined the speech recognition 
abilities of normal-hearing six- and seven-year-old children (n = 12) and adults 
(n = 12) using monosyllabic words and nonsense syllables presented at two levels 
of simulated conductive hearing loss characteristic of OME. Average speech
recognition scores decreased as the degree of simulated conductive hearing loss
increased. Both age groups scored significantly poorer for nonsense syllables
than for monosyllabic words. In general, the children performed more poorly than 
the adults with the exception of the easiest listening condition for word
stimuli. Furthermore, children appeared less able than adults to use their
knowledge of familiar words to improve performance. These findings suggest that
rehabilitative strategies may best be focused on combining familiarization
techniques and amplification options.

PMID: 15239203 [PubMed - indexed for MEDLINE]

1307: Int J Pediatr Otorhinolaryngol. 2004 Aug;68(8):1091-3.

Recurrent acute otitis media associated meningitis in a patient with a
contralateral cochlear implant and bilateral cochleovestibular dysplasia.

Belmont MJ, Arjmand EM.

East Tennessee Children's Hospital, 2100 Clinch Avenue, Suite 410, Knoxville, TN 
37917, USA. belmmj@yahoo.com

OBJECTIVE: To illustrate that a patient with a cochlear implant may be at
increased risk of meningitis secondary to developmental anatomic abnormality
associated with the underlying sensorineural hearing loss, as opposed to the
implant itself. METHODS: Case report. RESULTS: Our 12-year-old patient has
bilateral cochlear dysplasia, profound sensorineural hearing loss and no prior
history of recurrent acute otitis media or meningitis. He underwent a left
cochlear implant at 8 years of age and subsequently experienced three episodes of
right acute otitis media and meningitis over the next 4 years. Middle ear
exploration revealed a cerebrospinal fluid leak. A right radical mastoidectomy
with closure of the external auditory canal, removal of the tympanic membrane,
malleus, and incus, closure of the Eustachian tube, and obliteration of the
mastoid and middle ear with abdominal fat has prevented further episodes.
CONCLUSION: Meningitis in a patient with a cochlear implant is not necessarily
related to the implant.

Publication Types: 
    Case Reports

PMID: 15236899 [PubMed - indexed for MEDLINE]

1308: Int J Pediatr Otorhinolaryngol. 2004 Aug;68(8):1069-74.

Prevalence of otitis media with effusion in first and second grade primary school
students and its correlation with BCG vaccination.

Keleş E, Kaygusuz I, Karlidag T, Yalçin S, Açik Y, Alpay HC, Sakallioglu O.

Otorhinolaryngology Department, Firat University Medical Faculty, Tip Merkezi KBB
Klinigi, Elazig 23119, Turkey. keleserol@yahoo.com

OBJECTIVE: The object of this study was to determine the prevalence of otitis
media with effusion (OME) in first and second grade primary school students, to
analyze the causes of the difference in the prevalence, to define the effect of
OME on the academic performance of the children and to investigate a correlation 
between the prevalence of OME and Bacillus Calmette-Guerin (BCG) vaccination.
STUDY PLAN AND METHODS: The study was conducted during the September-November,
2002 period in Elazig. A total of 3675 clinically healthy primary school children
attending primary schools in the central district of Elazig, living in the same
region and of a similar socioeconomic status and age group were included in the
study. Of the 3675 children, 2042 were in their first and 1633 in their second
grade of primary school. The routine ear-nose and throat examinations of the
children were carried out at their schools by the same medical team. The
tympanometric test was performed in children diagnosed with OME following
otoscopic examination. A scale measuring the academic performance of the children
was developed. This scale was filled in by the student's teachers prior to
physical examination. RESULTS: OME was diagnosed in 64 out of 2042 (3.1%) first
grade and in 25 out of 1633 (1.5%) second grade students. The difference between 
the percentages of OME in first and second grade students was statistically
significant (P < 0.05). The frequency of other ear-nose and throat pathologies
accompanying OME was similar to those in children without OME. There was no
statistically significant difference between the academic performances of
children with and without OME (P > 0.05). CONCLUSION: The analysis of risk
factors for OME revealed no difference between first and second grade students.
The reason for the difference in the prevalence of OME between first and second
grade students may be the positive effect on the immune system of the BCG vaccine
which had been administered to the second grade students 4 months previously.

PMID: 15236895 [PubMed - indexed for MEDLINE]

1309: Indian J Med Res. 2004 May;119 Suppl:168-70.

Comparison of Streptococcus pneumoniae serotypes causing acute otitis media &
invasive disease in young children in the Czech Republic.

Prymula R, Motlova J, Kriz P.

Purkyne Military Medical Academy, Hradec Kralove, Prague, Czech Republic.

BACKGROUND & OBJECTIVES: The availability of a type-specific pneumococcal vaccine
for children is a worldwide problem. It is necessary to study the serotypes
prevalent in a country before introducing a type-specific vaccine. The objective 
of the present study was to analyse the prevalence of Streptococcus pneumoniae
serotypes in children suffering from acute otitis media or invasive pneumococcal 
disease and to compare a coverage of serotypes by individual pneumococcal
vaccines. METHODS: Children suffering from acute otitis media and invasive
pneumococcal disease were analysed in the Czech Republic from October 1999 to
November 2000. Serotyping was performed by the quellung technique using antisera 
from Statens Serum Institute (Denmark). RESULTS: The most frequent serotypes in
patients with acute otitis media were 3, 19F, 23F, 14, 9V, 1, 6B, 11A and 28F.
Vaccine coverage for the identified serotypes in acute otitis media patients was 
52.1 per cent for the 7-valent vaccine, 57.8 per cent for the 9-valent vaccine
and 75.7 per cent for the 11-valent form of the vaccine. In 108 patients with
invasive pneumococcal disease, the most frequent serotypes were 6B, 9V, 14, 19F, 
3 and 23F. Vaccine coverage for the identified serotypes in patients with
invasive pneumococcal disease was 62 per cent for the 7-valent vaccine, 66.4 per 
cent for the 9-valent vaccine and 77.5 per cent for the 11-valent form of the
vaccine. INTERPRETATION & CONCLUSION: Vaccine coverage for the identified
serotypes for the 11-valent pneumococcal vaccine was better than the other two
vaccines.

Publication Types: 
    Comparative Study
    Multicenter Study

PMID: 15232187 [PubMed - indexed for MEDLINE]

1310: Pediatrics. 2004 Jul;114(1):e58-67.

Tympanic membrane abnormalities and hearing levels at the ages of 5 and 6 years
in relation to persistent otitis media and tympanostomy tube insertion in the
first 3 years of life: a prospective study incorporating a randomized clinical
trial.

Johnston LC, Feldman HM, Paradise JL, Bernard BS, Colborn DK, Casselbrant ML,
Janosky JE.

Department of Pediatrics, University of Pittsburgh School of Medicine,
Pittsburgh, Pennsylvania, USA.

OBJECTIVE: One current practice guideline recommends myringotomy with
tympanostomy tube insertion (M&T) for young children in whom middle-ear effusion 
(MEE) has persisted for 3 months, and another recommends the procedure after MEE 
has persisted for 4 to 6 months provided that a bilateral hearing loss of > or=20
dB is present. Sequelae of M&T are not uncommon, but the extent to which these
sequelae are attributable to M&T itself or to the middle-ear disease that
prompted the procedure or to both has not been clear. Our objective in the
present study was to examine the prevalence of various tympanic membrane (TM)
abnormalities in otherwise healthy children at the age of 5 years and hearing
levels at the age of 6 years in relation to persistent MEE and M&T in the
children's first 3 years of life. METHODS: In a prospective study of child
development in relation to early-life otitis media, we randomly assigned 429
children who met specified criteria regarding the persistence of MEE in their
first 3 years of life to undergo M&T either promptly (the "early-treatment"
group) or after a defined extended period if MEE remained present (the
"late-treatment" group). We also followed a representative sample of 241 children
who ranged from having no MEE to having MEE whose cumulative duration fell just
short of meeting randomization criteria for the clinical trial (the "nontrial"
group). Most of the children in each group underwent both otomicroscopic
examination at the age of 5 years and audiometric testing at the age of 6 years, 
at times when they were free of MEE. Among these children, M&T had been performed
in 82.3% of those in the early-treatment group, 38.1% of those in the
late-treatment group, and 3.0% of those in the nontrial group. RESULTS: At the
age of 5 years, we found 1 or more types of TM abnormality in 1 or both ears in
70.7%, 42.5%, and 9.5% of the children in the early-treatment, late-treatment,
and nontrial groups, respectively. Within the 3 groups, however, among children
who received tubes, the proportions who had an abnormality of some type were
similar, namely, 82.6%, 80.4%, and 83.3%, respectively. The corresponding
proportions among children who had not received tubes were 15.4%, 19.3%, and
7.2%, respectively. Segmental atrophy and tympanosclerosis were the most common
abnormalities found. At the age of 6 years, mean pure-tone average audiometric
thresholds in the early-treatment, late-treatment, and nontrial groups,
respectively, were 6.18 dB, 5.49 dB, and 4.63 dB in left ears and 6.17 dB, 6.02
dB, and 4.32 dB in right ears. The thresholds in the early- and late-treatment
groups did not differ significantly, but the thresholds in the early- and
late-treatment groups were each significantly higher than in the nontrial group. 
Within the early- and late-treatment groups, we found no significant relation
between hearing levels and the presence or type of TM abnormalities. CONCLUSION: 
In otherwise healthy children who have persistent MEE during their first 3 years 
of life, ready resort to M&T results in far more TM abnormalities at age 5 than
does selective management in which most children do not receive the procedure.
With these differing approaches, however, hearing levels at age 6 do not differ. 
Regardless of whether children with persistent early-life MEE receive M&T, they
have more TM abnormalities at age 5 and negligibly poorer hearing at age 6 than
do children who had less or no otitis media. Longer term otologic and audiologic 
outcomes of persistent early-life MEE and of M&T remain to be determined. In view
of 1) the present findings and the remaining uncertainties concerning sequelae,
2) the fact that M&T involves certain immediate risks--albeit minimal--and
substantial cost, and 3) previously reported findings in the study's randomized
clinical trial that show no developmental advantage at ages 3 and 4 years
accruing from children's having received prompt M&T, a prolonged period of
watchful waiting seems desirable in otherwise healthy children who are younger
than 3 years and have persistent, asymptomatic MEE that is not complicated by
sensorineural or severe conductive hearing loss, balance dysfunction, or severe
TM retraction.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

PMID: 15231974 [PubMed - indexed for MEDLINE]

1311: Pediatrics. 2004 Jul;114(1):177-81.

A randomized clinical trial to assess the effects of tympanometry on the
diagnosis and treatment of acute otitis media.

Spiro DM, King WD, Arnold DH, Johnston C, Baldwin S.

Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of 
Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA.
david.spiro@yale.edu

OBJECTIVES: Acute otitis media (OM) is the most common indication for the use of 
antibiotics among children. Otoscopy alone is an imprecise method for the
diagnosis of OM, which may lead to inappropriate antibiotic use. We sought to
determine whether tympanometry, as an adjunct to otoscopy, would significantly
change physician prescribing behavior and whether physicians overprescribe
antibiotics for OM, using independently graded tympanometry results as a
standard. METHODS: A randomized, clinical trial was conducted among children 6 to
35 months of age who presented to a pediatric emergency department with either
fever or upper respiratory infection symptoms. Children were randomized into 2
groups, in which the attending physician evaluated tympanometry results (Tymp
Aware) or the attending physician was blinded to the tympanometry findings (Tymp 
Unaware). Tympanometry curves were graded independently by using a modified
version of the Jerger scale. RESULTS: Of the 698 patients enrolled, tympanometry 
was performed successfully for 99.3%. Antibiotics were prescribed for OM for
27.9% of all patients. No statistically significant difference in antibiotic
prescription rates for OM between the Tymp Aware group (28.8%) and the Tymp
Unaware group (26.8%) was found. Of all patients for whom antibiotics were
prescribed for OM, 14% had normal curves for both ears and 40% had some
tympanographic movement bilaterally. CONCLUSIONS: Tympanometry did not seem to
change diagnoses or prescribing behavior in the group of physicians studied.
Antibiotics were commonly prescribed for presumed OM in the absence of effusions 
documented with tympanometry.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15231925 [PubMed - indexed for MEDLINE]

1312: J Coll Physicians Surg Pak. 2004 Mar;14(3):146-9.

Erratum in:
    J Coll Physicians Surg Pak. 2004 Sep;14(9):582.

Comment in:
    J Coll Physicians Surg Pak. 2004 Sep;14(9):580-1; author reply 581.    J Coll Physicians Surg Pak. 2004 Sep;14(9):581; author reply 581.

Sensitivity and spectrum of bacterial isolates in infectious otitis externa.

Arshad M, Khan NU, Ali N, Afridi NM.

Department of ENT, Combined Military Hospital, Peshawar. drchohaan@hotmail.com

OBJECTIVE: To determine the spectrum and antibiotic sensitivity pattern of
organisms from aural swabs taken from cases of infectious otitis externa. DESIGN:
Descriptive study. PLACE AND DURATION OF STUDY: Department of ENT, Combined
Military Hospital, Peshawar, from May 2002 to April 2003. SUBJECTS AND METHODS:
One hundred and twenty-four patients, diagnosed clinically as infectious otitis
externa without concomitant suppurative otitis media, perforated tympanic
membrane or otomycosis, were selected for the study. Samples of pus from external
auditory canal were taken on sterile cotton swabs and were cultured on blood agar
and MacConkey Agar for 24 to 48 hours. Sensitivity was tested and interpreted by 
Kirby-Bauer disc diffusion method of grading zones of inhibition. RESULTS: One
hundred and twenty four subjects were cultured. Sixteen samples showed no growth.
One hundred and eight specimens yielded growth of bacteria. No specimen revealed 
multiple organisms. Staphylococcus aureus was found in 38%, and Pseudomonas
aeruginosa was found in other 38%. Others included Proteus, Enterococci,
Klebsiella, and E. coli. Majority of organisms were resistant to co-trimoxazole, 
amoxicillin and erythromycin, while 100% were sensitive to imipenem. Sensitivity 
to enoxacin was 96%, Ninety-two percent were sensitive to ciprofloxacin and
ofloxacin. CONCLUSION: Pseudomonas aeruginosa and Staphylococcus aureus were the 
most common bacterial isolates. Both were sensitive to fluoroquinolones. The
latter can be used empirically for treatment of acute infectious otitis externa.

PMID: 15228846 [PubMed - indexed for MEDLINE]

1313: Int J Antimicrob Agents. 2004 Jul;24(1):18-23.

Use of oral cephalosporins in the treatment of acute otitis media in children.

Brook I.

Department of Pediatrics, School of Medicine, Georgetown University, 4431
Albemarle St. NW, Washington, DC 20016, USA. ib6@georgetown.edu

The selection of the most effective antimicrobial to treat acute otitis media
(AOM) has become more difficult in recent years because of increasing antibiotic 
resistance among all AOM pathogens. Resistance of Streptococcus pneumoniae to
penicillin as well as amoxicillin ranges from 30 to 55% in the USA. Currently,
40-55% of Haemophilus influenzae and 90-100% of Moraxella catarrhalis are
resistant to penicillin because of the production of Beta-lactamases. This review
discusses the availability of oral cephalosporins that can be utilised for the
treatment of AOM in children. An evaluation is made regarding their in vitro
activity against the pathogens, their middle-ear concentrations, pharmacokinetics
and pharmacodynamics (PK/PD). The cephalosporins that will be discussed are
cefuroxime-axetil, cefprozil, cefdinir and cefpodoxime-proxetil. The current
recommendations for therapy of AOM limit the choices of clinicians to a single
cephalosporin (cefuroxime-axetil). However, clinical, bacteriological and PK/PD
data shows that several other cephalosporins (cefprozil, cefdinir and
cefpodoxime-proxetil) possess similar indices which provide the clinician with
wider therapeutic choices that can insure better compliance and ultimately better
success in eradication of the infection.

Publication Types: 
    Review

PMID: 15225855 [PubMed - indexed for MEDLINE]

1314: Ann Otol Rhinol Laryngol. 2004 Jun;113(6):450-4.

Changes in cochlear blood flow due to endotoxin-induced otitis media.

Sone M, Hayashi H, Tominaga M, Nakashima T.

Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine,
65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.

The purpose of this study was to elucidate the influence of otitis media on blood
flow in the lateral wall of the cochlea by means of a model of endotoxin-induced 
otitis media. The cochlear blood flow (CBF) following lipopolysaccharide
inoculation into the middle ear cavities of rats was measured by laser-Doppler
flowmetry and compared with that of untreated ears. After this evaluation, the
influence on CBF of concomitant use of a nitric oxide synthase inhibitor was also
investigated. The first day after inoculation, the CBF of treated ears decreased 
significantly. This decrease recovered gradually between the 7th and 14th days.
With concomitant use of a nitric oxide synthase inhibitor, the decrease in CBF
was prevented to some extent. The results showed a functional influence upon CBF 
by endotoxin-induced otitis media. The significance of prophylactic use of the
drug is also discussed in regard to the effect on CBF following otitis media.

PMID: 15224827 [PubMed - indexed for MEDLINE]

1315: Cleft Palate Craniofac J. 2004 Jul;41(4):364-7.

Middle ear disease in children with congenital velopharyngeal insufficiency.

Sheahan P, Miller I, Earley MJ, Sheahan JN, Blayney AW.

Department of Otolaryngology, The Children's University Hospital, Dublin,
Ireland. sheahanp@eircom.net

OBJECTIVE: To examine the incidence and natural history of middle ear disease in 
children with congenital velopharyngeal insufficiency (VPI) without cleft palate.
SETTING AND SUBJECTS: Children with congenital VPI attending the combined cleft
clinic at a tertiary cleft center. The diagnosis of congenital VPI in all cases
was confirmed be the observation of hypernasality, nasal air escape, or both by a
speech and language therapist and the demonstration of incompetence of the
velopharyngeal sphincter by means of nasoendoscopy or videofluoroscopy. Children 
with overt cleft palate or postsurgical VPI were excluded. DESIGN: The children's
medical records were reviewed, and a questionnaire regarding history of ear
problems was sent to all parents. Children were divided into those with Pruzansky
type I VPI (showing bifid uvula, midline diastasis of soft palate, or submucous
cleft of the hard palate) and Pruzansky type II VPI (no visible stigmata). MAIN
OUTCOME MEASURES: Incidence of reported ear problems, ear infections, hearing
loss, and surgical intervention for middle ear disease in the whole group and in 
each of the subgroups. RESULTS: Seventy-one parents returned completed
questionnaires. The overall incidence of middle ear disease was 63%, with 28%
reported to have below-normal hearing. There was no significant difference
between children with Pruzansky types I and II VPI with respect to incidence of
otopathology or hearing loss. CONCLUSIONS: Irrespective of the presence of any
visible palatal abnormalities, children with congenital VPI showed a substantial 
incidence of otopathology and should thus be closely monitored.

PMID: 15222782 [PubMed - indexed for MEDLINE]

1316: Infect Immun. 2004 Jul;72(7):4309-13.

Immunization with native or recombinant Streptococcus pneumoniae neuraminidase
affords protection in the chinchilla otitis media model.

Long JP, Tong HH, DeMaria TF.

Division of Otologic Research, College of Medicine and Public Health, The Ohio
State University, Room 4331, Cramblett Hall, 456 W. 10th Ave., Columbus, OH
43210, USA.

Streptococcus pneumoniae neuraminidase has been implicated as a virulence factor 
in the pathogenesis of pneumococcal otitis media. In this study, native
neuraminidase was partially purified from cultures of S. pneumoniae by serial
chromatography with DEAE-Sepharose and Sephacryl S-200. Recombinant
neuraminidase, a 3,038-bp fragment of the neuraminidase A (nanA) gene, was cloned
into the pET-28b vector and then expressed at high levels in Escherichia coli.
Chinchillas were immunized subcutaneously with either the gel-purified native or 
recombinant neuraminidase, and all responded with elevated titers of
antineuraminidase antibody in serum. Immunization with neuraminidase resulted in 
a significant reduction in nasopharyngeal colonization as well as in the
incidence of otitis media with effusion. These data demonstrate for the first
time that neuraminidase affords protection against S. pneumoniae nasopharyngeal
colonization and experimental otitis media.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15213181 [PubMed - indexed for MEDLINE]

1317: Arch Otolaryngol Head Neck Surg. 2004 Jun;130(6):705-9.

How appropriate is the OM6 as a discriminative instrument in children with otitis
media?

Kubba H, Swan IR, Gatehouse S.

Medical Research Council Institute of Hearing Research (Scottish Section),
Glasgow Royal Infirmary, Glasgow, Scotland. haytham@ihr.gla.ac.uk

BACKGROUND: The OM6 is a 6-item condition-specific handicap measure developed in 
the United States for children with recurrent acute otitis media and otitis media
with effusion. Easy and quick to use, it has high test-retest repeatability and
is sensitive to change after ventilation tube insertion. OBJECTIVES: To explore
aspects of the validity of OM6 in a United Kingdom population and to specifically
address the instrument's ability to discriminate between children with different 
burdens of disease. DESIGN: The parents of 179 consecutive newly referred
children with otitis media with effusion or recurrent acute otitis media
completed the OM6 on their first visit to the hospital. The parents of 72
children with sore throats completed the OM6 for comparison. Scores were compared
with markers of disease severity, demographic variables, and generic
quality-of-life measures. RESULTS: Poorer scores were found in those with ear
complaints than in those with sore throats. The OM6 scores were not associated
with age, sex, socioeconomic class, or respondent (mother vs father). The OM6
scores did not correlate with frequency of otalgia, frequency of otorrhea, or
time off school in the recurrent acute otitis media group. In the otitis media
with effusion group, poorer scores were associated with bilateral B or C2
tympanometric findings but not with a better ear threshold of more than 20 dB.
Correlation with a global 10-cm visual analog scale for quality of life and with 
the Health Utilities Index Mark III was good. CONCLUSIONS: The OM6 scores
correlate well with global quality-of-life measures and are free from many
potential biases. However, OM6 does not adequately reflect disease severity,
which may limit its usefulness as a discriminative measure.

Publication Types: 
    Clinical Trial
    Controlled Clinical Trial

PMID: 15210550 [PubMed - indexed for MEDLINE]

1318: Mediators Inflamm. 2004 Apr;13(2):75-88.

The immunoregulatory and allergy-associated cytokines in the aetiology of the
otitis media with effusion.

Smirnova MG, Birchall JP, Pearson JP.

School of Cell and Molecular Biosciences, University of Newcastle, The Medical
School, Framlington Place Newcastle upon Tyne, NE2 4HH, Nottingham, UK.
Marina.Smirnova@ncl.ac.uk

Inflammation in the middle ear mucosa, which can be provoked by different primary
factors such as bacterial and viral infection, local allergic reactions and
reflux, is the crucial event in the pathogenesis of otitis media with effusion
(OME). Unresolved acute inflammatory responses or defective immunoregulation of
middle inflammation can promote chronic inflammatory processes and stimulate the 
chronic condition of OME. Cytokines are the central molecular regulators of
middle ear inflammation and can switch the acute phase of inflammation in the
chronic stage and induce molecular-pathological processes leading to the
histopathological changes accompanying OME. In this review we present cytokines
identified in otitis media, immunoregulatory [interleukin (IL)-2, IL-10,
transforming growth factor-beta]) and allergy associated (IL-4, IL-5,
granulocyte-macrophage colony-stimulating factor), as crucial molecular
regulators, responsible for chronic inflammation in the middle ear and the
chronic condition of OME.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 15203548 [PubMed - indexed for MEDLINE]

1319: Vet Clin North Am Food Anim Pract. 2004 Jul;20(2):243-73, vi.

Brainstem and cranial nerve abnormalities: listeriosis, otitis media/interna, and
pituitary abscess syndrome.

Morin DE.

Farm Animal Reproduction, Medicine, and Surgery Section, Department of Veterinary
Clinical Medicine, College of Veterinary Medicine, University of Illinois, 218
Large Animal Clinic, 1008 West Hazelwood Drive, Urbana, IL 61802, USA.
d-morin@uiuc.edu

This article reviews three disorders associated with multiple asymmetric cranial 
nerve deficits in ruminants: encephalitic listeriosis,otitis media/interna, and
pituitary abscess syndrome. Emphasis is placed on encephalitic listeriosis, an
infectious disease of the brainstem and cranial nerves caused by Listeria
monocytogenes.The epidemiology, pathophysiology, clinical manifestations,
diagnosis,and treatment of encephalitic listeriosis are reviewed, and differences
between cattle and small ruminants are noted. Physical and neurologic examination
findings that distinguish otitis media/interna and pituitary abscess syndrome
from encephalitic listeriosis are highlighted.

Publication Types: 
    Review

PMID: 15203225 [PubMed - indexed for MEDLINE]

1320: Ear Nose Throat J. 2004 May;83(5):327-9.

Actinomycosis of the temporal bone: a report of a case.

Sobol SE, Samadi DS, Wetmore RF.

Division of Otolaryngology, Department of Surgery, The Children's Hospital of
Philadelphia, PA 19104-4399, USA.

Actinomycosis is a chronic suppurative infection of the cervicofacial region
caused by Actinomyces species, which are anaerobic, gram-positive filamentous
bacteria. Although actinomycosis has a propensity for involving the oral cavity, 
rare cases of actinomycosis involving the temporal bone have been published. We
report the case of a 14-year-old girl who presented with clinical, audiometric,
and radiologic findings consistent with right chronic suppurative otitis media
that persisted despite tympanomastoidectomy. Findings on histologic evaluation of
a specimen obtained during revision surgery were consistent with a diagnosis of
actinomycosis. Although actinomycosis of the temporal bone is rare, it should be 
considered in the differential diagnosis of chronic suppurative temporal bone
infections that are resistant to standard therapy.

Publication Types: 
    Case Reports

PMID: 15195879 [PubMed - indexed for MEDLINE]

1321: Otolaryngol Head Neck Surg. 2004 Jun;130(6):759-66.

Tuberculous otitis media: a significant diagnostic challenge.

Vaamonde P, Castro C, García-Soto N, Labella T, Lozano A.

ENT Service, University Clinical Hospital of Santiago de Compostela, Spain.
pedrovaal@yahoo.com

OBJECTIVE: This study was undertaken to revise the diagnostic characteristics of 
tuberculous otitis media (TOM), a disorder that is often diagnosed late, leading 
to delay in specific treatment. STUDY DESIGN AND SETTING: Retrospective study of 
a longitudinal series of 10 TOM patients over a 7-year period at an institutional
referral center. RESULTS: Most patients showed intractable otorrhea, moderately
severe hearing loss, and necrotic eardrums with granulation tissue and single
perforations. Multiple perforations, facial palsy, and cervical adenopathies were
rare (<10% of patients). CT generally showed soft tissue involvement of the
middle ear without bone erosion. The most effective laboratory test
microbiological culture of exudate (diagnostic efficacy 71%). Specific antibiotic
treatment was effective in all cases. CONCLUSION: The diagnosis of TOM remains a 
significant challenge for otorhinolaryngologists. SIGNIFICANCE: If there are
strong clinical grounds for suspicion, standard laboratory tests for tuberculosis
should be repeated even if initially negative.

PMID: 15195064 [PubMed - indexed for MEDLINE]

1322: Otolaryngol Head Neck Surg. 2004 Jun;130(6):747-50.

The role of food allergy in otitis media with effusion.

Aydoğan B, Kiroğlu M, Altintas D, Yilmaz M, Yorgancilar E, Tuncer U.

Department of Otolaryngology, Cukurova University Medical Faculty, Adana, Turkey.

OBJECTIVE: To detect the relationship between food allergy and otitis media with 
effusion (OME). MATERIALS AND METHODS: This study was performed on three
different groups. The patient group was made up of 56 patients with OME (group
I). There were 28 patients with food allergy in group II and these patients were 
investigated for OME. The control group consisted of 28 patients without any
complaints concerning food allergy or OME (group III). RESULTS: Food allergy was 
detected in 25 patients with OME (44.6%) (group I). In patients with food allergy
(group II), OME was detected in 7 patients (25%). In the control group (group
III) food allergy was diagnosed in 5 patients (18%) and OME in 1 patient (3%).
The incidence of food allergy in OME group was statistically significant when
compared to the normal group (P > 0.05). CONCLUSIONS: This study demonstrates
that food allergy may play a role in the etiopathogenesis of OME.

PMID: 15195062 [PubMed - indexed for MEDLINE]

1323: Otolaryngol Head Neck Surg. 2004 Jun;130(6):742-6.

Contact diode laser myringotomy and mitomycin C in children.

D'ereditá R.

Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric
Otolaryngology, Vicenza Civil Hospital, Italy. rderedita@hotmail.com

OBJECTIVE: To investigate the use of contact diode laser myringotomy (C-LAM),
combined with topical mitomycin C, as an alternative method for prolonged middle 
ear ventilation in children with otitis media with effusion. STUDY DESIGN AND
SETTING: Prospective study at a tertiary care pediatric institution. METHODS:
Fifteen children enrolled in the study. Mitomycin C was applied to the intact
tympanic membrane in the right ears, whereas saline on the left side was used for
controls. C-LAM was then performed in all ears. Outcome measures included healing
rate and scarring, ear infection, and long-term audiometric follow-up. RESULTS:
There was no significant difference in median healing rate. In each group, the
median was between the third and fourth month. Normal hearing thresholds were
obtained in all children at 2-year follow-up. CONCLUSION: C-LAM proved to be an
effective method for medium-term ventilation, but topical mitomycin C before
C-LAM did not prolong patency rate in our patients. No significant complication
was encountered at 2-year follow-up.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 15195061 [PubMed - indexed for MEDLINE]

1324: Otolaryngol Head Neck Surg. 2004 Jun;130(6):736-41.

Topical ciprofloxacin/dexamethasone otic suspension is superior to ofloxacin otic
solution in the treatment of granulation tissue in children with acute otitis
media with otorrhea through tympanostomy tubes.

Roland PS, Dohar JE, Lanier BJ, Hekkenburg R, Lane EM, Conroy PJ, Wall GM, Dupre 
SJ, Potts SL; CIPRODEX AOMT Study Group.

Department of Otolaryngology, University of Texas Southwestern Medical Center,
Dallas, TX 75390-9035, USA. Peter.Roland@UTSouthwestern.edu

OBJECTIVE: Comparison of topical ciprofloxacin/dexamethasone otic suspension
(CIP/DEX) to ofloxacin otic solution (OFL) for treatment of granulation tissue in
children with AOMT. STUDY DESIGN: 599 children aged >/=6 months to 12 years with 
AOMT of up to 3 weeks' duration were enrolled. Patients received either CIP/DEX 4
drops twice daily for 7 days or OFL 5 drops twice daily for 10 days. Granulation 
tissue severity was graded at clinic visits on days 1, 3, 11, and 18. RESULTS:
Granulation tissue was present in 90 of 599 AOMT patients (15.0%) at baseline.
CIP/DEX treatment was superior to OFL for reduction of granulation tissue at the 
day 11 visit (81.3% compared with 56.1%, P = 0.0067) and the day 18 visit (91.7% 
compared with 73.2%, P = 0.0223). Both topical otic preparations are safe and
well tolerated in pediatric patients. CONCLUSION: CIP/DEX was superior to OFL in 
the treatment of granulation tissue in children with AOMT.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15195060 [PubMed - indexed for MEDLINE]

1325: Twin Res. 2004 Jun;7(3):239-44.

Otitis media: genetic factors and sex differences.

Kvestad E, Kvaerner KJ, Røysamb E, Tambs K, Harris JR, Magnus P.

Division of Epidemiology, The Norwegian Institute of Public Health, Oslo, Norway.
ellen.kvestad@fhi.no

Although genetic factors are recognised as major contributors to otitis media,
the presence of sex differences in heritability needs clarification. The aim of
this study was to estimate the relative contribution of genetic and environmental
effects in otitis media liability with particular focus on sex differences. Data 
from a cohort of Norwegian twins born between 1967 and 1979 with repeated
measures on recurrent childhood otitis media were analysed. Altogether the sample
included 4247 twin pairs. The tetrachoric correlations for monozygotic twins were
.71 and .65 for males and females respectively. In dizygotic twins the
correlations were .35 and .25 for males and females, respectively, and was.34 in 
opposite sexed pairs. The contribution of genetic and environmental effects was
analyzed using structural equation modeling. The best fitting model showed that
additive genetic effects explained 72% and 61% of the variance in males and
females, respectively. The remaining variance was attributed to individual
environmental effects. A model specifying equal heritability estimates for males 
and females yielded an almost equivalent fit. We found substantial genetic
effects for liability to otitis media. There is no evidence that different sets
of genes influence liability in males and females, but there may be sex
differences in the relative importance of genetic effects.

Publication Types: 
    Twin Study

PMID: 15193168 [PubMed - indexed for MEDLINE]

1326: Int J Pediatr Otorhinolaryngol. 2004 Jul;68(7):975-8.

Otitis caused by Scedosporium apiospermum in an immunocompetent child.

Bhally HS, Shields C, Lin SY, Merz WG.

Division of Microbiology, Johns Hopkins University School of Medicine, USA.
hbhally@hotmail.com

Scedosporium apiospermum (Pseudallescheria boydii) is a ubiquitous saprophytic
mold. It is considered an infrequent but important and emerging human pathogen,
mostly in immunocompromised hosts. Otomycosis secondary to S. apiospermum is
extremely rare. We report an 8-year-old immunocompetent male who developed otitis
media and otitis externa from S. apiospermum, which was successful treated with
combination of surgical debridement and topical clotrimazole therapy. A brief
literature review of infections caused by S. apiospermum follows the case
presentation.

Publication Types: 
    Case Reports
    Review

PMID: 15183592 [PubMed - indexed for MEDLINE]

1327: Int J Pediatr Otorhinolaryngol. 2004 Jul;68(7):889-94.

The role of free oxygen radicals on the development of otitis media with
effusion.

Yariktas M, Doner F, Dogru H, Yasan H, Delibas N.

Head and Neck Surgery Department, School of Medicine, Suleyman Demirel
University, Yayla M. 1604 S 5/3, Isparta 32100, Turkey. myariktas@hotmail.com

OBJECTIVE: The purpose of this study was to determine if free oxygen radicals
(FORs) and antioxidant enzyme activities have some role in pathogenesis of otitis
media with effusion (OME) in children with adenoid hyperplasia. METHODS:
Seventy-four patients were enrolled in three groups of this study. The study
group (Group I) included 26 patients who had adenoidectomy with ventilation tube 
placement due to chronic OME. The control adenoid group (Group II) consisted of
28 age-matched patients who had adenoidectomy without ventilation tube insertion.
Twenty children were included in the healthy control group (Group III).
Erythrocyte malondialdehyde (MDA) levels, superoxide dismutase (SOD), catalase
(CAT), glutathione peroxidase (GSH-Px) enzyme activities were investigated in the
venous blood sample. RESULTS: Erythrocyte MDA level and GSH-Px enzyme activity in
the blood samples of study group (Group I) were significantly higher than those
of Group II and Group III (P < 0.05). SOD enzyme activity in the blood samples of
Group I was significantly lower than Group II (P < 0.05), and were significantly 
higher than Group III (P < 0.05). CAT enzyme activity of Group I was
significantly lower than that of Group III (P < 0.05). However, there was no
statistically significant difference between Group I and Group II regarding CAT
antioxidant enzyme activity (P < 0.05). CONCLUSIONS: The inflammation of the
middle ear increases the level of FORs in erythrocyte. FOR level is normally
maintained at a steady state by antioxidant enzymes. When the antioxidant defense
system is weakened, the increased FORs may contribute to OME formation. We
supposed that, antioxidant vitamins C and E, and scavenger enzymes such as CAT,
SOD and GSH-Px may be added in the management of OME.

PMID: 15183579 [PubMed - indexed for MEDLINE]

1328: Int J Clin Pharmacol Ther. 2004 Feb;42(2):110-9.

Alternative versus conventional treatment strategy in uncomplicated acute otitis 
media in children: a prospective, open, controlled parallel-group comparison.

Wustrow TP; Otovowen Study Group.

ENT Associates, Munich, Germany. wustrowt@web.de

OBJECTIVES: Evidence from clinical trials questions the benefit-risk ratio of
first-line antibiotic treatment for uncomplicated acute otitis media in
childhood. Alternative treatment strategies are very popular but have not been
the subject of larger controlled clinical trials. This trial compares an
alternative with a conventional treatment strategy for acute otitis media.
METHODS AND PATIENTS: 390 children aged 1-10 years presenting with uncomplicated 
acute otitis media participated in a prospective, open, non-randomized,
controlled, parallel-group study. According to self-assignment of investigators, 
children were treated either conventionally (free combinations of decongestant
nose drops, mucolytics, analgesics and antibiotics) or alternatively with
Otovowen (fixed combination of plant-based tinctures and homeopathic potencies), 
supplemented by conventional medications when considered necessary. RESULTS:
Alternatively treated patients (n = 192) had significantly less severe otoscopic 
findings and clinical symptom ratings at baseline than children treated in
conventional centers (n = 193). Patients cared for by conventional therapists
took more antibiotics (80.5% vs. 14.4%; chi2-test, p < 0.001) and analgesics
(66.8% vs. 53.2%; chi2-test, p = 0.007). Times to recovery were 5.3 +/- 2.4 and
5.1 +/- 2.2 days for alternative and conventional treatment, respectively. Odds
ratios (OR) with a lower limit of 1-sided 97.5% confidence interval (CI) were
0.98 (0.76), 0.95 (0.73) and 0.88 (0.69) for results adjusted to baseline
otoscopy, pain and symptom score, respectively (Cox-Mantel test). Absence from
school or preschool nursery was 1.7 days in both groups; ORs (CI) were 1.00
(0.76), 0.96 (0.73) and 1.04 (0.80). Noninferiority of alternative treatment (CI 
limit of OR above 0.696) was not proven for pain resolution (-5.2 vs. -5.8 score 
points); OR (CI) were 0.87 (0.68), 1.15 (0.87) and 0.74 (0.58). Alternative
treatment was judged both by doctors (Mann-Whitney estimator with 2-sided 95% CI 
0.41 (0.35-0.47)) and parents (0.42 (0.36-0.48)), to be significantly better
tolerated than conventional treatment. CONCLUSIONS: In primary care management of
uncomplicated acute otitis media in childhood, an alternative treatment strategy 
based on the natural medicine, Otovowen may substantially reduce the use of
antibiotics without disadvantage to the clinical outcome.

Publication Types: 
    Clinical Trial
    Controlled Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 15180172 [PubMed - indexed for MEDLINE]

1329: Mycopathologia. 2004 Apr;157(3):263-4.

First isolation of Cryptococcus magnus from a cat.

Kano R, Hosaka S, Hasegawa A.

Department of Pathobiology, Nihon University School of Veterinary Medicine, 1866,
Fujisawa, Kanagawa, 252-8510, Japan. kano@brs.nihon-u.ac.jp

A 6-month-old male Japanese domestic cat with otitis externa due to Aspergillus
fumigatus was treated with antifungal agents for 25 days and appeared to be
cured. Many yeast colonies however developed from the ear canal samples on
Sabouraud's dextrose agar at 27 degrees C for 5 days, instead of A. fumigatus.
This yeast colony was cream-colored and slim in texture with smooth and highly
glossy surface after 5-day incubation on Sabouraud's dextrose agar at 27 degrees 
C. The isolate was identified as Cryptococcus magnus by mycological analysis and 
28S ribosomal analysis.

Publication Types: 
    Case Reports

PMID: 15180152 [PubMed - indexed for MEDLINE]

1330: South Med J. 2004 May;97(5):465-71.

Declining susceptibility to neomycin and polymyxin B of pathogens recovered in
otitis externa clinical trials.

Cantrell HF, Lombardy EE, Duncanson FP, Katz E, Barone JS.

Daiichi Pharmaceutical Co., Ltd., Montvale, NJ 07645, USA.
hcantrell@daiichius.com

BACKGROUND: Otitis externa is usually treated empirically with topical
neomycin/polymyxin B/hydrocortisone. The predominant pathogens associated with
this infection are Pseudomonas aeruginosa and Staphylococcus aureus. METHODS: Two
multicenter clinical trials (one in adults and adolescents, and one in children),
conducted between 1995 and 1996, compared neomycin/polymyxin B/hydrocortisone
with ofloxacin for the treatment of otitis externa; two similar trials were
conducted between 1999 and 2000. Assessments included the minimum inhibitory
concentrations (MICs) of each antimicrobial drug for the major pathogens,
bacterial eradication, and clinical efficacy. RESULTS: The MICs of all bacterial 
isolates (including P. aeruginosa) for neomycin and polymyxin B increased
markedly in the 1999 to 2000 studies compared with the 1995 to 1996 studies. In
the later studies, mean MICs for all major pathogens tested had increased above
the breakpoint for polymyxin B (> or = 4 microg/ml). In contrast, MICs of all
isolates for ofloxacin remained similar between the two study periods and were
within the susceptible range for this drug. CONCLUSIONS: Although the bacterial
eradication rates for both treatments in each study were equivalent, the clinical
cure rate for neomycin/polymyxin B/hydrocortisone was lower (87%) than for
ofloxacin (93%). Therefore, the organisms most often causing otitis externa
appear to be developing resistance to neomycin and polymyxin B but not to
ofloxacin.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 15180022 [PubMed - indexed for MEDLINE]

1331: Laryngoscope. 2004 Jun;114(6):1032-6.

Cathepsin gene expression profile in rat acute pneumococcal otitis media.

Li-Korotky HS, Swarts JD, Hebda PA, Doyle WJ.

Department of Otolaryngology, University of Pittsburgh School of Medicine,
Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
shengli@pitt.edu

OBJECTIVES/HYPOTHESIS: Acute otitis media, often caused by infection with
Streptococcus pneumoniae, is characterized by inflammation of the middle ear
mucosa. A prominent feature of the host response to bacterial infection of the
middle ear mucosa is an influx of inflammatory cells that contributes to the
local pool of inflammatory mediators by releasing additional inflammatory
chemicals, which in turn cause further tissue injury. The objective was to
identify candidate effector and signaling molecules involved in acute otitis
media pathogenesis caused by S pneumoniae infection. STUDY DESIGN: Male
Sprague-Dawley rats were randomly assigned to 1 of 5 groups, including 1 control 
group without treatment, 2 placebo groups (12 and 48 hours) and 2 infected groups
(12 and 48 hours). The rat middle ear was bilaterally inoculated with either 25
microL of tryptic soy broth (TSB group) or 25 microL of TSB containing
approximately 1.24 x 10(9) cfu/mL of S pneumonias type 6A (SP group). Rats were
killed at 12 and 48 hours after inoculation and the middle ear mucosa was
collected. Total RNA was extracted and pooled from each group for gene expression
assays. METHODS: Gene expression profiles for rat middle ear mucosa at 12 and 48 
hours after S pneumoniae or placebo inoculation were constructed using microarray
technology (Clontech Atlas Rat 1.2 Array, 1176 cDNAs). Genes of interest were
further validated by real-time polymerize chain reaction. RESULTS: Middle ear
mucosa expression of a gene cluster encoding the lysosomal cysteine proteases,
cathepsins B (Ctsb), L (Ctsl), and K (Ctsk), was modified after S pneumoniae
challenge. Specifically, at 12 hours, Ctsk and Ctsl messenger RNA that was
abundantly expressed in the normal middle ear mucosa was decreased, whereas Ctsb 
transcript was induced. The changes in Ctsb and Ctsk gene expression were
sustained at 48 hours. CONCLUSION: The constitutive expression of Ctsk and Ctsl
messenger RNA in normal middle ear mucosa supports a function in the maintenance 
of middle ear mucosa homeostasis, and their downregulation as an early event in
acute otitis media may reflect a disruption in that function. The induction of
Ctsb messenger RNA in the infected middle ear mucosa suggests a role in early
tissue injury; thus, Ctsb may represent a potential target for molecular
diagnostics and/or rational intervention during the development of acute otitis
media.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15179208 [PubMed - indexed for MEDLINE]

1332: Laryngoscope. 2004 Jun;114(6):975-80.

Impact of pneumococcal polysaccharide vaccine (Prevnar) on middle ear fluid in
children undergoing tympanostomy tube insertion.

Caspary H, Welch JC, Lawson L, Darrow D, Buescher S, Shahab S, Derkay CS.

Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical
School, Norfolk, VA, USA.

OBJECTIVES: The purpose of this study was to describe the bacteriology of middle 
ear effusions in children who have received the pneumococcal polysaccharide
vaccine (Prevnar) compared with unvaccinated children. METHODS: A prospective
review of medical records from July 2001 to July 2002 was conducted on children
with middle ear effusion at time of tympanostomy tube insertion. Middle ear fluid
was plated onto culture media immediately after acquisition, and antimicrobial
resistance of cultured organisms along with serotyping of Streptococcus
pneumoniae was examined. Vaccination status, demographics, and risk factors were 
determined from patients' medical records, parent interviews, or contact with
their primary care physicians. RESULTS: After adjusting for age and number of
previous infections, children vaccinated with Prevnar are two times less likely
to have non-S. pneumoniae pathogenic bacteria isolated than children not
vaccinated. Of those with growth, vaccinated children were almost three times
more likely than nonvaccinated children to have the presence of H. influenzae.
Vaccinated children with H. influenzae were 7.5 times less likely to have
beta-lactamase producing H. influenzae than nonvaccinated children with H.
influenzae. CONCLUSION: Because the incidence of S. pneumoniae was low, no
inference could be made whether Prevnar decreased otitis media with effusion or
recurrent acute otitis caused by the S. pneumoniae serotypes covered by the
vaccine. However, vaccinated children did appear to have the unexpected benefit
of having a certain level of protection to growth of typical acute otitis media
pathogens.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15179198 [PubMed - indexed for MEDLINE]

1333: Curr Allergy Asthma Rep. 2004 Jul;4(4):302-9.

Air pollution and otitis media: a review of evidence from epidemiologic studies.

Heinrich J, Raghuyamshi VS.

GSF-National Research Center for Environment and Health, Institute of
Epidemiology, Neuherberg, Germany. joachim.heinrich@gsf.de

Otitis media (main types: acute otitis media and otitis media with effusion) is
one of the most common childhood infections, particularly before the age of 3
years. The main causes are viral and/or bacterial ear infections, commonly
accompanied by or following upper respiratory tract infection. Besides these
infections, other risk factors, such as male sex, young age, genetic
predisposition, low socioeconomic status, low vitamin A and C intake, and
bottle-feeding are discussed. There is indication that exposure to environmental 
tobacco smoke is a major environmental risk factor, although additional effects
of the exposure to ambient air pollutants is uncertain. Although some studies
reported statistically significant increased risk for otitis media in children
with high exposure to ambient air pollutants, the risks were not consistent among
the studies. Owing to the scarcity of available data, far-reaching conclusions
cannot be drawn yet. However, the evidence of an increased risk for environmental
tobacco smoke exposure and identified increased risk for ambient air pollution
exposure in some studies should stimulate future research using otitis media as
one of the major outcomes in air pollution epidemiology.

Publication Types: 
    Review

PMID: 15175145 [PubMed - indexed for MEDLINE]

1334: Curr Allergy Asthma Rep. 2004 Jul;4(4):294-301.

Common respiratory manifestations of food allergy: a critical focus on otitis
media.

James JM.

Colorado Allergy and Asthma Centers, P.C., Fort Collins, 80525, USA.
jamesftco@earthlink.net

Previous investigations have established the pathogenic role of food allergy in
respiratory tract symptoms, which rarely occur in isolation. Specific foods have 
been implicated in these reactions. The role of food allergy in otitis media is
controversial, probably uncommon, and further studies are needed. Food-induced
asthma is more common in young pediatric patients, especially those with atopic
dermatitis. Asthma induced by food allergy is considered a risk factor for fatal 
and near-fatal anaphylactic reactions. Moreover, food allergy can elicit airway
hyperreactivity and asthmatic responses. Therefore, evaluation for food allergy
should be considered among patients with recalcitrant or otherwise unexplained
acute severe asthma exacerbations; asthma triggered by ingestion of particular
foods; and asthma and other manifestations of food allergy (eg, anaphylaxis,
moderate to severe atopic dermatitis).

Publication Types: 
    Review

PMID: 15175144 [PubMed - indexed for MEDLINE]

1335: Ann Otol Rhinol Laryngol. 2004 May;113(5):404-10.

Controversies and criticisms on designs for experimental autoimmune
labyrinthitis.

García-Berrocal JR, Ramírez-Camacho R, Trinidad A, Zurita M, de la Fuente R, Lobo
D.

Service of Otorhinolaryngology, Hospital Universitario Puerta de Hierro, Autónoma
University, Madrid, Spain.

Although immune-mediated inner ear disease was reported around 25 years ago,
numerous attempts to identify the inner ear antigens have been performed.
Experimental animal models have been used to study the immune mechanisms involved
in hearing loss and to develop new therapies. Because animal models of autoimmune
labyrinthitis have been developed by means of different antigens, we cannot yet
show a valid immunopathologic explanation. A critical analysis of the more
relevant experimental models employed has been performed in order to validate the
methodology. Comparison between these models and animals with spontaneous
systemic autoimmune disease has raised more questions concerning the
pathophysiology of autoimmune hearing loss. A new pathogenetic theory is
suggested, involving the supporting cells of the organ of Corti.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15174770 [PubMed - indexed for MEDLINE]

1336: Am J Kidney Dis. 2004 Jun;43(6):e1-3.

tuberculous otitis media in a renal transplant recipient.

Ergün I, Keven K, Sengül S, Kutlay S, Sertcelik A, Ertürk S, Erbay B.

Department of Nephrology, Ankara University School of Medicine, Sihhiye, Ankara, 
Turkey.

Tuberculous otitis media is a rare cause of chronic suppurative infection of the 
middle ear and a very uncommon form of extrapulmonary tuberculosis. Although
there have been several case reports in the nonimmunosuppressive population of
tuberculous otitis media, it has never been reported in an immunosuppressed
allograft recipient. We present a case of diagnosed tuberculous otitis media
after recurrent chronic otitis media treated several times with empiric
antibiotic treatment. After the patient developed postauricular fistula and
underwent surgical removal of granulation tissue, the diagnosis was made on the
basis of histopathology and growth in culture of Ziehl-Neelsen. Clinical response
promptly followed institution of antituberculous treatment including isoniazid,
rifampicin, ethambutol, and pyrazinamide.

Publication Types: 
    Case Reports

PMID: 15168420 [PubMed - indexed for MEDLINE]

1337: Curr Opin Infect Dis. 2004 Jun;17(3):177-84.

Pneumococcal vaccines: do they prevent infection and how?

Posfay-Barbe KM, Wald ER.

Children's Hospital of Pittsburgh, Division of Allergy, Immunology and Infectious
Diseases, Pittsburgh, Pennsylvania 15213, USA.

PURPOSE OF REVIEW: The purpose of this review is to update and summarize
information concerning the epidemiology of infections due to Streptococcus
pneumoniae and the early results of effectiveness studies of the heptavalent
pneumococcal conjugate vaccine. This vaccine was licensed in the US in 2000, and 
has been used increasingly since that time. RECENT FINDINGS: Several studies have
documented a dramatic decline in the rate of invasive infections due to S.
pneumoniae in children under 5 years of age. There has been a simultaneous
decrease in serious infections in persons over 20 years of age, presumably
because of a decrease in transmission of S. pneumoniae to unvaccinated
individuals. Three different studies have shown a modest reduction in the overall
number of cases of acute otitis media in children who have received the vaccine. 
Although the overall number of cases has decreased there has been an increase in 
the number of cases of acute otitis media caused by serotypes of S. pneumoniae
not contained in the vaccine. Worldwide, many studies have appeared that examine 
the prevalence of different pneumococcal serotypes/serogroups as a cause of
invasive and respiratory disease, to assess the likelihood that the vaccine will 
be effective in particular geographic areas. SUMMARY: Use of the heptavalent
pneumococcal conjugate vaccine has led to a major decline in the prevalence of
invasive pneumococcal disease (bacteremia, meningitis) and a more modest decrease
in respiratory tract infections (acute otitis media, pneumonia). Continued
surveillance is essential to document future trends in the occurrence of
pneumococcal infections and the enduring protectiveness of the heptavalent
pneumococcal conjugate vaccine.

Publication Types: 
    Review

PMID: 15166818 [PubMed - indexed for MEDLINE]

1338: J Laryngol Otol. 2004 May;118(5):343-7.

Ciliary count in chronic suppurative otitis media: comparative quantitative study
between mucosal and squamous types using scanning electron microscopy and image
analysis.

Atef A, Ayad EE.

Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Cairo, 
Egypt. amratef@dr.com

The objective of this study was to prove ciliary destruction in the middle-ear
mucous membrane in cases of chronic suppurative otitis media (CSOM) and to
compare both types of chronic suppurative otitis media with regard to the degree 
of ciliary destruction and ciliary count using objective quantitative techniques.
The mucosa of the anterior mesotympanum over the promontory was sampled in 10
patients with mucosal CSOM and in another 10 patients with squamous type CSOM.
Specimens were examined by scanning electron microscopy in combination with image
analysis software techniques in order to study the cilia under higher
magnifications and to calculate the ciliary area. Five patients with
otosclerosis, no history suggestive of otitis media and normal ear drum
appearance served as controls. Samples were taken and studied at the Faculty of
Medicine of Cairo University. CSOM was found to be associated with significant
ciliary destruction and this was more evident in the squamous type than in the
mucosal type.

Publication Types: 
    Comparative Study

PMID: 15165307 [PubMed - indexed for MEDLINE]

1339: J Laryngol Otol. 2004 May;118(5):333-7.

Modified Bondy radical mastoidectomy: long-term personal experience.

Berrettini S, Ravecca F, de Vito A, Forli F, Valori S, Franceschini SS.

Department of Neuroscience, Otolaryngology Unit, University of Pisa, Pietrantoni 
Hospital, Forli, Italy. s.berrettini@ent.med.unipi.it

The 'Bondy operation', or modified Bondy radical mastoidectomy, consists of a
modification of the radical procedure by which the mastoid and epitympanum are
exteriorized with preservation of the pars tensa and ossicular chain. In the
10-year period from 1986 to 1996, 53 patients of the ENT Department of the
University of Pisa underwent a modified Bondy radical mastoidectomy, performed
with a personalized procedure; 45 of them had a follow up of at least five years.
After the surgical operation, the ears were free of complications in 38 cases
(84.5 per cent), while in the other seven cases residual cholesteatoma (one
case), tympanic retraction (four cases) or recurrent otorrhoea and phlogosis (two
cases) were observed. The post-operative hearing level was unchanged or improved 
in 41 patients (91 per cent) (33 subjects had an unchanged gap and eight an
improved gap), and only in the remaining four cases was the gap made worse. Based
on our experience, the modified Bondy radical mastoidectomy is an extremely
effective operation with a clear place in modern ENT surgery. When performed on
carefully selected patients, it has been proven to offer good functional and
anatomical results.

PMID: 15165305 [PubMed - indexed for MEDLINE]

1340: J Clin Immunol. 2004 Jul;24(4):354-60.

Antibody levels after regular childhood vaccinations in the immunological
screening of children with recurrent otitis media.

Wiertsema SP, Sanders EA, Veenhoven RH, Van Heerbeek N, van den Hof S, Berbers
GA, Rijkers GT.

Department of Pediatric Immunology, Wilhelmina Children's Hospital, University
Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands.

Recurrent otitis media may be related to defects in specific antibody production,
as suggested previously. This might be reflected in lower antibody responses to
vaccinations administered in the context of the national childhood vaccination
program in children suffering from recurrent otitis media. In a cross-sectional
study we determined the levels of antidiphtheria, antitetanus, anti- Haemophilus 
influenzae type b (anti-Hib) and antimeasles antibodies in sera of 163 children
with two or more episodes of acute otitis media per year and in 143 children with
repeated periods of persistent otitis media with effusion each lasting at least 3
months. The control group consisted of 521 age-matched healthy children, who were
free of recurrent respiratory tract infections. Children with recurrent acute
otitis media, including highly otitis-prone children, showed higher
antidiphtheria and antitetanus antibody titers compared to controls. No
differences were observed in anti-Hib and antimeasles antibody levels between
children with recurrent acute otitis media and controls, nor did any of the
antibody levels in children with persistent otitis media with effusion differ
from those in controls. Therefore, the results of our study do not point toward a
generalized immunological hyporesponsiveness in children with recurrent acute
otitis media and persistent otitis media with effusion. Determination of antibody
responses to regular vaccines is not indicative for otitis-proneness.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15163891 [PubMed - indexed for MEDLINE]

1341: J Commun Disord. 2004 Jul-Aug;37(4):313-23.

Pediatricians' opinions about otitis media and speech-language-hearing
development.

Sonnenschein E, Cascella PW.

Department of Communication Disorders, Southern Connecticut State University, 501
Crescent Street, New Haven, CT 06515, USA.

Twenty-five pediatricians responded to a confidential survey about their opinions
on the relationship between otitis media and children's speech-language-hearing
status. Results found that pediatricians did not necessarily agree that otitis
media has an impact on speech-language-hearing development. Pediatricians
reported that an early otitis media onset (birth to age 2) affects
speech-language development, but they also reported that parents and daycare
environments could mitigate any otitis media effect. Pediatricians reported a
possible otitis media impact on hearing status, but they did not necessarily
agree that an otitis media history required referral for audiological testing.
Clinical implications are discussed for collaboration among pediatricians,
speech-language pathologists, and audiologists. LEARNING OUTCOMES: (1) The reader
will become familiar with pediatricians' opinions about the impact of otitis
media on speech-language development. (2) The reader will become familiar with
strategies to support interdisciplinary collaboration between pediatricians,
speech-language pathologists, and audiologists.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15159192 [PubMed - indexed for MEDLINE]

1342: J Paediatr Child Health. 2004 May-Jun;40(5-6):258-64.

Aboriginal perspective on middle ear disease in the arid zone of Western
Australia.

Jeffries-Stokes C, Lehmann D, Johnston J, Mason A, Evans J, Elsbury D, Wood K.

Centre for Child Health Research, University of Western Australia, Telethon
Institute for Child Health Research, Perth, Western Australia, Australia.

OBJECTIVES: To explore perceptions, knowledge and experience of otitis media (OM)
and barriers to compliance with treatment among Aboriginal people of the
Kalgoorlie-Boulder area, Western Australia. METHODS: This qualitative applied
research study is based on a holistic design. We conducted structured interviews 
with three community focus groups, 56 key informants, and 22 mothers of babies
known to have suffered from OM. Written records of interviews were checked with
participants. The three sources of data enabled comparison and verification of
results. RESULTS: People were concerned about serious consequences of OM,
especially deafness and learning difficulties. Since early disease may have no
localizing symptoms, not surprisingly, people had limited understanding of the
aetiology of OM and were often only aware of disease once ear discharge was
visible. Nevertheless, they usually sought treatment for non-specific symptoms.
Competing demands in people's daily lives and the unpleasant, intensive nature of
treatment result in families becoming resigned to a child's chronic ear
discharge. Someone other than the biological mother within the extended family
may be responsible for administering treatments. Half the carers thought passive 
smoking may predispose children to OM and 70% suggested clearing the nasal
passages to prevent OM. Results of surgery were viewed positively but specialist 
services were not always readily accessible. CONCLUSIONS: Since responsibility
for treatment may not lie with the biological mother, awareness campaigns must
target the entire community. As early OM may be asymptomatic, health personnel
should be encouraged to do otoscopy on all children with non-specific symptoms.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15151578 [PubMed - indexed for MEDLINE]

1343: Acta Otolaryngol. 2004 Apr;124(3):249-52.

Vestibular involvement in myringitis bullosa.

Eliashar R, Gross M, Saah D, Elidan J.

Department of Otolaryngology/Head and Neck Surgery, Hadassah University Hospital,
Jerusalem, Israel. ron@eliashar.com

OBJECTIVE: Cochlear involvement manifested by sensorineural or mixed-type hearing
loss (HL) has been reported to occur in 30-67% of patients suffering from
myringitis bullosa (MB). The goal of this study was to investigate the incidence 
and nature of vestibular involvement in MB. MATERIAL AND METHODS: All adult
patients presenting to Hadassah University Hospital with MB between 2000 and 2002
were evaluated for inner ear involvement. Audiometry, tympanometry and
electronystagmography (ENG) were performed within the first 48 h after
presentation. The affected ears were examined on a regular basis and audiometric 
studies were repeated every other day. ENG was not repeated but a detailed
questionnaire was administered and a thorough physical examination performed to
rule out persistent vestibular dysfunction. RESULTS: Thirteen patients (17 ears) 
were diagnosed as suffering from MB. All 13 patients reported HL in the affected 
ears and 7 (54%) reported a sensation of vertigo at presentation. Audiometric
tests revealed HL in all 17 affected ears: sensorineural HL in 2, mixed-type HL
in 12 and conductive HL in 3. ENG was normal in only two cases, both of whom did 
not suffer from vertigo. Four patients with no vestibular symptoms whatsoever had
an abnormal electronystagmogram. All seven patients who complained of vertigo had
an abnormal electronystagmogram and recovered fully after treatment. All but two 
patients recovered their auditory function. CONCLUSIONS: Not only is the cochlear
part of the inner ear affected in patients suffering from MB, but the vestibular 
part as well. Sensorineural HL and vestibular abnormalities should both be
considered as manifestations of MB.

PMID: 15141751 [PubMed - indexed for MEDLINE]

1344: Otolaryngol Head Neck Surg. 2004 May;130(5 Suppl):S95-118.

Clinical practice guideline: Otitis media with effusion.

Rosenfeld RM, Culpepper L, Doyle KJ, Grundfast KM, Hoberman A, Kenna MA,
Lieberthal AS, Mahoney M, Wahl RA, Woods CR Jr, Yawn B; American Academy of
Pediatrics Subcommittee on Otitis Media with Effusion; American Academy of Family
Physicians; American Academy of Otolaryngology--Head and Neck Surgery.

SUNY-HSC Brooklyn, Department of Pediatric Otolaryngology, NY 11201, USA.
richrosenfeld@msn.com

The clinical practice guideline on otitis media with effusion (OME) provides
evidence-based recommendations on diagnosing and managing OME in children. This
is an update of the 1994 clinical practice guideline "Otitis Media With Effusion 
in Young Children," which was developed by the Agency for Healthcare Policy and
Research (now the Agency for Healthcare Research and Quality). In contrast to the
earlier guideline, which was limited to children aged 1 to 3 years with no
craniofacial or neurologic abnormalities or sensory deficits, the updated
guideline applies to children aged 2 months through 12 years with or without
developmental disabilities or underlying conditions that predispose to OME and
its sequelae. The American Academy of Pediatrics, American Academy of Family
Physicians, and American Academy of Otolaryngology-Head and Neck Surgery selected
a subcommittee composed of experts in the fields of primary care, otolaryngology,
infectious diseases, epidemiology, hearing, speech and language, and advanced
practice nursing to revise the OME guideline. The subcommittee made a strong
recommendation that clinicians use pneumatic otoscopy as the primary diagnostic
method and distinguish OME from acute otitis media (AOM). The subcommittee made
recommendations that clinicians should (1) document the laterality, duration of
effusion, and presence and severity of associated symptoms at each assessment of 
the child with OME; (2) distinguish the child with OME who is at risk for speech,
language, or learning problems from other children with OME and more promptly
evaluate hearing, speech, language, and need for intervention in children at
risk; and (3) manage the child with OME who is not at risk with watchful waiting 
for 3 months from the date of effusion onset (if known), or from the date of
diagnosis (if onset is unknown). The subcommittee also made recommendations that 
(4) hearing testing be conducted when OME persists for 3 months or longer, or at 
any time that language delay, learning problems, or a significant hearing loss is
suspected in a child with OME; (5) children with persistent OME who are not at
risk should be reexamined at 3- to 6-month intervals until the effusion is no
longer present, significant hearing loss is identified, or structural
abnormalities of the eardrum or middle ear are suspected; and (6) when a child
becomes a surgical candidate, tympanostomy tube insertion is the preferred
initial procedure. Adenoidectomy should not be performed unless a distinct
indication exists (nasal obstruction, chronic adenoiditis); repeat surgery
consists of adenoidectomy plus myringotomy, with or without tube insertion.
Tonsillectomy alone or myringotomy alone should not be used to treat OME. The
subcommittee made negative recommendations that (1) population-based screening
programs for OME not be performed in healthy, asymptomatic children and (2)
antihistamines and decongestants are ineffective for OME and should not be used
for treatment; antimicrobials and corticosteroids do not have long-term efficacy 
and should not be used for routine management. The subcommittee gave as options
that (1) tympanometry can be used to confirm the diagnosis of OME and (2) when
children with OME are referred by the primary clinician for evaluation by an
otolaryngologist, audiologist, or speech-language pathologist, the referring
clinician should document the effusion duration and specific reason for referral 
(evaluation, surgery), and provide additional relevant information such as
history of AOM and developmental status of the child. The subcommittee made no
recommendations for (1) complementary and alternative medicine as a treatment for
OME based on a lack of scientific evidence documenting efficacy and (2) allergy
management as a treatment for OME based on insufficient evidence of therapeutic
efficacy or a causal relationship between allergy and OME. Last, the panel
compiled a list of research needs based on limitations of the evidence reviewed. 
The purpose of this guideline is to inform clinicians of evidence-based methods
to identify methods to identify, monitor, and manage OME in children aged 2
months through 12 years. The guideline may not apply to children older than 12
years because OME is uncommon and the natural history is likely to differ from
younger children who experience rapid developmental change. The target population
includes children with or without developmental disabilities or underlying
conditions that predispose to OME and its sequelae. The guideline is intended for
use by providers of health care to children, including primary care and
specialist physicians, nurses and nurse practitioners, physician assistants,
audiologists, speech-language pathologists, and child development specialists.
The guideline is applicable to any setting in which children with OME would be
identified, monitored, or managed. This guideline is not intended as a sole
source of guidance in evaluating children with OME. Rather, it is designed to
assist primary care and other clinicians by providing an evidence-based framework
for decision-making strategies. It is not intended to replace clinical judgment
or establish a protocol for all children with this condition, and may not provide
the only appropriate approach to diagnosing and managing this problem.

Publication Types: 
    Guideline
    Practice Guideline

PMID: 15138413 [PubMed - indexed for MEDLINE]

1345: Pediatr Infect Dis J. 2004 May;23(5):475-6.

Otitis media associated with Vibrio alginolyticus in a child with
pressure-equalizing tubes.

Feingold MH, Kumar ML.

Department of Pediatrics, Case Western Reserve University, MetroHealth Medical
Center, Cleveland, OH, USA.

Vibrio alginolyticus is an unusual cause of otitis media. Infection usually
occurs in the presence of a chronically perforated eardrum or patent
pressure-equalizing tube. Infection with V. alginolyticus can occur after even
mild, brief exposure to seawater, and the interval between exposure to seawater
and onset of clinical infection can be prolonged.

Publication Types: 
    Case Reports

PMID: 15131479 [PubMed - indexed for MEDLINE]

1346: Pediatr Infect Dis J. 2004 May;23(5):465-6.

No evidence of Mycoplasma pneumoniae in acute myringitis.

Kotikoski MJ, Kleemola M, Palmu AA.

Tampere University Hospital, Tampere, Finland.

Our aim was to discover Mycoplasma pneumoniae in bullous and hemorrhagic
myringitis in children <2 years of age. Middle ear fluid samples (n = 37) and
samples taken from the blisters of the tympanic membranes (n = 12) studied by
polymerase chain reaction for M. pneumoniae were negative. This study does not
support an important role for M. pneumoniae as an etiologic agent in acute
myringitis.

PMID: 15131474 [PubMed - indexed for MEDLINE]

1347: Pediatr Infect Dis J. 2004 May;23(5):406-13.

Relationship among peripheral leukocyte counts, etiologic agents and clinical
manifestations in acute otitis media.

Polachek A, Greenberg D, Lavi-Givon N, Broides A, Leiberman A, Dagan R, Leibovitz
E.

Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, 
Israel.

OBJECTIVES: To analyze the peripheral leukocyte counts of children with acute
otitis media (AOM) in relation to etiology, age, clinical symptoms and signs,
prior antibiotic treatment, previous AOM history and pathogen eradication during 
antibiotic therapy. PATIENTS AND METHODS: Leukocyte counts were determined at
diagnosis and on days 4 to 6 of therapy in patients age 3 to 36 months with AOM
enrolled in double tympanocentesis studies. Clinical status was determined by a
clinical score evaluating severity of fever, irritability and tympanic membrane
redness and bulging. RESULTS: Of 771 enrolled patients, culture-positive middle
ear fluid was reported in 590 (77%): 294 (50%) Haemophilus influenzae; 150 (25%) 
Streptococcus pneumoniae; 127 (21%) H. influenzae and S. pneumoniae together; 9
(2%) Moraxella catarrhalis; and 10 (2%) others. Mean leukocyte count +/- sd in
patients with AOM caused by S. pneumoniae (15.7 +/- 6.7 cells x 10/mm) was
significantly higher than those of patients with AOM caused by H. influenzae
(13.7 +/- 5.8 cells x 10/mm) and patients with culture-negative AOM (13.8 +/- 5.6
cells x 10/mm), P < 0.01 for each comparison. Mean absolute neutrophil count
(ANC) +/- sd was higher in patients with AOM caused by S. pneumoniae (8.6 +/- 5.1
cells x 10/mm) than in patients with AOM caused by H. influenzae (6.5 +/- 4.0
cells x 10/mm) or culture-negative patients (6.5 +/- 4.4 cells x 10/mm), P < 0.05
for each comparison. When multivariant regression analysis was used, S.
pneumoniae etiology and fever (body temperature > or = 38 degrees Celsius) were
independent factors, each significantly associated with leukocyte and ANCs. A
significant correlation was found between leukocyte and ANCs and higher clinical 
scores in patients with pneumococcal AOM (P = 0.01, r = 0.21 and P < 0.01, r =
0.27, respectively). The mean leukocyte count on Days 4 to 6 was lower than on
Day 1 (11.5 +/- 4.1 compared with 14.2 +/- 6.0 cells x 10/mm, P < 0.01). When
paired (Day 1 and Days 4 to 6) examinations were analyzed, the leukocyte counts
were lower on Days 4 to 6 irrespective of bacterial eradication or persistence.
CONCLUSIONS: Significantly higher leukocyte counts and ANCs were found in
pneumococcal AOM than in AOM caused by H. influenzae or in culture-negative AOM. 
A significant decrease in leukocyte counts was found during antibiotic therapy
for AOM, regardless of etiology and bacteriologic outcome. Isolation of S.
pneumoniae and fever were each significantly associated with increased peripheral
leukocyte and ANCs.

Publication Types: 
    Clinical Trial

PMID: 15131462 [PubMed - indexed for MEDLINE]

1348: Pediatr Infect Dis J. 2004 May;23(5):390-8.

Potential role of fluoroquinolone therapy in childhood otitis media.

Dagan R, Arguedas A, Schaad UB.

Pediatric Infectious Disease Unit, Soroka University Medical Center, Ben-Gurion
University of the Negev, Beer-Sheva, Israel. rdagan@bgumail.bgu.ac.il

Increased resistance of pneumococci and other pathogens to available antibiotics 
raises concerns about bacteriologic and clinical failure in children with acute
otitis media. Few therapeutic options exist for patients with recurrent
infections or recent treatment failure. The limited experience from the
compassionate use of fluoroquinolones in pediatrics and pediatric studies has not
been linked unequivocally with arthrotoxicity, the primary safety concern in
children. Newer 8-methoxyfluoroquinolones may have a role in selected cases
associated with multidrug-resistant pathogens.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 15131460 [PubMed - indexed for MEDLINE]

1349: Int J Pediatr Otorhinolaryngol. 2004 Mar;68(3):331-9.

Otitis media with effusion: disease or defense? A review of the literature.

de Ru JA, Grote JJ.

Department of Otorhinolaryngology, University Medical Center Utrecht,
Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. j.a.deru@kmb.azu.nl

Many studies of otitis media with effusion (OME) have been published, most of
them dealing with risk factors. The literature correlates this condition with
various patient characteristics and socio-economic factors, but none of these
have been identified as the sole causative factor. A review of the literature
suggests that otitis media with effusion is a response to pathogenic bacteria and
thus a normal protective reaction of the body. Therefore, the decision on whether
or not treatment is indicated should take the natural course of that response
into account. In light of the literature reviewed here, we conclude that there is
usually no need to treat middle ear effusion in young children.

Publication Types: 
    Review

PMID: 15129944 [PubMed - indexed for MEDLINE]

1350: Int J Pediatr Otorhinolaryngol. 2004 Mar;68(3):317-24.

Complications of acute otitis media in children in southern Finland.

Leskinen K, Jero J.

Department of Otolaryngology, Helsinki University Central Hospital,
Haartmaninkatu 4E, PO Box 220, Helsinki, FIN-00029 HUCH, Finland.
kimmo.leskinen@hus.fi

BACKGROUND: The incidence of intratemporal and intracranial complications of
acute otitis media (AOM) has decreased and the need for operative treatment is
declined in developed countries during the antibiotic era. OBJECTIVES: To
establish the clinical picture, diagnostic procedures, outcome and current
treatment of pediatric patients with intratemporal and intracranial complications
of AOM. METHODS: A retrospective chart review with a sent questionnaire. All
pediatric patients treated for intratemporal and intracranial complications of
AOM over the past 10 years (1990-2000) at the Department of Otolaryngology in the
Helsinki University Central Hospital. RESULTS: During the study period 33
children (incidence 1.1/100,000 per year), aged from 3 months to 14.2 years were 
treated for intratemporal [97% (32/33)] and intracranial [3% (1/33)]
complications of AOM. Facial paresis was found in 9% (3/33) of the patients. The 
only intracranial complication was an extradural abscess with meningitis.
Eighteen patients (55%) were on antibiotic treatment because of AOM prior to the 
diagnosis of complication. Neither the duration or severity of the signs and
symptoms of infection at the time of admittance nor a lack of antibiotic
treatment before admittance were statistically significantly associated with the 
need for mastoidectomy or duration of hospitalization. Streptococcus pneumoniae
25% (8/33) and Pseudomonas aeruginosa 22% (7/33) were the most frequently found
bacteria in the culture of middle ear and mastoid effusions. Mastoidectomy was
performed on 55% (18/33) of the patients. After half a year of follow-up, all the
patients had normal hearing and facial function. CONCLUSIONS: Severe
complications of AOM are rare today in southern Finland and the need for
mastoidectomy has declined significantly. With early recognition and effective
treatment of complications, the prognosis is good.

PMID: 15129942 [PubMed - indexed for MEDLINE]

1351: Int J Pediatr Otorhinolaryngol. 2004 Mar;68(3):273-80.

Cochlear implantation in children with otitis media: second stage of a long-term 
prospective study.

Luntz M, Teszler CB, Shpak T.

Head and Neck Surgery, Department of Otolaryngology, Faculty of Medicine, Bnai
Zion Medical Center, Technion--Israel Institute of Technology, PO Box 4940, Haifa
31048, Israel. luntz@b-zion.org.il

OBJECTIVE: To present the findings of the second stage of an ongoing prospective 
study of the outcome of cochlear implantation in otitis media (OM)-prone and
non-OM-prone children who were treated according to a structured protocol
designed to control OM prior to implantation. PATIENTS AND METHODS: Of 60
children referred for cochlear implantation during the study period, 34 were
classified as OM-prone (Group A) and 26 as non-OM-prone (group B). Group A
patients were managed according to a structured protocol aimed at
pre-implantation control of OM. A ventilating tube (with or without
adenoidectomy) was inserted in the affected ear(s) of these children, if
necessary more than once. Post-implantation follow-up ranged from 3 to 45 months 
(average 20 months). RESULTS: In the OM-prone group of children, the mean age at 
referral and at implantation was significantly lower and the mean interval
between referral and implantation significantly higher than in the healthy group.
During implantation, 21 children (19 from the OM-prone group A) had thick middle 
ear mucosa that had to be removed to allow identification of the round window
niche. After implantation, 13 of the OM-prone children (38%) and 2 of the
non-OM-prone children (7.6%) developed acute OM in the implanted ear. Five of
these cases, all belonging to the OM-prone group, proved to be recurrent and
therapeutically challenging, and 2 of them also developed acute mastoiditis.
There were no other OM-related complications. CONCLUSIONS: Early referral led to 
early implantation, even in children susceptible to OM. The incidence of OM
decreased after implantation, but was still significantly higher in the OM-prone 
group. On the basis of these results, we recommend the continuous use of a
ventilating tube in OM-prone pediatric implantees until they outgrow their
susceptibility to OM.

Publication Types: 
    Clinical Trial
    Controlled Clinical Trial

PMID: 15129937 [PubMed - indexed for MEDLINE]

1352: J Nippon Med Sch. 2004 Feb;71(1):17-24.

Subjective evaluation and overall satisfaction after tympanoplasty for chronic
simple suppurative otitis media.

Baba S, Yagi T, Fujikura T.

Department of Otorhinolaringology, Chiba-Hokuso Hospital, Nippon Medical School, 
1715 Kamagari, Inba, Chiba 270-1694, Japan. shbaba@nms.ac.jp

A questionnaire survey was conducted in 324 patients with chronic, simple,
suppurative otitis media who had undergone tympanoplasty 6 months or more
previously to investigate post-operative hearing, tinnitus, vertigo, occlusive
feeling of the ear and otorrhea. In addition, the overall satisfaction with
tympanoplasty was assessed by VAS value. Subjective hearing improvement was
observed in 73.1% of the patients whose hearing was poor and in 50% of those
whose hearing was good before the operation. The degree of satisfaction assessed 
by VAS value corresponded with the subjective hearing assessment. As to tinnitus,
66.2% of the patients became aware of the disappearance or alleviation of
symptoms. In the case of patients who had tinnitus before the operation, the
degree of awareness of tinnitus and the degree of satisfaction assessed by VAS
value coincided. However, no changes in the VAS value were observed in those who 
did not have tinnitus before the operation. As for vertigo, 30.5% of the patients
who had vertigo preoperatively became aware of the disappearance of the symptoms 
after the operation. The degree of satisfaction assessed by VAS value
corresponded with the presence or absence, severity and frequency of vertigo. As 
to the fullness of the ear, alleviation of the symptoms was subjectively noted by
85.9% of the patients who had symptoms before the operation. The degree of
satisfaction assessed by VAS value corresponded with the severity of the symptoms
in those who had symptoms before the operation. As for otorrhea, the
disappearance of the symptoms was subjectively noted by 85.5% of the patients who
had otorrhea before the operation. The degree of satisfaction assessed by VAS
value corresponded with the post-operative changes in otorrhea. Based on the
above results, it was assumed that the patients placed greatest expectation on
hearing improvement when they underwent tympanoplasty. VAS is considered a useful
method to evaluate the degree of satisfaction of patients after surgery.

Publication Types: 
    Comparative Study

PMID: 15129591 [PubMed - indexed for MEDLINE]

1353: Otol Neurotol. 2004 May;25(3):318-22.

Neonatal middle ear effusion predicts chronic otitis media with effusion.

Doyle KJ, Kong YY, Strobel K, Dallaire P, Ray RM.

University of California Davis Medical Center, Sacramento, California, USA.
karen.doyle@ucdmc.ucdavis.edu

HYPOTHESIS AND AIMS: The specific aims of the research are to determine whether
newborn ears with persistent middle ear effusion at age 30 to 48 hours are more
likely to develop chronic otitis media with effusion over the first year of life 
when compared with ears without persistent middle ear effusion. The hypothesis is
that neonates with middle ear effusion persisting to 30 to 48 hours are more
likely to develop chronic otitis media with effusion. STUDY DESIGN: Prospective, 
case-control design. Loupe-magnified pneumatic otoscopy performed at the time of 
newborn hearing screening determined presence or absence of effusion. Infants
enrolled in the study returned for outpatient examinations. SETTING: University
medical center well-baby nursery and out-patient audiology clinic. SUBJECTS: From
454 neonates, 14 experimental subjects with neonatal middle ear effusions and 15 
control subjects free of neonatal effusion were recruited for the study and
followed-up for 1 year. INTERVENTIONS: Outpatient study tests included
transient-evoked otoacoustic emissions, tympanometry, pneumatic otoscopy, and
visual reinforcement audiometry (starting at age 6 months), at 3, 6, 9, and 12
months of age. Experimental (neonatal effusion) infants were followed-up starting
at age 1 month. Infants found at any follow-up examination to have effusion on
otoscopy were followed-up and tested 1 month later. MAIN OUTCOME MEASURES:
Chronic otitis media with effusion defined as hypomobile or immobile tympanic
membrane on pneumatic otoscopy in one or both ears for three consecutive monthly 
examinations. Hearing loss defined as greater than 25-dB hearing loss visual
reinforcement audiometry thresholds. RESULTS: Eight experimental infants (58%)
and three control infants (20%) developed chronic otitis media with effusion (p <
0.04). The average number of effusions was 1.27 for control and 4.14 for
experimental infants (average number of effusions for each group at 3-, 6-, 9-,
and 12-month visits). Warbled tone and speech visual reinforcement audiometry
thresholds averaged 3 dB worse in the experimental group, but these differences
were not statistically significant. For the control group, mean visual
reinforcement audiometry thresholds never exceeded 25 dB hearing loss. For the
experimental group, mean visual reinforcement audiometry thresholds exceeded 25
dB hearing loss at 1,000, 2,000, and 4,000 Hz at 9 months. CONCLUSIONS: A
majority of infants with persistent neonatal middle ear effusion found by
pneumatic otoscopy at 30 to 48 hours will develop chronic otitis media with
effusion during the first year of life. However, chronic otitis media with
effusion is common in all infants (20% of controls), a time during which infants 
are examined and tested frequently.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15129112 [PubMed - indexed for MEDLINE]

1354: Otol Neurotol. 2004 May;25(3):223-30.

Malleus relocation in ossicular reconstruction: managing the anteriorly
positioned malleus: results in a series of 268 cases.

Vincent R, Oates J, Sperling NM, Annamalai S.

Jean Causse Ear Clinic, Traverse de Béziers, Colombiers, France. robvinc@aol.com

OBJECTIVE: The objective of this study was to report an original method of
malleus relocation allowing for better placement of both partial and total
prostheses in ossicular reconstruction. STUDY DESIGN: We conducted a
retrospective review of clinical and audiometric findings. SETTING: A tertiary
referral center. MATERIALS AND METHODS: This is a study of 268 patients who
underwent ossiculoplasty surgery from October 1997 to October 2000 for chronic
otitis media, noninflammatory disease, and otosclerosis revision. Malleus
relocation with total and partial ossicular replacement prostheses was used in
all cases. Audiometric assessment included pre- and postoperative audiometric
evaluation using conventional audiometry. Air-bone gap, bone-conduction
thresholds, and air-conduction thresholds were measured. RESULTS: A postoperative
air-bone gap closed to within 10 dB was achieved in 56% of cases. An air-bone gap
smaller than 20 dB was obtained in 78% of cases. Postoperative improvement of
air-conduction thresholds superior to 20 dB was found in 41.5% of cases. The
postoperative bone-conduction thresholds were unchanged in 98% of cases. One case
of total postoperative sensorineural hearing loss was seen in this series (0.4%).
Extrusion of the protheses was not observed in this series. Follow up ranged from
6 to 36 months (mean, 12.4 months). CONCLUSION: This study shows that malleus
relocation is a safe and efficient technique for ossicular reconstruction. The
ideal position of the relocated malleus allows easier and more stable placement
of middle ear prostheses.

PMID: 15129096 [PubMed - indexed for MEDLINE]

1355: Contact Dermatitis. 2004 Feb;50(2):83-6.

Changing patterns of contact allergy in chronic inflammatory ear disease.

Millard TP, Orton DI.

Department of Dermatology, Amersham Hospital, Amersham, Buckinghamshire HP7 OJD, 
UK. thomasmillard83@hotmail.com

Chronic inflammatory ear disease comprises a wide range of conditions. Although
contact allergy to topical medicaments is common in such conditions, the causes
of these reactions have not been examined in a large series for over a decade.
Our aim was to investigate the major sensitizers recorded in 179 patients over
the last 17 years. Medicament contact allergic dermatitis was diagnosed in 45
patients (25%), of whom 34 (76%) demonstrated a relevant allergy to neomycin, 28 
(62%) to framycetin, 11 (31%) to gentamicin, 8 (18%) to quinoline mix and 5 (11%)
to caine mix. Of all neomycin-allergic patients, 28 (76%) were also allergic to
framycetin and 12 (43%) to gentamicin. Comparing the first 60 patients (1985-94) 
to the most recent 60 (1998-2002) identified a significant recent reduction in
the number of patients allergic to neomycin (P = 0.002) and framycetin (P =
0.050), with a non-significant reduction in the total number diagnosed as
medicament-allergic (P = 0.066). We have therefore demonstrated a high frequency 
of medicament contact allergy in chronic inflammatory ear disease, supporting the
routine use of patch testing in these patients. We have also shown a significant 
recent reduction in the number of such patients with allergy to neomycin and
framycetin.

PMID: 15128318 [PubMed - indexed for MEDLINE]

1356: Laryngoscope. 2004 May;114(5):863-6.

Adenoidectomy: selection criteria for surgical cases of otitis media.

Nguyen LH, Manoukian JJ, Yoskovitch A, Al-Sebeih KH.

Department of Otolaryngology, McGill University, Montreal, Quebec, Canada.

OBJECTIVE: Nasopharyngeal adenoids may serve as a mechanical obstruction to the
eustachian tube and contribute to the pathophysiology of otitis media (OM). The
purpose of this study was to determine whether abutment of adenoids laterally
against the torus tubaris affects the outcome of patients requiring pressure
equalization tubes (PET) for OM. STUDY DESIGN: Randomized, controlled,
prospective clinical trial. METHOD: Patients requiring PET for recurrent acute OM
or OM with persistent effusion were randomized into two groups: 1) PET placement 
and 2) PET placement and adenoidectomy, regardless of whether the adenoids were
abutting or not abutting the torus tubaris. Patients were followed for a minimum 
of 1 year to determine rate of treatment failure, defined as recurrence of acute 
OM (>3 times/year), OM with effusion, or reinsertion of PET. RESULTS: Of the 34
patients in the abutting group, 16 patients underwent only PET insertion, of whom
8 (50%) failed, whereas 18 patients had combined PET placement and adenoidectomy,
of whom 3 (17%) failed. There was a statistical difference between these two
groups (P < 05). Of the 29 patients in the nonabutting group, 24 patients
underwent only PET insertion, of whom 9 (37.5%) failed, whereas 5 patients
underwent combined PET placement and adenoidectomy, of whom 2 (40%) failed. There
was no statistical difference between these two groups (P =.92). CONCLUSION: This
study demonstrates that the position of hypertrophied adenoids may alter the
final otologic outcome of patients requiring PET insertion for OM. Patients with 
adenoids abutting the torus tubaris may benefit most from an adjuvant
adenoidectomy.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 15126745 [PubMed - indexed for MEDLINE]

1357: Laryngoscope. 2004 May;114(5):850-4.

Acute otitis externa: efficacy and tolerability of N-chlorotaurine, a novel
endogenous antiseptic agent.

Neher A, Nagl M, Appenroth E, Gstöttner M, Wischatta M, Reisigl F, Schindler M,
Ulmer H, Stephan K.

Department of Otorhinolaryngology, University Hospital of Innsbruck, Innsbruck,
Austria. Andreas.Neher@uibk.ac.at

OBJECTIVE: The study's objective was to test the tolerability and efficacy of the
endogenous antiseptic N-chlorotaurine (NCT) in comparison with a standard
clinical treatment according to a phase IIb clinical trial protocol. STUDY
DESIGN: The antimicrobial agent NCT was compared with the antibiotic component
drops Otosporin (containing neomycin, polymyxin B, and hydrocortisone) for
topical treatment of acute otitis externa in a randomized and rater-blinded
clinical study. METHODS: Fifty patients suffering from acute otitis externa were 
divided into two groups according to a randomized list. The test group was
treated with 1 mL of 1% aqueous NCT solution, the reference group with 1 mL of
Otosporin. The substances were applied to the external ear canal at one daily
session until the signs of infection disappeared. Efficacy and tolerability were 
evaluated daily by visual analogue scale and a six-step infection score. In
addition, smears were analyzed to identify the causative pathogens. RESULTS: Both
medications were equally well tolerated by the patients. The treatment was
successful for all patients of the NCT group, whereas in one patient from the
reference group, the infection did not disappear. The inflammation score improved
more rapidly in the NCT group, which resulted in an earlier termination of the
therapy. This difference became highly significant on days 4 to 7 (P <.01 each). 
Time needed for disappearance of inflammation (score 0) was 5.6 +/- 1.6 (mean +/-
SD, range 3-9) days in the NCT group and 7.4 +/- 1.6 (range 4-10) days in the
Otosporin group (P <.001). As expected, microbiologic cultures from ear swabs
revealed Pseudomonas aeruginosa (58%) followed by Staphylococcus aureus (18%) as 
the main causative pathogens. CONCLUSIONS: NCT appears to be well tolerated and
more effective than the therapy using antibiotic component drops. Because of its 
endogenous nature and its higher efficacy, NCT appears to be a good choice for
topical treatment of acute otitis externa.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15126742 [PubMed - indexed for MEDLINE]

1358: Laryngoscope. 2004 May;114(5):844-9.

Laser myringotomy versus ventilation tubes in children with otitis media with
effusion: a randomized trial.

Koopman JP, Reuchlin AG, Kummer EE, Boumans LJ, Rijntjes E, Hoeve LJ, Mulder PG, 
Blom HM.

Department of Pediatric Otolaryngology, Erasmus Medical Center, Rotterdam, The
Netherlands. j.koopman@leyenburg-ziekenhuis.nl

OBJECTIVES: Insertion of ventilation tubes in children with otitis media with
effusion (OME) is an accepted and common treatment procedure. The majority of
patients require general anesthesia. Although laser myringotomy can be performed 
in local anesthesia, evidence is lacking that this treatment modality is an
alternative for tubes, and outcome predictors for laser myringotomy are not
available. STUDY DESIGN: Prospective randomized trial. METHODS: We screened 1,403
children with chronic OME that were indicated for placement of ventilation tubes.
In the eligible patients, we performed laser myringotomy in one ear and placed a 
tube in the other ear, both within the same patient. Follow-up was scheduled each
month for 6 months. Success was defined as absence of effusion or aural
discharge. A logistic regression model was used with success of the therapy as
binary outcome. This model was based on base-line variables, asked for in a
parent's questionnaire. RESULTS: Two hundred eight children received the
allocated intervention, and no complications occurred. The mean closure time of
the laser perforation was 2.4 weeks, and the mean patency time of the ventilation
tube was 4.0 months. The mean success rate was 40% for laser and 78% for tubes.
Ten known variables were found to predict middle ear status after therapy.
CONCLUSION: Laser myringotomy is a safe but less-effective procedure than
insertion of a ventilation tube in the treatment of chronic OME. The prognostic
model enables the otolaryngologist to choose the surgical treatment for the child
that benefits most: laser myringotomy or ventilation tube.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15126741 [PubMed - indexed for MEDLINE]

1359: Laryngoscope. 2004 May;114(5):800-5.

Diagnosis and management of spontaneous cerebrospinal fluid-middle ear effusion
and otorrhea.

Brown NE, Grundfast KM, Jabre A, Megerian CA, O'Malley BW Jr, Rosenberg SI.

Department of Otolaryngology-Head and Neck Surgery, Boston University School of
Medicine and Boston Medical Center, Massachusetts 02118, USA.

OBJECTIVES/HYPOTHESIS: Spontaneous leak of cerebrospinal fluid (CSF) into the
middle ear can occur in adults without a history of temporal bone trauma or
fracture, meningitis, or any obvious cause. Therefore, clues may be lacking that 
would alert the otolaryngologist that fluid medial to an intact eardrum, or fluid
emanating from an eardrum perforation, is likely to be CSF fluid. A review of
relevant medical literature reveals that herniation of the arachnoid membrane
through a tegmen defect may be congenital, or CSF leak may occur when dynamic
factors (i.e., brain pulsations or increases in intracranial pressure) produce a 
rent in the arachnoid membrane. Because tegmen defects may be multiple rather
than single, identifying only one defect may not be sufficient for achieving
definitive repair. Data on nine cases of spontaneous CSF leak to the ear in adult
patients from four medical centers are presented and analyzed to provide
collective information about a disorder that can be difficult to diagnose and
manage. STUDY DESIGN: Retrospective review of nine cases of spontaneous CSF
middle ear effusion/otorrhea. RESULTS: The majority of patients presented with
symptoms of aural fullness and middle ear effusion. Many developed suspicious
clear otorrhea only after insertion of a tympanostomy tube. Two patients had
multiple defects in the tegmen and dura, and five patients had
meningoencephaloceles confirmed intraoperatively. Five patients underwent
combined middle cranial fossa/transmastoid repair. Materials used in repair
included temporalis fascia, free muscle graft, Oxycel cotton, calvarial bone,
pericranium, bone wax, and fibrin glue. CONCLUSIONS: CSF middle ear
effusion/otorrhea can develop in adults without a prior history of meningitis or 
head trauma or any apparent proximate cause. Although presenting symptoms can be 
subtle, early suspicion and confirmatory imaging aid in establishing the
diagnosis. Because surgical repair by way of a mastoid approach alone can be
inadequate if there are multiple tegmen defects, a middle fossa approach alone,
or in combination with a transmastoid approach, should be considered in most
cases.

Publication Types: 
    Case Reports

PMID: 15126733 [PubMed - indexed for MEDLINE]

1360: Int J Pediatr Otorhinolaryngol. 2004 Jun;68(6):795-804.

Racial/ethnic disparities in the diagnosis of otitis media in infancy.

Vernacchio L, Lesko SM, Vezina RM, Corwin MJ, Hunt CE, Hoffman HJ, Mitchell AA.

Slone Epidemiology Center, Boston University, 1010 Commonwealth Avenue, Boston,
MA 02215, USA. lvernacchio@slone.bu.edu

OBJECTIVE: Otitis media (OM) is an extremely common pediatric diagnosis. Several 
risk factors have been associated with OM, but the relationship between OM and
race/ethnicity remains controversial. We sought to define the relationship
between OM diagnosis and race/ethnicity in infants. METHODS: By multivariable
logistic regression, we evaluated the association between OM diagnosis and
race/ethnicity in 11,349 non-low-birthweight infants who were participants in a
prospective cohort study of infant care practices. RESULTS: As in previous
studies, breastfeeding was associated with a decreased risk of OM diagnosis while
other factors were independently associated with a substantially increased risk
of OM diagnosis: out-of-home daycare, multiple children living in the home, and
mother's multiparity. Daycare was associated with a "dose effect" in that the
risk of OM diagnosis increased with an increasing number of children in the
daycare. While the crude analysis suggested little relation of OM diagnosis and
race/ethnicity, the association was confounded by several covariates including
maternal marital status, number of children living in the home, breastfeeding
status, and maternal age. After adjustment for relevant confounders, Black (OR
0.74; 95% CI 0.61-0.89) and Asian infants (OR 0.77; 95% CI 0.57-1.0]) were less
likely to be diagnosed with OM than White infants. CONCLUSIONS: This large
prospective study confirms previous risk factors for OM and demonstrates a strong
"dose effect" of the size of daycare centers on OM. The study also demonstrates
that the association between race/ethnicity and OM diagnosis is confounded by
social factors. After adjusting for such factors, Black and Asian infants are
less likely to be diagnosed with OM than White infants. The reason for this
racial disparity remains unknown.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15126021 [PubMed - indexed for MEDLINE]

1361: Int J Pediatr Otorhinolaryngol. 2004 Jun;68(6):759-65.

Bacteriology of medically refractory acute otitis media in children: a 9-year
retrospective study.

Shiao AS, Guo YC, Hsieh ST, Tsai TL.

Department of Otolaryngology, Taipei Veterans General Hospital, National
Yang-Ming University School of Medicine, Taipei 112, Taiwan. ycguo@pchome.com.tw

OBJECTIVE: To identify the causative organisms for medically refractory acute
otitis media (AOM) in children, and to recommend the appropriate antibiotics for 
these patients. STUDY DESIGN: Retrospective chart review. METHODS: The medical
records for 671 children (1258 ears) undergoing myringotomies between January
1993 and December 2001 were retrospectively reviewed. "Medically refractory" AOM 
is defined as AOM requiring emergency myringotomy because of toxicity persisting 
despite second-phase antibiotics. Of these, 18 children were enrolled in our
study, with 25 of the ears affected by medically refractory AOM. Myringotomy was 
performed for pus drainage, bacterial culture and susceptibility studies in all
cases. Clinical factors were analyzed to demonstrate possible relationships with 
microbiological findings. RESULTS: Bacteria were recovered in specimens taken
from 12 ears. The positive culture rate was 48%. Bacteriological studies showed
mostly growing gram-positive bacteria, such as coagulase negative staphylococcus,
Staphylococcus aureus and Streptococcus pneumoniae (in decreasing order of
incidence). The sensitivity rate to pre-myringotomy antibiotics was 85.7%. With
the exception of Pseudomonas aeruginosa and two ears with intracranial
complications or pneumonia, all other isolated microorganisms were susceptible to
first-generation cephalosporins. No statistically significant differences were
noted between culture rates and clinical factors. CONCLUSION: The distribution of
organisms in our medically refractory AOM cases differed from that for simple
AOM, with gram-positive bacteria having significantly higher rates of incidence. 
Combining intravenous aminoglycoside with first-generation cephalosporin is
considered an inexpensive and effective treatment covering all potential
microorganisms. Vancomycin or third-generation cephalosporins are only needed for
major complications or other coincident infections extant during the initial
presentation.

PMID: 15126016 [PubMed - indexed for MEDLINE]

1362: BMC Infect Dis. 2004 May 5;4:12.

Antimicrobial activity of innate immune molecules against Streptococcus
pneumoniae, Moraxella catarrhalis and nontypeable Haemophilus influenzae.

Lee HY, Andalibi A, Webster P, Moon SK, Teufert K, Kang SH, Li JD, Nagura M, Ganz
T, Lim DJ.

The Gonda Department of Cell and Molecular Biology, House Ear Institute, Los
Angeles, California 90057, USA. hlee@hei.org

BACKGROUND: Despite its direct connection to the nasopharynx which harbors otitis
media pathogens as part of its normal flora, the middle ear cavity is kept free
of these bacteria by as yet unknown mechanisms. Respiratory mucosal epithelia,
including those of the middle ear and eustachian tube, secrete antimicrobial
effectors including lysozyme, lactoferrin and beta defensins-1 and -2. To
elucidate the role of these innate immune molecules in the normal defense and
maintenance of sterility of respiratory mucosa such as that of the middle ear, we
assessed their effect on the respiratory pathogens nontypeable Haemophilus
influenzae (NTHi) 12, Moraxella catarrhalis 035E, and Streptococcus pneumoniae 3,
and 6B. METHODS: Two assay methods, the radial assay and the liquid broth assay, 
were employed for testing the antimicrobial activity of the molecules. This was
done in order to minimize the possibility that the observed effects were
artifacts of any single assay system employed. Also, transmission electron
microscopy (TEM) was employed to evaluate the effect of antimicrobial innate
immune molecules on OM pathogens. For the statistical analysis of the data,
Student's t-test was performed. RESULTS: Results of the radial diffusion assay
showed that beta defensin-2 was active against all four OM pathogens tested,
while treatment with beta defensin-1 appeared to only affect M. catarrhalis. The 
radial assay results also showed that lysozyme was quite effective against S.
pneumoniae 3 and 6B and was partially bacteriostatic/bactericidal against M.
catarrhalis. Lysozyme however, appeared not to affect the growth of NTHi. Thus,
lysozyme seems to have a more pronounced impact on the growth of the
Gram-positive S. pneumoniae as compared to that of Gram-negative pathogens.
Lactoferrin on the other hand, enhanced the growth of the bacteria tested. The
results of the radial assays were confirmed using liquid broth assays for
antimicrobial activity, and showed that lysozyme and beta defensin-2 could act
synergistically against S. pneumoniae 6B. Moreover, in the liquid broth assay,
beta defensin-1 showed a modest inhibitory effect on the growth of S. pneumoniae 
6B. As assessed by ultrastructural analysis, lysozyme and beta defensin-2, and to
a much lesser extent, beta defensin-1, appeared to be able to cause damage to the
bacterial membranes. CONCLUSIONS: Here we report that lysozyme and the beta
defensins can inhibit the growth of clinical isolates of otitis media pathogens -
namely NTHi strain 12, S. pneumoniae strains 3 and 6B and M. catarrhalis strain
035E - and cause ultrastructural damage to these pathogens. Moreover, we
demonstrate that lysozyme and beta defensin-2 can act synergistically against S. 
pneumoniae. These findings are consistent with the concept that secreted
antimicrobial peptides and other components of innate immunity constitute the
first line of defense protecting host mucosal surfaces, including the
tubotympanal (eustachian tube and middle ear cavity) mucosa, against pathogens.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15125783 [PubMed - indexed for MEDLINE]

1363: Med Biol Eng Comput. 2004 Mar;42(2):245-52.

Fibre-optic array for curvature assessment: application in otitis diagnosis.

Sundberg M, Borga M, Knutsson H, Johansson A, Strömberg T, Oberg PA.

Department of Biomedical Engineering, Linköping University, Linköping, Sweden.
miksu@imt.liu.se

A contact-free sensor consisting of two parallel optical-fibre arrays was
designed to assess surface shapes of diffusely scattering media. By sequentially 
illuminating objects using one fibre array and detecting the diffusely
back-scattered photons by the other, a source-detector intensity matrix was
formed, where the matrix element (i, j) was the intensity at detector j when
light source i was excited. Experimental data from convex and concave polyacetal 
plastic surfaces were recorded. A mathematical model was used for simulating
source-detector intensity matrices for the surfaces analysed in the experiments. 
Experimental results from the system were compared with the theoretically
expected results provided by the mathematical model. The shape and relative
amplitude showed similar behaviour in the experiments and simulations. A
convex/concave discriminator index D, representing the detected intensity
difference between two source-detector separations, was defined. The relative
dynamic range of D, defined as the difference between the maximum and the minimum
divided by the mean of the index, was 1.37 for convex surfaces and 0.68 for
concave surfaces, at a measuring distance of 4.5 mm. The index D was positive for
convex surfaces and negative for concave surfaces, which showed that the system
could distinguish between convex and concave surfaces, an important result for
the diagnosis of otitis media.

PMID: 15125156 [PubMed - indexed for MEDLINE]

1364: Am J Otolaryngol. 2004 May-Jun;25(3):208-12.

Facial palsy and Wegener's granulomatosis.

Drinias V, Florentzson R.

Ear, Nose, and Throat Department, Ryhov Hopsital, Jönköping, Sweden.
billsof@otenet.gr

Facial palsy can occur as a result of various pathological processes, which are
not always amenable to early diagnosis. This article is a case presentation of a 
patient with facial palsy, after an acute otitis media manifestation, as a first 
symptom of Wegener's granulomatosis. The clues leading to diagnosis consist of
the practitioner's clinical suspicion of the disease, the use of the appropriate 
serological measurements (c-antineutrophil cytoplasmic autoantibody), and the
histological confirmation. The early initiation of treatment leads to high rates 
of remission of an otherwise lethal disease.

Publication Types: 
    Case Reports

PMID: 15124173 [PubMed - indexed for MEDLINE]

1365: Am J Otolaryngol. 2004 May-Jun;25(3):190-4.

Paraganglioma presenting as chronic otitis media with cholesteatoma: pitfalls and
strategies.

Hsu JL, Hwang CF, Kao YF, Lui CC, Lin JW, Peng JP.

Department of Otolaryngology, Chang Gung University, Chang Gung Memorial
Hospital, Kaohsiung Medical Center, Japan.

The coexistence of paraganglioma with cholesteatoma is a very rare clinical
disorder. The clinical presentations are nonspecific. There may be radiological
characteristics of either cholesteatoma or paraganglioma in the middle ear area, 
but the diagnosis of the coexistence of the 2 is usually made only
postoperatively. Here is such a case that is made more interesting not only
because it initially presented with conductive hearing loss but also because the 
clinical picture mimicked chronic otitis media. The patient underwent
postauricular tympanomastoidectomy with extended facial recess approach to remove
the tumor. No evidence of recurrence and complications were noted.

Publication Types: 
    Case Reports

PMID: 15124169 [PubMed - indexed for MEDLINE]

1366: Pediatrics. 2004 May;113(5):1451-65.

Comment in:
    Pediatrics. 2004 Sep;114(3):898-9; author reply 898-9.    Pediatrics. 2005 Feb;115(2):513; author reply 513-4.    Pediatrics. 2005 May;115(5):1443-4; author reply 1444-5.

Diagnosis and management of acute otitis media.

American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media.

This evidence-based clinical practice guideline provides recommendations to
primary care clinicians for the management of children from 2 months through 12
years of age with uncomplicated acute otitis media (AOM). The American Academy of
Pediatrics and American Academy of Family Physicians convened a committee
composed of primary care physicians and experts in the fields of otolaryngology, 
epidemiology, and infectious disease. The subcommittee partnered with the Agency 
for Healthcare Research and Quality and the Southern California Evidence-Based
Practice Center to develop a comprehensive review of the evidence-based
literature related to AOM. The resulting evidence report and other sources of
data were used to formulate the practice guideline recommendations. The focus of 
this practice guideline is the appropriate diagnosis and initial treatment of a
child presenting with AOM. The guideline provides a specific definition of AOM.
It addresses pain management, initial observation versus antibacterial treatment,
appropriate choices of antibacterials, and preventive measures. Decisions were
made based on a systematic grading of the quality of evidence and strength of
recommendations, as well as expert consensus when definitive data were not
available. The practice guideline underwent comprehensive peer review before
formal approval by the partnering organizations. This clinical practice guideline
is not intended as a sole source of guidance in the management of children with
AOM. Rather, it is intended to assist primary care clinicians by providing a
framework for clinical decision-making. It is not intended to replace clinical
judgment or establish a protocol for all children with this condition. These
recommendations may not provide the only appropriate approach to the management
of this problem.

Publication Types: 
    Guideline
    Practice Guideline
    Review

PMID: 15121972 [PubMed - indexed for MEDLINE]

1367: Pediatrics. 2004 May;113(5):1412-29.

Otitis media with effusion.

American Academy of Family Physicians; American Academy of Otolaryngology-Head
and Neck Surgery; American Academy of Pediatrics Subcommittee on Otitis Media
With Effusion.

The clinical practice guideline on otitis media with effusion (OME) provides
evidence-based recommendations on diagnosing and managing OME in children. This
is an update of the 1994 clinical practice guideline "Otitis Media With Effusion 
in Young Children," which was developed by the Agency for Healthcare Policy and
Research (now the Agency for Healthcare Research and Quality). In contrast to the
earlier guideline, which was limited to children 1 to 3 years old with no
craniofacial or neurologic abnormalities or sensory deficits, the updated
guideline applies to children aged 2 months through 12 years with or without
developmental disabilities or underlying conditions that predispose to OME and
its sequelae. The American Academy of Pediatrics, American Academy of Family
Physicians, and American Academy of Otolaryngology-Head and Neck Surgery selected
a subcommittee composed of experts in the fields of primary care, otolaryngology,
infectious diseases, epidemiology, hearing, speech and language, and
advanced-practice nursing to revise the OME guideline. The subcommittee made a
strong recommendation that clinicians use pneumatic otoscopy as the primary
diagnostic method and distinguish OME from acute otitis media. The subcommittee
made recommendations that clinicians should 1) document the laterality, duration 
of effusion, and presence and severity of associated symptoms at each assessment 
of the child with OME, 2) distinguish the child with OME who is at risk for
speech, language, or learning problems from other children with OME and more
promptly evaluate hearing, speech, language, and need for intervention in
children at risk, and 3) manage the child with OME who is not at risk with
watchful waiting for 3 months from the date of effusion onset (if known) or
diagnosis (if onset is unknown). The subcommittee also made recommendations that 
4) hearing testing be conducted when OME persists for 3 months or longer or at
any time that language delay, learning problems, or a significant hearing loss is
suspected in a child with OME, 5) children with persistent OME who are not at
risk should be reexamined at 3- to 6-month intervals until the effusion is no
longer present, significant hearing loss is identified, or structural
abnormalities of the eardrum or middle ear are suspected, and 6) when a child
becomes a surgical candidate (tympanostomy tube insertion is the preferred
initial procedure). Adenoidectomy should not be performed unless a distinct
indication exists (nasal obstruction, chronic adenoiditis); repeat surgery
consists of adenoidectomy plus myringotomy with or without tube insertion.
Tonsillectomy alone or myringotomy alone should not be used to treat OME. The
subcommittee made negative recommendations that 1) population-based screening
programs for OME not be performed in healthy, asymptomatic children, and 2)
because antihistamines and decongestants are ineffective for OME, they should not
be used for treatment; antimicrobials and corticosteroids do not have long-term
efficacy and should not be used for routine management. The subcommittee gave as 
options that 1) tympanometry can be used to confirm the diagnosis of OME and 2)
when children with OME are referred by the primary clinician for evaluation by an
otolaryngologist, audiologist, or speech-language pathologist, the referring
clinician should document the effusion duration and specific reason for referral 
(evaluation, surgery) and provide additional relevant information such as history
of acute otitis media and developmental status of the child. The subcommittee
made no recommendations for 1) complementary and alternative medicine as a
treatment for OME, based on a lack of scientific evidence documenting efficacy,
or 2) allergy management as a treatment for OME, based on insufficient evidence
of therapeutic efficacy or a causal relationship between allergy and OME. Last,
the panel compiled a list of research needs based on limitations of the evidence 
reviewed. The purpose of this guideline is to inform clinicians of evidence-based
methods to identify, monitor, and manage OME in children aged 2 months through 12
years. The guideline may not apply to children more than 12 years old, because
OME is uncommon and the natural history is likely to differ from younger children
who experience rapid developmental change. The target population includes
children with or without developmental disabilities or underlying conditions that
predispose to OME and its sequelae. The guideline is intended for use by
providers of health care to children, including primary care and specialist
physicians, nurses and nurse practitioners, physician assistants, audiologists,
speech-language pathologists, and child-development specialists. The guideline is
applicable to any setting in which children with OME would be identified,
monitored, or managed. This guideline is not intended as a sole source of
guidance in evaluating children with OME. Rather, it is designed to assist
primary care and other clinicians by providing an evidence-based framework for
decision-making strategies. It is not intended to replace clinical judgment or
establish a protocol for all children with this condition and may not provide the
only appropriate approach to diagnosing and managing this problem.

Publication Types: 
    Guideline
    Practice Guideline
    Review

PMID: 15121966 [PubMed - indexed for MEDLINE]

1368: Pediatrics. 2004 May;113(5):1352-6.

Initial and follow-up costs by treatment outcome for children with respiratory
infections.

Howard DH, McGowan JE Jr.

Department of Health Policy and Management, Rollins School of Public Health,
Emory University, Atlanta, Georgia 30322, USA. dhhowar@emory.edu

OBJECTIVE: To estimate the initial and follow-up costs of treatment of
respiratory infections among pediatric patients and the relationship between
costs and outcomes. METHODS: A total of 3677 episodes of care from 2328 patients 
who were <17 years of age and had respiratory or ear infections that were treated
with an antibiotic initially. The sample was drawn from the Medical Expenditure
Panel Surveys for the years 1996 through 1999. Treatment failure was defined as
the receipt of a second antibiotic, different from the first, in a 4-week window.
We compared follow-up costs by outcome (treatment failure vs success) using a
2-part model of medical costs. We also performed a paired analysis by selecting 2
episodes, one in which the outcome was failure and the other in which the outcome
was success, for patients with at least 1 of each type and computing the
difference in costs. RESULTS: Follow-up costs for provider visits for episodes
for which the patient experienced treatment failure were 216 dollars versus 53
dollars for episodes for which the patient did not experience treatment failure. 
Follow-up drug costs, including the cost of the second antibiotic, were 75
dollars for children who experienced treatment failure versus 23 dollars,
respectively. Cost estimates from the paired analysis were similar, confirming
that results are not biased by unobserved time-invariant patient characteristics.
CONCLUSION: Children who have respiratory infections and experience treatment
failure incur substantially higher costs.

PMID: 15121953 [PubMed - indexed for MEDLINE]

1369: Auris Nasus Larynx. 2004 Jun;31(2):155-9.

Hypertrophic chronic pachymeningitis associated with chronic otitis media and
mastoiditis.

Kanzaki S, Inoue Y, Watabe T, Ogawa K.

Department of Otolaryngology, Head and Neck Surgery, Keio University Hospital, 35
Shinanomachi, Shinjuku, Tokyo 160-0082, Japan. skan@sc.itc.keio.ac.jp

We describe the case history of a 70-year-old female patient presenting with
bilateral hearing disturbance, facial paralysis, and vertigo. Radiological tests 
of temporal bone revealed soft tissue in the mastoid and tympanic cavities, and
T1 weighted MRI revealed prominent Gd enhancement of the middle skull basal
meninges. Middle ear inflammation appeared to induce pachymeningitis and to
exacerbate associated symptoms, leading to a decline in the patient's overall
condition. Bilateral mastoidectomies were effective in improving her general
condition. Her hearing improved only on the right side because ossiculoplasty was
performed only on that side. Her facial movement progressively improved and
pachymeningitis diminished over time. We speculate that removal of the infectious
granulation within the middle ears and mastoids ameliorated the acute
inflammation. The etiology remains unknown in this case.

Publication Types: 
    Case Reports

PMID: 15121225 [PubMed - indexed for MEDLINE]

1370: Res Vet Sci. 2004 Aug;77(1):67-71.

In vitro antimicrobial activity of orbifloxacin against Staphylococcus
intermedius isolates from canine skin and ear infections.

Ganière JP, Médaille C, Etoré F.

Unité de Pathologie Infectieuse, Ecole Nationale Vétérinaire, Route de Gachet, BP
40706, 44307 Nantes 03, France. ganiere@vet-nantes.fr

The objective of the study was to evaluate the in vitro activity of orbifloxacin 
against Staphylococcus intermedius strains isolated in France from canine skin
and ear infections. The minimum inhibitory concentrations (MICs) of orbifloxacin 
against 240 field S. intermedius isolates (69 skin and 171 ear isolates) ranged
from 0.016 to 8 mg l(-1), with MIC50 and MIC90 equal to 0.5 and 1 mg l(-1),
respectively. Only one strain, a pyoderma isolate was resistant (MIC=8 mg l(-1)).
Orbifloxacin was tested at different concentrations for killing rate against five
isolates obtained from pyoderma cases and against a reference strain
(Staphylococcus aureus ATCC 29213). Orbifloxacin expressed a
concentration-dependent bactericidal activity against the S. aureus reference
strain, but a time-dependent bactericidal activity against S. intermedius.
Orbifloxacin induced bactericidal effect against the S. intermedius strains
tested with concentrations equal to or two times MIC.

PMID: 15120955 [PubMed - indexed for MEDLINE]

1371: Eur J Pediatr. 2004 Jul;163(7):364-8. Epub 2004 Apr 30.

Serotype distribution and antimicrobial susceptibility of Streptococcus
pneumoniae causing invasive infections and acute otitis media in children.

Zissis NP, Syriopoulou V, Kafetzis D, Daikos GL, Tsilimingaki A, Galanakis E,
Tsangaropoulou I.

Medical Department, Wyeth Hellas, Athens, Greece.

A prospective study was conducted to determine the serotypes and antibiotic
resistance patterns of pneumococcal isolates from children with invasive
pneumococcal disease (IPD) and acute otitis media (AOM). From October 2001 to May
2002, 65 children with IPD (28 bacteraemic pneumonia, 24 bacteraemia without
focus, 7 meningitis, 6 other infections) and 78 with AOM were identified. The
most common serotypes causing IPD were 14 (32.3%), 6B (20.0%), 1 (18.5%) and 19F 
(7.7%) whereas the predominant serotypes causing AOM were 19F (35.9%), 14 (16.7%)
and 23F (9.1%). Sixty-nine percent of IPD and 70.5% of AOM were caused by vaccine
serotypes. The vaccine serotypes were more commonly encountered in meningitis
cases and in children younger than 2 years of age. Intermediate resistance to
penicillin was observed in 6 of 65 (9.2%) IPD isolates, one of which was
intermediately resistant to cefotaxime (1.6%), whereas none exhibited high-level 
resistance to penicillin or other beta-lactam antibiotics. A higher proportion of
antimicrobial resistance was noted in AOM isolates; 29 of 78 (37.4%) exhibited
intermediate resistance and 8 (10.2%) high level resistance to penicillin, four
of which had intermediate resistance to cefotaxime. Significant resistance was
also noted to erythromycin; 38.5% of IPD and 48.7% of AOM isolates were
resistant. Multidrug resistance was observed in one IPD and in eight AOM
isolates. CONCLUSION: these findings have implications in the potential use of
7-valent conjugate vaccine in our region. Copyright 2004 Springer-Verlag

PMID: 15118910 [PubMed - indexed for MEDLINE]

1372: J Laryngol Otol. 2004 Apr;118(4):260-2.

Microbiology of cerumen in patients with recurrent otitis externa and cases with 
open mastoidectomy cavities.

Pata YS, Oztürk C, Akbaş Y, Unal M, Görür K, Ozcan C.

Department of Otorhinolaryngology, University of Mersin Faculty of Medicine,
Mersin, Turkey. yavuzpata@hotmail.com

This study investigated the common flora of human cerumen in patients with
recurrent otitis externa, and subjects who had been operated on and had an open
mastoidectomy cavity from chronic otitis media. Cerumen samples were collected
from three groups; group A (n = 20) consisted of patients with recurrent otitis
externa, group B (n = 20) consisted of patients with an open cavity and group C
(n = 30) consisted of healthy subjects. The mean of the microbial count was 3.4 x
10(4) in group A, 3.08 x 10(4) in group B and 2.48 x 10(4) in group C. The most
commonly isolated microorganism from the three groups was Staphylococcus
epidermidis. No growth was observed in five cases (25 per cent) in group A and in
three cases (10 per cent) in group C. In group B antimicrobial growth was
observed in all samples. In 46 (65 per cent) of the cerumen samples, the isolates
were monomicrobial and 24 (35 per cent) of the cerumen samples were
polymicrobial. The isolates were polymicrobial in 65 per cent of group A, 20 per 
cent in group B and 23.3 per cent in group C. In the process of investigating the
microbial flora of cerumen in all the three groups, microbial growth was observed
from all the samples from patients with an open cavity, unlike the other groups, 
and it was determined that the group with recurrent external otitis had the most 
abundant microbial flora.

PMID: 15117461 [PubMed - indexed for MEDLINE]

1373: Trop Doct. 2004 Apr;34(2):102-4.

Bacteriological profile in chronic suppurative otitis media in Eastern Nepal.

Sharma S, Rehan HS, Goyal A, Jha AK, Upadhyaya S, Mishra SC.

Department of Otorhinolaryngology, B.P. Koirala Institute of Health Sciences,
Dharan, Nepal, India.

Aural swabs were collected from 250 patients with chronic suppurative otitis
media (CSOM) (tubotympanic disease). Duration of ear discharge was more than 6
months for culture and sensitivity test. The disease was unilateral in 178
(71.2%) and bilateral in 72 (28.8%) patients. From a total of 322 aural swab
cultures, 324 organisms were isolated with predominance of Pseudomonas aerugimosa
(36.4%) followed by Staphylococcus aureus (30.2%). All the isolated Gram-negative
organisms showed in vitro sensitivity to ciprofloxacin, amikacin, ofloxacin, and 
gentamycin whereas cloxacillin, ofloxacin, erythromycin, ciprofloxacin,
gentamicin and tetracycline were more effective against Gram-positive isolates.
Most isolates were resistant to amoxycillin. It is concluded that ciprofloxacin
is preferred to aminoglycosides as an important tool in the treatment of CSOM
because of its lower cost, lack of ototoxicity and availability as topical oral
preparations.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 15117142 [PubMed - indexed for MEDLINE]

1374: South Med J. 2004 Apr;97(4):416-8.

Otogenic Fusobacterium meningitis, sepsis, and mastoiditis in an adolescent.

Morrison A, Weir I, Silber T.

Department of Internal Medicine, College of Osteopathic Medicine, Nova
Southeastern University, 3200 S. University Drive, Fort Lauderdale, FL 33328,
USA. amorriso@nova.edu

Fusobacterium necrophorum is a strict anaerobic organism responsible for a number
of clinical syndromes known as necrobacillosis. Although meningeal infections
with anaerobes are rare, delayed diagnosis and treatment can be potentially
fatal. We report a unique case of Fusobacterium meningitis, mastoiditis, and
sepsis in a previously healthy adolescent. Diagnosis and management of this
condition are discussed in the context of a literature review.

Publication Types: 
    Case Reports
    Review

PMID: 15108842 [PubMed - indexed for MEDLINE]

1375: Indian J Pediatr. 2004 Apr;71(4):319-24.

Efficacy and tolerability assessment of cefprozil in children with acute otitis
media.

Gupta N, Bagga V, Parmar BJ, Kar K, Mukherjee A, Mehta S, Moharana AK.

Department of Pediatrics, Batra Hospital & Research Centre, New Delhi, India.

Young children contract as many as six to eight upper respiratory tract viral
infections per year, and these infections frequently lead to secondary bacterial 
infections such as acute otitis media and sinusitis. Cefprozil is an orally
active third generation cephalosporin which has demonstrated activity against the
gram-positive organisms Streptococcus pyogenes, pneumoniae and agalactiae and
against methicilin-susceptible Staphylococcus aureus. Cefprozil is also active
against various gram-ves and certain anaerobic organisms, and is stable to
hydrolysis by a number of b-lactamases. Present study is an effort to study the
efficacy and safety of cefprozil in children with acute otitis media. Three
hundred and thirty four children aged 6 months through 12 years with clinical
symptoms and tympanic membrane signs of AOM received cefprozil 30 mg/kg/day in
two divided doses per day for 10 days. Clinically, 96.6% patients were cured,
2.4% improved and there was failure of therapy in 1% of the patients. There was
no need for any rescue medication and any change in antibiotic in any patient. A 
satisfactory bacteriological outcome was (i.e. cure, presumed cure, and cure plus
reinfection with a different pathogen) was achieved in 95% of patients. In
conclusion, cefprozil is a well tolerated and effective drug for acute otitis
media in children. Moreover, its expanded spectrum of activity, ability to
achieve adequate concentrations in tissues, suitability for twice-daily dosing,
and proven tolerability suggest that it is a better alternative to agents
conventionally used in acute otitis media.

Publication Types: 
    Clinical Trial
    Multicenter Study

PMID: 15107512 [PubMed - indexed for MEDLINE]

1376: Int Tinnitus J. 2003;9(2):87-91.

Interrelations between the middle and inner ear in otitis media.

Penha R, Escada P.

Department of Otolaryngology, New University of Lisbon, Lisbon, Portugal.
np46ab@mail.telepac.pt

This article reviews the importance of the round-window membrane in exposing the 
labyrinth to or protecting it from the toxic effects of otitis media.
Characteristics of the immune system in the human middle ear and middle-ear
mechanisms against bacteria are explained. The role of bacteria and bacterial
products in inner-ear damage is detailed, and related pathological events are
described. The hypothetical role of inflammatory mediators in bacteria-induced
inner-ear toxicity is particularly emphasized. Clinical conditions causing these 
events are detailed, and the most frequently involved microorganisms are
mentioned. Finally, round-window membrane macroscopic and microscopic anatomy is 
discussed, and considerations about the exact role of membrane
inflammation--protection versus damage of the inner ear--are expressed.

Publication Types: 
    Review

PMID: 15106280 [PubMed - indexed for MEDLINE]

1377: Int J Epidemiol. 2004 Jun;33(3):573-8. Epub 2004 Apr 22.

Household wood and charcoal smoke increases risk of otitis media in childhood in 
Maputo.

da Costa JL, Navarro A, Neves JB, Martin M.

Department of Community Health, Faculdade de Medicina UEM, Maputo, Mozambique.

BACKGROUND: This study examined the association of otitis media in children <6
years old and the exposure to wood and charcoal smoke, as well as to other risk
factors, in Maputo. METHODS: Case-control study. In all 750 children matched by
sex and age were enrolled in a hospital-community study. Cases were gathered from
among children visiting the Central Hospital of Maputo with otitis media and
controls were recruited in the same village as the cases. Conditional logistic
regression was performed to evaluate, simultaneously, the effect of each risk
factor. RESULTS: Cases were more likely to have been exposed to tobacco smoke (OR
= 1.51), to wood (OR = 1.85) and charcoal (OR = 1.50) household smoke, to short
term breastfeeding (OR = 1.47), and to live in overcrowded conditions (OR =
1.49). Multivariate analysis stratified by age groups (younger and older than 2
years) showed that cases were more likely to be exposed to wood and charcoal
smoke than controls, regardless of age. Among children aged >2 years, Eustachian 
tube dysfunction was evident (OR = 3.06) particularly in those living in less
overcrowded conditions. CONCLUSIONS: Findings of this study are consistent with
earlier studies that have reported an association between parental smoking, short
duration of breastfeeding, and Eustachian tube dysfunction. The association with 
wood and charcoal smoke indicates that there is a need to educate people
regarding the avoidance of exposing their children to this environmental hazard.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15105407 [PubMed - indexed for MEDLINE]

1378: Infect Immun. 2004 May;72(5):3002-10.

Partial analysis of the genomes of two nontypeable Haemophilus influenzae otitis 
media isolates.

Munson RS Jr, Harrison A, Gillaspy A, Ray WC, Carson M, Armbruster D, Gipson J,
Gipson M, Johnson L, Lewis L, Dyer DW, Bakaletz LO.

Center for Microbial Pathogenesis, Columbus Children's Research Institute and The
Department of Pediatrics, The Ohio State University, Columbus, Ohio 43205, USA.
munsonr@pediatrics.ohio-state.edu

In 1995, The Institute for Genomic Research completed the genomic sequence of a
rough derivative of Haemophilus influenzae serotype d, strain KW20. This
sequence, though extremely useful in understanding the basic biology of H.
influenzae, has yet to provide significant insight into our understanding of
disease caused by nontypeable H. influenzae (NTHI), because serotype d strains
are not generally pathogens. In contrast, NTHI strains are frequently mucosal
pathogens and are the primary pathogens of chronic otitis media as well as a
significant cause of acute otitis media in children. Thus, it is of great
importance to further understand their biology. We used a DNA-based microarray
approach to identify genes present in a clinical isolate of NTHI that were absent
from strain Rd. We also sequenced the genome of a second NTHI isolate from a
child with chronic otitis media to threefold coverage and then used an array of
bioinformatics tools to identify genes present in this NTHI strain but absent
from strain Rd. These methods were complementary in approach and results. We
identified, in both strains, homologues of H. influenzae lav, an autotransported 
protein of unknown function; tnaA, which encodes tryptophanase; as well as a
homologue of Pasteurella multocida tsaA, which encodes an alkyl peroxidase that
may play a role in protection against reactive oxygen species. We also identified
a number of putative restriction-modification systems, bacteriophage genes and
transposon-related genes. These data provide new insight that complements and
extends our ongoing analysis of NTHI virulence determinants.

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 15102813 [PubMed - indexed for MEDLINE]

1379: Otolaryngol Head Neck Surg. 2004 Apr;130(4):430-6.

Hearing loss with semicircular canal fistula in exotoxin A-deficient Pseudomonas 
otitis media.

Yunus TM, Molina RM, Prevatt AR, Gajewski BJ, Sedwick JD, Antonelli PJ.

Department of Otolaryngology,University of Florida, Gainseville, FL 32610-0264,
USA.

OBJECTIVE: The study goal was to compare the severity of hearing loss with
semicircular canal injury in the presence of otitis media (OM) due to an exotoxin
A-producing strain of Pseudomonas aeruginosa (PA+) and an exotoxin A-deficient
daughter strain (PA-). METHODS: PA+ or PA- was injected bilaterally into guinea
pig ears. Three days later, unilateral lateral semicircular canal transection was
performed. Hearing was tested before and after transection. RESULTS: PA OM was
induced in all injected ears. Significant elevation of click and 12-kHz
thresholds (P < 0.0001) were encountered in PA+-infected ears. No significant
threshold elevations were encountered in PA--infected ears. CONCLUSION: Hearing
loss resulting from canal injury in the presence of Pseudomonas OM may be
mediated by exotoxin A. SIGNIFICANCE: Treatment to neutralize the effects of
exotoxin A may minimize the risk of hearing loss with canal fistula in chronic
OM.

Publication Types: 
    Comparative Study

PMID: 15100639 [PubMed - indexed for MEDLINE]

1380: Otolaryngol Head Neck Surg. 2004 Apr;130(4):418-25.

Decreased ataxia and improved balance after vestibular rehabilitation.

Cohen HS, Kimball KT.

Department of Otolaryngology and Communicative Sciences, Baylor College of
Medicine, Houston, TX 77030, USA. hcohen@bcm.tmc.edu

OBJECTIVES: To determine the effects of vestibular rehabilitation on gait ataxia 
and balance. SETTING: Tertiary care center.Study design Subjects were patients
with chronic vertigo due to peripheral vestibular impairments, referred for
vestibular rehabilitation. They were assessed on the Timed Up and Go test, ataxia
during a path integration test, computerized dynamic posturography, level of
vertigo, independence in activities of daily living, and psychological locus of
control. They were randomly assigned to three home program treatment groups.
RESULTS: Ataxia decreased significantly, and posturography scores and time to
perform Timed Up and Go improved significantly, for all subjects. Improvements
were significantly related to scores on the ambulation subtest of the Vestibular 
Disorders Activities of Daily Living Scale, decreases in vertigo, and increases
in locus of control. CONCLUSIONS: For many patients, a simple home program of
vestibular habituation head movement exercises is related to reduced symptoms of 
imbalance during stance and gait.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

PMID: 15100637 [PubMed - indexed for MEDLINE]

1381: Clin Pediatr (Phila). 2004 Apr;43(3):261-7.

Acute mastoiditis in children: epidemiologic, clinical, microbiologic, and
therapeutic aspects over past years.

Nussinovitch M, Yoeli R, Elishkevitz K, Varsano I.

Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah 
Tikva and Sackler School of Medicine, Tel Aviv University, Israel.

Recent studies have indicated possible changes in the incidence of acute
mastoiditis. A retrospective review of children discharged with a diagnosis of
acute mastoiditis was undertaken to describe the epidemiology, clinical
presentation, microbiology, and treatment of acute mastoiditis over past years.
Demographic historic, clinical, and laboratory data were collected. Eighty-six
children (88 episodes of acute mastoiditis) were identified (1 month-16 years)
(median 3.3 years). Almost half had a history of middle ear disease; 8% recurrent
episodes and 68.2% received antibiotics preadmission, 91.2% for acute otitis
media. Bacterial etiology was established in 43 patients (68.2% isolation rate). 
Pseudomonas aeruginosa and Streptococcus pneumoniae were the most frequently
isolated agents. This review showed a significant increase (150%) in the number
of patients with acute mastoiditis.

PMID: 15094950 [PubMed - indexed for MEDLINE]

1382: Laryngoscope. 2004 Mar;114(3):490-4.

Long-term results of Armstrong beveled grommet tympanostomy tubes in children.

Lindstrom DR, Reuben B, Jacobson K, Flanary VA, Kerschner JE.

Division of Pediatric Otolaryngology, Children's Hospital of Wisconsin and the
Medical College of Wisconsin, Milwaukee, WI 53226-0099, USA.

OBJECTIVE: Many different tympanostomy tubes have been developed with different
sizes, shapes, compositions, and coatings. Despite the frequency of ventilation
tube placement, very few large studies have examined the outcomes of patients
receiving this procedure. An ideal tube would be easy to insert and would extrude
at a predictable interval without complications. This study was performed to
assess outcome measures and complication rates of the Armstrong beveled grommet
tube. DESIGN: A retrospective case series of patients who had Armstrong beveled
grommet tympanostomy tubes placed over a 3 year period by two Children's Hospital
of Wisconsin pediatric Otolaryngology staff. MAIN OUTCOME MEASURES: Patient age, 
diagnosis, operative findings, and time to tube extrusion were reviewed.
Otorrhea, perforation, and cholesteatoma rates were also assessed. RESULTS: Five 
hundred seven consecutive patients who had Armstrong tubes placed were reviewed. 
One thousand ninety-six Armstrong tubes were placed in these patients. Follow-up 
to extrusion rates were available for 756 tubes. The mean patient age at tube
placement was 33.3 months, and the median age was 23 months. Mean and median
times to extrusion were 16.5 and 15.5 months. One hundred sixty episodes of
otorrhea were noted in 148 patients. Four patients had histories of
cholesteatoma, none of which developed in conjunction with Armstrong tubes. Ten
(1.32%) perforations that have not resolved over time were noted after Armstrong 
tube placement. CONCLUSIONS: Armstrong beveled grommet tympanostomy tubes have
complication rates comparable with those reported for Armstrong or other
short-acting tubes in smaller series.

PMID: 15091223 [PubMed - indexed for MEDLINE]

1383: Laryngoscope. 2004 Mar;114(3):486-9.

Effectiveness of laser-assisted myringotomy for otitis media in children.

Cotter CS, Kosko JR.

Division of Pediatric Otolaryngology, Nemours Children's Clinic, Orlando, Florida
32806, USA.

OBJECTIVE: To evaluate the effectiveness of OtoScan CO2 laser-assisted
myringotomy (OtoLAM ESC/Sharplan) for acute otitis media and chronic otitis media
with effusion (COME) in children. STUDY DESIGN: Retrospective review of 47
children with refractory acute otitis media (RAOM) or COME more than 3 months in 
duration in a pediatric otolaryngology practice. METHODS: Laser-assisted
myringotomy was performed on 47 patients (79 ears) using the OtoLAM device. There
were 28 children (ages 0.50-3 years) with RAOM and 19 children (ages 0.58-15
years) with COME. RESULTS: A total of 57.4% of procedures were considered
treatment failures. Failures occurred in 53.6% of patients with RAOM on average
+/-SD 3.89 +/- 2.16 weeks after the procedure and in 63.2% of patients with COME 
on average +/-SD 7.25 +/- 5.57 weeks after the procedure. Age, sex, microorganism
isolated, myringotomy size, wattage, and laterality did not predict outcome.
Ventilation tube insertion was performed in 27 (57.4%) patients. Two patients
have persistent tympanic membrane perforations at 2 years. CONCLUSIONS:
Laser-assisted myringotomy in children with RAOM and COME was associated with a
high incidence of recurrence or persistence of disease and with perforation of
the tympanic membrane. Recommendations for use of the OtoLAM should include
discussion of high failure rates and the strong likelihood of subsequent
ventilation tube insertion. The OtoLAM remains an option for office-based
ventilation of the middle ear for families and patients where general anesthesia 
is a concern.

PMID: 15091222 [PubMed - indexed for MEDLINE]

1384: Laryngoscope. 2004 Mar;114(3):472-85.

Otitis media: treatment with intranasal aerosolized surfactant.

Chandrasekhar SS, Mautone AJ.

Department of Otolaryngology, Mount Sinai School of Medicine, New York, New York 
10029, USA. Sujana.Chandrasekhar@mssm.edu

OBJECTIVES/HYPOTHESIS: The objective was to determine the effect of intranasal
surfactant alone and with other medications administered by metered dose inhaler 
aerosol on the function of the eustachian tube and on the resolution of
experimentally induced otitis media with effusion (OME) and acute otitis media
(AOM). STUDY DESIGN: Randomized, experimental, controlled animal studies.
METHODS: Previously unreported (experiment 4) as well as published (experiments
1-3) data were detailed so that the reader could understand the continuum of
information leading to the conclusions. In experiment 1, after a live-animal
technique of measuring eustachian tube passive opening pressure was developed and
validated, eustachian tube passive opening pressure was determined in 61 adult
gerbils and 34 mice at baseline and 5 and 10 minutes after delivery of
aerosolized intranasal metered dose inhaler surfactant. In experiments 2 and 3
(Klebsiella pneumoniae), lipopolysaccharide-induced OME was developed in gerbils.
Thirty-five animals were randomly assigned to control, placebo, surfactant,
surfactant with betamethasone, and surfactant with phenylephrine groups. Seventy 
animals were randomly assigned to control, placebo once daily (QD) and twice
daily (BID), surfactant QD and BID, surfactant with betamethasone QD and BID, and
surfactant with phenylephrine QD and BID groups. Intranasal aerosolized MDI
medications were administered from postinfection day 2 until the effusion
resolved. Otomicroscopy and tympanometry were performed on alternate days for 30 
days. In experiment 4, AOM was developed in 39 chinchillas via transbullar
injection of nontypeable Haemophilus influenzae on day 1. Thirteen animals each
received placebo BID or surfactant BID, beginning on day 1. Thirteen animals
received surfactant BID beginning on day 3. All administrations were continued
for 10 days. Examinations were performed on seven occasions until day 27.
Appropriate statistical measurements were employed, including one- and two-way
ANOVA, strength-of-association measure (omega) calculation, chi, and Newman-Keuls
post hoc multiple comparison tests. Significance was set as P value of less
than.05. RESULTS: In experiment 1, a significant reduction in passive opening
pressure was seen in both 5- and 10-minute postsurfactant measurements.
Propellant alone was not effective. In experiments 2 and 3, OME resolved after an
average period of 16 to 16.5 days in control, placebo QD and BID, and surfactant 
with phenylephrine QD groups. A significant decrease in OME days was seen in the 
surfactant QD (10.57 d) and BID (8.57 d), and surfactant with betamethasone QD
(8.57 d) and BID (6.3 d) groups. A significant increase was seen in the
phenylephrine BID group (18.67 d). In experiment 4, tympanometry was normal or
near-normal in 62% and 48% of treated ears and in only 24% of placebo ears on day
12. Sixty-seven percent of placebo ears were culture positive at day 27, compared
with 10% and 16% in surfactant groups 1 and 2. Seventy-five percent of untreated 
animals developed severe labyrinthitis, compared with 15% in groups 1 and 2. On
day 27, 58% of placebo group middle ears had fluid, whereas 61% and 62% of ears
in groups 1 and 2, respectively, were dry. These findings were significant.
CONCLUSION: Intranasal application of aerosolized metered dose inhaler surfactant
alone or with steroid reduced eustachian tube passive opening pressure in normal 
animals and duration of effusion in animals with experimental OME. Intranasal
surfactant reduced the severity and duration of middle ear infection in AOM in
this animal model.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15091221 [PubMed - indexed for MEDLINE]

1385: J Dev Behav Pediatr. 2004 Apr;25(2):110-22.

Otitis media, hearing loss, and language learning: controversies and current
research.

Roberts J, Hunter L, Gravel J, Rosenfeld R, Berman S, Haggard M, Hall J, Lannon
C, Moore D, Vernon-Feagans L, Wallace I.

FPG Child Development Institute, University of North Carolina, Chapel Hill, North
Carolina 27599-8180, USA. joanne_roberts@unc.edu

This article reviews research on the possible linkage of otitis media with
effusion (OME) to children's hearing and development, identifies gaps, and
directions for research, and discusses implications for healthcare practices.
About half of children with an episode of OME experience a mild hearing loss
while about 5-10% of children have moderate hearing loss. Recent prospective and 
randomized clinical trials suggest none to very small negative associations of
OME to children's later language development. Based on both retrospective and
prospective longitudinal studies, associations between OME and perceiving speech 
in noise and tasks that require equal binaural hearing have been reported but
have not been adequately studied with regard to functional outcomes. Thus, on
average, for typically developing children, OME may not be a substantial risk
factor for later speech and language development or academic achievement.
However, these conclusions should be interpreted cautiously, since most of these 
studies used OME rather than hearing loss as the independent variable (although
hearing loss rather than OME is hypothesized to affect language development) and 
many studies did not control for important confounding variables such as
socioeconomic status (SES).

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 15083134 [PubMed - indexed for MEDLINE]

1386: Age Ageing. 2004 May;33(3):317-9.

Aspergillosis of the petrous apex.

Rushton P, Battcock T, Denning A, Herbetko J, Hillier C, Nicholas D.

Elderly Care Department, Southampton General Hospital, Tremona Road, Southampton 
SO16 6YD, UK. philrushton@hotmail.com

We present the case of an immunocompetent man who presented with multiple and
progressive cranial nerve palsies. The cause was found to be aspergillosis of the
petrous bone, arising as a result of chronic fungal otitis media. Despite
treatment with local excision and systemic anti-fungal therapy, he died after
suffering a subarachnoid haemorrhage. Diagnosis rests upon prompt radiological
imaging and the acquisition of tissue for histological examination and culture
but cannot be made without awareness of the condition.

Publication Types: 
    Case Reports

PMID: 15082443 [PubMed - indexed for MEDLINE]

1387: Int J Pediatr Otorhinolaryngol. 2004 May;68(5):557-62.

Prevalence of otitis media with effusion among primary school children in
Kahramanmaras, in Turkey.

Okur E, Yildirim I, Akif Kilic M, Guzelsoy S.

Department of Otorhinolaryngology, School of Medicine, Kahramanmaras Sutcu Imam
University, Hastane Cad. No. 32, 46050 Kahramanmaras, Turkey.

OBJECTIVE: The aim of this study was to determine the prevalence of otitis media 
with effusion (EOM) in primary school children. MATERIALS AND METHODS: Between
March 2002 and April 2002, children attending primary schools in Kahramanmaras
were screened. The schools were divided into two groups as urban and suburban.
Also, a primary boarding school in the city was included in the study as a third 
group. A total of 2930 children between the ages of 6 and 16 years were included 
in the study. After otoscopic examination, tympanogram and acoustic reflex tests 
were carried out. Audiogram was performed if the child had a type B or a type C
tympanogram. RESULTS: EOM was identified in 189 children, in 80 of whom EOM was
unilateral and in 109 of whom was it bilateral. The overall prevalence of EOM was
6.5%, with a maximum prevalence of 10.4% at ages between 6 and 8 years. By
increasing age, the prevalence of EOM decreased. Also, we found a higher
prevalence rate of EOM in children attending primary boarding school (7.6%) than 
those attending other schools. CONCLUSIONS: The present study showed that living 
in crowded places like boarding school may have a role in the occurrence of OME. 
Also, our findings support the opinion that the age is one of the most important 
risk factors for OME. Our prevalence rates were different when compared with some
other studies from Turkey and other countries. These different prevalence rates
may be related to climatic and environmental factors as well as the methods used.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15081228 [PubMed - indexed for MEDLINE]

1388: Laryngoscope. 2004 Apr;114(4):675-80.

Location and timing of initial osteoid deposition in postmeningitic labyrinthitis
ossificans determined by multiple fluorescent labels.

Tinling SP, Colton J, Brodie HA.

Department of Otolaryngology, University of California, Davis, Davis, California,
U.S.A.

OBJECTIVES/HYPOTHESIS: Variable amounts of fibrosis and neo-ossification fill the
cochlea following bacterial meningitis. The purpose of the study was to delineate
the timing and location of initial ossification following pneumococcal
meningitis, as well as subsequent remodeling and resorption, over the 3-month
period after infection. STUDY DESIGN: Randomized, double-blind study. METHODS:
Fluorochromes are compounds that specifically incorporate into ossifying bone.
Sequential addition of different colored fluorochromes during osteoneogenesis
define the timing and location of osteoid deposition and mineralization.
Mongolian gerbils were infected by intrathecal injection of Streptococcus
pneumoniae type 3, and control gerbils received saline. Both groups were injected
with calcein on postoperative day 3, followed by xylenol orange, oxytetracycline,
and alizarin red on days 7, 14, and 28 respectively. Ten experimental gerbils
were killed 24 hours after each label, and an additional group at 84 days after
infection. Two groups of 10 control gerbils were killed at 29 and 84 days after
treatment. The temporal bones and tibias were harvested, embedded in plastic, and
sliced with a diamond saw. Wafers at a thickness of 200 microm were mounted in
sequence and examined. RESULTS: Sixteen of 49 experimental animals (33%) were
positive for at least one of the fluorescent labels. Fluorescent labeled osteoid 
was present at all sampling times. Label extended from the endosteal wall into
the lumen of the scala tympani between the vestibule and the round window
membrane. Discrete sites of fluorescence varied among specimens and were
associated with the opening of the cochlear aqueduct, the scala tympani, organ of
Corti, and the stria vascularis and spiral ligament in all turns from base to
apex. CONCLUSION: The results indicate that osteoid is deposited and begins
mineralization by day 3 after infection, at least, and continues, at least,
through the first 28 days after infection. There was no apparent resorption of
new bone and remodeling by 84 days after infection.

Publication Types: 
    Evaluation Studies
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15064623 [PubMed - indexed for MEDLINE]

1389: Laryngoscope. 2004 Apr;114(4):622-6.

Cochlear changes in chronic otitis media.

Cureoglu S, Schachern PA, Paparella MM, Lindgren BR.

Department of Otolaryngology, Otitis Media Research Center, University of
Minnesota, Minneapolis, Minnesota, USA. schac002@tc.umn.edu

OBJECTIVES/HYPOTHESIS: The objective was to describe the morphological changes in
the cochlea in chronic otitis media. STUDY DESIGN: Retrospective human temporal
bone analysis. METHODS: Fifteen temporal bones with unilateral chronic otitis
media were selected and compared with contralateral normal temporal bones.
Standard cytocochleograms and spiral ganglion cell reconstructions were performed
on all temporal bones. Spiral ligament was divided into four segments according
to the locations of different types of fibrocytes. The average loss of fibrocytes
in each segment was estimated. Morphometric measurements of areas of stria
vascularis and spiral ligament were made in all turns of the cochlea on mid
modiolar sections. RESULTS: Loss of outer and inner hair cells was common in the 
basal turn of the cochlea in temporal bones with chronic otitis media compared
with control ears. There was no difference in the number of spiral ganglion cells
in the chronic otitis media and contralateral ears. The areas of stria vascularis
and spiral ligament in the basal turn decreased significantly in the ears with
chronic otitis media compared with control ears. There were no significant
differences between the ears with chronic otitis media and the contralateral ears
for any of the regions characterized by the presence of types I-IV fibrocytes.
CONCLUSION: The results of the study are consistent with the hypothesis that
chronic otitis media causes cochlear disease.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15064614 [PubMed - indexed for MEDLINE]

1390: J Control Release. 2004 Apr 16;96(1):1-7.

Regional delivery of vancomycin using pluronic F-127 to inhibit methicillin
resistant Staphylococcus aureus (MRSA) growth in chronic otitis media in vitro
and in vivo.

Lee SH, Lee JE, Baek WY, Lim JO.

Department of Otolaryngology, School of Medicine, Kyungpook National University, 
Daegu 700-721, South Korea.

For the effective treatment of chronic otitis media caused by methicillin
resistant Staphylococcus aureus (MRSA), the local delivery of vancomycin was
attempted based on a formulation with pluronic F-127. The phase transition
property of pluronic F-127, which is liquid at room temperature and becomes solid
at body temperature, enabled convenient injection and reduced the side effects of
the potent antibiotic. The temperature responsive polymer-vancomycin matrix
system was also shown to effectively deliver vancomycin locally to the infected
inner ear, plus the MRSA growth was inhibited by the formulation. The otitis
media was completely cured by the sustained local delivery of vancomycin from the
matrix in vivo. Accordingly, this system has potential clinical application for
treating chronic otitis media with improved patient compliance and better
therapeutic efficacy.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15063024 [PubMed - indexed for MEDLINE]

1391: Vet Clin North Am Small Anim Pract. 2004 Mar;34(2):541-55, vii-viii.

Medical therapy of otitis externa and otitis media.

Morris DO.

Section of Dermatology and Allergy, Department of Clinical Studies-Philadelphia, 
School of Veterinary Medicine, VHUP Room 2065, 3900 Delancey Street, University
of Pennsylvania, Philadelphia, PA 19104, USA. domorris@vet.upenn.edu

Medical regimens for the successful treatment of infectious otitis may vary
widely depending on the degree of pathologic changes of the external ear canals, 
the status of the tympanic membranes, and the specific microorganisms involved.
Chronic otitis media is especially problematic, because impaction of the bullae
can be difficult to resolve and these cases often involve antibiotic-resistant
bacterial organisms. In fact, the continuing emergence of resistant Pseudomonas
spp and Staphylococcus spp will ensure that the medical therapy of otitis remains
a dynamic art for the foreseeable future. This article considers the specific
antimicrobial agents available for otic use, their potential toxicities, and
guidelines for their use.

Publication Types: 
    Review

PMID: 15062623 [PubMed - indexed for MEDLINE]

1392: Vet Clin North Am Small Anim Pract. 2004 Mar;34(2):469-87.

Diagnosis and treatment of otitis media in dogs and cats.

Gotthelf LN.

Animal Hospital of Montgomery, 3310 Atlanta Highway, Montgomery, AL 36109, USA.
LouEGee@aol.com

Otitis externa/media is commonly found in dogs with chronic ear diseases and in
cats with upper respiratory disease and polyps. Diagnosis of otitis media
requires attention to history and clinical signs, but it also requires other
methods of determining disease within the bulla. If the integrity of the eardrum 
cannot be determined, assume that there is middle ear disease and proceed
accordingly. It is prudent to take necessary precautions to avoid the use of
potentially ototoxic ear cleaners or topical medications in suspected otitis
media cases. Therapeutic success is possible using systemic and topical treatment
within the cleaned bulla. Referral to a dermatology specialist or a radiologist
for a CT scan may be indicated in some refractory cases. Surgical intervention
may be required to cure these difficult cases.

Publication Types: 
    Review

PMID: 15062620 [PubMed - indexed for MEDLINE]

1393: Vet Clin North Am Small Anim Pract. 2004 Mar;34(2):459-68.

Causes of otitis externa.

Rosser EJ Jr.

Department of Small Animal Clinical Sciences, College of Veterinary Medicine,
Michigan State University, East Lansing, MI 48824-1314, USA. rosser@cvm.msu.edu

Dogs with long-standing, chronic, recurrent otitis externa often represent one of
the most frustrating types of problems in daily clinical practice. The important 
aspect of this discussion is that the clinician may be presented with a patient
in which the primary chief complaint is otitis externa but a wide variety of
disease processes may be causing the problem, including various combinations of
the primary, predisposing, and perpetuating causes as discussed previously. The
use of a thorough history and general and dermatologic physical examinations
often leads the clinician to establish a systematic approach to identify the
specific underlying problems. Until this is accomplished, the recurrent nature of
the otitis externa will remain as a persistent problem.

Publication Types: 
    Review

PMID: 15062619 [PubMed - indexed for MEDLINE]

1394: Vet Clin North Am Small Anim Pract. 2004 Mar;34(2):411-24.

Otic cytology in health and disease.

Angus JC.

Dermatology Section of Specialty Medicine, Department of Veterinary Clinical
Medicine, College of Veterinary Medicine, University of Illinois, 1008 West
Hazelwood Drive, Urbana, IL 61802, USA. angus@uiuc.edu

Accurate characterization of the primary cause and perpetuating factors is
essential for successful management of ear disease in dogs and cats. Cytology is 
a simple, rapid, and practical diagnostic test that should be performed routinely
on any and all patients presented for clinical signs consistent with otitis
externa. In combination with clinical signs, otoscopic evaluation, and diagnostic
testing of primary disease, serial cytology enhances the ability of veterinarians
to diagnose secondary infections, monitor progression of disease, evaluate
response to therapy, and make appropriate management decisions. Cytologic
specimens should be evaluated for the presence, numbers, and characteristics of
three key features: yeast, bacteria, and leukocytes. More than five yeast
organisms or more than 25 bacteria per high-powered field is suggestive of
significant microbial activity warranting therapeutic intervention. The presence 
of leukocytes, particularly with phagocytized bacteria, indicates "true
infection" rather than overgrowth; if suppurative discharge is present, systemic 
therapy is needed. Cytology combined with culture and susceptibility is the best 
method for identification of bacterial overgrowth and infection; however, if only
one test can be performed, always choose cytology. Culture results assist in the 
selection of appropriate antibiotic therapy, but cytology determines whether
systemic antibiotics are indicated, which organisms are most significant, and
when therapy can be discontinued.

Publication Types: 
    Review

PMID: 15062616 [PubMed - indexed for MEDLINE]

1395: Vet Clin North Am Small Anim Pract. 2004 Mar;34(2):397-410.

Otoscopic evaluation of the ear canal.

Cole LK.

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio 
State University, 601 Vernon L. Tharp Street, Columbus, OH 43210, USA.
cole.143@osu.edu

Otoscopic evaluation of the external ear canal and tympanic membrane is the first
diagnostic procedure that should be performed in animals presented with otitis
externa. It is important to become familiar with the normal structures of the ear
to identify any abnormalities. The video otoscope greatly enhances visualization 
of these structures as well as aiding in retrieval of foreign bodies, biopsy of
masses, and performance of a myringotomy. In some cases, a complete otoscopic
examination is not possible on the first visit, and the animal may require
anti-inflammatory medications or otic flushing to visualize the entire ear canal 
as well as the tympanic membrane. The purpose of the otoscopic examination is to 
address the otitis by evaluating the condition of the ear, looking for any masses
or foreign bodies; noting the presence, consistency, and color of any exudate;
and evaluating the patency of the tympanic membrane. Once a complete otic
evaluation has been performed, additional diagnostics as well as a treatment plan
can be formulated.

Publication Types: 
    Case Reports
    Review

PMID: 15062615 [PubMed - indexed for MEDLINE]

1396: Hindustan Antibiot Bull. 2002 Feb-Nov;44(1-4):42-6.

In vitro evaluation of sulfadrugs against fungi causing otomycosis.

Jain SK, Agrawal SC, Jain PC.

Department of Applied Microbiology, Cancer Hospital & Research Institute, Gwalior
474 009, India. Sudhirkjain1@rediffmail.com

The efficacy of four sulfadrugs i.e., sulfadiazine, sulfamethoxazole,
sulfaguanidine and sulfamoxole were taken in different doses (500, 1000, 1500,
2000 and 2500 ppm) to test their effectiveness against five pathogenic organisms 
for the control of mycelial growth and sporulation. Amongst the drugs tested
sulfamethoxazole seems to be most effective against most of the test fungi
showing 96.78, 90.53, 86.62, 54.16 and 43.91 percent inhibition in mycelial
growth of P. nigricans, A. flavus, A. corymbifera, A. niger and C. albicans,
respectively at its 2500 ppm dose in the basal medium. Gradual reduction in
sporulation in all the test organisms almost in all the sulfadrugs have caused
inhibition in sporulation, in comparison to their respective controls. Maximum
inhibitory effect of sulfadiazine was recorded in A. niger showing 77.26 percent 
inhibition in the mycelial growth at a dose of 2500 ppm. Sulfaguanidine at its
higher dose i.e., 2500 ppm proved to be most toxic against A. corymbifera causing
56.39 percent inhibition in the mycelial growth, while the same dose could not be
found much effective against other test fungi. Sulfamoxole was found to be quite 
effective against most of the test fungi causing 47.16 to 85.86 percent
inhibition in the mycelial growth. A gradual inhibition in the vegetative growth 
and sporulation or budding in all the test fungi was noted by increasing the
concentrations of the test sulfadrugs.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15061593 [PubMed - indexed for MEDLINE]

1397: J Microbiol Immunol Infect. 2004 Feb;37(1):57-62.

Intramuscular ceftriaxone in comparison with oral amoxicillin-clavulanate for the
treatment of acute otitis media in infants and children.

Wang CY, Lu CY, Hsieh YC, Lee CY, Huang LM.

Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan,
ROC.

In order to evaluate the clinical efficacy and safety profiles of single-dose
ceftriaxone (50 mg/kg, not exceeding 1 g) and a 10-day course of
amoxicillin-clavulanate (amoxi-clav) [45 mg/kg/day, in 3 divided doses] in
children with acute otitis media (AOM), we conducted a prospective, comparative, 
randomized trial. Between February 2000 and April 2002, 110 children with a mean 
age of 30.73 +/- 20.79 months were enrolled. 109 patients were evaluated for the 
safety assessment. The intent-to treat population included 96 patients who
completed at least 3 days of treatment. The standard analysis population included
73 patients who completed the 10-day treatment period without any major
violation. For the standard analysis population, 57 out of 73 patients
experienced treatment success; 31 out of 41 patients in the ceftriaxone group
were cured compared with 25 out of 32 patients in the amoxi-clav group. The rate 
of persistence of middle-ear fluid did not differ between the 2 groups at day 11 
or day 28. A higher treatment preference rate was observed in the ceftriaxone
group (93.9% vs 58.6%). The most common drug-related adverse effects were found
in the digestive system, skin and appendages in both treatment groups. A single
dose of ceftriaxone is as safe and effective as amoxi-clav for curing patients
with acute otitis media. In addition, a substantially higher proportion of
patients receiving single-dose ceftriaxone showed a preference for the study
medication compared with those treated with amoxi-clav for 10 days.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 15060689 [PubMed - indexed for MEDLINE]

1398: Int J Clin Pract. 2004 Feb;58(2):214-7.

Subdural empyema and cerebellar abscess due to chronic otitis media.

Polyzoidis KS, Vranos G, Exarchakos G, Argyropoulou MI, Korantzopoulos P, Skevas 
A.

Department of Neurosurgery, University of Ioannina, Medical School, Ioannina,
Greece.

The infratentorial variety of the subdural empyema, with or without coexisting
cerebellar abscess, is a rare clinical entity that carries a high mortality rate.
We briefly describe the case of a 49-year-old man presented with severe debility,
fever and an obviously neglected chronic otitis media. The patient had refused
surgical treatment several months ago. After admission, his level of
consciousness began to deteriorate, and the radiological studies showed
infratentorial subdural suppuration extending into the right cerebellar
hemisphere, along with chronic pyogenic infection of the middle ear and the
mastoid process. Radical mastoidectomy was performed first, followed by extensive
right posterior fossa craniectomy. The two subdural collections and the
cerebellar abscess were successfully evacuated. Subsequently, he received
post-operative antibiotic treatment for 6 weeks. At follow-up, 10 months after
surgery, his neurological recovery was complete except for a minor residual
cerebellar dysfunction on the right. This unusual case highlights that in
patients presented with severe intracranial complications of chronic otitis
media, early diagnosis and radical surgical intervention may be life saving.

Publication Types: 
    Case Reports

PMID: 15055872 [PubMed - indexed for MEDLINE]

1399: Antimicrob Agents Chemother. 2004 Apr;48(4):1419-21.

Eradication of Streptococcus pneumoniae in the nasopharyngeal flora of children
with acute otitis media after amoxicillin-clavulanate therapy.

Brook I, Gober AE.

Department of Pediatrics, Georgetown University School of Medicine, Washington,
D.C. 20016, USA. ib6@georgetown.edu

Nasopharyngeal cultures were obtained from 60 children with acute otitis media
before and after treatment with either 45 or 90 mg of amoxicillin (given as
amoxicillin-clavulanate) per kg of body weight per day for 10 days. The number of
Streptococcus pneumoniae isolates in the 45-mg/kg group was reduced from 12 to 6 
and was reduced from 14 to 1 (P = 0.0261) in the 90-mg/kg group.

PMID: 15047558 [PubMed - indexed for MEDLINE]

1400: Auris Nasus Larynx. 2004 Mar;31(1):23-8.

A comparison of patient satisfaction with conventional and nurse led outpatient
follow-up after grommet insertion.

Uppal S, Lee C, Mielcarek M, Banks P, Mackay E, Coatesworth A.

Department of Otolaryngology, Head and Neck Surgery, York Hospital, Wigginton
Road, York YO31 8HE, UK. uppalsandeep@yahoo.com

OBJECTIVE: The need to reduce costs while providing a first class service has led
to the expansion in the role of nurses in otolaryngology practice in the National
Health Service (NHS) in recent years. The aim of this study was to compare
patient satisfaction with conventional and nurse led follow-up after grommet
insertion. The hypothesis was that patient satisfaction is much greater with
doctor led conventional follow-up as compared with nurse led out-patient
follow-up. METHODS: The study was performed using a questionnaire survey using a 
validated patient satisfaction questionnaire. RESULTS: Our results indicate that 
there is no statistically significant difference in the mean factorial scores for
interpersonal skills and technical competence, physical surroundings, and
convenience between the conventional and nurse led follow-up clinic. The overall 
patient satisfaction was higher with nurse led grommet follow-up clinic than with
conventional doctor led out-patient follow-up. This was statistically significant
(Mann-Whitney U = 1357.50, Z = 02.39, P = 0.01). The waiting time in out-patients
was also significantly less in the nurse led grommet clinic. CONCLUSIONS: We
conclude that nurses provide a high quality service resulting in high patient
satisfaction. Nurse led grommet follow-up clinic has the potential for
substantial reduction in outpatient access times in the NHS.

Publication Types: 
    Comparative Study

PMID: 15041050 [PubMed - indexed for MEDLINE]

1401: Folia Morphol (Warsz). 2004 Feb;63(1):119-21.

Proliferation activity and apoptosis in granulation tissue and cholesteatoma in
middle ear reoperations.

Durko M, Kaczmarczyk D.

Otosurgery Department, Medical University, Łódź, Poland. durko@csk.am.lodz.pl

The aim of the study was to find out the potential prognostic value of
proliferation activity and apoptosis in cholesteatoma and granulation tissue
removed during middle ear reoperation in recurrent middle ear inflammation.
Granulation tissues and recurrent cholesteatoma were analysed after being
surgically removed from the middle ear in a group of 25 patients qualified for
middle ear reoperation procedure. Paraffin sections were stained with
haematoxylin and eosin according to Mallory's method. Immunohistochemical
reaction Anti-PCNA was performed. Apoptosis was evaluated using the TUNEL method.
The percentage of PCNA-positive cells was 42-95% in the matrix of the
cholesteatoma and 29-81% in the perimatrix. In the granulation tissue it was
35-75%. The percentage of apoptotic cells was 12-73% in the matrix of the
cholesteatoma, 5-72% in the perimatrix and 1-65 % in the granulation tissue. The 
prognostic value of the parameters studied in the recurrent middle ear
inflammatory process is questionable, probably due to the small number of cases
under examination.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15039916 [PubMed - indexed for MEDLINE]

1402: J Infect Dis. 2004 Apr 1;189(7):1304-12. Epub 2004 Mar 17.

Intranasal vaccination with recombinant P6 protein and adamantylamide dipeptide
as mucosal adjuvant confers efficient protection against otitis media and lung
infection by nontypeable Haemophilus influenzae.

Bertot GM, Becker PD, Guzmán CA, Grinstein S.

Virology Laboratory, Ricardo Gutierrez Children Hospital, Buenos Aires,
Argentina. gmbertot@yahoo.com.ar.

Nontypeable Haemophilus influenzae (NTHi) is a leading etiologic agent of otitis 
media in children and recurrent respiratory infections in patients with chronic
obstructive pulmonary disease. The highly conserved outer membrane protein P6
constitutes a promising vaccine candidate antigen. However, the small amount of
P6 produced by this fastidious microorganism renders large-scale production
difficult. Controversial data also exist concerning the suitability of
recombinant P6 (rP6) as a vaccine antigen. Therefore, we performed a comparative 
evaluation of the immunogenicity and efficacy of native P6 and rP6 in mice
intranasally vaccinated with adamantylamide dipeptide (AdDP) as an adjuvant. High
titers of P6-specific serum antibodies were elicited in mice vaccinated with
either native P6 or rP6, which cross-recognized both antigens. However, rP6
stimulated stronger mucosal responses. Mice vaccinated with rP6 were protected
against both pulmonary and middle-ear infections (P<.01). This demonstrates that 
rP6 plus AdDP constitutes a promising vaccine formulation against the most
relevant forms of disease caused by NTHi.

Publication Types: 
    Comparative Study
    Evaluation Studies
    Research Support, Non-U.S. Gov't

PMID: 15031801 [PubMed - indexed for MEDLINE]

1403: Vet Dermatol. 2004 Apr;15(2):127-36.

Ear cleaning: the UK and US perspective.

Nuttall T, Cole LK.

University of Liverpool Department of Veterinary Clinical Science, Small Animal
Hospital, Crown Street, Liverpool L7 7EX, UK. timn@liv.ac.uk

Ear cleaning helps maintain the normal otic environment and is important in the
treatment of otitis. Over cleaning, however, may trigger otitis through
maceration of the epidermal lining. Simple manual cleaning is useful for routine 
cleansing but doesn't remove tightly adherent debris. Bulb syringes are more
vigorous but may damage the ear in inexperienced hands. Devices using mains water
pressure or dental machines are also available. Thorough cleaning of the ear
canals and middle ear cavity can only be achieved by retrograde flushing using
specially adapted catheters, feeding tubes or video otoscopes under anaesthesia. 
Myringotomy, inspection and cleaning of the middle should be performed if the
tympanic membrane appears abnormal. There are a wide variety of cleaning fluids
available. Ceruminolytics soften and dissolve cerumen to facilitate cleaning.
Surfactants emulsify debris, breaking it up and keeping it in solution.
Astringents dry the ear canal surface, preventing maceration. Maintaining a low
pH and incorporating antimicrobial agents can inhibit microbial proliferation and
glucocorticoids can be used to reduce inflammation. Adverse effects and
contraindications following ear cleaning can include maceration, contact
reactions, otitis media, ear canal avulsion, vestibular syndrome, Horner's
syndrome, facial nerve paralysis and deafness. Care should be exercised in
selecting cleaning fluids if the tympanic membranes are ruptured.

Publication Types: 
    Review

PMID: 15030561 [PubMed - indexed for MEDLINE]

1404: Comp Med. 2004 Feb;54(1):93-9.

Outbreak of otitis media caused by Burkholderia gladioli infection in
immunocompromised mice.

Foley PL, Lipuma JJ, Feldman SH.

Center for Comparative Medicine, University of Virginia, Office of VP for
Research and Graduate Studies, PO Box 800392, Charlottesville, Virginia, USA.

An athymic nude mouse with severe head tilt due to otitis media was identified.
Within weeks of identification of this first case, immune-deficient mice of
various genotypes from the same facility were similarly affected, and cases from 
other facilities were found within two months. Culture of ear exudate specimens
from affected mice yielded bacteria that were initially identified as
Burkholderia cepacia, a plant pathogen considered an important opportunistic
pathogen in persons with cystic fibrosis or chronic granulomatous disease.
Several of these isolates, however, were subsequently identified as B. gladioli
on the basis of results of biochemical analysis and a species-specific polymerase
chain reaction (PCR) assay. Genotyping analysis revealed clonality among the
isolates, indicating a shared strain among affected mice. A 16S rDNA-based PCR
assay specific for the genera Burkholderia and Ralstonia, and a selective culture
medium were used in efforts to characterize the epidemiology of this outbreak. In
addition to culture of specimens from the oropharyngeal cavity of affected mice, 
samples were obtained from the environment, feces, sipper tubes, drinking water, 
and soiled bedding from cages of affected individuals. Burkholderia gladioli was 
most consistently detected in oropharyngeal swab specimens from affected mice.
The PCR assay was equivalent to selective culture in identifying mice in the
carrier state that did not have clinical signs of infection. However, neither
detection method had sufficient sensitivity to reliably identify all carrier
mice, causing the organism to persist at low levels unless entire colonies of
immune-deficient mice were removed. The organism was highly resistant to
antibiotic therapy. The source and epidemiology of this organism remain unknown. 
This epizootic serves as an important reminder that immunocompromised rodent
colonies may harbor important human opportunistic pathogens.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15027624 [PubMed - indexed for MEDLINE]

1405: Br J Clin Pharmacol. 2004 Apr;57(4):500-5.

Acute otitis media in children: a retrospective analysis of physician prescribing
patterns.

Quach C, Collet JP, LeLorier J.

Pharmacoepidemiology Unit, Research Institute, CHUM, Campus Hôtel-Dieu,
University of Montreal, Montreal (QC), Canada.

BACKGROUND: Acute otitis media (AOM) is one of the most common infectious
diseases of childhood and the most frequent indication for antibiotic use in
children. Aim To better understand the prescribing patterns and appropriateness
of AOM therapy. METHODS: We investigated a historical cohort of children aged <
or = 6 years who had a first AOM episode between June 1999 and June 2002, using
the Régie de l'assurance maladie du Quebec (RAMQ) administrative databases.
Conformity of prescription was based on the consensus guidelines on AOM treatment
from the Drug-resistant Streptococcus pneumoniae Therapeutic Working Group. These
recommendations suggested amoxicillin as the first-line drug, and
amoxicillin-clavulanic acid or cefuroxime for children who had received
antibiotics in the previous month. Data were analysed using descriptive
statistics, chi(2) test and logistic regression. RESULTS: During the study
period, 60 513 children < or = 6 years of age experienced their first AOM episode
with a mean age of 2.6 years. They were seen by 4708 physicians [87% general
practitioners (GPs), 9% paediatricians, and 3% ENT specialists]. Amoxicillin was 
the antibiotic that was prescribed the most (43%), followed by cefprozil and
azithromycin. Overall, 42% of physicians adhered to antibiotic guideline
recommendations. Compared with GPs, paediatricians were almost as likely to
prescribe in conformity with the consensus guidelines, whereas ENT specialists
were 50% less likely to prescribe an antibiotic recommended by the guidelines.
CONCLUSION: Continuing medical education is necessary to ensure appropriate
adherence to antibiotic guidelines.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15025749 [PubMed - indexed for MEDLINE]

1406: Clin Pediatr (Phila). 2004 Mar;43(2):159-69.

Diagnosis and management of acute otitis media in Michigan.

Linsk R, Cooke J.

Division of General Pediatrics University of Michigan, Ann Arbor, MI 48152, USA.

We surveyed pediatricians (PEDs), family physicians (FPs), otolaryngologists
(ENTs), and emergency physicians (ERs) from across Michigan (100 each), as well
as 30 nationally recognized experts about their clinical approach to acute otitis
media (AOM). The overall response rate was 52%. There was substantial variation
within each group with respect to diagnostic criteria and clinical
decision-making, but no significant differences among groups. The 63% of
respondents who considered symptoms among their diagnostic criteria for AOM were 
3.8-fold more likely to defer therapy for an asymptomatic toddler with a bulging,
red, immobile tympanic membrane (TM) (95% Confidence Interval (CI) 1.53, 9.74),
but 24% of respondents stated that they would prescribe oral antibiotics for a
symptomatic child with a red TM, even in the absence of a middle ear effusion.
These data suggest that diagnostic criteria are a major factor determining
whether clinicians prescribe antibiotics to a particular patient.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15024439 [PubMed - indexed for MEDLINE]

1407: Clin Pediatr (Phila). 2004 Mar;43(2):135-51.

Optimizing antibacterial therapy for community-acquired respiratory tract
infections in children in an era of bacterial resistance.

Low DE, Pichichero ME, Schaad UB.

Mount Sinai Hospital, Toronto, Canada.

The spread of antibacterial resistance in bacteria that commonly cause childhood 
community-acquired respiratory tract infections (RTIs), such as acute otitis
media, community-acquired pneumonia, and acute pharyngitis, is a major healthcare
problem. One of the foremost concerns is the rapid increase in penicillin,
macrolide, and multidrug resistance in Streptococcus pneumoniae. There is also a 
rising prevalence of macrolide resistance in Streptococcus pyogenes in pockets of
the United States, and beta-lactamase production in Haemophilus influenzae is
widespread. Although data are limited, some evidence suggests that resistance to 
antibacterials can impair bacteriologic and clinical outcomes in childhood RTIs. 
Optimizing antibacterial use is important both in the care of individual patients
and within strategies to address the wider problem of antibacterial resistance.
This involves encouraging judicious antibacterial use (i.e., reducing overuse for
viral infection and prophylaxis), and preventing misuse through the wrong choice,
dosage, and duration of therapy. Given that initial therapy is usually empiric,
antibacterials used to treat community-acquired RTIs in children should ideally
have the following properties: an optimal targeted spectrum of activity; high
clinical and bacteriologic efficacy against respiratory pathogens, including
resistant strains; simple, short-course therapy; and good tolerability and
palatability. New antibacterials will continue to have a role in the treatment of
RTIs in children, especially where resistance compromises existing therapies.

Publication Types: 
    Review

PMID: 15024437 [PubMed - indexed for MEDLINE]

1408: Arch Otolaryngol Head Neck Surg. 2004 Mar;130(3):289-92.

Complications of otitis media before placement of tympanostomy tubes in children.

Kacmarynski DS, Levine SC, Pearson SE, Maisel RH.

Department of Otolaryngology, University of Minnesota, Minneapolis 55455, USA.

OBJECTIVES: To report the incidence of short-term complications from otitis media
in children before placement of tympanostomy tubes (TTs) and to compare children 
treated according to the Agency for Health Care Policy and Research guidelines
with those who were treated earlier or later than recommended. DESIGN:
Retrospective outcomes review. PATIENTS: Subjects were children aged 10 or
younger who had TTs inserted at a tertiary care county hospital from January 1,
1999, to December 31, 2000. Exclusion criteria included prior TT placement, any
concurrent head and neck procedure, and craniofacial defects. INTERVENTION:
Tympanostomy tube placement. MAIN OUTCOME MEASURES: Any occurrences of otorrhea, 
tympanic membrane perforation, tinnitus, antibiotic reactions, speech or language
delay, febrile seizures, or meningitis before placement of TTs documented in the 
county hospital records were recorded as complications. Hearing loss was
considered separately. RESULTS: Of 147 children who met our criteria, 81 (55.1%) 
had 1 or more complications from otitis media before placement of TTs. Fifty-five
(37.4%) had 2 to 6 complications documented. Adverse reactions to antibiotics
were the most common complication, reported in 34 (23.1%). CONCLUSIONS: Most
children in this county hospital experienced short-term complications of otitis
media before receiving TTs. Even the children treated "on time" according to the 
guidelines from the Agency for Health Care Policy and Research experienced
complications; however, adherence to the guidelines had no significant effect on 
complications.

PMID: 15023834 [PubMed - indexed for MEDLINE]

1409: Arch Otolaryngol Head Neck Surg. 2004 Mar;130(3):273-8.

The genetic component of middle ear disease in the first 5 years of life.

Casselbrant ML, Mandel EM, Rockette HE, Kurs-Lasky M, Fall PA, Bluestone CD,
Ferrell RE.

Department of Otolaryngology, University of Pittsburgh School of Medicine, PA
15213, USA. margaretha.casselbrant@chp.edu

OBJECTIVE: To determine the genetic component of time with middle ear effusion
(MEE) and episodes of MEE and acute otitis media. DESIGN: Prospective
twin/triplet cohort. SETTING: Research center at a tertiary pediatric hospital.
PARTICIPANTS: A total of 168 healthy same-sex twin and 7 same-sex triplet sets
were recruited by age 2 months. INTERVENTIONS: Longitudinal assessment of middle 
ear status by pneumatic otoscopy and tympanometry at monthly evaluations, and at 
examinations during upper respiratory tract infections or symptoms of middle ear 
disease. OUTCOME MEASURES: Proportion of time with MEE and episodes of acute
otitis media and MEE. RESULTS: Of the 140 sets for which zygosity was obtained,
114 were followed up to age 3 years and 83 sets to age 5 years. The heritability 
estimate for proportion of time with MEE in the first 5 years of life was 0.72
(P<.001). The correlation of proportion of time with MEE between children within 
a set was significantly higher in monozygotic sets (0.65-0.77) than in dizygotic 
sets (0.31-0.39) for each year to age 3 years. In the fourth and fifth years of
life, the correlations decreased in both monozygotic and dizygotic twin sets.
CONCLUSIONS: Findings for the first 2 years of follow-up have been previously
published and indicate a strong genetic component to the proportion of time with 
MEE. In the present report, which details the entire 5-year follow-up, the effect
of this component appears to attenuate after the third year but its cumulative
effect remains significant after 5 years.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.
    Twin Study

PMID: 15023832 [PubMed - indexed for MEDLINE]

1410: Otol Neurotol. 2004 Mar;25(2):98-101.

Ossicular reconstruction using bone cement.

Babu S, Seidman MD.

Providence Hospital, Southfield, Michigan, USA.

OBJECTIVE: The objective of this study was to describe our results of ossicular
reconstruction using bone cement. STUDY DESIGN: We conducted a retrospective
review of 264 patients with chronic suppurative otitis media operated on since
1999. SETTING: Academic tertiary referral center. PATIENTS:: Two hundred
sixty-four patients with chronic suppurative otitis media underwent mastoidectomy
with tympanoplasty. Eighty patients had incudostapedial disarticulation secondary
to infection and or cholesteatoma and were reconstructed using an incus
interposition graft (n = 31), a partial ossicular prosthesis (POP; n = 31), or
more recently, bone source (n = 18). This study evaluates the results of the
ossiculoplasties using bone source. INTERVENTION: Ossicular discontinuity was
repaired using bone cement. MAIN OUTCOME MEASURE: Audiometric studies pre- and
postintervention were compared. One to 3 years of follow up are provided.
RESULTS: Preoperative air-bone gaps ranged from 18 dB to 60 dB and averaged 33
dB. Postoperative air-bone gaps ranged from 1 to 24 dB and averaged 10 dB. No
patients have experienced any increase in their persistent conductive hearing
loss. The pre-/postoperative hearing loss comparisons showed statistically
significant hearing improvement. There were no complications. CONCLUSION: The use
of POPs and incus interposition grafts is fraught with the possibility of
migration and resultant recurrent conductive hearing loss. Using bone cement to
reconstruct the ossicular chain restores the integrity of the ossicular chain in 
the most natural of ways. This reconstruction technique provides an excellent
alternative to currently accepted methods and should be considered for
incus-stapes disarticulation. There has been no dissolution of the bone source
and the results have persisted thus far.

Publication Types: 
    Comparative Study

PMID: 15021766 [PubMed - indexed for MEDLINE]

1411: Vet Microbiol. 2004 Apr 5;99(2):121-9.

Erratum in:
    Vet Microbiol. 2004 Jul 14;101(3):223.

Pseudomonas aeruginosa from canine otitis externa exhibit a quorum sensing
deficiency.

Tron EA, Wilke HL, Petermann SR, Rust L.

Department of Veterinary and Microbiological Sciences, Van Es Laboratories, North
Dakota State University, Fargo, ND 58105, USA.

Pseudomonas aeruginosa LasB elastase gene (lasB) transcription depends on cell
density-dependent quorum-sensing mechanisms of gene activation. Previously, we
collected several non-mucoid P. aeruginosa veterinary isolates and showed that
the total matrix protease phenotype was similar for isolates regardless of host
and site of isolation. In contrast, isolates from chronic canine ear infections
(otitis externa) were significantly more likely to exhibit less elastase activity
as measured by elastin Congo red than from any other site [Clin. Diag. Lab.
Immun. 8 (2001) 632]. In this study, we found that the elastase deficiency
phenotype is stable upon passage in broth culture. Transcript amplification
analyses indicated that the elastase deficiency appears to be strain-specific,
with each isolate exhibiting a unique expression profile relative to strain PAO1.
Although a number of strain-specific transcriptional differences were observed,
the overall pattern that emerges is a quorum sensing deficiency among canine ear 
P. aeruginosa isolates.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15019103 [PubMed - indexed for MEDLINE]

1412: J Clin Virol. 2004 Apr;29(4):315-9.

The value of virus serology in epidemiological studies of acute otitis media in
children.

Räty R, Ziegler T, Kleemola M.

Department of Microbiology, National Public Health Institute, Mannerheimintie
166, FIN-00300 Helsinki, Finland. riitta.raty@ktl.fi

BACKGROUND: Acute otitis media (AOM) is a major health problem in young children.
There is a general conception that AOM is a bacterial disease but with the
availability of sensitive diagnostic methods, it has gradually become evident
that viruses play an important role in the pathogenesis of AOM. Paired blood
samples are seldom taken from infants although valuable information could be
obtained by serological methods. During the recent Finnish Otitis Media (FinOM)
Cohort Study, in addition to nasopharyngeal aspirates (NPA) and middle ear fluids
(MEF), paired acute and convalescent serum samples were collected from children
with AOM. OBJECTIVES: To establish the diagnostic value of serological methods in
etiological and epidemiological studies of AOM. STUDY DESIGN: A complete set of
NPA, MEF, and paired sera was collected during 447 events of AOM experienced by
179 children between 2 months and 2 years of age. Antigens of respiratory
syncytial virus (RSV), adenoviruses, influenza A and B, and parainfluenza types
1-3 in NPAs and MEFs were detected by time-resolved fluoroimmunoassay (TR-FIA),
and antibody titers were determined by complement fixation test (CFT) or by
enzyme immunoassay. RESULTS: A total of 163 virus-positive events were
identified. Of those, only 34 were positive by TR-FIA and by serology. From 48
events a positive result was obtained only by TR-FIA and from 81 only by
serology. CONCLUSION: Although serological methods are usually of little use in
clinical practice, epidemiological studies clearly gain value if serology is
included. The number of virus-positive findings dramatically increased by
including serological tests in the diagnostic work-up of these AOM events.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15018861 [PubMed - indexed for MEDLINE]

1413: Ambul Pediatr. 2004 Mar-Apr;4(2):162-5.

Assessment of pediatric residents' otoscopic interpretive skills by videotaped
examinations.

Jones WS, Kaleida PH, Lopreiato JO.

San Antonio Military Pediatric Center, Lackland AFB, TX, USA. wjones@usuhs.mil

BACKGROUND: Accurate diagnosis of otitis media is essential to facilitate
appropriate management. Few residency programs assess formally their residents'
competency in diagnosing middle ear disease. OBJECTIVE: To evaluate the
performance of pediatric residents' otoscopic interpretive skills by level of
training, with a videotaped otoendoscopic examination (VOE). METHODS: A VOE was
used to assess and compare the performance of a cross-sectional sample of 141
residents with one another by level of training as well as with novice and expert
groups. Total score, sensitivity, specificity, and kappa coefficients were
calculated for each subject by comparing the subject's answers on the 50-ear test
with the VOE's expert panel-derived answers, and averages were determined for
each training level. RESULTS: Each pediatric resident training group had moderate
agreement (mean kappa coefficient range: .45-.56) with the VOE answers, compared 
with the novice group (mean kappa: .31, fair) and expert group (mean kappa: .80, 
substantial). Twenty-eight residents (20%) had fair or less agreement (kappa<.41)
with the VOE answers. The mean total scores of all pediatric resident training
levels were significantly (P<.05) lower than the expert group and significantly
(P<.05) higher than the novice group (with exception of the early postgraduate
year-1 group). Subjects with more training had higher kappa levels (r=.33,<.001, 
Spearman) when results were compared among novice, residents, and experts.
CONCLUSIONS: We found the VOE to be a feasible and reliable instrument to
accurately distinguish novice, resident, and expert level skills in the
determination of middle ear effusion status.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15018603 [PubMed - indexed for MEDLINE]

1414: Int J Pediatr Otorhinolaryngol. 2004 Apr;68(4):437-40.

Effect of middle ear effusion on distortion product otoacoustic emission.

Tas A, Yagiz R, Uzun C, Adali MK, Koten M, Tas M, Karasalihoglu AR.

Department of Otorhinolaryngology, Faculty of Medicine, Trakya University, Edirne
22030, Turkey. abdultas@yahoo.com

OBJECTIVES: It is well documented that children, particularly between the ages of
about 2 and 6 years, exhibit a high prevalence and incidence of otitis media.
Distortion product otoacoustic emissions (DPOAEs) offer great potential for
clinical testing of cochlear function in children. The aim of the present study
was to determine the influence of middle ear effusion and physical properties of 
the effusion on the recording of DPOAE. METHODS: Nineteen children (38 ears)
undergoing myringotomy and/or tympanostomy tube insertion for secretory otitis
media were studied. Pre-operative and post-operative first day DPOAE signal to
noise ratios were compared. The results were analyzed by paired samples test and 
ANOVA statistical methods. RESULTS: We were found significant differences between
pre-operative and post-operative first day DPOAE signal to noise at 1, 1.5, 2 and
4kHz. In addition, comparison of the pre-operative DPOAE signal to noise ratio
and per-operative middle ear findings are shown significant differences between
glue (thick mucous) and the other three groups (mucous, serous and no-effusion
groups) at 2 and 4kHz, and between glue and no effusion group at 8kHz. Also
post-operative DPOAE signal to noise ratio in relation to per-operative middle
ear findings were significantly different at 2, 4 and 8kHz. The most increase of 
emissions at the post-operative first day was seen in ears with glue effusion at 
1 and 2kHz. CONCLUSIONS: Otitis media with effusion can be monitored by DPOAE
measurement pre-operatively and post-operatively. In the pre-operative
evaluation, glue effusion may cause a reduction in the emissions at 2, 4 and 8kHz
more than the other kind effusions.

PMID: 15013610 [PubMed - indexed for MEDLINE]

1415: Int J Pediatr Otorhinolaryngol. 2004 Apr;68(4):433-5.

Cotton-tip applicators as a leading cause of otitis externa.

Nussinovitch M, Rimon A, Volovitz B, Raveh E, Prais D, Amir J.

Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah 
Tikva 49202, Israel. nussim@clalit.org.il

OBJECTIVE: Otitis externa (OE), also known as "swimmer's ear", is an inflammation
or infection of the external auditory canal. Many risk factors have been
identified, mainly excessive moisture in the canal from swimming. STUDY
DESIGN/METHODS: To study the leading risk factors of otitis externa. Eighty-seven
children aged 3.5-12 years (mean 68+/-6.5 months) who were diagnosed with otitis 
externa from December 1999 to March 2001 were studied for age, sex, cerumen
cleaning habits, signs and symptoms. Findings were compared to an age-matched
control group of 90 children without otitis externa. RESULTS: Sixty-one children 
(70.1%) in the study group had their ears cleaned with a cotton-tip applicator
(Q-tip) during the 10 days preceding the diagnosis of otitis externa. In the
control group, only 31 (34%) used applicators routinely during the 10 days prior 
to diagnosis (P<0.001). Other risk factors for otitis externa were swimming in a 
pool (34%), wax removal (5.8%) and ventilation tubes (1.1%). CONCLUSIONS: Use of 
a cotton-tip applicator to clean the ear seems to be the leading cause of otitis 
externa in children and should be avoided.

PMID: 15013609 [PubMed - indexed for MEDLINE]

1416: Am J Otolaryngol. 2004 Jan-Feb;25(1):1-4.

Asymptomatic food hypersensitivity prevalence in patients with eczematous
external otitis.

Yariktas M, Doner F, Dogru H, Demirci M.

Department of Otorhinolaryngology, Süleyman Demirel University School of
Medicine, Isparta, Turkey. myariktas@hotmail.com

PURPOSE: The purpose of our study was to investigate the association between food
hypersensitivity and eczematous external otitis. MATERIALS AND METHODS: In this
cross-sectional study, 27 patients with eczematous external otitis and 16 healthy
volunteer were included. The existence of food hypersensitivity was defined by
positive epicutaneous prick test and specific immunoglobulin E (IgE) antibodies. 
RESULTS: Food allergy test was positive in 13 (48.1%) out of 27 cases with
eczematous external otitis, and it was positive in 2 (12.5%) out of 16 cases in
control group. The difference between 2 groups was statistically significant (P
=.02). Specific IgE seropositivity (51.9%) was high in the patients with
eczematous external otitis compared with the control group (12.5%) (P =.02).
CONCLUSIONS: Food hypersensitivity may be a factor, which should be considered in
eczematous external otitis patients. Patients suffering from eczematous external 
otitis symptoms should be evaluated for food hypersensitivity.

PMID: 15011199 [PubMed - indexed for MEDLINE]

1417: West Afr J Med. 2003 Dec;22(4):366-8.

Mastoid cells myiasis in a Saudi man: a case report.

Al-Abidi AA, Bello C, Al-Ahmari M, Fawehinmi Y.

Department of Ear, Nose and Throat, Head and Neck, Assir Central Hospital, Box
34, Abha, Saudi Arabia.

We report here the case of myiasis of the mastoid cells in a 50-year old Saudi
farmer. Eight larvae of suspected Calliphorid fly were extracted from his right
mastoid at examination in the clinic. The larvae almost ate into his brain, using
their powerful screw-shaped mouth parts. It is the first report of Calliphorid
larvae affecting the mastoid cells from Saudi Arabia. The epidemiological and
clinical implications of this finding are discussed below.

Publication Types: 
    Case Reports

PMID: 15008312 [PubMed - indexed for MEDLINE]

1418: J Am Anim Hosp Assoc. 2004 Mar-Apr;40(2):102-8.

Comparison of microbial isolates and susceptibility patterns from the external
ear canal of dogs with otitis externa.

Graham-Mize CA, Rosser EJ Jr.

Department of Small Animal Clinical Sciences, Veterinary Medical Center, College 
of Veterinary Medicine, Michigan State University, East Lansing, Michigan 48824, 
USA.

Otic exudate was obtained from 33 dogs with otitis externa for cytopathology and 
culture. Two samples were taken from the same location in the external ear canal,
for a total of 100 samples. Thirty-six (36%) samples isolated only a single
organism, of which 21 (21%) were Malassezia spp. Two organisms were present in 23
(23%) of the samples. Cultures of the two samples agreed in 40 (80%) of the 50
pairs. Cytopathology agreed with culture results only 68% of the time.
Cytopathology and culture may not be as definitive as previously assumed because 
of apparent variability of the microbial population within the external canal.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15007044 [PubMed - indexed for MEDLINE]

1419: Scand J Infect Dis. 2004;36(1):6-9.

Effect of accurate diagnostic criteria on incidence of acute otitis media in
otitis-prone children.

Blomgren K, Pohjavuori S, Poussa T, Hatakka K, Korpela R, Pitkäranta A.

Helsinki University Hospital, Department of Otorhinolaryngology, Helsinki,
Finland. karin.blomgren@fimnet.fi

Over 70% of children currently suffer from acute otitis media (AOM) before their 
second birthday, and incidence is increasing rapidly. Recent studies have raised 
concern about inadequate use of diagnostic equipment and insufficient training in
diagnoses. We recruited 309 children with a history of recurrent otitis media who
were followed for 6 months during 1 infectious season. A study physician examined
and treated any child whose parents suspected AOM. Pneumatic otoscope and
tympanometry were used. Number of AOM diagnoses during the study was compared
with AOM diagnoses during the preceding 6-month period. AOM diagnoses decreased
56%, and nearly 80% of children had fewer episodes of AOM discovered than during 
the preceding 6 months. AOM is frequently over-diagnosed. Use of proper
diagnostic criteria, the pneumatic otoscope, and tympanometry can help correct
diagnosis, and thereby reduce incidence of AOM.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15000551 [PubMed - indexed for MEDLINE]

1420: Mycoses. 2004 Feb;47(1-2):85-6.

Trichophyton rubrum in the external auditory meatus.

Buzina W, Lang-Loidolt D, Ginter-Hanselmayer G.

Department of Otorhinolaryngology, Head and Neck Surgery, Graz Medical
University, Auenbruggerplatz, Graz, Austria. walter.buzina@uni-graz.at

We report the case of a 28-year-old immunocompetent male suffering from otitis
externa. The right external auditory meatus was filled with cerumen and detritus,
the tympanic membrane covered wallpaper-like with layers of fungi. Mycological
analysis revealed Trichophyton rubrum. With further examination tinea pedis of
plantar and interdigital type and concomitant onychomycosis of the toenails due
to T. rubrum could be detected. The auditory meatus was cleaned and treated
topically with clotrimazole. Two weeks later the auditory meatus and the tympanic
membrane were bare of fungi and the inflammation was resolved. Treatment of tinea
pedis and onychomycosis with terbinafine (systemically and topically) is still
lasting.

Publication Types: 
    Case Reports

PMID: 14998407 [PubMed - indexed for MEDLINE]

1421: Mycoses. 2004 Feb;47(1-2):82-4.

Chronic bilateral otomycosis caused by Aspergillus niger.

Mishra GS, Mehta N, Pal M.

Department of ENT, Shree Krishna Hospital and Pramukhswami Medical College,
Karamsad, Gujarat, India. dakshagiri@yahoo.com

Aspergillus niger, an opportunistic filamentous fungus, was identified as the
cause of chronic bilateral otomycosis in a 46-year-old female patient who was
unresponsive to different drugs. The patient showed signs of erythema, otalgia,
itching, otorrhoea and presence of greyish black coloured mass in both the ear
canals. The direct microscopical examination of the ear debris in potassium
hydroxide preparations, Giemsa, phase contrast and Gram revealed many thin,
branched septate hyphae, condia and conidiophores morphologically
indistinguishable from Aspergillus spp. The histopathological section of the ear 
wax mass by haematoxylin and eosin and periodic acid-Schiff techniques also
showed similar fungal elements. The patient responded to 1% solution of
mercurochrome. The use of mercurochrome in developing countries like India may be
recommended to treat the fungal otitis in patients. We also emphasize that
'Narayan' stain should be routinely employed by microbiology and public health
laboratories to study the morphology of pathogenic fungi.

Publication Types: 
    Case Reports

PMID: 14998406 [PubMed - indexed for MEDLINE]

1422: J Vet Med B Infect Dis Vet Public Health. 2004 Feb;51(1):1-7.

Otitis in cattle, an aetiological review.

Duarte ER, Hamdan JS.

Department of Microbiology, Biological Science Institute, Federal University of
Minas Gerais, Brazil.

Otitis externa in cattle has a significant impact in tropical and subtropical
regions, and the aetiological agents are predominantly rhabditiform nematodes and
mites of the genus Raillietia. Its prevalence is higher in mature and Zebu
cattle. In advanced clinical cases there can be irreversible and fatal neural
lesions. Ear infection in calves has been associated with concurrent respiratory 
diseases and mixed infection. The principal reported agents of otitis in calves
are bacteria such as Actinomyces spp., Corynebacterium pseudotuberculosis,
Escherichia coli, Haemophilus somnus, Pasteurella multocida, Mannheimia
haemolytica, Pseudomonas spp., Streptococcus spp. and Mycoplasma bovis. The
control and treatment of bovine otitis is not standardized and there is little
evidence-based support for the diverse treatments available in the literature.

Publication Types: 
    Review

PMID: 14995970 [PubMed - indexed for MEDLINE]

1423: Contemp Nurse. 2003 Dec-2004 Feb;16(1-2):145-50.

Erratum in:
    Contemp Nurse. 2004 Oct;17(3):281.

Middle ear problems in Aboriginal school children cause developmental and
educational concerns.

Thorne JA.

CNC Audiometry, Child & Family Health Centre, Northern Rivers Area Health
Service, Goonellabah, New South Wales.

An epidemiological study was carried out in the year 2000 and sought to measure
the occurrences of middle ear disease and hearing loss within school aged (4
years to 12 years) Aboriginal children. A number of the local schools and
preschools in Coraki and Lismore with a high percentage of Aboriginal students
were selected in an effort to identify service gaps regarding essential hearing
screenings and assessments. A total of 185 (370 ears) Aboriginal children aged 4 
years to 12 years were examined from four schools and three preschools. This
examination included otoscopy, tympanometry and audiometry. Data were collected
as each child was tested and this was then entered into a computer database on
returning to the work place. Results indicated that 61.08% of these children had 
middle ear problems of some type. Unilateral hearing loss of 30 dB or greater was
found in 10.80% of children, bilateral hearing loss of 30 dB and greater was
found in 22.16%, and perforation of tympanic membranes in 3.24%. Suggestions are 
made in relation to the need for ongoing training of Aboriginal Community
Audiometrists to provide community, school and preschool screening programs
together with health related promotional activities to minimise the occurrences
of ear infections.

PMID: 14994905 [PubMed - indexed for MEDLINE]

1424: Pediatrics. 2004 Mar;113(3 Pt 1):e238-48.

Comment in:
    J Pediatr. 2004 Sep;145(3):418-9.    Pediatrics. 2004 Aug;114(2):508-9; author reply 508-9.

Otitis media and speech and language: a meta-analysis of prospective studies.

Roberts JE, Rosenfeld RM, Zeisel SA.

Frank Porter Graham Child Development Institute, University of North Carolina,
Chapel Hill, North Carolina 27599-8180, USA. joanne_roberts@unc.edu

OBJECTIVE: Considerable controversy surrounds whether a history of otitis media
with effusion (OME) in early childhood causes later speech and language problems.
We conducted a meta-analysis of prospective studies to determine: 1) whether a
history of OME in early childhood is related to receptive language, expressive
language, vocabulary, syntax, or speech development in children 1 to 5 years old 
and 2) whether hearing loss caused by otitis media in early childhood is related 
to children's receptive language or expressive language through 2 years of age.
METHODS: We searched online databases and bibliographies of OME studies and
reviews for prospective or randomized clinical trials published between January
1966 and October 2002 that examined the relationship of OME or OME-associated
hearing loss in early childhood to children's later speech and language
development. The original search identified 38 studies, of which 14 had data
suitable for calculating a pooled correlation coefficient (correlational studies)
or standard difference between parallel groups (group studies). Random-effects
meta-analysis was used to pool data when at least 3 studies had usable data for a
particular outcome. RESULTS: We performed 11 meta-analyses. There were no
significant findings for the analyses of OME during early childhood versus
receptive or expressive language during the preschool years in the correlation
studies. Similarly, there were no significant findings for OME versus vocabulary,
syntax, or speech during the preschool years. Conversely, there was a significant
negative association between OME and preschoolers' receptive and expressive
language (lower language) (0.24 and 0.25 standard difference, respectively) in
the group studies. Additionally, hearing was also related to receptive and
expressive language in infancy (3%-9% of variance). CONCLUSIONS: Our results
indicate no to very small negative associations of OME and associated hearing
loss to children's later speech and language development. These findings may
overestimate the impact of OME on outcomes, because most studies did not adjust
for known confounding variables (such as socioeconomic status) and excluded data 
not suitable for statistical pooling, especially from methodologically sound
studies. Although some OME language differences were detectable by meta-analysis 
due to increased statistical power, the clinical relevance for otherwise healthy 
children is uncertain.

Publication Types: 
    Meta-Analysis
    Research Support, U.S. Gov't, P.H.S.

PMID: 14993583 [PubMed - indexed for MEDLINE]

1425: J Infect Chemother. 2004 Feb;10(1):46-8.

Molecular confirmation of transmission route of Staphylococcus intermedius in
mastoid cavity infection from dog saliva.

Kikuchi K, Karasawa T, Piao C, Itoda I, Hidai H, Yamaura H, Totsuka K, Morikawa
T, Takayama M.

Department of Infectious Diseases, Tokyo Women's Medical University School of
Medicine, Japan. kikuti@clabo.twmu.ac.jp

We report a case of infection of a mastoid cavity after mastoidectomy had been
performed for chronic otitis media with cholesteatoma. The infection was caused
by Staphylococcus intermedius after a pet dog had licked the patient's ears.
Bacterial strains from the dog's saliva and the otorrhea in the patient were
confirmed to be identical by pulsed-field gel electrophoresis analysis. The
possibility of an oral transmission route of S. intermedius from pets to humans
should be noted.

Publication Types: 
    Case Reports

PMID: 14991518 [PubMed - indexed for MEDLINE]

1426: Otolaryngol Head Neck Surg. 2004 Feb;130(2):249-54.

Effect of nitric oxide on mucin production in experimental otitis media.

Martin P, Choi DJ, Jinn TH, Cohen JG, John EO, Moorehead MT, Kaura CS, Kaura SH, 
Jung TT.

Division of Otolaryngology-Head adn Neck Surgery, Loma Linda University School of
Medicine, Loma Linda, California, 92354, USA. tjung1790@aol.com

OBJECTIVE: The purpose of this study was to determine the role of nitric oxide
(NO) in the pathogenesis of mucoid otitis media (OM) in lipopolysaccharide
(LPS)-induced OM. METHODS: OM was induced in chinchillas by injecting
S-nitroso-N-acetylpenicillamine (SNAP), LPS, and LPS + SNAP into the superior
bullae. Auditory brainstem response thresholds were measured every 24 hours.
Samples of middle ear fluid were collected and analyzed for mucin by the periodic
acid-Schiff method. At the end of each experiment, temporal bones were harvested 
for histopathologic study. RESULTS: Mucin concentration was greatest in the LPS +
the SNAP group and least in the SNAP-alone group. Auditory brainstem response
threshold was highest in the LPS group and lowest in the SNAP group, although not
significantly. Histopathology showed the greatest mucosal thickening and
inflammation in the LPS + SNAP group. CONCLUSION: The addition of NO in
LPS-induced OM increased the mucin concentration in middle ear fluid and
increased mucosal thickness and inflammation in middle ear mucosa. SIGNIFICANCE: 
In the OM disease process, NO may contribute to the pathogenesis of mucoid OM.

PMID: 14990923 [PubMed - indexed for MEDLINE]

1427: Otolaryngol Head Neck Surg. 2004 Feb;130(2):242-8.

Cell adhesion molecules and cytokines in middle ear effusions in children with or
without recent acute otitis media.

Russo E, Smith CW, Friedman EM, Smith EO, Kaplan SL.

Department of Otolaryngology, Baylor College of Medicine, Houston, Texas 77030,
USA. skaplan@bcm.tmc.edu

OBJECTIVES: We sought to compare the levels of cytokines and cell adhesion
molecules in middle ear effusions (MEEs) of children with (group 1) or without
(group 2) acute otitis media (AOM) within 3 months of obtaining MEE and to
correlate these levels with hearing loss. DESIGN AND SUBJECTS: MEE were collected
from children (49 and 51 children composed groups 1 and 2, respectively) with
otitis media with effusion (OME) undergoing tube placement who had an audiogram
performed preoperatively. MEE was assessed as serous or mucoid. Cytokines and
cell adhesion molecules were measured by enzyme-linked immunosorbent assay. Data 
were analyzed with the Student t test, chi(2) test, and the Pearson correlation
test. RESULTS: Concentrations of interleukin (IL)-1, IL-6, and vascular cell
adhesion molecules (VCAM) were greater in the MEE of the children in group 1
compared with those of group 2 children. (P < 0.001 for IL-1 and IL-6; P < 0.05
for VCAM). The concentrations of IL-1, IL-6, VCAM, and E-selectin were greater in
serous than in mucoid MEE. (P < 0.05). Concentrations of IL-6 correlated with the
concentrations of the other 2 cytokines and the 3 cell adhesion molecules. Only
concentrations of IL-6 in MEE correlated with the degree of hearing loss (P <
0.002). CONCLUSIONS: The inflammatory response leading to OME involves multiple
cytokines regardless of an AOM episode in the 3 months before obtaining MEE. IL-6
is an important cytokine in the pathogenesis of OME.

PMID: 14990922 [PubMed - indexed for MEDLINE]

1428: Ear Nose Throat J. 2004 Jan;83(1):50-2.

A case of pneumocephalus and meningitis as a complication of silent otitis media.

Turgut S, Ercan I, Alkan Z, Cakir B.

Otorhinolaryngology-Head and Neck Surgery Clinic, Sisli Etfal Teaching and
Research Hospital, Etfal S. Sisli, Istanbul, Turkey.

Silent otitis media is a progressive otogenic disease. Intracranial
manifestations of this complication are limited; the most common is meningitis.
We report a case of meningitis and pneumocephalus as a complication of silent
otitis media. To the best of our knowledge, this is the first reported case of
pneumocephalus as a complication of silent otitis media.

Publication Types: 
    Case Reports

PMID: 14986759 [PubMed - indexed for MEDLINE]

1429: Ear Nose Throat J. 2004 Jan;83(1 Suppl):9-11.

The evolution of ototopical therapy: from cumin to quinolones.

Myer CM 3rd.

Department of Pediatric Otolaryngology, Children's Hospital Medical Center,
Cincinnati, USA.

A radical change has occurred in the management of otorrhea over the past decade.
Multiple studies have supported the efficacy of topical quinolones in the
management of acute otitis media, acute otitis externa, and CSOM. For the first
time, otolaryngologists have a scientific foundation on which to base our
treatment protocols for these conditions. We no longer must rely solely on our
clinical experience and prejudices. The quinolone drops have a superior safety
profile and a broad antimicrobial spectrum, their overall cost is lower than the 
alternatives, and their convenient dosing schedule is tolerated well by most
patients. When one takes all these factors into consideration, it becomes clear
that topical quinolone therapy, with or without a steroid additive, is the
treatment of choice for otorrhea in patients with a tympanic membrane perforation
or ventilating tube. The development of ototopical medications has followed along
the lines of Darwinian evolution, and the quinolone drops have clearly
demonstrated the concept of "survival of the fittest."

Publication Types: 
    Review

PMID: 14986397 [PubMed - indexed for MEDLINE]

1430: Ear Nose Throat J. 2004 Jan;83(1 Suppl):5-8.

The formation and management of middle ear granulation tissue in chronic ear
disease.

Roland PS.

Department of Otolaryngology-Head and Neck Surgery, University of Texas
Southwestern Medical Center, Dallas, USA.

Granulation tissue is an important pathogenic feature of all types of chronic ear
disease, and it can be controlled and treated with good aural toilet, appropriate
antibiotic therapy, topical steroids, and chemical cautery or surgical
debridement.

Publication Types: 
    Review

PMID: 14986396 [PubMed - indexed for MEDLINE]

1431: Antimicrob Agents Chemother. 2004 Mar;48(3):860-6.

Effect of antibiotic treatment delay on therapeutic outcome of experimental acute
otitis media caused by Streptococcus pneumoniae strains with different
susceptibilities to amoxicillin.

Parra A, Ponte C, Cenjor C, Martínez-Marín C, Soriano F; Spanish Pneumoccal
Infection Study Network.

Department of Medical Microbiology, Fundación Jiménez Díaz, 28040 Madrid, Spain.

The effect of delayed administration of amoxicillin on the course of acute otitis
media (AOM) caused by two Streptococcus pneumoniae strains with different
susceptibilities to amoxicillin (MICs of 0.016 and 1 microg/ml for strains A and 
B, respectively) was evaluated in the gerbil model. The organisms were inoculated
by transbullar challenge into the middle ear, and antibiotic treatment was
administered at various times thereafter. The bacteriological and clinical
efficacies of treatment diminished significantly with the delay of antibiotic
administration. The bacterial eradication rates when antibiotic treatment was
started at 2, 5, 8, 18, and 21 h post-bacterial inoculation were different for
both strains (95, 95, 90, 55, and 55% for strain A and 95, 95, 65, 10, and 0% for
strain B). Results of further experiments using strain B with higher antibiotic
doses and numbers of administrations and different follow-up times indicate that 
the failures observed with the delayed administration were not related to the
bacterial burden, selection of antibiotic-resistant mutants, or inadequate
pharmacodynamic parameters. Such failures may be related to the metabolic
bacterial status. The delayed amoxicillin treatment of AOM caused by S.
pneumoniae may lead to therapeutic failures, mainly when organisms with
diminished antibiotic susceptibility are involved.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14982776 [PubMed - indexed for MEDLINE]

1432: ORL J Otorhinolaryngol Relat Spec. 2003 Nov-Dec;65(6):375-8.

Cochlear implantation after radical mastoidectomy: management of a challenging
case.

Karatzanis AD, Chimona TS, Prokopakis EP, Kyrmizakis DE, Velegrakis GA.

Department of Otolaryngology, University of Crete School of Medicine, Heraklion, 
Greece.

Due to increasing experience and technological improvement, the selection
criteria for cochlear implantation have improved. Cochlear implant application
can now be performed in selected patients with pathological middle ear lesions.
The surgical approach to a patient with a history of bilateral radical
mastoidectomy is addressed in detail. The benefits of cochlear implantation in
this case are also discussed. Copyright 2003 S. Karger AG, Basel

Publication Types: 
    Case Reports

PMID: 14981333 [PubMed - indexed for MEDLINE]

1433: J Laryngol Otol. 2004 Jan;118(1):65-8.

Extensive calvarial tuberculosis: rare complication of tuberculous mastoiditis.

Thandar MA, Fagan JJ, Garb M.

Department of Otolaryngology, Groote Schuur Hospital and University of Cape Town,
Cape Town, South Africa. mthandar@discoveymail.co.za

Tuberculous mastoiditis is a well-documented entity with decreasing incidence in 
recent years. Tuberculous osteitis of the skull is even rarer. The case of a
58-year-old male with tuberculous mastoiditis complicated by extensive
tuberculous osteitis of the skull is presented. This case serves to demonstrate
both the difficulty in establishing the diagnosis of tuberculosis and the
potentially disastrous consequences of the disease.

Publication Types: 
    Case Reports

PMID: 14979979 [PubMed - indexed for MEDLINE]

1434: J Laryngol Otol. 2004 Jan;118(1):54-6.

Radical mastoidectomy cavity myiasis caused by Wohlfahrtia magnifica.

Uzun L, Cinar F, Beder LB, Aslan T, Altintas K.

Department of ENT, Karaelmas University School of Medicine, Zonguldak, Turkey.
luzun@mailcity.com

In this article, a Wohlfahrtia magnifica otomyiasis case, a 31-year-old,
non-mentally retarded patient who had undergone radical mastoidectomy previously 
is presented. Maggots in the radical mastoidectomy cavity were removed then
topical treatment was applied. The maggots were identified as W. magnifica. In
cases of myiasis, identification of larvae following direct extraction and
application of preventative methods is essential.

Publication Types: 
    Case Reports

PMID: 14979975 [PubMed - indexed for MEDLINE]

1435: J Laryngol Otol. 2004 Jan;118(1):50-3.

Complicated otitis media caused by Fusobacterium necrophorum.

Giridharan W, De S, Osman EZ, Amma L, Hughes J, McCormick MS.

Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK.
giri85@hotmail.com

Fusobacterium necrophorum is implicated as an aetiological agent in a variety of 
necrotic diseases, such as Lemièrre's syndrome (LS) in humans. LS was initially
described as septic thrombophlebitis of the internal jugular vein secondary to an
acute oropharyngeal infection. Other primary sources of infection include
parotitis, otitis media, sinusitis, odontogenic infection and mastoiditis. In the
pre-antibiotic era LS carried a high mortality. This has been reduced as a result
of the widespread use of antibiotics, but there is still a definite morbidity and
mortality associated with infection with this virulent organism. We report three 
cases of complicated otitis media caused by Fusobacterium necrophorum. The
patients were treated successively with intravenous metronidazole and surgery.

Publication Types: 
    Case Reports

PMID: 14979974 [PubMed - indexed for MEDLINE]

1436: J Laryngol Otol. 2004 Jan;118(1):48-9.

Sweet's syndrome affecting the external auditory canal and tympanic membrane.

Saliba WR, Goldstein LH, Habib GS, Elias MS.

Department of Medicine C, Ha-Emeq Medical Center, Faculty of Medicine, Afula,
Israel. salibuss@yahoo.com

We report a patient who developed left ear pain, dry cough, and fever. The
external auditory canal was tender, swollen, erythematous and full of debris.
Later the patient developed widespread tender and red skin nodules and pustules
that subsequently coalesced to form plaques. Identical lesions developed also in 
the external auditory canal and the tympanic membrane of the affected ear. Skin
biopsy showed dermal neutrophilia, compatible with the diagnosis of Sweet's
syndrome. Rapid improvement was achieved with prednisone after the failure of
antibiotics.

Publication Types: 
    Case Reports

PMID: 14979973 [PubMed - indexed for MEDLINE]

1437: J Laryngol Otol. 2004 Jan;118(1):3-7.

Cochlear implantation in chronic otitis media.

Incesulu A, Kocaturk S, Vural M.

2nd ENT Clinic, SSK Ankara Hospital, Ankara, Turkey. armaganincesulu@yahoo.com

Patients with chronic otitis media (COM) may have profound sensorineural hearing 
loss either due to the disease process or secondary to a surgical procedure. Some
patients who are candidates for cochlear implantation may have COM
coincidentally. The patients in this group need special attention when cochlear
implantation is applied. The aim of this study is to evaluate the potential risks
and complications in patients with COM. Cochlear implantation was performed in
six patients with COM or an infected radical cavity and profound hearing loss.
Five of them underwent a two-stage operation, and one had a single-stage
operation. Cochlear implantation was performed in all patients without
complications. The follow-up period was uneventful. Although such patients have
some potential risks, when certain surgical rules are followed very strictly
cochlear implantation can be successfully performed in patients with COM.

Publication Types: 
    Review

PMID: 14979963 [PubMed - indexed for MEDLINE]

1438: J Laryngol Otol. 2004 Feb;118(2):97-101.

Anti-inflammatory effect of erythromycin on histamine-induced otitis media with
effusion in guinea pigs.

Aktan B, Gundogdu C, Ucuncu H, Unal B, Sütbeyaz Y, Altas S.

Department of Otorhinolaryngology-Head and Neck Surgery, Atatürk University,
School of Medicine, Erzurum, Turkey.

In this study, the anti-inflammatory effect of erythromycin was investigated in a
model of histamine-induced otitis media with effusion (OME). OME was induced in
guinea pigs by the transtympanic injection of histamine solution into the
middle-ear cavity. Guinea pigs were randomly assigned to one of three groups:
control, erythromycin treatment, or methylprednisolone treatment. After histamine
injection, the animals were treated with intraperitoneal medication for five days
consecutively. Afterwards, the animals were sacrificed and the temporal bones
were removed. The samples were examined stereologically. In the
erythromycin-treated group, it was observed that neutrophil infiltration was
significantly inhibited when compared to the control group. This result shows
that erythromycin may produce a significant anti-inflammatory effect in this
model of OME.

Publication Types: 
    Comparative Study

PMID: 14979944 [PubMed - indexed for MEDLINE]

1439: J Laryngol Otol. 2004 Feb;118(2):93-6.

Randomized controlled trial on the treatment of otitis externa with one per cent 
silver nitrate gel.

van Hasselt P, Gudde H.

Ear Clinic, Bamalete Lutheran Hospital, Ramotswa, Botswana. pvhasselt@planet.nl

Otitis externa (OE) and especially otomycosis can be very persistent and
difficult to control. In the present study the efficacy of treatment of OE with a
single instillation in the ear canal of one per cent silver nitrate in three per 
cent hypromellose gel compared to 0.1 per cent silver nitrate gel was tested in a
single-blinded randomized controlled parallel group study. The outcome measure
was complete resolution of the OE after one week. Forty-four patients with
refractory, bacterial as well as fungal, OE entered the study, comprising 30 ears
in each treatment arm. Eight patients defaulted from follow-up, five ears in each
treatment arm. A single instillation of one per cent silver nitrate gel cured 23 
(92 per cent) of 25 ears with OE, whereas with 0.1 per cent silver nitrate gel
seven (28 per cent) of 25 ears treated were cured (Fisher-exact test, p-exact =
0.00010). In a non-controlled series of 120 ears 93.3 per cent needed only a
single instillation of one per cent silver nitrate gel while another five per
cent were cured after a second instillation a week later. There were no adverse
reactions. OE can be treated effectively with instillation of one per cent silver
nitrate gel and is particularly useful in recalcitrant otomycosis. The treatment 
method saves both cost and time.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 14979943 [PubMed - indexed for MEDLINE]

1440: Acta Otolaryngol. 2004 Jan;124(1):69-76.

The aging ear: an otomicroscopic and tympanometric study.

Stenklev NC, Vik O, Laukli E.

ENT Department, University Hospital of Tromsø, Tromsø, Norway.
niels.christian.stenklev@unn.no

OBJECTIVES: To analyze changes in tympanometric measures with age and to study
some otitis-related issues in the elderly (> or = 60 years) population. MATERIAL 
AND METHODS: The study was designed as a combination of a cross-sectional survey 
and a controlled study. We studied a random sample of 232 elderly subjects using 
an extended battery of audiological tests, including pure-tone audiometry.
tympanometry with a probe frequency of 226 Hz, otomicroscopy and a standardized
questionnaire. A sample of 60 otologically normal subjects were selected for
comparative analysis with young healthy controls, and for description of
age-related changes and gender differences. RESULTS: Using linear regression
analyses of ear canal volume, middle ear pressure and tympanic membrane
compliance on age, no consistently significant change in these parameters with
age was found. When these measures were compared between the elderly and the
controls, using parametric and non-parametric statistical tests, no significant
differences were found for either gender. The only significant gender difference 
was found for ear canal volume, which was greater for elderly males than for
elderly females In the unscreened elderly sample, the adjusted prevalence for
reported previous or current otitis media was 15-27% of the population (95% CI). 
The adjusted prevalence for reported previous or current chronic otitis media
(COM) or sequelae thereof was 1-7% (95% CI). With the exception of cerumen
obstruction, the prevalence of outer ear canal-related complaints was 1-7% (95%
CI). There were some discrepancies between these reported complaints and the
findings at otomicroscopy. Although elderly subjects with COM were found to have 
poorer hearing at speech frequencies than normal elderly subjects. no such effect
was found in subjects with scarring or atrophy of the tympanic membrane. The
effect of pathological findings at otomicroscopy on tympanometric measures in the
elderly sample was highly variable and no consistent association was found.
CONCLUSIONS: No change in middle ear sound transmission, as assessed by
tympanometry, occurs with normal aging. Ear canal volume is smaller in elderly
females than elderly males, which is potentially relevant to the study of
otoacoustic emissions in the elderly. The estimated prevalence of ear
canal-related problems, excluding cerumen obstruction, is of such a magnitude
that the introduction of partially implanted hearing aids may be warranted in our
elderly population.

PMID: 14977081 [PubMed - indexed for MEDLINE]

1441: Acta Otolaryngol. 2004 Jan;124(1):36-40.

Horizontal vestibulo-ocular reflex dynamics in acute vestibular neuritis and
viral labyrinthitis: evidence of otolith-canal interaction.

Maire R, Van Melle G.

Clinic of Otolaryngology Head & Neck Surgery, Neurotology Unit, University
Hospital Lausanne, Lausanne, Switzerland. Raphael.Maire@chuv.hospvd.ch

OBJECTIVE: To evaluate the dynamic properties of the horizontal vestibulo-ocular 
reflex (h-VOR) in the acute stage of two common labyrinthine diseases that
provoke severe attacks of vertigo with spontaneous nystagmus: vestibular neuritis
(vestibular loss alone) and viral labyrinthitis (cochleovestibular loss).
MATERIAL AND METHODS: Sixty-three patients were investigated: 42 were diagnosed
with vestibular neuritis and 21 with viral labyrinthitis. The h-VOR function was 
evaluated by conventional caloric and impulsive testing. A simplified model of
vestibular function was used to analyze the vestibulo-ocular response to
rotational stimulation. RESULTS: The results showed a significant difference in
h-VOR characteristics between the two pathologies. Patients with vestibular
neuritis exhibited a strong horizontal semicircular canal deficit, but no h-VOR
asymmetry between the two rotational directions. In contrast, patients with viral
labyrinthitis demonstrated moderate canal paresis and a marked h-VOR deficit in
rotation toward the affected ear. CONCLUSION: These findings support the
hypothesis that the h-VOR dynamic asymmetry that occurs after an acute unilateral
inner ear lesion is not due to canal dysfunction alone, but involves complex
adaptive changes in the central VOR that may implicate the otolith system. Based 
on histopathologic and clinical differences in the two pathologies reported in
the literature, we postulate that this otolith-canal interaction is mainly linked
to the loss of saccular function.

PMID: 14977076 [PubMed - indexed for MEDLINE]

1442: Acta Otolaryngol. 2004 Jan;124(1):23-5.

Bacteriology of mastoid subperiosteal abscess in children.

Migirov L, Kronenberg J.

Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel
Hashomer, Israel.

OBJECTIVE: Subperiosteal abscess (SA) is the most frequent complication of acute 
mastoiditis (AM). Of pathogens cultured from the external auditory canal or
middle ear during myringotomy, 15% may be different from microorganisms isolated 
from the SA. We suggest, therefore, that only cultures obtained from the abscess 
cavity can truly reflect the bacteriology of this complication of AM. The purpose
of our study was to analyze the infectious agents which cause SA and mastoid
cortex erosion in children. MATERIAL AND METHODS: The medical records of 35
children who underwent mastoidectomy for SA between May 1984 and April 2002 were 
evaluated. RESULTS: Mastoid cortex erosion was found at surgery in 72.7% of
abscesses Purulent discharge was obtained from the SA cavity in 28 cases. The
commonest pathogens isolated in these cases, as well as in 18 cases of mastoid
cortex erosion, were Staphylococcus aureus and Streptococcus pyogenes, followed
by Streptococcus pneumoniae. Hemophilus influenzae, Pseudomonas aeruginosa,
Escherichia coli and Klebsiella pneumoniae. Sterile culture was found in 25% of
cases. CONCLUSIONS: Mastoid SA is a unilateral disease that can recur. Early
administration of anti-Staphylococcus medications should be considered for
patients with SA as a complication of AM.

PMID: 14977073 [PubMed - indexed for MEDLINE]

1443: Am J Otolaryngol. 2004 Mar-Apr;25(2):110-7.

Posttympanostomy tube otorrhea.

Oberman JP, Derkay CS.

Naval Medical Center, Portsmouth, VA 23321, USA. James.Oberman@cox.net

This article will focus on some theories and recent advances to explain chronic
post tympanostomy tube otorrhea, a step-wise approach to treatment and future
research areas of interest.

Publication Types: 
    Review

PMID: 14976657 [PubMed - indexed for MEDLINE]

1444: J Infect Dis. 2004 Mar 1;189(5):775-84. Epub 2004 Feb 16.

Does the presence of pneumococcal DNA in middle-ear fluid indicate pneumococcal
etiology in acute otitis media?

Palmu AA, Saukkoriipi PA, Lahdenkari MI, Kuisma LK, Makela PH, Kilpi TM, Leinonen
M.

Department of Vaccines, National Public Health Institute, Helsinki, Finland.
arto.palmu@ktl.fi.

Bacterial culture of middle-ear fluid (MEF), the standard for etiologic diagnosis
of acute otitis media (AOM), has revealed Streptococcus pneumoniae (Pnc) to be a 
major pathogen responsible for one-third of AOM cases. In the present study, we
compared the results of polymerase chain reaction (PCR) based on the
amplification of the pneumolysin gene with the results of pneumococcal culture,
for 2595 MEF samples obtained during AOM events in 831 children who were followed
from 2-24 months of age in the Finnish Otitis Media Vaccine Trial. PCR results
were positive for 47.1% of the MEF samples, and culture results were positive for
27.3% of the samples. PCR-positive, culture-negative samples were associated with
previous Pnc AOM in a time-dependent pattern, concurrent antibiotic treatment,
low volume of MEF, and concurrent nasopharyngeal carriage. PCR-positive AOM
represented a clinically less severe disease, compared with culture-positive Pnc 
AOM. A positive PCR result seemed to indicate the presence of viable, although
often nonculturable, Pnc.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14976593 [PubMed - indexed for MEDLINE]

1445: Cochrane Database Syst Rev. 2004;(1):CD001480.

Update of:
    Cochrane Database Syst Rev. 2002;(2):CD001480.

Pneumococcal vaccines for preventing otitis media.

Straetemans M, Sanders EA, Veenhoven RH, Schilder AG, Damoiseaux RA, Zielhuis GA.

Department of Epidemiology and Biostatistics, UMC Nijmegen, Geert Grooteplein 21,
Nijmegen, Netherlands. masjastraetemans@yahoo.com

BACKGROUND: Acute otitis media (AOM) is one of the most common diseases in early 
infancy and childhood. Long term effects of recurrent episodes of otitis media,
rapid emergence of drug resistant bacteria associated with AOM worldwide and huge
estimated direct and indirect annual costs associated with otitis media have
emphasized the need for an effective vaccination program to prevent episodes of
AOM. OBJECTIVES: The object of this review was to assess the effect of
pneumococcal vaccination in preventing AOM in children up to 12 years of age.
SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials
(CENTRAL) (issue 2, 2003) which contains the Cochrane Acute Respiratory Infection
Group's specialised register (30th June 2003), MEDLINE (January 1966 to June
2003), EMBASE (January 1990 to June 2003) and reference lists of all studies and 
review articles retrieved. We also contacted two vaccine manufacturers and first 
or corresponding authors of some of the included studies. SELECTION CRITERIA:
Randomised controlled clinical trials of pneumococcal vaccination with prevention
of AOM as outcome in children aged 12 years or younger and a follow-up of at
least six months after vaccination. DATA COLLECTION AND ANALYSIS: Five reviewers 
independently assessed trial quality and two reviewers extracted data. Two study 
authors were contacted. MAIN RESULTS: Eight trials on 8-to 14-valent pneumococcal
polysaccharide vaccine (PPV) and four trials on 7-to 9-valent pneumococcal
conjugate vaccine (PCV) were included. The highest efficacy of PPV was found in
children aged 24 months and older: the rate ratio was 0.779 [95% CI:
0.625-0.970]. PPV has little effect on the prevention of AOM in children without 
documented prior episodes of AOM and only a moderate effect in the group of
children with documented AOM episodes prior to vaccination. Pooled results of the
four PCV trials in infants vaccinated as early as two months of age and toddlers 
attending daycare and toddlers with recurrent AOM showed only a small effect on
prevention of AOM (rate ratio 0.921; 95% CI: 0.894-0.950). REVIEWER'S
CONCLUSIONS: Based on the currently available results of the effectiveness of
pneumococcal vaccination for the prevention of AOM, a large scale use of
pneumococcal polysaccharide and conjugate vaccination for this specific
indication is not yet recommended. So far, pneumococcal conjugate vaccinations
are not indicated in the management of recurrent AOM in toddlers and older
children. The results of currently ongoing trials of 9- and 11-valent conjugate
vaccines should provide more information as to whether pneumococcal vaccines are 
more effective in specific high-risk populations like infants and older children 
with recurrent AOM or immunodeficiency.

Publication Types: 
    Review

PMID: 14973970 [PubMed - indexed for MEDLINE]

1446: Cochrane Database Syst Rev. 2004;(1):CD000219.

Comment in:
    Ann Emerg Med. 2004 Nov;44(5):537-9.    Evid Based Nurs. 2004 Jul;7(3):74.

Update of:
    Cochrane Database Syst Rev. 2000;(4):CD000219.

Antibiotics for acute otitis media in children.

Glasziou PP, Del Mar CB, Sanders SL, Hayem M.

University of Oxford, Department of Primary Health Care, Institute of Health
Sciences, Old Road, Headington, Oxford, Oxon, UK, OX3 7LF.

BACKGROUND: Acute otitis media is one of the most common diseases in early
infancy and childhood. Antibiotic use for acute otitis media varies from 31% in
the Netherlands to 98% in the USA and Australia. OBJECTIVES: The objective of
this review was to assess the effects of antibiotics for children with acute
otitis media. SEARCH STRATEGY: We searched the Cochrane Central Register of
Controlled Trials (CENTRAL); MEDLINE, Index Medicus (pre 1965), Current Contents 
and reference lists of articles from 1958 to January 2000. The search was updated
in 2003. SELECTION CRITERIA: Randomised trials comparing antimicrobial drugs with
placebo in children with acute otitis media. DATA COLLECTION AND ANALYSIS: Three 
reviewers independently assessed trial quality and extracted data. MAIN RESULTS: 
Ten trials were eligible based on design, only eight of the trials, with a total 
of 2,287 children, included patient-relevant outcomes. The methodological quality
of the included trials was generally high. All trials were from developed
countries. The trials showed no reduction in pain at 24 hours, but a 30% relative
reduction (95% confidence interval 19% to 40%) in pain at two to seven days.
Since approximately 80% of patients will have settled spontaneously in this time,
this means an absolute reduction of 7% or that about 15 children must be treated 
with antibiotics to prevent one child having some pain after two days. There was 
no effect of antibiotics on hearing problems of acute otitis media, as measured
by subsequent tympanometry. However, audiometry was done in only two studies and 
incompletely reported. Nor did antibiotics influence other complications or
recurrence. There were few serious complications seen in these trials: only one
case of mastoiditis occurred in a penicillin treated group. REVIEWER'S
CONCLUSIONS: Antibiotics provide a small benefit for acute otitis media in
children. As most cases will resolve spontaneously, this benefit must be weighed 
against the possible adverse reactions. Antibiotic treatment may play an
important role in reducing the risk of mastoiditis in populations where it is
more common.

Publication Types: 
    Meta-Analysis
    Review

PMID: 14973951 [PubMed - indexed for MEDLINE]

1447: Diagn Microbiol Infect Dis. 2004 Feb;48(2):97-9.

The occurrence of Chlamydia pneumoniae, Mycoplasma pneumoniae, and herpesviruses 
in otitis media with effusion.

Storgaard M, Tarp B, Ovesen T, Vinther B, Andersen PL, Obel N, Jensen JS.

Department of Infectious Diseases, Skejby University Hospital, Aarhus, Denmark.
m.storgaard@dadlnet.dk

In a previous report we found Chlamydia (C.) pneumoniae to be present in middle
ear fluids (MEE) from older children with otitis media with effusion (OME).
However, OME is a disease of younger children the present study was conducted in 
toddlers. MEEs (n = 150) and nasopharynx samples (n = 83) from children with OME 
was analyzed by PCR for the presence of C. pneumoniae and Mycoplasma (M.)
pneumoniae. C. pneumoniae was not present in any and M. pneumoniae only in one of
the MEEs, and these pathogens could be demonstrated in one and two nasopharynx
samples, respectively. Further, 133 MEEs were analyzed by PCR for the presence of
the 8 human herpesviruses, and all samples were found to be negative. We conclude
that neither C. pneumoniae or M. pneumoniae, or any of the 8 human herpesviruses 
seems to play a major role in the pathogenesis of OME in early childhood OME.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14972377 [PubMed - indexed for MEDLINE]

1448: Ann Pharmacother. 2004 Mar;38(3):433-9. Epub 2004 Jan 23.

Single-dose azithromycin for respiratory tract infections.

Law C, Amsden GW.

Section of Clinical Pharmacology, Department of Adult and Pediatric Medicine, and
Clinical Pharmacology Research Center, Bassett Healthcare, Cooperstown, NY 13326,
USA.

OBJECTIVE: To describe the pharmacology, efficacy, and safety data of the use of 
single-dose azithromycin for respiratory tract infections in children and adults.
DATA SOURCES: A MEDLINE search (1990-September 2003) was performed to identify
all pertinent studies and review articles. When appropriate information was not
available in the literature, data were obtained from the product manufacturers or
abstracts from international conferences. STUDY SELECTION AND DATA EXTRACTION:
All available studies were reviewed to provide pharmacokinetic, pharmacodynamic, 
efficacy, and safety data on use of single-dose azithromycin for respiratory
tract infections. DATA SYNTHESIS: Several studies have demonstrated that shorter 
regimens of azithromycin (1500 mg over 3 day vs 5 day or single dose vs 3 day)
provide higher serum exposures compared with the longer regimens. This makes it
possible to give the same dose over a shorter period of time and achieve the same
efficacy with the potential for enhanced adherence. Single-dose azithromycin 30
mg/kg was approved in 2003 for treatment of acute otitis media (AOM) in children.
Studies have demonstrated that, when administering azithromycin as a single dose,
its efficacy and safety are comparable to that of other standard regimens for
AOM. Single-dose regimens for treatment of respiratory tract infections in adults
have not been studied widely, with only 2 studies being conducted for treatment
of community-acquired pneumonia and one study for treatment of tonsillitis; all
demonstrated at least equal efficacy with the single-dose regimen compared with
comparators given for longer periods of time. CONCLUSIONS: Available data
regarding single-dose azithromycin are promising. Although use of this regimen in
children is warranted based on studies to date, additional large-scale trials are
needed prior to mainstream use of the regimen in adults.

Publication Types: 
    Review

PMID: 14970367 [PubMed - indexed for MEDLINE]

1449: Lancet. 2004 Feb 7;363(9407):465-73.

Erratum in:
    Lancet. 2004 Mar 27;363(9414):1080.

Comment in:
    Lancet. 2004 Apr 17;363(9417):1324-5; author reply 1325.    Lancet. 2004 Apr 17;363(9417):1324; author reply 1325.

Otitis media.

Rovers MM, Schilder AG, Zielhuis GA, Rosenfeld RM.

Julius Centre for Health Sciences and Primary Care, University Medical Centre, PO
Box 85060, 3508 AB, Utrecht, Netherlands. MRovers@umcutrecht.nl

Otitis media (OM) continues to be one of the most common childhood infections and
is a major cause of morbidity in children. The pathogenesis of OM is
multifactorial, involving the adaptive and native immune system, Eustachian-tube 
dysfunction, viral and bacterial load, and genetic and environmental factors.
Initial observation seems to be suitable for many children with OM, but only if
appropriate follow-up can be assured. In children younger than 2 years with a
certain diagnosis of acute OM, antibiotics are advised. Surgical candidacy
depends on associated symptoms, the child's developmental risk, and the
anticipated chance of timely spontaneous resolution of the effusion. The
recommended approach for surgery is to start with tympanostomy tube placement,
eventually followed by adenoidectomy. The ideal intervention for OM, however,
does not yet exist, and an urgent need remains to explore new and creative
options based on modern insights into the pathophysiology of OM.

Publication Types: 
    Review

PMID: 14962529 [PubMed - indexed for MEDLINE]

1450: Clin Otolaryngol Allied Sci. 2004 Feb;29(1):38-46.

Is otitis media with effusion a biofilm infection?

Fergie N, Bayston R, Pearson JP, Birchall JP.

Department of Otolaryngology and Head and Neck Surgery, Queen's Medical Centre,
Nottingham, UK. neil.fergie@virgin.net

Recent attention has focused on the possibility that otitis media with effusion
(OME) may represent a chronic infective state such as those evidenced in
conditions secondary to biofilms or small colony variants. This review discusses 
the evidence suggesting that this may indeed be the case and explains why this
may prove to be important in the future management of this condition by
discussing recent advances in understanding these bacterial phenotypic variants.

Publication Types: 
    Review

PMID: 14961850 [PubMed - indexed for MEDLINE]

1451: Clin Otolaryngol Allied Sci. 2004 Feb;29(1):10-7.

Evaluation of hearing thresholds in 3-month-old children with a cleft palate: the
basis for a selective policy for ventilation tube insertion at time of palate
repair.

Andrews PJ, Chorbachi R, Sirimanna T, Sommerlad B, Hartley BE.

Department of Paediatric Otorhinolaryngology, Great Ormond Street Hospital for
Children, NHS Trust, London, UK. wells.andrew@virgin.net

Hearing thresholds in children with a cleft palate prior to cleft palate repair
are not widely documented, and audiological criteria for short-term ventilation
tube insertion do not exist. The aims of this prospective study are to estimate
hearing thresholds in 40 children with a cleft palate by 3-month developmental
age with auditory brainstem responses (ABRs) under natural sleep and to estimate 
a hearing threshold guideline for short-term ventilation tube insertion. Our
results show a wide range of air conduction hearing thresholds using click ABRs
(2-4 Hz), which ranged from 25 to 102 dBnHL in the left ear and from 25 to 80
dBnHL in the right ear with means of 53 and 49 and standard deviations of 17 and 
13 respectively. The bone conduction thresholds ranged from 0 to 55 dBnHL with a 
mean of 26 and a standard deviation of 13. Eighty-three per cent of children had 
flat, type B, on high-frequency tympanograms, indicative of middle ear effusion. 
Thirty per cent of the infants had a cleft palate associated with a known
syndrome. Currently, it is the authors' practice to use short-term ventilation
tubes on a selective basis at the time of cleft palate repair when there is a
conductive hearing loss of more than 55 dBnHL in the better ear as determined by 
ABR with type B high-frequency tympanograms. This threshold level takes into
account electrophysiological and auditory pathway maturation discrepancies. With 
this as the guideline, between 28% and 35% of the children in this study would be
eligible for surgery. This criterion still requires further validation.

PMID: 14961846 [PubMed - indexed for MEDLINE]

1452: Pediatr Infect Dis J. 2004 Feb;23(2):181-3.

Antimicrobial prescribing for otitis externa in children.

McCoy SI, Zell ER, Besser RE.

Biostatistics and Information Management Branch, Division of Bacterial and
Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.

We describe the patterns of antimicrobial prescribing and trends in disease
occurrence among children with otitis externa using the National Ambulatory
Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from
1995 to 2000. Oral antimicrobial therapy for otitis externa is more likely to
contribute to antimicrobial resistance than is topical antimicrobial therapy and 
is rarely indicated. Thirty-nine percent of visits resulted in a prescription for
topical antibiotics, and 25% of visits resulted in a prescription for oral
antibiotics. Inappropriate antimicrobial prescribing for otitis externa occurs
frequently.

PMID: 14872192 [PubMed - indexed for MEDLINE]

1453: Pediatr Infect Dis J. 2004 Feb;23(2 Suppl):S135-9.

Safety and tolerability of azithromycin in pediatric infectious diseases: 2003
update.

Ruuskanen O.

Department of Pediatrics, Turku University Hospitals, Turku, Finland.
olli.ruuskanen@tyks.fi

Oral azithromycin suspension has been prescribed to >80 million patients.
Children find the color and taste of the oral suspension of azithromycin
agreeable, and the drug is well-tolerated. On average 9% of patients have
treatment-related adverse events, which are most frequently gastrointestinal
complaints. The side effects are mild to moderate and very seldom necessitate
withdrawal of the treatment. In addition to the conventional 3-day 10-mg/kg/day
regimen and the 10 mg/kg on Day 1 followed by 5 mg/kg on Days 2 to 5 regimens,
single dose 30 mg/kg and 3-day 20-mg/kg/day regimens are well-tolerated, although
these new dosages are associated with more adverse effects.

Publication Types: 
    Comparative Study
    Review

PMID: 14770077 [PubMed - indexed for MEDLINE]

1454: Pediatr Infect Dis J. 2004 Feb;23(2 Suppl):S115-24.

Management of recurrent and persistent acute otitis media: new options with
familiar antibiotics.

Arrieta A, Singh J.

Children's Hospital of Orange County, CA 92868, USA. aarrieta@choc.org

Recurrent and persistent acute otitis media (AOM) is a common problem, affecting 
close to 20% of children in their first years of life. It presents a therapeutic 
challenge to physicians, particularly as beta-lactamase-producing Haemophilus
influenzae, as well as penicillin- and, more recently, macrolide-resistant
Streptococcus pneumoniae are often responsible for AOM in these patients.
Intramuscular ceftriaxone (50 mg/kg, once daily for 3 days) has been shown to be 
effective in treating nonresponsive AOM, but there have been relatively few
clinical trials exploring oral antibiotic regimens. Higher doses of commonly used
antibiotics (amoxicillin-clavulanate ratio, 14:1 ratio and azithromycin 60 mg/kg 
divided into three equal once daily doses) have demonstrated high rates of
clinical success. These studies will be discussed together with a review of the
clinical and microbiologic characteristics of this disease. We will also address 
the impact that the pneumococcal conjugate vaccine may have on the microbiology
of recurrent and persistent AOM.

Publication Types: 
    Review

PMID: 14770074 [PubMed - indexed for MEDLINE]

1455: Pediatr Infect Dis J. 2004 Feb;23(2 Suppl):S108-14.

Single dose azithromycin for the treatment of uncomplicated otitis media.

Arguedas A, Loaiza C, Soley C.

Instituto de Atención Pediátrica and Universidad de Ciencias Médicas, San José,
Costa Rica. aarguedas@iped.net

Three clinical trials have examined the efficacy and safety of single dose
azithromycin (30 mg/kg) in children with uncomplicated acute otitis media (AOM). 
In the first trial, a small pilot study, the clinical and microbiologic efficacy 
of single dose azithromycin was comparable with that of 3-day azithromycin or
single dose ceftriaxone. A second, non-comparative trial confirmed the clinical
and microbiologic efficacy of the single dose regimen. The third study, a large
double blind, double dummy trial, demonstrated comparable clinical success rates 
between single dose azithromycin and 10-day standard amoxicillin/clavulanate. The
incidence of drug-related adverse events in patients treated with single dose
azithromycin was low in all three trials and similar to rates that have been
reported for other antimicrobial agents used for the treatment of patients with
AOM. In the amoxicillin/clavulanate trial, compliance with single dose
azithromycin was significantly better than with the amoxicillin/clavulanate
regimen (P < 0.001). We conclude that a single dose of azithromycin (30 mg/kg) is
safe and effective for the treatment of uncomplicated AOM in children.

Publication Types: 
    Comparative Study
    Review

PMID: 14770073 [PubMed - indexed for MEDLINE]

1456: BMJ. 2004 Feb 28;328(7438):487. Epub 2004 Feb 9.

Adenoidectomy versus chemoprophylaxis and placebo for recurrent acute otitis
media in children aged under 2 years: randomised controlled trial.

Koivunen P, Uhari M, Luotonen J, Kristo A, Raski R, Pokka T, Alho OP.

University of Oulu, PO Box 5000, FIN-90014, Finland. petri.koivunen@ppshp.fi

OBJECTIVE: To evaluate the efficacy of adenoidectomy compared with long term
chemoprophylaxis and placebo in the prevention of recurrent acute otitis media in
children aged between 10 months and 2 years. DESIGN: Randomised, double blind,
controlled trial. SETTING: Oulu University Hospital, a tertiary centre in
Finland. PARTICIPANTS: 180 children aged 10 months to 2 years with recurrent
acute otitis media. INTERVENTION: Adenoidectomy, sulfafurazole (sulphisoxazole)
50 mg/kg body weight, given once a day for six months or placebo. Follow up
lasted for two years, during which time all symptoms and episodes of acute otitis
media were recorded. MAIN OUTCOME MEASURES: Intervention failure (two episodes in
two months or three in six months or persistent effusion) during follow up,
number of episodes of acute otitis media, number of visits to a doctor because of
any infection, and antibiotic prescriptions Number of prescriptions, and days
with symptoms of respiratory infection. RESULTS: Compared with placebo,
interventions failed during both the first six months and the rest of the follow 
up period of 24 months similarly in the adenoidectomy and chemoprophylaxis groups
(at six months the differences in risk were 10% (95% confidence interval -9% to
29%) and 18% (-2% to 38%), respectively). No significant differences were
observed between the groups in the numbers of episodes of acute otitis media,
visits to a doctor, antibiotic prescriptions, and days with symptoms of
respiratory infection. CONCLUSIONS: Adenoidectomy, as the first surgical
treatment of children aged 10 to 24 months with recurrent acute otitis media, is 
not effective in preventing further episodes. It cannot be recommended as the
primary method of prophylaxis.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 14769785 [PubMed - indexed for MEDLINE]

1457: Ann Otol Rhinol Laryngol. 2004 Jan;113(1):69-72.

Indications for mastoidectomy in acute mastoiditis in children.

Taylor MF, Berkowitz RG.

Department of Otolaryngology, Royal Children's Hospital, Melbourne, Australia.

The objective of this study was to identify clinical features of acute
mastoiditis in children that are indicative of the need for mastoidectomy. We
performed a retrospective chart review of 40 children (20 male, 20 female)
between 2 months and 12 years 9 months of age with a diagnosis of acute
mastoiditis who were managed in our institution between July 1998 and June 2002. 
All patients received intravenous antibiotics; this was the only treatment in 14 
patients (35%). Tympanostomy tubes were inserted in 22 patients, together with
postauricular needle aspiration in 12 (30%), and incision and drainage of
subperiosteal abscess in 10 (25%). Mastoidectomy was performed in 4 cases (10%), 
and cholesteatoma was found in 3. One other child was subsequently found to have 
cholesteatoma. We conclude that children who present with acute mastoiditis
should undergo mastoidectomy if cholesteatoma is clinically suspected, or if
extratemporal suppurative complications have occurred.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14763577 [PubMed - indexed for MEDLINE]

1458: Saudi Med J. 2004 Jan;25(1):38-40.

Prophylactic ciprofloxacin drops after tympanostomy tube insertion.

Nawasreh O, Al-Wedyan IA.

Department of Otolaryngology, Prince Rashid Ben Al-Husn Hospital, Jordan.
nawasreh1@hotmail.com

OBJECTIVE: To evaluate the effectiveness of prophylactic ciprofloxacin drops in
decreasing the incidence of post-tympanostomy otorrhea, and the relation between 
middle ear content and post-tympanostomy otorrhea. METHODS: One hundred and fifty
patients aged 3-14 years underwent tympanostomy and tube insertion at the Prince 
Rashid Ben Al-Hasan Hospital, Al-Husn, Jordan during the interval between
February 2000 to January 2003. The patients were randomized into 3 groups: group 
1 (control group) received no antibiotic drops, group 2 received a single dose of
ciprofloxacin drops intraoperatively and group 3 received an intraoperative dose 
followed by 5-day postoperative course. RESULTS: Application of topical
ciprofloxacin after tympanostomy tube insertion was associated with a
significantly lower incidence of early post-tympanostomy otorrhea. The rate of
otorrhea for the control group was 16.5% and the treatment groups were (group 1) 
8.4%, (group 2) 8.2% and p=0.011. A single dose of antibiotics was effective when
patient's middle ears were dry or had serous effusions. For those whose ears had 
mucoid or purulent content a 5-day course was indicated. CONCLUSION: Topical
administration of a single dose of ototopical ciprofloxacin after surgery is an
effective treatment for the prevention of early post-tympanostomy otorrhea, and a
prolonged course (5 days) may be indicated for those whose ears had purulent or
thick mucoid contents, and the content of middle ear are important in predicating
postoperative otorrhea.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 14758376 [PubMed - indexed for MEDLINE]

1459: Curr Opin Pediatr. 2004 Feb;16(1):58-60.

Impact of pneumococcal and influenza vaccines on otitis media.

Jenson HB, Baltimore RS.

PURPOSE OF REVIEW: The pneumococcal conjugate vaccine and influenza virus
vaccines have the potential to reduce the risk of acute otitis media. Several
recent studies have evaluated the impact of each of these vaccines on the
incidence of acute otitis media. RECENT FINDINGS: In controlled studies,
pneumococcal conjugate vaccine has resulted in a reduction in the incidence of
acute otitis media of approximately 6%. Inactivated influenza vaccine does not
appear to reduce the incidence of acute otitis media in children 6-24 months of
age, but a few studies, each with design or methodological limitations, suggest
that it may reduce the incidence among older children. One study reported that
the live-attenuated, cold-adapted trivalent influenza vaccine reduced the
incidence of febrile otitis media by 30%. Additional studies are needed to
clarify the value of influenza vaccines to prevent acute otitis media. SUMMARY:
The pneumococcal conjugate vaccine and the influenza vaccines may have a limited 
beneficial impact on the incidence of acute otitis media. Nevertheless, at this
time, these vaccines should be promoted because of their primary benefits, which 
are reduced serious pulmonary and invasive infections, and not because they may
reduce the incidence of acute otitis media.

Publication Types: 
    Editorial
    Review

PMID: 14758115 [PubMed - indexed for MEDLINE]

1460: J Emerg Med. 2004 Jan;26(1):61-3.

Hemotympanums secondary to spontaneous epistaxis in a 7-year-old.

Hurtado TR, Zeger WG.

Department of Emergency Medicine, Madigan-University of Washington Emergency
Medicine Residency, Madigan Army Medical Center, Fort Lewis, Washington, USA.

Hemotympanum is a well-known physical finding most often associated with basilar 
skull fractures and therapeutic nasal packing. A literature review demonstrated
only five cases of hemotympanum associated with spontaneous epistaxis in adults. 
To our knowledge, there have been no reported cases in children. We present a
case of a 7-year-old child with bilateral hemotympanums secondary to spontaneous 
epistaxis.

Publication Types: 
    Case Reports

PMID: 14751480 [PubMed - indexed for MEDLINE]

1461: Med J Malaysia. 2003 Aug;58(3):465-9.

Reevaluating the use of antibiotics in acute otitis media in children.

Elango S.

Department of Otolaryngology, International Medical University, Jalan Rasah,
70300, Seremban, Negeri Sembilan.

Increasing concern about the antibiotic resistance in acute otitis media (AOM)
has led to debate over use of antibiotic in AOM and duration of therapy. Many
studies have proved that watchful waiting should be used more often for acute
otitis media. In children over two years, the most appropriate treatment was
found to be initial observation followed by 5 days of an antibiotic if the child 
failed to improve spontaneously. In children less than 2 years or one with severe
symptoms antibiotic can be started after 24 hours if there is no improvement with
symptomatic treatment. Physician should be more selective in the prescription of 
antibiotics early in AOM.

Publication Types: 
    Review

PMID: 14750393 [PubMed - indexed for MEDLINE]

1462: Bull Soc Belge Ophtalmol. 2003;(290):43-7.

Gradenigo syndrome: a case-report.

Piron K, Gordts F, Herzeel R.

Department of Ophthalmology, Academisch Ziekenhuis, Vrije Universiteit Brussel,
Belgium. Kathy.Piron@az.vub.ac.be

We report a case of sixth nerve palsy as a rare complication of acute otitis
media (apical petrositis). The clinical triad of acute otitis media, pain in the 
distribution of the fifth cranial nerve and sixth nerve palsy is known as
Gradenigo syndrome.

Publication Types: 
    Case Reports

PMID: 14750230 [PubMed - indexed for MEDLINE]

1463: Eur Radiol. 2004 Mar;14(3):482-95. Epub 2004 Jan 29.

Imaging of the postoperative middle ear.

Williams MT, Ayache D.

Department of Medical Imaging, Fondation Ophtalmologique Adolphe de Rothschild,
25 rue Manin, 75940 Paris, France. mwilliams@fo-rothschild.fr

The aim of this article is twofold: (a) to present the principles and the
indications of surgical treatment of middle ear pathologies; and (b) to review
the imaging findings after middle ear surgery, including the normal postoperative
aspects and imaging findings in patients presenting with unsatisfactory surgical 
results or with suspicion of postoperative complications. This review is
intentionally restricted to the most common diseases involving the middle ear:
chronic otitis media and otosclerosis. In these specific fields of interest, CT
and MR imaging play a very important role in the postoperative follow-up and in
the work-up of surgical failures and complications.

Publication Types: 
    Review

PMID: 14749948 [PubMed - indexed for MEDLINE]

1464: Eur J Clin Pharmacol. 2004 Mar;60(1):37-43. Epub 2004 Jan 29.

Comment in:
    Eur J Clin Pharmacol. 2004 Jun;60(4):293-4.

Pharmacological treatment of acute otitis media in children. A comparison among
seven locations: Tenerife, Barcelona and Valencia (Spain), Toulouse (France),
Smolensk (Russia), Bratislava (Slovakia) and Sofia (Bulgaria).

Sanz E, Hernández MA, Kumari M, Ratchina S, Stratchounsky L, Peiré MA,
Lapeyre-Mestre M, Horen B, Kriska M, Krajnakova H, Momcheva H, Encheva D,
Martínez-Mir I, Palop V.

Department of Clinical Pharmacology, School of Medicine, University of La Laguna,
38071 La Laguna, Tenerife, Spain, esanz@ull.es

OBJECTIVE: To describe patterns observed in the treatment of acute otitis media
(AOM) in several locations of five countries. PATIENTS AND METHODS:
Cross-sectional, descriptive study. Random sample of 12,264 paediatric
outpatients seen by paediatricians or general practitioners (GPs). Data on
patient demographics, diagnoses and treatment were collected. Diagnoses were
coded by ICD-9 and drugs by ATC classification. Patients diagnosed with AOM
(ICD-9 codes: 381 and 382) were selected for analysis. RESULTS: Cases of AOM
(873) accounted for 7.1% of the sample. There is a clear variation in the
percentage of children diagnosed with AOM and treated with antibiotics in the
different locations, antibiotic prescriptions being higher in Barcelona (93% of
children), and lowest in Smolensk (56.4 % of children were treated without
antibiotics). The antibiotics used varied widely: ampicillin use is almost
limited to Smolensk (26.7%) and Bratislava (13.8%), whereas amoxicillin plus
clavulanic acid is the choice in Toulouse (33.8%), Valencia (30.2%) and Barcelona
(28.9%), and cephalosporins are more frequently prescribed in Tenerife (51.7%).
Finally, macrolides are used in Barcelona (18.3%), Valencia (17.5%) and Tenerife 
(13.6%), but not prescribed in Toulouse or Sofia. Prescriptions of
anti-inflammatory drugs were only relevant in Valencia (31.7%), Tenerife (27.2%) 
and Toulouse (17.4%) and of otological preparations in Sofia, where almost each
child received ear drops (91.9%). Nasal preparations are commonly used only in
Sofia (41.9%), Bratislava (65.5%) and Smolensk (68.6%). CONCLUSION: Despite the
general agreement of most guidelines, wide differences in the treatment of
uncomplicated AOM in children are observed. Non-antibiotic therapy for AOM and
the use of first-choice antibiotics should be more actively encouraged in the
primary care centres. Studies to measure prevailing rates of antibiotic
resistance in these populations are needed.

Publication Types: 
    Comparative Study
    Multicenter Study

PMID: 14749912 [PubMed - indexed for MEDLINE]

1465: J Infect Dis. 2004 Feb 1;189(3):385-92. Epub 2004 Jan 16.

Four antibiotic-resistant Streptococcus pneumoniae clones unrelated to the
pneumococcal conjugate vaccine serotypes, including 2 new serotypes, causing
acute otitis media in southern Israel.

Porat N, Barkai G, Jacobs MR, Trefler R, Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center and the
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,
Israel. npurat@bgumail.bgu.ac.il

This study examined the prevalence of antibiotic-resistant clones that belong to 
serotypes not included in the pneumococcal conjugate vaccines and that cause a
significant percentage of acute otitis media (AOM) in children in southern
Israel. During 1998-2001, 2467 pneumococcal isolates, obtained from middle-ear
fluid of children <3 years old with AOM, were characterized by antimicrobial
susceptibility testing, serotype testing, and pulsed-field gel electrophoresis.
Non-vaccine type (NVT) strains constituted 477 (19%) of the 2467 isolates, of
which 173 (36%) belonged to only 4 serotypes: 35B, 33F, 21, and 15B/C. For
serotype 35B, 47 (96%) of 49 strains were penicillin nonsusceptible, and 93%
constituted a single clone; for serotype 33F, 31 (82%) of 38 strains were
penicillin nonsusceptible, and 95% constituted a single clone; for serotype 21,
38 (93%) of 41 strains were penicillin nonsusceptible, and 93% constituted a
single clone; for serotype 15B/C, 22 (49%) of 45 strains were penicillin
nonsusceptible, and 42% constituted a single clone. Two of these clones have not 
been described elsewhere. The high prevalence of NVT clones should increase the
awareness of the potential for replacement of the vaccine strains with these NVT 
antibiotic-resistant strains.

PMID: 14745695 [PubMed - indexed for MEDLINE]

1466: Pediatr Infect Dis J. 2004 Jan;23(1):41-6.

Diversity and sharing of Haemophilus influenzae strains colonizing healthy
children attending day-care centers.

Farjo RS, Foxman B, Patel MJ, Zhang L, Pettigrew MM, McCoy SI, Marrs CF, Gilsdorf
JR.

Department of Pediatrics and Communicable Diseases, University of Michigan, Ann
Arbor, MI 48109-0244, USA.

BACKGROUND: Children attending day-care centers (DCCs) are at risk for
Haemophilus influenzae nasopharyngeal colonization and acute otitis media. The
degree to which a given strain circulates within a day-care center and the
heterogeneity of strains among DCCs in a geographic area are not
well-characterized. This study describes the prevalence rates of H. influenzae
colonization in a large number of children attending day-care centers and
examines the genetic diversity of colonizing strains and the degree of sharing
among children. METHODS: Throat cultures were collected from 198 healthy children
<3 years old attending 16 day-care centers in Michigan. All H. influenzae
isolates were genetically typed by enterobacterial repetitive intergenic
consensus PCR as the initial screening technique to identify unique strains
within each child. Pulsed field gel electrophoresis was used subsequently to
examine the genetic diversity of strains between children. RESULTS: There were
127 (64%) children colonized with H. influenzae. Wide variation in rates of
colonization was identified among day-care centers (0 to 95%). A total of 179
genetically unique H. influenzae strains were isolated, and 47 children (37%)
were colonized with 2 or more genetically distinct H. influenzae organisms.
Evidence of sharing of the same strain in different children was found in 13 of
15 colonized DCCs and 23% of genotypically unique strains were shared.
CONCLUSION: The degree of sharing of H. influenzae among children in this study
suggests transmission of these potentially pathogenic microorganisms in day-care 
centers.

Publication Types: 
    Comparative Study
    Multicenter Study
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 14743045 [PubMed - indexed for MEDLINE]

1467: Ann Pharmacother. 2004 Jan;38(1):15-9.

Comment in:
    Ann Pharmacother. 2004 Jan;38(1):158-60.

High-dose versus standard-dose amoxicillin for acute otitis media.

Garrison GD, Sorum PC, Hioe W, Miller MM.

Department of Pharmacy Practice, Albany College of Pharmacy, Albany, NY 12208,
USA. garrisog@acp.edu

BACKGROUND: Emergence of drug-resistant bacteria has led to a recommendation to
use high-dose (HD) amoxicillin (80-90 mg/kg/d) rather than standard-dose (SD)
amoxicillin (40-45 mg/kg/d) to treat children with acute otitis media (AOM).
OBJECTIVE: To compare the efficacy and tolerability of HD versus SD amoxicillin
among children with AOM who were considered at low risk for infection with
antibiotic-resistant bacteria. METHODS: A double-blind, randomized, 3-year
clinical trial was conducted using participants who met the following criteria:
age >3 mo, weight </=18 kg, diagnosed with AOM, and candidates for treatment with
amoxicillin. The primary endpoint was treatment success at a 3- to 4-day
follow-up visit based on the clinical decision to continue the prescribed
antibiotic therapy for AOM. Other endpoints included duration of illness, number 
of office visits and telephone calls related to illness, total number of
subsequent AOM episodes, and number of adverse effects. RESULTS: The absolute
difference in antibiotic failure rate with SD versus HD amoxicillin at the
follow-up visit was nonsignificant (95% CI -1.5% to 3.4%; p = 0.78). The mean
duration of illness was similar for both doses of amoxicillin (3 +/- 2 d). The
number of office visits and telephone calls related to illness and the number of 
subsequent AOM episodes did not differ between the 2 treatment groups. HD
amoxicillin did not result in a greater incidence of adverse effects than SD
amoxicillin. CONCLUSIONS: HD amoxicillin had neither benefit nor detriment
compared with SD for AOM in children at low risk for infection with
antibiotic-resistant bacteria.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 14742786 [PubMed - indexed for MEDLINE]

1468: Int J Antimicrob Agents. 2004 Jan;23(1):25-31.

In vivo activity of amoxicillin/clavulanic acid and erythromycin in experimental 
otitis media caused by Streptococcus pneumoniae plus Haemophilus influenzae.

Parra A, Ponte C, Cenjor C, García-Olmos M, Giménez MJ, Aguilar L, Soriano F.

Department of Medical Microbiology, Fundación Jiménez Díaz, Avenida de Reyes
Católicos 2, 28040 Madrid, Spain.

A gerbil model of acute otitis media induced by Streptococcus pneumoniae plus
Haemophilus influenzae was used to assess the efficacy of amoxicillin/clavulanic 
acid (A/C) (1.5/0.3, 2.5/0.5 and 10/2 mg/kg) and erythromycin (2.5, 10, 20 and 50
mg/kg) with or without acetaminophen. The amoxicillin/clavulanic acid MIC was
1/0.5 mg/l for both organisms and the erythromycin MICs were 0.12 and 4 mg/l for 
S. pneumoniae and H. influenzae, respectively. The organisms were inoculated
directly into the middle ear (ME) and antibiotic treatment started 2 h
post-inoculation and continued at 8h intervals for three doses. Acetaminophen was
administered at 50 mg/kg. Samples for bacterial counting were obtained from the
ME on day 2. Amoxicillin/clavulanic acid peri-MIC concentrations in ME were
effective in eradicating both organisms. Despite the inflammation induced by S.
pneumoniae, erythromycin did not eradicate H. influenzae at ME concentrations
(2.4 mg/l for erythromycin 50 mg/kg) higher than those obtained in humans but
lower than the MIC.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14732310 [PubMed - indexed for MEDLINE]

1469: Ambul Pediatr. 2004 Jan-Feb;4(1):13-7.

Comment in:
    Ambul Pediatr. 2004 Jan-Feb;4(1):11-2.

Latent class analysis: an illustrative application for education in the
assessment of resident otoscopic skills.

Benjamin DK, DeLong E, Steinbach WJ.

Duke University Medical Center Department of Pediatrics, Duke Clinical Research
Institute, Durham, NC 27715, USA. danny.benjamin@duke.edu

BACKGROUND: There is no gold standard readily available in several components of 
the routine physical exam: one example is the otoscopic exam, where the gold
standard is confirmation by tympanocentesis. Resident education does not
typically include routine assessment by the gold standard, making estimates of
trainee performance extremely difficult. This is one reason why the otoscopic
examination is difficult to teach. Available techniques can assess diagnostic
exams when there is no gold standard-one of these is latent class analysis.
METHODS: We use latent class analysis, a form of regression analysis, to compare 
the ability of pediatric residents to diagnose effusion with pediatric
otolaryngologists and tympanometry. We briefly outline the technique of how to
complete latent class analysis and provide an operational plan to use the method 
to assess resident performance. RESULTS: The sensitivity and specificity of
pediatric resident otoscopic examination to diagnose the presence of effusion was
72% and 84%, respectively. Pediatric otolaryngologist sensitivity and specificity
was 91% and 82%; tympanometry had a sensitivity of 70% and specificity 76%. Our
estimates of the performance of otolaryngologists and tympanometry to diagnose
effusion were the same as previously reported when these diagnosticians have been
compared with the gold standard of tympanocentesis. CONCLUSIONS: Latent class
analysis can help estimate otoscopic examination performance of residents. This
technique can be incorporated into assessment in medical education.

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 14731098 [PubMed - indexed for MEDLINE]

1470: Pol J Pharmacol. 2003 Nov-Dec;55(6):1105-10.

Effect of macrolide antibiotics on nitric oxide synthase and xanthine oxidase
activities, and malondialdehyde level in erythrocyte of the guinea pigs with
experimental otitis media with effusion.

Aktan B, Taysi S, Gümüştekin K, Uçüncü H, Memişoğullari R, Save K, Bakan N.

Department of Otorhinolaryngology-Head and Neck Surgery, Atatü University,
Medical School, Erzurum, Turkey. baktan@atauni.edu.tr

Although the long-term administrations of macrolide antibiotics are effective for
diffuse panbronchiolitis, otitis media with effusion (OME), and some other
diseases, their mechanism of action has not been fully understood. In order to
elucidate the mechanisms of possible effects of macrolide antibiotics on
activities of erythrocyte nitric oxide synthase (NOS), xanthine oxidase (XO), and
malondialdehyde (MDA) levels in experimental OME, we aimed to evaluate the effect
of macrolide antibiotics (erythromycin, azithromycin, roxithromycin, and
clarithromycin) using an experimental guinea pig otitis media model. Erythrocyte 
NOS, XO activities, and MDA level were measured in all groups. Erythrocyte NOS
activities were significantly higher in erythromycin-, azithromycin-,
roxithromycin-, and clarithromycin-treated groups than in the experimental group.
Erythrocyte XO activities were significantly lower in erythromycin-,
azithromycin-, roxithromycin-, and clarithromycin-treated groups than in the
control group. However, erythrocyte XO activities in experimental group were
significantly higher than those of control group. Erythrocyte MDA levels were
significantly lower in erythromycin-, azithromycin-, roxithromycin-, and
clarithromycin-treated groups than those of the experimental group. The MDA
levels in erythromycin- and roxithromycin-treated groups were significantly
higher than those of azithromycin-treated group. The MDA levels in
azithromycin-treated group were significantly lower than those of
roxithromycin-treated group. In conclusion, the present study shows that the
macrolide antibiotics (erythromycin, azithromycin, roxithromycin, and
clarithromycin) increase NOS activity, decrease XO activity and MDA level, which 
is an important indicator of oxidative stress.

Publication Types: 
    Comparative Study

PMID: 14730107 [PubMed - indexed for MEDLINE]

1471: J Med Microbiol. 2004 Feb;53(Pt 2):161-5.

Clonal similarity of salivary and nasopharyngeal Fusobacterium nucleatum in
infants with acute otitis media experience.

Haraldsson G, Holbrook WP, Könönen E.

Anaerobe Reference Laboratory, National Public Health Institute (KTL),
Mannerheimintie 166, FIN-00300, Helsinki, Finland. gunnsteinn.haraldsson@ktl.fi

The environment of an infant's nasopharynx during acute otitis media (AOM)
favours the growth of anaerobic bacteria, which can be recovered frequently
during infection, but hardly at all if the infant is healthy. The aim of this
investigation was to identify the potential source and inoculation route of
anaerobes that were present in the nasopharynx. Eleven Fusobacterium nucleatum
isolates that were collected through the nasal cavity from the nasopharynx of
eight infants with a history of AOM, and 161 F. nucleatum isolates from the
saliva of the same infants, were typed to the clonal level by using arbitrarily
primed PCR (AP-PCR). In five of the eight infants examined, identical AP-PCR
types were found among nasopharyngeal and salivary isolates. As anaerobes seem to
be present only transiently in the nasopharynx and salivary contamination of the 
nasopharyngeal samples can be excluded, this observation indicates that the
source of nasopharyngeal anaerobes is the oral cavity and that saliva is their
transmission vehicle.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14729939 [PubMed - indexed for MEDLINE]

1472: Int J Pediatr Otorhinolaryngol. 2004 Feb;68(2):205-10.

Presence of human herpesviruses in young children with acute otitis media.

Shinogami M, Ishibashi T.

Department of Otolaryngology, Japanese Red Cross Medical Center, Tokyo, Japan.

Some herpesviruses have been detected in middle ear fluid (MEF) of patients with 
acute otitis media (AOM), but their role in middle ear disease is unknown. We
examined 73 middle ear fluid samples from 73 children with acute otitis media for
the presence of four major herpesviral DNA, respiratory viral genomes, and
bacterial DNA by multiplex polymerase chain reaction (PCR). Herpesviruses were
detected in 16 specimens (22%), with 18 viral infections were identified overall.
Respiratory viruses were detected in 35 specimens (48%), 39 viral infections
overall. Bacterial DNA was detected in 51 specimens (70%), 60 bacterial
infections overall. Clinical outcome was compared in patients with and without
herpesvirus DNA, respiratory viral genomes, or bacterial DNA. Progression to
otitis media with effusion (OME) was more common when herpesviral DNA was
present. Presence of herpesvirus DNA may reflect an immunocompromised state that 
may make it difficult to eliminate bacteria from the middle ear after infection.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14725988 [PubMed - indexed for MEDLINE]

1473: Int J Pediatr Otorhinolaryngol. 2004 Feb;68(2):197-204.

Eustachian tube function and tympanic membrane findings after chronic secretory
otitis media.

Ryding M, White P, Kalm O.

Department of Otorhinolaryngology, Hospital of Ostersund, SE-831-83, Ostersund,
Sweden. marie.ryding@jll.se

OBJECTIVE: The etiology of secretory otitis media (SOM) is multifactorial. The
main factors discussed are infection and tubal dysfunction. This study aimed to
detect poor tubal function and tympanic membrane pathology in young adults after 
extremely long-standing SOM. METHODS: Thirty-four patients, 16-25 years old, with
previous chronic SOM persisting at least 6 years (mean 11.2 years, range 6.2-18.6
years), were retrospectively examined at a mean of 18 years after their first
myringotomy or tube insertion and comparison was made with 15 controls. The
medical records were scrutinized, otomicroscopic examination was performed and
the Eustachian tube function was studied in a mini pressure chamber. RESULTS: The
mean age at SOM onset was 2.4 years (range 0.5-8.4 years) and the mean period
from the last myringotomy or when the last tube had disappeared to follow-up was 
6.7 years (range 1.3-12.8 years). Tympanic membrane pathology was found in 76% of
the ears of SOM patients and in none (0%) of controls (P<0.001). The youngest
patients had more atrophy than the older patients (P<0.05) and more
myringosclerosis was observed in patients with shorter interval between SOM
ending and examination. The patients were found to have significantly poorer
active tubal function; i.e. higher inability to equilibrate negative or negative 
and positive middle ear pressure, compared with controls (P<0.001). The majority 
of the patients (74%) still experienced some kind of discomfort in their ears at 
the time of examination. CONCLUSIONS: Still in adulthood patients with chronic
SOM during childhood exhibit dysfunction of the tube and tympanic membrane
pathology to a high extent.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14725987 [PubMed - indexed for MEDLINE]

1474: Int J Pediatr Otorhinolaryngol. 2004 Feb;68(2):191-5.

The effect of the season on otitis media with effusion resolution rates in the
New York Metropolitan area.

Gordon MA, Grunstein E, Burton WB.

Department of Otolaryngology and Communicative Disorders, Section of Otology and 
Neurotology, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde
Park, NY 11040, USA. micagordon@yahoo.com

OBJECTIVE: To study the relationship between season and resolution rates of
otitis media with effusion (OME) in the New York Metropolitan area, in order to
provide objective data useful to the practicing otolaryngologist in determining
if seasonal factors should be considered in OME management decisions. METHODS:
This was a prospective study of children referred to a tertiary medical center.
Children with OME (confirmed by pneumatoscopy and tympanometry) were followed by 
an otologist at an academic medical center over a 3 years period. They returned
approximately every 6 weeks until the end points of resolution of the effusions
or ventilating tube placement. Each period between visits is termed an
"interval." RESULTS: 127 patients with 231 effusions were followed for a total of
354 intervals. Effusions at intervals beginning in autumn were least likely to
resolve by the next visit (24.29%) while intervals ending in the summer had the
greatest rate of resolution (44.32%). Analyzed by month, the lowest rates of
resolution were seen in intervals beginning in September, November, February, and
March (16.67, 21.05, 20.51, and 19.15%, respectively). Intervals beginning in May
had the greatest chance of resolution (51.72%). There was a positive correlation 
between resolution rates and average daily temperatures as reported by month.
CONCLUSIONS: The season and month of the year are relevant factors in the
clinical course of OME in the New York Metropolitan area. Based on the observed
rates of resolution, one could reasonably consider taking a more conservative
approach to OME management in May through August, and a more aggressive approach 
in the fall and winter months.

PMID: 14725986 [PubMed - indexed for MEDLINE]

1475: Rev Laryngol Otol Rhinol (Bord). 2003;124(3):171-7.

Cleft palate and otitis media with effusion: a review.

Sheahan P, Blayney AW.

Children's University Hospital, Department of Otolaryngology, Temple Street,
Dublin 1, Ireland. sheahanp@eircom.net

Otitis media with effusion is a common finding in children with cleft palate.
However, although middle ear effusions have been reported to be almost universal 
among infants with cleft palate, less is known regarding the epidemiology,
natural history, and outcome of middle ear disease among older children with
cleft palate. Furthermore, considerable controversy surrounds the management of
otitis media with effusion in these children: many authors have advocated a
policy of early or scheduled ventilation tube insertion on account of the high
incidence of hearing loss and speech difficulties; others have advocated a more
conservative policy on account of the high incidence of complications from
ventilation tubes and lack of evidence supporting a policy of early intervention.
In the present paper, we review the epidemiology, aetiology, and natural history 
of middle ear disease in children with cleft palate. We also discuss the
controversies involved in the management of these patients.

Publication Types: 
    Review

PMID: 14725133 [PubMed - indexed for MEDLINE]

1476: Otol Neurotol. 2004 Jan;25(1):14-8.

Eustachian tube gland changes in acute otitis media.

Cayé-Thomasen P, Tos M.

Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Gentofte University
Hospital of Copenhagen, Hellerup, Denmark. percaye@dadlnet.dk

OBJECTIVES: To investigate the histomorphologic impact of acute otitis media on
the subepithelial glands of the eustachian tube. Previous investigations have
shown an increase of eustachian tube goblet cell density during and up to at
least 6 months after acute otitis media. STUDY DESIGN: Longitudinal study in an
experimental animal model of acute otitis media caused by Streptococcus
pneumoniae. METHODS: Bacterial middle ear challenge, after which the animals were
killed, in groups of five rats on Days 4, 8, 16, 90, and 180. Dissection and
preparation of the eustachian tube and adjacent structures, followed by serial
transverse sectioning, periodic acid-Schiff/alcian blue staining, and
qualitative/quantitative morphometric light-microscopic investigations of the
histomorphology of the eustachian tube glands, in particular, the stainability,
composition, volume, and number of gland acini. RESULTS: The volume of the
eustachian tube glands progressed to peak 16 days after inoculation, followed by 
a gradual normalization. The volume was still increased 3 months after the acute 
infection but completely normalized after 6 months. The increase was primarily
due to hypertrophy of the mucous gland components, as the serous gland component 
volume and number of gland acini was unchanged. The periodic acid-Schiff/alcian
blue staining of the mucous gland acini changed temporarily during the acute
infection, indicating changes in mucus glycoprotein composition, from neutral to 
acidic/sulfated. CONCLUSION: The volume of the eustachian tube glands increases
during and up to at least 3 months after acute otitis media, primarily because of
hypertrophy of the mucous gland components. This may compromise tubal ventilatory
and drainage function.

PMID: 14724485 [PubMed - indexed for MEDLINE]

1477: Otol Neurotol. 2004 Jan;25(1):9-13.

The efficacy of Burow's solution as an ear preparation for the treatment of
chronic ear infections.

Kashiwamura M, Chida E, Matsumura M, Nakamaru Y, Suda N, Terayama Y, Fukuda S.

Department of Otolaryngology, Medical School of Hokkaido University, Sapporo,
Japan. true-north@eva.hi-ho.ne.jp

OBJECTIVE: To determine the efficacy of Burow's solution as an otologic
preparation for the treatment of chronic ear infection. STUDY DESIGN: Two studies
were included: 1) a prospective clinical study and 2) a laboratory study on
antibacterial and antifungal effects. SETTING: A private otology practice and a
laboratory study. PATIENTS: Fifty-eight patients with refractory otorrhea.
INTERVENTION: Diagnosis by otoscopy, audiometry, and bacteriology. METHODS:
Burow's solution was mixed in solutions with four organisms:
methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus
pneumoniae, Candida albicans, and Aspergillus. Soon after Burow's solution was
mixed in the solutions with organisms, and 5, 10, and 20 minutes thereafter, the 
mixtures were cultured on agars. The numbers of the bacterial or fungal colonies 
were counted to evaluate the effect of Burow's solution. MAIN OUTCOME MEASURES:
Changes in the clinical findings of the ears, the symptom of otorrhea, and side
effects were assessed. RESULTS: Thirty-five (70%) of the 50 ears assessed were
"cured" and 10 (20%) ears assessed were "improved." No significant side effect
was observed. Regarding the laboratory study, the four organisms disappeared
within 20 minutes after Burow's solution was mixed. CONCLUSION: Burow's solution 
was considered to be an effective otologic preparation.

Publication Types: 
    Clinical Trial

PMID: 14724484 [PubMed - indexed for MEDLINE]

1478: Otol Neurotol. 2004 Jan;25(1):1-8.

Laser eustachian tuboplasty.

Kujawski OB, Poe DS.

International ENT Center, Clinique des Grangettes, Genève, Eustachian Tube
Disorders Center, Clinique des Grangettes, Geneva, Switzerland.
kujawski@eustachian-tube.com

OBJECTIVES: Surgery on the eustachian tube for chronic eustachian tube
dysfunction has been previously directed toward the bony isthmus and failed to
produce lasting results. Dynamic video analysis demonstrates pathophysiology in
the tubal cartilaginous portion. This study investigated a new endoluminal
procedure that focused on the cartilaginous eustachian tube. STUDY DESIGN:
Prospective surgical trial. SETTING: Tertiary care private practice and
outpatient surgical center. PATIENTS: One hundred eight eustachian tubes with
intractable eustachian tube dysfunction (middle ear atelectasis or effusion) in
56 patients underwent laser eustachian tuboplasty by the first author (O. B. K.) 
since 1997. INTERVENTION: Dynamic video analyses of eustachian tube function were
performed perioperatively. Laser eustachian tuboplasties were performed
unilaterally or bilaterally under general anesthesia through a combined
endoscopic nasal and transoral approach to the eustachian tube nasopharyngeal
orifice. Carbon dioxide or 980-nm diode laser vaporization of mucosa and
cartilage from the luminal posterior wall was accomplished until adequately
dilation was achieved and the tube was packed. A laser myringotomy for temporary 
middle ear aeration while the eustachian tube was packed was also performed
during surgery. MAIN OUTCOME MEASURES: There were two outcome measures: 1) the
presence or absence of middle ear effusion or tympanic membrane atelectasis and
2) impedance tympanometry. In addition, dynamic videos were examined to rate the 
degree of visible opening of the tubal valve and effects on mucosal edema and
muscular movements. RESULTS: Seventy-four (68.51%) ears achieved normal middle
ear aeration at 1 year, 70 (71.42%) at 2 years, and 60 (65.21%) at greater than
or equal to 3 years. There were no intraoperative complications. Postoperative
complications were limited to minimal peritubal synechia in nine (8.33%) tubes
and epistaxis in one (0.9%) tubes. Seven (6.48%) ears failed treatment and
required tympanostomy tubes. CONCLUSION: Laser eustachian tuboplasty is a new
procedure that has demonstrated early promise in correcting intractable
eustachian tube dysfunction with few complications. Further studies will be
necessary to reproduce the results and establish the role of laser eustachian
tuboplasty in the management of chronic intractable eustachian tube dysfunction.

Publication Types: 
    Clinical Trial

PMID: 14724483 [PubMed - indexed for MEDLINE]

1479: Lancet Infect Dis. 2004 Jan;4(1):34-9.

The changing face of malignant (necrotising) external otitis: clinical,
radiological, and anatomic correlations.

Rubin Grandis J, Branstetter BF 4th, Yu VL.

Department of Otolaryngology, University of Pittsburgh School of Medicine, PA,
USA.

Malignant (necrotising) external otitis is an invasive infection of the external 
auditory canal. Although elderly patients with diabetes remain the population
most commonly affected, immunosuppressed individuals (eg, from HIV infection,
chemotherapy, etc) are also susceptible to malignant external otitis. Pseudomonas
aeruginosa is isolated from the aural drainage in more than 90% of cases. The
pathophysiology is incompletely understood although aural water exposure (eg,
irrigation for cerumen impaction) has been reported as a potential iatrogenic
factor. The typical patient presents with exquisitely painful otorrhoea. If
untreated, cranial neuropathies (most commonly of the facial nerve) can develop
due to subtemporal extension of the infection. The diagnosis of malignant
external otitis is based on a combination of clinical findings, an increased
erythrocyte sedimentation rate, and radiographic evidence of soft tissue with or 
without bone erosion in the external canal and infratemporal fossa. Treatment
consists of prolonged administration (6-8 weeks) of an antipseudomonal agent
(typically an orally administered quinolone). With the introduction and
widespread use of both oral and topical quinolones, there are reports of less
severe presentation of malignant external otitis and even the emergence of
ciprofloxacin resistance. Reservation of systemic quinolones for the treatment of
invasive ear infections is recommended.

Publication Types: 
    Comparative Study
    Review

PMID: 14720566 [PubMed - indexed for MEDLINE]

1480: Epidemiology. 2004 Jan;15(1):13-20.

Infant otitis media and the use of secondary heating sources.

Pettigrew MM, Gent JF, Triche EW, Belanger KD, Bracken MB, Leaderer BP.

Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department
of Epidemiology and Public Health, Yale University School of Medicine, New Haven 
Connecticut 06520-8034, USA. melinda.pettigrew@yale.edu

BACKGROUND: This prospective study investigated the association of exposure to
indoor secondary heating sources with otitis media and recurrent otitis media
risk in infants. STUDY DESIGN: We enrolled mothers living in nonsmoking
households and delivering babies between 1993 and 1996 in 12 Connecticut and
Virginia hospitals. Biweekly telephone interviews during the first year of life
assessed diagnoses from doctors' office visits and use of secondary home heating 
sources, air conditioner use, and day care. Otitis media episodes separated by
more than 21 days were considered to be unique episodes. Recurrent otitis media
was defined as 4 or more episodes of otitis media. Repeated-measures logistic
regression modeling evaluated the association of kerosene heater, fireplace, or
wood stove use with otitis media episodes while controlling for potential
confounders. Logistic regression evaluated the relation of these secondary
heating sources with recurrent otitis media. RESULTS: None of the secondary
heating sources were associated with otitis media or with recurrent otitis media.
Otitis media was associated with day care, the winter heating season, birth in
the fall, white race, additional children in the home, and a maternal history of 
allergies in multivariate models. Recurrent otitis media was associated with day 
care, birth in the fall, white race, and a maternal history of allergies or
asthma. CONCLUSION: We found no evidence that the intermittent use of secondary
home heating sources increases the risk of otitis media or recurrent otitis
media. This study confirms earlier findings regarding the importance of day care 
with respect to otitis media risk.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 14712142 [PubMed - indexed for MEDLINE]

1481: Laryngoscope. 2004 Jan;114(1):90-5.

Prothrombotic factors in children with otitis media and sinus thrombosis.

Oestreicher-Kedem Y, Raveh E, Kornreich L, Yaniv I, Tamary H.

Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center,
Beilinson Campus, Israel. dkyo@barak-online.net.il

OBJECTIVE: Venous sinus thrombosis (VST) is the second most common intracranial
complication of acute otitis media (AOM). There is some evidence that hereditary 
and acquired prothrombotic disorders are risk factors for VST. The aim of the
present study was to evaluate whether children with AOM complicated VST have a
prothrombotic tendency, which might have important therapeutic and preventive
implications. STUDY DESIGN: Retrospective. METHODS: The files of children
hospitalized at Schneider Children's Medical Center of Israel, a tertiary
referral center, from 1999 to 2002, because of AOM complicated by acute
mastoiditis and VST were reviewed. All children underwent laboratory work-up for 
hypercoagulability. RESULTS: Seven children met the study criteria. Of these,
five had prothrombotic disorders, namely elevated levels of lipoprotein
apolipoprotein (Lp[a]) (n = 4), antibodies to beta 2-glycoprotein and to
cardiolipin (markers of antiphospholipid syndrome) (n = 4), and heterozygosity
for factor V Leiden mutation (n = 1). One child had three abnormalities, two
children had two abnormalities, and two children had one abnormality.
CONCLUSIONS: A prothrombotic tendency may exist in children with AOM complicated 
by mastoiditis and VST. Further studies are needed to evaluate its extent.

PMID: 14710001 [PubMed - indexed for MEDLINE]

1482: Laryngoscope. 2004 Jan;114(1):85-9.

Comparison of free radicals and antioxidant enzymes in chronic otitis media with 
and without tympanosclerosis.

Karlidağ T, Ilhan N, Kaygusuz I, Keleş E, Yalçin S.

Department of Otorhinolaryngology, Medical Faculty, Firat University, Elaziğ,
Turkey. turgut_karlidag@yahoo.com

OBJECTIVE/HYPOTHESIS: The pathogenesis of tympanosclerosis is unclear. The study 
was performed to investigate the role of nitric oxide, free oxygen radicals, and 
antioxidants in development of tympanosclerosis in patients with chronic otitis
media. STUDY DESIGN: A prospective study in patients with nasal polyps. METHODS: 
Sixty-five patients who underwent tympanoplasty or tympanoplasty together with
mastoidectomy were included in the study. Preoperative venous blood samples were 
drawn, and serum sodium, potassium, calcium, alkaline phosphatase, inorganic
phosphorus, parathormone, and calcitonin levels were measured. The patients who
had tympanosclerotic plaques on tympanic membrane or middle ear mucosa or near
the ossicular chain or mastoid bone were designated as group 1 (n = 34), and the 
remaining patients as group 2 (n = 31). Intraoperatively, specimens were obtained
from the middle ear mucosa and tympanic membrane to measure nitric oxide and
malondialdehyde levels. In addition, plasma malondialdehyde levels and
erythrocyte superoxide dismutase and catalase activity were determined. RESULTS: 
All patients had similar demographic features and serum electrolyte and hormone
levels. Nitric oxide and malondialdehyde levels of the specimens obtained from
the middle ear mucosa (P =.001) and tympanic membrane (P =.01) and, in parallel
to this, the plasma malondialdehyde activity level were higher in group 1 than in
group 2. Moreover, group 2 had significantly lower erythrocyte catalase activity 
levels (P =.001) compared with group 1, whereas such a significant difference was
not present for superoxide dismutase activity levels (P >.05). CONCLUSION: The
study results suggest that nitric oxide, free oxygen radicals, and catalase may
have a role in the development of tympanosclerosis in patients with chronic
otitis media.

PMID: 14710000 [PubMed - indexed for MEDLINE]

1483: Laryngoscope. 2004 Jan;114(1):61-4.

Ossicular reconstruction with titanium prosthesis.

Martin AD, Harner SG.

Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota 55905, USA.

OBJECTIVES: To evaluate the results when using titanium total ossicular
replacement prosthesis (TORP) or partial ossicular replacement prosthesis (PORP) 
in chronic ear disease. STUDY DESIGN: Retrospective chart review was performed.
METHODS: Sixty-eight ossicular procedures using a titanium TORP (n = 30) or PORP 
(n = 38) were performed at a tertiary referral center between December 1999 and
June 2002. The ossiculoplasty was performed either alone or in combination with
other chronic ear surgery. Cartilage grafts were used universally. Nineteen
percent were primary operations, and 6% were planned second stages. The majority 
were revision procedures. Follow-up ranged from 3 months to 2.5 years. RESULTS:
The prosthesis is easy to insert, well tolerated, and has a low extrusion rate.
Average air-bone gap (ABG) improvement was 13 dB with closure of the ABG to
within 20 dB in 57% of cases. Hearing results were better for primary versus
revision cases for PORPs versus TORPs and for intact canal wall (ICW) procedures 
versus canal wall-down (CWD) procedures. CONCLUSION: Titanium is a satisfactory
material for use in ossicular reconstruction because of its ease of insertion,
tissue tolerance, and low rate of extrusion. Caution is advised when selecting
candidates for this procedure during revision surgery, especially if the canal
wall and stapes superstructure are absent.

PMID: 14709996 [PubMed - indexed for MEDLINE]

1484: J Chin Med Assoc. 2003 Oct;66(10):621-6.

Managements of complicated otitic abscess.

Guo YC, Tsai TL, Shiao AS.

Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan,
ROC. ycguo@vghtpe.gov.tw

The advent of antibiotics has significantly reduced the incidence and associated 
morbidity of otogenic complications. Its presentation, however, has dramatically 
changed and appears as a masked condition despite the presence of a potentially
fatal complication. Between 1998 and 2001, 3 cases of otitic abscesses, including
mastoid subperiosteal abscess, zygomatic abscess, and retropharyngeal abscess,
were collected retrospectively. Their clinical presentation, results of
investigations, and response to treatment were reviewed. After admission,
intravenous antibiotics were prescribed and early surgeries were performed for
eradication of infection source. The patients exhibited excellent postoperative
recovery, without facial palsy, vertigo or other complications. To be a
contemporary otologist, we should not overlook such severe complications of
otologic diseases. Appropriate intravenous antibiotics and adequate surgeries, as
soon as possible, are recommended. Advanced magnetic resonance imaging or
computed tomographic scans of the temporal bone with wider windows are necessary.

Publication Types: 
    Case Reports

PMID: 14703281 [PubMed - indexed for MEDLINE]

1485: Vet Radiol Ultrasound. 2003 Nov-Dec;44(6):648-51.

Inflammatory polyp in the middle ear with secondary suppurative
meningoencephalitis in a cat.

Cook LB, Bergman RL, Bahr A, Boothe HW.

Department of Veterinary Small Animal Medicine and Surgery, College of Veterinary
Medicine, Texas A&M University, College Station, TX 77843, USA.

A 15-month-old male Maine Coon Cat presented with persistent auricular discharge 
and progressive head tilt, ataxia, and loss of blink on the right side. Using
computed tomography a hyperattenuating, contrast-enhancing material within a
thickened right tympanic bulla and contrast enhancement of the adjacent
cerebellum were identified. Marked suppurative inflammation was identified on
cerebrospinal fluid analysis with no growth on bacterial culture. Ventral bulla
osteotomy was performed to remove a soft tissue mass, and an inflammatory polyp
with chronic severe suppurative inflammation was confirmed using histology.
Staphylococcus auricularis was grown on aerobic culture and Fusobacterium
necrophorum and Peptostreptococcus anaerobius were grown on anaerobic culture.
The cat was treated for 10 weeks with amoxicillin/clavulinic acid and
metronidazole. Dramatic improvement in body weight, appetite, energy level,
balance, and resolution of right-sided facial paralysis were noted, but the cat
retained a head tilt.

Publication Types: 
    Case Reports

PMID: 14703245 [PubMed - indexed for MEDLINE]

1486: Ear Nose Throat J. 2003 Dec;82(12):942-5.

An unusual case of external ear inflammation caused by sarcoidosis.

Lang EE, el Zaruk J, Colreavy MP, Kennedy S, Rowley H, Timon C.

Department of Otolaryngology-Head and Neck Surgery, Royal Victoria Eye and Ear
Hospital, Dublin, Ireland. emerlang@eircom.net

Inflammation of the pinna can occur in conjunction with polychondritis and otitis
externa. We describe a case of pinneal inflammation that proved to be
sarcoidosis, and we discuss the otolaryngologic manifestations of sarcoidosis.

Publication Types: 
    Case Reports

PMID: 14702877 [PubMed - indexed for MEDLINE]

1487: Pediatrics. 2004 Jan;113(1 Pt 1):e40-6.

Topical ciprofloxacin/dexamethasone otic suspension is superior to ofloxacin otic
solution in the treatment of children with acute otitis media with otorrhea
through tympanostomy tubes.

Roland PS, Kreisler LS, Reese B, Anon JB, Lanier B, Conroy PJ, Wall GM, Dupre SJ,
Potts S, Hogg G, Stroman DW, McLean C.

Department of Otolaryngology, University of Texas Southwestern Medical Center,
Dallas 75390-9035, USA. Peter.Roland@UTSouthwestern.edu

OBJECTIVE: To determine the efficacy and safety of topical
ciprofloxacin/dexamethasone otic suspension compared with ofloxacin otic solution
in the treatment of acute otitis media with otorrhea through tympanostomy tubes
(AOMT) in pediatric patients. METHODS: This multicenter, prospective, randomized,
observer-masked, parallel-group study was conducted at 39 sites in 599 children
aged >or=6 months to 12 years with an AOMT episode of <or=3 weeks' duration. The 
mean age of patients was 2.5 years (standard deviation: 2.37 years). Patients
received either ciprofloxacin 0.3%/dexamethasone 0.1% otic suspension 4 drops
twice daily for 7 days or ofloxacin 0.3% otic solution 5 drops twice daily for 10
days. Clinical signs and symptoms of AOMT were evaluated at clinic visits on days
1 (baseline), 3 (on therapy), 11 (end of therapy), and 18 (test of cure). A
patient diary was used to measure time to cessation of otorrhea. Principal
pretherapy pathogens included Streptococcus pneumoniae (16.8%), Staphylococcus
aureus (13.0%), Pseudomonas aeruginosa (12.7%), Haemophilus influenzae (12.4%), S
epidermidis (10.2%), and Moraxella catarrhalis (4.1%). RESULTS:
Ciprofloxacin/dexamethasone is superior to ofloxacin for clinical cure (90% vs
78%) and microbiologic success (92% vs 81.8%) at the test-of-cure visit, produces
fewer treatment failures (4.4% vs 14.1%), and results in a shorter median time to
cessation of otorrhea (4 days vs 6 days). Ciprofloxacin/dexamethasone treatment
is also superior to improvement in clinical response by visit, absence of
otorrhea by visit, and reduction of otorrhea volume by visit. Both topical otic
preparations are safe and well tolerated in pediatric patients. No change in
speech recognition threshold or decrease in hearing from baseline, based on
audiometric testing, was noted with either regimen. CONCLUSION: Topical
ciprofloxacin/dexamethasone treatment is superior to topical ofloxacin in the
treatment of AOMT.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 14702493 [PubMed - indexed for MEDLINE]

1488: Am J Ophthalmol. 2004 Jan;137(1):202-4.

Endogenous endophthalmitis after otitis media.

Siegersma JE, Klont RR, Tilanus MA, Verbeek AM, Schülin T, Cruysberg JR, Deutman 
AF.

Department of Ophthalmology, University Medical Centre Nijmegen, The Netherlands.
J.Siegersma@ohk.umcn.nl

PURPOSE: To report a case of bacterial endophthalmitis after otitis media in a
healthy adult. DESIGN: Interventional case report. METHODS: A healthy 49-year-old
Caucasian woman developed acute otitis media of the right ear. Three weeks after 
the first onset there was a recurrence of the otitis media, with perforation of
the tympanic membrane. Two days after this, the woman presented at our clinic
with endophthalmitis of the right eye. RESULTS: A culture of vitreous material
grew Streptococcus pyogenes (Streptococcus Lancefield group A). The same strain
was found in a smear from the perforated ear. Despite aggressive treatment, the
affected eye had to be eviscerated. CONCLUSIONS: Otitis media can result in a
bacteremia. This may, even in a healthy adult, lead to a devastating endogenous
bacterial endophthalmitis.

Publication Types: 
    Case Reports

PMID: 14700678 [PubMed - indexed for MEDLINE]

1489: J Speech Lang Hear Res. 2003 Apr;46(2):273-87.

Parent-reported language skills in relation to otitis media during the first 3
years of life.

Feldman HM, Dollaghan CA, Campbell TF, Colborn DK, Janosky J, Kurs-Lasky M,
Rockette HE, Dale PS, Paradise JL.

University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh,
University of Pittsburgh, Pittsburgh, PA 15213-2583, USA. Heidi.Feldman@chp.edu

As part of a larger study of the potential impact of early-life otitis media (OM)
on speech, language, cognition, and behavior, we studied the degree of
association between parent-reported language scores at ages 1, 2, and 3 years and
the cumulative duration of middle-ear effusion (MEE) during the first 3 years of 
life in a demographically diverse sample of 621 children. We estimated the
cumulative percentage of days with MEE from prospective monthly observations of
middle-ear status and interpolations for periods between visits. For each child, 
parents completed the appropriate inventory of the MacArthur Communicative
Development Inventories (CDI; L. Fenson et al., 1993) at ages 1, 2, and 3 years. 
We also evaluated the contribution of maternal education, as a proxy for
socioeconomic status, to scores on the parent reports. Scores on the new CDI-III 
(B. Oliver et al., in press) varied positively with sociodemographic variables
and were significantly correlated with scores from the CDI used when the children
were younger. Unadjusted correlations between scores at ages 1 and 2 years and
the percentages of days with MEE in the respective antecedent periods were
statistically nonsignificant or of questionable clinical importance. The
correlations between parent-reported scores at age 3 years and children's
cumulative percentage of days with MEE in Years 1, 2, and 3 combined ranged from 
-.187 to -.248 (all p values < .001). The percentage of days with MEE and
maternal education each contributed independently to scores at age 3 years. In
the light of other findings from the larger study, we think it likely that the
negative associations between language measures and MEE reflect confounding
factors that contribute, on the one hand, to the duration of OM in young children
and, on the other hand, to slow development of their language skills.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 14700371 [PubMed - indexed for MEDLINE]

1490: Clin Infect Dis. 2004 Jan 15;38(2):234-42. Epub 2003 Dec 19.

Association of clinical signs and symptoms with bacterial findings in acute
otitis media.

Palmu AA, Herva E, Savolainen H, Karma P, Mäkelä PH, Kilpi TM.

National Public Health Institute, Helsinki, Finland. arto.palmu@ktl.fi

In acute otitis media (AOM), a means of prediction of the bacterial pathogen
based on symptoms and signs would be valuable in selecting appropriate
antimicrobial treatment. Children in the control arm (n=831) in the Finnish
Otitis Media Vaccine Trial were prospectively observed in a study clinic setting 
from the age of 2 to 24 months. In patients with AOM, myringotomy with aspiration
was performed, and middle ear fluid samples were cultured for bacterial
pathogens. Symptoms and signs of respiratory infections were thoroughly recorded.
Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae were 
the most common bacterial pathogens. Pneumococcal AOM was associated with
more-severe AOM characterized by fever and earache. AOM due to H. influenzae was 
associated with eye symptoms and findings. Accurate prediction of a bacterial
cause of infection based on symptoms and signs of AOM was not possible, but a
specific cause was predicted in some situations, with a high probability of
applicability to clinical practice.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14699456 [PubMed - indexed for MEDLINE]

1491: J Med Virol. 2004 Feb;72(2):241-8.

Presence of specific viruses in the middle ear fluids and respiratory secretions 
of young children with acute otitis media.

Nokso-Koivisto J, Räty R, Blomqvist S, Kleemola M, Syrjänen R, Pitkäranta A,
Kilpi T, Hovi T.

Department of Microbiology, National Public Health Institute, Helsinki, Finland. 
johanna.nosko.koivisto@ktl.fi

The purpose of the study was to investigate the presence of different viruses in 
middle ear fluids and nasopharyngeal aspirates in young children with acute
otitis media. Two cohorts of children (N = 329 and 611) were followed from 2 to
24 months of age in Finland in two prospective studies (Finnish Otitis Media
Cohort Study and Finnish Otitis Media Vaccine Trial). During the study period,
nasopharyngeal and middle ear fluid specimens for each acute otitis media event
were examined for eight (Cohort Study) or ten (Vaccine Trial) common respiratory 
viruses; adenoviruses, influenza viruses A and B, parainfluenza viruses 1, 2, and
3, respiratory syncytial virus (RSV), enteroviruses, parechoviruses, and
rhinoviruses. Picornaviruses (rhinoviruses, enteroviruses, and parechoviruses)
were determined by reverse transcription PCR while antigen detection was used for
the other viruses. A virus was present in either nasopharyngeal or middle ear
specimen in 54% of events in the first cohort and in 67% of events in the second.
Rhinoviruses formed the most common virus group detected (41-32%), followed by
enteroviruses (25%, sought in the second cohort only) and respiratory syncytial
virus (RSV) (10%). All the other viruses represented jointly 8-10% of the events.
In conclusion, using the methods described in this study, a specific virus
infection was diagnosed in two thirds of all acute otitis media events in young
children. Picornavirus RNA was detected in association with more than a half of
all acute otitis media events. The use of PCR-based methods for the other
respiratory viruses might have increased further the overall virus detection rate
in acute otitis media. Copyright 2004 Wiley-Liss, Inc.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 14695665 [PubMed - indexed for MEDLINE]

1492: J Assoc Res Otolaryngol. 2003 Sep;4(3):384-93.

Expression of mucins in mucoid otitis media.

Lin J, Tsuboi Y, Rimell F, Liu G, Toyama K, Kawano H, Paparella MM, Ho SB.

Department of Otolaryngology, Otitis Media Research Center, University of
Minnesota School of Medicine, Minneapolis, MN 55455, USA. linxx004@tc.umn.edu

A hallmark of mucoid otitis media (MOM, i.e., chronic otitis media with mucoid
effusion) is mucus accumulation in the middle ear cavity, a condition that
impairs transduction of sounds in the ear and causes hearing loss. The mucin
identities of mucus and the underlying mechanism for the production of mucins in 
MOM are poorly understood. In this study, we demonstrated that the MUC5B and MUC4
were major mucins in MOM that formed distinct treelike polymers (mucus strands). 
The MUC5B and MUC4 mRNAs in the middle ear mucosa with MOM were up regulated
5-fold and 6-fold, compared with the controls. This upregulation was accompanied 
by the extensive proliferation of the MUC5B- and MUC4-producing cells in the
middle ear epithelium. Further study indicated that the mucin hyperproduction was
significantly linked to CD4+ and CD8+ T cells and/or CD68+ monocyte macrophages. 
It suggests that MUC5B and MUC4 expression may be regulated by the products of
these cells.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 14690056 [PubMed - indexed for MEDLINE]

1493: Pediatr Infect Dis J. 2003 Dec;22(12):1063-8.

Microbiology of otitis media in Costa Rican children, 1999 through 2001.

Arguedas A, Dagan R, Soley C, Loaiza C, Knudsen K, Porat N, Pérez A, Brilla E,
Herrera ML.

Instituto de Atención Pediátrica, San José, Costa Rica. aarguedas@iped.net

BACKGROUND: Because of the increasing number of resistant middle ear pathogens
and the impact of the new conjugate Streptococcus pneumoniae vaccine, an active
surveillance of the microbiology and susceptibility pattern of middle ear
pathogens is required. OBJECTIVE: To study the microbiology and susceptibility
pattern of middle ear pathogens obtained from Costa Rican children with acute
otitis media (AOM), recurrent otitis media (ROM) and therapeutic failure otitis
media (FOM). METHODS: Between 1999 and 2001 middle ear fluid (MEF) was collected 
from 276 Costa Rican patients. S. pneumoniae serotyping and pulsed field gel
electrophoresis analysis was done on available strains. RESULTS: Among the total 
study population, 102 were AOM patients, 98 were ROM patients and 76 were FOM
patients. Overall S. pneumoniae (88 strains) was the most common pathogen
isolated followed by Haemophilus influenzae (41 strains) and Streptococcus
pyogenes (10 strains). H. influenzae was the most common agent in FOM patients (P
= 0.015). Beta-lactamase production was observed in 3 of 41 (7%) H. influenzae
strains and 3 of 3 (100%) Moraxella catarrhalis strains.
Penicillin-nonsusceptible S. pneumoniae strains were more common in FOM (64%) and
ROM (63%) patients than in AOM (42%) patients (P = 0.05). S. pneumoniae serotype 
19F was the most prevalent serotype, mainly within one distinct clone.
CONCLUSIONS: Overall S. pneumoniae serotype 19F was the most common isolate from 
the middle ear fluid of Costa Rican children. Beta-lactamase-negative H.
influenzae was the most prevalent in the subpopulation of patients with FOM. S.
pyogenes was the third most common isolate and M. catarrhalis was uncommon.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14688566 [PubMed - indexed for MEDLINE]

1494: Infect Immun. 2004 Jan;72(1):76-81.

Ability of pneumococcal serotypes and clones to cause acute otitis media:
implications for the prevention of otitis media by conjugate vaccines.

Hanage WP, Auranen K, Syrjänen R, Herva E, Mäkelä PH, Kilpi T, Spratt BG.

Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial
College London, St. Mary's Hospital, London W2 1PG, United Kingdom.

The relative abilities of pneumococcal serotypes and strains (clones) to cause
acute otitis media (AOM) were investigated by comparing the serotypes and
genotypes of pneumococci recovered from cases of AOM (n = 149) in children <2
years of age with those from nasopharyngeal carriage (n = 288) in age-matched
controls from the same region. The odds ratio (OR) for association of pooled
vaccine serotypes with AOM was found to be slightly elevated over unity, although
this was not significantly different from that of pooled nonvaccine or
vaccine-related serotypes. Comparing individual serotypes, 19F and 23F had 2- to 
2.5-fold higher ORs, although these were not markedly different from the ORs of
nonvaccine serotypes. None of the major clones had an OR that was significantly
greater than the average, and the differences in ORs among serotypes and clones
were much less than those for invasive disease, suggesting little variation in
their ability to cause AOM. We conclude that serotype replacement may reduce the 
long-term efficacy of these vaccines against AOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14688083 [PubMed - indexed for MEDLINE]

1495: Int J Pediatr Otorhinolaryngol. 2004 Jan;68(1):101-10.

Eustachian tube gland tissue changes are related to bacterial species in acute
otitis media.

Cayé-Thomasen P, Tos M.

Department of Oto-rhino-laryngology, Head and neck surgery, Gentofte University
Hospital of Copenhagen, DK-2900, Hellerup, Denmark. percaye@dadlnet.dk

BACKGROUND AND OBJECTIVE: Prior investigations have shown that the number of
mucus producing goblet cells in the middle ear and Eustachian tube (ET) mucosa is
highly increased during and up to at least six months after experimental acute
otitis media (AOM) caused by Streptococcus pneumoniae (SP). Further, the volume
of the mucus producing paratubal gland components is increased up to 3 months
after the acute infection. These changes may in conjunction with a deteriorated
ET function predispose a subsequent development of secretory otitis media. The
present investigation compares changes in goblet cell density and gland
structures of the ET during and after AOM caused by various bacteria typically
encountered in this disease, with emphasis on potential differences due to
bacterial species. METHODS: Rat models of AOM caused by SP, non-typeable or type 
b Haemophilus influenzae (NTHI/HIB) or Moraxella catarrhalis (MC) were studied
longitudinally up to 6 months after bacterial challenge. The ET was dissected and
decalcified, paraffin embedded and serially sectioned, followed by PAS/alcian
blue staining. The goblet cell density and the paratubal gland composition and
volume were determined morphometrically in every 20th section, using a light
microscope. RESULTS: Regardless of bacterial species, the ET goblet cell density 
was increased from day 8 and peaked day 16, followed by some degree of
normalisation, although not reaching normal numbers within the 6 month period,
except for MC. The highest increase was seen in AOM caused by the non-typeable
Haemophilus strain, followed by HIB, SP and MC. Except with MC, pathological
intra-epithelial glands formed and goblet cells were found in mucosal areas
normally devoid of these. In all species but MC, the volume of the paratubal
glands progressed to peak 16 days post-inoculation, followed by a gradual
normalisation. The volume was still increased 3 months after the acute infection,
but completely normalised after 6 months. The increase was primarily due to
hypertrophy of the mucous gland components and highest in AOM caused by the
Haemophilus species, followed by SP. CONCLUSION: The Eustachian tube goblet cell 
density is increased during and up to at least six months after AOM regardless of
bacterial species, except when employing MC, by which the density was increased
for a few weeks only. Except in AOM caused by MC, the volume of the ET glands
increases during and up to at least 3 months after infection, primarily due to
hypertrophy of the mucous gland components. The non-typeable Haemophilus strain
induced the highest increase of both goblet cell density and mucous gland volume.
The increased secretory capacity of the ET following AOM may by excessive mucus
secretion contribute to the deteriorated ET function found after AOM and thus
predispose, sustain or aggravate middle ear disease.

PMID: 14687693 [PubMed - indexed for MEDLINE]

1496: Int J Pediatr Otorhinolaryngol. 2004 Jan;68(1):83-9.

Erratum in:
    Int J Pediatr Otorhinolaryngol. 2004 Oct;68(10):1353. Renzo, Mora [corrected to
Mora, Renz]; Giovanni, Ralli [corrected to Ralli, Giovanni]; Maria, Passali
Francesco [corrected to Passali, Francesco Mario];Barbara, Crippa [corrected to
Crippa, Barbara]; Stefano, Ottoboni [corrected to Ottoboni, Stefano]; Francesco, 
Mora [corrected to Mora, Francesco]; Marco, Barbieri [corrected to Barbieri,
Marco].

Short ribosomal prophylaxis in the prevention of clinical recurrences of chronic 
otitis media in children.

Mora R, Ralli G, Passali FM, Crippa B, Ottoboni S, Mora F, Barbieri M.

ENT Department, University of Genoa, Via dei Mille 11/9, Genoa, 16147, Italy.
renzomora@libero.it

The aim of this study was to compare the efficacy and the safety of a short oral 
ribosomal immunotherapy (Immucytal) in the prevention of chronic otitis media in 
children. Seventy-two patients were enrolled in this study, 41 males and 31
females, aged between 6 and 14 years, with an history of recurrent otitis media. 
Patients were randomised to receive Immucytal (group A) or placebo (group B)
according to the following protocol: one tablet daily in the morning 8 days per
month for three consecutive months. Immucytal and placebo were identical in shape
and size, in order to maintain double-blind conditions. The efficacy parameters
were (evaluated before, at the end and 6 months after the beginning of the
therapy): clinical score; changes in immunological parameters; patient's parents 
assessment of symptoms on a scale from 0 (much worse) to 4 (much improved) and
hearing tests. Patients of group A, had an improvement of clinical items
measured, serum concentrations of immunoglobulins, subjective patient's parents
assessment of symptoms and hearing tests. For all evaluations, a significant
difference between treatment groups was found. Using this dosage and posology
(shorter than others) the beneficial effects of Immucytal were maintained until
the end of the 6-month study period.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 14687691 [PubMed - indexed for MEDLINE]

1497: Int J Pediatr Otorhinolaryngol. 2004 Jan;68(1):57-63.

Effect of inhibitors of leukotriene and/or platelet activating factor on killed
H. influenzae induced experimental otitis media with effusion.

Jung TT, Park SK, Rhee CK.

Division of Otolaryngology Head and Neck Surgery, Jerry L. Pettis Memorial
Veterans Medical Center, Loma Linda University School of Medicine, Loma Linda, CA
92354, USA. tjung1790@aol.com

Our previous studies have shown that leukotriene (LT) and platelet activating
factor (PAF) are important inflammatory mediators (IMs) in the pathogenesis of
otitis media with effusion (OME). The purpose of this study was to determine the 
effect of a LT-inhibitor and/or PAF-antagonist on experimentally induced OME by
killed H. influenzae in chinchillas. LT-inhibitor SCH-37224 and/or PAF-antagonist
WEB-2170 were systematically administered, each separately or in combination, 2h 
prior and then at regular intervals after the injection of killed H. influenzae
into the superior bullae. After 48h, OME was completely prevented in the
combination group while it was only partially prevented in the other two
separately treated groups. Animals in the control group all developed OME.
Findings of this study suggest the importance of LT and PAF in the pathogenesis
of OME and the usefulness of their blockers in the prevention of OME suggesting
possible future therapeutic implication.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14687688 [PubMed - indexed for MEDLINE]

1498: Int J Pediatr Otorhinolaryngol. 2004 Jan;68(1):51-6.

Alloiococcus otitidis in acute otitis media.

Leskinen K, Hendolin P, Virolainen-Julkunen A, Ylikoski J, Jero J.

Department of Otolaryngology, Helsinki University Central Hospital, University of
Helsinki, Haartmaninkatu 4E, P.O. Box 220, Helsinki, HUCH 00029, Finland.
kimmo.leskinen@hus.fi

OBJECTIVE: The bacterium Alloiococcus otitidis has been found to be associated
with otitis media with effusion (OME). When the culture method is used, its
detection rate is low, whereas applying the polymerase chain reaction (PCR)
yields significantly higher frequencies. This study was carried out to
investigate the incidence of A. otitidis in children with acute otitis media
(AOM). METHODS: Multiplex PCR was used to detect A. otitidis together with
Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae in
the middle ear effusions (MEEs) of 118 children with AOM. The clinical outcome of
AOM and the bacterial findings of MEEs were compared. RESULTS: A. otitidis was
detected in 25% (30 of 118) of the tested MEE samples. Children over 2 years of
age had significantly more often A. otitidis-positive MEEs (37%; 22 of 59) than
younger children (14%; 8 of 59) (chi-square test, P<0.01). There were no
significant differences in the duration, clinical failures (after antibiotic
treatment), or number of recurrences of AOM between the A. otitidis-positive and 
A. otitidis-negative children. CONCLUSIONS: A. otitidis is found from the MEEs of
AOM. The present data suggest that it has no clinical significance in AOM, and it
does not increase the risk of developing OME after AOM.

PMID: 14687687 [PubMed - indexed for MEDLINE]

1499: Int J Pediatr Otorhinolaryngol. 2004 Jan;68(1):29-36.

International perspectives on management of acute otitis media: a qualitative
review.

Schilder AG, Lok W, Rovers MM.

Department of Otorhinolaryngology (KE 04.140.5), Wilhelmina Children's Hospital, 
University Medical Center Utrecht, P.O. Box 85090, 3508 AB, Utrecht, The
Netherlands. a.schilder@wkz.azu.nl

BACKGROUND: Current opinions regarding the management of acute otitis media (AOM)
in children vary across Western countries. With antibiotic resistance rising and 
more evidence regarding the limited clinical efficacy of antibiotics becoming
available, interest in managing AOM other than with antibiotics is renewed.
OBJECTIVES: To compare international rates of antibiotic prescription and surgery
for AOM. To provide current evidence regarding the efficacy of various treatment 
options for AOM and their potential complications. METHODS: Qualitative
(narrative) review. RESULTS: The percentage of patients given antibiotics for AOM
varies from 31% in The Netherlands to more than 90% in most other Western
countries. The 1998 prevalence of penicillin-resistant S. pneumoniae strains, on 
the other hand, ranges from 3% in The Netherlands to 53% in France. The surgical 
rate for tympanostomy tubes varies from 2 per 1000 children per year in the
United Kingdom to 20 per 1000 in The Netherlands. The benefit of both antibiotic 
and surgical therapy in AOM appears to be limited, with numbers needed to treat
ranging from 8 to 25 for antibiotic therapy, depending on the definition of
outcome. CONCLUSIONS: International rates of antibiotic prescription and surgery 
for AOM vary strongly, which can be explained largely by the lack of uniform
evidence-based guidelines. International debates with the aim of overcoming
cultural differences regarding the management of otitis media, and of reaching
agreement on guidelines on the basis of current evidence are necessary.

Publication Types: 
    Comparative Study
    Review

PMID: 14687684 [PubMed - indexed for MEDLINE]

1500: Int J Pediatr Otorhinolaryngol. 2004 Jan;68(1):7-13.

Efficacy of adenoidectomy in the treatment of nasal and middle ear symptoms in
children with Down syndrome.

Price DL, Orvidas LJ, Weaver AL, Farmer SA.

Mayo Medical School, Rochester, MN, USA.

OBJECTIVE: To compare the efficacy of adenoidectomy in children with Down
syndrome and control patients. METHODS: Medical records were reviewed for
preoperative symptoms, ear complaints, date and reason for adenoidectomy, and
postoperative symptoms in 27 children (mean age, 6.0 years; range, 1.6-14.5
years) with Down syndrome and 53 age- and sex-matched controls who had
adenoidectomy between January 1978 and September 1997. Long-term follow-up was
aided by telephone interviews. Improvement in nasal and middle ear symptoms after
adenoidectomy was calculated as the percentage of patients symptom-free
postoperatively among those with symptoms preoperatively. RESULTS: After
adenoidectomy, more controls than patients with Down syndrome had improvement in 
symptoms, including nasal obstruction (86.7% versus 50.0%; P=0.005); snoring
(73.2% versus 40.9%; P=0.01); mouth breathing (84.1% versus 40.9%; P<0.001); and 
middle ear disease (68.0% versus 23.1%; P<0.001). Patients with Down syndrome
were 7.7 times (95% confidence interval, 2.3-25.3) more likely to have chronic
ear drainage after adenoidectomy. CONCLUSIONS: The results of the study suggest
that the efficacy of adenoidectomy in children with Down syndrome is
significantly less than that in controls and should influence surgical decision
making in these children.

Publication Types: 
    Comparative Study

PMID: 14687681 [PubMed - indexed for MEDLINE]

1501: Int J Clin Pract. 2003 Nov;57(9):775-7.

Persistent otorrhoea after ventilation tube insertion: a treatment protocol.

Siddiq MA, Narula AA.

Department of Otorhinolaryngology--Head and Neck Surgery, Leicester Royal
Infirmary, Leicester.

Otorrhoea is the commonest complication of ventilation tube (grommet) insertion. 
In some cases it may be unresponsive to short courses of topical
antibiotic/steroid drops and/or systemic antibiotics. This study investigated
whether a five-day course of inpatient treatment with intravenous antibiotics,
topical medication and daily microsuction was effective in treating persistent
otorrhoea. Eleven subjects were included, of whom nine responded to the proposed 
treatment regimen. We recommend that patients with persistent otorrhoea after
ventilation tube insertion should be managed according to these guidelines before
considering an examination under anaesthetic or a ventilation tube removal.

PMID: 14686567 [PubMed - indexed for MEDLINE]

1502: Mycopathologia. 2003;156(4):313-5.

Etiological significance of Candida albicans in otitis externa.

Jadhav VJ, Pal M, Mishra GS.

Department of Veterinary Public Health, College of Veterinary Science, Anand 388 
001, Gujarat, India.

A study covering 79 patients (42 males, 37 females) of different age groups
clinically diagnosed as otomycosis were investigated mycologically to elucidate
the role of Candia albicans, an opportunistic polymorphic yeast, in otitis
externa. C. albicans was diagnosed as the sole pathogen in two patients (1 male
and 1 female) aged 18 and 20 years, respectively. The organism was repeatedly
demonstrated in the aural specimens both by direct microscopy as well as culture 
isolation. Both the patients had unilateral otomycosis and used antibiotic
solution and removed wax with wooden stick. The topical application of one per
cent clotrimazole lotion showed good response both clinically as well as
mycologically. The growing significance of opportunistic fungi emphasizes on
comprehensive studies to establish the etiologic role in various clinical
disorders in human and animal medicine.

PMID: 14682457 [PubMed - indexed for MEDLINE]

1503: Disabil Rehabil. 2004 Jan 21;26(2):97-102.

Impact of middle ear effusion on balance performance in children.

Engel-Yeger B, Golz A, Parush S.

Occupational Therapy Department, University of Haifa, Haifa, Israel.
Batya@research.haifa.ac.il

Middle ear effusion (MEE) is a common childhood disease characterized by
accumulation of fluid in the middle ear. MEE treatment focuses on the resultant
conductive hearing loss. Recently, researchers have investigated the potential
effects of MEE on balance. PURPOSE: The purpose of this study was to compare
balance of children with MEE to that of healthy children and to examine whether a
relation exists between balance skills and the degree of muscle strength.
METHODS: Twenty children with MEE and twenty healthy children aged 4.5 - 7.5
years underwent balance and strength sub-tests of Bruininks - Oseretsky Test of
Motor Performance (BOTMP) and electronystagmography recordings (ENG). Parents
completed a questionnaire designed to elicit their perceptions of their child's
balance abilities in daily living activities. RESULTS: MEE children performed
significantly worse than did the control group on BOTMP balance sub-test. BOTMP
strength subtest indicated that children with MEE had poorer muscle strength than
the control group, although the difference was not significant. ENG results
showed no pathologic recordings in both study group and control group. Finally, a
significant correlation was found between parents' responses on the questionnaire
and their child's performance on BOTMP balance subtest. CONCLUSIONS: MEE may
negatively impact children's balance, while muscle strength is less affected.
Furthermore, the BOTMP appears to be a sensitive assessment of balance
disturbances in children with MEE.

PMID: 14668146 [PubMed - indexed for MEDLINE]

1504: Otolaryngol Head Neck Surg. 2003 Dec;129(6):666-73.

Hearing loss with stapedotomy in otitis media.

Falcone MT, Gajewski BJ, Antonelli PJ.

Department of Otolaryngology, University of Florida, Gainesville, FL 32610-0264, 
USA.

OBJECTIVE: Stapes fixation is often found in patients with either active or
inactive otitis media (OM). Stapedotomy is generally not performed in ears with
OM because of the potential risk of sensorineural hearing loss (SNHL). Recent
studies have demonstrated that the inner ear may be fenestrated in the presence
of OM without significantly increased risk of SNHL. The goal of this study was to
determine if stapedotomy in the presence of OM significantly increases the
incidence of postoperative SNHL. METHODS: Streptococcus pneumoniae or Pseudomonas
aeruginosa was injected bilaterally into the middle ears of guinea pigs (n = 18
and 16, respectively). A control group (n = 14) was injected with saline
solution. Two days postinjection, a unilateral stapedotomy was performed.
Auditory thresholds were evaluated by electrocochleography before and after
stapedotomy. RESULTS: Bacterial OM was induced in all ears injected with
pneumococci and pseudomonas. Auditory thresholds increased in all ears treated
with stapedotomy. Stapedotomy performed in the presence of pseudomonas OM
resulted in significantly greater SNHL than in control or pneumococcal ears (P = 
0.0055). Hearing thresholds were not significantly different between pneumococcal
OM and control ears treated with stapedotomy. CONCLUSION: Stapedotomy in the
presence of pseudomonas OM, but not pneumococcal OM, significantly increases the 
risk of SNHL in the guinea pig model. SIGNIFICANCE: Stapedotomy should be avoided
in patients with active OM, particularly in the presence of pseudomonas.

PMID: 14663433 [PubMed - indexed for MEDLINE]

1505: Int J Pediatr Otorhinolaryngol. 2003 Dec;67 Suppl 1:S233-5.

Aseptic surgical technique and postgrommet otorrhoea.

Odutoye T, McGilligan A, Robb PJ.

Department of Ear, Nose and Throat Surgery, Whipps Cross Hospital, London, UK.
babatunde.odutoye@virgin.net

Myringotomy and grommet insertion is one of the most common operations performed 
in Europe today, with an estimated 70,000 being carried out annually in Britain
alone [Lancet 1 (1984) 835]. Otorrhoea is a common postoperative complication.
There is controversy about the degree to which surgical asepsis should be
maintained during the operation. This prospective study of 35 patients (70 ears) 
undergoing grommet insertion was carried out to evaluate the efficacy of two
differing degrees of surgical asepsis. Using each patient as their own control a 
grommet was inserted into one ear with the surgeon wearing sterile gloves and
masks, and the other wearing only clean non-sterile gloves. Discharge in the
first 14 days occurred in five ears, three cases belonging to the former group
and two to the latter. The results indicate that there is no significant
difference in the incidence of postoperative otorrhoea using either of the above 
methods, and demonstrate that this operation may be performed in a safe but more 
cost-efficient manner.

PMID: 14662203 [PubMed - indexed for MEDLINE]

1506: Int J Pediatr Otorhinolaryngol. 2003 Dec;67 Suppl 1:S63-7.

Effects of otitis media with effusion (OME) on central auditory function.

Moore DR, Hartley DE, Hogan SC.

University Laboratory of Physiology, University of Oxford, Parks Road, Oxford OX1
3PT, UK. davem@ihr.mrc.ac.uk

Conductive hearing loss attenuates and delays sound passing through the middle
ear. This impairs binaural hearing and other central auditory functions dependent
on high fidelity sound transmission. Persistent conductive loss leads to central 
impairments that persist after the peripheral loss has resolved. For example,
children who have had multiple episodes of otitis media with effusion (OME) in
the first few years of life may have poor detection of sounds in noisy
environments, evidenced by reduced binaural unmasking (BU). Recent research shows
that a 'threshold' level of OME is required to produce impaired BU. Children who 
had OME in one or both ears for more than about 50% of the first 5 years had
reduced BU. Animal research, using long-term ear plugging, suggests that total
OME duration, rather than age at the time of having the disease, determines its
effect on BU. Animals reared with bilateral (but not unilateral) ear plugs also
have poor auditory temporal resolution, and reduced sensitivity to short tones in
the presence of background noise, after plug removal. However, given time (6-24
months) and training, all animals regained normal temporal resolution.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14662170 [PubMed - indexed for MEDLINE]

1507: Laryngoscope. 2003 Dec;113(12):2116-22.

Topical ciprofloxacin/dexamethasone is superior to ciprofloxacin alone in
pediatric patients with acute otitis media and otorrhea through tympanostomy
tubes.

Roland PS, Anon JB, Moe RD, Conroy PJ, Wall GM, Dupre SJ, Krueger KA, Potts S,
Hogg G, Stroman DW.

Department of Otolaryngology, University of Texas Southwestern Medical Center,
5323 Harry Hines Boulevard, Dallas, TX 75390-9035, USA.
Peter.Roland@UTSouthwestern.edu

OBJECTIVE: To determine whether topical administration of a corticosteroid
improves resolution of acute tympanostomy tube otorrhea when combined with
topical antibiotic drops. STUDY DESIGN: Randomized, patient-masked,
parallel-group, multicenter trial of topical otic ciprofloxacin/dexamethasone
versus topical ciprofloxacin alone in 201 children aged 6 months to 12 years with
acute otitis media with tympanostomy tubes (AOMT) of less than or equal to 3
weeks' duration and visible otorrhea. METHODS: Eligible patients were randomized 
to receive three drops of either ciprofloxacin 0.3%/dexamethasone 0.1% or
ciprofloxacin 0.3% into the affected ear or ears twice daily for 7 days. Clinical
signs and symptoms of AOMT were evaluated on days 1 (baseline), 3, 8
(end-of-therapy), and 14 (test-of-cure), and twice-daily assessments of otorrhea 
were recorded in patient diaries. RESULTS: The mean time to cessation of otorrhea
in the microbiologically culture-positive patient population (n = 167) was
significantly shorter with topical ciprofloxacin/dexamethasone than with
ciprofloxacin alone (4.22 vs. 5.31 days; P =.004). This resulted in significantly
better clinical responses on days 3 and 8 (P <.0001 and P =.0499, respectively). 
However, there were no significant differences between the two treatment groups
in either the clinical response or the microbial eradication rate by day 14.
CONCLUSIONS: Topical otic treatment with ciprofloxacin/dexamethasone is superior 
to treatment with ciprofloxacin alone and results in a faster clinical resolution
in children with AOMT. The contribution of the corticosteroid in achieving a 20% 
reduction (1.1 day) in time to cessation of otorrhea is clinically meaningful and
represents an important advance over single-agent antibiotic therapy.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 14660913 [PubMed - indexed for MEDLINE]

1508: Eur J Pharmacol. 2003 Dec 15;482(1-3):313-8.

A comparative study of intratympanic steroid and NO synthase inhibitor for
treatment of cochlear lateral wall damage due to acute otitis media.

Sone M, Hayashi H, Yamamoto H, Tominaga M, Nakashima T.

Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine,
65 Tsurumai-cho, Showa, Nagoya 466-8550, Japan. michsone@med.nagoya-u.ac.jp

We studied the damage to the cochlear lateral wall induced by otitis media and
the therapeutic effects of intratympanic administration of steroid and nitric
oxide (NO) synthase inhibitor. In Sprague-Dawley rats, right middle ear cavities 
were inoculated with lipopolysaccharide, followed after 30 min by intratympanic
administration of dexamethasone, NOS-inhibitor or PBS. Twenty-four hours after
lipopolysaccharide inoculation, cochlear blood flow was measured by laser-Doppler
flowmetry. Prostaglandin E(1) was topically applied to the round window membrane 
of the right ear and changes in cochlear blood flow were calculated. Changes of
cochlear blood flow were significantly different among the three groups.
Increases in cochlear blood flow following PGE(1) application were higher in the 
group that received NOS-inhibitor. Electron microscopic examination revealed that
changes in the stria vascularis were less severe in rats treated with
dexamethasone or NOS-inhibitor. Our results show the effectiveness of
intratympanic dexamethasone or NOS-inhibitor in treating cochlear lateral wall
damage caused by otitis media.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 14660037 [PubMed - indexed for MEDLINE]

1509: Pediatrics. 2003 Dec;112(6 Pt 1):1379-87.

Evidence assessment of the accuracy of methods of diagnosing middle ear effusion 
in children with otitis media with effusion.

Takata GS, Chan LS, Morphew T, Mangione-Smith R, Morton SC, Shekelle P.

Division of General Pediatrics, Childrens Hospital Los Angeles, Los Angeles,
California 90027, USA. gtakata@chla.usc.edu

OBJECTIVES: We report the findings of an evidence assessment on the accuracy of
methods of diagnosing middle ear effusion in children with otitis media with
effusion (OME). METHODS: We searched Medline (1966-January 2000), the Cochrane
Library (through January 2000), and Embase (1980-January 2000) and identified
additional articles from reference lists in proceedings, published articles,
reports, and guidelines. Excluded were nonhuman studies; case reports;
editorials; letters; reviews; practice guidelines; non-English-language
publications; and studies on patients with immunodeficiencies, craniofacial
anomalies (including cleft palate), primary mucosal disorders, or genetic
conditions. From each eligible study, we calculated the sensitivity, specificity,
positive predictive value, negative predictive value, accuracy, and prevalence of
OME in the cohort. We determined the number of studies for each comparison of a
diagnostic method and a reference standard listed within the scope of our
assessment. For comparisons with 3 or more studies, we derived random effects
estimates of sensitivity, specificity, and prevalence rate. Using the pooled
estimates, we plotted the performance of each diagnostic test in terms of
sensitivity and (1 - specificity) and identified the best performer among the
tests included in the comparison. RESULTS: Among 8 diagnostic methods, pneumatic 
otoscopy had the best apparent performance with a sensitivity of 94% (95%
confidence interval: 92%-96%) and a specificity of 80% (95% confidence interval: 
75%-86%). However, examiner qualifications were reported inconsistently, and
training was not specified. CONCLUSIONS: The finding that pneumatic otoscopy can 
do as well as or better than tympanometry and acoustic reflectometry has
significant practical implications. For the typical clinician, pneumatic otoscopy
should be easier to use than other diagnostic methods. The important question may
be what degree of training will be needed for the clinician to be as effective
with pneumatic otoscopy as were the examiners in the studies reviewed in this
report.

Publication Types: 
    Meta-Analysis
    Review

PMID: 14654613 [PubMed - indexed for MEDLINE]

1510: Ann Otol Rhinol Laryngol. 2003 Nov;112(11):935-8.

Tuberculous otitis media: clinical aspects of 12 cases.

Nishiike S, Irifune M, Doi K, Osaki Y, Kiuchi N.

Department of Otolaryngology, Suita Municipal Hospital, Suita, Osaka, Japan.

The clinical features of tuberculous otitis media (TOM) have changed. This study 
was performed to evaluate changing trends in the clinical manifestations of TOM. 
We reviewed a series of 12 cases of TOM (13 ears) recently treated at Osaka
Prefectural Habikino Hospital. The results showed a mean age of 41 years and a
male predominance of 1.4 to 1. Central or total perforations of the tympanic
membrane were observed in most cases, but none of the patients had multiple
perforations. Nine patients (75%) had active pulmonary tuberculosis. Normal lung 
status or inactive pulmonary tuberculosis was significantly more frequent in the 
older age group. Diagnosis of primary TOM required more time than that of
secondary TOM. Most cases of primary TOM had high infectiousness of the primary
lesion. We summarize the clinical features of patients who should be evaluated
for TOM.

PMID: 14653361 [PubMed - indexed for MEDLINE]

1511: Microb Pathog. 2004 Jan;36(1):25-33.

Reduced severity of middle ear infection caused by nontypeable Haemophilus
influenzae lacking the hemoglobin/hemoglobin-haptoglobin binding proteins (Hgp)
in a chinchilla model of otitis media.

Morton DJ, Bakaletz LO, Jurcisek JA, VanWagoner TM, Seale TW, Whitby PW, Stull
TL.

Department of Pediatrics, University of Oklahoma Health Sciences Center, CHO
2308, 940 NE 13th Street, Oklahoma City, OK 73104, USA.

Since Haemophilus influenzae lacks enzymes necessary for synthesis of the
porphyrin ring, it has an absolute growth requirement for a porphyrin source.
This requirement can be satisfied in vitro by hemoglobin and hemoglobin complexed
to haptoglobin. The products of the hgp genes mediate the utilization of heme
from hemoglobin-haptoglobin. These genes are also involved in the use of heme
from hemoglobin, although additional gene products independently mediate the
acquisition of heme from this substrate. Different strains of H. influenzae
possess one to four hgp genes. A nontypeable H. influenzae mutant lacking all the
hgp genes was constructed and compared to the wild-type strain in a chinchilla
(Chinchilla lanigera) model of otitis media. Compared to the wild-type strain,
the hgp-deficient mutant exhibited a significantly delayed onset of detectable
middle ear infection and significantly reduced duration of infection as assessed 
by both video otoscopy and tympanometry and as evidenced by viable bacterial
counts in middle ear effusions. In addition, the maximum bacterial load in the
middle ears of chinchillas infected with the mutant strain was significantly
reduced when compared to the parent. These data indicate that the
hemoglobin/hemoglobin-haptoglobin binding proteins are required for bacterial
proliferation during H. influenzae-induced otitis media in chinchillas.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 14643637 [PubMed - indexed for MEDLINE]

1512: Int J Pediatr Otorhinolaryngol. 2003 Dec;67(12):1317-23.

Microbiology of otorrhea in children with tympanostomy tubes: implications for
therapy.

Dohar J.

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh,
Pittsburgh, PA 15213, USA. Joseph.Dohar@chp.edu

OBJECTIVE: Based on the prevalence of children with tympanostomy tubes who
develop otorrhea, an analysis was performed to identify specific prognostic
indicators in this population to enable clinicians to determine the likelihood of
specific pathogens and select the best empiric therapy. METHODS: Data from two
multicenter clinical trials of ofloxacin otic solution 0.3% (OFLX) trials in
pediatric patients 1-12 years of age were used to develop a statistical model to 
predict the likelihood of external auditory canal (EAC) or nasopharyngeal (NPG)
pathogens. Data were available for 283 microbiologically evaluable patients.
Potential indicators included subject age, season of enrollment, ear aspiration, 
cleaning, otorrhea, and granulation tissue. The model used a stepwise logistic
regression analysis relating the occurrence of NPG or EAC pathogens to the
potential prognostic indicators. RESULTS: Among the total study population, 42.8 
and 61.5% had NPG and EAC pathogens, respectively; 10.6% had both. The most
frequently isolated valid pathogens were Streptococcus pneumoniae and Haemophilus
influenzae. Significant prognostic indicators for NPG pathogens were subject age,
season of enrollment, and presence of ear odor. Although these indicators were
similar for EAC and NPG pathogens, the correlation was reversed, i.e. older
subjects had EAC pathogens, and younger ones (< 2 years) had NPG pathogens; EAC
pathogens were associated with presence of ear odor and NPG pathogens, with
absence of ear odor. CONCLUSIONS: A statistically and clinically valid model has 
been developed that has prognostic value for the clinician treating children with
otorrhea and tympanostomy tubes and serves as an aid in the appropriate choice of
empiric therapy.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 14643475 [PubMed - indexed for MEDLINE]

1513: J Infect Dis. 2003 Dec 1;188(11):1679-84. Epub 2003 Nov 10.

Epidemiology of acute otitis media caused by Streptococcus pneumoniae before and 
after licensure of the 7-valent pneumococcal protein conjugate vaccine.

McEllistrem MC, Adams J, Mason EO, Wald ER.

Division of Infectious Diseases, University of Pittsburgh School of Medicine and 
Graduate School of Public Health, Pittsburgh, Pennsylvania 15213-2582, USA.

We studied, by pulsed-field gel electrophoresis, multilocus sequence typing and
penicillin-binding protein 2b amplicon-restriction profiles, pneumococcal
isolates recovered from children with acute otitis media during 1 January-31
December 1999 and 2001. The proportion of nonvaccine serogroups increased from
14.8% (13/88) to 36.5% (23/63) from 1999 to 2001 (P<.01). Among children who
received at least 2 doses of the pneumococcal 7-valent protein conjugate (PNC7)
vaccine, 46.7% (7/15) of the isolates had nonvaccine serogroups, compared with
20.8% (26/125) of the isolates from children who did not receive the PNC7 vaccine
(P=.05). Overall, the serogroups involved in capsular switching were 6-19-NT,
6-14-35, 15-19, and the 19-Spanish 23F clone. In 1999 and 2001, 30.8% (4/13) and 
26.1% (6/23) of the nonvaccine serogroups were implicated in capsular switching, 
respectively. Continued surveillance will be of great importance as the
distribution of the PNC7 vaccine increases.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 14639539 [PubMed - indexed for MEDLINE]

1514: Eur J Oral Sci. 2003 Dec;111(6):472-6.

Asthma, ear problems, and dental anxiety among 6- to 8-yr-olds in Denmark: a
population-based cross-sectional study.

Wogelius P, Poulsen S, Sørensen HT.

Department of Community Oral Health and Pediatric Dentistry, Dental School,
Faculty of Health Sciences, University of Aarhus, Aarhus, Denmark.

The aim of this study was to examine the association between asthma, ear
problems, and dental anxiety in children in a population-based cross-sectional
study. The population included four municipalities in the County of North
Jutland, Denmark, in 2001. A total of 1235 children aged 6-8 yr, and their
parents, were identified. Data were obtained from a prescription database, from
parental-answered questionnaires, and from dental records. Children with asthma
were defined as children that had received prescriptions for both inhaled
beta2-agonists and corticosteroids during the past year. Data on ear problems and
dental anxiety were obtained from the questionnaires. Dental anxiety was measured
using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Use of
asthma-drugs was associated with dental anxiety (odds ratio = 1.70; 95%
confidence interval 0.90-3.22). A history of often ear problems was also
associated with dental anxiety (odds ratio = 1.83; 95% confidence interval
1.20-2.80). It is concluded that asthma and ear problems may be risk factors for 
dental anxiety in children.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14632682 [PubMed - indexed for MEDLINE]

1515: Paediatr Drugs. 2003;5 Suppl 1:1-12.

Acute otitis media in pediatric medicine: current issues in epidemiology,
diagnosis, and management.

Leibovitz E.

Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, 
Israel. eugenel@bgumail.bgu.ac.il

Acute otitis media (AOM) is not only the most common bacterial infection in
children in the United States, it is also the most common indication for the
prescription of antibiotics. Unfortunately, antibiotic resistance to pathogens
(Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis)
typically causative of AOM, continues to increase. More than 30% of the
beta-lactamase producing H. influenzae are resistant to amoxicillin and virtually
all strains of M. catarrhalis are beta-lactamase-positive. The emergence of
multidrug-resistant strains, particularly S. pneumoniae, complicates the
management of AOM and increases the risk for treatment failure. Because of
growing resistance, the Centers for Disease Control and the American Academy of
Pediatrics promote the judicious use of antibiotics in the treatment of AOM.
Their recommendations emphasize the importance of distinguishing AOM from otitis 
media with effusion, minimizing the use of antibiotics, and discerning between
first- and second-line antibiotics in the treatment of simple uncomplicated AOM
versus non-responsive/recurrent AOM. Because spontaneous cure rates are lower in 
complicated AOM and AOM secondary to S. pneumoniae infection, antibiotic therapy 
remains an appropriate treatment option for most children with AOM. When
amoxicillin, the treatment of choice in AOM, is not effective or not tolerated in
children, the prescriber should consider an alternative that displays not only
excellent antimicrobial activity against the suspected pathogens, but also
characteristics, such as convenient dosing, tolerability, and palatability, that 
promote compliance and adherence in children. The cephalosporins offer an
alternative to penicillins. Cephalosporins such as cefuroxime axetil
(second-generation) and cefdinir and cefpodoxime proxetil (third-generation),
offer a broad spectrum of activity and are approved for use in a convenient once-
or twice-daily dosing schedule, thus increasing the likelihood of compliance with
the full course of therapy. Cefdinir is a possible second-line alternative to
amoxicillin for children with AOM, particularly among children who are likely to 
be noncompliant with a two- to three-times-daily dosing schedule, and those
instances where there is a high likelihood for, or a known infection with an
amoxicillin-resistant pathogen.

Publication Types: 
    Review

PMID: 14632101 [PubMed - indexed for MEDLINE]

1516: Curr Opin Otolaryngol Head Neck Surg. 2003 Dec;11(6):416-23.

Otitis media: concepts and controversies.

Darrow DH, Dash N, Derkay CS.

Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, USA.

PURPOSE OF REVIEW: Otitis media is the most common bacterial infection among
children, accounting for as many as 30 million office visits annually. Proper
treatment has become critical as offending pathogens become increasingly
resistant to antibiotics and the cost of managing the disorder has exceeded 3
billion dollars per year. However, data suggest that many practitioners still
struggle with the diagnosis of otitis media and often recommend medical and
surgical intervention inappropriately. This article presents recent advances in
the otitis media literature and an evidence-based approach to its management.
RECENT FINDINGS: Recent investigations have resulted in the following findings:
(1) bacterial biofilms may account for the persistence of middle ear disease; (2)
there is increasing evidence that heredity and reflux are risk factors for otitis
media; (3) primary care providers may be receiving poor otitis media training,
leading to inadequate diagnostic skills; (4) medical and surgical therapy are of 
limited utility in the management of acute and recurrent acute otitis media; (5) 
antibiotics and steroids are of limited value in the treatment of chronic middle 
ear effusion; (6) delayed management of effusion may not adversely affect
development in children; (7) vaccination for pneumococcus may alter the serotypes
responsible for otitis media; and (8) vaccine candidates for other middle ear
pathogens are under investigation. SUMMARY: Management of otitis media is
constantly evolving, based on research from a variety of medical subspecialties. 
It is incumbent on the otolaryngologist and primary care providers treating
otitis media to keep pace with and synthesize these findings into a rational
approach to treatment.

Publication Types: 
    Review

PMID: 14631172 [PubMed - indexed for MEDLINE]

1517: BMJ. 2003 Nov 22;327(7425):1201-5.

Comment in:
    Evid Based Nurs. 2004 Apr;7(2):43.

Clinical efficacy of three common treatments in acute otitis externa in primary
care: randomised controlled trial.

van Balen FA, Smit WM, Zuithoff NP, Verheij TJ.

Julius Center for Health Sciences and Primary Care, PO Box 80560, 3508 AB
Utrecht, Netherlands. f.a.m.vanbalen@med.uu.nl

OBJECTIVE: To compare the clinical efficacy of ear drops containing acetic acid, 
corticosteroid and acetic acid, and steroid and antibiotic in acute otitis
externa in primary care. DESIGN: Randomised controlled trial. SETTING: 79 general
practices, Netherlands. PARTICIPANTS: 213 adults with acute otitis externa. MAIN 
OUTCOME MEASURES: Primary outcome: duration of symptoms (days) according to
patient diaries. Secondary outcome: cure rate according to general practitioner
completed questionnaires and recurrence of symptoms between days 21 and 42.
RESULTS: Symptoms lasted for a median of 8.0 days (95% confidence interval 7.0 to
9.0) in the acetic acid group, 7.0 days (5.8 to 8.3) in the steroid and acetic
acid group, and 6.0 days (5.1 to 6.9) in the steroid and antibiotic group. The
overall cure rates at seven, 14, and 21 days were 38%, 68%, and 75%,
respectively. Compared with the acetic acid group, significantly more patients
were cured in the steroid and acetic acid group and steroid and antibiotic group 
at day 14 (odds ratio 2.4, 1.1 to 5.3, and 3.5, 1.6 to 7.7, respectively) and day
21 (5.3, 2.0 to 13.7, and 3.9, 1.7 to 9.1, respectively). Recurrence of symptoms 
between days 21 and 42 occurred in 29% (50/172) of patients and was seen
significantly less in the steroid and acetic acid group (0.3, 0.1 to 0.7) and
steroid and antibiotic group (0.4, 0.2 to 1.0) than in the acetic acid group.
CONCLUSIONS: Ear drops containing corticosteroids are more effective than acetic 
acid ear drops in the treatment of acute otitis externa in primary care. Steroid 
and acetic acid or steroid and antibiotic ear drops are equally effective.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 14630756 [PubMed - indexed for MEDLINE]

1518: J Paediatr Child Health. 2003 Nov;39(8):635-6.

Comment in:
    J Paediatr Child Health. 2004 Jul;40(7):414-5; author reply 415.

Petrositis and cerebellar abscess complicating chronic otitis media.

Trimis G, Mostrou G, Lourida A, Prodromou F, Syriopoulou V, Theodoridou M.

1st Pediatric Clinic of University of Athens, Athens, Greece. gtrim@compulink.gr

A 12-year-old girl with chronic otitis media complicated by petrositis and
cerebellar abscess is presented. Early surgical intervention, in combination with
broad-spectrum antibiotics, provided a good outcome. Life-threatening
complications of otitis media, although rare, still occur in developed countries.

Publication Types: 
    Case Reports

PMID: 14629535 [PubMed - indexed for MEDLINE]

1519: J Paediatr Child Health. 2003 Dec;39(9):665-7.

The microbiology of glue ear in Australian Aboriginal children.

Stuart J, Butt H, Walker P.

The John Hunter Children's Hospital, The University of Newcastle, Newcastle, New 
South Wales, Australia. jstuart@mail.newcastle.edu.au

OBJECTIVE: To study the bacterial cultures of middle ear aspirates from 27
Aboriginal children with otitis media with effusion. METHODS: Standard
bacteriological techniques were used to analyse the middle-ear aspirates
collected during surgery to insert grommets in 27 Aboriginal children. Swabs of
the tympanic membrane were taken for comparison. RESULTS: Forty-five aspirates
were collected from 59 myringotomies. Positive cultures were obtained from 19 of 
these (13 children) with potentially pathogenic organisms identified in 11
children including Staphylococcus, Pseudomonas, Haemophilus influenzae,
Moraxella, Achromobacter, Enterobacter and Corynebacterium. CONCLUSION: This is
only the second study to look at the bacteria in middle ear effusions in
Aboriginal children. Streptococcus pneumoniae was notable in its absence as was
found in a previous study.

PMID: 14629496 [PubMed - indexed for MEDLINE]

1520: Prescrire Int. 2003 Oct;12(67):184-9.

Acute otitis media in children: amoxicillin remains the standard antibiotic, but 
justified in certain situations only.

[No authors listed]

(1) The best-assessed antibacterial agents in otitis are penicillin V and
amoxicillin. No other antibacterial agents are any more effective in clinical
trials. (2) In France, amoxicillin seems the best choice because it is still
active against pneumococci with diminished sensitivity to penicillin. Also,
amoxicillin causes very few serious adverse effects. (3) There is no firm
evidence that clavulanic acid makes amoxicillin any more effective. In fact the
combination of amoxicillin + clavulanic acid causes more gastrointestinal adverse
effects (including potentially severe diarrhoea) than any other antibacterial
agent. (4) For patients who are allergic to penicillin, a macrolide such as
erythromycin, or cotrimoxazole, appear to be acceptable first-line alternatives. 
(5) According to a reliable randomised trial, delaying the decision about
antibacterial treatment by 72 hours in children with acute otitis media does no
harm. If the decision is delayed, three quarters of children avoid antibacterial 
therapy altogether. (6) Patients get no extra benefit from extending treatment
beyond 5 to 7 days. (7) Prolonged treatment, and the use of low doses are risk
factors for subsequent carriage of resistant bacteria. (8) There are no
comparative trials of antibacterial agents in children at high risk of severe or 
complicated disease including infants under 3 months old, children with
immunosuppression, and those with high fever.

Publication Types: 
    Comparative Study

PMID: 14619906 [PubMed - indexed for MEDLINE]

1521: Child Care Health Dev. 2003 Nov;29(6):425-32.

Should children be screened to undergo early treatment for otitis media with
effusion? A systematic review of randomized trials.

Butler CC, van der Linden MK, MacMillan HL, van der Wouden JC.

Department of General Practice, University of Wales College of Medicine,
Llanedeyrn Health Centre, Llanederyn, Cardiff, UK. butlercc@cf.ac.uk

BACKGROUND: Otitis media with effusion (OME) is the most common cause of acquired
hearing loss in childhood and has been associated with delayed language
development and behavioural problems. Some have argued that children should be
screened and treated early if found to have clinically important OME. The aim of 
this review was to assess evidence from randomized controlled trials about the
effectiveness of screening and treating children with clinically important OME in
the first 4 years of their life. The primary outcome was language development.
METHODS: We searched the Cochrane Controlled Trials Register, MEDLINE and EMBASE 
and reference lists of all included studies in February 2003. We also contacted
the first authors of the studies included in this review. Search terms included
otitis media; otitis media with effusion; glue ear; OME; screen; children;
treatment; language; and behaviour. Data extraction and methodological quality
assessment were performed by at least two of us for each study independently,
using methods described in the Cochrane Collaboration Handbook. RESULTS: From the
three included randomized controlled trials evaluating interventions among
children with OME identified through screening, we found no evidence of
clinically important benefit in language development. CONCLUSIONS: The identified
randomized trials do not show an important benefit on language development from
screening the general population of asymptomatic children in the first 4 years of
life to undergo early treatment for OME. Screening asymptomatic children in the
first 4 years of life for OME is not recommended.

Publication Types: 
    Review

PMID: 14616899 [PubMed - indexed for MEDLINE]

1522: Clin Microbiol Infect. 2003 Oct;9(10):1006-10.

Otitis and respiratory distress episodes following a respiratory syncytial virus 
infection.

Kafetzis DA, Astra H, Tsolia M, Liapi G, Mathioudakis J, Kallergi K.

Second Department of Pediatrics, University of Athens, P. & A. Kyriakou
Children's Hospital, Athens, Greece. kafetzis@ath.forthnet.gr

OBJECTIVE: To document, over two consecutive respiratory syncytial virus (RSV)
seasons, the occurrence of acute otitis media (AOM) and recurrence of respiratory
distress in children < 2 years of age hospitalized for respiratory distress.
METHODS: Patients were examined during hospitalization and at 6 weeks and 6
months after discharge. RSV testing was performed on all patients, and
hospitalized patients were evaluated daily for the occurrence of AOM. RESULTS: In
total, 347 children were enrolled; 54.8% were RSV positive, and 45.2% were RSV
negative. Children were most frequently diagnosed as having bronchiolitis (71.9%)
or asthmatic bronchitis (17.9%); other diagnoses included pneumonia, laryngitis, 
and rhinitis. During hospitalization, AOM was diagnosed in 16.8% of RSV-positive 
versus 8.3% of RSV-negative children (P < 0.05). Six weeks after discharge, AOM
was reported in 10.4% of RSV-positive as compared with 5.8% of RSV-negative
patients. Six months later, AOM was reported in 2.9% of the RSV-positive and 7.6%
of the RSV-negative patients. A second episode of acute respiratory distress,
which either required (9) or did not require (35) hospitalization, occurred in
18.4% of the total population, with similar proportions of RSV-positive and
RSV-negative children (17% versus 18.6%). CONCLUSION: We conclude that RSV
appears to be an important contributing factor for the occurrence of AOM in young
children hospitalized with respiratory distress. The occurrence of a second
episode of acute respiratory distress did not appear to correlate with the
previous RSV infection, but longer-term follow-up is required.

PMID: 14616742 [PubMed - indexed for MEDLINE]

1523: APMIS. 2003 Oct;111(10):989-94.

A mouse model for acute otitis media.

Melhus A, Ryan AF.

Department of Medical Microbiology, Lund University, Malmö University Hospital,
Malmö, Sweden. asa.melhus@mikrobiol.mas.lu.se

To induce acute otitis media in the mouse and to describe the clinical and
bacteriological course of the infection, middle ears of BALB/c, Swiss-Webster and
C57BL/6 mice were inoculated with Streptococcus pneumoniae, Haemophilus
influenzae and Moraxella catarrhalis. Systemic and local changes were monitored
by clinical observations, otomicroscopy, and analysis of bacterial samples from
blood and middle ears. Agglutination of mouse erythrocytes by M. catarrhalis was 
also tested. Depending on bacterial strain, bacterial dose, and mouse strain
three responses were identified: acute otitis media, otitis media with serous
effusion, or no reaction. BALB/c mice were the most susceptible animals. On day
3, 76% of the BALB/c mice had developed middle ear infection, 50% had a positive 
middle ear culture, 56% were bacteremic, and 10% had succumbed to a disseminated 
infection. The local infections lasted approximately a week. Animals which
survived recovered without permanent deterioration or otomicroscopically
discernible changes. In no case did M. catarrhalis induce a culture-positive
middle ear infection, possibly due to an inability to agglutinate the mouse
erythrocytes. The mouse model can become a useful tool in studies of pneumococcal
and H. influenzae-induced otitis media, but the bacterial dose has to be
carefully titrated and adjusted to the chosen mouse strain.

Publication Types: 
    Comparative Study
    In Vitro
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 14616553 [PubMed - indexed for MEDLINE]

1524: Pediatr Infect Dis J. 2003 Nov;22(11):949-56.

Open label, multicenter study of gatifloxacin treatment of recurrent otitis media
and acute otitis media treatment failure.

Arguedas A, Sher L, Lopez E, Sáez-Llorens X, Hamed K, Skuba K, Pierce PF.

Hospital Nacional de Niños and Neeman-ICIC, Instituto de Atención Pediátrica, PO 
Box 6071-1150, San Jose, Costa Rica. aarguedas@uped.net

BACKGROUND: Recurrent otitis media and treatment failures of acute infections are
refractory to therapy. Newer fluoroquinolones have excellent activity against
respiratory pathogens, but their use in children has been limited because of
concerns about adverse effects. METHODS: This was an open label, multicenter
trial in which patients with recurrent otitis media or acute otitis media (AOM)
treatment failure were treated with 10 mg/kg gatifloxacin oral suspension once
daily for 10 days. Before treatment a tympanocentesis or a swab of middle ear
fluid was obtained. Nasopharyngeal swabs were obtained at baseline and at the end
of therapy. Efficacy was evaluated 3 to 10 days after cessation of treatment and 
at 3 to 4 weeks. Safety monitoring included special attention to any sign or
symptom suggestive of joint or bone abnormality. RESULTS: The study enrolled 254 
patients 6 months to 7 years of age, with one-half (52%) of the patients having
recurrent otitis media, 17% having AOM treatment failure and 28% having both.
Cure was achieved posttreatment in 88% of 198 clinically evaluable patients, with
similar outcomes for patients younger or older than 2 years of age. Of the 45
evaluable patients with Streptococcus pneumoniae, 38 (84%) were cured, including 
25 of 28 with penicillin-nonsusceptible strains. Also cured were 89% of those
with Haemophilus influenzae and those with Moraxella catarrhalis. No selection of
resistance to gatifloxacin was detected among nasopharyngeal pathogens.
Eighty-three percent of the children had sustained cure at the 4 weeks follow-up 
visit. Adverse events were primarily mild gastrointestinal, with no occurrences
of arthropathy. CONCLUSION: Gatifloxacin is safe and effective for treatment of
recurrent otitis media and AOM treatment failure in children.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 14614365 [PubMed - indexed for MEDLINE]

1525: Pediatr Infect Dis J. 2003 Nov;22(11):943-9.

Bacteriologic and clinical efficacy of oral gatifloxacin for the treatment of
recurrent/nonresponsive acute otitis media: an open label, noncomparative, double
tympanocentesis study.

Leibovitz E, Piglansky L, Raiz S, Greenberg D, Hamed KA, Ledeine JM, Press J,
Leiberman A, Echols RM, Pierce PF, Jacobs MR, Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center, Ben-Gurion
University, PO Box 151, Beer-Sheva 84101, Israel. eugenel@bgumail.bgu.ac.il

BACKGROUND: Gatifloxacin is an 8-methoxyfluoroquinolone with good activity
against respiratory pathogens. OBJECTIVES: To document the bacteriologic and
clinical efficacy of gatifloxacin in recurrent/nonresponsive acute otitis media
(AOM). METHODS: One hundred sixty patients 6 to 48 months of age with
recurrent/nonresponsive AOM received gatifloxacin suspension (10 mg/kg once daily
for 10 days). Recurrent AOM was defined as > or =3 AOM episodes during the
previous 6 months or > or =4 AOM episodes during the previous 12 months.
Nonresponsive AOM was defined as AOM occurring < or =14 days after completing
antibiotic treatment or not improving after > or =48 h of therapy. Middle ear
fluid (MEF) obtained by tympanocentesis pretreatment (Day 1) and 3 to 5 days
after initiation of treatment (Days 4 to 6) was cultured. Additional MEF cultures
were obtained if clinical failure or recurrence of AOM occurred. Bacteriologic
failure was defined by culture-positive MEF during treatment. Patients were
followed until Days 22 to 28. Susceptibility was determined by broth
microdilution. RESULTS: One hundred twenty-eight (80%) patients completed
treatment, and 32 discontinued the study prematurely (adverse events, 17; lost to
follow-up, 10; consent withdrawal, 3; and laboratory abnormalities, 2). From 89
patients (median age, 1 year; median number of prior AOM episodes, 4; range, 0 to
12), 121 pathogens were recovered: Haemophilus influenzae, 74 (61%);
Streptococcus pneumoniae, 36 (30%); Moraxella catarrhalis, 9 (7%); and
Streptococcus pyogenes, 2 (2%). The 36 S. pneumoniae isolates were susceptible to
gatifloxacin (MIC50 0.25 microg/ml); 26 of 36 (72%) were
penicillin-nonsusceptible (15 fully resistant). All 74 H. influenzae isolates
were susceptible to gatifloxacin (MIC < or = 0.03 mg/ml). Fourteen of 74 (19%)
and 9 of 9 (100%) H. influenzae and M. catarrhalis isolates, respectively,
produced beta-lactamase. Bacteriologic eradication was achieved for 118 of 121
(98%) pathogens: 74 of 74 H. influenzae; 34 of 36 (94%) S. pneumoniae; 9 of 9 M. 
catarrhalis; and 1 of 2 S. pyogenes. Clinical improvement/cure at end of
treatment was seen in 103 of 114 (90%) clinically evaluable patients. Clinical
recurrence of AOM after completion of therapy occurred in 31 patients. Of the 27 
recurrent AOM cases in which tympanocentesis was performed, there were 16 (59%)
new infections, 4 (15%) culture-negative results and only 7 (26%) true
bacteriologic relapses. Adverse events were recorded in 21 of 160 (13%) patients:
vomiting, 16; diarrhea, 3; maculopapular rash, 2. No articular adverse events
were recorded. CONCLUSION: Gatifloxacin is efficacious and safe for the treatment
of recurrent/nonresponsive AOM.

Publication Types: 
    Clinical Trial
    Clinical Trial, Phase II

PMID: 14614364 [PubMed - indexed for MEDLINE]

1526: Clin Linguist Phon. 2003 Oct-Nov;17(7):529-47.

A diagnostic marker for speech delay associated with otitis media with effusion: 
backing of obstruents.

Shriberg LD, Kent RD, Karlsson HB, McSweeny JL, Nadler CJ, Brown RL.

Phonology Project, Waisman Center, University of Wisconsin-Madison, 1500 Highland
Avenue, Madison, WI 53705, USA. shriberg@waisman.wisc.edu

A companion paper in this issue reported diagnostic accuracy findings for a
marker (the Intelligibility-Speech Gap) to identify speech delay associated with 
otitis media with effusion (SD-OME). The present paper reports findings for
another possible diagnostic marker for SD-OME--Backing of Obstruents.
Conversational speech samples and citation forms from 48 speech-delayed children 
with positive and negative histories for OME were analysed using both perceptual 
and acoustic methods. The perceptual findings indicated significant trends for
backing to be more prevalent in children with positive compared to negative
histories of OME. Among a number of candidate speech error variables, lowered
first spectral moments on lingual stops and sibilant fricatives as obtained from 
moments analysis emerged as a promising acoustic correlate of backing. Positive
and negative predictive values, and sensitivity and specificity values for the
acoustic marker, were above 75% for each of three stimulus words targeting /k/,
/z/ and /f/. Discussion considers alternative explanatory perspectives on the
ontogenetic development of backing in children who have experienced the fluctuant
hearing loss associated with early recurrent OME.

PMID: 14608798 [PubMed - indexed for MEDLINE]

1527: Clin Linguist Phon. 2003 Oct-Nov;17(7):507-28.

A diagnostic marker for speech delay associated with otitis media with effusion: 
the intelligibility-speech gap.

Shriberg LD, Flipsen P Jr, Kwiatkowski J, McSweeny JL.

Phonology Project, Waisman Center, University of Wisconsin-Madison, 1500 Highland
Avenue, Madison, WI 53705, USA. shriberg@waisman.wisc.edu

The goal of this study was to determine if notably reduced intelligibility is a
potential diagnostic marker for children with speech delay and histories of early
recurrent otitis media with effusion (SD-OME). Intelligibility was assessed in
one 5-10 minute conversational speech sample from each of 281 speakers. The OME
histories of 148 of these children with normal speech acquisition were described 
in two prior reports. OME histories of 85 additional children with speech delay
were obtained from case history reports. For both groups, the children with
positive OME (OME+) histories had significantly lower intelligibility scores but 
significantly higher speech production scores than children with negative OME
(OME-) histories. Findings for a diagnostic marker to discriminate speech delayed
children with OME+ versus OME- histories were promising, considering that the
data were obtained retrospectively and did not include audiological information
characterizing children's concurrent fluctuant hearing loss. The formula for the 
diagnostic marker, termed the Intelligibility-Speech Gap, was identified by a
machine learning routine. Diagnostic accuracy findings for the marker were as
follows: positive predictive value = 74%, negative predictive value = 86%,
sensitivity = 79%, specificity = 83%, positive likelihood ratio = 4.6 and
negative likelihood ratio = 0.25. Discussion considers speech processing
perspectives on the source of the intelligibility-speech gap in children with
suspected SD-OME, and methodological perspectives on its development as a
diagnostic marker of one etiological subtype of speech delay.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 14608797 [PubMed - indexed for MEDLINE]

1528: Minerva Pediatr. 2003 Oct;55(5):415-38.

Acute otitis media disease management.

Pichichero ME, Casey JR.

Elmwood Pediatric Group, University of Rochester Medical Center, Rochester, NY
14642, USA. michael_pichichero@urmc.rochester.edu

A first step in management decisions regarding otitis media must focus on
accurate diagnosis to distinguish normal from acute otitis media (AOM) from
otitis media with effusion (OME) or a retracted tympanic membrane without middle 
ear effusion. There are several classification schemes for AOM that may impact
management decisions: patients with acute, persistent, recurrent, or chronic AOM 
may have a different distribution of bacterial pathogens and a different
likelihood of success from antimicrobial therapy. Patient age, prior treatment
history and daycare attendance are other important variables. The natural history
of AOM without antibiotic treatment is generally favorable; however, from the few
studies available, this is difficult to quantitate because the diagnosis was
infrequently confirmed by tympanocentesis leaving the possibility that many
patients entered into these trials may not have had bacterial AOM. Antibiotic
choices should reflect pharmacokinetic/pharmacodynamic data and clinical trial
results demonstrating effectiveness in eradication of the most likely pathogens
based on tympanocentesis sampling and antibiotic sensitivity testing. Thereafter,
compliance factors such as formulation, dosing schedule and duration of treatment
and accessibility factors such as availability and cost should be taken into
account. The increasing prevalence of antibiotic resistance among AOM pathogens
and the changing susceptibility profiles of these bacteria should be considered
in antibiotic selection. Current best practice recommends amoxicillin for
uncomplicated AOM; continuing or switching to an alternative antibiotic based on 
clinical response after 48 hours of therapy; and selection of second line
antibiotics as first line choices when the patient has already been on an
antibiotic within the previous month or is otitis prone. Preferred second-line
agents frequently noted in various guidelines include amoxicillin/clavulanate,
cefdinir, cefpodoxime, cefprozil, and cefuroxime. Three injections of ceftriaxone
or gatifloxacin (when approved) or diagnostic/therapeutic tympanocentisis (when
approved) become a third-line treatment option. No single antibiotic or
management strategy is ideal for all patients.

Publication Types: 
    Comparative Study
    Review

PMID: 14608265 [PubMed - indexed for MEDLINE]

1529: Minerva Pediatr. 2003 Oct;55(5):407-14.

Otitis media. A scholarly review of the evidence.

Pappas DE, Owen Hendley J.

Division of General Pediatrics, Department of Pediatrics, University of Virginia 
School of Medicine, Charlottesville, VA 22908, USA.

Antibiotic therapy remains the treatment of choice for otitis media in most
countries despite persuasive evidence that antibiotic therapy provides limited
clinical benefit and promotes bacterial resistance. Meta-analysis of randomized, 
placebo-controlled trials demonstrated that antibiotics increased resolution at 1
week by only 13%. Amoxicillin remains as effective as any other antibiotic,
despite increasing resistance to amoxicillin among the major bacterial pathogens.
Immediate antibiotic treatment has been shown to reduce the duration of symptoms 
by 1 day but not until after the first 24 hours when symptoms were already
improving. A delayed prescribing strategy is currently utilized in most children 
for management of acute otitis media in the Netherlands; this method is now being
evaluated elsewhere. Antibiotic therapy is delayed for 48-72 hours after
diagnosis; thereafter, antibiotics are initiated only if symptoms persist or
worsen. In 2 studies utilizing this strategy (England and the United States),
only 24-30% of the patients in the delayed treatment group initiated antibiotic
therapy; a majority of parents of children in the delayed group were satisfied
with their child's treatment. Treatment of bacterial otitis media ("pus drum")
with high dose amoxicillin (80-100 mg/kg/kd) is recommmended; for acute otitis
media without bulging, watchful waiting with a delayed prescribing strategy and
treatment of pain is preferred. Yearly administration of the influenza vaccine
and/or treatment of influenza with an antiviral (oseltamivir) can significantly
decrease the incidence of acute otitis media during influenza season. Although
pneumococcal vaccination effectively reduces the incidence of acute otitis media 
due to vaccine-related serotypes, there is a significant increase in the number
of episodes of acute otitis media due to other serotypes of S. pneumoniae such
that the overall incidence of acute otitis media is reduced only minimally by
pneumoccocal vaccine. The careful use of strict diagnostic criteria coupled with 
judicious use of antibiotic therapy will direct antibiotic treatment to only
those patients likely to benefit.

Publication Types: 
    Comparative Study
    Review

PMID: 14608264 [PubMed - indexed for MEDLINE]

1530: Laryngoscope. 2003 Nov;113(11):2047-51.

Acute otitis media develops in the rat after intranasal challenge of
Streptococcus pneumoniae.

Eriksson PO, Hellström S.

Department of Clinical Sciences, Otorhinolaryngology, Umeå University Hospital,
Sweden. Per-Olof.Eriksson@ent.umu.se

OBJECTIVES/HYPOTHESIS: The rat is a frequently used animal model for middle ear
research. To date, acute otitis media (AOM) has been evoked after instillation of
bacteria directly into the middle ear cavity or after traumatizing the tympanic
membrane. The purpose of the study was to examine whether, with an intact
tympanic membrane and middle ear cavity, intranasally deposited bacteria cause
AOM and how tympanic membrane stimulation influences this procedure. STUDY
DESIGN: In vivo, murine model. METHODS: In a rat model, Streptococcus pneumoniae,
type 3, was intranasally inoculated for 5 consecutive days. The tympanic membrane
was treated with saline or with compound 48/80 or was left untreated. The
development of AOM was evaluated by otomicroscopy, light microscopy, and middle
ear culture. RESULTS: Ninety percent of the ears developed AOM. However, when the
tympanic membranes were treated with saline or compound 48/80, only 40% and 57%, 
respectively, developed AOM. In all, 23 of 40 ears developed AOM and 20 ears
showed growth of bacteria. CONCLUSION: Repeated intranasal deposition of S.
pneumoniae, type 3, causes AOM in the rat. The development of AOM can be
influenced by tympanic membrane stimulation.

PMID: 14603072 [PubMed - indexed for MEDLINE]

1531: Int J Antimicrob Agents. 2003 Nov;22(5):508-15.

Is it possible to achieve bacterial eradication in otitis media with effusion by 
empirical antibiotic high doses and concomitant administration of acetaminophen? 
A microbiological and pharmacological study in the gerbil model.

Parra A, Ponte C, Cenjor C, García-Olmos M, Giménez MJ, Aguilar L, Soriano F.

Department of Medical Microbiology, Fundación Jiménez Díaz, Avenida de Reyes
Católicos 2, 28040, Madrid, Spain.

The efficacy of amoxycillin-clavulanic acid (10 and 15 mg/kg amoxycillin) and
erythromycin (20 and 50 mg/kg) was assessed in a gerbil model of otitis media
with effusion induced by beta-lactamase-producing Haemophilus influenzae. Animals
were divided into groups receiving acetaminophen concomitantly or not receiving
it. Treatment started 2 h post-middle ear inoculation and continued t.i.d. for up
to three doses. Middle ear samples were obtained on day 2 post-inoculation.
Amoxycillin-clavulanic acid showed significantly higher efficacy than
erythromycin, regardless of acetaminophen administration (P<0.05).
Amoxycillin-clavulanic acid middle ear concentrations exceeded the amoxycillin
MIC (1/0.5 microg/ml) by 1.88-fold, whereas erythromycin concentrations were
below MIC level of 4 microg/ml. Animals receiving acetaminophen showed
significantly fewer polymorphonuclear cells and more Haemophilus organisms in the
middle ear exudate.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14602370 [PubMed - indexed for MEDLINE]

1532: Clin Pediatr (Phila). 2003 Oct;42(8):687-96.

Lack of association of race/ethnicity and otitis media in the first 2 years of
life.

Woods CR.

Department of Pediatrics, Wake Forest University School of Medicine,
Winston-Salem, North Carolina 27157, USA.

Race has been identified as a risk factor for otitis media (OM) in several
studies. To further explore this, a database of visits with age at visit < 24
months was constructed from data captured electronically at a public health
clinic in North Carolina between July 1994 and December 1996. Among 3,108
children with at least 1 visit, 45% were African-American, 26% were Latino, and
29% were White. There were no differences among the groups in episodes of OM per 
child or ratio of OM episodes to total visits per child. A cohort of 166 children
with follow-up throughout their first 2 years of life was identified. In this
group, being uninsured or having exposure to out-of-home child care was
associated with an increased risk of OM. Race/ethnicity had no association with
frequency of OM as measured by episodes per child, proportion with > or = 1
episode, or proportion with > or = 3 episodes.

Publication Types: 
    Comparative Study

PMID: 14601917 [PubMed - indexed for MEDLINE]

1533: Otol Neurotol. 2003 Nov;24(6):868-71.

Do the genes that cause otosclerosis reduce susceptibility to otitis media?

Manolidis S, Alford RL, Smith RJ, Ball C, Manolidis L.

The Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences,
Baylor College of Medicine, Houston, Texas 77030, USA. spirosm@bmc.tmc.edu

HYPOTHESIS: The genetic factors that cause otosclerosis reduce susceptibility to 
otitis media. BACKGROUND: Susceptibility to some infectious diseases is modulated
by host genetic factors. Genes that reduce the morbidity and mortality of
infectious diseases may confer a selective advantage and achieve high-frequency
in at-risk populations. Acute otitis media in the pre-antibiotic era frequently
led to complications with high morbidity and mortality. The long-term sequela of 
acute otitis media is chronic otitis media. Chronic otitis media has a prevalence
of 0.5 to 2 percent in the Caucasian population. Clinical otosclerosis occurs in 
1 percent of Caucasians. Histologic otosclerosis occurs in 10 percent of
Caucasians. MATERIALS AND METHODS: Retrospective analysis of 2,362 subjects with 
surgically confirmed otosclerosis. Subjects' medical records were reviewed for
evidence of chronic otitis media. The incidence of chronic otitis media in the
general population was compared with the subject population. RESULTS: Of the
2,362 subjects with surgically confirmed otosclerosis, one subject with evidence 
of chronic otitis media was identified. The incidence of chronic otitis media in 
the subject population is 0.04 percent (p < 0.0001). CONCLUSIONS: The incidence
of chronic otitis media in subjects with a surgically confirmed diagnosis of
otosclerosis is significantly lower than expected. The genes that cause
otosclerosis may confer resistance to the pathogens that cause chronic otitis
media and/or acute otitis media. The mechanism of resistance is unknown.

PMID: 14600465 [PubMed - indexed for MEDLINE]

1534: Int J Pediatr Otorhinolaryngol. 2003 Nov;67(11):1235-42.

The effect of a pneumococcal conjugate vaccine on the risk of otitis media with
effusion at 7 and 24 months of age.

Straetemans M, Palmu A, Auranen K, Zielhuis GA, Kilpi T.

Department of Vaccines, National Public Health Institute, Helsinki, Finland.
m.straetemans@epib.umcn.nl

OBJECTIVE: To explore the effect of a pneumococcal conjugate vaccine on the risk 
of otitis media with effusion and to search for subgroups in which the vaccine
had a higher or lower effect. METHODS: Analyses were performed on data from the
Finnish Otitis Media Vaccine Trial, a randomised controlled double-blind trial to
evaluate the efficacy of pneumococcal conjugate vaccination against acute otitis 
media. Data on the vaccination effect against otitis media with effusion were
obtained by means of symptom interview and pneumatic otoscopy during
pre-scheduled follow-up visits at the age of 7 and 24 months. Two endpoint
definitions were considered: otitis media/tube (otitis media or tympanostomy tube
in situ (OM/T)) as the primary endpoint and otitis media with effusion as the
secondary endpoint. No evidence was found of an age-dependent association with
vaccination effect. Therefore, the final marginal logistic regression analyses
were performed on the combined data from the two follow-up visits. RESULTS: The
risk of otitis media tended to be lower in the pneumococcal vaccine group. The
odds ratio for otitis media/tube was 0.94 (95% confidence interval 0.77-1.14) and
the odds ratio for otitis media with effusion was 0.90 (95% confidence interval
0.69-1.19). Presence of older siblings increased the risk of otitis media/tube
and otitis media with effusion at 7 months of age. In addition, it appeared that 
children without older siblings and attending day-care at 24 months of age tended
to benefit more from the pneumococcal conjugate vaccine. In this subgroup, the
odds ratio for otitis media/tube was 0.81 (95% confidence interval 0.55-1.20) and
for otitis media with effusion the odds ratio was 0.43 (95% confidence interval
0.22-0.86). CONCLUSION: The effect of pneumococcal conjugate vaccination on the
risk of otitis media with effusion was concordant with the efficacy seen against 
acute otitis media, although not distinguishable from no effect in the overall
analysis. In children without older siblings, vaccination appeared to reduce the 
point prevalence of otitis media with effusion; this effect was not apparent in
children with older siblings.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 14597376 [PubMed - indexed for MEDLINE]

1535: Int J Pediatr Otorhinolaryngol. 2003 Nov;67(11):1207-12.

The epidemiology of acute bullous myringitis and its relationship to recurrent
acute otitis media in children less than 2 years of age.

Kotikoski MJ, Palmu AA, Huhtala H, Savolainen H, Puhakka HJ.

Department of Otorhinolaryngology, Tampere University Hospital, P.O. Box 2000,
33521 Tampere, Finland. kotikoski@koti.tpo.it

OBJECTIVE: To evaluate the epidemiological characteristics of acute bullous
myringitis (BM), i.e. inflammation of the tympanic membrane with blister(s) in
children <2 years and study the relationship between bullous myringitis and
recurrent acute otitis media. METHODS: 2028 children aged 7-24 months in a
prospective longitudinal cohort study in the Finnish Otitis Media vaccine trial. 
The main outcome measures were the incidence of bullous myringitis and the
incidence of acute otitis media (AOM) before and after the event of bullous
myringitis. RESULTS: 82 children had a total of 86 events of acute bullous
myringitis. The incidence of bullous myringitis was 5.7 per 100 person years (95%
CI, 4.6-7.1 per 100 person years). The number of events with bullous myringitis
was 4.6% of the number of all AOM events diagnosed during the follow-up.
Recurrent AOM (> or =6 AOM events) occurred in 33% of children with bullous
myringitis in comparison with 23% of control children with at least one event of 
AOM (RR 1.7; 95% CI, 1.01-2.7). The incidence of AOM in children with bullous
myringitis was 1.8 per person year (95% CI, 1.4-2.2 per person year) before the
event of bullous myringitis and 2.9 per person year (95% CI, 2.3-3.5 per person
year) after the event of bullous myringitis. The higher incidence rate of AOM
lasted for 2 months after the office visit of bullous myringitis. CONCLUSIONS:
Acute bullous myringitis is not a rare disease; it was diagnosed in 5.7% of
children <2 years in a 1-year follow-up. It was present in almost 1 of every 20
AOM events. Acute bullous myringitis increases the subsequent risk of recurrent
AOM.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 14597372 [PubMed - indexed for MEDLINE]

1536: Int J Pediatr Otorhinolaryngol. 2003 Nov;67(11):1185-8.

Expression of mast cell tryptase in pediatric otitis media with effusion.

Jang CH, Jung JK.

Department of Otolaryngology, Wonkwang University Hospital, Wonkwang Medical
School, 570-711 Iksan, South Korea. chul@wonkwang.ac.kr

OBJECTIVE: To evaluate the possible relationship between allergy and otitis media
with effusion (OME), we investigated the presence and level of tryptase, which
reflect mast cell activity. MATERIALS AND METHODS: Twenty-five children with
intractable OME were studied. Thirteen patients were confirmed allergy positive
by multiallergosorbent test. Twelve patients were allergy negative. Evidence for 
mast cell tryptase presence and degree of activation in the middle ear effusion
(MEE) were measured by using Western blotting and radioimmunoassay (RIA).
RESULTS: The typical single band of 32 kDa tryptase was found in the MEE. And it 
was more strongly expressed in the MEE with allergy positive than negative. RIA
demonstrated that mean tryptase level was significantly higher in the MEE with
allergy positive than negative. CONCLUSION: These results suggest that allergy
may be one of the contributing factors in the persistence of intractable OME.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 14597368 [PubMed - indexed for MEDLINE]

1537: Int J Pediatr Otorhinolaryngol. 2003 Nov;67(11):1179-83.

Otitis media with effusion and histopathologic properties of adenoid tissue.

Yasan H, Dogru H, Tüz M, Candir O, Uygur K, Yariktaş M.

Ear, Nose and Throat-Head and Neck Surgery Department, School of Medicine,
Süleyman Demirel University, Isparta, Turkey. alpyasan@hotmail.com

OBJECTIVE: Adenoidectomy is being generally used for the treatment of otitis
media with effusion (OME). The purpose of current study was to determine
objectively the significance of the histopathology of adenoid tissue on the
development of otitis media with effusion. METHODS: The records of all the
patients operated on with the diagnosis of adenoid enlargement with or without
OME were reviewed and pathologic specimen were re-evaluated regarding
histopathological properties by one pathologist unfamiliar with the diagnosis.
Sixty-one patients with adenoid hyperplasia were enrolled in the study group, 38 
males and 23 females. Age ranged between 3 and 13 years (mean age was 7.03+/-3.26
years). All the patients of study group were those operated on due to the adenoid
hyperplasia and uni- or bilateral OME. Control group was composed of 39 male and 
26 female patients (age range was between 3 and 13 years, and mean age was
7.06+/-3.04 years) with solely adenoid hyperplasia. RESULTS: The squamous
metaplasia was present in 47 (77%) and 14 (22%) patients of study and control
groups, respectively. The fibrosis of connective tissue interspersed follicles of
adenoid was present in 29 (48%) and 6 (9%) patients of study and control groups, 
respectively. The statistical analysis revealed a significant prevalence of
squamous metaplasia (P<0.001) and fibrosis of connective tissue interspersed
follicles of adenoid (P<0.001) for a surgical indication of adenoid hyperplasia
with OME than for without OME. The prevalence of other parameters was not
significantly different between two groups. CONCLUSIONS: Adenoid tissue not only 
exerts an obstructive influence on the eustachian tube lumen when enlarged, but
also impedes (hinders) mucociliary drainage of the middle ear by the way of
non-ciliated metaplastic epithelium and fibrosis of connective tissue.

PMID: 14597367 [PubMed - indexed for MEDLINE]

1538: Int J Pediatr Otorhinolaryngol. 2003 Nov;67(11):1159-68.

Outpatient treatment suite: a safe and cost-effective venue to perform
myringotomy and tubes placement in children.

Compliment JM, Gendelman MS, Allera JF, Matisz M, Horvath J, Hores KM, Sperring
K, Herbert C, Smith JM, Kurpakus BJ, Borgman KM, Post JC.

Allegheny General Hospital, 320 East North Ave, Pittsburgh, PA 15212, USA.
jcomplim@wpahs.org

CONTEXT: Otitis media (OM) is the most common reason that a child undergoes a
general anesthetic, with the total costs of treating this disease exceeding five 
billion dollars annually. Concerns regarding the development of
antibiotic-resistant organisms in response to medical treatment for OM have
fueled the demand for surgical intervention. However, reimbursements are
decreasing. Non-traditional settings for children requiring bilateral myringotomy
and tube (BMT) placement for ear disease have the potential to offer the same
degree of patient safety and improved efficiency but at lower cost. OBJECTIVE: To
develop a non-traditional setting for BMT surgery that is safe, cost effective,
and well received by patients, families and staff. DESIGN: Prospective design of 
an outpatient treatment suite (OTS) for BMT placement; prospective evaluation of 
safety and family satisfaction; analysis of costs. SETTING: A 778 bed US urban
area level one trauma center and teaching hospital, with a 2160 ft(2)
electro-convulsive therapy suite that was underutilized and non-revenue
generating on Tuesdays and Thursdays. PARTICIPANTS: A design task force of health
care providers, administrators and operations personnel; 794 healthy children
between the ages of 6 months to 16 years requiring BMT surgery; 100 families of
patients. MAIN OUTCOME MEASURES: Financial comparison was made between the
traditional operating room (OR) setting, the outpatient surgery center (SC) and
the OTS comparing overhead and indirect costs to run each site. A prospective
survey was conducted of 100 consecutive patients undergoing surgery between
November 2000 and June 2001. The survey was conducted at the 2 weeks
postoperative check and was composed of 18 questions divided into five sections, 
with a 5-point rating scheme, with one being very poor, and five being very good.
RESULTS: Designing a new treatment venue was successful because of teamwork and a
willingness to think creatively. The OTS was found to be far more cost-effective 
than both the main OR and SC for BMTs. The contribution to margin for the SC was 
US$ 280 per case and for the main OR was US$ 2130 per case. By operating on 794
patients in OTS, the hospital was able to generate additional contribution to
margin of US$ 197,100 when compared to the cost of performing these cases in the 
SC and US$ 1,499,500 when compared to performing all cases in the main OR. No
adverse consequences were noted. Patient/Family satisfaction was also rated very 
high, with an overall rating of 4.85 and markedly reduced time in hospital.
CONCLUSION: Operating rooms (ORs) today are busier than in years past, but
revenues barely meet or in some cases fall below expenses due to insurers'
decreased reimbursement. This innovative approach to BMT placement has been shown
to be safe and results in excellent family satisfaction, with a substantial
contribution to margin. As over one million BMT cases are performed annually in
the US, adoption of this approach nationally has the potential to markedly reduce
the treatment costs of this common disease.

PMID: 14597365 [PubMed - indexed for MEDLINE]

1539: Vaccine. 2003 Nov 7;21(31):4539-44.

Bacterial otitis media: a new non-invasive rat model.

Tonnaer EL, Sanders EA, Curfs JH.

Department of Otorhinolaryngology, University Medical Center Nijmegen, Philips
van Leydenlaan 15, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
e.tonnaer@kno.umcn.nl

This study describes the development of a physiological rat model for otitis
media. The model is based on the assumption that bacteria, intranasally
introduced into the nasopharynx, will be transferred into the middle ear cavity
during swallowing provided that the ambient air pressure is higher than the
middle ear pressure. This model demonstrates that small pressure changes,
generated in a pressure cabin under controlled conditions, can be used as driving
force for the transfer of bacteria into the middle ear cavity resulting in
bilateral otitis media. Because invasive techniques or biochemical agents are not
applied, this model is suited to investigate immunological aspects of otitis
media, including the effects of vaccination.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14575765 [PubMed - indexed for MEDLINE]

1540: Acta Otorhinolaryngol Belg. 2003;57(3):205-8.

Bacteriology of chronic suppurative otitis media in congolese children.

Nyembue DT, Tshiswaka JM, Sabue MJ, Muyunga CK.

Department of Otorhinolaryngology, Kinshasa University Hospital, Kinshasa 11,
Democratic Republic of Congo. dieunyembue@yahoo.fr

AIM: The study intended to identify bacteria active in the chronic suppurative
otitis media and to determine their sensitivity to current antibiotics. METHODS: 
After clinical evaluation, middle-ear secretions were taken for bacteriological
examination from 78 children meeting the inclusion criteria. All children with
cholesteatoma and those with tumors occluding the ear canal were excluded.
RESULTS: The most frequent isolated germs, in descending order frequency, were as
follows: Proteus mirabilis (23%), Pseudomonas aeruginosa (22%), Citrobacter (20%)
and Salmonella (5%). There were no cases of mixed flora. Ofloxacin was
susceptible on all isolates. Neomycin, gentamicin and polymyxin B were
susceptible on 96%, 83% and 67% of the isolates respectively. All isolates were
resistant to amoxycillin. CONCLUSION: Peudomonas, Proteus and Citrobacter are the
most common causes of chronic otitis media among children in our community of
congolese children. Ofloxacin and neomycin are the most highly effective against 
most of the isolated germs, and are therefore recommended as the first line local
treatment. Amoxycillin and chloramphenicol should be avoided.

PMID: 14571655 [PubMed - indexed for MEDLINE]

1541: Med J Malaysia. 2002 Mar;57(1):104-7.

Cervical necrotising fasciitis consequent to mastoid infection.

Chua HK, Segar CB, Krishnan R, Ho CK.

Public Specialist Centre, 142 TUV, Jalan Burma, 10050, Penang.

We present a case of cervical necrotising fasciitis in a 56 year old man,
secondary to a rare mastoid infection. The patient had coexisting diabetes
mellitus and hypertension. He was treated with early surgical debridement
followed by neck and chest reconstruction and radical mastoidectomy. Aggressive
antibiotic therapy and supportive care was given. He recovered well with minimal 
residual functional deficit.

Publication Types: 
    Case Reports

PMID: 14569726 [PubMed - indexed for MEDLINE]

1542: Arch Otolaryngol Head Neck Surg. 2003 Oct;129(10):1098-100.

Evaluation of topical povidone-iodine in chronic suppurative otitis media.

Jaya C, Job A, Mathai E, Antonisamy B.

Department of Otorhinolaryngology and Head and Neck Surgery, Christian Medical
College, Vellore, India.

OBJECTIVES: To evaluate if povidone-iodine (PVP-I) can be used topically in the
treatment of chronic suppurative otitis media-tubotympanic disease and to compare
it with ciprofloxacin hydrochloride ear drops. DESIGN: Prospective double-blind
randomized study. SETTING: Academic tertiary medical center. PATIENTS: Forty
patients with chronic suppurative otitis media were randomized into 2 groups.
INTERVENTION: One group (19 patients) received 5% PVP-I ear drops, while the
other group (21 patients) received 0.3% ciprofloxacin ear drops. Both were
administered topically, 3 drops 3 times daily for 10 days. These patients were
followed up at weekly intervals for up to 4 weeks after commencing therapy.
RESULTS: Clinical improvement at the end of study was 88% in the PVP-I group and 
90% in the ciprofloxacin group. The most commonly isolated organism was
Pseudomonas aeruginosa. In vitro resistance to ciprofloxacin was seen in 17% of
organisms, while no resistance was seen for PVP-I. CONCLUSIONS: To our knowledge,
this is the first study to evaluate the efficacy of PVP-I as a topical agent in
the treatment of chronic suppurative otitis media. The results show that
clinically, topical PVP-I is as effective as topical ciprofloxacin, with a
superior advantage of having no in vitro drug resistance. Also, there is an added
benefit of reduced cost of therapy.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 14568795 [PubMed - indexed for MEDLINE]

1543: Arch Otolaryngol Head Neck Surg. 2003 Oct;129(10):1056-62.

The effect of otitis media with effusion on perceptual masking.

Hall JW, Grose JH, Buss E, Dev MB, Drake AF, Pillsbury HC.

Department of Otolaryngology Head & Neck Surgery, University of North Carolina at
Chapel Hill, 27599, USA.

OBJECTIVE: To determine the effect of otitis media with effusion (OME) on
perceptual masking (a phenomenon in which spondee threshold for a 2-talker masker
is poorer than for a speech-shaped noise masker). DESIGN: Longitudinal testing
over a 1-year period following insertion of tympanostomy tubes, using clinical
and normal-hearing control groups. SUBJECTS: Forty-seven children having a
history of OME were tested. Possible testing intervals were just before the
placement of tympanostomy tubes, and up to 3 separate occasions after the
placement of the tubes. An age-matched control group of 19 children was tested.
METHODS: A perceptual masking paradigm was used to measure the ability of the
listener to recognize a spondee in either a speech-shaped noise or a 2-talker
masker background. The masker was either continuous or gated on and off with the 
target spondee. RESULTS: In gated masking conditions, children with a history of 
normal hearing showed only slight perceptual masking, but the children with a
history of OME showed relatively great perceptual masking before surgery and up
to 6 months following surgery. In continuous masking conditions, both groups of
children showed relatively great perceptual masking and did not differ
significantly from each other in this respect either before or after surgery.
However, before surgery, the OME group showed higher thresholds in both the
2-talker and speech-shaped noise maskers. CONCLUSIONS: In agreement with previous
psychoacoustical findings, the relatively great perceptual masking in gated
conditions shown by children with OME history may reflect a general deficit in
complex auditory processing.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 14568787 [PubMed - indexed for MEDLINE]

1544: Pediatr Infect Dis J. 2003 Aug;22(8 Suppl):S139-48.

Amoxicillin/clavulanate for infections in infants and children: past, present and
future.

Klein JO.

Department of Pediatrics, Boston Medical Center, Boston, MA, USA.

Chemical synthesis of the penicillin nucleus in the 1950s made introduction of a 
broad array of new and important antimicrobials, including ampicillin and
amoxicillin, possible. Ampicillin was introduced in 1962 in oral and parenteral
forms as the first of the semisynthetic penicillins to provide increased activity
against Gram-negative bacteria. Amoxicillin replaced oral ampicillin beginning in
1974 because amoxicillin resulted in higher and more prolonged serum
concentrations than did equivalent doses of ampicillin. Amoxicillin/clavulanate
(Augmentin) was introduced in the United States in 1984 to enhance the activity
of amoxicillin by addition of the beta-lactamase inhibitor, clavulanic acid.
During the past 20 years, amoxicillin/clavulanate has proven effective for a
variety of pediatric infectious diseases, particularly acute otitis media (AOM). 
In 2001, a new pediatric formulation, high dose amoxicillin/clavulanate
(Augmentin ES-600) was approved for use in the United States. The high dose
preparation addressed the needs of pediatricians by providing greater amounts of 
amoxicillin while maintaining the same daily dose of clavulanic acid as the
regular strength formulation. Doubling the dose of amoxicillin for management of 
recurrent and persistent AOM was recommended in 1999 by the Centers for Disease
Control and Prevention because of concern about the increased incidence of
nonsusceptible strains of Streptococcus pneumoniae. The original formulation
combined amoxicillin/clavulanate in a 4:1 ratio and was followed by a 7:1 ratio
formulation. The high dose formulation (600 mg of amoxicillin per 5 ml) provides 
a 14:1 ratio of amoxicillin to clavulanate. Although management of AOM will
likely undergo changes in the coming years, amoxicillin is expected to remain
first line therapy for AOM. For children who fail initial therapy with
amoxicillin, high dose amoxicillin/clavulanate, an oral cephalosporin or
parenteral ceftriaxone is recommended.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 14567000 [PubMed - indexed for MEDLINE]

1545: Pediatr Infect Dis J. 2003 Aug;22(8 Suppl):S120-30.

Changes in treatment strategies for acute otitis media after full implementation 
of the pneumococcal seven valent conjugate vaccine.

Harrison CJ.

Department of Pediatrics, University of Louisville, Louisville, KY, USA.

BACKGROUND: Administration of the pneumococcal seven valent conjugate vaccine
(PCV-7) results in significant reductions in the incidence of invasive
pneumococcal disease and nasopharyngeal colonization rates; however, the
reduction in the overall incidence of acute otitis media (AOM) is minimal.
Despite an ongoing shortage of PCV-7 in the United States, during which children 
are receiving fewer doses at longer intervals than the recommended dosing
schedule, the incidence of invasive pneumococcal disease in young children has
continued to decrease. PURPOSE: The purpose of this article is to review why the 
reported effect of PCV-7 on AOM infection rates does not match the reduction in
invasive pneumococcal disease or the reduction in nasopharyngeal carriage of
Streptococcus pneumoniae. METHODS: The potential effect of a fully implemented
PCV-7 schedule on AOM infections is calculated based on serotype-specific AOM
reduction rates observed in clinical studies. Clinical success rates of various
antimicrobials used in the treatment of AOM in children fully immunized with
PCV-7 also are calculated based on projected PCV-7-induced changes in pathogen
profiles and documented antimicrobial resistance rates. Questions regarding
potential serotype substitution in children with AOM but not invasive
pneumococcal disease, the increased incidence of infection with Haemophilus
influenzae in children immunized with PCV-7 and the possibility of herd immunity 
also will be addressed. RESULTS: Although the majority of
penicillin-nonsusceptible S. pneumoniae are included in PCV-7, AOM caused by
these strains will not completely disappear, especially in children 24 months of 
age and younger. CONCLUSIONS: Consequently, clinicians must continue to consider 
penicillin-nonsusceptible pneumococci when prescribing antimicrobials for AOM.

Publication Types: 
    Review

PMID: 14566998 [PubMed - indexed for MEDLINE]

1546: J Craniomaxillofac Surg. 2003 Oct;31(5):316-20.

Conservative management of otitis media in cleft palate.

Shaw R, Richardson D, McMahon S.

Maxillofacial Unit, University Hospital Aintree, Liverpool, UK.
richardjohnshaw@hotmail.com

AIMS: Eustachian tube dysfunction affects nearly all children with cleft palate
but its management is controversial. Some units perform routine prophylactic
grommet insertion at the time of palate repair, whilst others are more
conservative, inserting grommets only when signs and symptoms of otitis media
with effusion are present. This study aims to present outcome data from one cleft
team practising a conservative approach. DESIGN: This is a retrospective study in
which consecutive palate repairs over 10 years are analysed and compared with
previously published data. The spectrum of clefting and severity (LAHSHAL),
otological and speech outcomes were recorded. Patients were excluded if
incomplete data was available, and if sensorineural deafness or syndromic
clefting was present. RESULTS: Data is presented for 72 of 109 consecutive
patients and the 37 excluded patients are discussed. Following a conservative
approach to otitis media with effusion, 29% of cases required grommets. The use
of grommets seemed to be more common in those with more severe clefting. Despite 
this, the group receiving grommets had better speech results than those who did
not, although this improvement was not statistically significant. CONCLUSIONS:
There is no evidence of poor overall otological outcome in this series. The data 
demonstrates that those receiving grommets had better results despite more severe
clefting.

Publication Types: 
    Comparative Study

PMID: 14563333 [PubMed - indexed for MEDLINE]

1547: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Oct;96(4):398-403.

Temporomandibular joint involvement in malignant external otitis.

Mardinger O, Rosen D, Minkow B, Tulzinsky Z, Ophir D, Hirshberg A.

Unit of Oral and Maxillofacial Surgery, Sapir Medical Center, Kfar-Saba, Israel.

OBJECTIVE: The purpose of this study was to present 6 patients with malignant
external otitis (MEO) that resulted in temporomandibular joint (TMJ) involvement 
and to discuss the incidence, clinical presentation, and treatment modalities.
STUDY DESIGN: All patients diagnosed with MEO between 1994 and 2002 were reviewed
for cases in which the TMJ was invaded by the infectious process. Only patients
in whom TMJ involvement was documented radiographically and in whom the clinical 
course was well documented were included in this study. RESULTS: MEO was
diagnosed in 42 patients over an 8-year period; TMJ involvement was recorded in 6
patients (14%). The medical history revealed controlled type 2 diabetes mellitus 
in 4 of the 6 patients. All patients reported early ear symptoms, mainly otalgia 
and otorrhea. Local signs included an ear canal filled with granulation material,
edematous overlying skin, and sensitivity to palpation. Cultures taken from the
external ear were positive for either Pseudomonas aeruginosa, Staphylococcus
epidermidis, Aspergillus, or Proteus mirabilis. TMJ symptoms developed between 1 
and 5 months after admission and included painful periauricular swelling and
trismus. In 3 patients, healing was uneventful; 3 also died of the disease.
CONCLUSIONS: TMJ involvement in MEO is associated with a resistant disease
process, often with several recurrences. Prolonged administration of antibiotics 
is the treatment of choice. Surgical debridement of the TMJ is necessary for the 
positive identification of the pathogenic organism, in cases of abscess
formation, or when osteomyelitic bone destruction of the condyle and glenoid
fossa develop.

Publication Types: 
    Case Reports
    Review

PMID: 14561963 [PubMed - indexed for MEDLINE]

1548: Pediatr Res. 2004 Jan;55(1):159-62. Epub 2003 Oct 15.

Immunoglobulins in otitis-prone children.

Veenhoven R, Rijkers G, Schilder A, Adelmeijer J, Uiterwaal C, Kuis W, Sanders E.

Department of Pediatrics, Spaarne Hospital Haarlem, Van Heythuijzenweg 1, P.O.
Box 1644, 2003 BR Haarlem, The Netherlands. r.veenhoven@wxs.nl

Defective or immature antibody responses to pathogens in children may explain the
increased susceptibility to acute otitis media (AOM) in otitis-prone children. In
literature, data on immunology have been based on studies of small groups of
severely otitis-prone children and have not been consistent. Humoral immune
status was assessed in 365 children, 1-7 years old, with two or more documented
episodes of AOM in the previous year. Children with 4 or more episodes in the
preceding year were defined as otitis-prone. Serum immunoglobulin levels were
determined by radial immunodiffusion. Immunoglobulin levels of otitis-prone
children were compared with those of children who had experienced 2-3 AOM
episodes per year. Children with recurrent episodes of AOM were found to have
normal or increased serum IgA, IgM, IgG, and IgG1 levels compared with normal
values for age, whereas the serum IgG2 levels were mostly in the lower normal
range. Twenty-two percent of all children showed IgG2 levels lower than 2 SD
below the age-specific mean. Interestingly, the otitis-prone group of children
showed significantly lower median and mean levels for all immunoglobulins
compared with those children with only 2-3 previous AOM episodes. Lower
immunoglobulin levels in otitis-prone children suggest a generalized decreased
antibody response in otitis-prone children.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14561788 [PubMed - indexed for MEDLINE]

1549: Clin Infect Dis. 2003 Nov 1;37(9):1155-64. Epub 2003 Oct 7.

Protective efficacy of a second pneumococcal conjugate vaccine against
pneumococcal acute otitis media in infants and children: randomized, controlled
trial of a 7-valent pneumococcal polysaccharide-meningococcal outer membrane
protein complex conjugate vaccine in 1666 children.

Kilpi T, Ahman H, Jokinen J, Lankinen KS, Palmu A, Savolainen H, Grönholm M,
Leinonen M, Hovi T, Eskola J, Käyhty H, Bohidar N, Sadoff JC, Mäkelä PH; Finnish 
Otitis Media Study Group.

National Public Health Institute (KTL), Helsinki, Finland. terhi.kilpi@ktl.fi

To assess the efficacy of a 7-valent pneumococcal polysaccharide-meningococcal
outer membrane protein complex conjugate vaccine (PncOMPC) against acute otitis
media (AOM), 1666 infants were randomly assigned to receive either PncOMPC or
control vaccine (hepatitis B vaccine) at 2, 4, 6, and 12 months of age. Of the
835 children assigned to receive PncOMPC, 187 received a 23-valent pneumococcal
polysaccharide vaccine (PncPS) at 12 months of age instead. Whenever AOM was
diagnosed, middle ear fluid was aspirated for bacterial culture. In the PncOMPC
and control groups, there were 110 and 250 AOM episodes, respectively, in
children between 6.5 and 24 months of age that could be attributed to vaccine
serotypes, which indicates a vaccine efficacy of 56% (95% confidence interval,
44%-66%). The serotype-specific efficacy ranged from 37% for 19F to 82% for 9V.
The 2 boosters seemed to provide equal protection against AOM, but PncPS induced 
markedly higher antibody concentrations. The efficacy of PncOMPC was comparable
to that of the recently licensed pneumococcal conjugate vaccine.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 14557958 [PubMed - indexed for MEDLINE]

1550: Eur Arch Otorhinolaryngol. 2004 Jul;261(6):326-30. Epub 2003 Oct 10.

Multisystem Langerhans' cell histiocytosis (Hand-Schüller-Christian disease) in
an adult: a case report and review of the literature.

Scolozzi P, Lombardi T, Monnier P, Jaques B.

Division of Oral and Maxillofacial Surgery, Centre Hospitalier Universitaire
Vaudois (CHUV), 1011 Lausanne, Switzerland. scolozzi@hotmail.com

Langerhans' cell histiocytosis (LCH) is a rare and enigmatic clonal disorder that
affects mainly children. It is characterized by single or multiple granulomatous 
mass lesions composed of cells with the Langerhans' cell phenotype. Clinical
presentation and behavior are heterogeneous and can range from a solitary lytic
bone lesion (i.e., eosinophilic granuloma) with a favorable course to a fatal
disseminated leukaemia-like form, with a wide spectrum of intermediate clinical
presentations between these two extremes. Although LCH typically involves the
bone, lesions can be found in almost all organs. We are reporting the case of a
multisystem LCH in a 47-year-old patient who presented with a panhypopituitarism 
and diabetes insipidus, and who, 5 years later, developed mandibular, mastoid and
femoral lesions. The final diagnosis of LCH was made on mandibular biopsy.

Publication Types: 
    Case Reports
    Review

PMID: 14551790 [PubMed - indexed for MEDLINE]

1551: Eur Arch Otorhinolaryngol. 2004 Jul;261(6):316-20. Epub 2003 Oct 9.

Laser myringotomy in otitis media with effusion: long-term follow-up.

Hassmann E, Skotnicka B, Baczek M, Piszcz M.

Department of Pediatric Otolaryngology, Medical University, Waszyngtona 17 St,
15-274 Białystok, Poland. pedorl@amb.edu.pl

Otitis media with effusion is a leading cause of conductive hearing loss in
children. Myringotomy and insertion of tympanostomy tubes is the accepted form of
treatment. Recently, several studies utilizing laser myringotomy have been
published, but few of them present late results. The objective of this study was 
to compare late results of the treatment with laser and classical myringotomy. A 
clinical effectiveness trial was conducted in three groups of children: (1) 37
children treated with laser myringotomy (ML), (2) 29 children treated with laser 
myringotomy and the insertion of tympanostomy tubes (ML+V) and (3) 43 children
treated with classical myringotomy and the insertion of tympanostomy tubes
(MC+V). All types of surgery were performed under general anesthesia because
adenoidectomy and/or tonsillectomy was done at the same time. The results of
treatment were assessed on the basis of the otoscopic examination (recurrences of
effusion, condition of the tympanic membrane, and audiological examination
(pure-tone audiometry, tympanometry and DPOAE). The minimum follow-up period was 
1 year. The recurrence rate was lowest in the ML+V (11%) group, and highest in
the ML group (36%). The difference between ML+V and MC+V was not significant.
Permanent changes in the tympanic membrane were observed in 8% of the ears after 
ML, 19% after ML+V and 31% after MC+V. The difference was significant between the
ML and MC+V groups. PTA was significantly higher in the MC+V group than in the
control group of otologically healthy children. Mean amplitudes of DPOAE,
measured in treated children with normal tympanometry results, were significantly
lower than in the control group, but within the normal range. The use of CO(2)
laser during myringotomy has no negative effect on the function of the cochlea.
Healing of the tympanic membrane after laser myringotomy was uneventful with a
low percentage of permanent sequelae.

Publication Types: 
    Comparative Study

PMID: 14551787 [PubMed - indexed for MEDLINE]

1552: Pediatr Infect Dis J. 2003 Oct;22(10):878-82.

Acute mastoiditis in Southern Israel: a twelve year retrospective study (1990
through 2001).

Katz A, Leibovitz E, Greenberg D, Raiz S, Greenwald-Maimon M, Leiberman A, Dagan 
R.

Pediatric Infectious Disease Unit, Ben-Gurion University of the Negev,
Beer-Sheva, Israel.

BACKGROUND: Acute mastoiditis is a serious complication of acute otitis media
(AOM) and has been increasingly reported in the last decade. OBJECTIVES: To
report the experience accumulated with acute mastoiditis at the Soroka University
Medical Center, Beer-Sheva, Israel, in a period of increasing antimicrobial
resistance with Streptococcus pneumoniae. PATIENTS AND METHODS: We reviewed the
records of all children with acute mastoiditis hospitalized from 1990 through
2001. Acute mastoiditis was diagnosed when one or more of the physical signs of
mastoiditis (swelling, erythema, tenderness of the retroauricular area and
anteroinferior displacement of the auricle) were diagnosed in the presence of
concomitant or recent (< or =4 weeks) AOM. RESULTS: One hundred sixteen episodes 
of acute mastoiditis occurred in 101 children age 2 months to 14 years (median,
25 months; 19% <1 year old). The average yearly incidence was 6.1 cases per 100
000 population <14 years old, with a significant increase in the number of cases 
during the study period. Acute mastoiditis was the first evidence of AOM in 10
(10%) patients. Fever >38 degrees C and >15,000 WBC/mm3 were present in 67 and
43% of cases, respectively. Irritability, retroauricular swelling, redness and
protrusion of the auricle occurred more commonly in patients <3 years old (79,
90, 84 and 76% vs. 28, 42, 45 and 30%, respectively, in patients > or =3 years
old; P < 0.002). Computed tomography scans were performed in 54 of 116 (47%)
cases and revealed bone destruction in 38 (70%). Periosteal abscess and lateral
sinus vein thrombosis were diagnosed in 8 and 2 patients, respectively. Simple
mastoidectomy was done in 32 of 116 (28%) cases, after no response to intravenous
antibiotics was observed; ventilation tubes were inserted in 12 patients.
Cultures were obtained at admission in 83 (72%) episodes (71 by tympanocentesis
and 12 from ear discharges). Overall 43 pathogens were isolated: 34 at admission;
14 at surgery; and 5 at both occasions. The most commonly isolated organisms were
S. pneumoniae (14 of 43, 33%; 4 penicillin-nonsusceptible), Streptococcus
pyogenes (11 of 43, 26%), nontypable Haemophilus influenzae (6 of 43, 14%),
Pseudomonas aeruginosa (5 of 43, 12%) and Escherichia coli (4 of 43, 9%). All S. 
pneumoniae organisms were isolated between 1996 and 2001. CONCLUSIONS: (1) The
incidence of acute mastoiditis in children in Southern Israel is greater than
that reported in the literature; (2) a significant increase in the number of
cases was recorded during the study period; (3) the clinical picture of acute
mastoiditis was more severe in infants and young children; (4) the pathogen
distribution in acute mastoiditis differs from that of AOM with significantly
higher rates of S. pyogenes and lower rates of nontypable H. influenzae recovery;
(5) penicillin-nonsusceptible S. pneumoniae played only a minor role in the
etiology of acute mastoiditis in Southern Israel.

Publication Types: 
    Comparative Study

PMID: 14551488 [PubMed - indexed for MEDLINE]

1553: Pediatrics. 2003 Oct;112(4):982-6.

Bullous myringitis: a case-control study.

McCormick DP, Saeed KA, Pittman C, Baldwin CD, Friedman N, Teichgraeber DC,
Chonmaitree T.

Division of General Academic Pediatrics, University of Texas Medical Branch at
Galveston, Galveston, TX 77555-1119, USA. david.mccormick@utmb.edu

Prior studies have shown that bullous myringitis (BM) accounts for <10% of acute 
otitis media (AOM) cases, and that the distribution of viral and bacterial
pathogens in BM is similar to that in AOM without BM, except for a relative
increase in the proportion of Streptococcus pneumoniae in BM. We studied 518
cases of AOM in children aged 6 months to 12 years. Using tele-otoscopy to assist
the diagnosis, we identified 41 cases (7.9%) with BM. Children who had AOM with
BM were older than AOM patients without BM (median age: 4.3 years vs 18 months). 
We compared 41 cases of AOM with BM to 41 control cases of age-, race-, and
gender-matched AOM patients without BM. When compared with this matched control
group, children with BM had more severe symptoms at the time of diagnosis and
were more likely to have bulging of the tympanic membrane in the quadrants that
were not obscured by the bulla. Children with AOM and BM may require aggressive
pain management. Although parents and clinicians may agree that a watchful
waiting approach is appropriate for older children with mild AOM, children
experiencing painful AOM with BM may not be successful candidates for a
watchful-waiting approach, because parents may resist postponement of antibiotic 
therapy in children who are more symptomatic.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 14523199 [PubMed - indexed for MEDLINE]

1554: Laryngoscope. 2003 Oct;113(10):1780-5.

Comment in:
    Laryngoscope. 2004 Jul;114(7):1318; author reply 1318.

Nasopharyngeal flora and drug susceptibility in children with macrolide therapy.

Iino Y, Sasaki Y, Miyazawa T, Kodera K.

Department of Otolaryngology, Teikyo University School of Medicine, 2-1-1-1 Kaga,
Itabashi-ku, Tokyo 113-8605, Japan. yiorl@med.teikyo-u.ac.jp

OBJECTIVES/HYPOTHESIS: Low-dose, long-term administration of macrolides
(macrolide therapy) has been used as an effective treatment for chronic
respiratory tract diseases. The authors reported on the nasopharyngeal flora in
children treated with macrolide therapy. STUDY DESIGN: Prospective study.
METHODS: Nasopharyngeal cultures were obtained from 73 children with chronic
rhinosinusitis and/or otitis media with effusion at the end of the low-dose
administration of clarithromycin (macrolide group). As control subjects, 98
children with chronic rhinosinusitis and/or otitis media with effusion who were
not given macrolides were also included in the study. The culture results were
evaluated with respect to antimicrobial susceptibility patterns, risk factors for
carriage of erythromycin-resistant Streptococcus pneumoniae, and the clinical
efficacy of the therapy. RESULTS: The macrolide therapy did not have a
significant effect on the incidence or the susceptibility patterns of potential
pathogens except for Moraxella catarrhalis. Most of children in the macrolide
group possessed a normal flora compared with the control children. The risk
factors for carriage of erythromycin-resistant S pneumoniae were male gender in
the macrolide group and age under 6 years and use of antimicrobial drugs other
than macrolides in the control group. The clinical efficacy of the therapy was
independent of carriage of erythromycin-resistant S pneumoniae. CONCLUSION:
Macrolide therapy has little effect on carriage of drug-resistant pathogens, and 
the efficacy of the therapy depends on the anti-inflammatory effect of the drugs,
which is independent of their antimicrobial effect.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14520106 [PubMed - indexed for MEDLINE]

1555: Laryngoscope. 2003 Oct;113(10):1645-57.

Natural history of untreated otitis media.

Rosenfeld RM, Kay D.

Dept. of Otolaryngology, State University of New York Downstate Medical Center,
340 Henry Street, Brooklyn, NY 11201, USA. richrosenfeld@msn.com

OBJECTIVE/HYPOTHESIS: Data from cohort studies and untreated groups in randomized
controlled trials can be identified through systematic literature review and
synthesized with meta-analysis to estimate natural history of acute otitis media 
(AOM) and otitis media with effusion (OME). STUDY DESIGN: Systematic literature
review and meta-analysis. METHOD: Source articles were identified by MEDLINE
search through August 2002 plus manual crosschecks of bibliographies and
published meta-analyses. Data were abstracted independently by two investigators 
and combined with random effects meta-analysis to estimate spontaneous
resolution, 95% confidence intervals (CI), and heterogeneity. Sensitivity
analysis was performed. RESULTS: Sixty-three articles met inclusion criteria. AOM
symptoms improved within 24 hours without antibiotics in 61% of children (95% CI,
50-72%), rising to 80% by 2 to 3 days (95% CI, 69-90%). Suppurative complications
were comparable if antibiotics were withheld (0.12%) or provided (0.24%).
Children entered recurrent AOM trials with a mean rate of 5.5 or more annual
episodes but averaged only 2.8 annual episodes while on placebo (95% CI,
2.2-3.4). No AOM episodes occurred in 41%, and only 17% remained otitis prone (3 
or more episodes). OME after untreated AOM had 59% resolution by 1 month (95% CI,
50-68%) and 74% resolution by 3 months (95% CI, 68-80%). OME of unknown duration 
had 28% spontaneous resolution by 3 months (95%, CI 14-41%), rising to 42% by 6
months (95% CI, 35-49%). In contrast, chronic OME had only 26% resolution by 6
months and 33% resolution by 1 year. CONCLUSIONS: The natural history of otitis
media is very favorable. Combined estimates of spontaneous resolution provide a
benchmark against which to judge new or established interventions. The need for
surgery in children with recurrent AOM or chronic OME should be balanced against 
the likelihood of timely spontaneous resolution and the potential risk of
learning, language, or other adverse sequelae from persistent middle ear
effusion. Further research is needed to identify prognostic factors that can
target children unlikely to improve spontaneously for earlier intervention.

Publication Types: 
    Meta-Analysis
    Review

PMID: 14520089 [PubMed - indexed for MEDLINE]

1556: J Pediatr. 2003 Sep;143(3):377-85.

A randomized, placebo-controlled trial of the effect of antihistamine or
corticosteroid treatment in acute otitis media.

Chonmaitree T, Saeed K, Uchida T, Heikkinen T, Baldwin CD, Freeman DH Jr,
McCormick DP.

Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas
77555-0371, USA. Tchonmai@utmb.edu

OBJECTIVES: To determine whether the adjunctive drugs antihistamine and
corticosteroid improve immediate and long-term outcomes of acute otitis media
(AOM). STUDY DESIGN: Children with AOM (3 mos-6 y) were enrolled in a randomized,
double-blind, placebo-controlled trial. All 179 children received one dose of
intramuscular ceftriaxone and were assigned to receive either chlorpheniramine
maleate (0.35 mg/kg/d) and/or prednisolone (2 mg/kg/day) or placebo for 5 days.
Main outcome measures were rate of treatment failure during the first 2 weeks,
duration of middle ear effusion, and rate of recurrences of AOM to 6 months.
RESULTS: Clinical outcomes and recurrence rates did not differ significantly with
treatment. Children who received antihistamine alone had significantly longer
duration of middle ear effusion (median, 73 days) than subjects in other
treatment groups (median, 23 to 36 days, P=.04). Temporary normalization of
tympanometric findings on day 5 occurred more frequently in the
corticosteroid-treated group (P=.04). CONCLUSIONS: Five-day treatment with
antihistamine or corticosteroid, in addition to antibiotic, did not improve AOM
outcomes. Antihistamine use during an acute episode of OM should be avoided,
since the drug may prolong the duration of middle ear effusion. The efficacy of
7- to 10-day treatment of AOM with corticosteroid, in addition to antibiotic,
deserves further investigation.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

PMID: 14517524 [PubMed - indexed for MEDLINE]

1557: Afr J Med Med Sci. 2001 Sep;30(3):221-3.

Behavioural pattern of malignant otitis external: 10-year review in Ibadan.

Lasisi OA, Nwaorgu OG.

Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria.

Malignant externa otitis is a rapidly progressive infection of the external ear
canal, mastoid and the base of the skull caused by Pseudomonas aeruginosa in
elderly diabetics and other immunosuppressive conditions. Thirteen cases of
malignant externa otitis seen in the E.N.T. Dept University College Hospital,
Ibadan between 1988 and 1997 were reviewed. The mean age was 62 years and the
mean duration of diabetes was 14 years. The most frequent symptoms were otalgia
13 (100%) and otorrhoea 12 (92%). The complications include multiple cranial
neuropathy 11 (85%), meningitis (31%), brain abscess (8%), and infratemporal
abscess 1 (8%). There were 8 deaths (62%) showing that this is still a dangerous 
condition in our environment. The problems identified were late presentation of
cases and inavailability of facilities for prompt control and monitoring of
patients. It is hoped that the outlook of the disease can be improved if there
are corrected.

PMID: 14510133 [PubMed - indexed for MEDLINE]

1558: Fam Pract. 2003 Oct;20(5):524-7.

Comment in:
    Fam Pract. 2004 Apr;21(2):221.

Is it possible to diagnose acute otitis media accurately in primary health care?

Blomgren K, Pitkäranta A.

Department of Otorhinolaryngology, Helsinki University Central Hospital, Finland.
karin.blomgren@fimnet.fi

BACKGROUND: Acute otitis media causes human suffering and enormous costs to
society. Symptoms of acute otitis media overlap those of the common cold, and
diagnostic methods confirming the diagnosis are used only occasionally.
Uncertainty in diagnostics may lead either to overdiagnosis and unnecessary
treatment or to underdiagnosis and an increase in complications. OBJECTIVE: Our
aim was to evaluate the inter-rater agreement in diagnosis of acute otitis media 
for children in primary health care. METHODS: The GP on duty and the
otorhinolaryngology resident at a primary health care clinic examined the same 50
children with caregiver-suspected acute otitis media. The otorhinolaryngologist
photographed the tympanic membranes. Afterwards, two experienced clinicians
evaluated the photographs with and without tympanograms. Diagnostic rates and
diagnostic methods between clinicians were compared. RESULTS: The
otorhinolaryngologist diagnosed acute otitis media in 44% and the GP in 64%. The 
GP based the diagnoses on symptoms and on the colour of the tympanic membrane,
whereas the otorhinolaryngologist paid more attention to the movement and
position of the tympanic membrane. CONCLUSION: The use of a pneumatic otoscope
and tympanometry reduces the number of acute otitis media diagnoses by >30%,
suggesting that acute otitis media may be misdiagnosed often. Between clinicians,
there was a substantial discrepancy in diagnoses of acute otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14507792 [PubMed - indexed for MEDLINE]

1559: JAMA. 2003 Sep 24;290(12):1633-40.

Does this child have acute otitis media?

Rothman R, Owens T, Simel DL.

Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
37232, USA. russell.rothman@vanderbilt.edu

CONTEXT: Acute otitis media (AOM) is one of the most common problems in
pediatrics. An accurate diagnosis of AOM can guide proper treatment and
follow-up. OBJECTIVE: To systematically review the literature regarding precision
and accuracy of history taking and physical examination in diagnosing AOM in
children. DATA SOURCES: We searched MEDLINE for English-language articles
published from 1966 through May 2002. Bibliographies of retrieved articles and
textbooks were also searched. STUDY SELECTION: We located studies with original
data on the precision or accuracy of history or physical examination for AOM in
children. Of 397 references initially identified, 6 met inclusion criteria for
analysis. DATA EXTRACTION: Two authors independently reviewed and abstracted data
to calculate likelihood ratios (LRs) for symptoms and signs. DATA SYNTHESIS: Four
studies of symptoms used clinical diagnosis as the criterion standard and were
limited by incorporation bias. Ear pain is the most useful symptom (positive LRs,
3.0-7.3); fever, upper respiratory tract symptoms, and irritability are less
useful. One study of clinical signs used tympanocentesis as the criterion
standard, and we adjusted the results to correct for verification bias. A cloudy 
(adjusted LR, 34; 95% confidence interval [CI], 28-42), bulging (adjusted LR, 51;
95% CI, 36-73), or distinctly immobile (adjusted LR, 31; 95% CI, 26-37) tympanic 
membrane on pneumatic otoscopy are the most useful signs for detecting AOM. A
distinctly red tympanic membrane is also helpful (adjusted LR, 8.4; 95% CI,
6.7-11) whereas a normal color makes AOM much less likely (adjusted LR, 0.2; 95% 
CI, 0.19-0.21). CONCLUSIONS: Although many of the studies included in this
analysis are limited by bias, a cloudy, bulging, or clearly immobile tympanic
membrane is most helpful for detecting AOM. The degree of erythema may also be
useful since a normal color makes otitis media unlikely whereas a distinctly red 
tympanic membrane increases the likelihood significantly.

Publication Types: 
    Review

PMID: 14506123 [PubMed - indexed for MEDLINE]

1560: JAMA. 2003 Sep 24;290(12):1608-16.

Comment in:
    J Fam Pract. 2004 Jan;53(1):17-8, 20.    J Pediatr. 2004 Mar;144(3):406-7.    JAMA. 2004 Feb 11;291(6):692-3; author reply 693-4.    JAMA. 2004 Feb 11;291(6):693; author reply 693-4.

Effectiveness of inactivated influenza vaccine in preventing acute otitis media
in young children: a randomized controlled trial.

Hoberman A, Greenberg DP, Paradise JL, Rockette HE, Lave JR, Kearney DH, Colborn 
DK, Kurs-Lasky M, Haralam MA, Byers CJ, Zoffel LM, Fabian IA, Bernard BS, Kerr
JD.

Department of Pediatrics, School of Medicine, University of Pittsburgh,
Pittsburgh, Pa, USA. hoberman@chp.edu

CONTEXT: Acute otitis media (AOM) frequently complicates influenza infection.
Previous studies have found influenza vaccine effective in reducing the
occurrence of AOM in children mainly older than 2 years. OBJECTIVE: To evaluate
the effectiveness of inactivated influenza vaccine in preventing AOM in children 
aged 6 to 24 months. DESIGN, SETTING, AND PATIENTS: Randomized, double-blind,
placebo-controlled trial of 786 children aged 6 to 24 months enrolled at
Children's Hospital of Pittsburgh before the 1999-2000 (411 children) and
2000-2001 (375 children) respiratory seasons (defined as December 1 through March
31 of the respective following year). Children received influenza vaccine or
placebo in a 2:1 ratio. The first cohort was observed for 1 year and the second
cohort until the end of the ensuing respiratory season. INTERVENTION: Two doses
(0.25 mL each) of inactivated trivalent subvirion influenza vaccine or placebo
were administered intramuscularly approximately 4 weeks apart. MAIN OUTCOME
MEASURES: Proportion of children who developed AOM, monthly occurrence rate of
AOM, estimated proportion of time with middle ear effusion, and utilization of
selected health care and related resources. RESULTS: Of the 66 children in the
vaccine group from whom serum samples were collected, seroconversion against
strains in the vaccine formulations developed in 88.6% to 96.8%, depending on the
specific strain. The efficacy of the vaccine against culture-confirmed influenza 
was 66% (95% confidence interval [CI], 34%-82%) in 1999-2000 and -7% (95% CI,
-247% to 67%) in 2000-2001; however, influenza attack rates differed between
these 2 periods (in the placebo group, 15.9% and 3.3%, respectively). Compared
with placebo, influenza vaccine did not reduce the proportion of children who had
at least 1 episode of AOM during the respiratory season (in the first cohort:
vaccine, 49.2% vs placebo, 52.2%; P =.56 ]; in the second cohort: vaccine, 55.8% 
vs placebo, 48.3%; P =.17). The vaccine also did not reduce the monthly rate of
AOM; the estimated proportion of time with middle ear effusion; or the
utilization of selected health care and related resources. There were also no
differences between the vaccine and placebo groups regarding any of these
outcomes during peak influenza periods. The vaccines administered to both cohorts
of children were well tolerated. CONCLUSION: Administration of inactivated
trivalent influenza vaccine to children aged 6 to 24 months did not reduce their 
burden of AOM or their utilization of selected health care and related resources.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 14506120 [PubMed - indexed for MEDLINE]

1561: Antimicrob Agents Chemother. 2003 Oct;47(10):3179-86.

Comment in:
    Antimicrob Agents Chemother. 2004 Jul;48(7):2784-5; author reply 2785-6.    Antimicrob Agents Chemother. 2004 Jul;48(7):2784; author reply 2785-6.

High-dose azithromycin versus high-dose amoxicillin-clavulanate for treatment of 
children with recurrent or persistent acute otitis media.

Arrieta A, Arguedas A, Fernandez P, Block SL, Emperanza P, Vargas SL, Erhardt WA,
de Caprariis PJ, Rothermel CD.

Children's Hospital of Orange County, Orange, California, USA.

Infants and young children, especially those in day care, are at risk for
recurrent or persistent acute otitis media (AOM). There are no data on oral
alternatives to high-dose amoxicillin-clavulanate for treating AOM in these
high-risk patients. In this double-blind, double-dummy multicenter clinical
trial, we compared a novel, high-dose azithromycin regimen with high-dose
amoxicillin-clavulanate for treatment of children with recurrent or persistent
AOM. Three hundred four children were randomized; 300 received either high-dose
azithromycin (20 mg/kg of body weight once a day for 3 days) or high-dose
amoxicillin-clavulanate (90 mg/kg divided twice a day for 10 days).
Tympanocentesis was performed at baseline; clinical response was assessed at day 
12 to 16 and day 28 to 32. Two-thirds of patients were aged < or =2 years. A
history of recurrent, persistent, or recurrent plus persistent AOM was noted in
67, 18, and 14% of patients, respectively. Pathogens were isolated from 163 of
296 intent-to-treat patients (55%). At day 12 to 16, clinical success rates for
azithromycin and amoxicillin-clavulanate were comparable for all patients (86
versus 84%, respectively) and for children aged < or =2 years (85 versus 79%,
respectively). At day 28 to 32, clinical success rates for azithromycin were
superior to those for amoxicillin-clavulanate for all patients (72 versus 61%,
respectively; P = 0.047) and for those aged < or =2 years (68 versus 51%,
respectively; P = 0.017). Per-pathogen clinical efficacy against Streptococcus
pneumoniae and Haemophilus influenzae was comparable between the two regimens.
The rates of treatment-related adverse events for azithromycin and
amoxicillin-clavulanate were 32 and 42%, respectively (P = 0.095). Corresponding 
compliance rates were 99 and 93%, respectively (P = 0.018). These data
demonstrate the efficacy and safety of high-dose azithromycin for treating
recurrent or persistent AOM.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 14506028 [PubMed - indexed for MEDLINE]

1562: Curr Opin Otolaryngol Head Neck Surg. 2003 Oct;11(5):316-23.

Skull base osteomyelitis secondary to malignant otitis externa.

Sreepada GS, Kwartler JA.

Division of Otolaryngology, University of Medicine and Dentistry of New
Jersey-New Jersey Medical School, Newark, New Jersey, USA. gsreepada@yahoo.com

PURPOSE OF REVIEW: Skull base osteomyelitis secondary to malignant otitis externa
was first described in 1959. Since then, advances have been made in the
diagnosis, treatment, and clinical outcomes of this condition. RECENT FINDINGS:
This review discusses the pathophysiology and microbiology of malignant otitis
externa. The review highlights the sometimes subtle presenting symptoms and
recent advances in imaging and their practical application to diagnosing and
monitoring the disease. Therapy for malignant otitis externa has changed since
this entity was first described; this article reviews the medical, surgical, and 
adjuvant therapies and the relevant controversies. SUMMARY: The review discusses 
the history, pathogenesis, diagnosis, and treatment of skull base osteomyelitis
in the context of malignant otitis externa with particular emphasis on HIV,
children, and other immunodeficient states.

Publication Types: 
    Review

PMID: 14502060 [PubMed - indexed for MEDLINE]

1563: Otol Neurotol. 2003 Sep;24(5):709-13.

Lipopolysaccharide concentration and bone resorption in cholesteatoma.

Peek FA, Huisman MA, Berckmans RJ, Sturk A, Van Loon J, Grote JJ.

Department of Otorhinolaryngology, Head and Neck Surgery, Leiden, The
Netherlands.

HYPOTHESIS: There is a relationship between the local lipopolysaccharide (LPS)
concentration in cholesteatoma and local bone resorption in chronic otitis media 
(COM) with cholesteatoma. BACKGROUND: During the past decade, it has become known
that the recruitment of osteoclasts is the main causative factor that induces
bone destruction in COM with cholesteatoma. Cellular inflammation factors like
cytokines may trigger the osteoclast. Sequel to this, LPS is able to up-regulate 
cytokines. This makes it of interest to study whether the local LPS concentration
is related to bone resorption in cholesteatoma. MATERIALS AND METHODS:
Twenty-four cholesteatoma samples and control tissue from COM patients without
cholesteatoma were collected. During surgery, the degree of bone resorption was
established and classified. Retrospectively, the authors checked whether patients
had chronic purulent otorrhea. LPS concentration of the tissue samples was
measured by the limulus amebocyte lysate test. The one-way analysis of variance
test was used to determine the relation between LPS concentration, otorrhea, and 
local bone resorption. RESULTS: A significantly higher concentration of LPS was
measured in samples from patients with cholesteatoma with bone resorption and
otorrhea compared with cholesteatoma without bone resorption and control tissue. 
There were no significant differences between the LPS levels of the different
groups of patients with bone resorption. CONCLUSION: It is suggested that LPS is 
one of the first factors in the cascade of bone resorption in COM with
cholesteatoma.

PMID: 14501443 [PubMed - indexed for MEDLINE]

1564: Infect Immun. 2003 Oct;71(10):5531-40.

Differential expression of cytokine genes and inducible nitric oxide synthase
induced by opacity phenotype variants of Streptococcus pneumoniae during acute
otitis media in the rat.

Long JP, Tong HH, Shannon PA, DeMaria TF.

Division of Otologic Research, College of Medicine and Public Health, The Ohio
State University, 456 W. 10th Avenue, Columbus, OH 43210, USA.

Phase variation in the colonial opacity phenotype of Streptococcus pneumoniae has
been implicated as a factor in bacterial adherence, colonization, and invasion in
the pathogenesis of pneumococcal otitis media (OM). The purpose of this study was
to determine whether S. pneumoniae opacity variants influence the induction of
gene expression for proinflammatory mediators in vivo using the rat model of OM. 
Both the opaque and transparent phenotype variants induced a significant
up-regulation in gene expression for interleukin-1alpha (IL-1alpha), IL-1beta,
IL-6, IL-10, tumor necrosis factor alpha, and inducible nitric oxide synthase
(iNOS) compared to saline sham-inoculated controls at both 4 and 24 h
postinoculation (P < 0.05 in all cases). Furthermore, whereas a significant
difference in gene expression was evident for only IL-6 (greater following
challenge with the opaque variant) and IL-1beta (greater following challenge with
the transparent variant) at 4 h, by 24 h the opaque variant cohort demonstrated a
significant increase in gene expression for IL-1alpha, IL-1beta, IL-6, IL-10, and
iNOS relative to animals inoculated with the transparent phenotype variant (P <
0.05 in all cases). Enzyme-linked immunosorbent assay results confirmed the gene 
expression data as determined by real-time PCR. Moreover, the concentrations of
the opaque variant in the middle ear lavage fluid were a full log higher than
those of the transparent variant. The aforementioned results indicate that the
opaque phenotype variant is more efficient at survival and multiplication within 
the middle ear space, resulting in the accumulation of more inflammatory cells
and the enhanced expression and production of inflammatory mediators. However,
when the data were normalized to account for differences in middle ear bacterial 
titers, it became apparent that the transparent variant of S. pneumoniae is a
more potent inducer of inflammation, triggering the accumulation of more
inflammatory cells and substantially greater fold increases in the expression and
production of inflammatory mediators. Data from this study indicate that S.
pneumoniae opacity variants influence the temporal mRNA expression of
inflammatory mediators within the middle ear.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 14500471 [PubMed - indexed for MEDLINE]

1565: Pediatr Radiol. 2003 Dec;33(12):877-9. Epub 2003 Sep 13.

MRI findings in a child with sigmoid sinus thrombosis following mastoiditis.

van den Bosch MA, Vos JA, de Letter MA, de Ru JA, van Diemen-Steenvoorde RA,
Plötz FB.

Department of Radiology, University Medical Centre Utrecht, Room E01-132,
Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. m.a.vandenbosch@azu.nl

We describe the MRI features of sigmoid sinus thrombosis following mastoiditis in
a 3-year-old girl. The features consisted of increased signal from the sinus on
T2-weighted images and absence of flow on MR venography. It is concluded that MRI
enabled a timely diagnosis of this life-threatening disease. MRI, as a
non-invasive technique that does not use ionizing radiation, should be considered
the investigation of first choice, especially in young patients.

Publication Types: 
    Case Reports

PMID: 13680004 [PubMed - indexed for MEDLINE]

1566: Am J Otolaryngol. 2003 Sep-Oct;24(5):323-7.

Superoxide dismutase in pediatric palatine tonsils and adenoids and its related
clinical parameters.

Park SN, Yeo SW, Park KH, Chung MK, Lee HY, Chae S.

Otolaryngology-HNS, Kangnam St. Mary's Hospital, The Catholic University of
Korea, College of Medicine, Seoul, Korea.

PURPOSE: The objective of this study was to investigate a protective system of
pediatric palatine tonsils and adenoids against superoxide radicals (O(2)(-)) and
to evaluate the clinical factors including otitis media with effusion that are
related to both the expression and activities of copper zinc superoxide
dismutases (CuZnSODs). DESIGN: CuZnSODs in the palatine tonsils and adenoids were
studied using immunohistochemistry and reverse-transcription polymerase chain
reaction. RESULTS: Immunohistochemistry showed that CuZnSODs distribute in the
crypt epithelium, mucous membrane, mantle zone, and extrafollicular area of the
pediatric adenoids as well as in the palatine tonsils. Otitis media with effusion
and paranasal sinusitis were related to CuZnSODs expression in the pediatric
adenoids. In addition, the frequency of tonsillitis and presence of recent
tonsillitis were significantly related to CuZnSODs expression in the pediatric
tonsils (P <.05). CONCLUSIONS: In both the pediatric palatine tonsils and
adenoids, the mechanism of tissue protection against infection and frequent
inflammatory reactions may be closely related to CuZnSODs expression. There may
be close relationship between the increased level of O(2)(-) that leads to an
increase in CuZnSODs in the pediatric adenoid tissue and the development of
otitis media.

PMID: 13130445 [PubMed - indexed for MEDLINE]

1567: Res Vet Sci. 2003 Dec;75(3):209-16.

Comparison of ultrasonography, radiography and a single computed tomography slice
for the identification of fluid within the canine tympanic bulla.

Dickie AM, Doust R, Cromarty L, Johnson VS, Sullivan M, Boyd JS.

Department of Veterinary Preclinical Studies, Faculty of Veterinary Medicine,
University of Glasgow, Bearsden Road, Glasgow G61 1QH, UK. A.Dickie@vet.gla.ac.uk

Fluid accumulation within the tympanic bulla (TB) is an important diagnostic
indicator in clinical cases of canine otitis media although its identification
can be a challenge using currently available imaging techniques. The aim of this 
study was to compare ultrasound with radiography and a single computed tomography
(CT) slice for the identification of fluid within the TB of canine cadavers. A
random number of TB in 66 cadavers were filled with ultrasound gel. Rostrocaudal 
open mouth (RCdoM) radiographs and CT images were interpreted by 2 blinded
radiologists and ultrasound examinations were performed by 2 blinded
sonographers. The heads were then frozen and sectioned to confirm the contents of
each TB. Although CT remained the most accurate method, comparable results were
obtained by one of the sonographers and even the inexperienced sonographer
produced results superior to radiography. Ultrasound has several advantages over 
the other imaging techniques and this study suggests that it may have an
application in the investigation of canine otitis media although further work in 
live animals would be required to confirm this.

Publication Types: 
    Comparative Study

PMID: 13129669 [PubMed - indexed for MEDLINE]

1568: Arch Otolaryngol Head Neck Surg. 2003 Sep;129(9):987-91.

Response-shift bias and parent-reported quality of life in children with otitis
media.

Timmerman AA, Anteunis LJ, Meesters CM.

Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of
Maastricht, The Netherlands. ATI@skno.azm.nl

OBJECTIVES: To validate the 6-item quality-of-life survey (OM-6) and to
investigate response-shift bias regarding children with otitis media. SETTING:
Otorhinolaryngology department of a university hospital that serves the
southernmost part of the Netherlands. PATIENTS: Seventy-seven children (age
range, 12-38 months) experiencing persistent otitis media with effusion and
scheduled for placement of tympanostomy tubes. SURVEY: The OM-6 measures
health-related quality of life in 6 domains: physical suffering, hearing loss,
speech impairment, emotional distress, activity limitations, and caregiver
concerns. INTERVENTION: Parents completed the OM-6 before surgery (pretest) and 6
weeks after surgery (posttest). At the posttest, parents also completed a
retrospective version of the pretest (retrospective pretest). RESULTS: For most
items, the test-retest reliability was good (R>0.8). The internal consistency of 
the OM-6 was satisfactory (alpha =.79). The construct validity, determined by
correlating the ear-related global quality-of-life measure and the OM-6 summary
score, was fair (R = -0.77, P<.01). Prospective change in quality of life on the 
OM-6 ranged from moderate (standardized response mean >/=0.5) to large
(standardized response mean >/=0.8). Response-shift bias was present at the group
level (t = -3.3, P<.01). Retrospective change was significant for hearing loss (z
= -3.3, P<.05) and ear-related global quality of life (z = -3.6, P<.05).
CONCLUSIONS: The validity of the OM-6 has been proved in a Dutch population. The 
data suggest that parents underestimate the seriousness of hearing loss and
overestimate the quality of life of their child before surgery, indicating a
response shift. Treatment results could lead parents to realize that the
situation before surgery had been worse than they thought.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12975273 [PubMed - indexed for MEDLINE]

1569: Laryngoscope. 2003 Sep;113(9):1503-7.

Invasive fungal and bacterial infections of the temporal bone.

Marzo SJ, Leonetti JP.

Department of Otolaryngology--Head and Neck Surgery, Loyola University of
Chicago, Maywood, Illinois, USA. smarzo@lumc.edu

OBJECTIVES/HYPOTHESIS: Objectives were to highlight the importance of surgical
therapy in treating invasive polymicrobial infections of the temporal bone, to
discuss the importance of antifungal therapy, and to review the differential
diagnosis of ear canal granulomatous disorders. STUDY DESIGN: Retrospective case 
review at a tertiary care medical center. METHODS: A retrospective chart review
of all patients diagnosed with invasive polymicrobial temporal bone infections
was performed. Four patients were identified. All patients required surgical
therapy for definitive management. All patients were followed for at least 1 year
or until death. RESULTS: Three of four patients had invasive fungi as pathogens. 
One patient had an occult squamous cell carcinoma. At the time of writing, one
patient was free of disease, two were dead of disease, and one was alive with
disease. CONCLUSION: Invasive polymicrobial temporal bone infections can occur in
immunocompromised patients and can possibly harbor an occult malignancy. Surgical
debridement may be necessary to arrive at a correct diagnosis. Modified radical
mastoidectomy with parenteral antibiotic therapy and other adjunctive measures
may be necessary for disease resolution.

Publication Types: 
    Case Reports

PMID: 12972924 [PubMed - indexed for MEDLINE]

1570: Clin Otolaryngol Allied Sci. 2003 Oct;28(5):442-5.

Epidemiology of otitis media in Chinese children.

Chen CH, Lin CJ, Hwang YH, Ku CJ.

Department of Otorhinolaryngology, Kaohsiung Municipal United Hospital,
Kaohsiung, Taiwan. judith 480127@yahoo.com.tw

From May to July 2001, 3013 Chinese children, aged 3-6 years old, from 19
kindergartens in Kaohsiung were examined for the prevalence of otitis media. A
senior paediatric otolaryngologist performed examinations. Tympanometric and
otoscopic records were combined for assessment of middle ear status. The
prevalence rate of otitis media was 9.82% for all children, 5.24% for middle ear 
effusion and 5.34% for retracted tympanic membrane. The prevalence rates of
otitis media in different age groups were as follows: 11.3% for 3-year-olds,
12.4% for 4-year-olds, 11.8% for 5-year-olds, and 6.1% for 6-year-olds.
Considering the genetic factors and the previous history of otitis media, there
was a significant difference between the normal group and the sick group.

PMID: 12969348 [PubMed - indexed for MEDLINE]

1571: J Paediatr Child Health. 2003 Sep-Oct;39(7):540-2.

Missed opportunities for a diagnosis of acute otitis media in Aboriginal
children.

Gibney KB, Morris PS, Carapetis JR, Skull SA, Leach AJ.

Department of Medicine, Royal Darwin Hospital, Darwin, Australia.

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.

PMID: 12969210 [PubMed - indexed for MEDLINE]

1572: Med Mycol. 2003 Apr;41(2):137-42.

Factors associated with the prevalence of Malassezia species in the external ears
of cattle from the state of Minas Gerais, Brazil.

Duarte ER, Batista RD, Hahn RC, Hamdan JS.

Department of Microbiology, Biological Sciences Institute, Federal University of 
Minas Gerais, Brazil.

Swabs collected from the external ears of 942 cattle, including both European and
zebu breeds, were used to evaluate the epidemiology of Malassezia species. High
numbers of Malassezia isolates were significantly associated with maturity of the
animals and with diagnosed otitis. In healthy animals, a particularly low
prevalence of the genus was found in Holstein cows, especially in the summer
months, a finding perhaps correlating with the open, air-exposed ears of this
breed. Pendutlous-eared zebu breeds and hybrids had higher levels of
colonization, although this effect was more pronounced in humid regions, and was 
least in the dry north and west of the state. The most common species seen was M.
sympodialis, which accounted for 47.1% of isolates from healthy cattle and 39.1% 
from cattle with otitis. In cattle with otitis sampled in summer, we found that
the relatively thermotolerant M. sympodialis made up 80.8% of isolates. By
contrast, during the winter the less thermotolerant M. globosa was the most
common species from otitis, making up 56% of the isolates. Humidity and
temperature may be the main factors explaining the epidemiology of Malassezia
diseases and colonizations in both animals and humans.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12964846 [PubMed - indexed for MEDLINE]

1573: Arch Pediatr Adolesc Med. 2003 Sep;157(9):861-6.

Comment in:
    Arch Pediatr Adolesc Med. 2003 Sep;157(9):852-3.

The use of osteopathic manipulative treatment as adjuvant therapy in children
with recurrent acute otitis media.

Mills MV, Henley CE, Barnes LL, Carreiro JE, Degenhardt BF.

Department of Pediatrics, Oklahoma State University Center for Health Sciences,
Tulsa 74107, USA. mmiriam@osu-com.okstate.edu

OBJECTIVE: To study effects of osteopathic manipulative treatment as an adjuvant 
therapy to routine pediatric care in children with recurrent acute otitis media
(AOM). STUDY DESIGN: Patients 6 months to 6 years old with 3 episodes of AOM in
the previous 6 months, or 4 in the previous year, who were not already surgical
candidates were placed randomly into 2 groups: one receiving routine pediatric
care, the other receiving routine care plus osteopathic manipulative treatment.
Both groups received an equal number of study encounters to monitor behavior and 
obtain tympanograms. Clinical status was monitored with review of pediatric
records. The pediatrician was blinded to patient group and study outcomes, and
the osteopathic physician was blinded to patient clinical course. MAIN OUTCOME
MEASURES: We monitored frequency of episodes of AOM, antibiotic use, surgical
interventions, various behaviors, and tympanometric and audiometric performance. 
RESULTS: A total of 57 patients, 25 intervention patients and 32 control
patients, met criteria and completed the study. Adjusting for the baseline
frequency before study entry, intervention patients had fewer episodes of AOM
(mean group difference per month, -0.14 [95% confidence interval, -0.27 to 0.00];
P =.04), fewer surgical procedures (intervention patients, 1; control patients,
8; P =.03), and more mean surgery-free months (intervention patients, 6.00;
control patients, 5.25; P =.01). Baseline and final tympanograms obtained by the 
audiologist showed an increased frequency of more normal tympanogram types in the
intervention group, with an adjusted mean group difference of 0.55 (95%
confidence interval, 0.08 to 1.02; P =.02). No adverse reactions were reported.
CONCLUSIONS: The results of this study suggest a potential benefit of osteopathic
manipulative treatment as adjuvant therapy in children with recurrent AOM; it may
prevent or decrease surgical intervention or antibiotic overuse.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 12963590 [PubMed - indexed for MEDLINE]

1574: Am J Rhinol. 2003 Jul-Aug;17(4):209-14.

Nasopharyngeal reservoir of bacterial otitis media and sinusitis pathogens in
adults during wellness and viral respiratory illness.

Chi DH, Hendley JO, French P, Arango P, Hayden FG, Winther B.

Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health
System, Charlottesville, Virginia 22906-0713, USA.

BACKGROUND: The carriage rate of pathogenic bacteria in the nasopharynx (NP) was 
determined using three separate techniques for obtaining samples. METHODS: The NP
of 99 healthy adults was sampled with (1) nasal swab, (2) oral swab, and (3)
nasal aspiration; 49 adults with common cold were sampled with an oral swab and
nasal aspiration. Three selective agars were used to detect Streptococcus
pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis. RESULTS:
Seventy-three percent of healthy adults and 74% of cold sufferers had at least
one pathogen detected in the NP. Detection rates were 65% (oral NP swab), 38%
(catheter aspiration), and 28% (nasal swab; p < 0.001). Carriage rates for S.
pneumoniae, M. catarrhalis, and H. influenzae were 45, 33, and 30%, respectively.
Both a nasal and an oral sample were required for optimal detection. CONCLUSION: 
Bacterial pathogens were present in the NP of three-quarters of adults during
wellness and during colds.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12962190 [PubMed - indexed for MEDLINE]

1575: ORL Head Neck Nurs. 2003 Summer;21(3):14-7.

The pediatric tympanic membrane: see it, describe it, treat it.

McDivitt K.

Indian Health Service, Blackfeet Indian Reservation, Montana, USA.
keith.mcdivitt@mail.ihs.gov

Acute otitis media (AOM) is one of the most common childhood conditions for which
antibiotics are prescribed, often unnecessarily. Current medical literature
focuses on the treatment of AOM, appropriate antibiotics, and antibiotic
resistance. Placing more emphasis on examination and description of the tympanic 
membrane (TM) reduces the over-diagnosing of AOM and concerns associated with
antibiotic use. A thorough examination of the ear must be performed in order to
make an accurate diagnosis. This article presents a three-step technique to
assist providers to perform pneumatic otoscopy, visualize the TM, describe their 
findings, and subsequently treat AOM.

Publication Types: 
    Review

PMID: 12961791 [PubMed - indexed for MEDLINE]

1576: Acta Otolaryngol. 2003 Aug;123(6):724-9.

Is hydrogen peroxide responsible for the inhibitory activity of alpha-haemolytic 
streptococci sampled from the nasopharynx?

Tano K, Grahn Håkansson E, Wallbrandt P, Rönnqvist D, Holm SE, Hellström S.

Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå,
Sweden. krister.tano@nll.se

OBJECTIVE: The inhibitory effect of alpha-haemolytic Streptococci (AHS) in vitro 
on the three commonest otitis media pathogens, Streptococcus pneumoniae,
Haemophilus influenzae and Moraxella catarrhalis, was previously investigated.
The aim of this study was to determine the mechanism of this inhibitory activity.
MATERIAL AND METHODS/RESULTS: When fractions of AHS filtrate were assayed to
determine their inhibitory activity after size-exclusion chromatography, the
inhibitory activity was found in the fractions with a low molecular weight. The
inhibitory effect was completely reversed when catalase was added to the
cell-free filtrate of AHS. A quantitative method also revealed high production
(approximately 3 mmol/l) of hydrogen peroxide in the AHS filtrate with the best
inhibitory activity. Electron microscopy of bacteria exposed to AHS filtrate with
an inhibitory effect showed changes similar to bacteria exposed to hydrogen
peroxide. CONCLUSIONS: We conclude that the inhibitory effect of AHS is most
likely due to the production of hydrogen peroxide. The significance of hydrogen
peroxide production of AHS is discussed in relation to the non-specific and
specific mucosal defence systems.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12953772 [PubMed - indexed for MEDLINE]

1577: East Afr Med J. 2003 Jun;80(6):308-11.

Intention-to-treat analysis in the chronic suppurative otitis media trials.

Otwombe KN, Ogutu B.

Wellcome Trust Research Laboratories, P.O. Box 230, Kilifi, Kenya.

OBJECTIVE: To determine the extent of application of the intention to treat
principle in the chronic suppurative otitis media (CSOM) randomised controlled
trials. DESIGN: Data were extracted from 28 CSOM randomised controlled trials.
MAIN OUTCOME MEASURES: Conceptual and methodological approaches of dealing with
protocol deviations with respect to withdrawal, missing response and
non-compliance. RESULTS: Of the 28 CSOM trials included in this study, only one
(4%) trial mentioned intention-to-treat (ITT) analysis. However, 10(36%) other
trials which did not mention ITT, had no protocol deviations and thus carried out
an ITT analysis by default. It is highly likely that a biased treatment effect
existed in the trial that mentioned ITT since the authors undertook a complete
case analysis disregarding the 22% protocol deviators. There were no attempts in 
any of the trials to impute for missing responses and carrying out a sensitivity 
analysis. For trials with a big percentage of protocol deviations, the validity
of their results are brought to question. CONCLUSIONS: In practice, not all those
entered into a randomised-controlled trial will complete the trial. Thus
intention-to-treat analysis is an important aspect of randomised controlled
trials of health care interventions which tries to bridge this gap. It is
important for authors to explicitly state the protocol deviations, the methods
used to handle them and the potential effect with reference to bias and study
outcome.

Publication Types: 
    Review

PMID: 12953740 [PubMed - indexed for MEDLINE]

1578: Mycoses. 2003 Sep;46(8):312-5.

Microbiological study of external otitis in Rosario City, Argentina.

Amigot SL, Gomez CR, Luque AG, Ebner G.

Laboratorio Policlínico Gral. San Martin (Municipalidad de Rosario), Facultad de 
Ciencias, Bioquimicas y Farmacéuticas, Universidad Nacional de Rosario, Balcarce 
1438 8p "A" (2000)_Rosario, República Argentina. samigot0@rosario.gov.ar

Mycological and/or bacteriological studies were performed on 294 samples isolated
from the external auditory control (EAC). It was observed that 185 (81.5%) of the
mycological analysis were negative while 42 (18.5%) were positive with the
following distribution: 22 Candida (9.7%), 15 Aspergillus (6.5%) and five
associations of Aspergillus and Candida (2.2%). The bacteriological studies were 
negative in 52 cases (23.6%) and the frequency of the bacterial agents (75.5%)
isolated were as follows: 41 Pseudomonas aeruginosa (18.6%), 24 Proteus mirabilis
(10.9%), 24 Staphylococcus aureus (10.9%), and three associations of Ps.
aeruginosa and Pr. mirabilis (1.4%). Pseudomonas aeruginosa, which was the most
frequent bacterial species isolated, did not present associations with any
fungus.

PMID: 12950900 [PubMed - indexed for MEDLINE]

1579: Pediatrics. 2003 Sep;112(3 Pt 1):527-31.

Treatment of otitis media with observation and a safety-net antibiotic
prescription.

Siegel RM, Kiely M, Bien JP, Joseph EC, Davis JB, Mendel SG, Pestian JP, DeWitt
TG.

Cincinnati Pediatric Research Group, Division of General and Community
Pediatrics, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
robertsiegel56@pol.net

OBJECTIVE: Several studies have demonstrated that acute otitis media (AOM) in
children can be managed without antibiotics. Because children with AOM have
traditionally been treated with antibiotics in the United States, there are
concerns that parents may not be comfortable with their children being treated
with pain control alone. Recently, Cates in England showed that antibiotic usage 
for AOM could be decreased by prescribing a safety-net antibiotic prescription
(SNAP) to be filled if symptoms do not resolve with observation after 48 hours.
It is not clear whether a SNAP will be acceptable to parents in other settings
such as the United States. The objective of our study was to determine whether
parents in the United States find a SNAP for AOM acceptable and whether
antibiotic usage could be decreased by its use. METHODS: A pediatric
practice-based research network in a midwestern community of 1.8 million was the 
setting for this study. The Cincinnati Pediatric Research Group (CPRG) includes
practices in Ohio, Kentucky, and Indiana. Children who were between 1 and 12
years of age and presented to the offices of the CPRG with uncomplicated AOM were
eligible for the study. Children were excluded when they had temperature >101.5
degrees F, had an ear infection in the past 3 months, showed signs of another
bacterial infection, or were toxic appearing. Families were given acetaminophen, 
ibuprofen, or topical otic anesthetic drops for pain control. They were also
given a prescription for an antibiotic and instructed not to fill it unless
symptoms either increased or did not resolve after 48 hours. The data were
entered directly by investigators via an Internet site. RESULTS: A total of 194
children were enrolled in 11 offices over 12 months; 175 (90%) completed the
follow-up interview. The average child's age was 5.0 years. Only 55 (31%) of the 
175 who were contacted for follow-up had filled their antibiotic prescription.
Compared with their previous experience, parents were overwhelmingly willing to
treat AOM with pain medication alone (chi(2) = 111). Seventy-eight percent (95%
confidence interval: 71%-84%) of parents reported that the pain medication was
effective. Sixty-three percent (95% confidence interval: 55%-70%) of parents
reported that they would be willing to treat future AOM episodes without
antibiotics and with pain medication alone. CONCLUSIONS: A subset of parents find
a safety-net prescription and pain control acceptable in the treatment of AOM,
and antibiotic usage can be lowered with this strategy.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12949278 [PubMed - indexed for MEDLINE]

1580: Pediatrics. 2003 Sep;112(3 Pt 1):514-20.

Trends in otitis media among children in the United States.

Auinger P, Lanphear BP, Kalkwarf HJ, Mansour ME.

Department of Pediatrics, University of Rochester School of Medicine and
Dentistry and the American Academy of Pediatrics Center for Child Health
Research, Rochester, New York 14620, USA. peggy_auinger@urmc.rochester.edu

BACKGROUND: The prevalence of repeated otitis media (OM) increased during the
1980s, but it is unknown if the increase has continued. OBJECTIVES: To determine 
trends in the prevalence of OM, early-onset OM, and repeated OM among US children
from 1988 to 1994 and to identify factors that may explain any observed changes. 
METHODS: The Third National Health and Nutrition Examination Survey was
administered in 2 phases: phase I (1988-1991) and phase II (1991-1994), each
comprising a national probability sample. OM (ever having had OM), early-onset OM
(first episode at <12 months of age), and repeated OM (>or=3 episodes) were
assessed for 8261 children <6 years of age. RESULTS: After controlling for risk
factors for OM, the prevalence of OM from phase I to phase II increased from
66.7% to 69.7% (odds ratio [OR] = 1.1; 95% confidence interval [CI] =.99, 1.1),
early-onset OM increased from 41.1% to 45.8% (OR = 1.1; 95% CI = 1.03, 1.2), and 
repeated OM increased from 34.8% to 41.1% (OR = 1.2; 95% CI = 1.1, 1.4). This
observed increase corresponds to 561,000 and 720,000 more children having
early-onset OM and repeated OM, respectively. Child care use, early breastfeeding
termination, asthma, and access to health care did not significantly increase
from phase I to phase II. The prevalence of early-onset OM and repeated OM was
higher for affluent children, but the greatest increase in prevalence was among
impoverished children. There was an increase in allergic conditions from phase I 
to phase II for poor children (22.6% to 30.2%). CONCLUSIONS: The prevalence of
early-onset OM and repeated OM continued to increase among preschool children in 
the United States. Further research to investigate this increasing prevalence
should explore changes in management practice and an increase in prevalence of
allergic conditions among poor children.

Publication Types: 
    Multicenter Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 12949276 [PubMed - indexed for MEDLINE]

1581: Acta Paediatr. 2003 Aug;92(8):905-9.

Baby swimming increases the risk of recurrent respiratory tract infections and
otitis media.

Nystad W, Njå F, Magnus P, Nafstad P.

Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
wenche.nystad@fhi.no

AIM: To estimate the association between baby swimming and recurrent respiratory 
tract infections and otitis media in the first year of life in children of
parents without and with atopy. METHODS: Norwegian schoolchildren (n = 2862) was 
enrolled in a cross-sectional study of asthma and allergy using the questionnaire
of the International Study of Asthma and Allergies in Childhood (ISAAC). The
outcomes were parental retrospective report of recurrent respiratory tract
infections and otitis media diagnosed by a physician in the first year of life.
The exposure was baby swimming during the same period. Parental atopy reflects a 
history of maternal or paternal asthma, hayfever or eczema. RESULTS: The
prevalence of recurrent respiratory tract infections was higher (12.3%) among
children who took part in baby swimming than among those who did not (7.5%). The 
prevalence of recurrent respiratory tract infections during the first year of
life was 5.6% and 10.5%, respectively, in children of parents without and with
atopy, whereas the prevalence of baby swimming was 5.6% and 5.1%, respectively,
in the two groups. Stratified analysis using parental atopy as strata showed that
the increased risk of recurrent respiratory tract infections was only present
among children of parents with atopy [adjusted odds ratio (aOR) 2.08, 95%
confidence interval (95% CI) 1.08-4.031. A similar trend was present for otitis
media (aOR 1.77, 95% CI 0.96-3.25). CONCLUSION: The results of this study suggest
that baby swimming and infant respiratory health may be linked. The findings need
to be examined in a longitudinal study.

PMID: 12948064 [PubMed - indexed for MEDLINE]

1582: J Assoc Res Otolaryngol. 2003 Jun;4(2):139-47.

Proinflammatory cytokine expression in the endolymphatic sac during inner ear
inflammation.

Satoh H, Firestein GS, Billings PB, Harris JP, Keithley EM.

Division of Otolaryngology-Head and Neck Surgery, University of California, San
Diego, CA 92093, USA.

The inner ear is capable of rapidly mounting an immune response that can
ultimately lead to cochlear degeneration and permanent hearing loss. The role of 
the endolymphatic sac in this immune process is not clear. In order to
investigate the cytokine expression of cells within the endolymphatic sac, a
secondary inner ear immune response to keyhole limpet hemocyanin (KLH) was
created in mice. The animals were sacrificed 3-48 h and 7 days following
initiation of the immune response. The cochleas and endolymphatic sacs were
assayed by immunocytochemistry for IL-1beta, TNFalpha, and IL-6. Three hours
after KLH challenge of the scala tympani, the perisaccular tissue of the
endolymphatic sac contained more inflammatory cells than the scala tympani or
endolymphatic sac lumen. Only a few of these cells, however, expressed the
proinflammatory cytokines IL-1beta and TNFalpha between 3 and 12 h after KLH
injection. On the other hand, TNFalpha, which plays an important role in the
cochlear secondary immune response, was expressed in cells in the endolymphatic
sac lumen. The maximum percentage of cells expressing TNFalpha was seen later
than in the scala tympani. Animals treated with systemic injection of the TNF
blocker, etanercept, showed a reduction in the number of cells in the
endolymphatic sac lumen. It is concluded that the cells in the endolymphatic sac 
lumen contribute to the amplification of the adaptive immune response by
expressing TNFalpha, while the infiltration of cells into the perisaccular
connective tissue is part of the nonspecific, innate, cochlear immune response.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 12943369 [PubMed - indexed for MEDLINE]

1583: J Assoc Res Otolaryngol. 2003 Jun;4(2):130-8.

The deaf mouse mutant Jeff (Jf) is a single gene model of otitis media.

Hardisty RE, Erven A, Logan K, Morse S, Guionaud S, Sancho-Oliver S, Hunter AJ,
Brown SD, Steel KP.

MRC Mammalian Genetics Unit and UK Mouse Genome Centre, Harwell, OX11 0RD, UK.

Otitis media is the most common cause of hearing impairment in children and is
primarily characterized by inflammation of the middle ear mucosa. Yet nothing is 
known of the underlying genetic pathways predisposing to otitis media in the
human population. Increasingly, large-scale mouse mutagenesis programs have
undertaken systematic and genome-wide efforts to recover large numbers of novel
mutations affecting a diverse array of phenotypic areas involved with genetic
disease including deafness. As part of the UK mutagenesis program, we have
identified a novel deaf mouse mutant, Jeff (Jf). Jeff maps to the distal region
of mouse chromosome 17 and presents with fluid and pus in the middle ear cavity. 
Jeff mutants are 21% smaller than wild-type littermates, have a mild craniofacial
abnormality, and have elevated hearing thresholds. Middle ear epithelia of Jeff
mice show evidence of a chronic proliferative otitis media. The Jeff mutant
should prove valuable in elucidating the underlying genetic pathways predisposing
to otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12943368 [PubMed - indexed for MEDLINE]

1584: J Assoc Res Otolaryngol. 2003 Jun;4(2):123-9.

Impaired binaural hearing in children produced by a threshold level of middle ear
disease.

Hogan SC, Moore DR.

University Laboratory of Physiology, University of Oxford, Oxford OX1 3PT, United
Kingdom.

Otitis media with effusion (OME), a form of middle ear disease, is the most
common reason for young children both to visit their family doctor and to have
surgery. Almost all children have at least a single episode of OME before their
first birthday and annual incidence rates exceed 50% in each of the first five
years. For most children, OME occurs infrequently, but about 10-15% of children
have OME during more than half of their first six years. Middle ear effusions
attenuate and delay sound, causing conductive sound distortion during the crucial
years for language acquisition. The many studies of OME effects on language and
other indices of development have produced mixed results. However, a consensus is
emerging of mild language impairment in the preschool years, with subsequent
performance, emotional, and behavioral difficulties. In addition to the
peripheral hearing loss produced directly by the disease, binaural and other
central auditory deficits can outlive the OME. It has been unclear which children
are at risk of central impairment following OME, since the children studied have 
generally been recruited from otolaryngology clinics. Consequently, a detailed
prospective history of the middle ear status of participants has not been
available. By studying six-year-old children with a lifetime known history of
OME, we show in this study that only those children with a cumulative OME
experience of more than about half the time during the first five years
consistently have residual impaired binaural hearing.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12943367 [PubMed - indexed for MEDLINE]

1585: Ann Otol Rhinol Laryngol. 2003 Aug;112(8):675-7.

Computed tomographic versus surgical findings in complicated acute
otomastoiditis.

Migirov L.

Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel
Hashomer, Israel.

Computed tomography (CT) plays an important role in planning surgery in cases of 
complicated middle ear infection. The purpose of this study was to determine, by 
comparison of radiologic and surgical findings, the diagnostic value of CT in
complicated acute otomastoiditis. The study group consisted of 37 patients
without a history of chronic ear disease. In this study, CT enabled correct
diagnosis of 26 of 27 cases (96%) of subperiosteal abscess, 17 of 18 cases (94%) 
of mastoid cortex erosion in patients with subperiosteal abscess, and several
intracranial complications, including epidural abscess, subdural empyema, and
perisinus abscess. The CT scan produced overdiagnosis in some cases: sigmoid
sinus thrombosis in 1 patient, mastoid cortex erosion in 2 children with
subperiosteal abscess, and bone erosion toward the posterior cranial fossa in 1
patient with meningitis. My findings suggest that subperiosteal abscess is a
disease of young children; however, when it develops in an older child,
cholesteatoma should be suspected. Furthermore, acute mastoiditis complicated
with facial nerve paralysis may be associated with cholesteatoma in 66% of cases.
My experience showed that CT had a sensitivity of 97% and a positive predictive
value of 94% in the diagnosis of complicated acute otomastoiditis.

Publication Types: 
    Comparative Study

PMID: 12940663 [PubMed - indexed for MEDLINE]

1586: Eur J Clin Microbiol Infect Dis. 2003 Sep;22(9):519-24. Epub 2003 Aug 21.

Diagnostic accuracy of otitis media and tympanocentesis skills assessment among
pediatricians.

Pichichero ME.

Elmwood Pediatric Group, University of Rochester Medical Center, 601 Elmwood
Avenue, Box 672, NY 14642, Rochester, USA. michael_pichichero@urmc.rochester.edu

The comparative study presented here evaluated pediatricians from Italy, Greece, 
South Africa, and a reference group in the USA to determine (i) their ability to 
accurately diagnose acute otitis media (AOM) and otitis media with effusion (OME)
using otoscopy, (ii) their knowledge of antibiotics, and (iii) their technical
competence in performing tympanocentesis. The participants included 66
pediatricians from Italy, 115 from Greece, 36 from South Africa and 2,190 from
the USA (reference group). Each pediatrician viewed nine video-recorded otoscopic
examinations of tympanic membranes, after which their ability to differentiate
AOM, OME and normal was ascertained. Questions were posed regarding appropriate, 
pathogen-directed antibiotic selection for AOM. A mannequin model was used to
assess the technical proficiency of each pediatrician in performing
tympanocentesis. Results were recorded for each group as the mean percentage +/- 
standard deviation. The correct diagnosis was made by each group of pediatricians
in the following frequencies: Italy, 54+/-27% (range, 18-94%); Greece, 36+/-12%
(range, 23-56%); South Africa, 53+/-21% (range, 22-88%); and the USA, 51+/-11%
(range, 29-72%). The difference between results from Greece and the US reference 
group was statistically significant ( P=0.002). Pediatricians from each group
over-diagnosed AOM with the following frequencies: Italy, 18+/-19% (range,
2-49%); Greece, 34+/-13% (8-50%); South Africa, 23+/-14% (7-44%); and the US
reference group, 26+/-19% (7-51%). Pediatricians correctly selected an antibiotic
recommended for treatment of AOM caused by drug-resistant Streptococcus
pneumoniae as follows: Italy, 89%; Greece, 77%; South Africa, 82%; and the USA,
80%. For treatment of beta-lactamase-producing Haemophilus influenzae, the
results were: Italy, 90%; Greece, 70%; South Africa, 81%; and the USA, 77%.
Tympanocentesis was optimally performed by >/=86% of all pediatricians. The
results indicate that pediatricians may often misdiagnose OME as AOM, but they
select appropriate antibiotics about 80% of the time and can be trained to
accurately perform tympanocentesis.

Publication Types: 
    Comparative Study
    Evaluation Studies

PMID: 12938004 [PubMed - indexed for MEDLINE]

1587: Pediatr Res. 2003 Dec;54(6):913-8. Epub 2003 Aug 20.

Does acetaminophen interfere in the antibiotic treatment of acute otitis media
caused by a penicillin-resistant pneumococcus strain? A gerbil model.

Ponte C, Parra A, Cenjor C, Garcia-Olmos M, Gimenez MJ, Aguilar L, Carcas A,
Soriano F.

Department of Medical Microbiology, Fundación Jiménez Díaz, 28040 Madrid, Spain.

The possible interference of acetaminophen, combined with antibiotics, in the
treatment of acute otitis media (AOM) caused by a penicillin-resistant (minimal
inhibitory concentration [MIC], 2 microg/mL), amoxicillin/clavulanic acid- and
erythromycin-sensitive pneumococcus was evaluated in a gerbil model. Animals were
challenged with approximately 5 x 106 bacteria in each ear through transbullar
instillation. Acetaminophen was administered s.c. at 50 mg/kg 30 min before each 
antibiotic dose. Amoxicillin/clavulanic acid and erythromycin (2.5 and 10 mg/kg) 
were administered s.c. at 2, 10, and 18 h after inoculation. Samples were
obtained from the middle ear (ME) on day 2 after inoculation for bacterial count.
The overall results showed no difference between animals that received
acetaminophen, with or without antibiotics, and those that did not receive
acetaminophen. The antibiotic concentrations in the ME were practically identical
in both groups of animals, so acetaminophen did not interfere with the
pharmacokinetics of antibiotics in the ME. However, both antibiotics
significantly reduced the number of culture-positive and the bacterial
concentration in ME samples when compared with antibiotic-untreated animals. Both
antibiotics, whether combined with acetaminophen or not, lowered the number of
AOM to <25%, but >75% of animals presented otitis media with effusion, and no
differences were shown between groups. A high rate of bacterial eradication from 
the ME correlated with antibiotic serum concentrations being over the MIC of the 
infecting organism for only >15% of the dose interval and with an ME
concentration exceeding the MIC by a factor of 1.7. In this experimental model,
acetaminophen had neither a synergistic nor an antagonistic effect on the
antibiotics tested.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12930908 [PubMed - indexed for MEDLINE]

1588: Am J Med. 2003 Aug 18;115 Suppl 3A:81S-89S.

Association between gastroesophageal reflux and sinusitis, otitis media, and
laryngeal malignancy: a systematic review of the evidence.

Weaver EM.

Department of Otolaryngology-Head and Neck Surgery, University of Washington,
Seattle, USA.

This study was conducted to review and evaluate the published evidence for an
association between gastroesophageal reflux (GER) and 3 supraesophageal
pathologies: sinusitis, otitis media, and laryngeal malignancy. Relevant articles
were located using MEDLINE (search limits: 1966-2001, English language, human
studies). Only new data or new analyses of previous data were included. Relevant 
articles were designated by their level of evidence, based on published
standards, and grouped by pathology. An overall grade was assigned to each group 
for the strength of evidence for or against an association. The search produced
152 articles, 42 of which met inclusion criteria and were reviewed in detail.
There is grade C evidence for a positive association between GER and sinusitis
(57 articles screened, 14 articles included); for a negative association between 
GER and otitis media (28 articles screened, 10 articles included); and for a
positive association between GER and laryngeal malignancy (67 articles screened, 
18 articles included). The published literature weakly supports a positive
association between GER and both sinusitis and laryngeal malignancy, and a
negative association between GER and otitis media.

Publication Types: 
    Review

PMID: 12928081 [PubMed - indexed for MEDLINE]

1589: Auris Nasus Larynx. 2003 Aug;30(3):279-82.

A rare and serious complication of chronic otitis media: lateral sinus
thrombosis.

Unsal EE, Ensari S, Koç C.

Department of Otolaryngology and Head and Neck Surgery, Ankara Numune Hospital,
Ankara, Turkey. e_unsal@yahoo.com

Before the antibiotic era, lateral sinus thrombosis (LST) was the most frequent
complication of otitis media. With the widespread usage of antibiotics, its
occurrence is rare. Nevertheless, it is still a major complication of middle ear 
disease. LST mortality fluctuates between 5 and 35%. The major clinical symptoms 
of patients with LST are pain in the mastoid region, spiking fever, anemia and
general health disorders. Computed tomography, magnetic resonance imaging and
angiography are the most helpful in diagnosis, but the final diagnosis is made by
surgical exploration. Three cases with LST are presented, and signs, diagnosis
and treatment of disease are discussed.

Publication Types: 
    Case Reports

PMID: 12927292 [PubMed - indexed for MEDLINE]

1590: Auris Nasus Larynx. 2003 Aug;30(3):253-7.

Types and causes of otorrhea.

Bardanis J, Batzakakis D, Mamatas S.

Department of Otorhinolaryngology, General Hospital of Ikaria, Ikaria 83300,
Greece.

INTRODUCTION: Otorrhea is a common symptom and sign of patients seeking
examination in an ENT Department of a General Hospital. The objective of this
review is to assess the cause of otorrhea according to the type of it. METHODS:
Retrospective review of 306 ears discharging some kind of fluid of 296 patients, 
who appeared in the ENT Department of our Hospital over a 58-month period.
RESULTS: The most common type of otorrhea was the purulent one: 276 ears among
306 discharging ears (90%). The most common cause of purulent otorrhea was otitis
externa: 156 ears among 276 ears discharging purulent fluid (56%). The germ most 
commonly isolated in the cultures of purulent aural discharge was Pseudomonas
aeruginosa: 67 isolations of P. aeruginosa among 256 cultures (26%). CONCLUSIONS:
Otomicroscopic examination and accurate culture of purulent discharge are
mandatory for the clinician to establish a correct diagnosis and suggest a proper
therapy in every case of otorrhea.

PMID: 12927287 [PubMed - indexed for MEDLINE]

1591: Auris Nasus Larynx. 2003 Aug;30(3):247-51.

Modulation of neutrophil adhesion to vascular endothelial cells in rat
experimental otitis media treated with a macrolide.

Enomoto F, Kin R, Kataoka T, Yamazaki Y, Yokoi H, Fujimori M, Nagaoka I, Ichikawa
G.

Department of Otorhinolaryngology, Juntendo University School of Medicine, 2-1-1 
Hongo, Bunkyu-ku, Tokyo 113-8421, Japan. fenomoto@med.juntendo.ac.jp

OBJECT: We previously reported that erythromycin (EM) affected the adhesion
molecules that interact with neutrophils and inhibited neutrophil infiltration in
a rat experimental otitis media model. PURPOSE: The purpose of the present study 
was to examine whether EM affects the adhesion of rat neutrophils to endothelial 
cells. METHODS: The adhesion of neutrophils to WK-5 endothelial cells was
evaluated. One group of rats was given EM for 2 weeks, while the other group
received no treatment. The adhesion of peripheral-blood neutrophils and
neutrophils accumulated in the middle ear from these two groups were compared.
RESULTS: Two-week EM pretreatment inhibited adhesion of neutrophils to WK-5
cells. The adhesion of neutrophils accumulated in the middle ear cavity to WK-5
cells was significantly higher than that of peripheral-blood neutrophils from
control rats. CONCLUSION: The results suggest that EM affects the adhesion of
neutrophils to endothelial cells.

PMID: 12927286 [PubMed - indexed for MEDLINE]

1592: Arch Otolaryngol Head Neck Surg. 2003 Aug;129(8):825-8.

Duration of patency of laser-assisted tympanic membrane fenestration.

Deutsch ES, Cook SP, Shaha S, Brodsky L, Reilly JS.

Department of Surgery, Division of Pediatric Otolaryngology, Alfred I. duPont
Hospital for Children, Wilmington, Del, USA. edeutsch@nemours.org

BACKGROUND: Laser-assisted tympanic membrane fenestration (LTMF) provides
intermediate-duration middle ear ventilation, which benefits selected children
with acute otitis media (AOM) and otitis media with effusion (OME). OBJECTIVE: To
evaluate clinical and technical factors that may affect duration of LTMF patency.
DESIGN: Prospective clinical cohort effectiveness trial. SETTING: Four tertiary
care children's hospitals. PATIENTS: Volunteer sample of 251 children (430 ears) 
followed up at 1, 2, 3, 4, 8, and 12 weeks; time to fenestration closure was
evaluable in 201 ears, and assessment of cure at study conclusion was evaluable
in 128 ears. INTERVENTIONS: Laser-assisted tympanic membrane fenestration for
prospectively defined AOM or OME. The surgeon determined spot size, wattage, and 
concurrent adenoidectomy based on clinical judgment. MAIN OUTCOME MEASURES: Cure 
of AOM/OME with effusion at 90 days and duration of LTMF patency relative to spot
size (1.8-2.8 mm), fenestration location on tympanic membrane, power (7-22 W),
concurrent adenoidectomy, age, diagnosis (AOM vs OME), type of effusion, and
preoperative tympanogram characteristics. Results are based on the number of ears
that could be evaluated at each data collection interval. RESULTS: Fenestrations 
remained patent for 2 to 4 weeks (mean = 2.52, median = 2.0, SD = 1.4, n = 201); 
97.4% were closed at 6-week follow-up. Spot sizes of 2.4 and 2.6 mm had a higher 
rate of patency than 2.0-mm spot size at 3 weeks following LTMF. Cure at 90 days 
was related to duration of patency for all patients combined and for patients
treated for AOM and OME, but not for those undergoing adjunctive adenoidectomy.
Cure at 90 days was related to larger spot size for all patients combined and
those treated for AOM. Other investigated factors did not achieve statistical
significance. CONCLUSIONS: Spot size of 2.4 mm or greater results in improved
duration of LTMF patency, persisting for up to 3 weeks after LTMF, especially for
treatment of AOM. Increased duration of LTMF patency correlates with greater
incidence of cure of middle ear effusion at 90 days. Additional investigation is 
indicated to determine optimum spot size and optimum duration of patency for
disease- severity-adjusted populations.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 12925339 [PubMed - indexed for MEDLINE]

1593: Vaccine. 2003 Sep 8;21(25-26):3608-13.

Anti-PsaA and the risk of pneumococcal AOM and carriage.

Rapola S, Jäntti V, Eerola M, Mäkelä PH, Käyhty H, Kilpi T.

Department of Vaccines, National Public Health Institute, Helsinki, Finland.

Pneumococcal surface adhesin A (PsaA) is one of the common protein antigens of
Streptococcus pneumoniae investigated as a possible vaccine candidate on the
basis of studies in experimental animal models. The relation between the serum
anti-PsaA concentration collected at 6, 12 and 18 months of age and the risk of
pneumococcal carriage and acute otitis media (AOM) in the following 6 months was 
evaluated in 329 children of the Finnish Otitis Media (FinOM) Cohort Study. A
higher anti-PsaA concentration at all three time points studied was found to
predict a higher risk of pneumococcal carriage 6 months later. A higher anti-PsaA
concentration at 6 months also predicted a higher risk of pneumococcal AOM during
the following 6 months (RR 1.51, 95% CI 1.24-1.83), whereas a higher anti-PsaA
concentration at 12 or 18 months seemed to decrease the risk of pneumococcal AOM 
(RR 0.94 [95% CI 0.80-1.09] and RR 0.88 [95% CI 0.73-1.07], respectively). These 
relations remained the same when concomitant risk factors for pneumococcal AOM
were included in the models. Previous pneumococcal AOM was the most important
risk factor for a subsequent pneumococcal AOM (RR 5.93 [95% CI 2.87-12.3], RR 2.2
[95% CI 1.21-4.00], and RR 3.3 [95% CI 1.72-6.32] during the three periods).

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12922089 [PubMed - indexed for MEDLINE]

1594: J Comp Pathol. 2003 Aug-Oct;129(2-3):100-10.

Mycoplasma bovis-associated suppurative otitis media and pneumonia in bull
calves.

Maeda T, Shibahara T, Kimura K, Wada Y, Sato K, Imada Y, Ishikawa Y, Kadota K.

Hokkaido Research Station, National Institute of Animal Health, 4 Hitsujigaoka,
Toyohira, Sapporo 062-0045, Japan.

Outbreaks of Mycoplasma bovis-associated otitis media and pneumonia occurred on
four beef cattle farms in Hokkaido, Japan between 2000 and 2001. The morbidity
and mortality were estimated at 8-40 and 30-100%, respectively. Eight calves with
bilateral ear droop and exudative otitis media were examined bacteriologically
and histopathologically. M. bovis was isolated post mortem from nasal swabs and
from the ears, lungs, lymph nodes (cranial and pulmonary), brain and heart of all
calves. At necropsy, suppurative exudates were observed in the tympanic bullae of
all cases. Numerous abscesses were also found in the petrous portion of the
temporal bone and lungs in seven cases. Histopathologically, the exudates within 
the tympanic bullae consisted of a mixture of neutrophils, necrotic cell debris
and fibrin, and the tympanic mucosa was thickened with neutrophil and macrophage 
infiltration and proliferation of fibrous connective tissue. Pulmonary lesions
included extensive foci of coagulative necrosis surrounded by numerous
neutrophils. Hepatocytes or renal tubular epithelial cells were enlarged with
hyaline cytoplasmic inclusions in four calves. Immunohistochemical labelling
confirmed the presence of M. bovis antigen in the cytoplasm of the inflammatory
cells in the middle ear, temporal bone and lungs, and was also demonstrated
within the cytoplasmic inclusions of the hepatocytes and renal tubular epithelial
cells. Ultrastructurally, mycoplasma-like organisms, 200-500 microm in diameter, 
were found within not only hepatocytes and renal tubular epithelia but also
within axons of the facial nerves. The present results show that M. bovis spreads
to multiple organs and is capable of invading various kinds of host cell. The
intracellular localization may be favourable for evading host immune responses.

PMID: 12921715 [PubMed - indexed for MEDLINE]

1595: AJNR Am J Neuroradiol. 2003 Aug;24(7):1310-6.

Central skull base osteomyelitis in patients without otitis externa: imaging
findings.

Chang PC, Fischbein NJ, Holliday RA.

Department of Radiology, University of California, San Francisco, School of
Medicine, San Francisco, CA 94143, USA.

BACKGROUND AND PURPOSE: Skull base osteomyelitis typically arises as a
complication of ear infection in older diabetic patients, involves the temporal
bone, and has Pseudomonas aeruginosa as the usual pathogen. Atypical skull base
osteomyelitis arising from the sphenoid or occipital bones without associated
external otitis occurs much less frequently and initially may have headache as
the only symptom. The purpose of this study was to review the clinical and MR
imaging features of central skull base osteomyelitis. METHODS: We retrospectively
reviewed MR images obtained in six patients with central skull base
osteomyelitis. No patient had predisposing external otitis or osteomyelitis of
the temporal bone. RESULTS: All of our patients presented with headache, no
external ear pain, and cranial nerve deficits. Five of six patients had a
predisposition to infection, and the erythrocyte sedimentation rate was elevated 
in the five patients in whom it was checked. In each case, the diagnosis was
delayed until MR imaging demonstrated central skull base abnormality, and the
diagnosis was then confirmed with tissue sampling. The most consistent imaging
findings were clival bone marrow T1 hypointensity and preclival soft tissue
infiltration. Five of six patients were cured with no recurrence of skull base
infection over a 2-4-year follow-up period. CONCLUSION: In the setting of
headache, cranial neuropathy, elevated erythrocyte sedimentation rate, and
abnormal clival imaging findings, central skull base osteomyelitis should be
considered as the likely diagnosis. Early tissue sampling and appropriate
treatment may prevent or limit further complications such as intracranial
extension, empyema, or death.

Publication Types: 
    Case Reports

PMID: 12917118 [PubMed - indexed for MEDLINE]

1596: Med J Aust. 2003 Aug 18;179(4):185-90.

Comment in:
    Med J Aust. 2004 Jan 19;180(2):91-2; author reply 92-3.    Med J Aust. 2004 Jan 19;180(2):91; author reply 92-3.    Med J Aust. 2004 Jul 19;181(2):84.

Effectiveness of ototopical antibiotics for chronic suppurative otitis media in
Aboriginal children: a community-based, multicentre, double-blind randomised
controlled trial.

Couzos S, Lea T, Mueller R, Murray R, Culbong M.

National Aboriginal Community Controlled Health Organisation, PO Box 168, Deakin,
ACT 2600, Australia. scouzos@tpgi.com.au

OBJECTIVES: To compare the effectiveness of ototopical ciprofloxacin (0.3%; CIP) 
with framycetin (0.5%), gramicidin, dexamethasone (FGD) eardrops (5 drops twice
daily for 9 days) together with povidone-iodine (0.5%) ear cleaning as treatments
for chronic suppurative otitis media (CSOM) in Aboriginal children. DESIGN AND
PARTICIPANTS: Aboriginal community-controlled, community-based, multicentre,
double-blind, randomised controlled trial in eight Aboriginal Community
Controlled Health Services across northern Australia, involving 147 Aboriginal
children with CSOM. MAIN OUTCOME MEASURES: Resolution of otorrhoea (clinical
cure), proportion of children with healed perforated tympanic membrane (TM) and
improved hearing, 10-21 days after starting treatment. RESULTS: 111 children aged
1-14 years (CIP, 55; FGD, 56) completed treatment. CSOM cures occurred in 64%
(CIP, 76.4%; FGD, 51.8%), with a significantly higher rate in the ciprofloxacin
group (P = 0.009, absolute difference of 24.6% [95% CI, 15.8%-33.4%]). TM
perforation size and the level of hearing impairment did not change. Pseudomonas 
aeruginosa was the most common bacterial pathogen (in 47.6%), while respiratory
pathogens were rare (in 5.7%). CONCLUSIONS: Twice-daily ear cleaning and topical 
ciprofloxacin is effective at community-level in achieving cure for CSOM.
Healthcare providers to Aboriginal children with CSOM should be given special
access to provide ototopical ciprofloxacin as first-line treatment.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 12914507 [PubMed - indexed for MEDLINE]

1597: J Med Microbiol. 2003 Sep;52(Pt 9):829-33.

Bacteriocin-like inhibitory substance (BLIS) production by the normal flora of
the nasopharynx: potential to protect against otitis media?

Walls T, Power D, Tagg J.

Department of Microbiology, University of Otago, PO Box 56, Dunedin, New Zealand.

The normal bacterial flora of the upper airways provides an important barrier to 
invading pathogens. This study investigated the production of bacteriocin-like
inhibitory substances (BLIS) by streptococci isolated from the nasopharyngeal
flora of children who either do or do not experience recurrent acute otitis media
(AOM). Twenty children with recurrent AOM and 15 controls were tested. Swabs from
the nasopharynx were evaluated for streptococci having BLIS activity against two 
representative strains of each of the AOM pathogens Streptococcus pneumoniae,
Streptococcus pyogenes, Haemophilus influenzae and Moraxella catarrhalis.
Streptococci displaying strong BLIS activity were characterized further and
tested for known streptococcal bacteriocin structural genes. Sixty-five per cent 
of children had nasopharyngeal streptococcal isolates that were inhibitory to
strains of one or more of the AOM pathogens. Six children (17 %) had streptococci
that demonstrated strong BLIS activity against strains of at least three of the
pathogenic species. Three of these inhibitory isolates were Streptococcus
salivarius, two were S. pneumoniae and one was S. pyogenes. The inhibitory S.
salivarius and S. pyogenes were shown to have structural genes for known
streptococcal bacteriocins. No statistically significant difference was found
between the two groups of children with respect to the presence of inhibitory
streptococci in their nasopharyngeal floras. The finding of S. salivarius with
strong inhibitory activity against several AOM pathogens in the nasopharyngeal
flora of children is unique. Although there is no clear evidence from the present
study that these organisms protect against AOM, their low pathogenicity and
strong in-vitro BLIS production capability indicate that they should be
incorporated in future trials of bacteriotherapy for recurrent AOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12909662 [PubMed - indexed for MEDLINE]

1598: Prescrire Int. 2003 Aug;12(66):148-50.

Antibiotics in children with acute otitis media?

[No authors listed]

Acute otitis media is defined as eardrum inflammation associated with middle-ear 
effusion and acute signs and symptoms. Viruses are the primary pathogens, and
bacterial superinfection is common. Pneumococci and Haemophilus influenzae are
the most frequently isolated bacterial pathogens. Recovery is usually rapid,
though somewhat slower in children under 2 years of age. The only benefits of
antibacterial chemotherapy are a marginal reduction in the duration of pain and
use of analgesics. Antibacterial therapy has no effect on the risk of relapse,
medium term auditory outcome in children, or complications. It does, however,
increase the risk of becoming a carrier of resistant strains

Publication Types: 
    Comparative Study

PMID: 12908498 [PubMed - indexed for MEDLINE]

1599: Int J Pediatr Otorhinolaryngol. 2003 Sep;67(9):1019-21.

Otogenic cerebral venous infarction: a rare complication of acute otitis media.

Ozer E, Sivasli E, Bayazit YA, Sirikci A, Gök A, Mumbuç S, Kanlikama M.

Department of Otolaryngology, Faculty of Medicine, University of Gaziantep,
Kolejtepe, Gaziantep, Turkey. enverozer@hotmail.com

A case of cerebral venous infarction (CVI) as a complication of acute otitis
media (AOM) was presented in a 16-month-old male patient. The patient admitted
with AOM in the right ear, ipsilateral facial paralysis and contralateral
hemiplegia. Computerized tomography of the brain showed low density areas
involving both the cortex and subcortical white matter in the right
frontoparietal region, and there were patchy and multifocal enhancing areas with 
intravenous contrast enhancement. These findings disclosed the diagnosis of
venous infarctions involving the superficial cortical veins on the right side.
Complete recovery was achieved with 2 weeks of sulbactam-ampicilline, amikacin
and prednisolone treatment. Although it is rather rare, CVI should also be
remembered among the otogenic intracranial complications.

Publication Types: 
    Case Reports

PMID: 12907060 [PubMed - indexed for MEDLINE]

1600: Int J Pediatr Otorhinolaryngol. 2003 Sep;67(9):965-8.

Penetration of cefprozil to middle ear effusion in children with chronic otitis
media with effusion.

Jang CH, Park SY.

Department of Otolaryngology, Wonkwang Medical School, Iksan 570-711, South
Korea. chul@wonkwang.ac.kr

BACKGROUND: Because of chronic otitis media with effusion (COME) demonstrates
pathogenic bacteria, treatment with appropriate antibiotic is reasonable.
OBJECTIVE: We determined the penetration of cefprozil into the middle ear
effusion (MEE) in children with COME. MATERIALS AND METHODS: 25 patients 2-13
years of age with COME were eligible for study. After the single dose of 15 mg/kg
patients were assigned to have MEE, and serum samples were obtained during
ventilation tube insertion at 0.5, 2, 3, 5, or 6 h after administration of the
dose. The concentration of cefprozil was measured using validated high
performance liquid chromatography method. RESULTS: The mean concentrations of
cefprozil in the MEE ranged from 0.4 to 4.4 microg/ml. The penetration into MEE
was rapid and effective. Cefprozil in the MEE was maintained at a greater level
than MIC 90 in S. pneumoniae for at least 6 h after administration of 15 mg/kg.
CONCLUSION: Cefprozil penetrated well into the MEE in children with COME.

Publication Types: 
    Clinical Trial

PMID: 12907051 [PubMed - indexed for MEDLINE]

1601: Int J Pediatr Otorhinolaryngol. 2003 Sep;67(9):943-6.

Effect of positional change and inhalant anesthesia on parameters of acoustic
reflectometry.

Uğur MB, Kemaloğlu YK, Ceylan A, Boynueğri S, Babacan A, Gŏksu N.

Department of ENT-HNS, Faculty of Medicine, Gazi University, Ankara, Turkey.

OBJECTIVE: Purpose of this study was to find out the effect of positional change 
and inhalant anesthesia on acoustic reflectometry (AR) parameters (reflectivity
and curve angle). METHOD: AR parameters were measured on 58 ears with otitis
media in sitting position before anesthesia and in supine position under inhalant
anesthesia, subsequently. RESULTS: Under anesthesia, ears with effusion disclosed
more changes in reflectivity (Chi-squared analysis, chi2-test; P<0.05) and curve 
angle (P>0.1) than those without effusion. Further, inhalant anesthesia caused
more changes in the false negative ears (63.63%) than in those with effusion
having positive test before anesthesia (12.90%) (P<0.001). CONCLUSIONS: From the 
data of this study, it could be said that reflectivity shows changes according to
the amount of effusion which is in contact with the tympanic membrane under
anesthesia, and that curve angle becomes more sensitive to detect effusion when
anesthetic gas diffuses into the middle ear with effusion, probably due to the
pushing of effusion towards the tympanic membrane.

PMID: 12907048 [PubMed - indexed for MEDLINE]

1602: J Immunol. 2003 Aug 15;171(4):1978-83.

The fourth surface-exposed region of the outer membrane protein P5-homologous
adhesin of nontypable Haemophilus influenzae is an immunodominant but
nonprotective decoying epitope.

Novotny LA, Bakaletz LO.

Division of Molecular Medicine, Department of Pediatrics, Columbus Children's
Research Institute, Ohio State University College of Medicine and Public Health, 
Columbus, OH 43205, USA.

Nontypable Haemophilus influenzae is a major cause of otitis media and other
mucosal infections. After natural disease in children and experimental disease in
chinchillas, we found a hierarchical pattern of immunodominance among the four
surface-exposed regions of the P5-homologous adhesin, with the greatest response 
directed to region 4. However, Ab to region 4 is not protective. When this
natural but biased response was refocused to region 3 by immunization, augmented 
bacterial clearance and protection from ascending otitis media was observed.
Collectively, the data indicate that region 4 contains a highly immunodominant
but nonprotective decoying epitope, the presence of which dampens the immune
response to a subdominant but protective epitope in region 3.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12902501 [PubMed - indexed for MEDLINE]

1603: Ann Univ Mariae Curie Sklodowska [Med]. 2002;57(2):127-30.

Labyrinthitis in chronic otitis media.

Siwiec H, Klatka J, Szymański M, Trojanowski P.

Department of Otolaryngology, Medical University of Lublin.

Labyrinthitis is the most frequent complication of chronic otitis media (COM).
Retrospective analysis of 1,210 patients operated due to COM was carried out.
Circumscribed labyrinthitis was found in 17.2% and deafness in 1.2% of patients. 
To evaluate the effect of labyrinthitis on bone conduction (BC) we measured BC
threshold in a group of 140 patients with unilateral COM without labyrinthitis
and in a group of 42 patients with unilateral COM with labyrinthitis. BC
threshold of the healthy ear was subtracted from the BC threshold of the affected
ear in the same patient to eliminate presbyacusis. There was no significant
difference in bone conduction threshold between the patients with circumscribed
labyrinthitis and patients with COM without labyrinthitis. The incidence of
labyrinthitis was higher in patients with cholesteatoma than in patients without 
cholesteatoma. Management of labyrinthine fistula is presented.

PMID: 12898830 [PubMed - indexed for MEDLINE]

1604: Ann Univ Mariae Curie Sklodowska [Med]. 2002;57(2):58-61.

TEOAE after treatment of otitis media with effusion.

Niedzielska G, Katska E.

Department of Paediatrics Otolaryngology, Phoniatry and Audiology Medical
University of Lublin.

Otoacoustic emission is a noninvasive method of testing inner ear function. OAE
is susceptible to the influence of many different factors of which the principal 
ones are the changes taking place in the middle ear. In transiently evoked
otoacoustic emission (TEOAE) we deal with double signal transmission through the 
middle ear. This means that the sound reaching the cochlea depends on the
function of middle ear. In the case of secretion into the tympanic cavity,
suppression of the high-frequency otoemission components results from the effect 
of the mass increasing in the middle ear. The purpose of the study was the
evaluation of otoemission in children treated with adenotomy and myringotomy due 
to MEE. The OAE value was estimated during the first 24 hours post surgery. The
results of OAE study were compared with the clinical data, the level of hearing
loss and the type of middle ear secretion. The study confirmed the presence of
OAE in the majority of the cases. The results of the study indicate the applied
treatment was effective.

Publication Types: 
    Clinical Trial

PMID: 12898819 [PubMed - indexed for MEDLINE]

1605: Laryngoscope. 2003 Aug;113(8):1347-51.

Alpha 1-antitrypsin and ilomastat inhibit inflammatory proteases present in human
middle ear effusions.

Antonelli PJ, Schultz GS, Kim KM, Cantwell JS, Sundin DJ, Pemberton PA, Barr PJ.

Department of Otolarynology, University of Florida, Gainesville, 32610-0264, USA.
antonpj@ent.ufl.edu

OBJECTIVES: Proteases of both the serine and metalloproteinase families have been
shown to play a role in the pathogenesis of otitis media (OM). Inhibitors of
proteases from each of these families have been shown to beneficially impact
disease progression in a number of related chronic inflammatory conditions, but
their use has not been studied in OM. The purpose of this study was to assess the
activity of the protease inhibitors recombinant alpha 1-antitrypsin (rAAT) and
ilomastat on inflammatory proteases present in human middle ear effusions (MEEs),
with a view to their potential utility in the treatment of OM. STUDY DESIGN:
Prospective and ex vivo. METHODS: MEEs were collected from 100 patients
presenting for middle ear surgery, most commonly tympanostomy tube placement or
treatment of acute posttympanostomy otorrhea (APTO). MEEs were analyzed for the
presence of matrix metalloproteinases (MMPs) and human neutrophil elastase (HNE) 
and the inhibitory activity of rAAT and ilomastat on these proteases,
respectively. RESULTS: MMP levels were highest in APTO, and HNE was highest in
chronic suppurative OM and APTO. High levels of MMP and HNE (>3 mAU/min) were
found in 52% and 37% of MEEs, respectively. Ilomastat and rAAT demonstrated
significant inhibition of MMP and HNE activity (>30% reduction), respectively, in
80% and 82% of MEEs with high levels of activity. CONCLUSIONS: Proteases are
commonly found in OM. Ilomastat and rAAT are potent inhibitors of proteases in
MEEs across a wide range of OM in humans. Investigation into the potential
therapeutic benefits of these protease inhibitors is warranted.

Publication Types: 
    In Vitro
    Research Support, Non-U.S. Gov't

PMID: 12897557 [PubMed - indexed for MEDLINE]

1606: Pediatrics. 2003 Aug;112(2):265-77.

Comment in:
    J Fam Pract. 2003 Dec;52(12):939-40.

Otitis media and tympanostomy tube insertion during the first three years of
life: developmental outcomes at the age of four years.

Paradise JL, Dollaghan CA, Campbell TF, Feldman HM, Bernard BS, Colborn DK,
Rockette HE, Janosky JE, Pitcairn DL, Kurs-Lasky M, Sabo DL, Smith CG.

Department of Pediatrics, University of Pittsburgh School of Medicine,
Pittsburgh, Pennsylvania, USA. jpar@pitt.edu

OBJECTIVE: In a long-term, prospective study, we set out to determine whether
otitis media in the first 3 years of life persisting for periods currently
considered developmentally threatening actually results in later impairments of
children's cognitive, language, speech, or psychosocial development; whether
prompt insertion of tympanostomy tubes prevents or lessens any such impairments; 
and whether, irrespective of causality, associations exist between persistent
early-life otitis media and later developmental impairments. This report
describes findings in study participants at the age of 4 years. METHODS: We
enrolled 6350 healthy infants from 2 to 61 days of age at urban hospitals and 2
small-town/rural and 4 suburban private pediatric practices. We regularly
evaluated the children for the presence of middle-ear effusion (MEE) throughout
their first 3 years of life by pneumatic otoscopy, supplemented by tympanometry; 
we monitored the validity of the otoscopic observations on an ongoing basis; and 
we treated children for otitis media according to specified guidelines. In the
clinical trial component of the study, we randomly assigned 429 children who met 
specified minimum criteria regarding the persistence of MEE to undergo
tympanostomy tube insertion either promptly or after a defined extended period if
MEE remained present. In the associational component of the study, we selected a 
representative sample of 241 children who ranged from having no MEE to having MEE
the cumulative duration of which fell just short of meeting randomization
criteria for the clinical trial. In 397 (92.5%) of the children in the clinical
trial and in 234 (97.1%) of the children in the representative sample, we
assessed cognitive, language, speech, and psychosocial development at the age of 
4 years, using formal tests, conversational samples, and parent questionnaires.
RESULTS: In children in the randomized clinical trial, there were no
statistically significant differences in mean (+/-standard deviation) scores
(higher denotes more favorable) favoring the early-treatment group over the
late-treatment group on the General Cognitive Index of the McCarthy Scales of
Children's Abilities (97 +/- 14 and 98 +/- 14, respectively); the Peabody Picture
Vocabulary Test-Revised, a measure of receptive language (90 +/- 15 vs 92 +/-
16); the Nonword Repetition Test, a measure of phonological memory (66 +/- 12 vs 
70 +/- 12); the Number of Different Words, a measure of word diversity (150 +/-
34 vs 150 +/- 31); the Mean Length of Utterance in Morphemes, a measure of
sentence length and grammatical complexity (3.4 +/- 0.8 vs 3.4 +/- 0.7); or the
Percentage of Consonants Correct-Revised, a measure of speech-sound production
(92 +/- 5 vs 93 +/- 5). There were also no significant differences in ratings
(higher denotes less favorable) on the Parenting Stress Index-Short Form (Total
Stress scores: 68 +/- 18 vs 65 +/- 17) or the Child Behavior Checklist (Total
Problem T scores: 50 +/- 10 vs 49 +/- 10). In the associational component of the 
study, correlations between the children's durations of MEE and their
developmental outcomes were generally weak and, in most instances,
nonsignificant. Exceptions, after adjustment for sociodemographic variables and
for hearing thresholds at the time of developmental testing, consisted of a
significant negative correlation between children's cumulative durations of MEE
in their first 3 years of life and scores on the McCarthy Verbal subscale, and
significant positive correlations between durations of MEE and scores on 2
measures of parent-child stress. The percentage of variance in these scores
explained by time with MEE beyond that explained by sociodemographic variables
ranged from 1.6% to 3.3%. In both the randomized clinical trial and the
associational component, sociodemographic variables seemed to be the most
important factors influencing developmental outcomes, and in both components, the
results at 4 years of age were consistent with the results that had been obtained
at 3 years of age. CONCLUSIONS: In otherwise healthy children who are younger
than 3 years and have persistent MEE within the duration limits that we studied, 
prompt insertion of tympanostomy tubes does not measurably improve developmental 
outcomes at 4 years of age. In such children, persistent MEE within the duration 
limits that we studied is negligibly associated with and probably does not affect
developmental outcomes at 4 years of age.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12897272 [PubMed - indexed for MEDLINE]

1607: Am Fam Physician. 2003 Jul 15;68(2):309-12.

Comment in:
    Am Fam Physician. 2004 Nov 15;70(10):1860.

Necrotizing (malignant) external otitis.

Handzel O, Halperin D.

Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center,
Rehovot, Israel. ohandzel@clalit.org.il

Necrotizing (malignant) external otitis, an infection involving the temporal and 
adjacent bones, is a relatively rare complication of external otitis. It occurs
primarily in immunocompromised persons, especially older persons with diabetes
mellitus, and is often initiated by self-inflicted or iatrogenic trauma to the
external auditory canal. The most frequent pathogen is Pseudomonas aeruginosa.
Patients with necrotizing external otitis complain of severe otalgia that worsens
at night, and otorrhea. Clinical findings include granulation tissue in the
external auditory canal, especially at the bone-cartilage junction. Facial and
other cranial nerve palsies indicate a poor prognosis; intracranial complications
are the most frequent cause of death. Diagnosis requires culture of ear
secretions and pathologic examination of granulation tissue from the infection
site. Imaging studies may include computed tomographic scanning, technetium Tc
99m medronate bone scanning, and gallium citrate Ga 67 scintigraphy. Treatment
includes correction of immunosuppression (when possible), local treatment of the 
auditory canal, long-term systemic antibiotic therapy and, in selected patients, 
surgery. Family physicians and others who provide medical care for
immunocompromised patients should be alert to the possibility of necrotizing
external otitis in patients who complain of otalgia, particularly if they have
diabetes mellitus and external otitis that has been refractory to standard
therapy. Susceptible patients should be educated to avoid manipulation of the ear
canal (i.e., they should not use cotton swabs to clean their ears) and to
minimize exposure of the ear canal to water with a high chloride concentration.
Appropriate patients should be referred to an otolaryngologist.

PMID: 12892351 [PubMed - indexed for MEDLINE]

1608: J Antimicrob Chemother. 2003 Sep;52(3):469-72. Epub 2003 Jul 29.

Randomized, double-blind study of the clinical efficacy of 3 days of azithromycin
compared with co-amoxiclav for the treatment of acute otitis media.

Dunne MW, Latiolais T, Lewis B, Pistorius B, Bottenfield G, Moore WH, Garrett A, 
Stewart TD, Aoki J, Spiegel C, Boettger D, Shemer A.

Pfizer Global Research & Development, 50 Pequot Ave. MS 6025-C2173, New London,
CT 06320, USA. michael_w_dunne@groton.pfizer.com

BACKGROUND: Compared with 5 days of dosing, a 3 day dosing regimen of
azithromycin for treatment of acute otitis media (AOM) may improve compliance,
will simplify therapy for the caregiver and, by giving the same total dose as the
5 day regimen, provide more drug when the bacterial burden is highest. METHODS:
Children of 6 months-12 years were enrolled if they had had symptoms and signs of
AOM for <4 weeks and tympanic membrane effusion by acoustic reflectometry.
Eligible children were randomized to azithromycin 10 mg/kg/day x 3 days or
co-amoxiclav 45 mg/kg/day x 10 days. The primary endpoint was clinical response
at day 28. RESULTS: One hundred and eighty-eight children (mean age 3.5 years)
were randomized to azithromycin and 185 to co-amoxiclav. At day 10, the clinical 
success rate was 153/185 (83%) in children treated with azithromycin and 159/181 
(88%) in children treated with co-amoxiclav. At day 28, 134/182 (74%) of the
children were cured on azithromycin compared with 124/180 (69%) on co-amoxiclav. 
Also at day 28, signs of AOM, such as abnormal reflectometry (45% versus 59%; P =
0.017), bulging of the eardrum (10% versus 16%; P = 0.059) and loss of tympanic
membrane landmarks (11% versus 22%; P = 0.010) were seen less frequently in
azithromycin- than co-amoxiclav-treated children, respectively. Adverse events
related to therapy were seen in 11% of azithromycin patients compared with 20% on
co-amoxiclav (P = 0.014). CONCLUSIONS: Azithromycin given over 3 days is as
effective as co-amoxiclav for treatment of AOM, may result in more complete
resolution of tympanic membrane disease, and is better tolerated.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 12888586 [PubMed - indexed for MEDLINE]

1609: Am J Otolaryngol. 2003 Jul-Aug;24(4):209-12.

Has cerumen a protective role in recurrent external otitis?

Pata YS, Ozturk C, Akbas Y, Gorur K, Unal M, Ozcan C.

Department of Otorhinolaryngology, Mersin, Turkey. yavuzpata@hotmail.com

PURPOSE: We investigated the bactericidal activity of the cerumen in patients
with recurrent otitis externa. Materials and methods: Cerumen samples were
collected from 2 groups. Group A (n = 20) consisted of patients with recurrent
otitis externa (2 or more acute otitis externa attack in the current year) and
group B (n = 30) consisted of cerumen from a healthy population. We examined the 
bactericidal activity against the common microorganisms (Staphylococcus aureus,
Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, and
Enterococcus) that encounter the recurrent otitis externa. RESULTS: A significant
decrease in the count of S epidermidis was observed in group A (P <.05) and B (P 
<.01) was observed. A comparison of decreases and increases in the percentages of
microorganisms between the groups A and B showed that there was a significant
difference only in the count of E coli (P <or=.05). The count of E coli decreased
in cerumen suspension in group A, but it increased in the normal population.
CONCLUSION: We did not confirm that cerumen from patients with recurrent otitis
externa had less bactericidal activity than from a healthy population.

Publication Types: 
    In Vitro

PMID: 12884208 [PubMed - indexed for MEDLINE]

1610: Eur Arch Otorhinolaryngol. 2003 Jul;260(6):320-1. Epub 2003 Feb 6.

Myringitis bullosa haemorrhagica associated with meningo-encephalitis.

Wild DC, Spraggs PD.

Department of Otorhinolaryngology, North Hampshire Hospital, Basingstoke,
Hampshire, UK. dcwild@rcsed.ac.uk

An unusual case of a patient presenting with myringitis bullosa haemorrhagica
(MBH), who subsequently developed acute otitis media and meningo-encephalitis, is
described. The aetiology of MBH is discussed, and recommendations for the
management of patients with acute otitis are made.

PMID: 12883956 [PubMed - indexed for MEDLINE]

1611: Ambul Pediatr. 2003 Jul-Aug;3(4):203-10.

Correlates of parental antibiotic knowledge, demand, and reported use.

Kuzujanakis M, Kleinman K, Rifas-Shiman S, Finkelstein JA.

Harvard Pediatric Health Sevices Research Fellowship, the Department of
Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health
Care, Boston, Mass 02215, USA.

BACKGROUND: Clinicians cite parental misconceptions and requests for antibiotics 
as reasons for inappropriate prescribing. AIMS: To identify misconceptions
regarding antibiotics and predictors of parental demand for antibiotics and to
determine if parental knowledge and attitudes are associated with use. METHODS:
Survey of parents in 16 Massachusetts communities. Domains included
antibiotic-related knowledge, attitudes about antibiotics, antibiotic use during 
a 12-month period, demographics, and access to health information. Bivariate and 
multivariate analyses evaluated predictors of knowledge and proclivity to demand 
antibiotics. A multivariate model evaluated the associations of knowledge,
demand, and demographic factors with parent-reported antibiotic use. RESULTS: A
total of 1106 surveys were returned (response rates: 54% and 32% for
commercially-insured and Medicaid-insured families). Misconceptions were common
regarding bronchitis (92%) and green nasal discharge (78%). Two hundred
sixty-five (24%) gave responses suggesting a proclivity to demand antibiotics.
Antibiotic knowledge was associated with increased parental age and education,
having more than 1 child, white race, and receipt of media information on
resistance. Factors associated with a proclivity to demand antibiotics included
decreased knowledge, pressure from day-care settings, lack of alternatives
offered by clinicians, and lack of access to media information. Among all
respondents, reported antibiotic use was associated with younger child age and
day-care attendance. Among Medicaid-insured children only, less antibiotic
knowledge and tendency to demand antibiotics were associated with higher rates of
antibiotic use. CONCLUSIONS: Misconceptions regarding antibiotic use are
widespread and potentially modifiable by clinicians and media sources. Particular
attention should be paid to Medicaid-insured patients in whom such misconceptions
may contribute to inappropriate prescribing.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12882598 [PubMed - indexed for MEDLINE]

1612: Int J Pediatr Otorhinolaryngol. 2003 Aug;67(8):895-903.

NF-kappaB in cultivated middle ear epithelium.

Barrett TQ, Kristiansen LH, Ovesen T.

ENT Department, Aarhus University Hospital, DK-8000 Aarhus C, Denmark.
toves@akh.aaa.dk

OBJECTIVE: Otitis media with effusion (OME) may develop into a chronic course in 
some patients. In the majority of cases lipopolysaccharide (LPS) is detected in
the middle ear fluid being capable of initiating and maintaining the inflammatory
process associated with the disease. In addition, various extracellular signs of 
the inflammatory cascade are present, such as cytokines and ICAM-1 receptors.
However, the underlying regulatory mechanisms situated intracellularily are
sparsely recognized. NF-kappaB is a ubiquitously transcription factor complexed
to its inhibitor within the cytoplasm. In response to stimuli, e.g. LPS or
cytokines, NF-kappaB becomes activated and is translocated to the nucleus. At
this level it induces transcription of various genes and subsequent expression of
mRNA encoding for many immunoglobulins and cytokines, e.g. interleukin 8 (IL-8)
which may be responsible for prolonging and maintaining the inflammatory process.
METHODS: To evaluate if NF-kappaB is present in middle ear epithelium including
to identify possible stimulating factors in vitro studies using rabbit middle ear
epithelial cells (meec) were undertaken. Both normal cells and LPS exposed cells 
were studied. ELISA techniques were applied to detect NF-kappaB, ICAM-1 receptors
and IL-8. All measurements were adjusted to the concentration of total cell
protein (TP). RESULTS: NF-kappaB was detected in the normal middle ear epithelium
in concentrations between 16.8 and 28.6 ng/microg TP. In response to LPS the
NF-kappaB content increased with 25-33%. This enhancement became more pronounced 
with longer duration of the LPS exposition. A relatively distinct expression of
ICAM-1 preceded the NF-kappaB increase, after which the ICAM-1 measurements
declined. IL-8 was hardly measurable in normal cells. The IL-8 concentrations
were higher in LPS exposed cultures. The time related curve demonstrated a
diphasic shape with an early and a late maximum. CONCLUSION: The chronic
inflammation seen in some OME patients may be due to LPS activating ICAM-1
receptors and NF-kappaB followed by release of IL-8. An autocrine pathway may be 
established through activation of TNF alpha and IL-1beta. Thus, elucidation of
alternative pathways in the inflammatory cascade and elimination of LPS,
alternatively inhibition of NF-kappaB and/or IL-8, should be an issue for future 
investigation.

PMID: 12880670 [PubMed - indexed for MEDLINE]

1613: Int J Pediatr Otorhinolaryngol. 2003 Aug;67(8):861-6.

Left-right differences in Eustachian tube function in children with ventilation
tubes.

van Heerbeek N, Akkerman AE, Ingels KJ, Engel JA, Zielhuis GA.

Department of Otorhinolaryngology, University Medical Center Nijmegen, Nijmegen, 
P.O. Box 9101, 6500 HB Nijmegen, Netherlands. n.vanheerbeek@kno.umcn.nl

OBJECTIVE: To study the intraindividual variation in Eustachian tube (ET)
function in children with ventilation tubes. METHODS: The forced response test,
the pressure equilibration test and the sniff test were performed on both ears of
148 children. The results of both ears were compared. RESULTS: No systematic
differences were found between the left and the right ears. However, the
intraindividual variation was very pronounced. The variation in passive ET
function within children was of similar magnitude as the variation in passive ET 
function between children. Twenty-eight percent of the children had different
active ET function in both ears and 15% had an opposite result in each ear with
respect to the sniff test. CONCLUSIONS: This study shows that ET function is much
more a characteristic of the individual ear than of the individual child. These
findings also question the validity of trials on ET function or middle ear
disease that use the opposite ear as a control (split level design).

Publication Types: 
    Comparative Study
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 12880665 [PubMed - indexed for MEDLINE]

1614: Int J Pediatr Otorhinolaryngol. 2003 Aug;67(8):853-9.

Eustachian tube function in older children and adults with persistent otitis
media.

Swarts JD, Bluestone CD.

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 3705
Fifth Avenue, Pittsburgh, PA 15213, USA. dswarts@pitt.edu

OBJECTIVE: Otitis media (OM) is most common in infants and young children.
Despite a dramatic reduction in its incidence after the age of six, the disease
still occurs in older children, adolescents, and may even persist into adulthood.
The goal of this study was to identify characteristics of eustachian tube (ET)
function in an older population which may underlie their persistent OM. METHODS: 
Following a medical history and a head and neck examination, 38 subjects over 6
years of age (64 ears) had their ET function assessed with the forced-response
test (FRT). Parameters derived from this test included opening and closing
pressures as well as steady-state and active resistances. RESULTS: Adenoidectomy 
had previously been performed in 71% of the sample. Clinically, 5% of these
subjects had evidence of nasopharyngeal inflammation. The distributions of
closing pressure and steady-state resistance were very similar to the
distributions of the historic normal controls. The distributions of opening
pressure and active resistance were highly skewed relative to the control sample.
All study subjects had either abnormal opening pressures or high active
resistance, with 79% having both abnormalities. CONCLUSIONS: If nasopharyngeal
inflammation and hypertrophied adenoids are significantly correlated to ET
dysfunction and persistent OM, this sample should be free of middle-ear (ME)
disease. However, these individuals suffer persistent OM due to ET dysfunction
characterized by high opening pressures and high active resistances. The
abnormalities underlying these skewed forced-response parameters must be
identified and corrected if we are going to alleviate the ME disease in these and
similar patients.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12880664 [PubMed - indexed for MEDLINE]

1615: Int J Pediatr Otorhinolaryngol. 2003 Aug;67(8):841-5.

Audiological range in Turner's syndrome.

Serra A, Cocuzza S, Caruso E, Mancuso M, La Mantia I.

Department of Otolaryngology, School of Medicine, University of Catania, Catania,
Italy.

Turner's syndrome is generally characterised by bilateral gonadal disgenesis,
short stature and inadequate sexual development secondary to anomalous karyotype.
The purely otorhinolaryngoiatric pathology considerably influences the
symptomatological features in Turner's subject and this is based on possible
morphologically structured anomalies in the external, middle and inner ear, but
also on the oral cavity and pharynx. From this there is evidence of otological
emergence on a phlogistic infectious basis with remarkable long-term repercussion
on the hearing process. Otofunctional evaluation in 21 Turner's syndrome patients
shows predominance of conductive hearing loss (42.8%), proven through evidence of
otitis media (33.3%) and chronic otitis media (9.5%). This, therefore, demands an
attentive audiologic monitoring related to the possible development of chronic
forms or cholesteatoma and the possible rehabilitative-prothesis procedure.

PMID: 12880662 [PubMed - indexed for MEDLINE]

1616: Antimicrob Agents Chemother. 2003 Aug;47(8):2663-5.

Efficacy of single-dose azithromycin in treatment of acute otitis media in
children after a baseline tympanocentesis.

Dunne MW, Khurana C, Mohs AA, Rodriguez A, Arrieta A, McLinn S, Krogstad JA,
Blatter M, Schwartz R, Vargas SL, Emparanza P, Fernandez P, Gooch WM 3rd, Aspin
M, Podgore J, Roine I, Blumer JL, Ehrlich GD, Chow J.

Pfizer Global Research & Development, New London, Connecticut 06320, USA.
michael_w_dunne@groton.pfizer.com

Children with acute otitis media underwent tympanocentesis and were given a
single dose of 30 mg of azithromycin/kg of body weight. At day 28, the overall
clinical cure rate was 206 of 242 (85%). Clinical cure rates for patients
infected with Streptococcus pneumoniae (67 of 76; 88%) and Haemophilus influenzae
(28 of 44; 64%) were consistent with historical rates for the 5-day dosing
regimen.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 12878537 [PubMed - indexed for MEDLINE]

1617: Fam Pract. 2003 Aug;20(4):417-9.

Acute otitis media--a brief explanation to parents and antibiotic use.

Pshetizky Y, Naimer S, Shvartzman P.

Family Medicine Department, Sial Research Center for Family Medicine and Primary 
Care, Division of Community Health, Ben-Gurion University of the Negev, Clalit
Health Services, 84105 Beer-Sheva, Israel. family@bgumail.bgu.ac.il

BACKGROUND: Acute otitis media (AOM) is a common self-limiting disease in
children. Antibiotic use is controversial. Physicians in the USA and in Israel
prescribe antibiotics almost universally, while physicians in other countries
report good outcome without any treatment. Parents' expectation is an important
factor influencing a physician's decision to prescribe antibiotics. OBJECTIVES:
Our aim was to assess whether a brief explanation to parents regarding the
self-limited nature of AOM and the controversy regarding antibiotic prescription 
for the disease will influence the parents' decision regarding antibiotics use.
METHODS: Parents of the children participating in the study in two primary care
clinics belonging to HMO-Clalit Health Services (CHS) in the southern district of
Israel were randomly assigned to an intervention (44) and control (37) group. The
intervention group received the brief explanation. The two groups received
prescription for antibiotics. The subjects comprised 81 children aged 3 months to
4 years visiting the family practice clinics and diagnosed with AOM. The rate of 
antibiotics purchase, using the prescription given and the factors influencing
the decision were evaluated. RESULTS: Fewer parents administered antibiotics to
their children in the intervention group compared with the control group (37%
versus 63%, respectively, P < 0.0001). Mother's education level was the only
factor found to be significantly lower in the group that eventually purchased
antibiotics (P < 0.05). CONCLUSIONS: In children with AOM, a brief explanation by
the family physician to the child's parents about the disease and the expected
spontaneous recovery could decrease antibiotic use by approximately 50%.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 12876113 [PubMed - indexed for MEDLINE]

1618: Acta Otolaryngol. 2003 Jun;123(5):583-7.

Inflammation of embryonic connective tissue in the middle ear spaces.

Bernal-Sprekelsen M, Borkowski G, Sudhoff H, Hildmann H.

ENT Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.
mbernal@clinic.ub.es

OBJECTIVE: Persistent embryonic connective tissue has been considered to be a
cause of chronic otitis media with effusion in neonates and of cholesteatoma in
later life. As part of a study of pneumatization and resorption of embryonic
connective tissue from the middle ear of pre- and postnatal infants, inflammatory
processes of variable extents have been observed within the embryonic connective 
tissue. The aim of the present study was to characterize this inflammation and to
detect patterns in its presence and distribution. MATERIAL AND METHODS: Twenty
fetal temporal bones obtained at 4-8 months of development and 31 temporal bones 
from children who died of sudden infant death syndrome aged < 1 year were studied
to assess the inflammation within the middle ear cleft and specifically in the
embryonic connective tissue. RESULTS: Sixteen of 27 (59.3%) pre- and 10/31
(32.2%) postnatal specimens displayed a non-specific inflammatory lymphocytic
infiltration without signs of bacterial infection or the presence of or reaction 
to amniotic contents. Eleven of 27 prenatal temporal bones (40.7%) and 16/31
(51.6%) postnatal specimens showed no evidence of histologic middle ear
inflammation. The presence or absence of inflammation was independent of age.
CONCLUSION: Our observations indicate resorption of the embryonic connective
tissue with individual variations indicating that genetic factors are responsible
for the development of the middle ear spaces during the phases of development
studied.

PMID: 12875579 [PubMed - indexed for MEDLINE]

1619: Acta Otolaryngol. 2003 Jun;123(5):575-82.

Mucosal expression of genes encoding possible upstream regulators of Na+
transport during pneumococcal otitis media.

Li HS, Doyle WJ, Swarts JD, Lo CY, Hebda PA.

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh
Pennsylvania 15213, USA. shengli@pitt.edu

OBJECTIVE: Recently, we reported that gene transcripts encoding 3 Na+ transport
proteins (pump, channel and exchanger) in the middle ear mucosa (MEM) were
simultaneously suppressed at 12 and 48 h after Streptococcus pneumoniae (SP)
challenge of rat middle ears. MATERIAL AND METHODS: From cDNA microarray
screening of those specimens, several gene clusters, including Nos2 and the
transcription factors Fos, Fosl1, Jun and Nfkb1, were identified as possible
upstream regulators of Na+ transport protein expression. The altered expression
of those genes in MEM was validated and quantified using real-time polymerase
chain reaction and MEM protein expression for Atp1a1, Nos2 and Nfkb1 was studied 
using Western blot and/or immunohistochemistry assays. RESULTS: At both
time-points. Atp1a1 mRNA and protein were decreased and Nos2 mRNA and protein
were increased in MEM. While Nfkb1 protein was decreased at those times. the
corresponding mRNA was increased at 12 h but decreased at 48 h. Gene expression
for Fos was suppressed at both times, while that for Fosl1 and Jun was augmented 
at 12 h and suppressed at 48 h. Immunohistochemical study of specimens challenged
with SP showed a swollen MEM with infiltration of inflammatory cells that stained
positive for Nos2. CONCLUSION: Given the known activities of Nos2, these results 
can be interpreted as evidencing a transcriptional suppression of Na+ transport
protein synthesis secondary to upregulated Nos2 expression during SP infection of
the rat MEM. This proposed signaling pathway does not require the continuous
upregulation of Nfkb1 or the other assayed transcription factors as early as 12 h
after middle ear infection.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12875578 [PubMed - indexed for MEDLINE]

1620: Acta Otolaryngol. 2003 Jun;123(5):569-74.

Chronic tympanic membrane perforation: middle ear pressure and tubal function.

Brattmo M, Tideholm B, Carlborg B.

Department of Otorhinolaryngology, University Hospital, Lund University, Malmö,
Sweden. marianne.brattmo@oron.mas.lu.se

OBJECTIVE: To monitor the middle ear (ME) pressure continuously, day and night,
in subjects with chronic central perforation (CCP) whose ears were temporarily
sealed off from ambient air. MATERIAL AND METHODS: Twenty-three consecutive
patients at our outpatient clinic, considered for myringoplasty, were studied.
RESULTS: The measurements revealed slow pressure changes with a similar pattern
in 21/23 subjects. The pattern could be divided into four periods: coupling;
erect body position; sleep; and the period after getting up in the morning. The
coupling period was characterized by an immediate fall in pressure in 19/23
subjects and the negative pressure trend continued during most of the time in the
erect position. During sleep the ME pressure initially rose and then stabilized. 
When the subjects got up in the morning, the ME pressure declined again.
CONCLUSION: The different pressure periods observed in this study confirm that ME
pressure regulation is a dynamic process. There is clearly a difference in the ME
pressure of ears with CCP compared to previous results obtained from continuous
measurements in 20 healthy ears.

PMID: 12875577 [PubMed - indexed for MEDLINE]

1621: Acta Otolaryngol. 2003 Jun;123(5):564-8.

Factors associated with poor outcome in children with acute otitis media.

Monobe H, Ishibashi T, Fujishiro Y, Shinogami M, Yano J.

Department of Otolaryngology, University of Tokyo, Tokyo, Japan.

OBJECTIVE: To identify factors determining poor outcome in children with acute
otitis media (AOM). MATERIAL AND METHODS: We considered the following factors in 
children with AOM: age; gender; the presence of group nursing; the presence of
siblings; the duration of breastfeeding; and the type of bacteria isolated from
the middle ear fluid (MEF) or nasopharynx. The 73 pediatric patients studied
included 61 examined in outpatient clinics and 12 seen at a children's home.
RESULTS: Of the 61 children examined in outpatient clinics, 32 (52%) had
persistent MEF (fluid accumulation in the middle ear persisting for up to 1 month
after treatment); 14 (23%) had early recurrence of AOM (within 1 month following 
an initial improvement); and 14 (23%) developed recurrent AOM (> 3 recurrences
during 6 months of follow-up). Using univariate and multivariate analyses, age < 
2 years was found to be significantly related to the development of recurrent AOM
and an absence of group nursing was found to be significantly related to the
development of early recurrence. Persistent MEF was significantly related to the 
development of recurrent AOM. There was no difference between bacterial species
isolated from the MEF or nasopharynx in terms of clinical outcome. CONCLUSIONS:
These findings indicate that particularly close long-term follow-up is necessary 
for children aged < 2 years and children with a middle ear effusion that persists
for up to 1 month after treatment.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12875576 [PubMed - indexed for MEDLINE]

1622: Acta Otolaryngol. 2003 Jun;123(5):559-63.

Expression of vascular endothelial growth factor receptors in experimental otitis
media in the rat.

Chae SW, Kim SJ, Kim JL, Jung HH.

Department of Otolaryngology--Head and Neck Surgery, Korea University College of 
Medicine, Seoul, South Korea.

OBJECTIVE: Increased vascular permeability and endothelial cell growth are
important in the pathogenesis of otitis media with effusion (OME) and vascular
endothelial growth factor (VEGF) is known to play an important role in the
increased vascular permeability and angiogenesis associated with OME. The action 
of VEGF is mediated by two different high-affinity receptors--VEGF receptor-1
(VEGFR-1; flm-like tyrosine kinase-1; flt-1) and VEGFR-2 (kinase insert
domain-containing receptor; flk-1)--predominantly located on the vascular
endothelium. The purpose of this study was to investigate the expression of three
forms of VEGFR (-1, -2 and -3) in an endotoxin-induced rat model of OME. MATERIAL
AND METHODS: Middle ear mucosa were obtained at 0, 1, 3, 6 and 12 h and 1, 3, 7
and 14 days after induction, and the expression of VEGFR mRNA and protein was
evaluated using semi-quantitative reverse transcriptase polymerase chain reaction
(RT-PCR) and Western blotting. RESULTS: RT-PCR revealed that the expression of
VEGFR-1 and -2 mRNA was upregulated between 1 h and 3 days after endotoxin
instillation, with peak expression occurring at 12 h and on Day 1. No expression 
of VEGFR-3 mRNA was detected in any of the samples. Expression patterns of
VEGFR-1 and -2 protein observed by Western blotting were similar to those of
VEGFR-1 and -2 mRNA and peak expression was observed on Day 1. Expression of
VEGFR mRNA or protein was not detected in either normal or saline-instilled
middle ear mucosa. CONCLUSION: These results suggest that both VEGFR-1 and -2 are
upregulated during experimental otitis media in the rat and these receptors may
play different roles in the production of effusion in OME.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12875575 [PubMed - indexed for MEDLINE]

1623: Clin Otolaryngol Allied Sci. 2003 Aug;28(4):355-9.

Does a trial on the effects of ventilation tubes influence clinical practice?

Rovers MM, Van Der Bij S, Ingels K, Van Der Wilt GJ, Zielhuis GA.

Department of Epidemiology and Biostatistics, University Medical Centre Nijmegen,
the Netherlands. M.M.Rovers@med.uu.nl

A survey was performed to study the implementation of the results of a clinical
trial on the effect of ventilation tubes on daily clinical practice. Two random
samples of 75 Dutch otorhinolaryngologists each were drawn: one before the
conduction of the trial and another after the results were disseminated. In both 
surveys participants were asked to give their personal estimate of the
probability of complete recovery without treatment and after the insertion of
ventilation tubes in an infant with bilateral otitis media with effusion. The
trial showed no long lasting effects of ventilation tubes on hearing, language
development and quality of life, yet, the overall expectation with respect to the
effect of ventilation tubes remained high. The study suggests that the adoption
of research results require more than simple dissemination of the results.
(Inter)national debate is recommended to value the results of clinical trials for
daily practice.

PMID: 12871252 [PubMed - indexed for MEDLINE]

1624: Clin Otolaryngol Allied Sci. 2003 Aug;28(4):335-40.

Serum IgA and IgG functional antibodies and their subclasses to Streptococcus
pneumoniae capsular antigen found in two aged-matched cohorts of children with
and without otitis media with effusion.

Drake-Lee AB, Hughes RG, Dunn C.

The Department of Otorhinolaryngology, Birmingham Children's Hospital, Steelhouse
Lane, Birmingham B4 6NH, UK. adrakelee@aol.com

The relationship between acute otitis media and otitis media with effusion (OME) 
is uncertain and the aetiology of OME is multifactorial. Otitis media with
effusion may be an inflammatory condition; both bacteria and viral infections
could play a part in this inflammation. The four bacteria Streptococcus
pneumoniae, Haemophilus influenza, Staphylococcus aureus and Branhamella
catarrhalis cause 60% of the infections whereas S. pneumoniae accounts for up to 
35%. IgA provides the dominant surface response to polysaccharide and
lipopolysaccharide antigens, of which IgA2 is the main subclass. Once the mucosa 
has been breached, most protection is provided by IgG. IgG2 acts mainly against
bacterial capsular antigens. This study looked at two groups of 50 children with 
and without OME who were aged between 3 and 10 years. The aims were to determine 
if, firstly, the levels of the serum immunoglobulins were different in the two
groups, secondly whether these children made the appropriate antibody response to
the capsular antigen to S. pneumoniae (PCP), and finally if there was a delay in 
the maturity of the IgA response. The total IgG, IgA and all subclass levels were
measured using radial immunodiffusion. Levels of functional IgA and IgG were
measured using ELISAs (25 patients in each group). The results were analysed with
non-parametric tests. The immunoglobulin levels were within the normal levels for
both groups. There were very good correlations between the IgG total anti-PCP and
the IgG2 anti-PCP (R > 0.9, p = 0.001). There was a good correlation between the 
levels of both IgG total and IgG2 anti-PCP against IgA total anti-PCP in both
groups (R > 0.85, p > 0.01). This confirms a normal antibody response between
both groups of patients. The ages of the controls and patients (50 samples) were 
correlated with increasing titres of circulating functional antibodies (P =
0.001). This is highly suggestive of a normal age-related response. In
conclusion, the findings were contradictory to our original hypothesis that there
is a subtle difference in surface protection between children with and without
OME. We believe that a previous history of recurrent acute otitis media is
unrelated to the development of OME after 3 years of age.

PMID: 12871248 [PubMed - indexed for MEDLINE]

1625: Clin Otolaryngol Allied Sci. 2003 Aug;28(4):331-4.

Comparison of compliance between topical aural medications.

Lancaster J, Mathews J, Williams RS, Thussey C, Kent SE.

Department of Otolaryngology, Warrington Hospital, Warrington, Cheshire, UK.
jeffreylancaster@hotmail.com

Patients receiving Gentisone HC, Sofradex and Otomize for chronic suppurative
otitis media and otitis externa were investigated for compliance of medication.
Drops were accurately weighed before and after use so that both the amount used
and the expected amount patients should have used could be calculated. The amount
used differed statistically from the amount expected for Sofradex (P = 0.0008)
but not for Gentisone HC (P = 0.1049) or Otomize (P = 0.7553) when analysed by a 
Mann-Whitney U-test. There was a trend to overdose with both Sofradex & Gentisone
HC. The reason for the differences, we believe, is due to a combination of both
differing delivery systems and drop viscosities. Manufacturers need to improve
delivery systems so that patients can deliver a reproducible volume of medication
each time with ease.

Publication Types: 
    Comparative Study

PMID: 12871247 [PubMed - indexed for MEDLINE]

1626: Clin Otolaryngol Allied Sci. 2003 Aug;28(4):320-4.

External auditory canal pH in chronic otitis externa.

Martinez Devesa P, Willis CM, Capper JW.

ENT Department, Wycombe Hospital, Queen Alexandra Road, High Wycombe,
Buckinghamshire, HP11 2TT, UK. pablo@2oto.fsnet.co.uk

Several risk factors have been postulated to play a part in the progression of
acute into chronic otitis externa, including changes towards alkalinity of the
skin pH of the external auditory canal. These changes have been previously
reported to occur in the acute stage, and their persistence may predispose to a
chronic status of this condition. This prospective control study was designed to 
look at this possible relationship in more depth, by comparing the external
auditory canal pH of individuals with chronic otitis externa, but with no current
exacerbation, with an age-/sex-matched control group. Analysis of the data
revealed a significantly higher external auditory canal pH in the chronic otitis 
externa group (P < 0.004) when compared with the controls, with no concomitant
difference in body skin pH. Within this chronic otitis externa cohort, a
statistically significant correlation was found between external auditory canal
pH and the severity of the condition, as assessed using a multiparameter scoring 
system (r = 0.562; P < 0.02). Importantly, the pH was not related to the length
of time since the last exacerbation. There was a significant age relationship
present within our sample. Younger patients displayed more severe chronic otitis 
externa(r = -0.813; P < 0.001), with correspondingly higher external auditory
canal pH values (r = -0.550; P < 0.02). The results suggest that alkaline ear
canal skin is a local risk factor for the progression into chronic otitis
externa, occurring, in this study, with greater severity in younger individuals.

PMID: 12871245 [PubMed - indexed for MEDLINE]

1627: Otolaryngol Head Neck Surg. 2003 Jul;129(1):136-40.

Prognostic value of otoacoustic emissions in children with middle ear effusion.

Yeo SW, Park SN, Park YS, Suh BD.

Department of Otolaryngology--HNS, Kangnam St Mary's Hospital, The Catholic
University of Korea, College of Medicine.

The amplitude and frequency spectra of otoacoustic emissions are influenced by
the condition of the middle ear. These are noninvasive measurements of cochlear
function that are accurate, rapid, and simple to perform. In this study,
prognostic value of otoacoustic emissions in children with middle ear effusion
(MEE) was investigated. A total of 49 children aged 3.5 to 11.2 years with MEE
were included. Spontaneous otoacoustic emission, transient evoked otoacoustic
emission (TEOAE), and distortion product (DP) otoacoustic emission measurements
were performed on each ear before medical treatment and were compared according
to the responsiveness of medical treatment (medicine responder vs medicine
nonresponder groups). Responses of spontaneous otoacoustic emissions and DP
audiogram showed no significant difference between the 2 groups but TEOAE
response was significantly decreased in medicine nonresponders (P < 0.05).
Positive responses of the DP Input-Output function curve in geometric mean
frequencies at 5 and 6 kHz using a primary tone of 55 dB SPL were significantly
detected in medicine responders (P < 0.01). The sensitivity, specificity, and
predictive values of TEOAE and the DP I-O function curve in geometric mean
frequency at 6 kHz using a primary tone of 55 dB SPL showed the high prognostic
value of these tests in terms of predicting response to medical treatment in the 
patients with MEE. This suggests that otologists may have to be more aggressive
in their treatment of children with MEE who showed no response.

PMID: 12869929 [PubMed - indexed for MEDLINE]

1628: Diagn Microbiol Infect Dis. 2003 Jul;46(3):167-72.

Nasopharyngeal carriage of anaerobes during health and acute otitis media by two 
years of age.

Könönen E, Syrjänen R, Takala A, Jousimies-Somer H.

Department of Microbiology, National Public Health Institute (KTL), Helsinki,
Finland. eija.kononen@ktl.fi

The nasopharyngeal acquisition of anaerobic bacteria was longitudinally examined 
among a homogeneous group of Caucasian infants by 2 years of age. Nasopharyngeal 
swab (NP) samples were collected at scheduled healthy visits at 2, 6, 12, 18, and
24 months of age, and nasopharyngeal aspirates (NPA) during every visit for acute
otitis media (AOM). The infants were divided into 4 groups according to the
number (0, 1, 2-3, and > 3) of AOM episodes experienced by 2 years of age. At 2
years, the cumulative carriage rates of anaerobic species in these infant groups 
were 29%, 62%, 89%, and 89%, respectively. Anaerobic species were found in 15/220
(6.8%) of the NP samples and in 34/71 (47.9%) of the NPA samples. Our present
results indicate that anaerobic species do not belong to the indigenous
nasopharyngeal microflora but only transiently colonize the nasopharynx during
AOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12867091 [PubMed - indexed for MEDLINE]

1629: J Emerg Med. 2003 Jul;25(1):45-9.

Otomastoiditis-related facial nerve palsy.

Helms D, Roberge RJ, Kovalick M.

Emergency Medicine Residency Program, Department of Emergency Medicine, Ohio
Valley Medical Center, 2000 Eoff Street, Wheeling, West Virginia 26003, USA

A 9-year-old girl with persistent otitis media, despite antibiotic therapy
developed a facial nerve palsy. Computed tomography (CT) scan revealed
ipsilateral mastoiditis, prompting admission for intravenous antibiotic and
steroid therapies. Acute mastoiditis, uncommon in the post-antibiotic era, is
usually diagnosed on physical examination findings, but two variants, masked
mastoiditis or silent mastoiditis, may be difficult to appreciate clinically.
Patients who present with facial nerve palsy in the setting of persistent otitis 
media should undergo CT scan for evaluation of intracerebral or extracerebral
pathology, including mastoiditis. Failure to identify associated concomitant
pathology may result in treatment failure or persistent neurological deficit.

Publication Types: 
    Case Reports

PMID: 12865108 [PubMed - indexed for MEDLINE]

1630: Aviat Space Environ Med. 2003 Jul;74(7):707-10.

Therapeutic effects of eustachian tube surfactant in barotitis media in guinea
pigs.

Feng LN, Chen WX, Cong R, Gou L.

Department of Clinical Aerospace Medicine, Faculty of Aerospace Medicine, The
Fourth Military Medical University, Xi'an, PR China. congrui@fmmu.edu.cn

BACKGROUND: Previous research has shown that the eustachian tube (ET) in animals 
and humans is lined with a substance that lowers surface tension and thus
facilitates the opening of the eustachian tube and aeration of the middle ear.
The aims of the present study were to observe the role of eustachian tube
surfactant (ETS) on the opening of the ET and to explore the therapeutic effect
of natural and artificial ETS on barotitis media (BOM). METHODS: BOM was
successfully established in 50 guinea pigs by simulated ascent in an altitude
chamber. Subsets of the affected ears were treated by flushing with natural ETS, 
artificial ETS, artificial phospholipid, or saline. The effects were evaluated by
measuring eustachian tube pressure opening level (POL). Other animals with BOM
were treated with artificial ETS on one side and saline in the other, after which
the clinical signs were observed. RESULTS: The POL of the saline group remained
unchanged. Natural ETS decreased the POL from 11.98 to 6.11 kPa (p < 0.01);
artificial ETS reduced the POL from 11.91 to 6.67 kPa (p < 0.01); there was no
significant difference between the two treatments. Artificial phospholipid was
less effective, decreasing POL from 11.86 to 8.61 kPa (p < 0.05). Clinical
observations showed that after 1 wk of treatment with artificial ETS, the
congestion in the tympanic membrane was alleviated, the hearing threshold
improved, and the effusion in tympanic cavity diminished. CONCLUSION: Artificial 
ETS was as effective as natural ETS in facilitating the opening of eustachian
tube and had definite therapeutic effects on BOM in this model.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12862323 [PubMed - indexed for MEDLINE]

1631: Proc Natl Acad Sci U S A. 2003 Jul 22;100(15):8898-903. Epub 2003 Jul 10.

Host-derived sialic acid is incorporated into Haemophilus influenzae
lipopolysaccharide and is a major virulence factor in experimental otitis media.

Bouchet V, Hood DW, Li J, Brisson JR, Randle GA, Martin A, Li Z, Goldstein R,
Schweda EK, Pelton SI, Richards JC, Moxon ER.

Maxwell Finland Laboratory for Infectious Diseases, Division of Pediatric
Infectious Diseases, Boston University School of Medicine, Boston Medical Center,
774 Albany Street, Boston, MA 02118, USA.

Otitis media, a common and often recurrent bacterial infection of childhood, is a
major reason for physician visits and the prescription of antimicrobials.
Haemophilus influenzae is the cause of approximately 20% of episodes of bacterial
otitis media, but most strains lack the capsule, a factor known to play a
critical role in the virulence of strains causing invasive H. influenzae disease.
Here we show that in capsule-deficient (nontypeable) strains, sialic acid, a
terminal residue of the core sugars of H. influenzae lipopolysaccharide (LPS), is
a critical virulence factor in the pathogenesis of experimental otitis media in
chinchillas. We used five epidemiologically distinct H. influenzae isolates,
representative of the genetic diversity of strains causing otitis media, to
inoculate the middle ear of chinchillas. All animals developed acute bacterial
otitis media that persisted for up to 3 wk, whereas isogenic sialic
acid-deficient mutants (disrupted sialyltransferase or CMP-acetylneuraminic acid 
synthetase genes) were profoundly attenuated. MS analysis indicated that WT
bacteria used to inoculate animals lacked any sialylated LPS glycoforms. In
contrast, LPS of ex vivo organisms recovered from chinchilla middle ear exudates 
was sialylated. We conclude that sialylated LPS glycoforms play a key role in
pathogenicity of nontypeable H. influenzae and depend on scavenging the essential
precursors from the host during the infection.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12855765 [PubMed - indexed for MEDLINE]

1632: Clin Diagn Lab Immunol. 2003 Jul;10(4):721-4.

Systemic inflammatory responses in children with acute otitis media due to
Streptococcus pneumoniae and the impact of treatment with clarithromycin.

Scharer G, Zaldivar F, Gonzalez G, Vargas-Shiraishi O, Singh J, Arrieta A.

Residency Program, Children's Hospital of Orange County, Orange, California
92868, USA.

This pilot study was designed to determine the serum cytokine profile of acute
otitis media (AOM) due to Streptococcus pneumoniae and the impact of
clarithromycin (Abbott Laboratories, Inc). Serum levels of interleukin-1 beta
(IL-1 beta), tumor necrosis factor alpha (TNF-alpha), IL-6, and IL-8 were
measured at diagnosis and 3 to 5 days after start of antibiotic treatment in 10
patients (mean age, 18.3 +/- 13.9 months) who had middle ear fluid culture
positive for S. pneumoniae. The mean concentrations of all cytokines were
elevated at diagnosis of AOM compared to levels in healthy controls, yet only
IL-6 reached statistical significance (P = 0.05). IL-6 showed a statistically
significant decrease in mean serum concentration at visit 2 (P = 0.03). IL-8
displayed a similar pattern to IL-6, but the difference between samples from day 
1 and day 2 did not reach statistical significance. The cytokines IL-1 beta and
TNF-alpha appear to be elevated in the serum of patients with S. pneumoniae AOM, 
but there was no significant change between mean serum levels obtained pre- and
postinitiation of antibiotic treatment in the time frame studied. The results
suggest a systemic inflammatory response as evidenced by increased IL-6. A
significant decrease of IL-6 and improvement of clinical symptoms were observed. 
Determining cytokine levels, especially IL-6, in AOM could offer a powerful tool 
for objective assessment of response to treatment, minimizing unnecessary
treatment of asymptomatic children who may still have some otoscopic findings
suggestive of AOM at follow-up visits.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12853412 [PubMed - indexed for MEDLINE]

1633: Otol Neurotol. 2003 Jul;24(4):621-4.

Childhood otitis media and electrically elicited stapedius reflexes in adult
cochlear implantees.

Todd NW, Ajayi E, Hasenstab MS, Webster DA, Boyd PJ.

ntodd@emory.edu

BACKGROUND: Electric stapedius reflex thresholds are helpful in programming
cochlear implants, but only approximately two-thirds of patients have
identifiable reflexes. HYPOTHESIS: Childhood otitis media correlates with absent 
stapedius reflexes or with high electric stimulation needed to elicit a reflex in
cochlear implantees. STUDY POPULATION: Twenty-five adults with acquired hearing
loss who underwent implantation with the MED-EL COMBI 40+ standard electrode
array. STUDY PARAMETERS: The extent of temporal bone pneumatization, an indicator
of childhood otitis media, was measured from preoperative computed tomographic
images. Clinical units (in microamperes) needed to elicit a contralateral
stapedius reflex, or maximum stimulation tried, were recorded. RESULTS: No
definite association of pneumatization volume with intensity of stimulation was
observed. The null hypothesis of no association cannot be rejected. CONCLUSION:
Childhood otitis media does not seem to explain absent electric stapedius
reflexes and the wide range of clinical units needed for maximum comfortable
loudness level. Remaining potential explanations probably include the wide range 
of cochlear neurons that can be electrically stimulated, and that the maximum
tolerable stimulation is too low to elicit a stapedius reflex.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12851555 [PubMed - indexed for MEDLINE]

1634: Lancet. 2003 Jun 28;361(9376):2189-95.

Comment in:
    Lancet. 2003 Jun 28;361(9376):2170-1.    Lancet. 2003 Sep 27;362(9389):1080-1; author reply 1081.

Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal 
vaccine on recurrent acute otitis media: a randomised study.

Veenhoven R, Bogaert D, Uiterwaal C, Brouwer C, Kiezebrink H, Bruin J, IJzerman
E, Hermans P, de Groot R, Zegers B, Kuis W, Rijkers G, Schilder A, Sanders E.

Department of Paediatrics, Spaarne Hospital, Haarlem, Netherlands.

BACKGROUND: Pneumococcal conjugate vaccine prevents recurrent acute otitis media 
(AOM) in infants immunised at 2, 4, 6, and 12-15 months of age. We aimed to find 
out whether this vaccine also prevents AOM in older children who have had
previous episodes of AOM. METHODS: In this double-blind, randomised study, we
enrolled 383 patients aged 1-7 years who had had two or more episodes of AOM in
the year before entry. Randomisation was stratified in four groups according to
age (12-24 months vs 25-84 months) and the number of previous AOM episodes (two
or three episodes vs four or more episodes). Children received either 7-valent
pneumococcal conjugate vaccine followed by 23-valent pneumococcal polysaccharide 
vaccine, or hepatitis A or B vaccines. They were followed up for 18 months for
recurrence of AOM. We also cultured samples of middle-ear fluid and
nasopharyngeal swabs to assess association of pneumococcal serotypes with AOM
after vaccination. FINDINGS: We noted no reduction of AOM episodes in the
pneumococcal vaccine group compared with controls (intention-to-treat analysis:
rate ratio 1.25, 95% CI 0.99-1.57). Although nasopharyngeal carriage of
pneumococci of serotypes included in the conjugate-vaccine was greatly reduced
after pneumococcal vaccinations, immediate and complete replacement by
non-vaccine pneumococcal serotypes took place. INTERPRETATION: These data do not 
lend support to the use of pneumococcal conjugate vaccine to prevent otitis media
in previously unvaccinated toddlers and children with a history of recurrent AOM.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 12842372 [PubMed - indexed for MEDLINE]

1635: Int J Infect Dis. 2003 Mar;7 Suppl 1:S21-6.

Achieving bacterial eradication using pharmacokinetic/pharmacodynamic principles.

Dagan R.

The Pediatric Infectious Disease Unit, Soroka University Medical Center,
Ben-Gurion University, Beer-Sheva, Israel. rdagan@bgumail.bgu.ca.il

Evidence from studies in otitis media indicates that antimicrobials and dosing
regimens that have equivalent bacteriologic efficacy against susceptible
pathogens can have significantly different bacteriologic success rates against
resistant strains of the same species. Unlike macrolide and fluoroquinolone
resistance, penicillin resistance can be overcome in Streptococcus pneumoniae by 
increasing the dose, and hence increasing the time for which the serum
concentrations are above the MIC. The new clinical formulation of extra-strength 
amoxicillin-clavulanate provides 90 mg/kg per day amoxicillin plus 6.4 mg/kg per 
day clavulanate (14:1) divided every 12 h, compared with 45/6.4 mg/kg per day
b.i.d. with conventional dosing. The pharmacokinetic/pharmacodynamic (PK/PD)
profiles of extra-strength amoxicillin-clavulanate predict that the new
formulation will be more effective than the conventional formulation against S.
pneumoniae with elevated amoxicillin MICs and against Haemophilus influenzae. In 
an open-label, non-comparative study in children with acute otitis media, the
extra-strength formulation had high bacteriologic success rates against the major
respiratory pathogens, including penicillin-resistant S. pneumoniae. The
development of new antimicrobial agents and formulations should be aimed at
meeting PK/PD parameters predictive of bacterial eradication of both susceptible 
and resistant strains.

Publication Types: 
    Review

PMID: 12839704 [PubMed - indexed for MEDLINE]

1636: Scand J Infect Dis. 2003;35(4):284-8.

Malignant otitis externa due to Aspergillus niger.

Bellini C, Antonini P, Ermanni S, Dolina M, Passega E, Bernasconi E.

Division of Infectious Diseases, Hospital of Lugano, Switzerland.

The case is reported of a 73-y-old diabetic man with malignant otitis externa due
to Aspergillus niger. Cure was achieved with a 3 week course of intravenous
amphotericin B, followed by oral itraconazole for 3 months. The characteristics
and the outcome of 13 reported cases of malignant otitis externa caused by
Aspergillus sp. are presented.

Publication Types: 
    Case Reports
    Review

PMID: 12839164 [PubMed - indexed for MEDLINE]

1637: Laryngoscope. 2003 Jul;113(7):1228-30.

Preliminary results with the use of AlloDerm in chronic otitis media.

Fayad JN, Baino T, Parisier SC.

Department of Otolaryngology-Head & Neck Surgery, Columbia University College of 
Physicians and Surgeons, The New York-Presbyterian Hospital, 180 Fort Washington 
Avenue, Harkness Pavilion, Suite 813, New York, NY 10032, USA. jfayed@aol.com

OBJECTIVES/HYPOTHESIS: AlloDerm, an acellular dermal graft, has been used
successfully as a material for soft tissue implantation. The authors report their
experience with the use of AlloDerm in the reconstruction of the tympanic
membrane. STUDY DESIGN: Case review study. METHODS: Charts were reviewed for all 
patients who underwent tympanoplasty with and without mastoidectomy between June 
1999 and June 2002 in whom AlloDerm was used as a grafting material. There were
24 patients, 17 with simple perforations (8 revisions) and 7 with chronic otitis 
media with cholesteatoma (6 revisions). Success was defined as closure of the
tympanic membrane perforation. RESULTS: Closure of the perforation using AlloDerm
was achieved in 87.5% of the patients (ie, in all but three patients). Another
patient developed serous otitis media and required a myringotomy tube in the
postoperative period. CONCLUSIONS: The success rate for AlloDerm in tympanoplasty
was similar to that of temporalis fascia in the authors' experience. AlloDerm can
provide a suitable grafting material when fascia is not available or when the
size of the defect precludes the use of fascia.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12838024 [PubMed - indexed for MEDLINE]

1638: Laryngoscope. 2003 Jul;113(7):1224-7.

Cochlear implantation in children with otitis media.

Fayad JN, Tabaee A, Micheletto JN, Parisier SC.

Department of Otolaryngology-Head & Neck Surgery, Columbia University College of 
Physicians and Surgeons, The New York-Presbyterian Hospital, 180 Fort Washington 
Avenue, Harkness Pavilion, Suite 813, New York, NY 10032, USA. jfayed@hei.org

OBJECTIVE: To describe the outcome of cochlear implantation in a cohort of
pediatric patients with a history of otitis media. STUDY DESIGN: Retrospective
chart review and follow-up phone survey. METHODS: The medical records of patients
younger than 48 months of age who underwent cochlear implantation were reviewed
for demographics, complications, and history of otitis media and bilateral
myringotomy and ventilation tubes. A follow-up phone survey was performed to
determine the long-term natural history of otitis media. RESULTS: The records of 
126 profoundly deaf pediatric patients were reviewed. Seventy-two percent had a
history of at least one episode of otitis media, 31% had a history of greater
than three episodes, and 2% had a history of chronic serous otitis media.
Twenty-three percent underwent bilateral myringotomy and tubes in the distant
past, 6 to 8 weeks before implantation, at the time of implantation, or after
implantation. A phone survey was successfully completed for 76 patients with a
mean follow-up period of 46 months. There was a significant decrease in the
incidence of otitis media after the cochlear implantation in the majority of
patients with a history of otitis media with and without a history of bilateral
myringotomy and tubes. CONCLUSIONS: Placement of ventilation tubes either before 
or at the time of cochlear implantation seems to adequately prevent infectious
disease-related complications in otitis-prone children. Therefore, implantation
should not be delayed, and subsequent episodes of otitis media can be managed by 
conventional therapy.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12838023 [PubMed - indexed for MEDLINE]

1639: Pediatrics. 2003 Jul;112(1 Pt 1):143-9.

Diagnosis and treatment of acute otitis media: an assessment.

Garbutt J, Jeffe DB, Shackelford P.

Division of General Medical Sciences, Washington University School of Medicine,
St Louis, Missouri, USA. jgarbutt@im.wustl.edu

OBJECTIVE: To assess compliance with the Centers for Disease Control and
Prevention (CDC) evidence-based guidelines for the judicious use of
antimicrobials in children with acute otitis media (AOM). METHODS: Compliance
with CDC's recommended diagnostic criteria and antimicrobial treatments for
management of AOM was assessed by chart review and self-report for 29 community
pediatricians in St. Louis, Missouri. For each physician, a simple random sample 
of AOM visits was selected and reviewed by trained reviewers. In addition, each
physician completed a questionnaire. RESULTS: Compliance with recommended
diagnostic criteria was 38% (95% confidence interval: 34%-42%; n = 573) by chart 
audit and 41% (95% confidence interval: 24%-61%; n = 29) by self-report.
Antimicrobial selection assessed by chart audit was consistent with CDC
guidelines in 68% (95% confidence interval: 64%-72%) of visits for a new
infection, 63% (95% confidence interval: 47%-78%) of visits for treatment
failure, and 50% (95% confidence interval: 33%-67%) for recurrent disease.
Self-reported compliance with treatment guidelines for new infection was 100%
(95% confidence interval: 88%-100%) and 83% (95% confidence interval: 64%-94%)
for treatment failure. Noncompliance was most frequently attributable to overuse 
of broad-spectrum antimicrobials. Most patients treated with amoxicillin received
a 10-day course (98%). Subtherapeutic dosing occurred in 26% of patients treated 
with amoxicillin. CONCLUSIONS: Overdiagnosis of AOM is common. Efforts to improve
the judicious use of antimicrobials for AOM should focus on improving diagnostic 
accuracy, limiting the use of broad-spectrum antimicrobials to cases where they
offer clinical benefit, and ensuring that amoxicillin dosing regimens are
optimal.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12837880 [PubMed - indexed for MEDLINE]

1640: Ann Otol Rhinol Laryngol. 2003 Jun;112(6):558-66.

First forty-eight hours of developing otitis media: an experimental study.

Eriksson PO, Mattsson C, Hellström S.

Department of Clinical Sciences, Division of Otorhinolaryngology, Umeå University
Hospital, Umeå, Sweden.

The early inflammatory changes in the tympanic membrane were explored in 2 rat
models. Acute otitis media was induced by instillation of Streptococcus
pneumoniae type 3 into the middle ear cavity, and otitis media with effusion was 
induced by blockage of the eustachian tube. Otomicroscopic examination was
performed before the rats were painlessly sacrificed at 3, 6, 9, 12, 18, 24, or
48 hours after initiation of the otitis media conditions. The tympanic membrane
was studied by light and electron microscopy. Both acute otitis media and otitis 
media with effusion caused early inflammatory changes of the tympanic membrane,
and the pars flaccida was the portion that reacted first. The inflammatory
alterations were most pronounced in the acute otitis media model. The course of
inflammation showed a bimodal pattern with an early deposition of a filamentous
material with a band pattern, typical of fibrin. Despite a fluid-filled middle
ear cavity, the inflammatory changes in the otitis media with effusion model were
moderate, as was consistent with the clinical appearance of the tympanic
membrane.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12834127 [PubMed - indexed for MEDLINE]

1641: J Small Anim Pract. 2003 Jun;44(6):253-6.

Comment in:
    J Small Anim Pract. 2004 Apr;45(4):222; author reply 222.

Primary secretory otitis media in the Cavalier King Charles spaniel: a review of 
61 cases.

Stern-Bertholtz W, Sjöström L, Håkanson NW.

Strömsholm Referral Animal Hospital, Kolbäck, Sweden.

Sixty-one episodes of primary secretory otitis media (PSOM) were diagnosed in 43 
Cavalier King Charles spaniels over a 10-year period. The principal findings were
signs of moderate to severe pain localised to the head or cervical area, and/or
neurological signs. Diagnosis was made by examination of the tympanic membrane
and middle ear with the aid of an operating microscope under general anaesthesia.
A bulging, but intact, tympanic membrane was found in most cases. Following
myringotomy, a highly viscous mucus plug was found filling the middle ear.
Treatment, consisting of removal of the mucus plug, flushing of the middle ear,
and local and systemic medical therapy, had to be repeated between one and five
times. The prognosis was good in all cases. PSOM is an important differential
diagnosis in Cavalier King Charles spaniels with signs of pain involving the head
and neck, and/or neurological signs.

PMID: 12831101 [PubMed - indexed for MEDLINE]

1642: Vet Microbiol. 2003 Jul 30;94(4):295-301.

Mechanisms of fluoroquinolone resistance in Pseudomonas aeruginosa isolates from 
canine infections.

Teresa Tejedor M, Martín JL, Navia M, Freixes J, Vila J.

Microbiology, Facultad de Veterinaria, Universidad de Las Palmas de Gran Canaria,
P.O. Box 550, 35080 Las Palmas de Gran Canaria, Canary Islands, Spain.
mtejedor@dcc.ulpgc.es

Chronic otitis externa in dogs is often associated with Pseudomonas aeruginosa
infection. Fluoroquinolones are often used for treating such infections.
Fluoroquinolone resistance mechanisms were characterized in 10 strains of P.
aeruginosa isolated from chronic canine otitis externa. Nine out of ten strains
harbored a mutation in the gyrA gene and presented an overexpression of efflux
pump(s). There was a good correlation between the lipophilicity of the
fluoroquinolone being tested and the effect of the efflux pump inhibitor in the
final MIC. Therefore, both mechanisms, mutation in the gyrA gene and increased
efflux pump(s), seem to play an important role in the acquisition of
fluoroquinolone resistance in veterinary clinical isolates of P. aeruginosa.
Levels of resistance to fluoroquinolones suggest that they could not be a good
choice for systemic therapy of Pseudomonas otitis.

PMID: 12829383 [PubMed - indexed for MEDLINE]

1643: Prescrire Int. 2003 Jun;12(65):108-9.

Acute otitis media in adults: many unknowns.

[No authors listed]

(1) Acute otitis media is likely in adults with recent-onset otalgia, fever, and 
a bulging eardrum on otoscopy. Management is similar to that in children: no
antibiotics in the first instance, then amoxicillin later if antibiotic therapy
is needed. (2) Otitis media with a perforated eardrum, and evidence of pus must
be distinguished from external otitis. In patients with otitis media and a
perforated eardrum, the commonest bacterial isolates are staphylococci,
pseudomonas and pneumococci. (3) If antibiotics are prescribed the choice of
agent is based on individual clinical findings and underlying health status.

PMID: 12825601 [PubMed - indexed for MEDLINE]

1644: Prim Care. 2003 Mar;30(1):109-35.

The laws of acute otitis media.

Harrison CJ.

Department of Pediatrics, Division of Infectious Diseases, University of
Louisville, 571 South Floyd/Suite 321, Louisville, KY 40202, USA.
cjharr01@gwise.louisville.edu

One key to successfully navigating the quagmire of otitis media is to understand 
otitis media and share that understanding with parents. The Laws of Otitis Media 
can be useful in this endeavor. Another key to success is to help parents
understand that they and their child's physician are partners in the goal of
preventing AOM as much as possible, and treating episodes as precisely as
possible when they occur. Parents need to know that AOM usually occurs at < 3
years of age and most normal children experience some AOM. The number of AOM
episodes depends on a combination of inherited factors that are compounded by
immature immunity and anatomy plus the degree of exposure to provoking
respiratory pathogens. A firm understanding of the difference between AOM and OME
makes it simpler to withhold antibiotics for OME; and understanding that
infrequent AOM usually gets well without antibiotics also may reduce some of
parents' anxieties. Parents of patients with frequent AOM deserve more guidance
about the need for more potent antibiotics and the reduced expectations for cure 
despite use of appropriate antibiotics. Clinicians need to share with parents the
fact that most information about antibiotics and AOM comes from studies sponsored
by pharmaceutical companies, with the goal of optimizing the chance that the
company's drug would appear to be a good choice. Therefore, only by understanding
critical study-design characteristics that ensure fair and proper comparison,
will the clinician (or parent using the Internet) be able to decide which drugs
are best. Because there are so few well-designed studies, pharmacodynamics has
become an alternative method to decide which drugs are best. Practitioners may
need to rely on an expert to help interpret the application of pharmacodynamics
to local AOM pathogens. While shorter courses of antibiotics are attractive from 
the compliance and perhaps even the reduction of resistance perspective, failure 
rates will be higher in young children with tough-to-treat AOM. Further, some of 
the better tasting or more convenient drugs turn out to be less effective in
these same hard-to-treat patients. To further minimize parental anxiety,
clinicians should share the fact that it is very rare to see severe complications
or lifelong hearing problems due to AOM that is reasonably managed. This is
important because the available tools to prevent AOM are limited in number and
efficacy. The Laws of AOM can be a basis for busy practitioners to establish a
structure for constructively sharing information and responsibility with parents 
concerning AOM.

Publication Types: 
    Review

PMID: 12825252 [PubMed - indexed for MEDLINE]

1645: ORL J Otorhinolaryngol Relat Spec. 2003 Mar-Apr;65(2):106-16.

A systematic review of the effectiveness of ofloxaxin otic solution for the
treatment of suppurative otitis media.

Abes G, Espallardo N, Tong M, Subramaniam KN, Hermani B, Lasiminigrum L,
Anggraeni R.

Ear Institute, University of the Philippines, Manila, Philippines.
gtabes@pacific.net.ph

The objectives of the study were to determine the effectiveness and incidence of 
adverse events of ofloxacin otic solution for suppurative otitis media compared
with other treatments. All randomized controlled trials and nonrandomized
comparative clinical trials published from 1966 to 2000 using ofloxacin otic
solution as one of the interventions were reviewed and data were extracted and
analyzed. Eleven clinical trials (9 randomized and 2 nonrandomized) enrolling
1,484 adults and children were finally included in the analysis. Five studies
employed clear concealment procedure in the allocation of treatment whereas
evaluation of outcome was at least single-blinded in 6 trials. The probability of
overall cure rate was higher with 0.3% ofloxacin otic solution than with other
topical or systemic antibiotics in 9 of the studies analyzed (OR = 2.67; 95% CI =
2.04, 3.50). Resolution of secondary outcome parameters evaluated at least 1 week
after treatment was higher with 0.3% ofloxacin otic solution: resolution of
otalgia (4 trials; OR = 2.41; 95% CI = 1.2, 4.82); resolution of otorrhea (11
trials; OR = 2.78; 95% CI = 2.12, 3.65), and bacterial eradication rate (6
trials; OR = 3.86; 95% CI = 2.54, 5.87). A subgroup analysis of 4 studies
comparing ofloxacin otic solution with antibiotic- and steroid-containing otic
solution showed a higher cure rate for ofloxacin otic solution (OR = 2.73; 95% CI
= 1.52, 4.90). Another subgroup analysis on 3 studies comparing ofloxacin otic
solution with oral systemic antibiotics showed higher resolution of otorrhea with
ofloxacin otic solution (OR = 2.78; 95% CI = 2.12, 3.65). Of 4 studies with data 
on adverse events, the probability of adverse events was lower with ofloxacin
otic solution than with other topical antibiotics (OR = 0.28; 95% CI = 0.19,
0.42). Subgroup analysis showed that 0.3% ofloxacin otic solution showed better
results in terms of overall cure rate, resolution of otorrhea, otalgia, bacterial
eradication rate and incidence of adverse events. Whether due to chronic
suppurative otitis media (CSOM) or draining tympanostomy tube, the overall cure
rate (CSOM OR = 4.86; with tympanostomy tube OR = 2.13) and resolution of
otorrhea (CSOM OR = 4.42; with tympanostomy tube OR = 1.66) were likewise in
favor of 0.3% ofloxacin otic solution. The studies included in this meta-analysis
showed generally homogenous results in all clinical and laboratory outcomes
analyzed, except for the evaluation of adverse events. The authors conclude that 
0.3% ofloxacin otic solution is better than other otic antibiotic drops and other
oral antibiotics in terms of overall cure rate and resolution of secondary
outcome parameters. Estimates on the beneficial effects of ofloxacin otic
solution are limited to the period of study included in this review. Copyright
2003 S. Karger AG, Basel

Publication Types: 
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review

PMID: 12824733 [PubMed - indexed for MEDLINE]

1646: Eur J Pediatr. 2003 Sep;162(9):576-81. Epub 2003 Jun 19.

The burden of acute otitis media on the patient and the family.

Greenberg D, Bilenko N, Liss Z, Shagan T, Zamir O, Dagan R.

The Paediatric Infectious Disease Unit, Ben-Gurion University of the Negev,
Soroka University Medical Centre, Beer-Sheva, Israel. dudi@bgumail.bgu.ac.il

The aim of our study was to determine the burden of acute otitis media (AOM) on
patients and their families. Parents of children with AOM were interviewed with
regard to the week preceding the AOM diagnosis and every 3 days henceforth for an
additional 21 days. The interview included information on loss of workdays, use
of health care services and impact on the patient's and family's quality of life.
Parents of age- and neighbourhood-matched controls were interviewed in an
identical manner. A total of 150 patients and 51 controls were included in the
analysis. The following variables differed significantly ( P<0.001) between
patients and controls (mean +/- SD): non-routine days 18.5+/-11.0 in patients
versus 3.4+/-6.5 in controls; number of visits to primary health centres
2.6+/-1.6 versus 0.4+/-0.6; number of emergency room visits 0.2+/-0.5 versus
0.1+/-0.02 and number of visits to an otolaryngology clinic 0.3+/-0.6 versus 0.
Days of antibiotic and over the counter drug use were 9.0+/-5.6 versus 0.3+/- 0.9
and 7.0+/-6.0 versus 4.9+/-6.0, respectively per episode. The mean loss of
workdays per child was 1.6+/-1.8 in patients versus 0.25+/-0.6 in controls, for
working mothers and 0.6+/-1.1 versus 0.1+/-0.4 for working fathers; duration of
absenteeism from day care facilities was 3.5+/-2.5 versus 0.9+/-2.7. CONCLUSION: 
Acute otitis media significantly reduces the quality of life of both child and
parents, causes substantial use of medical services and significant loss of
workdays.

Publication Types: 
    Comparative Study

PMID: 12819964 [PubMed - indexed for MEDLINE]

1647: Arch Dis Child. 2003 Jul;88(7):566-9.

Airway infections in infancy and the presence of allergy and asthma in school age
children.

Njå F, Nystad W, Hetlevik O, Lødrup Carlsen KC, Carlsen KH.

Geilomo Children's Hospital for Asthma and Allergy, Geilo and Sandvika, Norway.
fnja@online.no

AIM: To investigate the association between a history of otitis media and
respiratory tract infections in infancy and allergic sensitisation and asthma in 
school age children of atopic and non-atopic parents. METHODS: Based on a survey 
of 4585 schoolchildren, three groups of children aged 6-16 years were selected,
of whom 502 were eligible with complete data: (1) diagnosed asthma (n = 166); (2)
wheeze within past 12 months (n = 155); and (3) no asthma/no wheeze (n = 181).
This study population was further analyzed by subgroups of children with or
without parental atopy. Main outcome measures were allergic sensitisation
verified by skin prick test and asthma. RESULTS: Children of atopic parents had a
reduced risk of developing allergic sensitisation in school age if they had a
combined history of both otitis media and lower respiratory tract infections
during infancy (adjusted odds ratio (aOR) 0.13, 95% CI 0.03 to 0.50) or a history
of otitis media (aOR 0.31, 95% CI 0.12 to 0.83). A history of lower respiratory
tract infections in infancy increased the risk of asthma in children of
non-atopic parents (aOR 4.21, 95% CI 1.68 to 10.57). CONCLUSION: In the present
study population, a history of otitis media in infancy seems to be negatively
associated with allergic sensitisation in school age children of atopic parents, 
whereas a history of lower respiratory tract infections was positively associated
with asthma in children of non-atopic parents.

PMID: 12818897 [PubMed - indexed for MEDLINE]

1648: J Laryngol Otol. 2003 Jun;117(6):454-8.

Computed tomography in suppurative ear disease: does it influence management?

Banerjee A, Flood LM, Yates P, Clifford K.

Department of Otorhinolaryngology, North Riding Infirmary, Middlesbrough, UK.

The value of high resolution computerized tomography (CT) prior to routine
mastoid surgery for cholesteatoma remains controversial. Doubts about sensitivity
and specificity, in detecting the extent of underlying pathology and in
predicting asymptomatic complications, prevent widespread adoption. This
retrospective study looks at the influence of pre-operative scanning on the
surgical management of chronic suppurative otitis media over an 18-month period. 
The radiological findings determined the choice of surgical approach, but
contributed less to the decision to operate and the prediction of potential
hazards. CT is of most value when the otologist can be flexible in surgical
technique, tailoring it to imaging findings.

PMID: 12818053 [PubMed - indexed for MEDLINE]

1649: J Laryngol Otol. 2003 Jun;117(6):449-53.

Increased antimicrobial resistance in organisms recovered from otitis media with 
effusion.

Brook I, Yocum P, Shah K, Feldman B, Epstein S.

Department of Paediatrics of Georgetown and George Washington University, School 
of Medicine, Washington DC, USA. ib6@georgetown.edu

Previous studies concerning the microbiology of otitis media with effusion (OME) 
did not correlate the past use of antimicrobial agents with the recovered
organism's antimicrobial susceptibility. A retrospective analysis of cultures
obtained from aspirates of 129 children with OME was performed. The study
identified the isolated organisms and determined their susceptibility to the most
recently administered antimicrobials. Bacterial growth was noted in 58 (45 per
cent) patients. Aerobic organisms only were recovered in 37 aspirates (63 per
cent of the culture-positive aspirates); anaerobic bacteria in seven (12 per
cent); and mixed aerobic and anaerobic bacteria in 14 (24 per cent). A total of
92 bacterial isolates were recovered, accounting for 1.6 isolates per specimen
(1.1 aerobes and 0.5 anaerobes). There were a total of 66 aerobic isolates,
including Haemophilus influenzae non type-b (20 isolates), Streptococcus
pneumoniae (17), and Staphylococcus spp. (seven). Twenty-six anaerobes were
recovered, including Peptostreptococcus spp. and Prevotella spp. (eight each) and
Propionibacterium acnes (four). Resistance to the antimicrobial used was found in
60 (65 per cent) isolates, recovered from 41 (71 per cent) of the patients. Of
the 41 patients in whom resistance was detected, 37 (90 per cent) had been
treated within three months of culture and four (10 per cent) had completed
treatment more than three months before the cultures were taken (p < 0.01). The
highest rate of recovery of resistant organisms was following
trimethoprim-sulfamethoxazole (96 per cent), amoxycillin (71 per cent), and
azithromycin (56 per cent). Of the patients treated with amoxycillin, H
influenzae predominated. S pneumoniae was recovered from four of the seven (57
per cent) after trimethoprim-sulfamethoxazole, four of 14 (29 per cent) following
amoxycillin, and three of 11 (27 per cent) after azithromycin. The data
illustrate the relationship between resistance to the antimicrobials given to
children and their recovery from the middle ear of patients with OME.

PMID: 12818052 [PubMed - indexed for MEDLINE]

1650: Ann Clin Lab Sci. 2003 Spring;33(2):232-6.

Evaluation of oxidative stress in erythrocytes of guinea pigs with experimental
otitis media and effusion.

Aktan B, Taysi S, Gumustekin K, Bakan N, Sutbeyaz Y.

Department of Otorhinolaryngology-Head and Neck Surgery, Atatürk University
Medical School, Erzurum, Turkey.

Oxygen free radicals (OFRs) have been implicated in the pathogenesis of an
increasing number of diseases and inflammatory states. They may cause cell and
tissue damage by their chemical modification of proteins, carbohydrates,
nucleotides, and lipids. Under physiological conditions OFRs are part of normal
regulatory circuits and are neutralized by antioxidants. Infections are one cause
of increased OFR production. The aims of our study were to assess whether the
increased oxidative stress in experimental otitis media with effusion (OME) is
reflected in erythrocytes by lipid peroxidation and to survey the alterations in 
oxidant and antioxidant enzyme activities in experimental OME in guinea pigs.
Erythrocyte total (enzymatic plus non-enzymatic) superoxide scavenger activity
(TSSA), non-enzymatic superoxide scavenger activity (NSSA), superoxide dismutase 
(SOD), catalase (CAT), and xanthine oxidase (XO) activities, and malondialdehyde 
(MDA) level were measured in 6 guinea pigs with OME and in 6 controls. The TSSA, 
SOD, XO activities, and MDA level in experimental OME were significantly higher
than in controls. No significant differences were found in erythrocyte NSSA and
CAT activities. In experimental OME induced by histamine injection, increased OFR
production was observed, suggesting that OFRs may play an important role in cell 
and tissue damage due to OME.

PMID: 12817629 [PubMed - indexed for MEDLINE]

1651: J Laryngol Otol. 2003 Apr;117(4):307-9.

Hearing loss due to mannosidosis and otitis media with effusion. A case report
and review of audiological assessments in children with otitis media with
effusion.

Ahmmed AU, O'Halloran SM, Roland NJ, Starkey M, Wraith JE.

Fulwood Audiology Centre, Preston, UK. ahmmed@man.ac.uk

A case of a child with mannosidosis and bilateral otitis media with effusion
(OME) is reported here along with some discussion of relevant literature to
emphasize the need for age appropriate audiometric assessment before and after
insertion of grommets for glue ear (OME). There is a need for multidisciplinary
teamwork in the management of children with hearing loss. If OME is treated
surgically, age-appropriate hearing assessment is required before and after
insertion of grommets. The need for audiological assessments will be relevant
even if children had passed the newborn hearing screening test.

Publication Types: 
    Case Reports

PMID: 12816222 [PubMed - indexed for MEDLINE]

1652: Neuroradiology. 2003 Jul;45(7):482-8. Epub 2003 Jun 17.

High incidence and spontaneous resolution of mastoid effusion after craniotomy on
early postoperative magnetic resonance images.

Watanabe T, Saito N, Sato N, Takahashi A, Fujimaki H, Tosaka M, Sasaki T.

Department of Neurosurgery, Gunma University School of Medicine, 3-39-22
Showa-machi, 371-8511, Maebashi, Gunma, Japan. nswata@med.gunma-u.ac.jp

Mastoid effusion is a poorly understood complication after craniotomy. The
incidence and severity of postoperative mastoid effusion were retrospectively
examined on postoperative magnetic resonance (MR) images to assess any
association with craniotomy procedures, time course, and neuro-otological
complications. We evaluated the early postoperative MR images (within 4 days of
craniotomy) and medical records of 74 patients who underwent 77 operations for
the treatment of various intracranial diseases from January 2000 to December
2001. Mastoid effusion was classified into four grades: none, partial, moderate, 
and severe diffuse effusion in the mastoid air cells. Thirty-three follow-up MR
images from 26 patients were also reviewed. Postoperative mastoid effusion
occurred ipsilateral to the craniotomy site in 62 cases and contralateral in 56
cases. Mastoid effusion was significantly more severe ipsilateral than
contralateral to craniotomy with exposure of the mastoid air cells ( P<0.0001).
There was no significant difference in severity between the contralateral and
ipsilateral sides after craniotomy without mastoid air cell opening ( P=0.437).
Mastoid effusion following craniotomy without exposure of mastoid air cells
resolved within 3 months. However, otitis media with effusion developed in six
patients with severe mastoid effusion ipsilateral to craniotomy with exposure of 
the mastoid air cells. Mastoid effusion frequently developed on both sides. Any
grade of mastoid effusion on the ipsilateral side to craniotomy without exposure 
of mastoid air cells, or on the contralateral side, was asymptomatic or had a
benign course, and disappeared within 3 months.

Publication Types: 
    Comparative Study

PMID: 12811440 [PubMed - indexed for MEDLINE]

1653: Pediatr Clin North Am. 2003 Apr;50(2):399-411.

Modern management of acute otitis media.

Weber SM, Grundfast KM.

Immunology Training Program and Section of Infectious Diseases, Boston University
School of Medicine, 80 East Concord Street, Box #171, Boston, MA 02118, USA.

Although recent clinical trials suggest that conjugate vaccination will be less
effective for the prevention of AOM than for IPD, these trials have demonstrated 
impressive reductions in the incidence of AOM due to invasive and
antibiotic-resistant pneumococcal serotypes. These data suggest that if serotype 
replacement does occur in immunized children, the causative agents are likely to 
be less virulent than vaccine strains. Furthermore, a recent cost-effectiveness
analysis projected that immunization of healthy infants with the heptavalent
conjugate vaccine could prevent over one million episodes of AOM and 12,000 cases
of invasive pneumococcal disease. Because significant reductions have been
demonstrated in the incidence of frequently recurrent AOM, children with the
worst disease stand to benefit most from vaccination. Based on data currently
available, however, the conjugate vaccine is not going to eradicate AOM.
Consequently, there will continue to be a need to scrutinize the threshold for
prescribing antibiotics. In addition, there will be an ongoing need for surgery
in some cases of recurrent AOM and persistent OME.

Publication Types: 
    Review

PMID: 12809330 [PubMed - indexed for MEDLINE]

1654: Otol Neurotol. 2003 May;24(3):447-52.

Topical ofloxacin for chronic suppurative otitis media and acute exacerbation of 
chronic otitis media: optimum duration of treatment.

Suzuki K, Nishimura T, Baba S, Yanagita N, Ishigami H.

Department of Otolaryngology, Second Affiliated Hospital, Fujita Health
University, Nagoya, Japan. ken-suzu@fujita-hu-ac.jp

OBJECTIVE: To assess the optimum duration of topical ofloxacin therapy for
chronic otitis media and to compare the response between patients with chronic
suppurative otitis media (CSOM) and acute exacerbation of chronic otitis media
(AE). STUDY DESIGN: Prospective observational study. SETTING: Five university
hospitals and 30 affiliated institutions. PATIENTS: A total of 294 patients who
presented to the participating institutions with CSOM were enrolled. Among them, 
268 patients were evaluable for safety and 237 were evaluable for efficacy (64
with CSOM and 173 with AE .INTERVENTION: Ofloxacin otic solution was administered
for as long as 4 weeks. MAIN OUTCOME MEASURES: Clinical and bacteriologic
assessment was done weekly during the treatment period. The clinical response was
assessed on the basis of the symptom scores. RESULTS: There were no differences
between CSOM and AE patients with respect to sex, age, and severity. The most
common bacterial isolate from middle ear discharge was Staphylococcus aureus. The
clinical response rates in patients with CSOM and AE were 39.1% and 61.3% after 2
weeks of treatment and 57.8% and 75.1% after 4 weeks, respectively, and the
bacterial eradication rate was 91.0% at 2 weeks and 94.6% at 4 weeks. Detection
of new fungal infection did not increase as the duration of therapy was
prolonged. No serious adverse events were reported. CONCLUSIONS: The duration of 
treatment was shorter and the clinical response was higher in AE patients than in
CSOM patients. The standard topical ofloxacin regimen for chronic otitis media
should consist of a 2-week course from the aspect of bacteriologic efficacy,
although patients showing insufficient symptomatic improvement after 2 weeks may 
benefit from another 1 or 2 weeks of therapy. Administration of this drug for as 
long as 4 weeks can increase the clinical efficacy without causing safety
problems.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12806297 [PubMed - indexed for MEDLINE]

1655: Otol Neurotol. 2003 May;24(3):358-64.

Pars flaccida displacement pattern in purulent otitis media in the gerbil.

Larsson C, Dirckx JJ, Decraemer WF, Bagger-Sjöbäck D, von Unge M.

Department of Otorhinolaryngology, Karolinska Hospital and Karolinska Institute, 
Stockholm, Sweden. larson_christina@hotmail.com

HYPOTHESIS: Our hypothesis is that purulent otitis media and otitis media with
effusion cause stiffness loss of the tympanic membrane. This loss of stiffness
may be persistent and precede the development of retraction pockets and
cholesteatoma. BACKGROUND: Postinflammatory changes such as retraction pockets
and cholesteatoma develop in the pars flaccida and in the pars tensa of the
tympanic membrane. In our previous experimental studies, stiffness changes were
shown to develop early in the pars tensa in response to purulent otitis media and
otitis media with effusion. These changes are suggested to be precursors to a
later development of retraction pockets and cholesteatoma. In the clinical
situation, retraction pockets are often found in the pars flaccida only. The aim 
of the current study was thus to investigate whether stiffness changes appear
also in the pars flaccida during purulent otitis media. METHODS: Streptococcus
pneumoniae type 3 was injected into the middle ear to induce purulent otitis
media. As a measure of pars flaccida stiffness, peak displacement versus middle
ear pressure was used. The peak displacement measurements were obtained from
full-field moiré; interferometry, which is a noncontacting optical technique for 
deformation measurements. RESULTS: Ears with purulent otitis media showed
increased peak displacement of the pars flaccida at a middle ear pressure of 200 
daPa, compared with normal controls. CONCLUSION: There was a decreased mechanical
stiffness of the pars flaccida in acute purulent otitis media. This decreased
stiffness may predispose for future retraction pocket formation and cholesteatoma
development.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12806284 [PubMed - indexed for MEDLINE]

1656: Cochrane Database Syst Rev. 2003;(2):CD004163.

Update in:
    Cochrane Database Syst Rev. 2007;(1):CD004163.

Screening children in the first four years of life to undergo early treatment for
otitis media with effusion.

Butler CC, van der Linden MK, MacMillan H, van der Wouden JC.

Department of General Practice, University of Wales College of Medicine,
Llanedeyrn Health Centre, Llanedeyrn, Cardiff, UK, CF23 9PN. butlercc@cf.ac.uk

BACKGROUND: Otitis media with effusion (OME) is the most common cause of acquired
hearing loss in childhood and has been associated with delayed language
development and behavioural problems. This condition has a prevalence of about
20% at the age of two years, a time of rapid language development. It is most
often asymptomatic. Effective treatment exists for clearing effusions. Some have 
argued, therefore, that children should be screened and treated early if found to
have clinically important OME. However, there is a high rate of spontaneous
resolution of effusions and for some children, effusions may represent a
physiological response that does not reduce hearing significantly or impact
negatively on language development or behaviour. Previous reviews of the effect
of screening and treatment have included studies using non-randomised designs.
OBJECTIVES: The aim of this review was to assess evidence from randomised
controlled trials about the effectiveness, on language and behavioural outcomes, 
of screening and treating children with clinically important OME in the first
four years of their life. The focus was on the first four years of life because
this is the time of most rapid language development. The consequences of hearing 
loss are likely to be most serious during this time. In addition, children of
this age are least likely to be able to report or seek help for impaired hearing,
particularly if these problems have a slow onset and are subtle. SEARCH STRATEGY:
We searched the Cochrane Controlled Trials Register (the Cochrane Library Issue
1, 2002), MEDLINE (1966-2002) and EMBASE (1974-2002) (all in February 2002) and
reference lists of all studies. We also contacted the first authors of the
studies we included in this review. SELECTION CRITERIA: 1. Randomised controlled 
trials evaluating interventions for OME among children with OME identified
through screening. 2. Comparison of outcomes for children randomised to be
screened for OME and outcomes for children who were not randomised to be screened
for OME. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data
and assessed trial quality. MAIN RESULTS: We identified no trials comparing
outcomes for children randomised to be screened for OME with outcomes for
children who were not randomised to be screened for OME. We identified three
trials evaluating interventions for OME among children with OME identified
through screening. From these trials, we found no evidence of clinically
important benefit in language development from screening and treating children
with clinically important OME. Although there was a beneficial effect on the
resolution of OME and improved hearing in the short-term (six months), this
effect largely disappeared in the long-term (12 months). REVIEWER'S CONCLUSIONS: 
The identified randomised trials do not show an important benefit from screening 
of the general population of asymptomatic children in the first four years of
life for OME on language development and behaviour.

Publication Types: 
    Review

PMID: 12804500 [PubMed - indexed for MEDLINE]

1657: J Laryngol Otol. 2003 May;117(5):353-7.

Labyrinthine fistula: a complication of chronic suppurative otitis media.

Grewal DS, Hathiram BT, Dwivedi A, Kumar L, Sheth K, Srivastava S.

Department of Otolaryngology, T. N. Medical College and B.Y.L. Nair Hospital,
Mumbai, India.

A labyrinthine fistula is a frequent complication of long-standing unsafe chronic
suppurative otitis media. It is characterized by a slowly progressive erosion of 
the bony labyrinth. In this paper we present our observations regarding the
diagnosis and management in 50 patients with unsafe chronic suppurative otitis
media with labyrinthine fistula.

PMID: 12803784 [PubMed - indexed for MEDLINE]

1658: Ear Hear. 2003 Jun;24(3):191-4.

Comparison of tone burst and tapping evocation of myogenic potentials in patients
with chronic otitis media.

Yang TL, Young YH.

Department of Otolaryngology, National Taiwan University Hospital and National
Taiwan University College of Medicine, Taipei, Taiwan.

OBJECTIVE: Vestibular evoked myogenic potential (VEMP) has recently been broadly 
studied in cochleo-vestibular disorders to elucidate its mechanism. Because it is
evoked by loud sound stimulation, impairment of the sound transmission through
the middle ear may affect VEMP results. This study aims to compare the response
rate of VEMPs using the tone burst method and the tapping method in patients with
chronic otitis media (COM). DESIGN: Fourteen patients (22 ears) with conductive
hearing loss due to COM were subjected to VEMP tests using both the tone burst
method and the tapping method. Each ear was stimulated by a short-tone burst (95 
dB nHL, 500 Hz), followed by tapping on the forehead with a tendon hammer, 200
times at a frequency of 5 Hz. RESULTS: Thirteen (59%) of the 22 ears showed
positive VEMPs using the tone burst method, whereas 20 ears (91%) displayed
positive VEMPs by the tapping method (p < 0.05). The latencies of wave p13 and
n23, and the amplitude p13-n23 using the tone burst method were 13.4 +/- 4.1
msec, 20.5 +/- 4.6 msec, and 77.2 +/- 17.2 microV, respectively. These results do
not significantly differ from those obtained using the tapping method. In ears
with perforated eardrums (N = 11), five ears (45%) displayed positive VEMPs by
the tone burst method; compared with nine ears (82%) with positive VEMPs using
the tapping method, representing a nonsignificant difference. In ears with healed
eardrums (N = 11), eight ears exhibited positive VEMPs by tone burst, with a mean
air-bone gap of 25.6 +/- 15.2 dB at 500 Hz, in contrast to a gap of 30.0 +/- 22.9
dB in three ears without VEMPs, indicating no significant difference.
CONCLUSIONS: When stimulating sound is attenuated by middle ear pathology, VEMPs 
are expected to be poorly elicited. Under such conditions, myogenic potentials
may be evoked with the tapping method to elicit the absent VEMPs that result from
middle ear or inner ear pathology.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12799539 [PubMed - indexed for MEDLINE]

1659: Pediatr Infect Dis J. 2003 Jun;22(6):515-24.

Review of randomized controlled trials on pneumococcal vaccination for prevention
of otitis media.

Straetemans M, Sanders EA, Veenhoven RH, Schilder AG, Damoiseaux RA, Zielhuis GA.

Department of Epidemiology and Biostatistics, University Medical Center Nijmegen,
Nijmegen, the Netherlands.

BACKGROUND: Increasing resistance to antibiotics of the pathogens causing acute
otitis media (AOM) emphasize the need for effective methods to prevent episodes
of otitis media in young children. OBJECTIVE: To assess the effectiveness of
pneumococcal vaccination for prevention of AOM in children age 12 years and
younger. METHODS: Systematic review of 11 randomized controlled trials including 
46 074 children in whom pneumococcal vaccination against AOM was compared with a 
control treatment. Vaccine effect was estimated as a rate ratio (RR): AOM
episodes per child month in pneumococcal vaccination group divided by the AOM
episodes per child-month in control group. RESULTS: A moderate effect of
pneumococcal polysaccharide vaccination was found in children 24 months of age
and older [RR 0.78; 95% confidence interval (CI) 0.63 to 0.97]. Pneumococcal
polysaccharide vaccine had little effect on prevention of AOM in children without
previous documented episodes before vaccination (RR 0.92; 95% CI 0.85 to 0.99).
Better efficacy was seen in those children with documented prior AOM before
vaccination (RR 0.81; 95% CI 0.72 to 0.91). Pooled results of pneumococcal
conjugate vaccine trials in infants vaccinated as early as 2 months of age and in
toddlers attending day care showed only a small effect on prevention of AOM (RR
0.92; 95% CI 0.85 to 0.99). CONCLUSION: Based on these results, a large scale
pneumococcal vaccination program for a primary indication of preventing AOM in
infancy is not indicated. The results of ongoing trials should provide more
information whether the conjugate vaccine is effective in high risk
(otitis-prone) children after 1 year of age.

Publication Types: 
    Comparative Study
    Review

PMID: 12799508 [PubMed - indexed for MEDLINE]

1660: Pediatr Infect Dis J. 2003 Jun;22(6):509-15.

Can acute otitis media caused by Haemophilus influenzae be distinguished from
that caused by Streptococcus pneumoniae?

Leibovitz E, Satran R, Piglansky L, Raiz S, Press J, Leiberman A, Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center and Faculty
of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

BACKGROUND: Previous limited data suggest that acute otitis media (AOM) caused by
Streptococcus pneumoniae can present as a more severe disease than that caused by
Haemophilus influenzae or Moraxella catarrhalis, as expressed by both tympanic
membrane and systemic findings. OBJECTIVES: To evaluate the severity of disease
and impact of various pathogens, age, disease history and previous antibiotic
therapy in children with AOM by using a comprehensive clinical/otologic score.
PATIENTS AND METHODS: The study group consisted of 372 children ages 3 to 36
months with AOM seen at the pediatric emergency room during 1996 through 2001.
All patients had tympanocentesis and middle ear fluid culture performed at
enrollment. Clinical status was determined by a clinical/otologic score
evaluating severity (0 = absent to 3 = severe) of tympanic membrane findings
(redness and bulging) and patient's fever, irritability and ear tugging. Maximal 
severity score was 15. RESULTS: There were 138 (37%) H. influenzae, 76 (21%) S.
pneumoniae, 64 (17%) mixed infections (H. influenzae + S. pneumoniae) and 94
(25%) culture-negative cases. The overall clinical/otologic score was higher in
culture-positive than in culture-negative patients (9.27 +/- 2.75 vs.8.38 +/-
3.08, P = 0.01). When analyzed by age groups, this difference was significant
only for the youngest age group (3 to 6 months, P = 0.05). The severity scores
for AOM caused by H. influenzae and S. pneumoniae were significantly higher than 
in the culture-negative AOM when tympanic membrane redness and bulging were
analyzed separately. No differences were recorded in clinical/otologic scores
between different pathogens (9.49 +/- 2.86, 9.03 +/- 2.72 and 9.09 +/- 2.54 for
H. influenzae, S. pneumoniae and H. influenzae + S. pneumoniae, respectively).
The mean clinical/otologic score was higher in culture-positive than in
culture-negative patients without relationship to previous antibiotic treatment
or number of previous AOM episodes. CONCLUSIONS: (1) The clinical/otologic score 
of culture-positive young infants was higher than that of culture-negative
infants; (2) the severity of tympanic membrane redness and bulging were the most 
indicative factors discriminating between a bacterial and nonbacterial etiology
of AOM; and (3) the use of a clinical/otologic score could not discriminate among
various bacterial etiologies of AOM.

Publication Types: 
    Comparative Study

PMID: 12799507 [PubMed - indexed for MEDLINE]

1661: Infect Genet Evol. 2003 May;3(1):57-66.

High rates of recombination in otitis media isolates of non-typeable Haemophilus 
influenzae.

Cody AJ, Field D, Feil EJ, Stringer S, Deadman ME, Tsolaki AG, Gratz B, Bouchet
V, Goldstein R, Hood DW, Moxon ER.

Molecular Infectious Diseases Group, Department of Paediatrics, Weatherall
Institute of Molecular Medicine, University of Oxford, Oxford OX3 9DS, UK.
acody@molbiol.ox.ac.uk

Non-typeable (NT) or capsule-deficient, Haemophilus influenzae (Hi) is a common
commensal of the upper respiratory tract of humans and can be pathogenic
resulting in diseases such as otitis media, sinusitis and pneumonia. The
lipopolysaccharide (LPS) of NTHi is a major virulence factor that displays
substantial intra-strain and inter-strain variation of its oligosaccharide
structures. To investigate the genetic basis of LPS variation we sequenced
internal regions of each of seven genes required for the biosynthesis of either
the inner or the outer core oligosaccharide structures. These sequences were
obtained from 25 representative NTHi isolates from episodes of otitis media. We
found abundant evidence of recombination among LPS genes of NTHi, a finding in
marked contrast to previous analyses of biosynthetic genes for capsular
polysaccharide, a well-documented virulence factor of Hi. We found mosaic
sequences, linkage equilibrium between loci and a lack of congruence between gene
trees. These high rates were not confined to LPS genes since evidence for similar
amounts of recombination was also found in eight housekeeping genes in a subset
of the same 25 isolates. These findings provide a population based foundation for
a better understanding of the role of NTHi LPS as a virulence factor and its
potential as a candidate vaccine.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 12797973 [PubMed - indexed for MEDLINE]

1662: J Indian Med Assoc. 2002 Nov;100(11):669-70.

Gradenigo's syndrome--a rare complication of otitis media.

Jagadeesan P, Madeswaran K, Thiruppathy SP, Kalairajan D, Inbasekaran V.

Department of Neurosurgery, Government Rajaji Hospital & Madurai Medical College,
Madurai 625 020.

Petrous apicitis is a rare intracranial complication of otitis media. A
4-year-old female child was presented with persistent ear discharge,
retro-orbital pain and lateral rectus palsy (triad of Gradenigo's syndrome). A
right temporal burr-hole was placed and tapping was done under antibiotic
coverage. Turbid cerebrospinal fluid could be drained. Follow-up could not be
done as the patient refused treatment and was discharged against medical advice.

Publication Types: 
    Case Reports

PMID: 12797641 [PubMed - indexed for MEDLINE]

1663: Pediatr Infect Dis J. 2003 May;22(5):453-6.

Tuberculous otitis media with mastoiditis and central nervous system involvement.

Mongkolrattanothai K, Oram R, Redleaf M, Bova J, Englund JA.

Department of Pediatrics, University of Chicago Children's Hospital, Chicago, IL,
USA.

Tuberculosis of the middle ear and mastoid is currently a rare disease in
developed countries, but this disease still occurs and may cause serious
consequences. We report a case of disseminated tuberculosis involving the middle 
ear, mastoid, lung and central nervous system. Tuberculosis should be considered 
in the differential diagnosis of chronic ear drainage, especially in young
children.

Publication Types: 
    Case Reports

PMID: 12792390 [PubMed - indexed for MEDLINE]

1664: Pediatr Infect Dis J. 2003 May;22(5):405-13.

Comment in:
    Pediatr Infect Dis J. 2003 Oct;22(10):936-7; author reply 937.

Bacteriologic and clinical efficacy of high dose amoxicillin for therapy of acute
otitis media in children.

Piglansky L, Leibovitz E, Raiz S, Greenberg D, Press J, Leiberman A, Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center and Faculty
of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

BACKGROUND: High dose (70 to 90 mg/kg/day) amoxicillin is recommended as first
line therapy of acute otitis media (AOM) in geographic areas where drug-resistant
Streptococcus pneumoniae is prevalent. Information on the bacteriologic efficacy 
of high dose amoxicillin treatment for AOM is limited. OBJECTIVES: To evaluate
the bacteriologic and clinical efficacy of high dose amoxicillin as first line
therapy in AOM. METHODS: In a prospective study 50 culture-positive patients ages
3 to 22 months (median, 9 months; 77% <1 year) were treated with high dose
amoxicillin (80 mg/kg/day three times a day for 10 days) No antibiotics were
administered 72 h before enrollment. Twenty-four (48%) patients presented with
their first episode of AOM. Middle ear fluid was cultured by tympanocentesis at
enrollment and on Days 4 to 6 of therapy. Additional middle ear fluid cultures
were obtained if clinical relapse occurred. Bacteriologic failure was defined by 
positive cultures on Days 4 to 6 and clinical failure by no change or worsening
of AOM signs and symptoms and requirement for additional antibiotics during
therapy and/or at end of therapy. Patients were followed until Day 28 +/- 2.
Susceptibility to penicillin and amoxicillin was measured by E-test. RESULTS:
Sixty-five organisms were recovered at enrollment: Haemophilus influenzae (38),
Streptococcus pneumoniae (24), Streptococcus pyogenes (2) and Moraxella
catarrhalis (1). Eighteen (75%) S. pneumoniae were nonsusceptible to penicillin
(MIC > 0.1 microg/ml). All 24 S. pneumoniae isolates had amoxicillin MIC < or =
2.0 microg/ml. Thirteen (34%) of the 38 H. influenzae were beta-lactamase
producers. Eradication was achieved in 41 (82%) patients for 54 of 65 (83%)
pathogens: 22 of 24 (92%) S. pneumoniae, 21 of 25 (84%) beta-lactamase-negative
H. influenzae, 8 of 13 (62%) beta-lactamase-positive H. influenzae, 2 of 2 S.
pyogenes and 1 of 1 M. catarrhalis. Seven organisms not initially present were
isolated on Days 4 to 6 in 5 patients: 3 beta-lactamase-positive H. influenzae; 1
beta-lactamase-negative H. influenzae; 2 S. pneumoniae; and 1 M. catarrhalis. In 
total 14 of 50 (28%) patients failed bacteriologically on Days 4 to 6
(persistence + new infection), of whom 9 (64%) had beta-lactamase-positive H.
influenzae. Three (33%) of the 9 patients with bacteriologic failure (2
beta-lactamase-positive H. influenzae, 1 S. pneumoniae) failed also clinically on
Days 4 to 6. CONCLUSIONS: The predominant pathogens isolated from children with
AOM failing high dose amoxicillin therapy were beta-lactamase-producing
organisms. Because its overall clinical efficacy is good, high dose amoxicillin
is still an appropriate choice as first line empiric therapy for AOM, followed by
a beta-lactamase-stable drug in the event of failure.

Publication Types: 
    Comparative Study

PMID: 12792379 [PubMed - indexed for MEDLINE]

1665: Int J Pediatr Otorhinolaryngol. 2003 Jul;67(7):801-6.

Role of respiratory viruses in children with acute otitis media.

Monobe H, Ishibashi T, Nomura Y, Shinogami M, Yano J.

Department of Otolaryngology, Japanese Red Cross Medical Center, Tokyo, Japan

OBJECTIVE: The role of viral infection in acute otitis media (AOM) has not been
fully elucidated. We determined the presence of various respiratory viruses in
middle ear fluid (MEF) specimens from children with AOM in order to determine
whether viral infection or combined effects of viral and bacterial infection
enhance or prolong the inflammation in the middle ear, thus worsening clinical
outcome. METHODS: Multiplex nested reverse transcription-polymerase chain
reactions was carried out to detect influenza A and B viruses, respiratory
syncytial virus (RSV) types A and B, parainfluenza virus types 1, 2, and 3;
rhinovirus; and adenovirus in 93 MEF specimens from 79 children with AOM. And we 
examined whether viral infection with or without an identifiable bacterial
infection affect clinical outcomes in AOM. We considered persistent MEF (fluid
accumulation in the middle ear persisting up to 1 month after treatment), early
recurrence of AOM (within 1 month after initial improvement), and recurrent AOM
(more than three recurrences during 6 months of follow up) as indicators for
evaluating clinical outcomes. RESULTS: One or more respiratory viruses were
detected in 39 specimens (42%); a total of 42 viral infections identified (three 
specimens were infected by two viruses). Of the 42 infections, RSV type A was
detected in 29, adenovirus in eight, rhinovirus in three, and influenza virus in 
two. RSV accounted for 73% of viral detections. In children younger than 2 years,
RSV infection combined with Streptococcus pneumoniae or Hemophilus influenzae
infection carried a higher risk for persistent middle ear effusion than infection
with RSV infection alone or those bacterial infection alone. CONCLUSIONS:
Accordingly, vaccination of young children against RSV as well as S. pneumoniae
and H. influenzae is important in improving the prognosis in AOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12791457 [PubMed - indexed for MEDLINE]

1666: Int J Pediatr Otorhinolaryngol. 2003 Jul;67(7):785-93.

Incidence and outcome of middle ear disease in cleft lip and/or cleft palate.

Sheahan P, Miller I, Sheahan JN, Earley MJ, Blayney AW.

Department of Otolaryngology, The Children's Hospital, Temple Street, 1, Dublin, 
Ireland. sheahanp@eircom.net

OBJECTIVE: Otitis media with effusion is known to be very common among children
with cleft palate, however, less is known regarding the natural history and
outcome in this group. The purpose of the present study was to examine the
incidence, natural history, treatment, and outcome of middle ear disease in
children with clefts. METHODS: A questionnaire was sent to the parents of all
children registered on the cleft lip and palate database at our institution. The 
medical records of all respondents were also reviewed. Statistical analysis of
the results was performed using Fisher's exact test in contingency tables and
binary logistic regression analyses, where appropriate. RESULTS: 397 fully
completed questionnaires were returned. Ear disease was much more common in
children with cleft palate, or cleft lip and palate, than in children with cleft 
lip. Among children with cleft palate, ear problems (infections and/or hearing
loss) were most prevalent in the 4-6-year-old age group. However, ear problems
persisted at a substantial level for many years after this; only after the age of
12 years did problems appear to settle. The incidence of below normal current
hearing and of surgery for chronic otitis media was significantly related to
history of ear infections (P=0.000 and 0.000, respectively), and to increased
number of ventilation tube insertions (P=0.000 and 0.000, respectively).
CONCLUSIONS: Middle ear disease is common in children with cleft palate, and,
unlike the case for children without clefts, has a prolonged recovery, and a
substantial incidence of late sequelae. The higher incidence of below normal
hearing and surgery for chronic otitis media in children undergoing a greater
number of ventilation tube insertions, although most likely reflecting an
increased underlying severity of otitis media in these children, also underlines 
the lack of long-term benefits of ventilation tubes in this group.

PMID: 12791455 [PubMed - indexed for MEDLINE]

1667: Int J Pediatr Otorhinolaryngol. 2003 Jul;67(7):757-60.

Clinical significance of incidental magnetic resonance image abnormalities in
mastoid cavity and middle ear in children.

Blomgren K, Robinson S, Lönnqvist T, Saxèn H, Pitkäranta A.

Helsinki University Hospital, Department of Otorhinolaryngology, P.O. Box 220,
FIN-00029 HUS, Helsinki, Finland. karin.blomgren@fimnet.fi

OBJECTIVE: Magnetic resonance imaging of the head may reveal incidental findings 
in paranasal sinuses. The purpose of this study was to discover whether similar
changes could be identified in the mastoid cavity and middle ear as well.
METHODS: A group of 50 children undergoing magnetic resonance imaging of the head
for suspected intracranial pathology were prospectively gathered. Their parents
completed a questionnaire concerning each child's medical history connected with 
acute otitis media. Otoradiologists evaluated the pictures for mastoid cavity and
middle ear and paranasal sinus abnormalities. RESULTS: In six (12%) children,
magnetic resonance imaging detected abnormalities resembling acute inflammatory
changes, although none had had acute otitis media during the preceding last 3
months. Abnormalities detected in the paranasal sinuses were not correlated with 
abnormalities in the mastoid cavity and middle ear. CONCLUSIONS: High signal
intensity in magnetic resonance images from the mastoid cavity and middle ear may
be incidental and without any clinical significance. These findings must be
interpreted together with knowledge of the child's medical condition and clinical
examination of the ears.

PMID: 12791451 [PubMed - indexed for MEDLINE]

1668: Int J Pediatr Otorhinolaryngol. 2003 Jul;67(7):749-55.

Development and characterization of a pooled Haemophilus influenzae genomic
library for the evaluation of gene expression changes associated with mucosal
biofilm formation in otitis media.

Erdos G, Sayeed S, Antalis P, Hu FZ, Hayes J, Goodwin J, Dopico R, Post JC,
Ehrlich GD.

Center for Genomic Sciences, Allegheny-Singer Research Institute, Allegheny
General Hospital, 320 E. North Ave., Pittsburgh, PA 15212, USA. gerdos@wpahs.org

Haemophilus influenzae is one of the most important respiratory pathogens of man.
It has been etiologically associated with otitis media, otorrhea, and chronic
obstructive pulmonary disease. Identification of new genomic elements will
provide novel targets to fight chronic infections caused by this organism.
OBJECTIVE: The new paradigm that chronic infections are caused by bacterial
biofilms prompted us to study the relationship between bacterial pathogenicity,
biofilm formation and bacterial communal cooperation. To do this, it is essential
to determine the virulence gene sets that are involved in the above processes and
whether they are present in every bacterial cell or distributed in a "communal
gene-pool", the distributed genome hypothesis (DGH). We designed, constructed and
characterized a highly redundant genomic DNA library comprised of the genomes of 
ten low passage clinical isolates of H. influenzae carrying large numbers of
genes that are not present in the laboratory strains of H. influenzae. METHODS:
Genomic DNA fragments of the ten clinical strains were hydro-dynamically sheared 
to produce a mean fragment size of 1.5-2.5 kb. The ten sheared DNAs were than
pooled and used in the construction of a genomic library with 76800 clones.
RESULTS: Our restriction endonuclease and sequence analyses of 800 clones
demonstrate that 75% of the clones carry an insert larger than 0.5 kb. The
library has an approximately 1.5 kb average insert size, and therefore, better
than 4.5x redundancy for each of the genomes of the ten clinical isolates. Our
sequencing effort ( approximately 1 million nucleotides to date) reveals that a
high percentage of genes (75 clones, 11% of the 686 sequenced clones) present in 
this library are not represented in the genome of the reference strain H.
influenzae Rd. CONCLUSIONS: The library, based on the above results, has a better
than 4.5x coverage for each of the ten constituent genomes. On the basis of our
preliminary sequencing data ( approximately 1 million nucleotides) the library
lacks of highly repeated sequences, therefore, the expected genome coverage
(4.5x) is not degraded. Using the prevalence of non-Rd like sequences (11%)
detected during characterization of the genomic library, we estimated that the
library contains DNA sequences equivalent to approximately 2 million bp, which
are not represented in the reference genome of the H. influenzae Rd strain and
that is greater in size than the genome of this reference strain, providing ample
targets for innovative drug design.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12791450 [PubMed - indexed for MEDLINE]

1669: Curr Allergy Asthma Rep. 2003 Jul;3(4):335-40.

Viral otitis media.

Buchman CA, Brinson GM.

Department of Otolaryngology/Head and Neck Surgery, University of North Carolina 
School of Medicine, G0412 Neurosciences Hospital, Chapel Hill, NC 27599-7070,
USA. brinson@med.unc.edu

Acute otitis media (AOM) and viral upper respiratory tract infections (URIs)
represent the two most common diseases affecting the human population, and
account for substantial patient morbidity and health care costs. Epidemiologic
and experimental studies suggest that URIs play a causal role in the pathogenesis
of AOM. Specifically, viruses can either invade the middle ear (ME) space and
invoke an inflammatory response that culminates in ME effusion formation and
consequent symptoms, or URIs might cause eustachian-tube dysfunction, resulting
in negative ME pressures and subsequent ME effusion (hydrops ex vacuo theory).
The events responsible for the inflammatory response of the human ME following
viral exposure have not been well characterized. Although many prophylactic and
therapeutic interventions have been evaluated for the treatment of AOM, the
information on virus-specific interventions is sparse. In this article, the
epidemiology, pathogenesis, diagnosis, and management of viral otitis media are
reviewed.

Publication Types: 
    Review

PMID: 12791211 [PubMed - indexed for MEDLINE]

1670: Curr Allergy Asthma Rep. 2003 Jul;3(4):326-34.

Prevention of otitis media caused by viral upper respiratory tract infection:
vaccines, antivirals, and other approaches.

Doyle WJ, Alper CM.

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 3705
Fifth Avenue at DeSoto Street, Pittsburgh, PA 15213, USA. william.doyle@chp.edu

Otitis media (OM) imposes significant morbidity on the pediatric age group and a 
large financial burden on the general population. Because standard medical
treatments are not highly efficacious in resolving the accompanying middle ear
(ME) inflammation, a goal of current research is OM prevention. Past studies show
that new episodes of OM are usually a complication of viral upper respiratory
infection (vURI), and therefore, a rational approach to achieving that goal is to
develop intervention strategies that target vURI-associated OM. However, past
experiences with antibiotics show that, in the absence of well-defined treatment 
protocols that maximize expected efficacy, the adoption of prophylactic or active
treatments for OM can have negative consequences for the patient and for the
general population. In this review, we discuss the hypothesized mechanisms by
which a vURI is translated into an acute OM episode and describe different
strategies for aborting that process. Limitations to deployment of each strategy 
are outlined.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 12791210 [PubMed - indexed for MEDLINE]

1671: Curr Allergy Asthma Rep. 2003 Jul;3(4):321-5.

Risk factors for the development of otitis media.

Dhooge IJ.

Department of Otorhinolaryngology, Ghent University Hospital, De Pintelaan 185,
B-9000 Ghent, Belgium. ingeborg.dhooge@rug.ac.be

Otitis media (OM) is the most frequently diagnosed disease in infants and young
children. Large, prospective studies suggest an increase in incidence of this
disease during the past 10 to 20 years, possibly reflecting a change in host and 
environmental risk factors for the development of OM. Good knowledge of host
(intrinsic) and environmental (extrinsic) risk factors for the development of
otitis media is important in identifying a child at risk for recurrent and
persistent OM. This could result in primary and/or secondary prevention of OM and
a decrease in complications and sequelae.

Publication Types: 
    Review

PMID: 12791209 [PubMed - indexed for MEDLINE]

1672: Curr Allergy Asthma Rep. 2003 Jul;3(4):313-20.

Clinical considerations in the diagnosis of otitis media.

Klaudt MR, Steinbach WJ, Sectish TC.

Division of General Pediatrics, Department of Pediatrics, Stanford University
School of Medicine, 750 Welch Road, Palo Alto, CA 94304, USA.
mklaudt@stanford.edu

Acute otitis media and otitis media with effusion are commonly encountered by
both general practitioners and specialists. The diagnosis of otitis media
requires a focused history and accurate physical examination. Unfortunately, many
practitioners are either unaware of the criteria needed to make the diagnosis, or
they incorrectly perform or misinterpret the physical examination. We review the 
pertinent historical and physical examination findings needed to accurately
diagnose otitis media. Additionally, we examine the accessory tests that might
help make the correct diagnosis in difficult cases. Finally, we address the
issues involved in ensuring that both current and future physicians are
appropriately trained in the diagnosis of this common illness.

Publication Types: 
    Review

PMID: 12791208 [PubMed - indexed for MEDLINE]

1673: J Zoo Wildl Med. 2001 Sep;32(3):393-5.

Chronic otitis externa/media with total ear canal ablation and bulla curettage in
a North American bison (Bison bison).

Ferrell ST, Valverde C, Phillips LG Jr.

Companion Avian & Exotic Pet Medicine Service, Veterinary Medical Teaching
Hospital, University of California, One Shields Avenue, Davis, California 95616, 
USA.

An adult female North American bison (Bison bison) with a chronic otitis
externa/media of the right ear was examined because of a 4-mo history of
intermittent anorexia, apparent painful behavior, and auricular discharge from
the right ear. Computerized tomography (CT) demonstrated osteolysis of the
tympanic, petrous, and squamous aspects of the temporal bone with soft tissue
replacement and sclerosis of the right bulla. A total ear canal ablation with
bulla curettage was performed, and cefazolin-impregnated polymethacrylate beads
were left within the right bulla and the remnant temporal bone. Six months after 
the surgery, the bison had no clinical signs of otitis media.

Publication Types: 
    Case Reports

PMID: 12785693 [PubMed - indexed for MEDLINE]

1674: Ann Otol Rhinol Laryngol. 2003 May;112(5):450-4.

Characteristics of the type B tympanogram can predict the magnitude of the
air-bone gap in otitis media with effusion.

Sichel JY, Priner Y, Weiss S, Levi H, Barshtein G, Eliashar R, Elidan J.

Department of Otolaryngology-Head and Neck Surgery, Hadassah University Hospital,
Jerusalem, Israel.

Tympanometry is well established as a means of assessing the presence of fluid in
the middle ear. The type B tympanogram is usually considered a unique entity.
However, its shape may vary from a rounded type B with a "pseudopeak" to a
completely flat response. The aim of this study was to compare the
characteristics of the B curve (maximum admittance, tympanometric peak pressure, 
and area under the curve) to the viscosity of the middle ear fluid and to the
air-bone gap (ABG). In 67 children (93 ears) who underwent ventilation tube
insertion, no correlation was found between the viscosity of the middle ear fluid
and the characteristics of the B curve. However, these characteristics were able 
to differentiate between a low ABG (0 to 20 dB) and a high ABG (>20 dB). A
statistical difference was also found for the three parameters (maximum
admittance, p < .0025; pressure, p < .025; and area under the curve, p < .0005). 
Tympanometry may be used as an objective measure to estimate the extent of
conductive hearing loss, especially in young children.

Publication Types: 
    Comparative Study

PMID: 12784986 [PubMed - indexed for MEDLINE]

1675: West Afr J Med. 2003 Jan-Mar;22(1):103-5.

Human immunodeficiency virus and invasive external otitis--a case report.

Lasisi OA, Bakare RA, Usman MA.

Department of Otorhinolaryngology, University College Hospital, Ibadan.

Acute invasive external otitis is an uncommon life-threatening infection of the
external auditory canal (EAC), most often affecting the elderly diabetic
patients. Although few reports have been made in HIV-positive/Aids patients among
the caucasians. We present here a 25 year old nursing mother with a month history
of fever, persistent otalgia with acutely inflammed EAC, gross facial cellulitis,
mastoid abscess and facial paresis, following a minor left ear trauma with a
matchstick. This unusual course of ear infection in an otherwise healthy young
adult prompts a search for an immunodepressing factor which was confirmed to be
Human Immunodeficiency Virus (HIV). This article highlights the clinical
peculiarities and the management of invasive external otitis in an HIV-positive
patient.

Publication Types: 
    Case Reports

PMID: 12769321 [PubMed - indexed for MEDLINE]

1676: East Afr Med J. 2003 Mar;80(3):130-4.

Chronic suppurative otitis media in school pupils in Nigeria.

Ologe FE, Nwawolo CC.

Department of Otorhinolaryngology, Faculty of Health Sciences, University of
Ilorin, Ilorin, Nigeria.

OBJECTIVE: To compare the prevalence of chronic supperative otitis media (CSOM)
among two populations of school children. DESIGN: A survey-demographic data
collection and otoscopy was carried out among the two populations of school
children. SETTING: A rural government primary school and an urban private primary
school SUBJECTS: Six hundred and ninety nine school pupils in the rural school
and two hundred and seventy pupils in the urban school. RESULTS: Six per cent of 
the pupils in the rural schools had CSOM as evidenced by persistent perforation
of tympanic membrane of more than three months duration. No tympanic membrane
perforations were observed in the children in the urban school at the time of
this study. The difference in the prevalence of CSOM between the two populations 
is statistically significant (P < 0.001). The difference in socio-economic status
between the two populations is statistically significant in relation to the
prevalence of CSOM in the two populations. The poorer rural population had a
significantly higher prevalence of CSOM (P < 0.001). CONCLUSION: The two study
populations are just seven kilometres apart geographically but there is a world
of difference in their socio-economic status, availability of social
infrastructure and health facilities. This presumably had reflected in the marked
difference in the prevalence of CSOM between the two study populations. A
collective effort of government and well meaning indigenes of rural communities
in Nigeria can help promote the socio-economic status and enhance the
availability of social infrastructure and health facilities of rural areas. This 
we hope will lead to a decline in the prevalence of CSOM in the rural areas.

Publication Types: 
    Comparative Study

PMID: 12762427 [PubMed - indexed for MEDLINE]

1677: Am J Otolaryngol. 2003 May-Jun;24(3):159-62.

Autoimmunity in the etiology of otitis media with effusion.

Kirglu M, Yildirim I, Aydogan B, Okur E, Tuncer U, Erken E.

Department of Otolaryngology, Cukurova University Medical Faculty, Balcali,
Adana, Turkey.

Otitis media with effusion (OME) is one of the most common health problems seen
in children. The role of autoimmunity in the etiology of OME has been discussed
for a long time. The purpose of this investigation is to determine the role of
circulating antibodies in the pathogenesis of OME. The presence of antibodies
against rabbit tympanic bulla epithelium was investigated by indirect
immunoflouresence in the serum samples of 25 patients with OME and serum samples 
of 25 healthy children as a control group. In the control group, positive
staining was seen in only 1 case (4%), whereas 8 cases with OME were positively
stained (%32). There was statistically significant difference between the 2
groups. The presence of antibodies against middle ear epithelium in the cases
with OME suggest that autoimmunity might play a role in the formation of effusion
in the tympanic cavity.

PMID: 12761702 [PubMed - indexed for MEDLINE]

1678: Infect Immun. 2003 Jun;71(6):3454-62.

Nontypeable Haemophilus influenzae gene expression induced in vivo in a
chinchilla model of otitis media.

Mason KM, Munson RS Jr, Bakaletz LO.

Columbus Children's Research Institute, Department of Pediatrics, The Ohio State 
University College of Medicine and Public Health, Columbus 43205, USA.

The gram-negative bacterium nontypeable Haemophilus influenzae (NTHI) is the
predominant pathogen in chronic otitis media with effusion and, with
Streptococcus pneumoniae and Moraxella catarrhalis, is a causative agent of acute
otitis media. To identify potential virulence determinants, bacterial gene
expression was monitored by differential fluorescence induction during early
disease progression in one specific anatomical niche of a chinchilla model of
NTHI-induced otitis media. Genomic DNA fragments from NTHI strain 86-028NP were
cloned upstream of the promoterless gfpmut3 gene. NTHI strain 86-028NP served as 
the host for the promoter trap library. Pools of 2,000 transformants were
inoculated into the left and right middle ear cavities of chinchillas. Middle ear
effusions were recovered by epitympanic tap at 24 and 48 h, and clones containing
promoter elements that were induced in vivo and producing green fluorescent
protein were isolated by two-color fluorescence-activated cell sorting. Insert
DNA was sequenced and compared to the complete genome sequence of H. influenzae
strain Rd. In a screen of 16,000 clones, we have isolated 44 clones that contain 
unique gene fragments encoding biosynthetic enzymes, metabolic and regulatory
proteins, and hypothetical proteins of unknown function. An additional eight
clones contain gene fragments unique to our NTHI isolate. Using quantitative
reverse transcription-PCR, we have confirmed that 26 clones demonstrated
increased gene expression in vivo relative to expression in vitro. These data
provide insight into the response of NTHI bacteria as they sense and respond to
the middle ear microenvironment during early events of otitis media.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12761130 [PubMed - indexed for MEDLINE]

1679: Arch Otolaryngol Head Neck Surg. 2003 May;129(5):517-22.

Chronic otitis media with effusion sequelae in children treated with tubes.

Daly KA, Hunter LL, Lindgren BR, Margolis R, Giebink GS.

University of Minnesota Otitis Media Research Center, University of Minnesota
School of Medicine, USA. dalyx002@umn.edu

OBJECTIVE: To determine incidence and prevalence of middle ear sequelae and
abnormal tympanometry results among children with chronic otitis media with
effusion (OME) who received standard treatment with tympanostomy tubes. DESIGN:
Prospective cohort study. SETTING: Community clinic and academic medical
center.Patients A total of 140 children followed up for 8 years after tube
treatment. MAIN OUTCOME MEASURES: Tympanic membrane perforation, atrophy,
retraction, hearing loss, myringosclerosis, low static admittance (SA) and
broad-peaked tympanogram, high SA and narrow-peaked tympanogram, and negative
tympanometric peak pressure. RESULTS: Annual incidence of sequelae was typically 
greater during 3 to 5 years than 6 to 8 years of follow-up. Greatest increases in
incidence during the 5-year follow-up were for atrophy (67%), high SA and
narrow-peaked tympanogram (70%), and retraction pocket (47%). Prevalence of these
sequelae also increased over time, whereas low SA and broad-peaked tympanogram
and negative tympanometric peak pressure decreased during follow-up. Sequela
tended to become bilateral over time, and concordance of different sequelae in
the same ear was low (kappa, 0.05-0.42). CONCLUSIONS: Annual incidence of
sequelae decreased during follow-up. This finding parallels decreasing incidence 
of OME and tube placement as children mature and demonstrates that sequelae are
more likely to develop during active acute and chronic OME. The cumulative effect
of incidence resulted in few ears free of sequelae by 8 years of follow-up. Based
on this cohort of healthy children with OME, although the risk of sequelae
decreased over time, functional and morphologic sequelae were prevalent and may
put children at risk for continuing middle ear problems as they grow into
adolescence and adulthood.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12759263 [PubMed - indexed for MEDLINE]

1680: Vet Ther. 2003 Spring;4(1):12-23.

Erratum in:
    Vet Ther. 2003 Summer;4(2):108.

Evaluation of an ear cleanser for the treatment of infectious otitis externa in
dogs.

Cole LK, Kwochka KW, Kowalski JJ, Hillier A, Hoshaw-Woodard SL.

Department of Veterinary Clinical Sciences, The Ohio State University, College of
Veterinary Medicine, 601 Vernon Tharp Street, Columbus, OH, 43210, USA
[corrected].

Thirty-one ears (16 dogs) with otitis externa originating from bacterial or yeast
infections were enrolled in a study to evaluate the in vivo efficacy of an ear
cleanser containing 2.5% lactic acid and 0.1% salicylic acid for the treatment of
infectious otitis externa. The affected ears were treated with the ear cleanser
twice daily for 2 weeks and evaluated after 1 and 2 weeks of treatment. The ear
cleanser was effective in resolution of infection in 67.7% of the ears, and
clinical signs of infectious otitis externa were significantly reduced within 2
weeks.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 12756632 [PubMed - indexed for MEDLINE]

1681: Clin Otolaryngol Allied Sci. 2003 Jun;28(3):183-6.

Could the presence of a Carhart notch predict the presence of glue at
myringotomy?

Kumar M, Maheshwar A, Mahendran S, Oluwasamni A, Clayton MI.

Department of Otolaryngology, Head and Neck Surgery, Royal Gwent Hospital,
Newport, Wales, UK. manoj.kumar@talk21.com

The Carhart notch is a dip in the bone conduction at 2000 Hz without a
corresponding dip in the air conduction. The main objective of this study was to 
establish how reliable is the presence of the Carhart notch in a preoperative
audiogram in predicting the presence of glue at myringotomy. A prospective study 
has been carried out in 50 children presenting with glue ear to find out the
association between the Carhart notch and the presence of glue at myringotomy.
Children were seen before the operation and an audiogram and tympanogram were
carried out. Myringotomy was carried out in 95 ears and the presence or absence
of glue was recorded. The significance of the air-bone gap and the type of
tympanogram in predicting a middle ear effusion were also examined. The
audiograms of 37 ears showed a Carhart notch; of these, 36 ears were noted to
have glue ear. The correlation between the presence of a Carhart notch in the
preoperative audiogram and the presence of glue at myringotomy was found to be
significant (P < 0.001) (chi-square test). Using the decision rule that the
presence of a Carhart notch predicts the presence of glue, the following
operating characteristics were determined: correct, 83 ears (87.4%); false
positive, one ear (1.1%); false negative, 11 ears (11.6%). The presence of a
Carhart notch was found to be a strong predictor of the presence of glue at
myringotomy.

PMID: 12755752 [PubMed - indexed for MEDLINE]

1682: Clin Diagn Lab Immunol. 2003 May;10(3):417-22.

Role of macrophage migration inhibitory factor in otitis media with effusion in
adults.

Kariya S, Okano M, Aoji K, Kosaka M, Chikumoto E, Hattori H, Yuen K, Nishioka S, 
Nishioka K, Nishizaki K.

Department of Otolaryngology-Head and Neck Surgery, Okayama University Medical
and Dental School, Okayama, Japan.

Otitis media with effusion (OME) is one of the most common ear diseases.
Bacterial endotoxins and several inflammatory cytokines appear to be involved in 
the pathogenesis of OME in children; however, little is known of the
immunological aspects of the onset of OME in adults. We sought to determine the
presence of macrophage migration inhibitory factor (MIF) as well as interleukin
1beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha), RANTES (regulated upon
activation, normal T-cell expressed and presumably secreted), and endotoxin in
middle ear effusions (MEEs) from adult patients with OME. In addition, the levels
of MIF in MEEs from adults and children were compared. MEE was obtained from 95
adults and 11 children. The levels of MIF, IL-1beta, TNF-alpha, and RANTES were
determined by enzyme-linked immunosorbent assay, and the concentrations of
endotoxin and total protein were determined by the Endospec assay and
bicinchoninic acid assay, respectively. MIF was detected in 97.9% of the MEEs
from adults, while endotoxin, IL-1beta, TNF-alpha, and RANTES were detected in
96.8, 12.6, 5.3, and 43.9%, respectively. In addition, the level of MIF was
significantly higher than those of endotoxin, IL-1beta, and TNF-alpha. A positive
correlation between the levels of MIF and endotoxin was observed. MIF and
endotoxin were detected in 81.8 and 72.7%, respectively, of the MEEs from the
children. The level of MIF was significantly higher in the children, and
conversely that of endotoxin was significantly higher in the adults. These
results suggest that the interaction between MIF and endotoxin may promote fluid 
collection in the middle ear, particularly in adults.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12738641 [PubMed - indexed for MEDLINE]

1683: Pac Health Dialog. 2002 Mar;9(1):64-7.

Malignant otitis externa: a review.

Bhandary S, Karki P, Sinha BK.

Majuro Hospital, P.O. Box 16, Marshall Islands, MH 96960, USA.
sangitabhandary@hotmail.com

Malignant otitis externa is a rare but potentially fatal disease of the external 
auditory canal seen mostly among elderly, diabetic or immunocompramised patients.
The causative organism is mainly Pseudomonas aeruginosa. The disease spreads
rapidly, invading surrounding soft tissues, cartilage and bones causing their
necrosis and even spreading to the cranial nerves. The disease can be fatal if
treatment is not aggressive and timely, especially if it spreads outside the
auditory canal with involvement of the cranial nerves. Treatment is mainly
medical with antipseudomonal drugs like the third generation cephalosporin and
the fluoroquinolones and local debridement. With aggressive treatment the
mortality rate from this disease, which used to be 50% in the past has now been
reduced to 10-20%. The pathophysiology of the disease, clinical presentation,
diagnosis, treatment and the outcome has been discussed and reviewed.

Publication Types: 
    Review

PMID: 12737420 [PubMed - indexed for MEDLINE]

1684: Acta Otolaryngol. 2003 Apr;123(3):383-7.

IL-5 and eotaxin levels in middle ear effusion and blood from asthmatics with
otitis media with effusion.

Nonaka M, Fukumoto A, Ozu C, Mokuno E, Baba S, Pawankar R, Yagi T.

Department of Otorhinolaryngology, Nippon Medical School, Tokyo, Japan.
nonaka@nms.ac.jp

OBJECTIVE: The purpose of this study was to evaluate eosinophil infiltration as
well as IL-5 and eotaxin levels in middle ear effusion (MEE) and blood from
otitis media with effusion (OME) patients with asthma and to compare the findings
with those from OME patients without asthma (control group). MATERIAL AND
METHODS: Levels of IL-5 and eotaxin in MEE and blood were measured by means of
enzyme-linked immunosorbent assay. RESULTS: 5 levels in MEE were significantly
higher than those in blood in both groups of patients and in OME patients with
asthma than in the control group. In addition, in OME patients with asthma, there
was a significant correlation between the percentage of eosinophils and IL-5
levels in MEE. Eotaxin levels in blood were significantly higher than those in
MEE in both groups of patients and in OME patients with asthma than in the
control group. In addition, in OME patients with asthma, the percentage of
eosinophils and eotaxin levels in blood tended to correlate, but did not reach
statistical significance. CONCLUSION: These data suggest that, in OME patients
with asthma, eosinophilia in MEE depends more on IL-5 than on eotaxin, and that
eotaxin may play an important role in the mobilization of eosinophils from the
bone marrow into the blood.

PMID: 12737295 [PubMed - indexed for MEDLINE]

1685: Cleft Palate Craniofac J. 2003 May;40(3):304-9.

Audiologic and tympanometric findings in children with cleft lip and palate.

Tunçbilek G, Ozgür F, Belgin E.

Department of Plastic and Reconstructive Surgery, Hacettepe University, Bogaz
sokak 4/11, Gaziosmanpasa 06700, Ankara, Turkey. gtunc@ada.net.tr

OBJECTIVE: To evaluate the otologic and audiologic status of 50 children with
repaired cleft lip, cleft palate, or both in Hacettepe University, Ankara,
Turkey. DESIGN: Audiometric and tympanometric evaluation of 100 ears in 50
children were performed. Hearing levels < or = 15 dB and middle ear pressures
between -50 to +50 decaPascals were considered to be normal. Results were
examined according to cleft type and laterality. The least and most affected
frequencies were calculated. A simple evaluation of speech characteristics
including nasal resonance, nasal air escape, and errors of articulation was also 
performed. RESULTS: Sixty-three of the 100 ears had normal hearing status,
whereas 40 had normal middle ear pressures. No evidence was found to suggest that
individual cleft type and laterality of the ear had any effect on hearing loss or
middle ear disease. Two-thirds of the patients had normal or acceptable degree of
language skills. CONCLUSION: The final hearing status of patients with cleft
palate is a result of a combination of surgical correction, developmental
factors, and treatment of middle ear disease. Early and aggressive ventilation
tube placement is the standard of cleft care in many countries. Our long-term
hearing outcome is relatively good in a population not treated with routine
insertion of ventilation tubes. The majority of patients also have satisfactory
speech. Patients with cleft palate should have close follow-up for middle ear
disease, but further research is warranted to determine the aggressive usage of
ventilation tubes.

PMID: 12733961 [PubMed - indexed for MEDLINE]

1686: Pharmacoepidemiol Drug Saf. 2003 Apr-May;12(3):213-9.

Antibiotic prescribing for otitis media: how well does it match published
guidelines?

McEwen LN, Farjo R, Foxman B.

University of Michigan, Ann Arbor, MI 48109, USA.

Otitis media (OM) accounts for approximately 31 million physician visits
annually, and is typically treated with antibiotics. Amoxicillin is the
recommended first-line treatment; appropriate antibiotic use slows the
development of resistance. We analyzed insurance claims from families of
employees working at a single company to determine if OM treatments (1) matched
published standards; and (2) varied by patient characteristics, type of physician
practice or geographic location. Persons diagnosed with OM between 1996 and 1999 
were matched to prescription drug claims for those who filled an antibiotic
prescription within 3 days of diagnosis. Physicians prescribed amoxicillin for
only 31% of acute cases and 19% of recurrent cases. For acute infections in
children < or = 2 years the prescribed duration often matched the standard of 10 
days, but for persons > 2 years the prescribed duration was often longer than the
suggested duration of 5-7 days. For persons of all ages with recurrent
infections, the prescribed duration was often shorter than suggested (10 days
versus > or = 14 days). There were only modest variations by urban/rural location
or provider type.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12733474 [PubMed - indexed for MEDLINE]

1687: Ann Otol Rhinol Laryngol. 2003 Apr;112(4):342-7.

Is secretory otitis media a single disease entity?

Sadé J, Russo E, Fuchs C, Cohen D.

Ear Research Laboratory, Tel-Aviv University, Tel-Aviv, Israel.
jsade@netvision.net.il

The outcome of 809 children who had middle ear effusion (MEE) was correlated with
their age and medical history and the bacteriologic and cytologic findings of the
MEE. Three groups emerged. Group A (n = 384) had a medical history of relatively 
recent acute otitis media (AOM) with a peak prevalence of 2.6 years of age, and
its MEE was hypercellular (mostly polymorphonuclear leukocytes) with a 24% rate
of positive bacteriologic culture. In contrast, the peak prevalence of group B (n
= 280) was approximately 5 years of age. Its MEE followed no otologic medical
history and was bacteriologically sterile with relatively few cells (mostly
lymphocytes typical of viral infections). Group AB (n = 145) resembled group B
except that they had a history of AOM some years before hearing loss onset.
Altogether, the clinical features of group A are statistically distinguishable
from those of groups B and AB in most respects. These findings explain the
bimodal peak prevalence distribution that was found in many available
epidemiological studies of secretory otitis media (SOM) and that was also seen in
our data. It appears that SOM should neither be termed nor treated as an otitis
media, but as a sequela of either bacterial AOM (group A) or of insidious,
asymptomatic, probably viral otitis media (groups B and AB). Our data do not
support antibiotic treatment for SOM (otitis media with effusion)--especially not
in chronic cases.

PMID: 12731629 [PubMed - indexed for MEDLINE]

1688: Pediatrics. 2003 May;111(5 Pt 1):e574-9.

Comment in:
    J Fam Pract. 2003 Sep;52(9):673, 676.

Naturopathic treatment for ear pain in children.

Sarrell EM, Cohen HA, Kahan E.

Pediatric and Adolescent Ambulatory Community Clinic of the General Health
Services, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

OBJECTIVE: Otitis media is 1 of the most frequent diseases of early infancy and
childhood and 1 of the most common reasons for children to visit a physician. In 
the past 2 decades, there has been a substantial increase in the diagnosis of
otitis media worldwide. In the United States, 93% of all children have had at
least 1 episode of acute otitis media (AOM) by 7 years of age. Otalgia is the
hallmark of AOM. Most affected children either complain of earache or manifest
behavior that the parents interpret as indicating ear pain. Treatment of the ear 
pain early in the course of AOM decreases both parental anxiety and the child's
discomfort and accelerates the healing process. The objective of this study was
to determine the efficacy and tolerability of naturopathic versus traditional
treatment for the management of otalgia commonly associated with AOM in children.
METHODS: The study was designed as a double-blind trial in an outpatient
community clinic. A total of 171 children who were aged 5 to 18 years and had
otalgia and clinical findings associated with middle-ear infection were studied. 
The children were randomly assigned to receive treatment with Naturopathic Herbal
Extract Ear Drops (NHED) or anesthetic ear drops, with or without amoxicillin. On
enrollment, the children were assigned by computer-numbered randomization to
receive NHED (contents: allium sativum, verbascum thapsus, calendula flores,
hypericum perfoliatum, lavender, and vitamin E in olive oil) 5 drops 3 times
daily, alone (group A) or together with a topical anesthetic (amethocaine and
phenazone in glycerin) 5 drops 3 times daily (group B), or oral amoxicillin 80
mg/kg/d (maximum 500 mg/dose) divided into 3 doses with either NHED 5 drops 3
times daily (group C) or topical anesthetic 5 drops 3 times daily (group D). A
double-blind design was used, and all ear drops were placed in identical bottles.
Treatment was initiated by the nurse in all cases. A single physician (M.S.)
evaluated and treated all of the patients included in the study and recorded all 
of the data. The presence or absence of ear pain was assessed over 3 days with a 
visual analog scale. Ear pain was assessed by a specially devised observational
instrument based on previous reports. One side of the instrument consisted of a
linear numbered scale, from 1 (no pain) to 10 (worst possible pain), and a
corresponding color scale, ranging from blue to dark red. The reverse side
contained a scale of 5 facial expressions, ranging from broad smile (no pain) to 
a sad and crying face (worst possible pain), and a corresponding color scale,
ranging from blue to dark red. RESULTS: There were no significant between-group
differences in patient age or gender, degree of fever, main symptoms, associated 
symptoms, and severity or laterality of acute otitis media. Each group had a
statistically significant improvement in ear pain over the course of the 3 days. 
Patients who were given ear drops alone had a better response than patients who
were given ear drops together with amoxicillin. Results were better in the NHED
group than in the controls. Nevertheless, the findings indicated that the pain
was mostly (80%) self-limited and could be explained simply by the time elapsed. 
The American Academy of Otolaryngology-Head and Neck Surgery guidelines recommend
topical medications as the first line of treatment for ear pain in the absence of
systemic infection or serious underlying disease. Because no evidence was found
that systemic antibiotics alone improved treatment outcome, if antibiotics do not
change the natural course of otitis media, then the main goal of treatment, as in
the present study, should be to alleviate the ear pain. The alternative,
naturopathic herbal extract medications, may offer many new possibilities in the 
management of ear pain associated with AOM. Primary care physicians should be
aware that at least 10% of their patients may have tried 1 or more forms of
alternative/complementary medicine before presenting for consultation. As it was 
widely reported in the medical literature, these herb, these herbal extracts have
the potential to meet all of the requirements of appropriate medication that
could be routinely used in the pediatric patient, namely in vitro bacteriostatic 
and bacteriocidal activity against common pathogens, immunostimulation ability,
antioxidant activity, and anti-inflammatory effects. They are also well-absorbed 
with good penetration into the tissue surrounding the tympanic membrane. They
have been found to enhance local immunologic activity. Finally, herbal extracts
are well-tolerated (owing to their long elimination time), easy to administer,
and less expensive than the new antibiotics. There are no documented side
effects. On the basis of our findings that the group with the most significant
treatment effects (NHED with topical anesthetic) explained only 7.3% of the total
pain reduction, we propose that sometimes the general practitioner or
pediatrician needs to give the human body a chance to repair itself.
Nevertheless, if the physician believes that there is an indication for some
treatment, especially if the parents are anxious, then a local treatment such as 
one used in our study might be adequate. CONCLUSIONS: This study suggests that in
cases of ear pain caused by AOM in children in which active treatment, besides a 
simple 2- to 3-day waiting period, is needed, an herbal extract solution may be
beneficial. Concomitant antibiotic treatment is apparently not contributory.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial

PMID: 12728112 [PubMed - indexed for MEDLINE]

1689: Pediatrics. 2003 May;111(5 Pt 1):1061-7.

Comment in:
    Pediatrics. 2004 Jan;113(1 Pt 1):178-9; author reply 178-9.

Antibiotic treatment of acute otorrhea through tympanostomy tube: randomized
double-blind placebo-controlled study with daily follow-up.

Ruohola A, Heikkinen T, Meurman O, Puhakka T, Lindblad N, Ruuskanen O.

Department of Pediatrics, Turku University Hospital, Turku, Finland.
aino.ruohola@utu.fi

OBJECTIVE: The role of routine antimicrobial treatment of acute middle-ear
infections is under debate, because the efficacy of antimicrobials in the
resolution of middle-ear fluid has not been unambiguously proven. Acute tube
otorrhea is regarded as evidence of acute otitis media, and for methodologic
reasons it was chosen to provide objectivity for diagnostics and outcome
assessment. The objective of this study was to assess whether
amoxicillin-clavulanate accelerates the resolution of acute tube otorrhea. DESIGN
AND SETTING: Randomized, double-blind, placebo-controlled study in outpatient
setting. PATIENTS: Volunteer sample of basically healthy 6- to 72-month-old
children with a tympanostomy tube. Eligibility required having acute tube
otorrhea of <48 hours' of duration and no prior treatment within the last 2
weeks. The mean age of the participants was 25 months; they had a history of 3
episodes of acute otitis media (median), and 99% had manifestations of a
concomitant respiratory infection. Of 79 randomized patients, 7 were withdrawn
because of adverse events; 66 patients completed the study. INTERVENTIONS:
Amoxicillin-clavulanate (N = 34; 45 mg/kg/d) or matching placebo (N = 32) for 7
days and daily suction of middle-ear fluid through tympanostomy tube. MAIN
OUTCOME MEASURES: Duration of acute tube otorrhea and duration of bacterial
growth in middle-ear fluid. RESULTS: The median duration of tube otorrhea was
significantly shorter in amoxicillin-clavulanate than in the placebo group (3 vs 
8 days). At the end of the 7-day medication period, tube otorrhea was resolved in
28 of 34 children receiving amoxicillin-clavulanate compared with 13 of 32
children on placebo (treatment-control difference 41%; 95% confidence interval,
20%-63%; number needed to treat, 2.4). The median duration of bacterial growth in
middle-ear fluid was shorter in amoxicillin-clavulanate than in the placebo group
(1 vs 8 days). CONCLUSIONS: Oral antibiotic treatment significantly accelerates
the resolution of acute tube otorrhea by reducing bacterial growth in middle-ear 
fluid.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 12728089 [PubMed - indexed for MEDLINE]

1690: Trends Biotechnol. 2003 May;21(5):217-23.

Bacterial replacement therapy: adapting 'germ warfare' to infection prevention.

Tagg JR, Dierksen KP.

Department of Microbiology, University of Otago, P.O. Box 56, Dunedin, New
Zealand. john.tagg@stonebow.otago.ac.nz

The individual bacterial members of our indigeneous microbiota are actively
engaged in an on-going battle to prevent colonisation and overgrowth of their
terrain by competing microbes, some of which might have pathogenic potential for 
the host. Humans have long attempted to intervene in these bacterial
interactions. Ingestion of probiotic bacteria, particularly lactobacilli, is
commonly practiced to promote well-balanced intestinal microflora. As bacterial
resistance to antimicrobials has increased, so too has research into colonisation
of human tissues with specific effector strains capable of out-competing known
bacterial pathogens. Recent progress is particularly evident in the application
of avirulent Streptococcus mutans to the control of dental caries, alpha
hemolytic streptococci to reduction of otitis media recurrences and Streptococcus
salivarius to streptococcal pharyngitis prevention.

Publication Types: 
    Review

PMID: 12727383 [PubMed - indexed for MEDLINE]

1691: Rev Laryngol Otol Rhinol (Bord). 2002;123(4):263-6.

An important procedure in ossiculoplasty: autoclaving the ossicles.

Miman MC, Cura O, Erdem T, Kirazli T, Oztop F, Ozturan O, Oncel S.

Inonu University Medical Faculty, Otorhinolaryngology Department, Malatya, Izmir,
Turkey.

Autoclaving of the ossicles prior to ossiculoplasty is a very important procedure
in surgery of cholesteatomatous chronic otitis media. Autoclaving allows the
reuse of the ossicles removed from patients with cholesteatomatous chronic otitis
media as an autograft. It also allows utilization of the malleus, incus and
stapes taken from cadavers or of the uneroded malleus and incus removed from
patients undergoing non-functional middle ear surgery chosen carefully with
detailed history and laboratory analysis. The powerful disinfecting effect of the
sterilising procedures of the homografts inactivates prion proteins which cause
degenerative encephalopathies. In various studies, it has been concluded that
autoclaving does not alter the matrix of the bone which is responsiable for its
biophysical properties, whereas it removes all viable cells within the bone and
dentures the soft tissue attached to the surface of the ossicle. We have also
found confirming histological results in our two previous studies published in
1999 and 2001. It is usually recommended that soft tissue on the surface of the
ossicles is removed before autoclaving. It is also sufficient to autoclave the
ossicles at 134 degrees C, and at 2.5 atmosphere pressure for 5 minutes in a
flash autoclave. The autoclaving time of the homograft ossicles must be longer,
for 20 minutes. Following the autoclaving, these homograft ossicles should be
kept at pH 5.6 for 3 days, then use a solution of 0.5% formaldehyde at pH 7 and 4
degrees C for 21 days and it should be washed with physiologic saline solution
three times for 7 minutes before use. Depending on the results obtained from our 
planned comparative experimental study, there will be no need for additional
formaldehyde fixation procedure after autoclaving and the autoclaved ossicles
will be used immediately without preservation in formaldehyde solution for 24
days.

PMID: 12723494 [PubMed - indexed for MEDLINE]

1692: Vet Radiol Ultrasound. 2003 Mar-Apr;44(2):210-3.

Ultrasonography versus radiography for detection of fluid in the canine tympanic 
bulla.

Griffiths LG, Sullivan M, O'Neill T, Reid SW.

The University of Liverpool, Department of Veterinary Clinical Science and Animal
Husbandry, Small Animal Hospital, Crown Street, Liverpool, Merseyside, L7 7EX,
England.

The tympanic bullae of 20 previously healthy cadaver animals were randomly filled
with sterile saline or air. The heads were positioned using tape ties and a
rostrocaudal open mouth radiograph taken. The resulting radiographs were assessed
by a blinded ECVDI diplomate, with each tympanic bulla being recorded as being
either air or fluid filled. Ultrasound examination of the bullae was performed,
by a blinded assessor, using a B-mode 5 mHz sector probe (Sonotron-VingMed Sound 
A/S, PO Box 141, N3191, Horten, Norway) operating at 3 mHz. Each bulla was
recorded as being either air or fluid filled. Results of radiography and
ultrasonography were each compared to the actual status of the bulla in a chi
square analysis. Sensitivity of radiography was 80%, with specificity of 65%.
Ultrasonographic sensitivity was 100% and specificity 100%. Ultrasonography may
in future provide a cheap, noninvasive, rapid and widely available method for
diagnosing otitis media in clinical cases.

Publication Types: 
    Comparative Study

PMID: 12718358 [PubMed - indexed for MEDLINE]

1693: Kulak Burun Bogaz Ihtis Derg. 2003 Feb;10(2):47-50.

Factors that affect the outcome of open-technique procedures performed in the
treatment of cholesteatoma.

Ozgirgin ON, Aydin E, Ozçelik T, Ozlüoğlu LN.

Department of Otolaryngology, Medicine Faculty of Başkent University, Ankara,
Turkey. ozgirgin@politzersociety.org

OBJECTIVES: We evaluated the factors that have considerable significance on the
outcome of open cavity procedures in the treatment of cholesteatoma. PATIENTS AND
METHODS: The study included 66 patients (43 males, 23 females; mean age 47 years;
range 21 to 69 years) who underwent surgery for cholesteatoma. Of these, 56
patients completed at least a five-year follow-up. RESULTS: Mucosal infections
and granulation tissue formation occurred in seven patients (10%) in the early
postoperative period. Retraction pockets developed in three patients (4%); of
these, only one patient required excision because of deep localization. Drum
perforations that occurred in two patients (3%) were repaired by myringoplasty.
Revision surgery was performed in four patients (7.1%) due to residual
cholesteatoma within a five-year follow-up. CONCLUSION: The height of the facial 
ridge was found as the most important factor related to a successful outcome of
open-technique procedures. Other factors included the creation of a smooth
mastoid cavity with round edges, removal of all diseased mastoid cells, and an
extensive conchameatoplasty.

Publication Types: 
    Evaluation Studies

PMID: 12717056 [PubMed - indexed for MEDLINE]

1694: Pediatr Radiol. 2003 Jul;33(7):503-5. Epub 2003 Apr 18.

Abscess of the cavum septum pellucidum.

Akansel G, Dalbayrak S, Yilmaz M, Yavuzer D, Seymen M, Gurel I, Demirci A.

Department of Radiology, Kocaeli University School of Medicine, 41900 Derince,
Izmit, Turkey. gakansel@superonline.com

A 14-year-old girl presented with symptoms and signs of left otomastoiditis and
meningitis. CT and MRI revealed a largely expanded cavum septum pellucidum with
enhancing walls and findings suggesting left otomastoiditis and meningitis. At
surgery, an abscess was found within the cavum septum pellucidum. Five similar
cases have been reported in the literature. To our knowledge, this is the first
case associated with otomastoiditis. Although rare, abscess of the cavum septum
pellucidum should be suspected in patients with meningitis and/or head trauma and
delayed clinical deterioration.

Publication Types: 
    Case Reports
    Review

PMID: 12707740 [PubMed - indexed for MEDLINE]

1695: Int J Audiol. 2003 Apr;42(3):117-31.

Transient evoked otoacoustic emissions in patients with middle ear disorders.

Zhao F, Wada H, Koike T, Ohyama K, Kawase T, Stephens D.

Department of Bioengineering and Robotics, Tohoku University, Sendai, Japan.

The aim of this study is to investigate the middle ear dynamic characteristics
and their influence on TEOAEs in patients with middle ear disorders. The middle
ear dynamic characteristics and TEOAE findings were investigated in 89 patients
with middle ear disorders using the sweep frequency impedance (SFI) meter and the
ILO88 system, respectively. These patients were divided into six subcategories:
tympanic membrane aberrations, otitis media with effusion, chronic otitis media, 
tympanic membrane perforation, otosclerosis, and ossicular chain dislocation.
Details of the TEOAE frequency characteristics were compared with the
individual's middle ear dynamic characteristics. TEOAE status as a function of
hearing threshold and middle ear dynamic characteristics was also examined. The
results showed that the middle ear dynamic characteristics in patients with
middle ear disorders correlated with the TEOAE frequency characteristics and
amplitudes. The hearing level and middle ear mobility were the controlling
factors affecting TEOAE status. Using both non-linear and linear stimulus modes, 
larger TEOAE responses were obtained when the hearing level was better than 20 dB
HL, and there was moderately good middle ear mobility. Moreover, TEOAEs were
absent using the non-linear mode when the hearing level was worse than 30 dB HL, 
whereas with the linear mode. TEOAEs were recordable even with hearing losses of 
up to 40 dB HL in patients with middle ear disorders. A higher incidence of
recordable TEOAEs was found in the subgroups with tympanic membrane abnormalities
and secretory otitis media when compared with the other subgroups. No TEOAEs were
recordable in patients with chronic otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12705777 [PubMed - indexed for MEDLINE]

1696: Acta Otolaryngol. 2003 Jan;123(2):288-91.

Can chronic nasal obstruction cause dysfunction of the paratubal muscles and
otitis media? An experimental study in developing Wistar rats.

Scarano E, Fetoni AR, Picciotti P, Cadoni G, Galli J, Paludetti G.

Department of Otolaryngology, Catholic University of Rome, Rome, Italy.
iclot@rm.unicatt.it

OBJECTIVE: To quantitatively analyze modifications of the paratubal muscles in
developing Wistar rats following nasal obstruction. MATERIAL AND METHODS:
Twenty-four Wistar rats were used. Twelve were examined at 6, 8 and 12 weeks
after birth and were considered normal controls. The nostrils of the remaining 12
rats were bilaterally obstructed by means of a synthetic resin 28 days after
birth. The animals were sacrificed at either 2, 4 or 8 weeks after nostril
occlusion. Serial sections were made in the dorsoventral plane and stained with
hematoxylin-eosin. Four 5 x 5 microm2 areas, selected within the paratubal
muscles, were histologically analyzed and the number of muscular fibers was
counted manually. RESULTS: The number of tensor veli palatini muscle fibers
progressively decreased in the obstructed rats compared with age-matched normal
controls and in those that had been obstructed for 4 and 8 weeks these reductions
were statistically significant. CONCLUSION: The correct development of the
paratubal muscles seems to be linked to physiological nasal breathing and is
negatively affected by oral breathing.

Publication Types: 
    Comparative Study

PMID: 12701760 [PubMed - indexed for MEDLINE]

1697: Acta Otolaryngol. 2003 Jan;123(2):253-7.

Ear and hearing problems in Turner's syndrome.

Hultcrantz M.

Department of Otorhinolaryngology, Karolinska Hospital, Stockholm, Sweden.
malou.hultcrantz@ks.se

OBJECTIVES: To report hearing results in Swedish women with Turner's syndrome
(TS), describe the recommendations of the Otologic Section of the Swedish Turner 
Academy for handling these patients and discuss the effect of estrogen on hearing
in animals. MATERIAL AND METHODS: Audiometric and karyotype tests were performed 
in 325 Swedish women with TS. A questionnaire was completed by 143 females with
TS. Immunohistochemical staining of inner ear specimens was undertaken using
antibodies against estrogen receptors in both human fetuses with TS and
middle-aged women. Temporal bones obtained from various animal species were also 
studied immunohistochemically. RESULTS: A total of 61% of the women had suffered 
from otitis media. A senorineural dip in hearing could be observed as early as
the age of 6 years, progressed over time and was related to karyotype. The
results of the questionnaire revealed that hearing impairment was rated as the
fourth most serious problem associated with TS. The immunohistochemical study
confirmed that estrogen receptors are present in the inner ear of humans. The
animal experiments showed that estrogen receptors were present at almost equal
amounts in rats, mice, TS mice, beta knockout mice and ovariectomized rats and at
the same localization as in the human inner ear. CONCLUSIONS: Both the
senorineural dip in hearing and the karyotype can be used to predict the future
course of hearing problems in TS patients. Estrogen may have an effect on hearing
loss in TS patients but this phenomenon requires further investigation.

PMID: 12701752 [PubMed - indexed for MEDLINE]

1698: Acta Otolaryngol. 2003 Jan;123(2):219-22.

The role of mastoidectomy in cochlear implant surgery.

Kronenberg J, Migirov L.

Department of Otorhinolaryngology and Head and Neck Surgery, Sheba Medical
Center, Tel Hashomer, Israel. kro@zahav.net.il

OBJECTIVE: The classical technique for cochlear implantation (CI) involves
mastoidectomy and posterior tympanotomy. The question raised in this work is
whether mastoidectomy is indispensable in CI surgery. MATERIAL AND METHODS: The
advantages and disadvantages of performing mastoidectomy during CI surgery were
weighed, in particular the effect of mastoidectomy on chronic secretory otitis
media (SOM) and the ability of the electrode to expand in the mastoid during
skull growth. RESULTS: No effect of mastoidectomy on chronic SOM was found and
the assumption that the electrode in the mastoid cavity has the ability to expand
during skull growth was not proven. Eliminating mastoidectomy in CI surgery
simplifies the procedure, shortens the duration of surgery, minimizes the amount 
of drilling and provides broader, better exposure of the middle ear and
promontory. Mastoidectomy was found not to be obligatory in CI surgery and in
fact may have more disadvantages than advantages. CONCLUSION: The development of 
alternative CT techniques which eliminate the need for mastoidectomy is
justified.

PMID: 12701744 [PubMed - indexed for MEDLINE]

1699: Eur Arch Otorhinolaryngol. 2003 Sep;260(8):432-5. Epub 2003 Apr 8.

Meconium-stained amniotic fluid is not a risk factor for otitis media.

Straetemans M, Schönbeck Y, Engel JA, Zielhuis GA.

Department of Epidemiology and Biostatistics, University Medical Centre Nijmegen,
P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. M.Straetemans@epib.umcn.nl

It has recently been hypothesised that large amounts of amniotic fluid cellular
content (AFCC) in the middle ear may lead to chronic inflammation and predispose 
young children to recurrent middle ear infections. Because children born with
meconium-stained amniotic fluid (MSAF) have higher AFCC in the middle ear, we
performed a retrospective cohort study to determine whether children born with
MSAF had a higher risk of OM during infancy. Children born between May 1998 and
April 2000 formed two groups based on the absence or presence of MSAF at birth as
documented in the hospital birth records. In April 2002, home visits were made to
take tympanometric measurements and administer a questionnaire on OM history and 
possible confounders. Logistic regression models were constructed to assess odds 
ratios (OR) as a measure of the effect of MSAF on OM and to adjust for potential 
confounders. There were no differences in the point prevalence of a type-B
tympanogram at the home visit (OR 0.81; 95% confidence interval: 0.38-1.76).
Also, no statistically significant association was found between the proportion
of children with OM diagnosed in the 1st year of life (OR 0.86, 95% confidence
interval: 0.27-2.73) and in the proportion of children that had ever been
diagnosed with OM (OR 0.91, 95% confidence interval: 0.40-2.91). It can be
concluded that children born with MSAF do not constitute a high-risk group for OM
in early childhood. A long-term OM effect, especially in severe MSAF cases,
cannot be excluded.

PMID: 12682845 [PubMed - indexed for MEDLINE]

1700: Clin Otolaryngol Allied Sci. 2003 Apr;28(2):146-53.

The role of ventilation tube status in the hearing levels in children managed for
bilateral persistent otitis media with effusion.

MRC Multicentre Otitis Media Study Group.

The study determined the effects on hearing of the status of ventilation tubes,
using a combination of otoscopy and tympanometry to determine function, in
children managed for bilateral persistent otitis media with effusion (OME). The
subjects were aged between 3.5 and 7 years and had a documented history of
bilateral OME over a 12-week watchful waiting period associated with a hearing
impairment in both ears of >or= 20 dB HL. The children reported are those
randomized to the two surgical arms, both of which had bilateral myringotomy,
aspiration of middle ear fluid and insertion of Shepard ventilation tubes. One
arm furthermore received adenoidectomy. The data were analysed 'as treated' to
document therapeutic progress. Tubes confirmed to be functioning on otoscopy and 
tympanometry only partially alleviate the conductive impairment associated with
childhood OME (AC mean 12 dB HL, SD 4; ABG 13 dB, SD 7, 3 months post operation).
Thus, children with a functioning ventilation tube cannot be considered to have
'normal' hearing. Once the tube has extruded, ears that no longer have OME still 
have a small conductive hearing impairment (at 12 months AC 14 dB HL, SD 6; ABG
16 dB, SD 9) but this improves with time. In children with bilateral tubes, both 
remain functioning for a median duration of 21 weeks (IQR 10-40) and at least one
for a median of 40 weeks (IQR 24-61). Tube blockage significantly (P = 0.001)
increases the risk of extrusion (84% versus 44%). When inserted in children
between 3.5 and 7 years for OME, the otoscopic incidence of tube infection is low
(1%).

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial

PMID: 12680834 [PubMed - indexed for MEDLINE]

1701: Int J Pediatr Otorhinolaryngol. 2003 May;67(5):531-3.

Demonstration of RANTES and eosinophilic cataionic protein in otitis media with
effusion with allergy.

Jang CH, Kim YH.

Department of Otolaryngology, Wonkwang Medical School, Iksan 570-711, South
Korea. chul@wonkwang.ac.kr

Regulated upon activation, normal T cell-expressed and -secreted (RANTES) is a
chemokine which is an effective eosinophil and memory T cell chemoattractant and 
activator, and eosinophil is an important effector cell in allergic disease. It
may contribute to the pathogenesis of otitis media with effusion (OME).
Eosinophil cataionic protein (ECP), one of the major components of basic granules
of eosinophils which is identified in middle ear effusion (MEE). We measured
RANTES and ECP in MEEs of OME to determine whether RANTES is increased in the
MEEs of OME with allergy. We also evaluated the correlation between RANTES and
ECP to determine the role of RANTES as an eosinophil activator in the
pathogenesis in OME with allergy. Both RANTES and ECP in MEE of OME with allergy 
were significantly higher than controls. There was a significant correlation
between the contents of RANTES and ECP. Our results suggest the allergic role of 
chemokine in the pathogenesis of OME.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12697356 [PubMed - indexed for MEDLINE]

1702: Int J Pediatr Otorhinolaryngol. 2003 May;67(5):511-6.

Pathogens in acute otitis media--impact of intermittent penicillin V prophylaxis 
on infant nasopharyngeal flora.

Foglé-Hansson M, White P, Hermansson A.

Department of Otorhinolaryngology, Central Hospital, S-541 85 Skövde, Sweden.
margaretha.fogle-hansson@vgregion.se

OBJECTIVE: To investigate whether intermittent short-term courses of penicillin V
(PcV) administered as intermittent prophylaxis against acute otitis media (AOM)
during upper respiratory tract infections altered the nasopharyngeal bacterial
flora and/or its susceptibility to penicillin. METHODS: In a double blind,
placebo controlled study 70 children (30 in the PcV group and 40 in the placebo
group) were followed for 1 year. At episodes of upper respiratory tract infection
the children were given PcV or placebo and then seen by one of the investigators 
within 3 days. The tympanic membranes were examined by otomicroscopy and a
culture from the nasopharynx was obtained. If AOM was found PcV was given (25
mg/kg bw b.i.d) for 5 days. If the child presented normal eardrums or signs of
secretory otitis media (SOM) the study treatment was continued for a total of 5
days. All children were also examined bimonthly throughout the study irrespective
of episodes of URTI or AOM. RESULTS: No increase in the number of isolates of S. 
pneumoniae with reduced susceptibility to penicillin (MIC> or =0.125 mg/l) was
noted in either group compared with the incidence in the population in Sweden at 
the time of the study (when ca. 10% of pneumococci had a reduced susceptibility
to penicillin). The number of cultures positive for S. pneumoniae were
statistically reduced in children during treatment with PcV compared with
children receiving placebo, while the number of cultures positive for H.
influenzae and M. catarrhalis were unaffected. No increase in the number of
cultures positive for beta-lactamase producing H. influenzae was noted (ca. 10%).
CONCLUSION: Repetitive short term PcV courses during URTI in infants did not
increase the number of cultures positive for S. pneumoniae with reduced
susceptibility to penicillin or beta-lactamase producing H. influenzae.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 12697353 [PubMed - indexed for MEDLINE]

1703: S D J Med. 2003 Mar;56(3):103-7.

Middle ear pathogens in otitis-prone children.

Weiner R, Collison PJ.

A cohort of 191 children with recurrent otitis media and persistent middle ear
effusion underwent myringotomy and tubes, at which time middle ear cultures were 
taken. The indications, fluid type, culture and sensitivity results, and pre- and
post-procedure frequency of otitis media were evaluated. Sixty-seven percent of
the effusions were mucoid in nature, and 24% of cultures grew pathogens,
including Hemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis,
and Staphylococcus aureus in that order of frequency. A relatively high rate of
antibiotic resistance was noted, with 75% of Streptococcus pneumoniae being
penicillin resistant. Prognosis with respect to recurrent otitis media was
favorable after myringotomy and tubes, even in children with antibiotic-resistant
organisms.

PMID: 12693271 [PubMed - indexed for MEDLINE]

1704: Clin Microbiol Rev. 2003 Apr;16(2):230-41.

Importance of respiratory viruses in acute otitis media.

Heikkinen T, Chonmaitree T.

Department of Pediatrics, Turku University Hospital, Turku, Finland.
terho.heikkinen@utu.fi

Acute otitis media is usually considered a simple bacterial infection that is
treated with antibiotics. However, ample evidence derived from studies ranging
from animal experiments to extensive clinical trials supports a crucial role for 
respiratory viruses in the etiology and pathogenesis of acute otitis media. Viral
infection of the upper respiratory mucosa initiates the whole cascade of events
that finally leads to the development of acute otitis media as a complication.
The pathogenesis of acute otitis media involves a complex interplay between
viruses, bacteria, and the host's inflammatory response. In a substantial number 
of children, viruses can be found in the middle-ear fluid either alone or
together with bacteria, and recent studies indicate that at least some viruses
actively invade the middle ear. Viruses appear to enhance the inflammatory
process in the middle ear, and they may significantly impair the resolution of
otitis media. Prevention of the predisposing viral infection by vaccination
against the major viruses would probably be the most effective way to prevent
acute otitis media. Alternatively, early treatment of the viral infection with
specific antiviral agents would also be effective in reducing the occurrence of
acute otitis media.

Publication Types: 
    Review

PMID: 12692096 [PubMed - indexed for MEDLINE]

1705: Pediatr Infect Dis J. 2003 Apr;22(4):309-14.

Early versus delayed insertion of tympanostomy tubes for persistent otitis media:
developmental outcomes at the age of three years in relation to prerandomization 
illness patterns and hearing levels.

Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Colborn DK, Bernard BS,
Rockette HE, Janosky JE, Pitcairn DL, Sabo DL, Kurs-Lasky M, Smith CG.

Department of Pediatrics, Children's Hospital of Pittsburgh, 3705 Fifth Avenue,
Pittsburgh, PA 15213-2538, USA. jpar@pitt.edu

BACKGROUND: Whether prompt insertion of tympanostomy tubes in children with
persistent early life otitis media prevents or minimizes subsequent developmental
impairment has been the subject of conflicting opinions and differing approaches 
to management. METHODS: We randomly assigned 429 children with persistent middle 
ear effusion (MEE) before the age of 3 years to have tympanostomy tubes inserted 
either as soon as possible or up to 9 months later if MEE persisted. In 402 of
these children, we found no significant differences at age 3 years between the 2 
treatment groups in mean scores on any measure of speech, language and cognition 
and in 401 of the children no significant differences in measures of psychosocial
development. We then examined outcomes within subgroups of children who might
have been the most severely affected, namely those who had been randomized on the
basis of bilateral, continuous MEE rather than unilateral and/or discontinuous
MEE and those who had the greatest degrees of hearing loss. RESULTS: In none of
the subgroups we considered were scores on any outcome measure significantly more
favorable in children in the early treatment group than in children in the late
treatment group. CONCLUSIONS: In otherwise normal children who have MEE, during
the first 3 years of life within the durations we studied, prompt insertion of
tympanostomy tubes does not measurably improve developmental outcomes at age 3
years, irrespective of whether MEE has been continuous or discontinuous and
unilateral or bilateral and whether or not MEE has been accompanied by mild to
moderate hearing loss.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12690269 [PubMed - indexed for MEDLINE]

1706: Drug Saf. 2003;26(6):405-20.

A benefit-risk assessment of ofloxacin otic solution in ear infection.

Wai TK, Tong MC.

Division of Otorhinolaryngology, Department of Surgery, University of Hong Kong, 
Prince of Wales Hospital, Shatin, New Territories, Hong Kong.

Ofloxacin is a fluoroquinolone antibacterial with potent bactericidal activities 
and the topical otological preparation of this drug has been clinically utilised 
since the late 1980s. The rate of eradication with ofloxacin ranges from 83.3% to
100% for all pathogens commonly isolated from middle ear effusions in cases of
otitis media and otitis externa. Despite the significant length of its usage,
emergence of resistant pathogens has been rarely encountered in clinical trials; 
only two strains of Pseudomonas aeruginosa have been documented with decreased
susceptibility to ofloxacin following the use of the otic solution.Ear
infections, including otitis externa, chronic suppurative otitis media and
otorrhoea associated with tympanostomy tubes, are common problems in clinical
practice. The potential complications associated with ear infection can be
otological, extratemporal, or even psychosocial. They are sometimes fatal and the
effect can be long-lasting and detrimental. The use of an effective topical
antibacterial with high cost-effectiveness is definitely warranted. As regards
various clinical aspects, including overall success rate, symptomatic relief of
otalgia and otorrhoea, ofloxacin otic solution was found to be more effective
than comparator agents, be it a topical antibacterial, a systemic antibacterial
or combination drugs.The systemic absorption of fluoroquinolones is minimal after
topical application. Ofloxacin otic solution 0.3% has been shown to have a low
rate of adverse drug reactions. Adverse reactions to ofloxacin otic solution were
generally mild. The lack of ototoxic effect from ofloxacin eardrops, even in the 
concentration higher than 0.3%, has been demonstrated in animal studies. In the
clinical setting, no increase in bone-conduction threshold has been shown after
the treatment of topical ofloxacin otic solution. There have not been any reports
of ototoxicity with ofloxacin otic solution since its approval.To conclude,
ofloxacin otic solution 0.3% is clinically effective in the treatment of otitis
externa and chronic suppurative otitis media in particular with respect to the
overall cure rate, relief of otalgia and otorrhoea. It is well tolerated, with
minimal adverse effects. It is not associated with any ototoxicity both
experimentally and clinically.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 12688832 [PubMed - indexed for MEDLINE]

1707: Eur Arch Otorhinolaryngol. 2003 Mar;260(3):141-7. Epub 2002 Oct 3.

Mucin in middle ear effusions inhibits attachment of Haemophilus influenzae to
mucosal epithelial cells.

Solzbacher D, Hanisch FG, van Alphen L, Gilsdorf JR, Schroten H.

Department of Otorhinolaryngology, University of Essen, Essen, Germany.

Although otitis media with effusion is often preceded by an infection of the
tympanic cavity, when cultured, many effusions show no culturable bacteria. Based
on the hypothesis that the effusion might play a protective role in the course of
infection, the influence of this fluid on adhesion of H. influenzae (Hi) type-b
strain 770235 and nontypeable H. influenzae (NTHi) strains to buccal epithelial
cells was investigated. Effusions were classified as mucoid, seromucoid and
serous. Mucoid secretions inhibited adhesion to a significantly greater extent
(62%) than did seromucous (52%) and serous effusions (47%) ( P<0.001). The
glycoprotein and high-molecular-weight fractions showed similar levels of
inhibition. Sialic acid concentration, and, to a lesser extent, protein
concentration, correlated with the level of inhibition. Desialylated effusions
lost their ability to block bacterial attachment. Thus, middle ear effusion fluid
exhibits an inhibitory effect that is due to mucins, which determine viscosity
and represent the sialylated high-molecular-weight glycoprotein fraction of the
effusion.

Publication Types: 
    In Vitro

PMID: 12687386 [PubMed - indexed for MEDLINE]

1708: WMJ. 2001;100(8):55-9.

Feasibility survey for a study on selective antibiotic management of acute otitis
media.

Yen K, Walsh-Kelly C, Hennes H.

Division of Pediatric Emergency Medicine, Medical College of Wisconsin,
Children's Hospital of Wisconsin, Milwaukee, WI, USA. kyen@mcw.edu

OBJECTIVE: To assess the views of community physicians on management of acute
otitis media (AOM) without antibiotics and their willingness to support research 
on this issue. METHODS: Community physicians who admit to a children's hospital
were surveyed using a questionnaire containing questions on current issues in AOM
management and their willingness to support research on management of AOM without
antibiotics. RESULTS: Fifty-two percent of the surveys were returned. All
respondents report concern about antibiotic resistant bacteria. Sixty-three
percent treat otitis media with effusion with antibiotics and 68% give
prophylactic antibiotics for recurrent otitis media. Thirty-five percent consider
management of AOM without antibiotics as a possible alternative management
practice. Forty-five percent of the respondents are willing to support research
in this practice and 46% need more information. CONCLUSIONS: Surveyed physicians 
indicate concern about antibiotic resistance and a willingness to support further
research on the initial management of acute otitis media without antibiotics.

PMID: 12685298 [PubMed - indexed for MEDLINE]

1709: J Nucl Med. 2003 Apr;44(4):559-64.

Radio-tympano-sinu-orthesis with 186Re-colloid: a new treatment modality for
chronic otitis media and paranasal mucositis.

Kampen WU, Godbersen GS, Czech N, Besch OF, Brenner W, Henze E.

Clinic of Nuclear Medicine, Christian-Albrechts-University, Arnold-Heller-Strasse
9, D-24105 Kiel, Germany. ukampen@nuc-med.uni-kiel.de

This preliminary treatment trial was performed to evaluate the safety and
clinical efficacy of intracavitary therapy with (186)Re-colloid in patients with 
recurrent otitis media and paranasal sinusitis, resistant to pharmacotherapy and 
surgical treatment. METHODS: Thirty-nine applications of 5-35 MBq (186)Re-colloid
into the tympanon and the paranasal sinuses were performed in 6 patients.
Biodistribution and biokinetics were studied by gamma-camera imaging. Clinical
success was documented 6-20 mo after therapy by each patient's self-evaluation
and by rhinootologic follow-up, using a 4-step score. RESULTS: No harmful side
effects were seen. There was good-to-excellent clinical improvement with a score 
of +1.44 +/- 0.5 by each patient's self-evaluation and by physicians scoring of
+0.81 +/- 0.9 with only negligible extracranial tracer deposition. CONCLUSION:
This novel treatment option using intracavitary application of (186)Re-colloid in
chronic otitis media and sinusitis is safe and effective. The term
"radio-tympano-sinu-orthesis" might be proposed analogously to the well-known
radiosynoviorthesis.

Publication Types: 
    Clinical Trial

PMID: 12679400 [PubMed - indexed for MEDLINE]

1710: East Afr Med J. 2002 Dec;79(12):665-6.

Multiple cranial nerve palsies complicating tympanomastoiditis: case report.

Oyatsi DP.

Department of Paediatrics and Child Health, College of Health Sciences,
University of Nairobi, P.O. Box 19676, Nairobi, Kenya.

Otitis media either acute or chronic, is not uncommon in childhood. Multiple
cranial nerve palsies occuring as a complication of either form of otitis media
is unusual. A case of a nine year old boy with chronic suppurative otitis media
with associated mastoiditis complicated with ipsilateral multiple cranial nerve
palsies is presented. A skull X-ray and MRI scan showed sclerotic mastoids. The
outcome on antibiotic treatment was good.

Publication Types: 
    Case Reports

PMID: 12678451 [PubMed - indexed for MEDLINE]

1711: J Infect Chemother. 2003 Mar;9(1):46-52.

Current status of bacterial resistance in the otolaryngology field: results from 
the Second Nationwide Survey in Japan.

Suzuki K, Nishimura T, Baba S.

Department of Otolaryngology, Second Affiliated Hospital, Fujita Health
University, 3-6-10 Otobashi, Nakagawa-ku, Nagoya 454-8509, Japan.
ken-suzu@fujita-hu.ac.jp

The study reported here was a nationwide assessment of otitis media (466 patients
with acute suppurative otitis media and 476 with chronic suppurative otitis
media), sinusitis (447 with acute sinusitis and 426 with chronic sinusitis),
acute tonsillitis (724 patients), and peritonsillar abscess (141 patients)
performed between November 1998 and March 1999. Eighty university hospitals, 79
affiliated hospitals, and 103 general practitioners participated.
Methicillin-resistant Staphylococcus aureus(MRSA) comprised 15.6% of the 786
isolated strains of S. aureus. MRSA was frequently detected in patients with
suppurative otitis media, but was uncommon in those with acute tonsillitis or
peritonsillar abscess, and it was more common in those who had already been
treated than in those who had not, with a significant difference between the
groups. Vancomycin (VCM) showed the highest antimicrobial activity against MRSA
and no VCM resistance was detected. Penicillin-sensitive Streptococcus
pneumoniae(PSSP), penicillin-intermediate-resistant S. pneumoniae (PISP), and
penicillin-resistant S. pneumoniae (PRSP) accounted for 49.6%, 28.5%, and 21.9%
of the 228 isolated strains of S. pneumoniae, respectively. PISP and PRSP were
frequently detected in children aged 5 years or younger. beta-Lactamase was
produced by 96 of the 100 strains (96%) of Moraxella (Branhamella) catarrhalis.
The 281 strains of Haemophilus influenzae isolated consisted of 199
beta-lactamase-negative, ampicillin-sensitive (BLNASe) strains (70.8%), 65
beta-lactamase-negative ampicillin-resistant (BLNAR) strains (23.1%), and 17
beta-lactamase-producing strains (6.0%). BLNAR strains were frequently detected
in pretreated patients. Of these 281 strains of H. influenzae, 214 had nontypable
capsules. In conclusion, the major bacterial species showed resistance to
beta-lactams, indicating that care should be taken when selecting an appropriate 
antimicrobial agent.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12673407 [PubMed - indexed for MEDLINE]

1712: Laryngoscope. 2003 Apr;113(4):583-91.

Laser eustachian tuboplasty: a preliminary report.

Poe DS, Metson RB, Kujawski O.

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear
Infirmary, Harvard Medical School, Boston, Massachusetts, USA. dpoe@massmed.org

OBJECTIVES/HYPOTHESIS: Surgical correction of eustachian tube dysfunction remains
an elusive challenge. Repeat ventilation tube placement is often inadequate to
prevent tympanic membrane and middle ear complications. Endoscopic analyses of
eustachian tube dynamics have localized the site of primary pathophysiology to
within the cartilaginous tube. The study investigated the feasibility, safety,
and efficacy of a new endoluminal eustachian tube operation for the treatment of 
eustachian tube dysfunction. STUDY DESIGN: Prospective, institutional review
board-approved surgical trial in a tertiary-care medical center. METHODS: Ten
patients with more than 5 consecutive years of intractable otitis media with
effusion recurring after two or more tympanostomy tube placements were treated
with unilateral laser eustachian tuboplasty. Surgery was performed on an
outpatient basis with the use of general anesthesia and combined both transnasal 
and transoral approaches. A 980-nm diode or argon laser was used to vaporize an
appropriate amount of mucosa and cartilage on the posterior wall of the tubal
lumen. Preoperative and postoperative dynamic video eustachian tube function
analyses were compared. Outcome measures were presence or absence of middle ear
effusion and impedance tympanograms. RESULTS: Five patients had at least 12
months of follow-up, and three of them had absence of any effusion (60%). Two
patients had recurrence of their otitis media with effusion and required
tympanostomy tubes again. Five patients had at least 6 months of follow-up, and
four of them had absence of any effusion. The remaining patient had recurrence of
otitis media with effusion and received a tympanostomy tube again. Overall
results for all 10 patients after 6 months were 7 free of effusion (70%). There
were no intraoperative complications. Postoperative complications were limited to
minimal peritubal adhesions and one intranasal synechia. CONCLUSIONS: Preliminary
results suggest that laser eustachian tuboplasty is safe and efficacious in the
treatment of intractable eustachian tube dysfunction. Further study will be
necessary to determine whether laser eustachian tuboplasty is a suitable
alternative to repeated tympanostomy tube placement in selected patients.

Publication Types: 
    Clinical Trial

PMID: 12671411 [PubMed - indexed for MEDLINE]

1713: Pediatrics. 2003 Apr;111(4 Pt 1):e304-8.

Hearing deficits in young adults who had a history of otitis media in childhood: 
use of personal stereos had no effect on hearing.

de Beer BA, Graamans K, Snik AF, Ingels K, Zielhuis GA.

Department of Otorhinolaryngology, University Medical Center Nijmegen, Nijmegen, 
The Netherlands. b.debeer@kno.umcn.nl

OBJECTIVE: To test the hypothesis proposed in a recent French study that a
history of recurrent otitis media (OM) in childhood increases susceptibility to
hearing loss from frequent exposure to a personal stereo (PS) during development 
to early adulthood. METHODS: A subcohort of 358 young adults selected from a
historic cohort study, all 18 years old and with a well-documented OM history
(secretory and acute), provided data on the sound level and length of exposure to
PSs. Four contrasting groups were formed: those with the highest or lowest PS
exposure combined with a positive or negative history of OM (n = 238). The main
outcome measure was hearing thresholds from pure-tone audiometry (0.5-8 kHz).
RESULTS: Young adults with a history of recurrent OM in childhood did not show
greater susceptibility to hearing loss from PS use than their peers without a
history of OM. However, a history of recurrent OM was associated with significant
mean air-conduction hearing loss of 4 dB and a mean bone-conduction hearing loss 
of 2 dB compared with the participants without a history of OM (Fig 1).
CONCLUSIONS: Recurrent OM in childhood may have an irreversible effect on the
middle ear and the cochlea and may lead to hearing deficits in later life. No
interaction with PS exposure is seen.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12671143 [PubMed - indexed for MEDLINE]

1714: J S Afr Vet Assoc. 2002 Dec;73(4):162-70.

Diagnosis and medical treatment of otitis externa in the dog and cat.

Jacobson LS.

Department of Companion Animal Clinical Studies, Faculty of Veterinary Science,
University of Pretoria, Private Bag X04, Onderstepoort, 0110 South Africa.
linda@frcs.alt.za

Otitis externa is no longer viewed as an isolated disease of the ear canal, but
is a syndrome that is often a reflection of underlying dermatological disease.
Causes are classified as predisposing (increase the risk of otitis); primary
(directly induce otitis), secondary (contribute to otitis only in an abnormal ear
or in conjunction with predisposing factors) and perpetuating (result from
inflammation and pathology in ear, prevent resolution of otitis). Common primary 
causes include foreign bodies, hypersensitivity (particularly atopy and food
allergy), keratinisation disorders (most commonly primary idiopathic seborrhoea
and hypothyroidism) and earmites, particularly in cats. A systematic diagnostic
procedure is required to identify causes and contributing factors. This should
include history, clinical examination, otoscopy and cytology in all cases and
culture and sensitivity as well as otitis media assessment and biopsy in severe
and recurrent cases. Ancillary tests may be required depending on the underlying 
cause. Treatment consists of identifying and addressing predisposing and primary 
factors; cleaning the ear canal; topical therapy; systemic therapy where
necessary; client education; follow-up; and preventive and maintenance therapy as
required.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 12665128 [PubMed - indexed for MEDLINE]

1715: Int J Pediatr Otorhinolaryngol. 2003 Apr;67(4):417-20.

All that drains is not infectious otorrhea.

Dohar JE.

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 3705
Fifth Avenue, PA 15213, USA. joseph.dohar@chp.edu

It has been said that, 'All that wheezes is not asthma.' Thus, is also so of
otorrhea. Bacterial infection most often causes otorrhea which, in turn,
generally responds to treatment with ototopical antimicrobial therapy. When it
persists, non-infectious etiologies must be considered. Although allergic causes 
of otorrhea have been described in the literature, inhalant environmental
allergens (Type I Allergy) causing eustachian tube dysfunction or ototopical
drops, most notoriously neomycin containing formulations, causing contact
dermatitis are those usually mentioned. Further, most reports of contact allergic
reactions of the ear have involved the external auditory canal skin or pinna and 
have been attributed to non-medicinal triggers like shampoos and metals used in
ear rings. A search of the literature failed to reveal a reported case of
recurrent or chronic otorrhea without cholesteatoma due to an allergic reaction
to the components of a tympanotomy tube (TT). Such a case is presented here.

Publication Types: 
    Case Reports

PMID: 12663117 [PubMed - indexed for MEDLINE]

1716: Int J Pediatr Otorhinolaryngol. 2003 Apr;67(4):409-12.

Hyper immunoglobulin-E syndrome: a case with chronic ear draining mimicking
polypoid otitis media.

Görür K, Ozcan C, Unal M, Akbaş Y, Vayisoğlu Y.

Fatih mah, Babil cad, Girne sitesi, D. blok, No: 1/1. 33170 Mezitli, Mersin,
Turkey. kgorur@mersin.edu.tr

The hyper-IgE syndrome is a rare, complex immunoregulatory disorder characterized
by pruritic dermatitis, recurrent staphylococcus skin abscesses and extremely
elevated levels of IgE in serum. In this report, an 8-year-old girl with
hyper-IgE syndrome is presented. She had pruritic dermatitis and skin abscesses
on her extremities and scalp. Discharge and granulation tissue in right external 
ear canal were recognized in otorhinolaryngologic examination. Cultures of the
suppuration of the external ear canal yielded S. aureus. Biopsy of the lesion was
reported as granulation tissue. Local treatment of the ear canal was performed
with ear wick soaked with steroid and antibiotic solutions two times per day.

Publication Types: 
    Case Reports

PMID: 12663115 [PubMed - indexed for MEDLINE]

1717: Int J Pediatr Otorhinolaryngol. 2003 Apr;67(4):313-6.

Emergence of ciprofloxacin-resistant pseudomonas in pediatric otitis media.

Jang CH, Park SY.

Department of Otolaryngology, Wonkwang Medical School, Iksan 570-711, Republic of
Korea. chul@wonkwang.ac.kr

OBJECTIVE: The widespread use of fluoroquinolone otic drops has resulted in the
emergence and subsequent increase of fluoroquinolone resistance, at rates greater
than anticipated. To evaluate the patients with recurrent otorrhea that were
unresponsive to topical ciprofloxacin. METHODS: Seventeen pediatric patients who 
were treated with refractory otorrhea between 2000 and 2001 were reviewed
retrospectively. RESULTS: All patients had ciprofloxacin-resistant pseudomonas on
culture and sensitivity test. Ciprofloxacin-resistant pseudomonas from these
patients were multidrug resistant. Imipenem was the most sensitive antibiotic
agent, followed by amikacin. Most patients were treated with intramuscular
amikacin and two patients were treated with intravenous imipenem. CONCLUSION: In 
our series, resistance to cirpfloxacin in patients with otitis media is
increasing recently. Culture and antibiotic sensitivity test may help guide
management. Continuous surveillance is necessary to monitor antibiotic resistance
and to guide antibacterial therapy.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12663100 [PubMed - indexed for MEDLINE]

1718: J Huazhong Univ Sci Technolog Med Sci. 2002;22(2):168-70.

A retrospective study on cholesteatoma otitis media coexisting with cholesterol
granuloma.

Luo L, Gong S, Bai G, Wang J.

Department of Otolaryngology, Xiehe Hospital, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan 430022.

To investigate the etiology and pathogenesis of cholesteatoma otitis media
accompanied by cholesterol granuloma and the relationship between cholesteatoma
and cholesterol granuloma, 63 cases of middle ear cholesterol granuloma treated
in our hospital during the period from March 1988 to May 2000 were
retrospectively reviewed. All cases were surgically and pathologically verified. 
15 cases of cholesteatoma coexisting with cholesterol granuloma were found among 
the 63 patients. All 15 cases had a long-term history of otitis media, such as
otorrhea (sanguine purulent otorrhea and bloody otorrhea in 8 cases) and
perforation of the eardrum (perforation of pars flaccida in 8 cases). Temporal
bone CT scans showed cholesteatoma in 11 cases. All patients were treated
surgically, and cholesteatoma and cholesterol granuloma were found coexisting
alternately, the latter lying mainly in the tympanic antrum, attic and mastoid
air cells. Chocolate-colored mucus was accumulated in well-developed mastoid air 
cells, and glistening dotty cholesterol crystals were also found. In most cases, 
enlarged aditus, destruction of lateral attic wall, erosion of ossicular chain,
exposure of horizontal segment of facial nerve and tegmen of attic were observed.
Occlusion of Eustachian tube was noted in 6 cases, and occlusion of tympanic
isthmus was revealed in all cases. A post-operative dry ear was achieved in all
patients, and hearing improvement was achieved in all 12 cases following
tympanoplasty. Cholesteatoma and cholesterol granuloma in middle ear may share a 
common pathophysiological etiology: occlusion of ventilation and disturbance of
drainage. The diagnosis should be considered when patients presented with chronic
otitis media with bloody otorrhea. CT and magnetic resonance imaging are useful
for the diagnosis before operation. The surgical approach depends on the
location, extension and severity of the lesion. The purpose of surgery is to
remove the lesion and create an adequate drainage.

PMID: 12658765 [PubMed - indexed for MEDLINE]

1719: Ann Otol Rhinol Laryngol. 2003 Mar;112(3):252-7.

Multiplex nested reverse transcription-polymerase chain reaction for respiratory 
viruses in acute otitis media.

Ishibashi T, Monobe H, Nomura Y, Shinogami M, Yano J.

Department of Otolaryngology, Social Insurance Central General Hospital, Tokyo,
Japan.

Because respiratory viruses play an important role in the causation and
pathogenesis of acute otitis media (AOM), determining which virus has infected a 
child is important with respect to vaccines and antiviral drugs. In some
instances, this information might be used to prevent the occurrence of AOM. We
used a rapid, economical, and sensitive diagnostic system involving a multiplex
nested reverse transcription-polymerase chain reaction (RT-PCR) assay to detect
various respiratory viruses in clinical specimens of middle ear fluid (MEF) from 
children with AOM in our hospital. Multiplex RT-PCR was completed on 40 MEF
samples from 28 infants and children less than 6 years old with AOM. Viral RNA
was detected in 17 MEF samples (43%). Respiratory syncytial virus type A was
present in 12 samples, adenovirus in 3, rhinovirus in 2, and influenza A (H3N2)
in 1. The multiplex RT-PCR assay is recommended to clinical laboratories that are
considering adoption of a molecular technique for viral diagnosis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12656418 [PubMed - indexed for MEDLINE]

1720: Ann Otol Rhinol Laryngol. 2003 Mar;112(3):230-5.

Barotrauma vis-a-vis the "chronic otitis media syndrome": two conditions with
middle ear gas deficiency Is secretory otitis media a contraindication to air
travel?

Sadé J, Ar A, Fuchs C.

Ear Research Laboratory, Department of Biomedical Engineering, The Sackler
Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

We compared 17 patients (29 ears) with barotrauma with 171 patients suffering
from "chronic ears" (secretory otitis media, atelectasis, or previously operated 
cholesteatoma). The patients with "chronic ears" were followed up prospectively, 
and none were found to suffer from barotrauma after flying on a commercial
airplane. The mastoid pneumatization (seen on lateral mastoid radiographs) was
significantly larger in ears with barotrauma, averaging 16.85 cm2, versus 12.9
cm2 in normal controls, whereas in "chronic ears" it was only 3.6 cm2. During
flight on a commercial airplane, the middle ear has to equalize about 20% of its 
gas volume with the ambient pressure. This equalization must happen within 15 to 
20 minutes of ascent and descent in order to avoid barotrauma. This 20% is a
fivefold greater task for ears with a large mastoid pneumatization than for ears 
with an undeveloped pneumatization; "chronic ears" usually have an undeveloped
mastoid pneumatization. The smaller the middle ear (mastoid) volume, the smaller 
the volume of gas needed to pass through the eustachian tube in order to equalize
pressure changes during flying. This factor may explain why "chronic ears" rarely
suffer from barotrauma. It also implies that eustachian tubes of secretory
otitis, atelectatic, and cholesteatomatous ears have little problem in equalizing
large pressure differences (over 2,000 mm H2O) within 15 to 20 minutes of
landing, in contrast to what has been traditionally believed. Individuals with
"chronic ears" can be advised that they can fly safely.

Publication Types: 
    Comparative Study

PMID: 12656414 [PubMed - indexed for MEDLINE]

1721: Antimicrob Agents Chemother. 2003 Apr;47(4):1355-63.

Pharmacokinetics and efficacy of linezolid in a gerbil model of Streptococcus
pneumoniae-induced acute otitis media.

Humphrey WR, Shattuck MH, Zielinski RJ, Kuo MS, Biermacher JJ, Smith DP, Jensen
JL, Schaadt RD, Zurenko GE, Richards IM.

Pharmacia Corporation, Kalamazoo, Michigan 49007, USA.
william.r.humphrey@pharmaia.com

The oxazolidinone linezolid represents a new antibacterial class of potential
benefit in managing multidrug-resistant gram-positive infections, including those
caused by Streptococcus pneumoniae. In a gerbil model of acute otitis media (AOM)
induced by either penicillin-resistant S. pneumoniae (PRSP; amoxicillin MIC = 8
micro g/ml, linezolid MIC = 1 micro g/ml) or penicillin-susceptible S. pneumoniae
(PSSP; amoxicillin MIC = 0.015 micro g/ml, linezolid MIC = 1 micro g/ml), we
explored the plasma and ear fluid levels of linezolid required to demonstrate
efficacy. Threshold pathogen doses required to induce bilateral AOM (1,500
CFU/ear with PRSP; 30 CFU/ear with PSSP) were administered to gerbils by
intrabullar injection on day 0. At peak infection ( approximately 10(6) to 10(7) 
CFU/ear flush; day 2 for PRSP-AOM and day 3 for PSSP-AOM), twice-a-day oral doses
of linezolid, amoxicillin, or vehicle were administered over 4.5 days prior to
collection and assay of middle ear effluents for S. pneumoniae content. Linezolid
doses of >/=10 mg/kg of body weight induced significant cure rates of >/=72%
versus both PRSP and PSSP infections, whereas amoxicillin at </=100 mg/kg was
consistently effective only versus PSSP-AOM. Plasma and ear fluid levels of
linezolid necessary to elicit pneumococcal eradication from the middle ear were
measured by high-performance liquid chromatography-tandem mass spectrometry and
found to be similar both within and between each infection protocol. The
plasma-ear fluid pharmacodynamic profile associated with linezolid efficacy was a
T>MIC of >/=42%, a C(max)/MIC ratio of >/=3.1, and a (24-h area under the
curve)/MIC ratio of >/=30 h. Application of this model will be useful in defining
preclinical pharmacodynamic relationships of novel antibiotics necessary to cure 
S. pneumoniae-induced AOM.

PMID: 12654670 [PubMed - indexed for MEDLINE]

1722: J Laryngol Otol. 2003 Mar;117(3):195-7.

The Canterbury technique for canalplasty via an endaural approach in the surgical
management of chronic refractory otitis externa.

Sharp HR, Oakley RJ, Padgham ND.

Department of Otolaryngology, Royal Surrey County Hospital, Guildford, UK.

We describe an endaural technique for soft tissue and bony meatoplasty and
canalplasty in the surgical management of chronic otitis externa unresponsive to 
medical treatment and out-patient microsuction. Following analysis of the
surgical outcome via a retrospective review of patient records, we would
recommend this surgical treatment in this patient group.

PMID: 12648375 [PubMed - indexed for MEDLINE]

1723: J Laryngol Otol. 2003 Mar;117(3):177-81.

Mastoiditis in children.

Khan I, Shahzad F.

Department of Otolaryngology, Federal Government Services Hospital, Islamabad,
Pakistan. ike@isb.compol.com

Fifty-two children with mastoiditis were treated at the Federal Government
Services Hospital over a period of 15 years (from 1986 to 2000). The salient
feature in these cases was the presence of a post-auricular swelling and mastoid 
abscess. Extensive cholesteatoma was seen in 80.7 per cent of cases and 19.3 per 
cent had granulations in the mastoid cavity. Significantly, all patients had a
history of chronic ear discharge prior to abscess formation. These children
belonged to poor communities, were malnourished and attended hospital in a state 
of emergency. The presentation and course of the disease confirms the aggressive 
and potentially serious nature of the pathology requiring early medical attention
in order to avert impending complications. It appears that in our environment
acute mastoiditis with abscess formation develops from chronic otitis media and
the cholesteatoma. The surgical procedures conducted in these cases were radical 
and modified radical mastoidectomy.

PMID: 12648371 [PubMed - indexed for MEDLINE]

1724: J Laryngol Otol. 2003 Mar;117(3):173-6.

Failure of antibiotic therapy in acute otitis media.

Babin E, Lemarchand V, Moreau S, Goullet de Rugy M, Valdazo A, Bequignon A.

Department of Otolaryngology - Head and Neck Surgery, Caen University Hospital,
F-14033 Caen Cedex, France. babin-e@chu-caen.fr

The aim of this retrospective study was to determine the possible causes of
failure of antibiotic therapy in children with acute otitis media (AOM).
Thirty-nine samples of middle-ear fluid were obtained by myringotomy from 31
children suffering from AOM, unrelieved by antibiotic therapy administered for
over 48 hours. The samples were analysed by the usual microbiological techniques,
including cultures, tests for beta-lactamase producing strains and the
determination of the minimal inhibitory concentration of penicillin for
Streptococcus pneumoniae. In 14 samples, no bacterial strains were detected in
the cultures of middle-ear fluid; and in two samples the cultures revealed two
strains of bacteria. The bacteria most frequently identified were Haemophilus
influenzae, found in 11 samples, and Streptococcus pneumoniae, found in seven
samples, of which four produced strains with reduced susceptibility to
penicillin. The failure of antibiotic therapy in AOM appears to be related to the
increased resistance of Haemophilus influenzae and to the reduced susceptibility 
of Streptococcus pneumoniae to penicillin. Other factors contributing to the
failure of antibiotic therapy in AOM may be the viruses or the bacteria that
produce multiple pathogens in the middle ear.

PMID: 12648370 [PubMed - indexed for MEDLINE]

1725: J Laryngol Otol. 2003 Mar;117(3):169-72.

Bacterial aetiology of non-resolving otitis media in South African children.

Huebner RE, Wasas AD, Hockman M, Klugman KP; ENT Study Group.

Respiratory and Meningeal Pathogens Research Unit of the MRC/NHLS/University of
the Witwatersrand, Johannesburg, South Africa.

Little is known of the aetiology, serotypes or susceptibility of the pathogens
causing non-resolving otitis media in children receiving care from specialists in
private practice in developed or in developing countries. Increased access to
antibiotics in the community amongst children receiving such private care in
South Africa may be anticipated to lead to levels of resistance similar to those 
found in countries with similar models of private practice, such as the United
States. This study was conducted to determine the aetiology of non-resolving
otitis media in South African children receiving private care and to determine
the antimicrobial resistance patterns and serotypes of the bacterial isolates.
Middle-ear fluid was cultured from 173 children aged two months to seven years
with non-resolving acute otitis media accompanied by persistent pain or fever who
were referred to otorhinolaryngologists for drainage of middle-ear fluid within
14 days of the start of symptoms. While 92 per cent of the children had recently 
received antibiotics and 54 per cent were currently receiving them, bacteria were
isolated from 47 children (27 per cent). Streptococcus pneumoniae was the most
common pathogen (35), followed by Haemophilus influenzae (nine), Staphylococcus
aureus (six), Moraxella catarrhalis (two), Streptococcus pyogenes (two) and
Pseudomonas aeruginosa (one). Two isolates were identified in each of eight
children. Antimicrobial resistance to one or more antibiotics was found in 33/35 
(94 per cent) of the pneumococci isolated, with resistance to penicillin in 86
per cent, resistance to trimethoprim-sulfamethoxazole in 54 per cent and to
erythromycin and clindamycin in 69 per cent and 57 per cent, respectively. The
pneumococcal serotypes found were 19F (28 per cent), 14 (26 per cent), 23F (23
per cent), 6B (nine per cent), 19A (87 per cent), and four (three per cent).
Children with a bacterial pathogen isolated were younger (mean age of 17 months) 
than children from whom no bacteria were isolated (mean age of 23 months; p =
0.03). Isolation of a pneumococcus was also significantly associated with younger
age (mean = 16 months versus 22 months, p = 0.03), the presence of fever (OR =
2.15, p = 0.049), and having one or more prior episodes of otitis media within
the six months before tympanocentesis (OR = 7.72, p = 0.03). Almost all
pneumococci isolated from non-resolving acute otitis media in this community are 
antibiotic-resistant and should be considered especially in young children who
have failed previous therapy and who have non-resolving pain or fever.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12648369 [PubMed - indexed for MEDLINE]

1726: Int J Audiol. 2003 Mar;42(2):89-105.

Hearing loss induced by noise, ear infections, and head injuries: results from
the Nord-Trøndelag Hearing Loss Study.

Tambs K, Hoffman HJ, Borchgrevink HM, Holmen J, Samuelsen SO.

Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
kristian.tambs@folkehelsa.no

Pure-tone audiometry was administered to the adult population in Nord-Trøndelag
County, Norway, 1995-97. The 51,975 participants also provided questionnaire
information about occupational and leisure noise exposure, previous ear
infections, and head injury. Values averaged over both ears were calculated for
low (250 and 500 Hz), middle (1 and 2 kHz) and high frequencies (3, 4, 6 and 8
kHz). The aim was to estimate the magnitude of hearing loss associated with
various types of exposure by age and sex. Noise, ear infections and head injury
explained 1-6% of the variance in hearing loss (varying with age, sex, and
frequency range), in addition to what could be explained by age alone (30-58%).
Only moderate effects of noise could be detected among women. The upper tenth
percentile regarding occupational noise among men older than 44 years had on
average an 8-9-dB high-frequency loss, adjusted for other predictors. Exposure to
impulse noise (hunting, sports shooting) caused a 7-8-dB high-frequency loss in
the same group. No significant effects of frequent use of personal stereo players
or regular attendance at discotheques or rock concerts could be demonstrated.
There were clear effects of recurrent ear infections and head injury.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12641392 [PubMed - indexed for MEDLINE]

1727: Radiographics. 2003 Mar-Apr;23(2):359-72.

Imaging of complications of acute mastoiditis in children.

Vazquez E, Castellote A, Piqueras J, Mauleon S, Creixell S, Pumarola F, Figueras 
C, Carreño JC, Lucaya J.

Department of Pediatric Radiology, Area Materno-infantil, Hospital Universitario 
Vall d'Hebron, Psg Vall d'Hebron 119-129, E-08035 Barcelona, Spain.
evazquez@cs.vhebron.es

Acute mastoiditis is a serious complication of acute otitis media in children.
Suppurative disease in the mastoid region occasionally spreads to the adjacent
dura mater of the posterior and middle cranial fossae and the sigmoid sinus by
means of thrombophlebitis, osseous erosion, or anatomic pathways, producing
intracranial complications. Computed tomography (CT) should be performed early in
the course of the disease to classify the mastoiditis as incipient or coalescent 
and to detect intracranial complications. On the basis of the clinical features
and imaging findings, the disease is managed conservatively with intravenously
administered antibiotics or treated with mastoidectomy and drainage plus
antibiotic therapy. CT is therefore a decisive diagnostic tool in determining the
type of therapy. In addition, magnetic resonance imaging is performed in patients
with clinical symptoms or CT findings suggestive of intracranial complications
because of its higher sensitivity for detection of extraaxial fluid collections
and associated vascular problems. Copyright RSNA, 2003

PMID: 12640152 [PubMed - indexed for MEDLINE]

1728: Pediatr Infect Dis J. 2003 Mar;22(3):262-8.

Differences in nasopharyngeal bacterial flora in children with nonsevere
recurrent acute otitis media and chronic otitis media with effusion: implications
for management.

Marchisio P, Claut L, Rognoni A, Esposito S, Passali D, Bellussi L, Drago L,
Pozzi G, Mannelli S, Schito G, Principi N.

Department of Pediatrics, University of Milan, Italy.

BACKGROUND: The interactions between nasopharyngeal flora and the individual
entities covered by the broad term otitis media have not been completely
elucidated. We investigated in infants and children ages 6 months to 7 years with
nonsevere recurrent acute otitis media (rAOM) or with chronic otitis media with
effusion (cOME): (1) the nasopharyngeal carriage rate and bacterial density of
respiratory pathogens and alpha-hemolytic streptococci in comparison with healthy
children; (2) the resistance pattern of respiratory pathogens; and (3) the
relationship between the type of nasopharyngeal colonization and long term
outcome. METHODS: Nasopharyngeal cultures were obtained from 85 children with
rAOM,113 children with cOME and 55 controls. A semiquantitative analysis was used
in the reading of cultures. A 12-week follow-up without treatment was planned.
RESULTS: The carrier rate of respiratory pathogens was significantly greater in
cOME (70%) than in rAOM (45%) (P = 0.0006) or controls (31%) (P < 0.0001).
Similarly colonization density was significantly greater in cOME than in rAOM.
The carriage rate and the colonization density of alpha-hemolytic streptococci
were significantly lower in rAOM than in cOME or controls. The incidence of
resistant (R) strains was greater in rAOM (Streptococcus pneumoniae penicillin-R,
24%; macrolide-R, 64%; Haemophilus influenzae amoxicillin-R, 24%) compared with
cOME (S. pneumoniae penicillin-R,18%; macrolide-R, 44%; H. influenzae
amoxicillin-R, 5%) or controls (S. pneumoniae penicillin-R, 8%; macrolide-R, 23%;
H. influenzae amoxicillin-R, 10%). During the follow-up period persistence of OME
and occurrence of AOM were greater among carriers of respiratory pathogens at
baseline. CONCLUSIONS: There are substantial differences in nasopharyngeal flora 
between children with nonsevere rAOM and children with cOME. The results of
nasopharyngeal cultures should be taken into account to avoid treatment with
drugs that are ineffective and likely to select resistant organisms.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12634589 [PubMed - indexed for MEDLINE]

1729: Pediatr Infect Dis J. 2003 Mar;22(3):209-16.

Recurrent acute otitis media occurring within one month from completion of
antibiotic therapy: relationship to the original pathogen.

Leibovitz E, Greenberg D, Piglansky L, Raiz S, Porat N, Press J, Leiberman A,
Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center and the
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,
Israel. eugenel@bgumail.bgu.ac.il

OBJECTIVES: (1) To determine the relationship between acute otitis media (AOM)
pathogens isolated in cases of early clinical recurrence of AOM (occurring within
1 month from completion of therapy) to the original pathogens causing the initial
AOM episode; and (2) To determine whether shorter time intervals between
completion of antibiotic therapy and clinical recurrences of AOM are associated
with higher rates of true bacteriologic relapse. PATIENTS AND METHODS: From 1995 
through 2000, 1077 infants and young children ages 3 to 36 months with AOM were
enrolled in double tympanocentesis (performed on Day 1 in all patients and Days 4
to 6 in those initially culture-positive) studies. Of these, 834 (77%) completed 
successfully the antibiotic treatment [pathogen eradication on Days 4 to 6 of
therapy or no pathogen on middle ear fluid (MEF) culture on Day 1 and clinical
improvement at end of therapy]. Patients were followed for 3 to 4 weeks after
completion of therapy, and additional MEF cultures were obtained if clinical
recurrence occurred. True bacteriologic relapse was defined as the presence of a 
pathogen identical with that isolated before therapy by serotype and pulsed field
gel electrophoresis for and by pulsed field gel electrophoresis for Streptococcus
pneumoniae and beta-lactamase production for Haemophilus influenzae. RESULTS: MEF
cultures were performed in 108 consecutive patients with early recurrent AOM. One
hundred pathogens were isolated at recurrence in 88 of 108 (81%) patients: 54 H. 
influenzae; 45 S. pneumoniae; and 1 Moraxella catarrhalis. Most recurrent AOM
episodes developed during the first 2 weeks of follow-up; 39 (36%), 38 (35%), 21 
(19%) and 10 (9%) recurrent AOM episodes occurred on Days 1 to 7, 8 to 14, 15 to 
21 and 22 to 28 after completion of therapy, respectively. In most patients these
episodes were caused by a new pathogen. True bacteriologic relapses were found in
30 (28%) of 108 patients whose MEF cultures were positive for 35 pathogens: 13 of
108 (12%) S. pneumoniae; 12 of 108 (11%) H. influenzae; and 5 of 108 (5%) both.
When timing of recurrent AOM after completion of therapy was analyzed, true
bacteriologic relapses were found in 16 of 39 (41%), 10 of 38 (26%), 3 of 21
(14%) and 1 of 10 (10%) of all episodes on Days 1 to 7, 8 to 14, 15 to 21 and 22 
to 28 after completion of therapy, respectively (P = 0.01). The respective rates 
for were 11 of 17 (65%), 3 of 10 (30%), 3 of 13 (23%) and 1 of 5 (20%) (P =
0.02). For H. influenzae the respective rates were 8 of 19 (42%), 9 of 23 (39%), 
0 of 8 (0%) and 0 of 4 (0%) (P = 0.02). CONCLUSIONS: Most recurrent AOM episodes 
occurring within 1 month from completion of antibiotic therapy are in fact new
infections. Most of the true bacteriologic AOM relapses occur within 14 days
after completion of therapy, but even during this time interval most of the
recurrences are caused by new pathogens. H. influenzae is very unlikely to cause 
true bacteriologic AOM relapses 14 days or later after completion of therapy.

PMID: 12634580 [PubMed - indexed for MEDLINE]

1730: Int J Pediatr Otorhinolaryngol. 2003 Mar;67(3):277-81.

Acute mastoiditis in children: Pseudomonas aeruginosa as a leading pathogen.

Butbul-Aviel Y, Miron D, Halevy R, Koren A, Sakran W.

Pediatric Department 'B', Ha'Emek Medical Center, Afula 18101, Israel.

OBJECTIVE: Acute mastoiditis is a serious bacterial infection of the temporal
bone and is the most common complication of otitis media. The goal of this study 
is to assess the clinical features, pathogens, management, and outcome of acute
mastoiditis in children in northern Israel. METHODS: A systematic review of
medical records of all children who were admitted with acute mastoiditis from
January 1990 through December 2000. RESULTS: Fifty-seven children were included. 
Median was age: 36 months. In 26 patients (45.6%) mastoiditis complicated the
first episode of acute otitis media (AOM). Twenty-five children (44%) received
antibiotic treatment prior to admission. Frequent symptoms included mastoid area 
erythema in 54 children (94.7%), proptosis of the auricle in 52 children (91.2%) 
and fever in 43 children (75.4%). Middle ear, and subperiostal culture yielded
growth of pathogen in 30 children (75%), two cultures yielded more then one
pathogen. The most frequent pathogens were: Pseudomonas aeruginosa in 10 children
(25%), Streptococcus pneumoniae in eight children (20%), Group A streptococcus in
six children (15%). The highest incidence of Streptococcus pneumoniae was found
in children who did not suffer from AOM before admission (35 vs. 5%). Fifty-two
(91.2%) children were cured with antibiotic treatment alone. Seventeen children
underwent computed tomography (CT) of the mastoid. Mastoid bone destruction was
demonstrated in six children and subperiostal abscess in eight. Mastoidectomy was
performed in five children. CONCLUSIONS: The diagnosis of acute mastoiditis can
be made on clinical basis alone requiring CT only when complications are
suspected. Half of the children admitted with acute mastoiditis had no previous
history of recurrent AOM. In those children S. pneumoniae was the leading
pathogen while P. aeruginosa was more prevalent in children with recurrent AOM.
Most of the children recovered with medical therapy alone, without surgical
intervention.

PMID: 12633928 [PubMed - indexed for MEDLINE]

1731: Int J Pediatr Otorhinolaryngol. 2003 Mar;67(3):221-30.

Middle ear fluid histamine and leukotriene B4 in acute otitis media: effect of
antihistamine or corticosteroid treatment.

McCormick DP, Saeed K, Uchida T, Baldwin CD, Deskin R, Lett-Brown MA, Heikkinen
T, Chonmaitree T.

Department of Pediatrics, University of Texas Medical Branch, 301 University
Boulevard, Galveston, TX 77555-0371, USA.

OBJECTIVE: Two potent mediators of acute inflammation, histamine and leukotriene 
B4 (LTB4), have been shown to play important roles in the pathogenesis and
clinical course of acute otitis media (AOM) in children. The purpose of this
study was to evaluate the ability of adjuvant drugs, antihistamine and
corticosteroid, in reduction of the levels of histamine and LTB4 in the middle
ear and their ability to improve outcomes of AOM. METHODS: Eighty children with
AOM (aged 3 months to 6 years) were enrolled in a prospective, randomized,
double-blind, placebo controlled study. All children received one dose of
intramuscular ceftriaxone and were randomly assigned to receive either
chlorpheniramine maleate (0.35 mg/kg per day) and/or prednisolone (2 mg/kg per
day) or placebos three times a day for 5 days. Tympanocentesis was performed at
enrollment and after 5 days of adjuvant drug treatment. MEFs were collected for
bacterial and viral studies and histamine and LTB4 levels. The subjects were
followed for the duration of middle ear effusion or up to 3 months. RESULTS:
Histamine or LTB4 levels in the MEF after 5 days of treatment were not
significantly reduced by adjuvant drug treatment. However, subjects receiving
corticosteroid had a lower rate of treatment failure during the first 2 weeks and
shorter duration of middle ear effusion. CONCLUSIONS: Five day of antihistamine
or corticosteroid treatment does not reduce the levels of histamine or
leukotriene B4 in the MEF of children with AOM. Positive clinical outcomes of AOM
cases associated with corticosteroid treatment needs to be confirmed in a larger 
clinical trial of children with intact tympanic membranes, who do not receive
tympanocentesis.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

PMID: 12633920 [PubMed - indexed for MEDLINE]

1732: East Afr Med J. 2002 Apr;79(4):202-5.

Pathogenic agents of chronic suppurative otitis media in Ilorin, Nigeria.

Nwabuisi C, Ologe FE.

Department of Medical Microbiology, Faculty of Health Sciences, University of
Ilorin, Kwara State, Nigeria.

OBJECTIVE: To determine the type and pattern of antibiotic susceptibility of the 
pathogenic micro-organisms causing chronic suppurative otitis media (CSOM) in our
environment. DESIGN: A retrospective study of ear discharges from patients
presenting consecutively with chronic suppurative otitis media. SETTINGS:
University of Ilorin Teaching Hospital, a major referral centre in the Middle
Belt region of Nigeria. MAIN OUTCOME MEASURES: Bacterial isolates and their
sensitivity patterns. SUBJECTS: Three hundred and seventy five patients aged
between eight months and 70 years referred to the ear, nose, and throat clinic of
The University of Ilorin Teaching Hospital were enrolled in the study. RESULTS:
About 95.5% and 4.5% of the specimens were culture positive and negative
respectively. The commonest bacterial aetiologic agents were Pseudomonas
aeruginosa (26.0%) and Proteus spp (21.8%). Peak prevalence of 30.5% occurred
among the 0-5 years age group. Seventy five per cent of isolates were
gram-negative bacteria. Ofloxacin produced 100% sensitivity in both gram positive
and gram-negative organisms tested. Colistin, ceftazidime and cefuroxime were
highly active (80%) against the gram-negative bacteria while erythromycin and
cloxacillin were very effective (80%) against the gram-positive isolates.
CONCLUSION: Chronic suppurative otitis media is still highly prevalent in our
environment, affecting mainly children. The antibiotic susceptibility pattern of 
pathogenic isolates is different from those of other regions of Nigeria with
increasing resistance recorded for some organisms. Hence, where possible and
available, susceptibility tests should guide the management of CSOM in this
environment, otherwise, ofloxacin if indicated and cloxacillin/erythromycin may
provide relief and delay emergence of resistant strains.

PMID: 12625677 [PubMed - indexed for MEDLINE]

1733: ORL J Otorhinolaryngol Relat Spec. 2003 Jan-Feb;65(1):49-51.

Pneumocystis carinii infection of the middle ear and external auditory canal.
Report of a case and review of the literature.

Menger DJ, v d Berg RG.

Department of Otolaryngology and Head and Neck Surgery, Academic Medical Center, 
University of Amsterdam, Amsterdam, The Netherlands. d.j.menger@amc.uva.nl

We present a 50-year-old male with Pneumocystis carinii infection involving the
middle ear and the external auditory canal as the first manifestation of a
previously unknown HIV infection. In case of therapy-resistant otitis with a
polypoid mass in the external auditory canal histological evaluation should be
considered to rule out malignancy or pathogens, like Pneumocystis carinii, that
cannot be cultured. Oral or intravenous antiprotozoal agents are the treatment in
line with current practice. Exploration of the os petrosum is never required.
Copyright 2003 S. Karger AG, Basel

Publication Types: 
    Case Reports

PMID: 12624507 [PubMed - indexed for MEDLINE]

1734: Int J Pediatr Otorhinolaryngol. 2003 Feb;67(2):165-72.

The symptoms and clinical course of acute bullous myringitis in children less
than two years of age.

Kotikoski MJ, Palmu AA, Puhakka HJ.

Department of Otorhinolaryngology, Tampere University Hospital, PO Box 2000,
33521, Tampere, Finland. kotikoski@koti.tpo.it

OBJECTIVE: the most characteristic symptom of acute bullous myringitis
(inflammation of the tympanic membrane) is a sudden onset of severe ear pain.
However, in infants and young children a precise symptom history is more
difficult to obtain and the symptoms may be less specific. Our objective was to
determine the occurrence of different symptoms, signs and the recovery of
symptoms during the course of acute bullous myringitis in children less than 2
years. We also evaluated whether there were any specific features in bullous
myringitis in comparison with acute otitis media (AOM). METHODS: 2028 children
(aged 7-24 months) at primary care level in a prospective longitudinal cohort
study in the Finnish Otitis Media Vaccine Trial. RESULTS: during the follow-up
there were 86 office visits with bullous myringitis in 92 ears and 1876 office
visits with acute otitis media in 2683 ears. Middle ear fluid developed in 97% of
cases of bullous myringitis during the course of disease. Earache was present in 
58% and fever (>or=38 degrees C) in 62% of cases of bullous myringitis. The
symptoms of upper respiratory tract infection (rhinitis in 93% and cough in 73%
of events) were present in a majority of cases. Earache, fever, rubbing of the
ear, restless sleeping, excessive crying and poor appetite were present more
often in bullous myringitis than in acute otitis media. The symptoms were
relieved in 1-2 days in a majority of cases. There were no recognized cases of
bullous myringitis in ears with patent tympanostomy tubes. CONCLUSIONS: acute
bullous myringitis in children represents a special form of AOM with more severe 
symptoms. Earache and fever were more common in bullous myringitis than in AOM.
However, the condition resolved rapidly and the short-term outcome was good.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12623153 [PubMed - indexed for MEDLINE]

1735: Arch Otolaryngol Head Neck Surg. 2003 Mar;129(3):293-6.

Incidence of and risk factors for additional tympanostomy tube insertion in
children.

Boston M, McCook J, Burke B, Derkay C.

Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical
School, Norfolk 23507, USA.

OBJECTIVE: To determine the incidence and risk factors that account for
additional tympanostomy tube placement among children who have undergone an
initial placement of ventilation tubes. DESIGN: Retrospective case review of
consecutive patients. SETTING: A tertiary care pediatric hospital. PATIENTS:
Five-year consecutive series of 2121 children cared for in a hospital-based,
tertiary care pediatric otolaryngology practice. INTERVENTION: Subsequent need
for additional ventilation tube surgery. RESULTS: Four hundred twenty-three
(19.9%) of the 2121 children who underwent initial placement of bilateral
myringotomy tubes (BMTs) between April 20, 1995, and May 25, 1998, subsequently
had a second set of tubes placed by May 25, 2000. Children 18 months or younger
at the time of initial BMT placement were nearly twice as likely (26.3% vs 15.9%)
to undergo a second BMT procedure when compared with children who were older than
18 months at initial surgery (P<.005). The probability of having a second BMT
procedure was reduced if adenoidectomy was performed at the first BMT procedure
(0.08 vs 0.24, P<.001). Adenoidectomy status, craniofacial deformities, and a
family history of adenoidectomy or tonsillectomy with or without BMTs were
independent risk factors for multiple BMTs. CONCLUSIONS: Epidemiologic analysis
of this consecutive series of patients who underwent BMT placement in a tertiary 
care pediatric otolaryngology practice suggests that 1 in 5 patients will
subsequently require a second set of ventilation tubes. Age younger than 18
months at the time of the initial BMT procedure is associated with an increased
risk for additional surgery but is not an independent risk factor. Adenoidectomy 
reduces the incidence of subsequent BMTs following initial surgery.

PMID: 12622537 [PubMed - indexed for MEDLINE]

1736: Otol Neurotol. 2003 Mar;24(2):158-64.

Comment in:
    Otol Neurotol. 2005 May;26(3):554-5.

Adipose graft: an original option in myringoplasty.

Ayache S, Braccini F, Facon F, Thomassin JM.

Otorhinolaryngology and Cervical and Facial Surgery Federation, La Timone
Hospital, Marseille Cedex, France.

OBJECTIVE: To describe the fat graft as a reconstructive material in
myringoplasty. METHOD: In a review of 45 patients conducted between 1993 and
1999, the authors analyzed their patients' outcomes after having myringoplasties 
with fat graft. Median follow-up was 2.5 years (range, 6 mo-6 yr). RESULTS: We
achieved a success rate of 91.1%. Different features of the patient and the
tympanic perforation were studied to demonstrate their role in the quality of the
surgical closing. A review of the literature was done to compare our results with
the results of other series using this type of graft as well as with studies of
the temporalis fascia as a graft material. CONCLUSION: The high reliability of
the fat graft and the technical simplicity of this procedure in anterior
perforations, especially with the use of intraoperative endoscopy, make it an
attractive technique.

PMID: 12621327 [PubMed - indexed for MEDLINE]

1737: Otol Neurotol. 2003 Mar;24(2):153-7.

Prolonged middle ear ventilation with the cartilage shield T-tube tympanoplasty.

Duckert LG, Makielski KH, Helms J.

Department of Otolaryngology-Head and Neck Surgery, University of Washington, Box
357923, Seattle, WA 98195-7923, USA. duckert@u.washington.edu

BACKGROUND: In 1994, the favorable experience with composite cartilage shield
tympanoplasty was reported to the American Otological Society. On that occasion, 
the technical question regarding the concomitant placement of a ventilating tube 
was posed. In response, the authors proposed that the tympanostomy tube be
incorporated in the cartilage graft. Moreover, they proposed that this marriage, 
when used to reverse atelectasis and to repneumatize the middle ear, should offer
the advantage of both procedures while reducing the incidence of tube extrusion
and other complications of prolonged intubation. Although attractive in theory,
this supposition could be validated only after prolonged follow-up, reported
here. OBJECTIVE: To describe an effective means to secure prolonged middle ear
ventilation in a patient population prone to atelectasis and chronic middle ear
effusion and to establish the incidence of favorable and unfavorable outcomes
after 6 years of observation. STUDY DESIGN: Retrospective case series. SETTING:
Tertiary referral center. PATIENTS: Forty patients (28 adults and 12 children)
who underwent tympanic membrane reconstruction with a composite cartilage shield 
T-tube "unit."RESULTS The overall retention rate was 62.5% over 6 years.
Sixty-five percent of retained tubes were maintained for a minimum of 4 years in 
adult patients. Extrusion and permanent perforation rates were 0%. CONCLUSION:
The cartilage shield T-tube tympanoplasty can effectively reverse atelectasis and
provide prolonged middle-ear ventilation. The technique can be used safely and
minimizes the risk of tympanic membrane perforation and other complications
associated with prolonged middle ear intubation.

PMID: 12621326 [PubMed - indexed for MEDLINE]

1738: Otol Neurotol. 2003 Mar;24(2):145-8.

Lateralization of the tympanic membrane as a complication of canal wall down
tympanoplasty: a report of four cases.

Gyo K, Hato N, Shinomori Y, Hakuba N.

Department of Otolaryngology, Ehime University, Onsen-gun Shigenobu-cho, Ehime,
Japan. kiyofumi@m.ehime-u.ac.jp

OBJECTIVE: To describe the pathophysiology and treatment of the lateralized
tympanic membrane that occurs after canal wall down tympanoplasty. STUDY DESIGN: 
Retrospective case review. SETTING: Tertiary referral hospital. PATIENTS: Four
patients in whom lateralization of the tympanic membrane developed as a
complication of canal wall down tympanoplasty. RESULTS: The patients had
undergone middle ear surgery 20 to 34 years before their first visit to the
authors. A Bondy operation with soft-wall reconstruction of the ear canal had
been performed in three patients and a modified radical mastoidectomy in one
patient. They all had severe conductive hearing loss. Common findings were
anterior canal sulcus blunting, good tubal function, normal middle ear mucosa,
and mobile stapes. At revision surgery, the lateralized tympanic membrane was
removed, and the temporalis fascia was grafted medial to the malleus manubrium.
The exposed bony surface in the ear canal was covered with a split-thickness skin
graft, and the ear canal and the mastoid cavity were tightly packed to secure the
graft. All the patients regained good hearing after the revision. Although
deterioration of the anterior tympanic ring was presumed to be the primary cause 
of the graft lateralization, the lack of a posterior bony ear canal might have
facilitated this condition. CONCLUSION: Lateralization of the tympanic membrane
can occur even in an ear with a radicalized mastoid cavity, especially when the
anterior tympanic ring is torn and the posterior ear canal is reconstructed with 
soft tissue.

Publication Types: 
    Case Reports

PMID: 12621324 [PubMed - indexed for MEDLINE]

1739: Otol Neurotol. 2003 Mar;24(2):141-4.

Sensorineural hearing loss in chronic otitis media.

Papp Z, Rezes S, Jókay I, Sziklai I.

University of Debrecen Health Science Center Medical School, Clinic of
Otorhinolaryngology, Debrecen, Hungary.

OBJECTIVE: To determine whether chronic suppurative otitis media may cause
sensorineural hearing loss. METHODS: The files of 121 patients with unilateral
chronic suppurative otitis media were reviewed in a retrospective study. Air
conduction and bone conduction threshold averages were calculated over the speech
frequencies (500 Hz, 1,000 Hz, and 2,000 Hz). Thresholds at 4 kHz were examined
separately but in a similar way. Multiple linear regression models were used to
clarify the relationships between sensorineural hearing loss and chronic otitis
media. RESULTS: Chronic suppurative otitis media was seen to be associated with
sensorineural hearing loss. When age and normal side were corrected for,
pure-tone threshold and bone conduction threshold at either the speech
frequencies or at 4 kHz increased gradually according to the duration of the
chronic suppurative otitis media. The threshold shift was more accentuated as age
increased. The sensorineural hearing loss at 4 kHz seemed to be higher than that 
at the speech frequencies. CONCLUSIONS: The inner ear is vulnerable against
chronic suppurative otitis media. Older age increases this vulnerability. The
proximity of the sensory cells to the potential source of harm (inflamed middle
ear) may mean higher exposure, as reflected by the fact that sensory cells
processing higher frequencies are more seriously damaged.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12621323 [PubMed - indexed for MEDLINE]

1740: Vet Radiol Ultrasound. 2003 Jan-Feb;44(1):28-31.

Otolithiasis in three dogs.

Ziemer LS, Schwarz T, Sullivan M.

Department of Clinical Studies, School of Veterinary Medicine, University of
Pennsylvania, 3850 Spruce Street, Philadelphia, PA 19104, USA.

Mineral opacities within the tympanic bullae, termed otoliths, were detected in
three dogs by means of radiography and computed tomography. Radiographic signs of
otitis externa were present in two dogs. One dog had clinical signs of vestibular
disease, whereas the other two dogs had no clinical evidence of ear disease.
Otolithiasis may represent mineralized necrotic material of a current or previous
case of otitis media.

Publication Types: 
    Case Reports

PMID: 12620046 [PubMed - indexed for MEDLINE]

1741: Oral Oncol. 2003 Apr;39(3):296-300.

Detection of LMP-1 gene in middle ear effusion of NPC.

Hao SP, Tsang NM, Chen YL, Chang KP, Su JL.

Department of Otolaryngology/Head-Neck Surgery, Chang Gung Cancer Center, Chang
Gung Memorial Hospital and University, 14F, No. 16, Alley 4 Lane 137, Sec. 5
Ming-Sheng E. Road, Taipei, Taiwan, ROC. shengpo@adm.cgmh.org.tw

Nasopharyngeal carcinoma (NPC) is closely related with Epstein-Barr virus (EBV). 
Almost every NPC tumor cells carries clonal EBV genomes. Detection of EBV derived
latent membrane protein-1 gene (LMP-1) indicate the presence of NPC. Middle ear
effusion (MEE) is a frequent sign of NPC. There have been no reports on LMP-1 in 
MEE. Tympanocentesis of 88 ears with MEE of 66 patients were done in three groups
of patients, group (I) NPC, 31 patients, 50 ears, (II) other head and neck
cancers, five patients, six ears and (III) no cancer history, 30 patients, 32
ears. The middle ear aspirate and nasopharyngeal swab specimen were collected to 
detect LMP-1 with a PCR-based method. Sixty aspirates (68%) out of 88 ears with
MEE had enough DNA for PCR amplification. LMP-1 was detected in six middle ear
aspirate specimen from three patients in group I who had petrous apex invasion.
LMP-1 was detected in 30 swab specimen (93.8%) out of 32 nasopharyngeal swabs in 
group I. LMP-1 was not detected in middle ear aspirates or nasopharyngeal swab in
group II and III patients. LMP-1 was not detected in MEE in patients without NPC.
In NPC patients, the detection of LMP-1 may indicate petrous apex invasion.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12618203 [PubMed - indexed for MEDLINE]

1742: Prescrire Int. 2003 Feb;12(63):26-7.

Fluoroquinolones in ambulatory ENT and respiratory tract infections: rarely
appropriate.

[No authors listed]

(1) The risk-benefit ratio of antibiotic therapy in exacerbations of chronic
bronchitis is uncertain. If an antibiotic is considered, fluoroquinolones are at 
best second-line options, after betalactam agents such as amoxicillin, and
macrolides. (2) For community-acquired pneumonia the first-line antibiotics are
betalactam agents such as amoxicillin, and macrolides. Patients with severe
disease should receive combination therapy with a betalactam and a macrolide or a
fluoroquinolone. (3) Acute sinusitis generally resolves spontaneously. If an
antibiotic is prescribed, fluoroquinolones are at best second-line options, after
betalactam agents such as amoxicillin, and macrolides. The value of systemic
antibiotic therapy is also controversial in chronic sinusitis and chronic otitis 
media; once again, fluoroquinolones are not agents of first choice. (4)
Fluoroquinolones share many adverse effects, especially neuropsychiatric,
cutaneous, tendon, and cardiac involvement. They can also damage cartilage in
children. They are contraindicated in pregnant women. They potentiate oral
anticoagulants.

PMID: 12602405 [PubMed - indexed for MEDLINE]

1743: Otolaryngol Head Neck Surg. 2003 Feb;128(2):263-6.

Efficacy of surgical treatment of chronic otitis media.

Cruz OL, Kasse CA, Leonhart FD.

Disciplina de Otorrinolaringologia Pediátrica, Universidade Federal de São Paulo,
Escola Paulista de Medicina, São Paulo, Brasil. olacruz@uol.com.br

This article presents our results of surgical treatment of chronic otitis media
(COM) and discusses its efficacy regarding the control of disease and hearing
results. A retrospective chart review of 84 ears was performed. Forty-one ears
with noncholesteatomatous COM underwent tympanomastoidectomy, 43 ears with
cholesteatoma were managed according to the extension of the disease, closed
mastoidectomy was indicated in 19 cases, and open mastoidectomy was performed in 
24 ears. In the group without cholesteatoma, a stable ear with closed tympanic
membrane was obtained in 85% of cases after the first procedure. The speech
response threshold before and after surgery was 38 and 26 dB. In patients with
cholesteatoma, a dry ear was achieved in 79% of cases on both techniques after
the first intervention. The recurrence rate of cholesteatoma was 10% for the
closed technique and 4% for the open technique. The mean preoperative and
postoperative SRTs for the closed technique were 30 and 29 dB and for the open
technique were 50 and 54 dB. The surgical treatment for COM can be a rewarding
procedure if a correct technique is indicated. The surgery should be tailored
regarding the clinical stage and intraoperative findings in each case.

Publication Types: 
    Clinical Trial

PMID: 12601324 [PubMed - indexed for MEDLINE]

1744: Med Sci Monit. 2003 Feb;9(2):CR73-8.

Chondrotympanoplasty: a modified technique of cartilage graft tympanoplasty.

Ferekidis EA, Nikolopoulos TP, Kandiloros DC, Ferekidou EE, Yiotakis JE,
Tsangaroulakis A, Adamopoulos GK.

ENT Department, Athens University School of Medicine, Athens, Greece.
eferek@cc.uoa.gr

BACKGROUND: Although the temporalis fascia has been widely used since 1957as a
graft in tympanoplasty, it can eventually become thin and atrophic. In addition, 
due to the lack of elasticity and resistance to pressure changes in the external 
ear canal, secondary perforations may also develop. Therefore, several authors
have suggested that temporalis fascia should be strengthened by periosteum or
replaced by cartilage. MATERIAL/METHODS: In the present paper the term
chondrotympanoplasty is introduced to describe modified techniques of cartilage
graft tympanoplasty and intratympanal chondroplasties. These techniques were used
in 76 patients who were prospectively followed up for two years post-operatively.
RESULTS: In type I chondrotympanoplasty, the mean pre-operative air-bone gap was 
reduced from 20 dB to 8 dB at 2000 Hz. In 93% of these cases the cartilage graft 
was taken without problems and there was no perforation in the new eardrum. In
two cases of type I chondrotympanoplasty who experienced acute post-operative
otitis media, the cartilage graft was found to be relatively resistant to
infection, as only a pinhole perforation was noted. Type III chondrotympanoplasty
with endotympanic chondroplasty (intratympanal tubal chondroplasty and
intratympanal stapes chondroplasty) was found to give good aeration in the
cavity, an intact new eardrum, and remarkable hearing results, reducing the mean 
pre-operative air-bone gap from 25 dB to 10 dB at 2000 Hz. CONCLUSIONS: Cartilage
was found to be an excellent graft material and the described
chondrotympanoplasties gave very promising results. Cartilage should be used more
widely in tympanoplasty (chondrotympanoplasty).

PMID: 12601290 [PubMed - indexed for MEDLINE]

1745: J Infect Dis. 2003 Feb 15;187(4):589-96. Epub 2003 Jan 29.

Nationwide surveillance of nasopharyngeal Streptococcus pneumoniae isolates from 
children with respiratory infection, Switzerland, 1998-1999.

Mühlemann K, Matter HC, Täuber MG, Bodmer T; Sentinel Working Group.

Institute for Infectious Diseases, University Hospital, University of Bern,
Switzerland. kathrin.muehlemann@ifik.unibe.ch

The surveillance of pneumococcal antibiotic resistance and serotype distribution 
is hampered by the relatively low numbers of invasive pneumococcal infections. In
Switzerland, a nationwide sentinel surveillance network was used to assess
antibiotic resistance and serotype distribution among 1179 pneumococcal isolates 
cultured from 2769 nasopharyngeal swabs obtained from outpatients with acute
otitis media or pneumonia during 1998 and 1999. The proportion of
penicillin-susceptible pneumococcal isolates overall (87%) and among infants <2
years old (81%) was comparable to that of invasive isolates (90% and 81%,
respectively). The high number of nasopharyngeal isolates allowed for the
detection of a rapid increase in the number of penicillin-nonsusceptible
pneumococcal (PNSP) strains in the West region of Switzerland, partly because of 
an epidemic caused by the 19F clone of Streptococcus pneumoniae. Clustering of
risk factors for the carriage of PNSP isolates further explained the geographic
variation in resistance rates. The nationwide sentinel surveillance of
nasopharyngeal pneumococcus proved to be valuable for the monitoring of
antibiotic resistance, risk factors for carriage of PNSP isolates, and serotype
distribution and for the detection of the emergence of a new epidemic clone.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12599075 [PubMed - indexed for MEDLINE]

1746: Ear Hear. 2003 Feb;24(1):38-47.

Hearing levels in infants and young children in relation to testing technique,
age group, and the presence or absence of middle-ear effusion.

Sabo DL, Paradise JL, Kurs-Lasky M, Smith CG.

Department of Communication Science and Disorders, School of Health and
Rehabilitative Science, University of Pittsburgh, Pennsylvania, USA.
diane.sabo@chp.edu

OBJECTIVE: As part of a prospective study of possible effects of early-life
otitis media on speech, language, cognition, and psychosocial development, we
evaluated hearing both during episodes of middle-ear effusion (MEE) and when MEE 
was not present. The objective of this report is to describe age-specific hearing
threshold levels in relation to the presence or absence of MEE in a large sample 
of young children. DESIGN: Participants were 1,055 children drawn from a sample
of 6,350 children who were enrolled in the larger study by 2 mo of age. Otologic 
evaluation of each child was conducted at least monthly. The protocol of the
larger study called for hearing evaluations 1) after 8 wk of continuous
unilateral or bilateral MEE and every 4 wk thereafter until one test had been
conducted when MEE was no longer present; 2) immediately before developmental
testing; and 3) in a sample of children without MEE to obtain age-specific
normative data. RESULTS: Results are presented by testing technique, age group,
and middle-ear condition. In general, hearing threshold levels were highest in
the youngest children tested with visual reinforcement audiometry and lowest in
the oldest children tested with conventional audiometry. In general also,
thresholds were lowest in children with normal middle-ear status, intermediate in
children with unilateral MEE, and highest in children with bilateral MEE. On
average, the presence of bilateral MEE was associated with hearing threshold
levels 10 to 15 dB higher than the normative values for the corresponding age
group. CONCLUSIONS: In infants and young children, audiometric results are
influenced by testing technique, age group, and the presence or absence of
effusion in each ear.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12598812 [PubMed - indexed for MEDLINE]

1747: Ann Otol Rhinol Laryngol. 2003 Feb;112(2):191-4.

Natural history of sigmoid sinus thrombosis.

Agarwal A, Lowry P, Isaacson G.

Department of Otolaryngology-Head and Neck Surgery, Temple University School of
Medicine, Philadelphia, Pennsylvania 19140, USA.

To demonstrate the evolution of sigmoid sinus thrombosis, we performed a
prospective observational study on a 6-year-old girl who presented with
mastoiditis, epidural abscess, and occipital osteomyelitis from multiple
drug-resistant Streptococcus pneumoniae. She underwent mastoidectomy and partial 
occipital craniectomy. This procedure produced a window in the occipital bone
that allowed serial ultrasonography of the sigmoid sinus during medical
treatment. Computed tomography was performed, followed by weekly Doppler
ultrasonography used to monitor resolution of sigmoid sinus thrombosis. The
natural history of a treated episode of sigmoid sinus thrombosis was illustrated.
Venous occlusion resolved over a 4- to 6-week period without surgical drainage or
venous anticoagulants. Collateral flow, reversal of normal venous flow, and
ultimate return to normal venous transport characterized the period of
resolution. We conclude that an occluded sigmoid sinus from mastoiditis can
naturally recanalize. Aberrant venous flow can be demonstrated during the period 
of resolution. This case supports a conservative approach to management of the
occluded sinus and suggests that 4 to 6 weeks of antibiotic therapy after removal
of perisinus infection is sufficient for cure.

Publication Types: 
    Case Reports

PMID: 12597296 [PubMed - indexed for MEDLINE]

1748: East Mediterr Health J. 2001 Jan-Mar;7(1-2):26-30.

Topical ciprofloxacin versus topical gentamicin for chronic otitis media.

Nawasreh O, Fraihat A.

Prince Rashid Ben Al-Hasan Hospital, Al-Husn, Jordan.

We compared the therapeutic efficiency of ciprofloxacin hydrochloride and
gentamicin sulfate in the treatment of chronic otitis media. A total of 88
patients aged 9-62 years with chronic suppurative media were randomly placed into
two groups. In the first group, 48 patients (54.5%) received topical
ciprofloxacin hydrochloride, while in the second group 40 patients (45.5%)
received local gentamicin sulfate. Of the 48 patients who received ciprofloxacin 
hydrochloride, 42 (87.5%) were cured, while in 6 patients (12.5%) the treatment
failed. In the gentamicin group, 12 (30%) of the patients were cured, while 28
patients showed no clinical or bacteriological improvement. Topical ciprofloxacin
is safe and more efficacious and efficient than topical gentamicin in the
treatment of acute exacerbation of chronic suppurative otitis media.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 12596948 [PubMed - indexed for MEDLINE]

1749: J Laryngol Otol. 2003 Jan;117(1):69-70.

Necrotizing fasciitis: a rare occurrence in the external auditory meatus.

Umapathy N.

Department of Otolaryngology, Basildon Hospital, Basildon, UK.
Pathy97@yahoo.co.uk

The diagnosis and management of a patient with a sloughing otitis externa thought
to be necrotizing fasciitis is described. The clinical characteristics of this
condition, diagnostic difficulties faced and a brief literature review are
presented.

Publication Types: 
    Case Reports
    Review

PMID: 12590861 [PubMed - indexed for MEDLINE]

1750: Auris Nasus Larynx. 2003 Feb;30(1):7-14.

Factors affecting the results of nonsurgical treatment of secretory otitis media 
in adults.

Lesinskas E.

Department of Otorhinolaryngology, Vilnius University Hospital Santariskiu
klinikos, Vilnius University, Santariskiu 2, 2021 Vilnius, Lithuania.
e.lesinskas@santa.lt

OBJECTIVE: There is only limited knowledge of the factors influencing the results
of nonsurgical treatment of secretory otitis media (SOM) in adults. The present
study was carried out to determine the effect of the middle ear (ME) inflation
and to clear up the factors affecting the results of conservative treatment of
SOM. METHODS: A total of 198 adult patients were randomized to either a group
receiving treatment with ME inflation for 10 days or to a group receiving ME
inflation and antibiotics (oral Amoxicillin 500 mg 3/day) for 10 days or to a
control group. A wide variety of anamnestic and clinical pre-treatment variables 
were assessed by administered questionnaires. Pneumo-otoscopy, tympanometry and
pure-tone audiometry were performed before the treatment and at the 3-5th,
10th+/-2 and 60th+/-5 day of the study. For the prognostic factors, univariate
analyses were first performed to determine the significant predictors, which were
afterwards entered into a stepwise logistic regression model. RESULTS: The
effectiveness of treatment was 50.6% in Group A and 58.7% in Group B (control
group-11%, P<0.001). The results of treatment were stable and were found
unchanged 6 weeks after the treatment. The most important prognostic criteria
were defined by analyzing the dynamics of tympanometry (OR, 2.17) and audiometry 
(OR, 10.27) during conservative treatment. The results of the treatment were
related to the mastoid pneumatization, the pathology of paranasal sinuses, the
previous history of SOM, the age, and the pre-treatment otoscopic data.
CONCLUSIONS: The results suggest, that daily ME inflation can be effective
treatment for adults patients with SOM having regard to the factors significant
for the prognosis of treatment.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 12589843 [PubMed - indexed for MEDLINE]

1751: Mycoses. 2003 Feb;46(1-2):12-8.

Mycological and histological investigations in humans with middle ear infections.

Vennewald I, Schönlebe J, Klemm E.

Department of Dermatology, Institute of Pathology Georg Schmorl, Hospital
Dresden-Friedrichstadt, Dresden, Germany.

The aim of our investigations was to characterize fungal colonization of the ear 
in immunocompetent patients. From 1993 to 2000, 128 patients supposed to suffer
from otomycosis were included. Mycological examination conducted by direct
microscopy and fungal cultures was performed on 139 specimens. Among these, 115
patients suffered from chronic otitis media with persisting tympanum perforation 
and otorrhea. A further 13 patients had clinical signs of an otitis externa only.
Out of 139 samples, fungi were identified in the auditory canal (n = 54), on the 
tympanic membrane (n = 5), and in the middle ear (n = 5). Two-thirds were as
moulds and one-third yeasts. The dominating species were Aspergillus niger and
Candida parapsilosis. Samples from 15 patients supposed to have mastoiditis or
cholesteatoma were examined histologically. Fungal hyphae were observed in the
middle ear cavity and/or between horny lamellae of cholesteatoma in four
patients. In the middle ear of immunocompetent patients chronic-hyperplastic
(polypoid) inflammation was detected with increased production of mucus, which
probably promotes colonization by pathogenic fungi in the middle ear as well as
in the auditory canal. Invasive fungal growth into the subepithelial connective
tissue was not observed.

Publication Types: 
    Case Reports

PMID: 12588477 [PubMed - indexed for MEDLINE]

1752: Bangladesh Med Res Counc Bull. 2002 Apr;28(1):36-44.

Comparative study between tubotympanic and atticoantral types of chronic
suppurative otitis media.

Chowdhury MA, Alauddin M.

Dept of Otolaryngology, Sir Salimullah Medical College & Mitford Hospital, Dhaka.

This prospective study was done to compare the different aspects of tubotympanic 
(group I) and atticoantral types (group II) of chronic suppurative otitis media. 
The study included 200 patients of chronic suppurative otitis media, of them 100 
were of tubotympanic type and 100 were with atticoantral disease. The age (mean
+/- SD) of group I and II were 17 +/- 2.7 years and 12 +/- 2.3 years respectively
(P < 0.05). The majority of the patients having poor socio-economic condition 69%
in group I and 87% in-group II. In both groups, slum dwellers with bathing habit 
in pond or river and illiterate were more sufferer (P < 0.05). There was central 
perforation in all patients in-group I, and in-group II, 67% were with attic and 
33% were with marginal perforations. In group I, aural discharge was mucoid or
mucopurulent in majority of cases 80% and in-group II foul smelling scanty ear
discharge was from 88% of subjects. In atticoantral type, hearing impairment was 
more than tubotympanic disease. Complications were more in atticoantral type of
disease. In-group II, post auricular sinus 25% was the commonest extracranial
complication followed by subperiosteal abscess 18%, and meningitis 10% was the
commonest intracranial complication followed by brain abscess 8%. In tubotympanic
type conservative treatment with reconstructive surgery were the treatment of
choice, whereas radical or some modifications of radical surgery (with or without
reconstruction) were the treatment plan for atticoantral disease. Among the
groups the mortality rate was only 4% in-group II and was due to intracranial
complications. The study recommends early detection and effective surgical
treatment of the disease to improve the situation.

Publication Types: 
    Comparative Study

PMID: 12587759 [PubMed - indexed for MEDLINE]

1753: Vet Ther. 2002 Winter;3(4):493-500.

Development of resistant bacteria isolated from dogs with otitis externa or
urinary tract infections after exposure to enrofloxacin in vitro.

Brothers AM, Gibbs PS, Wooley RE.

Department of Medical Microbiology and Parasitology, College of Veterinary
Medicine, University of Georgia, Athens, GA 30602, USA.

Minimum inhibitory concentrations for enrofloxacin were determined for 63
bacterial isolates from dogs with otitis externa or urinary tract infections.
Development of resistant mutants was determined after exposing the isolates to
enrofloxacin in vitro for up to five serial passages. Results indicated that
Pseudomonas aeruginosa and Enterococcus spp isolates exposed to enrofloxacin
developed resistance rapidly, whereas Klebsiella, Proteus, and Streptococcus spp 
were less likely to develop resistance. Despite the presence of enrofloxacin
pressure, no resistant bacteria developed in the Escherichia coli and
staphylococcal isolates. In many isolates, susceptibility patterns changed from
susceptible to intermediate.

PMID: 12584687 [PubMed - indexed for MEDLINE]

1754: Zhonghua Yi Xue Za Zhi (Taipei). 2002 Nov;65(11):523-8.

Mastoid-obliteration surgery with cartilage for suppurative cholesteatomatous
ears.

Tsai TL, Lien CF, Guo YC.

Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan,
ROC.

BACKGROUND: Autologous cartilage has been widely used as a material for
tympanoplasty and mastoid-obliteration surgery. Since it remains vulnerable to an
infectious condition, this study aims to evaluate if it can be used for a chronic
suppurative cholesteatomatous ear to achieve single-stage tympanoplasty with
mastoidectomy and obliteration of the cavity. METHODS: From January 1988 to
August 1998, the records of patients with cholesteatoma who received
cartilage-obliteration surgery performed by Dr. Lien were examined for any
infection-associated problems within three months after the operation. The
Fisher's exact test was used to compare the difference in the incidence of
post-operative infection-associated problems between suppurative ears and
non-suppurative ears. RESULTS: One hundred and seven surgical procedures
performed upon 96 patients were included in this study, with 97 being primary
surgical procedures and ten being revision surgery for previous open cavity with 
cholesteatoma recurrences. The average follow-up was 47.7 months. At time of
surgery, there were 59 non-suppurative ears; 48 ears were suppurative and
cultured. Granulations were found in the middle ear or mastoid for 42 ears
(39.3%). Five ears (4.7%) exhibited infection-associated post-operative problems 
within three post-operative months. Three cases (5.1%) were non-suppurative ears 
and two cases (4.2%) were suppurative ears. There was no significant statistical 
difference when examined with the Fisher's Exact test. CONCLUSIONS: In an
immunocompetent patient with a cholesteatomatous chronic suppurative ear,
autologous cartilage could potentially tolerate an infection condition to serve
as a material for mastoid-obliteration in a single-stage surgical procedure.

PMID: 12583516 [PubMed - indexed for MEDLINE]

1755: Eur Arch Otorhinolaryngol. 2003 Feb;260(2):78-80. Epub 2002 Sep 13.

Screening of middle ear effusion for the common sinus pathogen Bipolaris.

Shin EJ, Guertler N, Kim E, Lalwani AK.

Department of Otolaryngology and Head and Neck Surgery, University of California 
San Francisco, 94143-0342, USA.

Recently, a third of middle ear effusions have been shown to harbor fungal DNA by
polymerase chain reaction (PCR). This suggests that fungi, in addition to being
an important sinus pathogen, may also play an important role in acute and serous 
otitis media. Bipolaris is an important sinus pathogen whose role in infections
of the ear is unknown. In this study, we assessed if Bipolaris DNA was present in
19 middle ear effusions that were PCR positive for the presence of fungi. Primer 
pair specific for Bipolaris spicifera was tested against DNA from various
bacterial and fungal species to demonstrate its specificity and was subsequently 
used on DNA isolated from effusions to determine if Bipolaris-specific DNA was
present. None of the nineteen specimens tested positive for Bipolaris by PCR or
standard culture technique. This suggests that while fungi may play an important 
role in otitis media, this study does not support a role for Bipolaris as a
middle ear pathogen and may reflect regional differences in its prevalence.

Publication Types: 
    Comparative Study

PMID: 12582783 [PubMed - indexed for MEDLINE]

1756: Arch Pediatr Adolesc Med. 2003 Feb;157(2):196-200.

Child care and common communicable illnesses in children aged 37 to 54 months.

Bradley RH; National Institute of Child Health and Human Development (NICHD)
Early Child Care Research Network.

Center for Applied Studies in Education, University of Arkansas at Little Rock,
72204, USA. rhbradley@ualr.edu

OBJECTIVE: To examine the relationship between experience in child care and
communicable illnesses (gastrointestinal tract infection, upper respiratory tract
infection, and otitis media) in children aged 37 months to 54 months with
particular focus on the effect of entry into child care after age 3 years.
DESIGN: Health, child care, and family data were obtained from more than 1100
participants in the National Institute of Child Health and Human Development
Study of Early Child Care, a 10-site prospective study that began at birth.
Longitudinal logistic regression analyses were performed using each type of
communicable illness as the outcome variable, with family, child, and child care 
variables as predictors in the model. RESULTS: For children aged 37 to 54 months,
rates of upper respiratory tract illness, gastrointestinal tract illness, and ear
infections were higher in those enrolled in child care arrangements with more
than 6 children. During this period, children with experience in large-group care
prior to age 3 years were less likely to be ill than children who entered child
care for the first time after age 3 years. Even so, their rates were still higher
than for those in small-group care or who were cared for at home between the ages
of 37 and 54 months. Reported rates of respiratory tract and gastrointestinal
tract illnesses were higher for European American than African American children.
Number of hours per week in child care was not a factor. CONCLUSION: Children in 
child care arrangements with more than 6 other children experience more bouts of 
upper respiratory tract illness between the ages of 37 and 54 months.

PMID: 12580692 [PubMed - indexed for MEDLINE]

1757: Arch Otolaryngol Head Neck Surg. 2003 Feb;129(2):163-8.

Prevention of otitis media by adenoidectomy in children younger than 2 years.

Mattila PS, Joki-Erkkilä VP, Kilpi T, Jokinen J, Herva E, Puhakka H.

Department of Otorhinolaryngology, Helsinki University Central Hospital, PO Box
220, 00029 Helsinki, Finland. petri.mattila@hus.fi

OBJECTIVES: To test the effect of adenoidectomy in connection with tympanostomy
compared with tympanostomy only in preventing otitis media in children younger
than 2 years. DESIGN: Prospective trial with randomized and nonrandomized arms.
SETTING: Primary care study clinics. PARTICIPANTS AND INTERVENTIONS: The study
participants were selected from 2497 children who had been enrolled in the
Finnish Otitis Media Vaccine Trial at the age of 2 months. A total of 306
children, aged 1 to 2 years, who had experienced recurrent episodes of otitis
media were randomized into 2 treatment groups: tympanostomy with or without
adenoidectomy. Of the 306 children, 137 were operated on according to random
basis (randomized trial). The 169 children whose parents declined participation
in the randomized trial were operated on according to the parents' preferences
(nonrandomized trial). All children were followed up until 2 years of age. The
mean follow-up time was 7 months. MAIN OUTCOME MEASURE: The rate of acute otitis 
media episodes. RESULTS: The average reduction in the rate of all acute otitis
media episodes in the adenoidectomy group was 19% (95% confidence interval [CI], 
-14% to 43%) among children enrolled in the randomized trial and 25% (95% CI,
-13% to 50%) in the nonrandomized trial. The reduction in the randomized trial
was mainly due to reduction in the rate of pneumococcal otitis media (58%, 95%
CI, 16%-79%). CONCLUSION: In children younger than 2 years, concurrent
adenoidectomy during the insertion of tympanostomy tubes does not seem to have a 
major advantage over the insertion of tympanostomy tubes alone in preventing
otitis media.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 12578443 [PubMed - indexed for MEDLINE]

1758: Otolaryngol Head Neck Surg. 2003 Jan;128(1):27-31.

The role of rhinitis in chronic otitis media.

Mion O, de Mello JF Jr, Lessa MM, Goto EY, Miniti A.

Otorhinolaryngology Division, University of São Paulo Hospital, Brazil.

OBJECTIVE: We investigated the role of allergic rhinitis in chronic otitis media 
(otitis media with effusion [OME] and chronic perforation of the tympanic
membrane) in São Paulo, Brazil and whether there is any association between these
diseases. STUDY DESIGN AND SETTING: We studied 51 patients followed in the
otologic group of the Otorhinolaryngology Division of the University of São Paulo
Hospital. The patients were divided into 3 groups: allergic rhinitis, nonallergic
rhinitis with eosinophils syndrome (NARES), and patients with types of rhinitis
or without rhinitis. We analyzed the age, gender, intensity of the nasal disease,
surgical procedure, and surgical results in each group. RESULTS: We found about
50% of patients presenting with nasal disease and nasal eosinophilia (33.33% of
allergic and 15.69% of NARES). CONCLUSION: Nasal disease has an impact on
otologic middle ear disease, considering that the normal nasal mucosa do not have
eosinophils.

Publication Types: 
    Comparative Study

PMID: 12574755 [PubMed - indexed for MEDLINE]

1759: Otolaryngol Head Neck Surg. 2003 Jan;128(1):14-6.

Allergy and chronic rhinosinusitis.

Krause HF.

Department of Otolaryngology, University of Pittsburgh, PA, USA.

Allergy and its relationship to chronic rhinosinusitis are important contemporary
topics in the practice of otolaryngology. The relationship may go unrecognized.
It is important to understand the current knowledge.

Publication Types: 
    Review

PMID: 12574753 [PubMed - indexed for MEDLINE]

1760: Comput Med Imaging Graph. 2003;27(1):27-34.

CT and MRI in malignant external otitis: a report of four cases.

Karantanas AH, Karantzas G, Katsiva V, Proikas K, Sandris V.

Department of CT-MRI, Larissa General Hospital, 1 Tsakalof. Str., Larissa 412 21,
Greece. apolsen@yahoo.com

Malignant external otitis (MEO) is a severe infection of the external auditory
canal and skull base which most often affects elderly patients with diabetes
mellitus. Early diagnosis and aggressive treatment are important in terms of
reducing risks of dissemination. We report four cases of MEO in patients with
diabetes mellitus who were observed with computed tomography (CT) and/or magnetic
resonance imaging (MRI). MRI was superior to CT in patients with MEO in terms of 
estimating the anatomic extent of the disease, but it cannot be used for
monitoring therapy.

Publication Types: 
    Case Reports

PMID: 12573887 [PubMed - indexed for MEDLINE]

1761: Mycoses. 2002 Oct;45(8):317-28.

Randomized prospective comparative study: short-term treatment with
ciclopiroxolamine (cream and solution) versus boric acid in the treatment of
otomycosis.

del Palacio A, Cuétara MS, López-Suso MJ, Amor E, Garau M.

Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain.

Sixty-four patients with symptomatic otomycosis (80 infected ears) confirmed by
direct microscopy and culture were randomly treated for I week with
ciclopiroxolamine cream 11% (group A, 20 infected ears, 17 patients),
ciclopiroxolamine solution 1% (group B, 20 infected ears, 17 patients) and boric 
acid (group C, 40 infected ears, 30 patients) and daily mechanical suction
aspiration of the debris. An attempt was made to match 11 clinical parameters
with both the mycological and bacteriological findings. There was no significant 
association between the fungal species cultured and the clinical parameters did
not vary with the presence or absence of different bacteria; pus was never
present in fungal otitis externa (Fisher's test, P < 0.001). Before therapy, a
significant number of ears had completely sterile bacterial cultures (p < 0.01,
chi2 test); saprophytic Gram-positive bacteria increased after treatment, whilst 
Gram-negative bacteria, Pseudomonas aeruginosa and Proteus species, decreased
after treatment. Clinical total cure rates 3 days after the end of therapy ranged
from 50% in group A, 25% in group B to 22.5% in group C. Mycological cure rates
were 80% (group A), 95% (group B) and 72.5% (group C). Two weeks after the end of
therapy the clinical cure rates were 60% (group A), 65% (group B) and 80% (group 
C) and the mycological cure rates was 65% for group A and 75% for both group B
and C. Eleven patients relapsed with otitis externa: four (20%) in groups A and C
and three (15%) in group B. In four cases the infection was due to bacteria and
the remaining seven were due to fungi. Six sites relapsed with the same fungal
species as that isolated at the start of the study. In this short-term assessment
the relapse rate was not significantly associated with predisposing conditions.
The tolerance was excellent in group A. Four patients (20%) in group B had mild
(two patients) or moderate (two patients) burning and itching with each
application. Twelve patients (30%) in group C had severe stinging and five of
these patients who had perforated tympanic membranes also experienced pain. In
terms of clinical and mycological effectiveness, there were no significant
differences between the three treatment groups, although group A
(ciclopiroxolamine cream 1%) and B (ciclopiroxolamine solution 1%) both showed
significantly better tolerance (Fisher's test, P < 0.05) when compared with boric
acid (group C).

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 12572722 [PubMed - indexed for MEDLINE]

1762: Laryngoscope. 2003 Feb;113(2):322-7.

Antigenic as well as nonantigenic stimuli induce similar middle ear responses in 
the rat.

Tonnaer EL, Ingels KJ, Rijkers GT, Curfs JH.

Department of Otorhinolaryngology, University Medical Center St. Radboud,
Nijmegen, The Netherlands. E.Tonnaer@KNO.UMCN.NL

OBJECTIVES/HYPOTHESIS: The observation that during otitis media many different
types of micro-organisms have been cultured from effusions indicate that, once
present in the middle ear cavity, most types of micro-organisms are able to
trigger an inflammatory reaction leading to otitis media. The present study was
designed to determine the middle ear response after injection of different
substances into the middle ear cavity. STUDY DESIGN: To determine whether and to 
what extent an inflammatory response of the middle ear depends on the entering
agent, the response in the tympanic cavity was studied by otomicroscopy and
histological examination after inoculation of various substances. METHODS: Lewis 
rats were inoculated in transtympanic fashion either with live or heat-killed
bacteria (pathogenic and nonpathogenic), Keyhole limpet hemocyanin, active
charcoal, or saline. The mucosal response of the challenged middle ears was
studied histologically. RESULTS: Irrespective of the inoculated substance, no
essential differences in the mucosal response were found. The intensity of the
inflammatory response was greater when live bacteria were inoculated.
CONCLUSIONS: The present study demonstrates that any substance reaching the
middle ear cavity is likely to induce otitis media. These observations emphasize 
the role of the eustachian tube as "porte d'entrée" in the pathogenesis of this
disorder. Determination of specific aspects of the eustachian tube involved in
protection or in facilitating bacterial translocation will be important for the
understanding of the pathogenesis of otitis media and the subsequent development 
of new therapeutic strategies. In addition, elucidation of bacterial factors
involved in the process of colonization and translocation will be of equal
importance.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12567090 [PubMed - indexed for MEDLINE]

1763: Laryngoscope. 2003 Feb;113(2):226-7.

Bordetella pertussis causing otitis media: a case report.

Decherd ME, Deskin RW, Rowen JL, Brindley MB.

Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical
Branch at Galveston, 301 University Boulevard, Route 0521, Galveston, TX 77555,
USA.

OBJECTIVE/HYPOTHESIS: is an unusual cause of otitis media with effusion. We
report a case in a neonate. STUDY DESIGN: Case report. METHODS: A case is
presented. RESULTS: A 1-month-old infant girl was admitted because of respiratory
distress and subsequently was found to have pertussis. On examination she was
noted to have a middle ear effusion. Myringotomy was performed for culture.
Culture confirmed. We were unable to find a previous report of otitis media.
CONCLUSION: has been identified in the middle ear effusion of an infant with the 
pertussis syndrome.

Publication Types: 
    Case Reports

PMID: 12567073 [PubMed - indexed for MEDLINE]

1764: Curr Med Res Opin. 2002;18(8):520-2.

Comparative efficacy of two anti-bacterial/anti-inflammatory formulations
(Auricularum otic powder and Dex-Otic drops) in the medical treatment of otitis
externa.

Yaniv E, Shevro J, Nageris B, Lapidot M, Hadar T, Cahani B, Zegerman C.

Hasharon Hospital, Petach Tikva, Israel.

BACKGROUND: Otitis externa (OE) is a common disorder which can cause severe pain 
and discomfort with discharge and hearing loss. The majority of topical
preparations for OE treatment contain a combination of steroids and antibiotics
and are administered as ear drops. Otic powder preparations are less common. We
found no studies which compared the efficacy of the two dosage forms. OBJECTIVE: 
The purpose of the study was to compare the healing process of the external ear
canal when treated locally either with otic powder (Auricularum), a preparation
containing antibiotic, steroidal and antimycotic components, or with otic drops
(Dex-Otic), a commercial ear drop preparation containing antibiotic and steroidal
components. METHODS: The study was designed as an open, randomised, comparative
clinical trial. Ambulatory patients suffering from OE were examined by an ear
specialist and randomly divided into an otic powder (Auricularum) treatment group
and an ear drop (Dex-Otic) treatment group. Each treatment group was treated in
accordance with the daily doses recommended by the manufacturers. Patients were
treated for a period of 14 days and examined on days 0, 3, 7, 10 and 14. Clinical
signs and symptoms recorded were pain, erythema, swelling and discharge. RESULTS:
A total of 67 patients entered the study. The probability of healing within 7
days was 74% in the otic powder group as opposed to 40% in the ear drops group
(log rank test, p = 0.0013). The probability of total pain relief after 3 days of
treatment was 60% in the otic powder group compared to 53% in the ear drops group
(log rank test, p = 0.0001). CONCLUSION: We conclude that treatment with an otic 
powder (Auricularum) may promote earlier healing and pain relief than does
treatment with otic drops (Dex-Otic).

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 12564664 [PubMed - indexed for MEDLINE]

1765: Pediatrics. 2003 Feb;111(2):E162-7.

Tobacco counseling at well-child and tobacco-influenced illness visits:
opportunities for improvement.

Tanski SE, Klein JD, Winickoff JP, Auinger P, Weitzman M.

Strong Children's Research Center, University of Rochester, Rochester, New York
14620-3917, USA. susanne_tanski@urmc.rochester.edu

OBJECTIVE: To assess the frequency of clinician-reported delivery of counseling
for avoidance of child environmental tobacco smoke (ETS) exposure and tobacco use
at periodic well-child visits and at illness visits for asthma and otitis media
(OM). METHODS: Combined data from the National Ambulatory Medical Care Survey and
the outpatient portion of the National Hospital Ambulatory Medical Care Survey
from 1997 to 1999 were analyzed. The frequency of pediatric visits (<or=18 years)
that included clinician-reported counseling for tobacco use/exposure prevention
was assessed. Diagnosis-specific visits were determined by using International
Classification of Diseases, Ninth Revision codes for asthma (493-), OM (381-,
382-), and well-child visits. Bivariate and regression analyses were performed.
RESULTS: Of 33 823 ambulatory care visits by children, 1.5% were reported to
include delivery of tobacco counseling. Only 4.1% of well-child visits, 4.4% of
illness visits for asthma, and 0.3% of illness visits for OM included tobacco
counseling. With the use of logistic regression models, adolescent patient visits
(13-18 years) were more likely to include delivery of tobacco counseling than
younger child visits [OR = 15.8, 95% CI (7.5-33.5)]. Visits by children with
Medicaid and those seen by a nurse practitioner or a physician's assistant were
also more likely to include tobacco counseling (odds ratio: 1.6; 95% confidence
interval: 1.002-2.50; and odds ratio: 3.0; 95% confidence interval: 1.5-6.0,
respectively). There were no significant differences in counseling delivery by
race, ethnicity, or clinician specialty. CONCLUSIONS: Rates of tobacco counseling
at well-child visits and at illness visits for diagnoses directly affected by
tobacco use and ETS are extremely low. Significant opportunities exist to improve
counseling rates for child ETS exposure and adolescent tobacco use in primary
care.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12563090 [PubMed - indexed for MEDLINE]

1766: Int J Pediatr Otorhinolaryngol. 2003 Jan;67(1):53-8.

Mucin gene expression in the effusions of otitis media with effusion.

Takeuchi K, Yagawa M, Ishinaga H, Kishioka C, Harada T, Majima Y.

Department of Otorhinolaryngology, Mie University School of Medicine, 2-174
Edobashi Tsu, Mie 514-8507, Japan. kazuhiko@clin.medic.mie-u.ac.jp

OBJECTIVES: The purpose of the study is to know if mucin gene expression can be
detected in the middle ear effusion and if so, which mucin genes are expressed in
the effusions. METHODS: Mucin gene expression in the middle ear effusions
obtained from five patients with otitis media with effusion were analyzed by
reverse transcription-polymerase chain reaction. Ribonucleic acids (RNAs) were
extracted from the effusion and the expression of 12 mucin genes was analyzed by 
reverse transcription-polymerase chain reaction. RESULTS: Mucin gene expression
examined by reverse transcription-polymerase chain reaction indicated the
expression of MUC1, MUC4, MUC5AC, MUC6, MUC7, MUC8, MUC9, MUC11 and MUC12 mRNA in
the effusion. This mucin gene expression was similar to that in BEAS-2B cell, a
bronchial epithelial cell line. CONCLUSION: Middle ear effusion can give us
valuable information on mucin gene expression in the middle ear. There is
similarity between mucin gene expression in the middle ear effusion and that in
the bronchial epithelia.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12560150 [PubMed - indexed for MEDLINE]

1767: Int J Pediatr Otorhinolaryngol. 2003 Jan;67(1):43-51.

Etiology of acute otitis media in childhood and evaluation of two different
protocols of antibiotic therapy: 10 days cefaclor vs. 3 days azitromycin.

Oğuz F, Unüvar E, Süoğlu Y, Erdamar B, Dündar G, Katircioğlu S, Sidal M.

Institute of Child Health, Istanbul University, Istanbul, Turkey.
foguz@istanbul.edu.tr

BACKGROUNDS: Acute otitis media (AOM) is a common childhood infection that is
frequently treated by antibiotics. There are no prospective and comprehensive
trials evaluating childhood AOM for etiologic pathogens and resistance pattern in
Turkey. The aims of the study were to determine the bacterial etiologies and
resistance patterns, and identify the efficacy and the relapse rates of 3 days of
azitromycin and 10 days of cefaclor therapy in AOM. METHODS: This prospective,
randomized, single-blind, open study was carried out in 78 cases of AOM. Mean age
was 30.7+/-27 months. Tympanocentesis and aspiration of middle ear fluid (MEF)
were used to obtain purulent material from the middle ear. Group 1 consisted of
the cases (n=41) on azitromycin therapy and Group 2 (n=37) on cefaclor. Dosage of
azitromycin was 10 mg/kg per day for 3 days and cefaclor 40 mg/kg per day for 10 
days. The patients were evaluated on days 3-5 (second visit), day 10 (third
visit), and day 30 (fourth visit) during follow-up. RESULTS: A total of 50
species were isolated from 44 of 78 cases from which materials were obtained
(44/78; 56.4%). Most frequently isolated microorganism was Streptococcus
pneumoniae (n=18; 36%), followed by Haemophilus influenzae (n=11; 22%), S. aureus
(n=9; 18%), Moraxella catarrhalis (n=4; 8%), and group A beta-hemolytic
streptococcus (GAS, n=4; 8%). Enterococcus faecalis was isolated from three cases
and H. parainfluenzae from one. Penicillin and amoxicillin resistances of
bacteria were found to be 40 and 36%, respectively. The frequency of penicillin
and amoxicillin resistance in </=24-month age group was 59 and 66.6%,
respectively. The patients did not demonstrate significant differences in terms
of cure rate on the third to fifth day (Group 1: 32.5%; Group 2: 36.4%), 10th day
(Group 1: 76.9%; Group 2: 84.8%), and on 30th day (Group 1: 91.3%; Group 2:
81.8%). There were no significant differences with respect to side effects,
relapse, and re-infection rate between the two groups. CONCLUSION: In more than
half of the AOM cases, bacteria were isolated from MEF and most frequently
isolated organisms were S. pneumoniae, H. influenzae, and S. aureus. Three-day
azitromycin therapy was as effective as 10-day cefaclor therapy.

Publication Types: 
    Clinical Trial
    Comparative Study
    Evaluation Studies
    Randomized Controlled Trial

PMID: 12560149 [PubMed - indexed for MEDLINE]

1768: Int J Pediatr Otorhinolaryngol. 2003 Jan;67(1):31-3.

Acute mastoiditis caused by Moraxella catarrhalis.

Leskinen K, Jero J.

Department of Otolaryngology, Helsinki University Central Hospital,
Haartmaninkatu 4 E, P.O. Box 220, FIN-00029 Helsinki, Finland.
kimmo.leskinen@hus.fi

Acute mastoiditis is the most frequent intratemporal complication of otitis
media. The bacteriology of acute otitis media is changing continuously and it
differs markedly from the bacteriology of acute mastoiditis. Moraxella
catarrhalis (M. catarrhalis) is the third most common bacteria found in acute
otitis media, and in recent years its importance as an etiological factor of
acute otitis media has markedly increased in certain geographic areas. However,
there are no reports of acute mastoiditis caused solely by M. catarrhalis. This
report describes a case of a 2-year-old girl with acute mastoiditis and M.
catarrhalis in the bacterial culture of middle ear effusion.

Publication Types: 
    Case Reports

PMID: 12560147 [PubMed - indexed for MEDLINE]

1769: Vaccine. 2003 Mar 7;21(11-12):1118-24.

Total genome polymorphism and low frequency of intra-genomic variation in the
uspA1 and uspA2 genes of Moraxella catarrhalis in otitis prone and non-prone
children up to 2 years of age. Consequences for vaccine design?

Hays JP, van der Schee C, Loogman A, Eadie K, Verduin C, Faden H, Verbrugh H, van
Belkum A.

Department of Medical Microbiology and Infectious Diseases, Erasmus University
Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The
Netherlands. hays@bacl.azr.nl

Intra-genomic variation in the uspA1 and uspA2 genes of Moraxella catarrhalis was
studied using pulsed field gel electrophoresis (PFGE) and polymerase chain
reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. From a set
of 91 M. catarrhalis isolates, 19 pairs of PFGE identical isolates were found.
Five pairs originated from otitis non-prone children, 11 pairs from otitis prone 
children and for 3 pairs, one of the pair originated from an otitis prone and the
other from an otitis non-prone child. No particular M. catarrhalis isolate was
associated with either the otitis prone or non-prone children. One of these 19
pairs of isolates was found to exhibit both uspA1 and uspA2 intra-genomic
variation, whilst another pair exhibited uspA2 intra-genomic variation only.
Sequence data obtained from these variants showed that PCR-RFLP pattern
differences reflected actual changes in predicted amino acid composition and that
minor amino acid changes in a 23 base pair "NINNIY" repeat region (a conserved
UspA1 and UspA2 binding site for the neutralising antibody mAb17C7) occurred.
Variation in the uspA2 5' non-coding "AGAT" repeat region was also observed.
These results may have implications for future M. catarrhalis vaccines comprising
UspA1 or UspA2 components. Copyright 2002 Elsevier Science Ltd.

Publication Types: 
    Comparative Study

PMID: 12559789 [PubMed - indexed for MEDLINE]

1770: Pediatr Infect Dis J. 2003 Jan;22(1):10-6.

Erratum in:
    Pediatr Infect Dis J. 2003 Feb;22(2):163.

Impact of the pneumococcal conjugate vaccine on otitis media.

Fireman B, Black SB, Shinefield HR, Lee J, Lewis E, Ray P.

Kaiser Permanente Division of Research and the Kaiser Permanente Vaccine Studies 
Center, Oakland, CA 94612, USA. bruce.fireman@kp.org

CONTEXT: The heptavalent pneumococcal conjugate vaccine (PCV) is recommended for 
infants to protect against invasive disease, but its impact on otitis might also 
have public health importance. OBJECTIVE: To examine the impact of PCV on the
incidence of otitis media, frequent otitis media and tympanostomy tube procedures
and to assess whether the effectiveness of the vaccine wanes after age 24 months 
and varies by race, sex or season. DESIGN, SETTING AND PATIENTS: From 1995 to
1998, 37 868 children at Kaiser Permanente in Northern California were randomized
to receive PCV or a control vaccine in a double blind trial and were followed
through April 1999. INTERVENTIONS: Children received a primary series at 2, 4 and
6 months of age and a booster at 12 to 15 months. MAIN OUTCOME MEASURES: Visits
for otitis, frequent visits for otitis and tympanostomy tube procedures. Otitis
was ascertained from diagnosis checklists routinely marked by physicians.
RESULTS: Control children averaged 1.8 otitis visits per year. Children given PCV
had fewer otitis visits than control children in every age group, sex, race and
season examined. Intention-to-treat analysis permitted rejection of the null
hypothesis that PCV is ineffective against otitis media (P < 0.0001). In children
who completed the primary series per protocol, PCV reduced otitis visits by 7.8% 
[95% confidence interval (CI), 5.4 to 10.2%] and antibiotic prescriptions by 5.7%
(CI 4.2 to 7.2%). Frequent otitis was reduced by amounts that increased with
otitis frequency, from a 10% reduction in the risk of 3 visits to a 26% reduction
in the risk of 10 visits within a 6-month period. Tube placements were reduced by
24% (CI 12 to 35%). CONCLUSION: In children followed up to 3.5 years, PCV
provided a moderate amount of protection against ear infections while reducing
frequent otitis media and tube procedures by greater amounts.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 12544402 [PubMed - indexed for MEDLINE]

1771: Otol Neurotol. 2003 Jan;24(1):113-7.

Acute otitis media and facial nerve paralysis in adults.

Redaelli de Zinis LO, Gamba P, Balzanelli C.

Department of Otolaryngology, University of Brescia, Italy.
redaelli@master.cci.unibs.it

OBJECTIVE: The pathophysiology and treatment of facial nerve paralysis associated
with acute otitis media are still under debate. The objective of this study was
to review treatment strategies and extent of recovery in adult patients with the 
aim of defining a standard treatment protocol for this rare pathologic condition.
STUDY DESIGN: Retrospective chart review. SETTING: University hospital, tertiary 
referral center. PATIENTS: Between 1993 and 2000, 11 patients were admitted for
facial nerve paralysis secondary to acute otitis media. There were six women and 
five men without a history of chronic middle ear disease, who ranged in age from 
21 to 71 years. Facial palsy was graded with the House-Brackmann scale: four
patients had Grade III palsy, six had Grade IV palsy, and one patient had Grade V
palsy. Bacteriologic examination of middle ear fluid was performed in four
patients Streptococcus pneumoniae was observed in one patient, and the remaining 
three cultures were negative. INTERVENTIONS: All patients were treated with
parenteral ampicillin-sulbactam or a third-generation cephalosporin in
conjunction with oral or intravenous corticosteroids, except in a single patient 
with diabetes mellitus who received antibiotics alone. Myringotomy alone or with 
ventilation tube application was performed in eight patients. A simple
mastoidectomy without facial nerve decompression was used in a patient with
sudden impairment to Grade VI paralysis and worsening otitis after an initial
improvement. RESULTS: Normal facial function returned in all patients,
independently of the grade of the paralysis, the treatment strategy, or the
outcome of the middle ear disease. The time of recovery varied from 2 weeks to 3 
months, except for one patient who underwent mastoidectomy and in whom normal
function returned in 10 months. CONCLUSIONS: The treatment of facial nerve
paralysis secondary to otitis media should be as conservative as possible, using 
antibiotics and corticosteroids. Myringotomy and a ventilation tube should be
added when spontaneous perforation of the tympanic membrane is not present.
Mastoidectomy should be performed only when it is necessary to treat otitis
media. Facial nerve decompression should not be necessary.

Publication Types: 
    Case Reports

PMID: 12544039 [PubMed - indexed for MEDLINE]

1772: Otol Neurotol. 2003 Jan;24(1):52-7.

Blockage of immune-mediated inner ear damage by etanercept.

Wang X, Truong T, Billings PB, Harris JP, Keithley EM.

Division of Otolaryngology-Head and Neck Surgery, University of California and
Research Service of the Department of Veterans Affairs, San Diego, 92093-0666,
USA.

HYPOTHESIS: Etanercept will be able to reduce the inflammation and hearing loss
associated with experimentally induced labyrinthitis. BACKGROUND: Inner ear
immune responses cause hearing loss that may be reversible with pharmacologic
treatment. Etanercept, tumor necrosis factor receptor blocker, was investigated
in a guinea pig model of immune-mediated hearing loss. Sterile labyrinthitis was 
created by injection of keyhole limpet hemocyanin into the inner ear after
systemic sensitization to keyhole limpet hemocyanin with adjuvant. Labyrinthitis 
involves infiltration of inflammatory cells and hearing loss detectable 3 to 5
days after challenge with keyhole limpet hemocyanin. METHODS: Etanercept was
administered either systemically (2.5 mg) 30 minutes before intracochlear
challenge with keyhole limpet hemocyanin, with a second intraperitoneal dose (2.5
mg) 3 days later or locally by long-term infusion into the scala tympani with an 
osmotic pump (5.0 microg/h for 7 days). Auditory evoked brainstem response
thresholds were measured before and after treatment to determine hearing loss.
Cochleas were evaluated for the amount of inflammation. RESULTS: Hearing loss in 
the untreated systemic group averaged 71 +/- 21 dB versus 37 +/- 32 dB in the
etanercept-treated animals (t test, P < 0.001). There was also less inflammation 
in the cochleas from etanercept-treated animals (t test, P < 0.01). Hearing loss 
with local administration of etanercept was 59 +/- 31 dB in the nontreated ears
and 18 +/- 8 dB in the treated ears (t test, P < 0.02). Inflammation was also
less (t test, P < 0.01). Etanercept was not ototoxic. CONCLUSION: Prompt
intervention with the anti-inflammatory drug etanercept significantly reduces
inflammation sufficient for substantive hearing preservation.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 12544029 [PubMed - indexed for MEDLINE]

1773: Otol Neurotol. 2003 Jan;24(1):38-42.

Cartilage palisades in type III tympanoplasty: anatomic and functional long-term 
results.

Bernal-Sprekelsen M, Romaguera Lliso MD, Sanz Gonzalo JJ.

Ear, Nose and Throat Department, Hospital Clínic, University of Barcelona, Spain.
mbernal@medicina.ub.ed

OBJECTIVE: To evaluate the long-term anatomic and functional results after
partial and total autologous cartilage palisade type III tympanoplasties to
assess the efficacy of cartilage palisades in preventing recurrent cholesteatoma.
STUDY DESIGN: Retrospective data bank and patient review. SETTING: Tertiary
referral center. PATIENTS: The study population included all patients with more
than 36 months follow-up who underwent tympanoplasty or tympanomastoidectomy for 
previously untreated cholesteatoma using partial or total autologous cartilage
palisade graft associated with a reconstruction of the ossicular chain from
October 1, 1992, to October 31, 1998. INTERVENTION: Tympanoplasty or
tympanomastoidectomy using autologous cartilage palisade graft for partial or
total reconstruction of the tympanic membrane and the ossicular chain. MAIN
OUTCOME MEASURES: Anatomic results, i.e., closure of the perforation, rate of
retraction pockets, recurrent cholesteatoma, and reperforation rate related to
the use of autologous cartilage were clinically evaluated. Postoperative speech
reception thresholds, speech discrimination scores, and postoperative air-bone
gap were compared with preoperative levels. The outcomes of canal wall up and
canal wall down procedures were compared. RESULTS: Closure of the tympanic
membrane was achieved in 98.3% of patients. Speech reception thresholds did not
change significantly. Speech discrimination scores were stable or improved in all
patients. Postoperative air-bone gap was less than 10 dB in 29.8% of patients and
between 11 and 20 dB in 32.3%. The complication rate of the tympanoplasty in
general was 0.67%. The rate of recurrences of cholesteatoma was 2.2%. No
complications could be related to the use of cartilage. CONCLUSIONS: The
cartilage palisade technique is effective for the reconstruction of the tympanic 
membrane and also prevents new retractions and recurrences of cholesteatoma. The 
functional results show that autologous cartilage grafts are able to transmit
sound.

Publication Types: 
    Evaluation Studies

PMID: 12544026 [PubMed - indexed for MEDLINE]

1774: Otol Neurotol. 2003 Jan;24(1):33-7.

Type III tympanoplasty applying the palisade cartilage technique: a study of 61
cases.

Neumann A, Schultz-Coulon HJ, Jahnke K.

Department of Otorhinolaryngology, University of Essen, Germany.
andreas.neumann@uni-essen.de

OBJECTIVE: To determine the morphologic and hearing results of the combined
application of the palisade cartilage technique and titanium ossicular
replacement prostheses in Type III tympanoplasty. STUDY DESIGN: Retrospective
review of 61 tympanoplasties. SETTING: Tertiary referral center. PATIENTS: 59
patients (39 women and 20 men, mean age 36 years, range 7-81 years) consecutively
operated on because of cholesteatoma, adhesive otitis, chronic otitis media,
subtotal tympanic membrane defects, and tympanofibrosis requiring tympanoplasty
with ossiculoplasty. INTERVENTIONS: Tympanoplasty Type III, with application of
the palisade cartilage technique and total or partial titanium ossicular
replacement prosthesis. MAIN OUTCOME MEASURES: Otoscopic findings and hearing
results using a four-frequency pure tone average air-bone gap. RESULTS: A
recurrent defect was seen in 1 ear (1.6%). The graft take rate was 100%. There
were no extrusions of prostheses. Preoperatively, a pure tone average air-bone
gap of 0 to 10 dB was seen in 1 ear, 11 to 30 dB in 30, and 31 to 50 dB in
another 30 ears. Postoperatively, the corresponding numbers were 11, 41, and 9
ears, respectively. Hearing results were better in the total ossicular
replacement prosthesis group. CONCLUSIONS: The palisade cartilage technique is
suitable to manage difficult pathologic conditions in middle ear surgery. It was 
demonstrated that the palisade cartilage technique can be combined safely with
titanium ossicular replacement prostheses. Regarding postoperative hearing
results, the negative preselection of pathologic conditions must be considered.

Publication Types: 
    Comparative Study

PMID: 12544025 [PubMed - indexed for MEDLINE]

1775: Otol Neurotol. 2003 Jan;24(1):29-32.

Relationship of preoperative findings and ossicular discontinuity in chronic
otitis media.

Jeng FC, Tsai MH, Brown CJ.

Department of Otolaryngology, China Medical College Hospital, Taichung, ROC.
fuh-cherng-jeng@uiowa.edu

BACKGROUND: Ossicular discontinuity may result from chronic otitis media, with or
without cholesteatoma, and usually cannot be determined unless an operation is
performed. If preoperative information can be used to determine whether or not
the ossicular chain is intact, the patient can be better informed and the surgeon
can be better prepared before surgery. OBJECTIVE: To examine the correlation
between preoperative findings and the status of the ossicular chain at surgery.
STUDY DESIGN: Retrospective. SETTING: A tertiary referral center. PATIENTS: Data 
from 190 patients (212 ears) who were undergoing their first operations for
chronic otitis media were reviewed. INTERVENTION: The operations for the
cholesteatoma or noncholesteatoma ears were classified into different groups and 
analyzed separately. Ossicular discontinuity was identified only if the
discontinuity of the ossicular chain was confirmed at the time of operation.
RESULTS: The cholesteatoma group consisted of 59 ears, and the noncholesteatoma
group contained 153 ears. In the cholesteatoma group, two statistically
significant preoperative parameters were observed to be significantly correlated 
with ossicular discontinuity: persistently draining ears (p = 0.026) and a
cholesteatoma that extended to the tympanic sinus (p = 0.006). In the
noncholesteatoma group, only one parameter was observed to be predictive of
ossicular discontinuity. In this group of patients, perforation of the tympanic
membrane with an edge adherent to the promontory occurred significantly more
frequently in patients with ossicular discontinuity (p = 0.004) than in those
with intact ossicular chains. Surprisingly, an air-bone gap was not significantly
correlated with ossicular discontinuity. The cholesteatoma and granulation tissue
in the middle ear cavity may serve as transmission bridges of acoustic energy,
resulting in narrowed air-bone gaps. CONCLUSIONS: In the cholesteatoma group,
both cholesteatoma extension into the tympanic sinus and persistently draining
ears were predictive of ossicular discontinuity. In the noncholesteatoma group,
perforation edges adhering to the promontory also revealed a higher incidence of 
ossicular discontinuity. Therefore, all these findings can be considered as
potential preoperative predictors of ossicular discontinuity in chronic otitis
media.

PMID: 12544024 [PubMed - indexed for MEDLINE]

1776: Otol Neurotol. 2003 Jan;24(1):2-5.

Use of cartilage plate as tympanic membrane in total middle ear reconstructive
surgery for infected radicalized ear.

Ishimoto S, Ito K, Shinogami M, Yamasoba T, Kaga K.

Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Japan.

OBJECTIVE: To evaluate the usefulness of cartilage plates as tympanic membranes
combined with total middle ear reconstructive surgery for radicalized ears. STUDY
DESIGN: Retrospective study between 1994 and 1999. SETTING: Tertiary care
referral medical center. PATIENTS: Seven patients had seven ears with severe
chronic otorrhea after radical mastoidectomy. All patients had severe to profound
sensorineural hearing loss and expected a trouble-free ear rather than improved
hearing after surgery. Patients were followed up for 4 years postoperatively.
METHODS: After the middle ear space was cleaned, the tympanic membrane was
reconstructed using a plate prepared from the tragal cartilage. The major part of
the posterior wall was reconstructed using a conchal cartilage plate. Cortical
bone segments were inserted to support the cartilage plate. RESULTS:
Preoperatively, cultures of ear discharge were positive for various bacteria.
Recovery with dry eardrums was noted in six patients, and one patient showed
minimal erosion. No postoperative complications were encountered, but the hearing
threshold did not improve postoperatively. CONCLUSIONS: Total middle ear
reconstructive surgery is suitable for patients with chronic otorrhea
complicating radical mastoidectomy. The use of cartilage plates seems to be
clinically appropriate, particularly for patients with severe infection who
expect a trouble-free ear rather than hearing gain after surgery.

Publication Types: 
    Evaluation Studies

PMID: 12544019 [PubMed - indexed for MEDLINE]

1777: Auris Nasus Larynx. 2003 Feb;30 Suppl:S97-8.

Pediatric bilateral facial nerve palsy secondary to acute otitis media.

Ochi K, Miyamoto Y, Ohashi T.

Department of Otolaryngology, St. Marianna University School of Medicine 2-16-1, 
Sugao, Miyamae-ku, 216-8511, Kawasaki City, Japan. k2ochi@marianna-u.ac.jp

Bilateral facial palsy after the onset of acute otitis media is presented in a
19-month-old patient. Facial nerve palsy disappeared gradually after myringotomy.
The mechanisms underlying the facial nerve palsy with otitis media are discussed.

Publication Types: 
    Case Reports

PMID: 12543170 [PubMed - indexed for MEDLINE]

1778: Acta Otolaryngol. 2002 Dec;122(8):827-30.

Community-acquired methicillin-resistant Staphylococcus aureus infections in
discharging ears.

Hwang JH, Tsai HY, Liu TC.

Department of Otolaryngology, Poh-Ai Hospital, Lotung, Taiwan.

OBJECTIVES: Although community-acquired methicillin-resistant Staphylococcus
aureus (MRSA) infections have recently become an increasing problem in various
fields of medicine, they have rarely been studied in the ear. The purpose of this
study was to determine the prevalence of community-acquired MRSA infections in
discharging ears and to compare the epidemiology of MRSA with that of other
pathogens. MATERIAL AND METHODS: Between August 2000 and February 2002, 248
isolates recovered from 221 discharging ears of patients with 3 disease entities 
(chronic otitis media, acute otitis externa and granular myringitis) were
prospectively analyzed using bacteriology. The isolates analyzed using
bacteriology were divided into three groups: MRSA, methicillin-susceptible S.
aureus (MSSA) and non-SA. RESULTS: S. aureus was found in 108 (43.5%) isolates
and MRSA in 27. Therefore, the percentage of MRSA among the S. aureus isolates
was 25.0% (27/108). The prevalence of community-acquired MRSA infections in
discharging ears was 12.2% (27/221) and the MRSA strains were highly susceptible 
to vancomycin, teicoplanin, fusidic acid and minocycline. The MRSA-infected
patients were older than those infected with other groups of pathogens. Also,
MRSA infections appeared to be more common in chronic otitis media than in acute 
otitis externa or granular myringitis. CONCLUSIONS: Community-acquired MRSA
represents an increasing problem. In this study, MRSA strains were highly
susceptible to vancomycin, teicoplanin, fusidic acid and minocycline.

PMID: 12542200 [PubMed - indexed for MEDLINE]

1779: J Laryngol Otol. 2002 Dec;116(12):996-1000.

Revision surgery for chronic otitis media: recurrent-residual disease and
hearing.

O'Leary S, Veldman JE.

Department of Otolaryngology, University of Melbourne, The Royal Victorian Eye
and Ear Hospital, Melbourne, Australia.

The aim of this study was to determine the effect of surgical approach, intact
canal wall (ICW) or canal wall down (CWD), upon the success of revision surgery
for chronic otitis media (COM). A retrospective analysis of 367 patients
(including 65 children aged <15 years) who underwent revision tympanoplasty
because of persistent disease was performed. Single-staged tympanoplasty was
performed, preserving the canal wall when present. Hearing was reconstructed with
allograft incus. Follow-up ranged from one to 15 years. Hearing was determined by
pre- and post-operative air-bone gaps. Post-operative re-perforation, aural
discharge and/or cholesteatoma rates were similar for CWD and ICW. Cholesteatoma 
could present following the revision, even though it was not apparent at surgery.
Following tympanoplasty, the final hearing was not significantly affected by the 
surgical approach or presence of cholesteatoma. Improvement in hearing was
adversely affected by cholesteatoma or an absent stapes suprastructure. Revision 
ICW and CWD operations were both successful in controlling signs of COM.
Cholesteatoma is a peripheral risk in COM and may become apparent after revision 
surgery.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12537610 [PubMed - indexed for MEDLINE]

1780: Ann Otol Rhinol Laryngol. 2003 Jan;112(1):85-90.

Validation assessment of the Chinese-version Chronic Ear Survey: a comparison
between data from English and Chinese versions.

Wang PC, Chu CC, Liang SC, Tai CJ, Gliklich RE.

Department of Otolaryngology, Cathay General Hospital, 280, Sec 4, Jen-Ai Rd,
106, Taipei, Taiwan, Republic of China.

The Chronic Ear Survey (CES) is a valid, disease-specific measure for the
evaluation of health status and treatment effectiveness for adults with chronic
suppurative otitis media (CSOM). This study compares the validation properties of
the English and Chinese versions of the CES. The CES was translated into Mandarin
Chinese by means of a parallel model. The Chinese version of the CES (CCES) was
administered to 103 patients in a prospective manner, then was validated
according to established criteria for reliability, validity, and longitudinal
sensitivity. The CCES demonstrated good test-retest reliability and internal
consistency (Cronbach's a = 0.81). The CCES significantly correlated with the
Mandarin Chinese (Taiwan) version of the generic 36-Item Short-Form Health Survey
(TSF-36). The standardized response mean for the CCES total score was 2.1,
indicating excellent sensitivity to clinical change. This validation study
demonstrated that the performance characteristics of the CCES were equivalent to 
those of the English-version CES. The CCES is a valid tool for evaluation of
adults with CSOM among the Chinese-speaking population.

Publication Types: 
    Comparative Study
    Evaluation Studies
    Research Support, Non-U.S. Gov't

PMID: 12537064 [PubMed - indexed for MEDLINE]

1781: Immunol Cell Biol. 2003 Feb;81(1):46-51.

Bacterial otitis media: current vaccine development strategies.

Cripps AW, Kyd J.

Gadi Research Centre for Medical and Health Sciences, University of Canberra,
Canberra, Australia. allan.cripps@canberra.edu.au

Otitis media is the most common reason for children less than 5 years of age to
visit a medical practitioner. Whilst the disease rarely results in death, there
is significant associated morbidity. The most common complication is loss of
hearing at a critical stage of the development of speech, language and cognitive 
abilities in children. The cause and pathogenesis of otitis media is
multifactorial. Among the contributing factors, the single most important are
viral and bacterial infections. Infection with respiratory syncytial virus,
influenza viruses, para-influenza viruses, enteroviruses and adenovirus are most 
commonly associated with acute and chronic otitis media. Streptococcus
pneumoniae, non-typeable Haemophilus influenzae and Moraxella catarrhalis are the
most commonly isolated bacteria from the middle ears of children with otitis
media. Treatment of otitis media has largely relied on the administration of
antimicrobials and surgical intervention. However, attention has recently focused
on the development of a vaccine. For a vaccine to be effective against bacterial 
otitis media, it must, at the very least, contain antigens that induce a
protective immune response in the middle ear against the three most common
infecting bacteria. Whilst over the past decade there has been significant
progress in the development of vaccines against invasive S. pneumoniae disease,
these vaccines are less efficacious for otitis media. The search for candidate
vaccine antigens for non-typeable H. influenzae are well advanced whilst less
progress has been made for M. catarrhalis. No human studies have been conducted
for non-typeable H. influenzae or M. catarrhalis and the concept of a
tribacterial vaccine remains to be tested in animal models. Only when vaccine
antigens are determined and an understanding of the immune responses induced in
the middle ear by infection and immunization is gained will the formulation of a 
tribacterial vaccine against otitis media be possible.

PMID: 12534945 [PubMed - indexed for MEDLINE]

1782: Drugs. 2003;63(3):311-40.

Amoxicillin/clavulanic acid: a review of its use in the management of paediatric 
patients with acute otitis media.

Easton J, Noble S, Perry CM.

Adis International Limited, Auckland, New Zealand.

Amoxicillin/clavulanic acid (Augmentin), Augmentin ES-600 is a well established, 
orally administered combination of amoxicillin (a semisynthetic antibacterial
agent) and clavulanic acid (a beta-lactamase inhibitor). Amoxicillin/clavulanic
acid shows good activity against the main pathogens associated with acute otitis 
media (AOM), including penicillin-susceptible and -intermediate strains of
Streptococcus pneumoniae, and beta-lactamase producing strains of Haemophilus
influenzae and Moraxella catarrhalis. It has moderate activity against
penicillin-resistant S. pneumoniae; a high-dose formulation has been developed
with the aim of providing better coverage for penicillin-resistant strains.
Amoxicillin/clavulanic acid (conventional formulations, mostly 40/10 mg/kg/day in
three divided doses) produced clinical response rates similar to those of oral
cephalosporin comparators and similar to or significantly greater than those for 
intramuscular ceftriaxone in randomised trials in paediatric patients with AOM
(mean age approximately 2 to 5 years). Clinical response rates were generally
similar for amoxicillin/clavulanic acid and macrolide comparators (mean patient
age approximately 1 to 6 years), although significantly better clinical and
bacteriological responses were seen versus azithromycin in one randomised trial
(mean patient age approximately 1 year). The high-dose formulation of
amoxicillin/clavulanic acid (90/6.4 mg/kg/day in two divided doses) eradicated a 
high proportion of penicillin-resistant S. pneumoniae (penicillin MICs 2 or 4
mg/L) in a large noncomparative trial in children with AOM (upper limit of the US
indication for S. pneumoniae is 2 mg/L). Amoxicillin/clavulanic acid is generally
well tolerated. A low total incidence of adverse events (3.6%) and no serious
events were reported from a large paediatric postmarketing study. The most
frequently reported adverse events in children are mild gastrointestinal
disturbances. Diarrhoea is generally less frequent with twice-daily than with
three-times-daily treatment. The new high-dose formulation showed similar
tolerability to a conventional twice-daily formulation (45/6.4 mg/kg/day) in a
well controlled trial. CONCLUSIONS: Amoxicillin/clavulanic acid is a well
established broad-spectrum antibacterial treatment which is effective and well
tolerated in the treatment of AOM in paediatric patients. The high-dose
combination should prove valuable in treating AOM caused by
penicillin-intermediate and -resistant S. pneumoniae (approved in the US for
penicillin MIC < or =2 mg/L). Based on recent recommendations and the available
data, high-dose amoxicillin/clavulanic acid can be considered a treatment of
choice for recurrent or persistent paediatric AOM (after failure of amoxicillin
alone) where involvement of resistant pathogens is suspected.

Publication Types: 
    Comparative Study
    Review

PMID: 12534334 [PubMed - indexed for MEDLINE]

1783: Rocz Akad Med Bialymst. 2002;47:105-12.

Lymphocyte subpopulations in hypertrophied adenoid in children with otitis media 
with effusion.

Wysocka J, Hassmann E, Kasprzycka E, Musiatowicz M, Lipska A.

Department of Pediatric Laboratory Diagnostics, Medical Academy of Bialystok,
Białystok, Poland. zldpam@poczta.fm

Otitis media with effusion (OME) usually coexist with the adenoid hypertrophy.
The aim of this study was a quantitative evaluation of the lymphocyte
subpopulations in hypertrophied adenoid in children with persistent (ove three
months) otitis media with effusion. We used flow cytometry for study the
subpopulations of the lymphocytes in the pharyngeal adenoid during otitis media
in the children, alternative group consist of children with simple adenoid
hypertrophy. The monoclonal antibodies selected were specific markers for T
lymphocytes (CD3), T-helper cells (CD4), T-suppressor cells (CD8), B cells (CD19)
and NK cells (CD56). There were also analyzed T activation markers: HLA-DR and
CD25. The percentage of NK cells was significantly decreased in the group of
younger children with otitis media with effusion (0.81 +/- 0.51) in comparison to
older ones (1.40 +/- 0.59%). Also, in the group of younger children with adenoid 
hypertrophy, the NK cells percentage was significantly lower (0.85 +/- 0.37%)
than in the group of older children--(1.46 +/- 0.83). In both subgroups of
younger children the percentage of lymphocytes T with HLA-DR activation marker
was close, but it was significantly lower in the group of older children with
otitis media with effusion (4.28 +/- 3.40%) in comparison to the group of older
children with adenoid hypertrophy (5.03 +/- 3.00%).

Publication Types: 
    Comparative Study

PMID: 12533952 [PubMed - indexed for MEDLINE]

1784: Paediatr Drugs. 2003;5(2):133-40.

Shortened course of antibacterial therapy for acute otitis media.

Ovetchkine P, Cohen R.

Department of Pediatrics, Jean Verdier Hospital, Bondy, France.

Acute otitis media (AOM) is the most frequent bacterial disease and leading cause
of antibacterial prescriptions in infants and children. Although AOM resolves
spontaneously in most patients, antibacterial treatment is believed to be
indicated in most industrial countries, particularly for infants, to prevent
severe complications and relieve symptoms more rapidly. The classical duration of
oral antibacterial therapy has been 10 days. During the last decade, the efficacy
of shortened course antibacterial therapy has been demonstrated in many trials.
Advantages of shorter treatment periods include less expense, better compliance, 
and potentially less impact on the commensal flora. However, short course
antibacterial therapy may not be appropriate for children <2 years of age,
particularly those attending daycare centers, those with otorrhea or a recent
episode (<1 month), and otitis-prone children. Reasons for a poorer efficacy in
these groups of children are still not completely understood.

Publication Types: 
    Comparative Study
    Review

PMID: 12529165 [PubMed - indexed for MEDLINE]

1785: Jt Comm J Qual Saf. 2003 Jan;29(1):27-36.

Deciding not to measure performance: the case of acute otitis media.

Mangione-Smith R, Onstad K, Wong L, Roski J.

University of California, Los Angeles, Department of Pediatrics, USA.
ritams@ucla.edu

BACKGROUND: No Health Plan Employer Data and Information Set (HEDIS) performance 
measures evaluate health plans for possible overuse or inappropriate use of
antibiotics. Acute otitis media (AOM), or infection of the middle ear, is one of 
the most common infections in children. The antibiotic resistance of the bacteria
that cause AOM and the general overuse and inappropriate use of antibiotics for
this condition are taking center stage as a major public health threat. An effort
was undertaken to develop a new HEDIS performance measure that evaluates
appropriate antibiotic use in children with AOM. THE MEASURE DEVELOPMENT PROCESS:
The measure development process has three major phases: the initial development
phase, the field-testing and analysis phase, and the measure refinement phase.
With AOM, the measure development process could not proceed beyond the first
phase for reasons that are be discussed in detail. CONCLUSIONS: Additional
difficulties beyond feasibility issues may arise in developing a quality of care 
performance measure. The measure development process discussed in this article
failed primarily because of issues related to relevance as well as the scientific
soundness of the proposed measures. If the evidence base related to the diagnosis
and management of a particular condition is sparse, no standard can be developed 
against which to measure performance, and the criterion of scientific soundness
cannot be met. This is the case with AOM. Unfortunately, the evidence base will
likely remain inadequate to support the development of such a measure in the
future.

Publication Types: 
    Evaluation Studies
    Research Support, Non-U.S. Gov't

PMID: 12528571 [PubMed - indexed for MEDLINE]

1786: Eur Arch Otorhinolaryngol. 2003 Jan;260(1):24-7. Epub 2002 Aug 1.

Concomitant otomycosis and dermatomycoses: a clinical and microbiological study.

Ozcan M, Ozcan KM, Karaarslan A, Karaarslan F.

Ankara Numune Education and Research Hospital 1 ENT Clinic, Yucetepe sit A blok
59/6 06580 Anittepe, Ankara, Turkey. mugeozcan@yahoo.com

Otomycosis tends to recur despite long-term treatment. To our knowledge, there is
no study in the English literature concerning the clinical importance of
concomitant otomycosis and dermatomycoses. We investigated the presence of
dermatomycoses in 52 patients with otomycosis in order to document the clinical
and microbiological importance of their coexistence. Dermatomycoses on the feet
and/or hands were identified in 19 patients (36.5%). The most common pathogen for
otomycosis was Aspergillus niger, while it was Candida albicans for the
dermatomycoses. The same pathogenic fungi were isolated from the otomycosis and
dermatomycoses in nine of the 19 patients (47.4%). Aspergillus niger was the most
common shared pathogen. The pathogens isolated in concomitant dermatomycoses were
common pathogens for the fungal infection of the ear ( Aspergillus niger,
Aspergillus flavus, Aspergillus fumigatus, Candida albicans). It was concluded
that the autoinoculation of the ear canal by pathogenic fungi might be possible
in the presence of the untreated dermatomycoses. Dermatomycoses must be
investigated in patients with otomycosis and must be treated simultaneously in
order to prevent the recurrence of both.

PMID: 12520352 [PubMed - indexed for MEDLINE]

1787: J Vet Med Sci. 2002 Dec;64(12):1145-7.

Studies of certain factors affecting the microenvironment and microflora of the
external ear of the dog in health and disease.

Yoshida N, Naito F, Fukata T.

Gifu University Veterinary Medical Teaching Hospital, Faculty of Agriculture,
Gifu University, Japan.

A total of 187 dogs, 110 with clinical signs of otitis externa (OE), and 77
without history or clinical signs of OE, were examined microenvironment and
microbiological analysis of their ear exudates made. The aural temperature and
humidity of 160 dogs were measured. There were no significant difference between 
healthy dogs and OE dogs. German shepherd showed relatively lower temperature
(p<0.01) and higher humidity (p<0.01). The mean log(10) number of microbial
organisms of ears of OE dogs (4.16 +/- 0.31 cfu/g) was significantly increased,
compared to that from the ears of non-OE group (2.55 +/- 0.24 cfu/g). Pseudomonas
spp. and Proteus spp. were detected only from OE dogs. In addition, three
enterotoxigenic Staphylococcus aureus were isolated from ear specimens.

PMID: 12520110 [PubMed - indexed for MEDLINE]

1788: Cochrane Database Syst Rev. 2002;(4):CD001935.

Update in:
    Cochrane Database Syst Rev. 2006;3:CD001935.

Update of:
    Cochrane Database Syst Rev. 2000;(4):CD001935.

Oral or topical nasal steroids for hearing loss associated with otitis media with
effusion in children.

Butler CC, Van Der Voort JH.

Department of General Practice, University of Wales College of Medicine,
Llanedeyrn Health Centre, Llanedeyrn, Cardiff, UK, CF23 9PN. butlercc@cf.ac.uk

BACKGROUND: Otitis media with effusion (OME) is common and may cause hearing loss
with associated developmental delay. Treatment remains controversial. The
effectiveness of both systemic and topical intranasal steroids in promoting the
resolution of effusions has been assessed by randomised controlled trials.
OBJECTIVES: To examine evidence for or against treating children with hearing
loss associated with OME with systemic or topical intranasal steroids. SEARCH
STRATEGY: Searches were conducted in January 2002. We searched the Cochrane
Controlled Trials Register using the terms 'otitis media', 'otitis media with
effusion', 'glue ear', or 'OME', and 'steroids', 'glucocorticoids, synthetic',
'glucocorticoids, topical', 'anti-inflammatory agents, steroidal'. EMBASE and
MEDLINE were also searched for additional information. SELECTION CRITERIA:
Randomised controlled trials of oral and topical intranasal steroids, either
alone or in combination with another agent such as an antibiotic, were included. 
Exclusions: publications in abstract form only since adequate appraisal was not
possible; uncontrolled, non-randomised or retrospective studies; studies
reporting outcomes with ears (rather than children) as the unit of analysis
unless data were of sufficient detail to allow analysis by child. DATA COLLECTION
AND ANALYSIS: Data were extracted from the published reports by the two authors
independently (CCB and JH van der V) using standardised data extraction forms and
methods. The methodological quality of the included studies was independently
assessed by the two authors using the scheme described in the Cochrane Handbook. 
Dichotomous results were expressed as an odds ratio using a fixed effects model
together with the 95% confidence intervals. Continuous data were analysed using
the weighted mean difference in a fixed effects model. Tests for heterogeneity
between studies were performed using a Mantel-Haenszel approach. In trials with a
cross over design, post crossover treatment data were not used. MAIN RESULTS: No 
study prospectively documented hearing loss associated with OME prior to
randomisation. Follow up was mainly short term. No serious or lasting adverse
effects were reported in the six studies that did mention adverse effects. Most
comparisons involved small numbers of subjects. The odds ratio for OME persisting
after short term follow up in children treated with oral steroids compared to
control was 0.22 (95% CI 0.08 to 0.63). The odds ratio for OME persisting after
short term follow up for children treated with oral steroids plus antibiotic
compared to control plus antibiotic was 0.32 (95% CI 0.20 to 0.52). However there
was significant heterogeneity between studies included in the latter comparison
(p<0.01). Trends favoured steroids for most other comparisons, but confidence
intervals included unity. There was no evidence of benefit for steroid treatment 
for resolution of OME or of resolution of hearing loss associated with OME in the
longer term. REVIEWER'S CONCLUSIONS: Both oral and topical intranasal steroids
alone or in combination with an antibiotic lead to a quicker resolution of OME in
the short term. However, there is no evidence of a long term benefit from
treating OME effusions or associated hearing loss with either oral or topical
intranasal steroids. No serious adverse events were reported in the six studies
that presented data on adverse effects. Future studies should document hearing
loss associated with OME before the start of study treatment. Follow up should be
longer and ideally include health related quality of life and hearing
assessments. Data should not be presented only with ears as the unit of analysis.

Publication Types: 
    Meta-Analysis
    Review

PMID: 12519563 [PubMed - indexed for MEDLINE]

1789: Kaohsiung J Med Sci. 2002 Nov;18(11):585-8.

Foreign-body-induced otitis media: a case report.

Lin CC, Ho KY, Wang LF, Kuo WR.

Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung
City, Taiwan.

Unilateral ear discharge is one of the usual complaints of the patients who
visited the otolaryngology clinics, especially those patients who suffered from
external or middle ear disease. We present a 33-year-old female patient who
suffered from persistent ear discharge of the left ear. The local findings showed
a yellowish to greenish discharge and fetid odor from her left ear canal,
occupied by a large amount of granulation tissue. Wide removal of the diseased
granulation tissue and tympanoplasty were performed in the patient. Four pieces
of cotton were found in the external auditory canal and middle ear cavity during 
the operation. For more than 2 years of follow-up at our clinic, the patient has 
had a dry ear and her hearing ability also improved. Foreign-body-induced otitis 
media in adults is very rare. Therefore, we present this rare case and review the
reported literature so that the clinical symptoms and signs, imaging findings,
clinical treatment, prognosis, and hearing change in foreign-body-induced otitis 
media may be recognized and understood.

Publication Types: 
    Case Reports

PMID: 12513023 [PubMed - indexed for MEDLINE]

1790: J Otolaryngol. 2002 Oct;31(5):287-93.

Randomized evaluation of the audiologic outcome of ventilation tube insertion for
middle ear effusion in patients with nasopharyngeal carcinoma.

Ho WK, Wei WI, Kwong DL, Sham JS, Au DK, Chua DT, Choy DT.

Department of Surgery, Division of Otorhinolaryngology-Head and Neck Surgery,
University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong,
PR China.

OBJECTIVE: Complications after ventilation tube insertion for middle ear effusion
in patients with nasopharyngeal carcinoma are frequent. This may compromise the
overall benefit obtained from the procedure. This study evaluates the hearing
improvement after tube insertion compared with observation alone to see if the
benefits of the procedure outweigh its potential complications. DESIGN:
Prospective randomized controlled trial. SETTING: Full clinical and emergency
otolaryngologic services hospital in an academic institution. METHODS: Patients
with nasopharyngeal carcinoma and middle ear effusion were randomized for
preradiotherapy ventilation tube insertion or observation. Audiologic assessment 
with a pure-tone audiogram was performed before the procedure, after ventilation 
tube insertion, and at fixed intervals after irradiation. Audiologic outcome was 
compared between the two groups. MAIN OUTCOME MEASURE: Air-conduction threshold
and air-bone gap on a pure-tone audiogram at different intervals after
radiotherapy. RESULTS: There was no significant difference in hearing threshold
changes between the two groups for up to 4 years. Both groups had air-bone gap
improvement following radiotherapy and the improvement was not significantly
different between the two groups. The proportion of patients with closure of the 
air-bone gap on follow-up was not different between the two groups. CONCLUSIONS: 
Ventilation tube insertion before radiotherapy did not offer additional hearing
benefit when compared with observation alone. The procedure had no deleterious
effect on hearing for up to 4 years.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 12512893 [PubMed - indexed for MEDLINE]

1791: ORL J Otorhinolaryngol Relat Spec. 2002 Nov-Dec;64(6):433-5.

Blood group in otitis media with effusion.

Apostolopoulos K, Labropoulou E, Konstantinos B, Rhageed S, Ferekidis E.

Ear, Nose and Throat Department, Faculty of Medicine, University of Athens,
Greece. lapa@hol.gr

The aim of the present study was to assess whether blood group ABO is a risk
factor for otitis media with effusion (OME). In a screening program 889 children 
were studied with pneumatic otoscopy, tuning fork tests, audiometry, impedance
measures and blood group tests. Among these children, there were 51 children with
OME at the time of examination (5.7%), and 838 healthy children. Multivariate
logistic regression risk for OME was compared between children with different
blood groups, taking sociodemographic and history-related risk factors into
account. Blood group and OME were found to be statistically related. Considering 
children of blood group A as a reference, children with blood group O had a
statistically significant lower risk of OME. Children with blood group B did not 
have lower risk. Children with blood group AB had lower relative risk for OME,
but not significantly so. Examining Rhesus factor as a predictor for OME, no
relationship was found. It is concluded that blood group O (and possibly AB)
plays a preventive role, while blood group A or B are burdensome for OME.
Copyright 2002 S. Karger AG, Basel

PMID: 12499769 [PubMed - indexed for MEDLINE]

1792: Br J Clin Pharmacol. 2002 Dec;54(6):652-6.

Amoxicillin/clavulanic acid is ineffective at preventing otitis media in children
with presumed viral upper respiratory infection: a randomized, double-blind
equivalence, placebo-controlled trial.

Autret-Leca E, Giraudeau B, Ployet MJ, Jonville-Béra AP.

Department of Clinical Pharmacology, Hospital Bretonneau and University François 
Rabelais, Tours, France. autret-leca@med.univ-tours.fr

AIMS: To assess the equivalence of amoxicillin/clavulanic acid and placebo in the
prevention of acute otitis media in children at high risk of acute otitis media
who develop upper respiratory tract infection. METHODS: This was a multicentre,
equivalence, randomized, double-blind trial of two parallel groups comparing 5
days of amoxicillin/clavulanic acid 75 mg kg-1 day-1 (i.e. 25 mg kg-1 every 8 h) 
and placebo. The main outcome measure was acute otitis media occurring within
8-12 days of initiating treatment. RESULTS: Two hundred and three infants, aged 3
months-3 years with upper respiratory tract infection over 36 h and a history of 
recurrent acute otitis media were included over 8.5 months. Two children were
lost to follow-up. Patient characteristics were similar in both groups. In the
intention to treat analysis the frequency of acute otitis media was 16.2% (16/99)
in the placebo group and 9.6% (10/104) in the amoxicillin/clavulanic acid group
(P = 0.288). The difference between acute otitis media rates was 6.6% (one-sided 
95% confidence interval of 14.3%). The occurrence of side-effects was similar in 
the amoxicillin/clavulanic acid and placebo groups. CONCLUSIONS: The difference
in effectiveness between antibiotic and placebo was not greater than 14.3%, and
we calculated that 94 children would need to be exposed to antibiotics to avoid
six cases of acute otitis media. In view of the risk of development of resistance
due to frequent exposure to antibiotics, our study supports the need for
reduction in the administration of antibiotics in upper respiratory tract
infection even in children at high risk of acute otitis media.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 12492614 [PubMed - indexed for MEDLINE]

1793: J Vet Med B Infect Dis Vet Public Health. 2002 Nov;49(9):419-23.

Identification and antimicrobial susceptibility of coagulase positive
staphylococci isolated from healthy dogs and dogs suffering from otitis externa.

Tejedor Junco MT, Martín Barrasa JL.

Departamento de Microbiología, Facultad de Veterinaria, Universidad de Las Palmas
de Gran Canaria, Canary Islands, Spain. mtejedor@dcc.ulpgc.es

A total of 67 strains of coagulase positive staphylococci isolated from healthy
dogs and dogs suffering from otitis externa were studied. Twenty-two isolates
were from healthy dogs (five from hound dogs and 17 from companion dogs) and 45
from dogs suffering otitis externa (14 from hound dogs and 31 from companion
dogs). Presumptive identification was attempted using the following tests:
production of acetoin, anaerobic utilization of mannitol, acid production from
mannitol, presence of beta-galactosidase, and growth on P agar supplemented with 
different concentrations of acriflavine. Susceptibility of staphylococci to 16
antibiotics was determined. Most effective antibiotics were imipenem,
amoxycillin/clavulanic acid, ciprofloxacin, tobramycin, gentamicin and
marbofloxacin. Penicillin, ampicillin and polymyxin B showed the lowest activity.
There were no significant differences in antimicrobial susceptibility among
isolates from healthy dogs and dogs suffering from otitis externa.

PMID: 12489709 [PubMed - indexed for MEDLINE]

1794: Pediatr Infect Dis J. 2002 Dec;21(12):1124-6.

Turicella otitidis and Corynebacterium auris do not cause otitis media with
effusion in children.

Holzmann D, Funke G, Linder T, Nadal D.

Department of Otorhinolaryngology, University of Zurich, Switzerland.
holzmann@orl.usz.ch

BACKGROUND: The recently described coryneform bacteria and were first detected in
the middle ear of patients with acute otitis media and chronic otitis media.
Whether these bacteria play an essential role in the pathogenesis of otitis media
with effusion (OME) is unclear. METHODS: In a prospective study 60 children with 
OME and 205 controls were evaluated to determine the incidence of and. Swabs from
the external auditory canal (EAC) and the middle ear effusion (MEE) of OME
children undergoing tympanotomy, ventilation tube insertion or both were
cultured. Swabs from the EAC from healthy children served as controls. RESULTS:
In control children was found in EAC swabs from 23 of 205 (11.2%) and in 32 of
205 (15.6%). was isolated from 14 of 60 (23.3%) OME patients from the EAC only
and in 6 of 60 (10.0%) OME patients from both EAC and MEE. was isolated in 2 of
60 (3.3%) from the EAC only and in 1 of 60 (1.7%) from both EAC and MEE. In no
patient did or grow exclusively from MEE. CONCLUSION: and may be part of the
normal bacterial flora of the EAC in some children. Neither organism seems to
cause OME in children.

Publication Types: 
    Comparative Study

PMID: 12488661 [PubMed - indexed for MEDLINE]

1795: Pediatr Infect Dis J. 2002 Dec;21(12):1110-5.

Tympanostomy tube placements, sociodemographic factors and parental expectations 
for management of acute otitis media in Iceland.

Arason VA, Sigurdsson JA, Kristinsson KG, Gudmundsson S.

Department of Family Medicine, Univeristy of Iceland, Solvangur, Hafnarfjordur,
Iceland. vaa@hgsolvangur.is

BACKGROUND: Widespread antimicrobial use is a risk factor for development of
antimicrobial resistance. Antimicrobial treatment of acute otitis media (AOM) may
not always be necessary. Little is known about the influence of parental
expectations on physicians' decision-making in relation to treatment of AOM.
Evidence is insufficient as to whether tympanostomy tube placement reduces
antibiotic consumption. METHODS: We randomly selected 1,030 children 1 to 6 years
old living in 4 geographic areas in Iceland to be invited to participate in the
study. Information about sociodemographic factors, antimicrobial prescriptions
and their indications during the preceding 12 months, tympanostomy tube
placements and parental views on antimicrobial use and bacterial resistance were 
obtained from a questionnaire completed by the parents and medical records.
RESULTS: The incidence of AOM episodes resulting in antimicrobial prescription
for 804 children recruited into the study was 0.7 (95% confidence interval, 0.6
to 0.8) per child per year, highest among children age 1 year, i.e. 1.8
prescriptions (95% confidence interval, 1.4 to 2.2). The cumulative incidence of 
tympanostomy tube placements was approximately 30%. Antimicrobial use during the 
preceding 8 weeks for children with and without tubes did not differ (P = 0.36). 
Fifteen percent of children with tubes had received antimicrobials during the
preceding 8 weeks at last once for AOM compared with 14% of those without tubes
(P = 0.97). Parents in the area where antimicrobial consumption was lowest were
less likely to accept antimicrobial treatment than parents in the other areas (P 
= 0.005). Parents of children who had previously received antimicrobials for AOM 
were more likely to accept antimicrobials (P = 0.04). CONCLUSIONS: Parental
expectations to antimicrobial treatment and awareness about resistance
development appear to influence treatment strategies for AOM. The high rate of
tympanostomy tube placement in preschool children does not result in reduced
antimicrobial consumption.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12488659 [PubMed - indexed for MEDLINE]

1796: Otolaryngol Clin North Am. 2002 Aug;35(4):827-39.

Surgical management of chronic otitis media: beyond tympanotomy tubes.

Haynes DS, Harley DH.

Department of Otolaryngology, Department of Hearing and Speech Sciences,
Vanderbilt University Medical Center, 1301 22nd Avenue South, Suite 2900
Nashville, TN 37232-5555, USA. david.haynes@vanderbilt.edu

Chronic ear disease encompasses a wide range of clinical entities amenable to
medical and surgical intervention. The otolaryngologist must always consider the 
goals of surgery--first and foremost to achieve a safe ear. The least invasive
procedure capable of eradicating disease is generally chosen. During surgery, a
delicate balance has to exist between the careful preservation of function and
the aggressive prevention of potentially recurrent disease. Postoperatively,
thorough follow-up and good judgment are paramount in avoiding complications and 
preventing unnecessary additional surgical procedures.

Publication Types: 
    Review

PMID: 12487084 [PubMed - indexed for MEDLINE]

1797: Otolaryngol Clin North Am. 2002 Aug;35(4):811-25.

Medical and surgical management of otitis media in children.

Perkins JA.

Division of Pediatric Otolaryngology-Head and Neck Surgery, University of
Washington, Children's Hospital, Regional Medical Center, 4800 Sand Point Way
NE/CH-62, Seattle, WA 98105, USA. jperk1@chmc.org

OM, though frequent and seemingly simple to evaluate and manage, remains a
treatment challenge. Increasingly sophisticated clinical trials assessing OM
medical treatment efficacy and outcome have demonstrated that many treatment
regimens that were commonly used a decade ago are no longer recommended. Surgical
therapy for OM, though remaining the same, has come under intense scrutiny from
several angles but still plays a central role for this disease. Given the
multiple facets of OM, its frequency, and its potential to cause short- and
long-term morbidity in children, the next decade is sure to bring further
treatment innovations.

Publication Types: 
    Review

PMID: 12487083 [PubMed - indexed for MEDLINE]

1798: Acta Otolaryngol. 2002 Oct;122(7):692-7.

Experimental autoimmune labyrinthitis: assessment of molecular size of
autoantigens in fractions of inner ear proteins eluted on the Mini Whole Gel
Eluter.

Tomiyama S.

Department of Otolaryngology, Nippon Medical School, Tama-Nagayama Hospital,
Tokyo, Japan. tomii@nms.ac.jp

In order to determine the molecular size of the causative autoantigens of
experimental autoimmune labyrinthitis, crude inner ear antigen was separated into
14 fractions and the constituent molecules were identified by means of sodium
dodecyl sulfate-polyacrylamide gel electrophoresis using the Mini Whole Gel
Eluter. The mean total protein recovery was approximately 66%. Sensitization with
55-65 kDa proteins induced the highest number of infiltrating cells among the
fractions and sensitization with 38-45 kDa proteins induced the second highest
number of inflammatory cells. These results suggest that 38-45 kDa and 55-65 kDa 
proteins are the causative autoantigens of experimental autoimmune labyrinthitis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12484643 [PubMed - indexed for MEDLINE]

1799: Surg Neurol. 2002 Sep-Oct;58(3-4):271-3.

Gas-containing otogenic brain abscess.

Paolini S, Ralli G, Ciappetta P, Raco A.

Department of Neurosciences, Neurosurgical Service, S. Maria Hospital, Terni,
Italy.

BACKGROUND: Gas-containing brain abscesses are very rare. Two mechanisms may be
responsible for the presence of intracavitary gas: bacterial fermentation or
penetration through an abnormal communication between the exterior and the
intracranium. The need to search for this potential communication is considered
an indication for open surgery. We report the case of a surgically treated
gas-containing brain abscess originating from an undiagnosed chronic otitis
media. CASE DESCRIPTION: A 54-year-old man developed acute neurologic
deterioration, becoming comatose within 24 hours. A contrast-enhanced computed
tomography (CT) scan disclosed a gas-containing cystic mass in the right temporal
lobe. Urgent surgical decompression revealed the presence of an abscess, which
was excised. During the same surgery, we performed a radical mastoidectomy,
removing a previously undiagnosed attic cholesteatoma. Neither procedure revealed
a discontinuity of the floor of the middle cranial fossa. Cultures grew a mixed
flora. Antibiotics were administered for 6 weeks. The patient made a complete
neurologic recovery. CONCLUSION: This report demonstrates that otogenic brain
abscesses may contain gas due to fermentation of nonclostridial bacteria.

Publication Types: 
    Case Reports

PMID: 12480240 [PubMed - indexed for MEDLINE]

1800: Mol Cell Probes. 2002 Oct;16(5):385-90.

Real-time quantitative PCR for the detection of Streptococcus pneumoniae in the
middle ear fluid of children with acute otitis media.

Saukkoriipi A, Palmu A, Kilpi T, Leinonen M.

National Public Health Institute (KTL), Oulu, Finland. Annika.Saukkoriipi@ktl.fi

PCR based on the amplification of pneumolysin gene fragments has previously been 
applied to demonstrate Streptococcus pneumoniae in clinical specimens. Here, a
real-time PCR method for the detection and quantification of pneumococci by
amplifying a 206-bp fragment of the pneumolysin-encoding gene is described. The
amplified fragments were detected simultaneously using fluorescent-labeled
sequence-specific hybridization probes. The applicability of the assay to
clinical samples was evaluated by studying 50 middle ear fluid (MEF) specimens
from children with acute otitis media. Twenty-six of the MEF samples were
positive by real-time PCR and the numbers of genome equivalents detected varied
from 90 to 88,000/microl in 17 culture-positive samples and from 1 to
1,200/microl in 9 culture-negative samples. The results were compared to culture 
findings and to results obtained by using agarose gel electrophoresis or
Europium-labeled hybridization probes for the detection of amplification products
of conventional PCR. The sensitivity and specificity of the real-time PCR assay
developed in the present study compared to culture were 100 and 73%, and to
conventional PCR with agarose gel and/or TRF detection 93 and 96%, respectively. 
The real-time PCR assay was found to be rapid, easy to use, and sensitive in
detecting and quantifying pneumococci.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12477443 [PubMed - indexed for MEDLINE]

1801: Clin Otolaryngol Allied Sci. 2002 Dec;27(6):494-500.

Sequelae of otitis media with effusion among children with cleft lip and/or cleft
palate.

Sheahan P, Blayney AW, Sheahan JN, Earley MJ.

Department of Otolaryngology, The Children's Hospital, Temple Street, Dublin,
Ireland. sheahanp@eircom.net

Otitis media with effusion (OME) is common among children with cleft palate, and 
may lead to such long-term consequences as hearing loss, tympanic membrane
retraction, and chronic otitis media (COM). In total, 104 children with cleft lip
and/or palate treated for OME at our institution were reviewed. Mean duration of 
follow-up was 6.9 years, and mean age at latest follow-up was 9.6 years. The
incidence of COM was 19%, and the incidence of cholesteatoma was 1.9%. Ears
showing such long-term sequelae of OME as hearing loss, tympanic membrane
retraction, and chronic otitis media, were noted to have undergone a
significantly greater number of ventilation tube insertions than ears not showing
these sequalae. Our findings would suggest that a conservative approach to the
management of OME in children with cleft palate is more likely to be beneficial
in the long term.

PMID: 12472518 [PubMed - indexed for MEDLINE]

1802: Ear Nose Throat J. 2002 Nov;81(11):792-4.

Tuberculous otitis media: two case reports and literature review.

Awan MS, Salahuddin I.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Aga Khan
University Hospital, Stadium Rd., Karachi 74800, Pakistan. sohail.awan@aku.edu

Tuberculous otitis media can be difficult to diagnose because it can easily be
confused with other acute or chronic middle ear conditions. Compounding this
problem is the fact that physicians are generally unfamiliar with the typical
features of tuberculous otitis media. Finally, the final diagnosis can be
difficult because it requires special culture and pathologic studies. To increase
awareness of this condition, we describe two cases of tuberculous otitis media
and we review the literature.

Publication Types: 
    Case Reports

PMID: 12472035 [PubMed - indexed for MEDLINE]

1803: Int J Audiol. 2002 Jan;41(1):78-87.

Otoacoustic emissions in the general adult population of Nord-Trøndelag, Norway: 
II. Effects of noise, head injuries, and ear infections.

Engdahl B, Tambs K.

Department of Environmental Medicine, National Institute of Public Health, Oslo, 
Norway. bo.engdahl@folkehelsa.no

Otoacoustic emissions (OAEs) have been suggested as a sensitive measure of
cochlear function with the potential for preclinical detection of damage. The
present work assesses the risk for decreased OAEs associated with occupational
and leisure noise, head injuries and recurrent ear infections. The predictive
power of the environmental factors on different OAE values is compared with the
prediction of conventional pure-tone hearing thresholds (PTTs). The analyses are 
based on data from 5072 adult subjects comprising a subsample of the 51975
subjects from the Nord-Trøndelag Hearing Loss Study. The subjects participated in
a general health screening, including an examination of pure-tone audiometry,
transient OAEs and distortion-product OAEs, and completed a questionnaire
regarding history of noise exposure and ear disease. The predictions of OAEs and 
PTTs were analysed using regression analysis for various sex and age groups
(20-44 years, 45-64 years, > or = 65 years). The fraction of the variance
explained by exposure was generally moderate (0-4%, varying with age, sex, and
type of measurement). Males showed moderate effects of work noise, impulse noise 
and ear infection, while ear infection was the only significant predictor in
females. There were no effects of music noise and head injuries. The effect of
exposure on OAEs that remained after controlling for PTTs was small and similar
to the effect of exposure on PTTs that remained after controlling for OAEs.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12467373 [PubMed - indexed for MEDLINE]

1804: Pediatrics. 2002 Dec;110(6):1071-80.

Systemic steroid for chronic otitis media with effusion in children.

Mandel EM, Casselbrant ML, Rockette HE, Fireman P, Kurs-Lasky M, Bluestone CD.

ENT Research Center, Department of Pediatric Otolaryngology, Children's Hospital 
of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. mandele@pitt.edu

OBJECTIVE: To determine the efficacy of a short course of an adrenocorticosteroid
agent (prednisolone) given with amoxicillin as compared with that of amoxicillin 
alone for the treatment of chronic middle ear effusion (MEE). The efficacy of 2
weeks versus 4 weeks of amoxicillin with and without steroid was also assessed.
METHODS: In a double-blind, randomized trial, children who were 1 to 9 years of
age and had MEE of at least 2 months' duration were assigned to 1 of 4 treatment 
arms: 1) steroid + amoxicillin for 14 days, then amoxicillin for 14 more days; 2)
steroid + amoxicillin for 14 days, then placebo for amoxicillin for 14 more days;
3) placebo (for steroid) + amoxicillin for 14 days, then amoxicillin for 14 more 
days; or 4) placebo (for steroid) + amoxicillin for 14 days, then placebo for
amoxicillin for 14 more days. Children were examined by otoscopy, tympanometry,
and audiometry at entry and 2 and 4 weeks after entry; those without MEE at the
4-week visit returned monthly for up to 3 more visits or until recurrence of
effusion. Serum immunoglobulin (Ig) G, IgM, IgA, and varicella titers were
obtained at entry, and allergy skin testing was performed at the 4-week visit.
RESULTS: A total of 144 children was entered; 135 children (94%) returned for the
2-week visit, and 132 (92%) were seen for the 4-week visit. At the 2-week visit, 
33.3% of children in the steroid + amoxicillin group had no MEE compared with
16.7% in the placebo + amoxicillin group (95% confidence interval for the
difference in proportions: 2.4%-31.0%). At the 4-week visit, the percentage of
children with no MEE in the steroid-treated group was 32.8%, whereas that in the 
placebo group was 20.0% (95% confidence interval for the difference in
proportions in the 2 groups: -2.0%-27.7%). Comparing change in middle ear status 
from the 2- to the 4-week visit, there were no significant differences in
recurrence of MEE or additional clearance of MEE between those who were treated
with amoxicillin for 2 weeks and those who were treated for 4 weeks. By the
4-month visit, 68.4% of children who were in the steroid group and had no MEE at 
the 4-week visit had recurrence of MEE as did 69.2% of such children in the
placebo group. A total of 126 (87.5%) children underwent allergy skin testing. Of
the 122 children who had a positive reaction to histamine, 51 (41.8%) had 1 or
more positive reactions to the test allergens. There was no difference in
response to treatment between those with positive allergy tests and those
without. CONCLUSIONS: There was a significant difference in the proportion of
children who were effusion-free immediately after 14 days of treatment with
steroid and amoxicillin compared with those who were treated only with
amoxicillin for 14 days. Within 2 weeks of finishing treatment, there was no
longer any significant difference between the 2 groups regardless of whether
amoxicillin was continued or not. Therefore, we conclude that treatment with the 
dose and type of steroid used in this study should not be universally recommended
for treatment of chronic otitis media with effusion, and treatment with
amoxicillin, if used, should not continue beyond 14 days.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

PMID: 12456902 [PubMed - indexed for MEDLINE]

1805: Pediatrics. 2002 Dec;110(6):1064-70.

Comment in:
    Pediatrics. 2003 Jul;112(1 Pt 1):205-6.

Diagnostic accuracy, tympanocentesis training performance, and antibiotic
selection by pediatric residents in management of otitis media.

Pichichero ME.

Elmwood Pediatric Group, University of Rochester Medical Center, Rochester, New
York 14642, USA. michael_pichichero@urmc.rochester.edu

OBJECTIVE: To assess the accuracy of pediatric residents in recognizing the
physical examination findings of acute otitis media (AOM) and otitis media with
effusion (OME), technical competence to perform tympanocentesis, and knowledge of
guideline-recommended antibiotic management of AOM. METHODS: A total of 383
pediatric residents from various programs in the United States viewed 9 different
video-recorded pneumatic otoscopic examinations of tympanic membranes during a
continuing medical education course. The ability to differentiate AOM, OME, and
normal was ascertained. A mannequin of a child was used to assess technical
proficiency of performing tympanocentesis on artificial tympanic membranes. A
series of questions was posed regarding appropriate, pathogen-directed,
second-line antibiotic selection for AOM. RESULTS: The average +/- standard
deviation correct diagnosis on the otoscopic video examination was 41% +/- 16%
(range: 19%-70%; median: 38%) by pediatric residents, tympanocentesis was
optimally performed by 89%, and appropriate antibiotic therapy for drug-resistant
Streptococcus pneumoniae was selected by 78% and appropriate therapy for
beta-lactamase-producing Haemophilus influenzae was selected by 74%. CONCLUSIONS:
According to this video-based examination, pediatric residents misdiagnose OME
frequently. Pediatric residents have the skills to be trained to perform
tympanocentesis. Approximately 75% of pediatric residents have knowledge of the
appropriate antibiotics to select for treatment of resistant AOM pathogens.
Interactive instruction with simulation technology may enhance skills and lead to
improved diagnostic accuracy and treatment paradigms.

PMID: 12456901 [PubMed - indexed for MEDLINE]

1806: Front Biosci. 2003 Jan 1;8:e87-93.

Molecular epidemiology of Streptococcus pneumoniae mediated otitis media.

McCoy S, Pettigrew M.

Department of Epidemiology, University of Michigan School of Public Health, Ann
Arbor, MI, USA.

Streptococcus pneumoniae is leading cause of bacterial otitis media in young
children. Increasing rates of antibiotic resistance and the changing epidemiology
of pneumococcal strains dictate the need to develop new methods to study,
control, and prevent these important infections. Investigation into the molecular
epidemiology of these bacteria will provide important insights into disease;
progress in this field is described below.

Publication Types: 
    Review

PMID: 12456346 [PubMed - indexed for MEDLINE]

1807: Zhonghua Yi Xue Za Zhi (Taipei). 2002 Aug;65(8):372-7; discussion 363-4.

Comment in:
    Zhonghua Yi Xue Za Zhi (Taipei). 2002 Aug;65(8):363-4.

Diagnostic methods for otitis media with effusion in children.

Guo YC, Shiao AS.

Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan,
ROC. ycguo@vghtpe.gov.tw

BACKGROUND: Correct diagnosis of otitis media with effusion (OME) in children is 
imperative for instituting appropriate treatment. This study aims to establish
the diagnostic value of pneumatic otoscopy, tympanometry, acoustic reflectometry 
and videotelescopy by comparing them with myringotomy findings. METHODS: Between 
November 1999 and July 2001, we conducted a prospective study on diagnosis of OME
in children. The children studied were candidates for ventilation tube insertions
or other ENT surgeries. All tests, including acoustic reflectometry,
tympanometry, pneumatic otoscopy and videotelescopy, were performed two days
before surgery. Myringotomy or tympanocentesis was then performed to confirm the 
presence or absence of OME. A type B tympanogram was accepted as a predictor of
effusion. The curve angle of acoustic reflectometry with cut-point of 69 degrees 
(< or = 69 degrees) was also used to predict the presence of OME. RESULTS:
Eighty-nine children (58 males and 31 females), ranging in age from 1 to 13
years, participated in the study. Of 172 ears assessed in the study, middle ear
effusion was detected in 124; the remaining 47 ears were found to be dry at
myringotomy or tympanocentesis. Videotelescopy gave the highest sensitivity,
specificity and accuracy, followed by pneumatic otoscopy, tympanometry and
acoustic reflectometry. CONCLUSIONS: Videotelescopy seems to have the potential
to become the standard for diagnosis of OME in children and for validation of
pneumatic otoscopy. When videotelescopy is not available, tympanometry could be
an instrumental adjunct to pneumatic otoscopy. Although acoustic reflectometry
gave the worst results, it is still useful for assessing and screening OME in
children because of the ease and speed of its operation irrespective of crying,
cerumen, an air seal in the ear, or lack of cooperation from the young children.

PMID: 12455807 [PubMed - indexed for MEDLINE]

1808: J Indian Med Assoc. 2002 Oct;100(10):619.

Evaluation of efficacy of nizer versus nimesulide tablets in otitis media.

Dasgupta KS, Deshpande AS, Vedi JN, Patel S.

Leet in ENT, 18 - Jeevan Jyoti LIC Flats, Rahate Colony, Nagpur.

An evaluation of clinical efficacy of nizer versus nimesulide tablets was
undertaken in 118 patients suffering from otitis media. Nizer demonstrated rapid 
and powerful analgesic and antipyretic effects compared to plain nimesulide,
without additional side effects.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 12452517 [PubMed - indexed for MEDLINE]

1809: Qual Saf Health Care. 2002 Jun;11(2):121-4.

Comment in:
    Qual Saf Health Care. 2002 Jun;11(2):118.    Qual Saf Health Care. 2003 Apr;12(2):159.

Reduction in the use of surgery for glue ear: did national guidelines have an
impact?

Black N, Hutchings A.

Health Services Research Unit, London School of Hygiene and Tropical Medicine,
Keppel Street, London WC1E 7HT, UK. nick.black@lshtm.ac.uk

BACKGROUND: It is widely accepted that the passive dissemination of national
clinical guidance has little or no impact on practice. OBJECTIVE: To assess the
impact in England of an Effective Health Care bulletin on childhood surgery for
glue ear issued in 1992 and to understand the reasons for any change (or lack of 
change) in practice that ensued. METHOD: Time series analysis of the rate of use 
of surgery by children under 10 years of age from 1975 to 1997/8 in 13 English
health districts. RESULTS: Following a rise in the rate of surgery in public
(National Health Service) hospitals from 1975 to 1985, the rate declined by 1.6% 
a year from 1986 to 1992/3. Following publication of the guidelines in November
1992, the rate of decline increased to 10.1% a year. Even after allowing for a
slight increase in the use of independent (private) hospitals between 1992/3 and 
1997/8, the overall rate of decline was at least 7.9%. It appears that the rate
of referral of cases by primary care physicians (general practitioners) halved
during this period. Several contextual factors are thought to have contributed to
the effect of the guidelines, including pre-existing professional concern about
the value of surgery, the introduction of an internal market into the NHS, and
growing apprehension among parents fuelled by scepticism in the mass media.
During this unprecedented period of rapid change in usage, staff delivering the
service remained unaware of the alterations in their own practice. CONCLUSIONS:
Passive dissemination of national guidelines can accelerate an existing trend in 
clinical practice if the context is hospitable. Policy makers should identify and
target such situations.

PMID: 12448802 [PubMed - indexed for MEDLINE]

1810: J Infect Dis. 2002 Dec 15;186(12):1761-9. Epub 2002 Nov 22.

Participation of Ras and extracellular regulated kinase in the hyperplastic
response of middle-ear mucosa during bacterial otitis media.

Palacios SD, Pak K, Kayali AG, Rivkin AZ, Aletsee C, Melhus A, Webster NJ, Ryan
AF.

Department of Head and Neck Surgery, University of California, San Diego, School 
of Medicine, La Jolla, California, USA.

Hyperplasia of middle-ear mucosa (MEM) during otitis media (OM) is thought to be 
partially mediated by the actions of growth factors and their receptors. The
intracellular pathway leading from the small G-protein Ras to the extracellular
regulated kinases (Erks) often links growth factor stimulation to cellular
proliferation. This study assessed whether this pathway is involved in MEM
hyperplasia during bacterial OM via the activation of Erk1/Erk2 in MEM of an in
vivo rat bacterial OM model. Activation was maximal at 1 and 6 h and at 1 week
after introduction of bacteria into the middle ear. Additionally, an in vitro
model of rat MEM in bacterial OM was treated with farnesyl transferase inhibitor 
277 or the Mek inhibitor U0126. MEM explants treated with either inhibitor
demonstrated significant suppression of bacterially induced growth. These data
support a role for Ras and Erk signaling in MEM hyperplasia during bacterial OM.

Publication Types: 
    In Vitro
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 12447762 [PubMed - indexed for MEDLINE]

1811: Int J Pediatr Otorhinolaryngol. 2002 Dec 2;66(3):291-6.

Synchronous fat plug myringoplasty and tympanostomy tube removal in the
management of refractory otorrhoea in younger patients.

Liew L, Daudia A, Narula AA.

Department of Otorhinolaryngology-Head and Neck Surgery, Leicester Royal
Infirmary, Leicester LE1 5WW, UK. lennyliew@ukgateway.net

OBJECTIVE: Tympanostomy tubes are associated with many complications, the most
common being recurrent otorrhoea, in many cases resistant to medical treatment.
With the associated vestibulo-cochlear toxicity of many topical antibiotics,
their use is dose limited. Removal of the tympanostomy tube has been shown to
cure the otorrhoea, however, it is associated with a high persistent perforation 
rate of 10-28%. A synchronous fat plug myringoplasty was performed with tube
removal in an attempt to reduce the residual perforation rate. METHODS: A
retrospective study of 13 consecutive children, nine male and four female, mean
age 9.1 years (median=9, range 2-15), with a total of 15 ears (left=6, right=9)
had either Shah Tubes (n=5), Shepard Tubes (n=1) or Shah Long Term Tubes (n=9)
in-situ for middle ear effusions. The tubes were removed for recurrent otorrhoea.
The tubes had been in-situ for a mean of 38.8 months (median=31, range 9-84
months). All ears had recurrent infections, with a variable response to topical
antibiotics. All were under the care of one specialist, who performed all the
procedures. At the time of tube removal, a standard fat graft myringoplasty was
done. RESULTS: The procedure was successful in 15 of the 15 ears, and all
perforations had closed by 3 weeks. Pure tone audiometry improved in 11 ears,
remained the same in two and worsened in two (0-10 and 11-15 dBA, respectively). 
There were no complications arising from the procedure. Mean follow up was 13.7
months (median=9, range 3-31). None of the patients have re-perforated, but two
have required re-ventilation of their middle ear for middle effusions, and one of
these two has also undergone subsequent adeno-tonsillectomy. CONCLUSIONS: Our
experience in this small series shows that the removal of a tympanostomy tube for
recurrent otorrhoea can be successfully managed with a fat plug myringoplasty,
with the benefit of a reduction in the persistent perforation rate following
tympanostomy tube removal. It is a simple technique that requires little extra
operating time with no significant morbidity.

Publication Types: 
    Comparative Study

PMID: 12443819 [PubMed - indexed for MEDLINE]

1812: Int J Pediatr Otorhinolaryngol. 2002 Dec 2;66(3):281-9.

Ventilation tubes after surgery for otitis media with effusion or acute otitis
media and swimming. Systematic review and meta-analysis.

Carbonell R, Ruíz-García V.

ENT Department, Hospital de Sagunto, Regional Health Authority, Avda. Ramón y
Cajal s/n, 46520 Sagunto, Valencia, Spain. carbonell_raf@gva.es

OBJECTIVE: To determine if the use of ear protection when swimming of children
with ventilation tubes modifies the risk of acute otitis media (AOM) compared to 
not swimming. METHODS: Systematic review. DATA SOURCES: Search conducted in
MEDLINE, EMBASE and The Cochrane Library databases. STUDY SELECTION: Prospective 
cohort studies and controlled clinical trials of children with ventilation tubes,
with a minimum follow-up of 2 months. Data extraction: Two reviewers
independently assessed trial quality and extracted data. RESULTS: 11 studies were
selected. No difference was found in risk of AOM in children who swim without ear
protection compared with those who do not swim: Odds ratio=0.78, 95% confidence
interval 0.42-1.44; nor compared with those who use earplugs and swimming caps,
odds ratio=0.75, 95% confidence interval 0.38-1.48; nor in those who use ear
drops after swimming compared with those who used earplugs or swimming caps, odds
ratio=0.76, 95% confidence interval 0.56 to 1.02. The use of ear drops after
swimming increases the risk of AOM in children with ventilation tubes as compared
with those who do not swim, odds ratio=3.14, 95% confidence interval 1.40 to
7.05. CONCLUSIONS: There is no evidence to suggest that protection when swimming 
with earplugs, swimming caps or ear drops in children with ventilation tubes
reduces the risk of AOM. Ear drops may even increase this risk.

Publication Types: 
    Comparative Study
    Review

PMID: 12443818 [PubMed - indexed for MEDLINE]

1813: Int J Pediatr Otorhinolaryngol. 2002 Dec 2;66(3):247-50.

Rhinovirus RNA in children with longstanding otitis media with effusion.

Pitkäranta A, Rihkanen H, Carpén O, Vaheri A.

Department of Otorhinolaryngology, University of Helsinki, PL 220, 00029 HUS,
Helsinki, Finland. anne.pitkaranta@hus.fi

BACKGROUND: Earlier studies indicate that respiratory viruses may play a role in 
the pathogenesis of otitis media with effusion (OME). OBJECTIVES: To study the
presence of rhinovirus RNA in middle ear mucosa in children with OME without
signs of present acute infection. METHODS: Eighteen children scheduled for
tympanostomy tube placement due to longstanding OME were recruited and a biopsy
of the promontory mucosa was obtained. In addition, adenoidectomy was performed
for eight of these children and a biopsy of adenoid tissue was taken as well. The
samples were collected from December to May. Rhinovirus RNA was studied by in
situ hybridization (ISH). RESULTS: Seven out of eight adenoid biopsies were
positive for rhinovirus by ISH. However, rhinovirus RNA was not found in any of
the 18 middle ear biopsies. CONCLUSIONS: These results show that children with
longstanding OME do not have a rhinovirus infection in the middle ear mucosa,
although the same children frequently harbor large amounts of rhinovirus RNA in
their adenoid tissue.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12443813 [PubMed - indexed for MEDLINE]

1814: Int J Pediatr Otorhinolaryngol. 2002 Dec 2;66(3):227-42.

Microbiologic findings and risk factors for antimicrobial resistance at
myringotomy for tympanostomy tube placement--a prospective study of 601 children 
in Toronto.

Ford-Jones EL, Friedberg J, McGeer A, Simpson K, Croxford R, Willey B, Coyte PC, 
Kellner JD, Daya H; Members of the Toronto Antibiotic Resistance at Myringotomy
Study Group.

Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, 
Toronto, Ont., Canada M5G 1X8.

CONTEXT: There is limited information on the identity and antibiotic
susceptibility of bacterial pathogens in children with chronic otitis media whose
repeated antibiotic use may place them at increased risk of antibiotic-resistant 
bacteria. OBJECTIVE: To determine, at myringotomy for tympanostomy tube
placement, (1) the prevalence of bacteria, (2) the extent and patterns of
antibiotic resistance, and (3) the risk factors associated with the presence and 
resistant status of pathogens. DESIGN: Prospective, multi-site, cohort study.
SETTING AND PATIENTS: Children undergoing myringotomy for tympanostomy tube
placement between November 1, 1999 and March 31, 2000 in seven hospitals in
Toronto, Ontario, were identified. If fluid was present, aspirates were submitted
for bacteriologic testing. A follow-up telephone questionnaire was administered
to patient caregivers in order to identify risk factors for the presence of (1)
culturable pathogens and (2) resistant pathogens. MAIN OUTCOME MEASURES: The
identification and prevalence of bacteria cultured from the middle ears of
subjects, and the degree of nonsusceptibility to commonly prescribed antibiotics.
RESULTS: Among 601 patients (mean age 3.9 years, 60.7% male), both a telephone
interview (n=544) and an ear specimen (n=527) were obtained for 478. Pathogens
were found in middle ear effusions of 37% of the children in the study; including
at least one 'definite' pathogen in 189 children (31.4%), and a further 32
children (5.3%) with at least one 'possible' pathogen. Definite pathogens
included Haemophilus influenzae in 17% of the children, followed by Moraxella
catarrhalis (9%) and Streptococcus pneumoniae (6%); ampicillin nonsusceptibility 
was found in 40, 100 and 24%, respectively. Overall, 123 children (20.5%) were
found to have definite pathogens with resistance to ampicillin/penicillin,
trimethoprim-sulfamethoxazole, or clarithromycin/erythromycin. Patient
characteristics included premature birth and/or long length of stay in the
nursery (23%), first infection before the age of 6 months (26%), put to bed with 
a bottle (28%), household smoker (34%), in out-of-home child care (38%), history 
of eczema, bronchiolitis and/or asthma (39%), and use of pacifiers (40%).
Household characteristics were smoking (34%), married/common law parents (85%),
and 60% had completed college or university; in 26% both parents were born
outside of Canada; 73% of children were Caucasian. Of the 75% who responded to
the question regarding income, 42% had household income over $60,000 (CAN). Risk 
factors for the presence of a pathogen and for a resistant pathogen in
multivariate analysis included younger age, lower maternal education, day care
centre attendance, no previous adenoidectomy and bilateral, primarily winter
infections as well as amoxicillin use in the previous 6 months. CONCLUSION:
Modifiable risk factors for otitis media including household smoking and pacifier
use are present in many children undergoing tympanostomy tube placement; child
care centre attendees are over-represented. Multiple antibiotic courses were
commonly prescribed prior to surgery. H. influenzae and M. catarrhalis are
important pathogens and therapy in clinical failures should be directed against
them. The 7-valent protein conjugate polysaccharide vaccine (Prevnar) would have 
covered 73% of the serotypes of S. pneumoniae isolated in this study.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 12443811 [PubMed - indexed for MEDLINE]

1815: Pediatr Infect Dis J. 2002 Nov;21(11):1008-16.

Multinational study of pneumococcal serotypes causing acute otitis media in
children.

Hausdorff WP, Yothers G, Dagan R, Kilpi T, Pelton SI, Cohen R, Jacobs MR, Kaplan 
SL, Levy C, Lopez EL, Mason EO Jr, Syriopoulou V, Wynne B, Bryant J.

Wyeth Vaccines, West Henrietta, NY 14586, USA. Hausdowp@wyeth.com

BACKGROUND: Streptococcus pneumoniae is a major cause of acute otitis media (AOM)
in young children. More than 90 immunologically distinct pneumococcal serotypes
have been identified, but limited information is available regarding their
relative importance in AOM. METHODS: We analyzed nine existing datasets
comprising pneumococcal isolates from middle ear fluid samples collected from
1994 through 2000 from 3,232 children with AOM from Finland, France, Greece,
Israel, several East European countries, the US and Argentina. We examined the
distribution of pneumococcal serotypes in relation to several demographic and
epidemiologic variables, including gender, age, antibiotic resistance and source 
of culture material. RESULTS: The major serotypes identified included 19F and
23F, each comprising 13 to 25% of pneumococcal middle ear fluid isolates in most 
datasets; 14 and 6B, comprising 6 to 18%; whereas 6A, 19A and 9V each comprised 5
to 10%. Despite differences in location, study design and antibiotic
susceptibility, each major serotype was prominent in most age groups of each
dataset. Serotypes represented in the 7-valent pneumococcal conjugate vaccine
(PCV-7, 4, 6B, 9V, 14, 18C, 19F, 23F) accounted for 60 to 70% of all pneumococcal
isolates in the 6- to 59-month age range, but only 40 to 50% of isolates in
children <6 or >/=60 months old. Serotype 3 and, in certain datasets, serotypes 1
and 5, were more important in the <6- and >/=60-month age groups. In each age
group vaccine-related serotypes (mainly 6A and 19A) comprised an additional 10 to
15% of all pneumococcal isolates. Four serotypes (23F, 19F, 14 and 6B) accounted 
for 83% of all penicillin-resistant observations. CONCLUSIONS: This analysis of
several geographically diverse datasets indicates that a limited number of
serotypes, largely represented in PCV-7, accounted for the majority of episodes
of pneumococcal AOM in children between 6 and 59 months of age. Certain serotypes
appeared to be relatively more significant in children <6 months or >59 months of
age.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 12442021 [PubMed - indexed for MEDLINE]

1816: J La State Med Soc. 2002 Sep-Oct;154(5):226-8.

Acute otitis externa.

Daneshrad D, Kim JC, Amedee RG.

Department of Otolaryngology-Head and Neck Surgery, Tulane University School of
Medicine, New Orleans, Louisiana, USA.

Acute otitis externa is a common presenting disorder seen in many primary care
offices. Serious complications may be avoided by appropriate diagnosis and
treatment. This article will summarize the basic anatomy and physiology of the
external auditory canal, the pathophysiology and microbiology of acute otitis
externa, the clinical presentation and diagnosis of this disease, and its
potential complications and treatment.

Publication Types: 
    Review

PMID: 12440748 [PubMed - indexed for MEDLINE]

1817: Med J Malaysia. 2002 Sep;57(3):376-82; quiz 383.

Otitis media with effusion: an update.

Pang KP, Ang AH, Tan HK.

Department of Otolaryngology, National University Hospital, 5 Lower Kent Ridge
Road, Singapore 119074.

Otitis media with effusion (OME) is a very common condition seen in children, and
is the commonest cause of hearing loss in an infant. It is also a fairly common
condition encountered by the family practitioner, and often the family
practitioner is the first doctor the parents bring the child to. Otitis media
with effusion is a simple condition but, if left undiagnosed or untreated, can
lead to preventable long-term consequences. Hence, a high index of suspicion is
necessary, early and accurate diagnosis, prompt treatment, with close follow-up
is of essence. The epidemiology, aetiological factors, clinical presentations,
diagnosis, various medical and surgical options, cost-effectiveness of therapy
and the impact of OME on the child's development are discussed.

Publication Types: 
    Review

PMID: 12440282 [PubMed - indexed for MEDLINE]

1818: Laryngoscope. 2002 Nov;112(11):2054-6.

A new ventilation tube for long-term middle ear ventilation.

Bonvin P, Hansen BB, Hentzer E.

Department of Otolaryngology, Fyn Hospital, Svendborg, Denmark. Bonvin@lycos.com

OBJECTIVES: The treatment of secretory otitis media often requires repeated
tubulation of the tympanic membrane as the standard ventilation tubes are
extruded before the disease of the middle ear has remitted. The T-tube and its
modification have been developed to remain longer in situ, often requiring
surgical removal. The rates of subsequent persisting tympanic membrane
perforations and granulations around the tube have been unacceptably high. In the
search for a long-term ventilation tube with fewer complications, the Duravent
tube (Smith and Nephew) has been developed. The aim of the study was to estimate 
duration in situ and observe complications in using the Duravent tube compared
with standard tubes and T- tubes. STUDY DESIGN: Retrospective study. METHODS: In 
all, 51 patients have been treated with the Duravent tube over a 2-year period.
In all, 72 Duravent tubes have been inserted. All patients were subsequently
invited for a follow-up examination at a median time of 28 months (range, 11-43
mo) after the tube insertion and were followed up for 5 years. RESULTS: The
duration in situ was optimal with a median duration of 17 months. The Duravent
tube was extruded spontaneously in all but four cases in which surgical removal
was necessary. The rate of persisting perforations of the tympanic membrane was
low (4.2%) compared with 24% after the use of the T-tube. Likewise, the usual
complications connected with long-term ventilation tubes were less frequent (14% 
compared with 35% when using the T-tube). CONCLUSIONS: In the present study, the 
Duravent tube has proved superior to other known long-term ventilation tubes. The
problem of granulations, otorrhoea, and tube occlusion was significantly less
than reported in other studies using the T-tube.

PMID: 12439180 [PubMed - indexed for MEDLINE]

1819: Laryngoscope. 2002 Nov;112(11):2042-5.

Effect of 23 valent pneumococcal polysaccharide and Haemophilus influenza
conjugated vaccines on the clinical course of otitis media with effusion.

Kiliç R, Safak MA, Ozdek A, Göçmen H, Kiliç D, Samim E.

ENT Department, Ankara Research and Training Hospital, Turkey. kiliç@tr.net

OBJECTIVE: To determine if there is any clinical effect of 23-valent pneumococcal
and type B conjugate vaccine on prognosis of otitis media with effusion. METHOD: 
All children who have middle ear effusion despite long-standing antibiotherapy
with a beta lactamase stable agent were offered for tympanostomy tube insertion
between February 1999 and December 2001. Patients who accepted the surgical
intervention were operated under general anesthesia and a Shepard grommet-type
tympanostomy tube was inserted. Those who refused the surgical intervention were 
vaccinated with 23-valent pneumococcal and type B conjugate vaccine. State of the
middle ear effusion was evaluated at the end of the 12th month in the vaccine
group and 1 month after the myringotomy site was healed in the tympanostomy tube 
insertion group. RESULTS: Twenty-six children in the vaccine group and 37
children in the tympanostomy tube insertion group proved the inclusion criteria
at the end of study. Complete or partial resolution of middle ear effusion was
observed in 73.1% of 26 children in the vaccine group and 59.5% of children in
the tympanostomy tube insertion group. There was no significant difference
between the two groups. CONCLUSION: Vaccination against and type b seems to aid
resolution of middle ear effusion in children with otitis media with effusion.

PMID: 12439177 [PubMed - indexed for MEDLINE]

1820: Laryngoscope. 2002 Nov;112(11):2037-41.

Detection of fungal DNA in effusion associated with acute and serous otitis
media.

Kim EJ, Catten MD, Lalwani AK.

Department of Otolaryngology-Head and Neck Surgery, University of California at
San Francisco, 94143-0342, USA.

OBJECTIVES/HYPOTHESIS: Routine bacterial and viral cultures of middle ear fluid
are often negative, suggesting that other infectious agents may be involved.
Because of the similarities between the paranasal sinuses and middle ear space
and the recent recognition of fungi as important pathogens in inflammation of the
paranasal sinuses, we investigated the potential role of fungi in acute otitis
media and serous otitis media using culture and polymerase chain reaction
techniques. STUDY DESIGN: Prospective study. METHODS: Middle ear effusions of 29 
patients who underwent myringotomy and pressure equalization tube placement for
persistent serous otitis media or recurrent acute otitis media were collected.
Fungal culture of the effusion samples was performed on potato flake agar. DNA
from the effusion was isolated using standard techniques. Polymerase chain
reaction, using radiolabeled universal fungus primer for internal transcribed
spacer of 5.8s ribosomal DNA, was performed to detect the presence of any fungal 
DNA in the samples. RESULTS: Culture of middle ear effusions showed no evidence
of fungal growth. Polymerase chain reaction analysis was able to detect the
constituent ribosomal DNA of a single fungal genome. Fungal DNA was present in
34% of middle ear effusion samples. CONCLUSIONS: Fungal DNA is present in
recurrent acute otitis media and serous otitis media suggesting that it may play 
an etiological role in serous otitis media and acute otitis media. However,
additional studies are necessary to delineate the role of fungi in the
pathogenesis of otitis media.

PMID: 12439176 [PubMed - indexed for MEDLINE]

1821: Laryngoscope. 2002 Nov;112(11):1930-4.

Comment in:
    Laryngoscope. 2005 Jan;115(1):188; author reply 188-9.

Is gastric reflux a cause of otitis media with effusion in children?

Tasker A, Dettmar PW, Panetti M, Koufman JA, P Birchall J, Pearson JP.

Department of Physiological Sciences, University of Newcastle upon Tyne, UK.
Andrea.Tasker@ncl.ac.uk

OBJECTIVES/HYPOTHESIS: Otitis media with effusion is the most common cause of
childhood deafness. Gastroesophageal reflux has been implicated in the disease
pathogenesis; therefore, it is necessary to identify the presence or absence of
gastric juice in the middle ear. STUDY DESIGN: Middle ear effusions were
collected from children undergoing myringotomy. If gastric reflux has occurred,
effusions should contain pepsin protein. METHODS: Total pepsin/pepsinogen
protein, fibrinogen, and albumin content of effusions were measured in
enzyme-linked immunosorbent assays using antibodies to porcine pepsin, human
albumin, and human fibrinogen. Proteolytic activity of each effusion was measured
at pH 2. The pH of effusions was measured. RESULTS: Fifty-nine of 65 effusion
samples gave a positive result with the antipepsin antibody, which also
recognized pepsinogen. Pepsin/pepsinogen levels ranged from 0.8 to 213.9
microg/mL (serum reference levels, 49.8-86.6 ng/mL). All effusions contained
albumin and fibrinogen with respective ranges of 1.77 to 95.75 and 0.30 to 2.30
mg/mL (serum reference levels, 35-45 and 2.2 to 4.6 mg/mL, respectively). Acidic 
protease activity occurred in 19 of 65 effusion samples. The pH of effusion
samples was 7 to 9. CONCLUSIONS: The majority of effusion samples contained
pepsin/pepsinogen protein; only 29% were active. The pepsin level in effusion
samples based on activity is substantially lower than levels based on antibody
detection; however, the pH present would irreversibly inhibit pepsin, which would
explain the low levels of active enzyme. Pepsin/pepsinogen levels in the effusion
samples were up to 1000 times higher than serum levels, whereas albumin and
fibrinogen levels were of the same magnitude. The pepsin in middle ear effusions 
is almost certainly due to reflux of gastric contents, and there may be a role
for antireflux therapy in the treatment of otitis media with effusion.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12439157 [PubMed - indexed for MEDLINE]

1822: Otol Neurotol. 2002 Nov;23(6):912-9.

A comparison of the audiometric performance of bone anchored hearing aids and air
conduction hearing aids.

Bance M, Abel SM, Papsin BC, Wade P, Vendramini J.

Department of Otolaryngology, Dalhousie University, Halifax, Nova Scotia, Canada.
m.bance@dal.ca

OBJECTIVE: To compare the function of bone anchored hearing aids (BAHA) with
conventional air conduction hearing aids (ACHA) by means of objective audiometric
tests focusing on temporal acuity and consonant discrimination in quiet and
noise, as well as subjective quality-of-life questionnaires. SETTING: Tertiary
referral center. STUDY DESIGN: Prospective. SUBJECTS: Patients using BAHAs
because of profuse drainage from chronic suppurative otitis media, and a
comparison group of healthy volunteers. MAIN OUTCOME MEASURES: Objective
measures: sound field audiograms, duration discrimination, gap discrimination,
and final and initial consonant discrimination in quiet and in noise. Subjective 
measures: Sanders' Profiles, MOS SF-36 questionnaire. RESULTS: Normal-hearing
subjects always performed better than hearing-impaired patients in all tests.
When the BAHA was compared with the ACHA, there were no significant differences
in any of the measures. CONCLUSIONS: The BAHA and the ACHA provided similar
audiometric functioning in audiometric tests. The BAHA, although using a
nonphysiologic sound conduction route, did not sacrifice temporal processing
ability or speech perception in noise, and should be considered for patients with
profuse ear drainage.

Publication Types: 
    Clinical Trial
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12438855 [PubMed - indexed for MEDLINE]

1823: Otol Neurotol. 2002 Nov;23(6):845-9.

Evolving acoustic characteristics of the canal wall down cavities due to
neo-osteogenesis by periosteal flap.

Satar B, Yetişer S, Ozkaptan Y.

Department of Otolaryngology, Head and Neck Surgery, Gülhane Military Medical
Academy, Ankara, Turkey. bsatar@ixir.com

OBJECTIVE: To determine whether the acoustic properties of the canal wall down
cavity would come closer to those of the normal ear canal as the cavity is lined 
with periosteal flap. STUDY DESIGN: Prospective study. SETTING: Tertiary referral
center. PATIENTS: Twenty one subjects who underwent canal wall down mastoidectomy
and total ossicular replacement prosthesis tympanoplasty were selected.
INTERVENTIONS: Canal wall down cavities were lined with postauricular periosteal 
flap. The acoustic properties of 21 canal wall down cavities (mastoidectomy ears)
and 16 contralateral normal ears (control ears) were measured with a hearing aid 
fitting system. MAIN OUTCOME MEASURES: Frequency, amplitude, bandwidth, and Q
factor of the resonance curve along with the loss in amplitude below 1 kHz were
compared in a paired-wise manner between the first and third months and the third
and sixth months postoperatively in mastoidectomy ears, and also between
mastoidectomy and control ears. RESULTS: In the mastoidectomy ears, the peak
resonance frequency and bandwidth significantly increased at the end of the third
and six months as the volume of the cavity decreased ( < 0.05). However, the
amplitude and Q factor of the resonance curve remained stable. At the end of the 
first month, all parameters were different in both groups ( < 0.05). At the end
of the sixth month, the frequency and bandwidth of the resonance curve in both
groups were not different. The mastoidectomy ears had some decibel-amplitude loss
below 1 kHz. Only its frequency changed as the cavity became smaller ( < 0.05).
CONCLUSIONS: New bone formation facilitated by a periosteal flap in the posterior
part of the CWD cavity behind the facial ridge may provide acoustic properties
similar to those of the normal ear canal.

PMID: 12438844 [PubMed - indexed for MEDLINE]

1824: Otol Neurotol. 2002 Nov;23(6):832-5.

Labyrinthine fistula as a late complication of middle ear surgery using the canal
wall down technique.

Hakuba N, Hato N, Shinomori Y, Sato H, Gyo K.

Department of Otolaryngology, Ehime University School of Medicine, Japan.
hakubax@m.ehime-u.ac.jp

OBJECTIVES: To evaluate the clinical features of labyrinthine fistulae occurring 
as a late complication of middle ear surgery using the canal wall down technique.
STUDY DESIGN: This was a retrospective study of the past 23 years, conducted at a
single tertiary care center. The authors evaluated the backgrounds, clinical
features, and surgical findings in 25 patients with labyrinthine fistulae, who
had a history of ear surgery using the canal down technique and who underwent a
second operation at their hospital. INTERVENTIONS: All the patients underwent
revision surgery because of persistent or recurrent vertigo caused by
labyrinthine fistulae, circumscribed labyrinthitis, or suppurative labyrinthitis.
MAIN OUTCOME MEASURES: The clinical features of this disease entity were assessed
by history, surgical findings, and the results of audiovestibular testing.
RESULTS: The patients had a long history of repetitive postoperative aural
discharge before experiencing vertigo, which initially occurred 4 to 64 years
(average, 20.2 years) after the previous operation. At the first visit to the
authors' clinic, the results of a fistula test conducted with a Politzer's bulb
were positive in 14 patients and negative in 5 patients. In the remaining 6 ears,
pressure loading of the ear canal induced the sensation of vertigo without
accompanying nystagmus. Surgical intervention showed that the fistulae were
located at the lateral semicircular canal in 19 ears, at the footplate of the
stapes in 4 ears, and at the promontory in 2 ears. Labyrinthine fistulae were
closed with conchal cartilage, bone paste (bone dust mixed with fibrin glue),
and/or temporalis fascia. In some patients, the fistulae were further covered
with pedicled temporalis muscle. In 2 cases complicated by acute suppurative
labyrinthitis, the mastoid cavity was obliterated after completion of the
labyrinthectomy. The postoperative courses in all patients were uneventful.
CONCLUSIONS: A labyrinthine fistula may be created by repeated and insidious
infection of a mastoid cavity that has been exposed to the outside during canal
wall down surgery. Intensive care of the opened mastoid cavity is essential to
avoid this late complication.

Publication Types: 
    Evaluation Studies

PMID: 12438841 [PubMed - indexed for MEDLINE]

1825: J Laryngol Otol. 2002 Oct;116(10):794-9.

Effect of middle-ear effusion on otoacoustic emissions.

Yeo SW, Park SN, Park YS, Suh BD.

Department of Otolaryngology-HNS, Kangnam St. Mary's Hospital, The Catholic
University of Korea, College of Medicine, Seoul, Korea.

Because otoacoustic emissions (OAEs) are transmitted from the cochlea to the ear 
canal via the middle ear, the transmission properties of the middle ear directly 
influence OAEs' characteristics. In general, middle-ear effusion (MEE) reduces
measured emission amplitudes and sometimes eliminates the response entirely. The 
purpose of this study was to establish the relationship between the conduction of
the middle ear and OAEs' properties and to elucidate the effect of middle-ear
effusion on detecting OAEs. Spontaneous otoacoustic emissions (SOAEs),
transiently evoked otoacoustic emissions (TEOAEs) and distortion product
otoacoustic emissions (DPOAEs) were recorded from 44 normal ears and 32 ears with
middle-ear effusion. DPOAEs were collected in two basic forms consisting of
distortion product audiograms (DP grams) and input-output (I-O) functions,
elicited by two primary tones F1 and F2 and varying geometric mean frequencies
between 1-6 kHz. The results of air and bone conduction hearing levels in pure
tone audiogram were also analysed. In 21 ears out of 32 otitis media with
effusion (OME) ears, SOAEs were absent. In the 28 ears with middle-ear effusion, 
the response and wave reproducibility were diminished, and in the 17 ears with
middle-ear effusion, the DP gram was diminished or eliminated. In particular, I-O
function curves at 3 kH and 4 kHz were diminished by the primary tones of 45 and 
55 dB under the condition of MEE. The SOAEs, TEOAEs and DPOAEs (DP gram and I-O
function curve) are highly reliable and useful tests for monitoring changes in
middle-ear condition in children with OME and in predicting the course of OME.

PMID: 12437833 [PubMed - indexed for MEDLINE]

1826: J Laryngol Otol. 2002 Sep;116(9):726-9.

Abducens nerve palsy as the sole presenting symptom of petrous apicitis.

Price T, Fayad G.

Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK.

Petrous apicitis as a potentially fatal complication of suppurative otitis media 
presents in a variety of forms. Gradenigo's triad of abducens paralysis, deep
facial pain due to trigeminal involvement and acute suppurative otitis media
rarely occurs. The conflicting symptoms reported in the literature usually result
in the delayed recognition of the condition with potentially disastrous
consequences. The VIth nerve palsy is considered to be the least reliable sign as
it is least often present. We present a case in which it was the sole presenting 
symptom.

Publication Types: 
    Case Reports

PMID: 12437811 [PubMed - indexed for MEDLINE]

1827: Arch Otolaryngol Head Neck Surg. 2002 Nov;128(11):1313-6.

Idiopathic inflammatory medial meatal fibrotizing otitis.

Hopsu E, Pitkäranta A.

Department of Otorhinolaryngology, Helsinki University Hospital, Finland.
erkki.hopsu@hus.fi

BACKGROUND: Idiopathic inflammatory medial meatal fibrotizing otitis (IMFO) is
rare. Only a few cases with unknown cause have been reported. OBJECTIVE: To
report 3 cases of IMFO as a specific diagnostic entity. PATIENTS AND METHODS: Two
adults and 1 child with bilateral IMFO were observed for several years at the
Department of Otorhinolaryngology of Helsinki University Hospital, Helsinki,
Finland. RESULTS: Only the osseous part of the external ear canals was affected
by IMFO. The skin and skin organs over the lateral cartilage of the ear canals
remained rigorously and constantly uninflamed through the active, relentless
progression of the disease over several years, resulting in the formation of a
fibrous plug of the medial meatal canal. The middle ears and mastoid air cells
were not affected during the active inflammatory phase. CONCLUSION: IMFO has its 
own specific pathophysiologic characteristics, and perhaps also etiopathologic
characteristics, which are still unknown.

Publication Types: 
    Case Reports

PMID: 12431178 [PubMed - indexed for MEDLINE]

1828: Zhonghua Yi Xue Za Zhi. 2002 Sep 25;82(18):1261-2.

Selection of surgical interference in mastoidectomy with tympanoplasty.

Liu Y, Sun J, Hu N, Qian J.

Navy General Hospital PLA, Beijing 100037, China.

OBJECTIVE: To discuss the long-term results of different surgical patterns for
chronic suppurative otitis media. METHODS: The data of 231 cases of chronic
suppurative otitis media who underwent open-mastoidectomy with tympanoplasty
(OMT), combined approach tympanoplasty (CAT), and intact bridge mastotymplasty
(IBM) and were followed up for 2 - 5 years from 1990 to 2001 were collected to
analyze the surgical technology, long-term recurrence rate, and level of hearing 
improvement. RESULTS: The improved hearing threshold level of air conduction in
0.5, 1, 2 KHz was 21 dBHL after IBM, significantly higher than that after OMT (12
dBHL) and that after CAT (9.5 dBHL). The long-term recurrence rate was 24.4%
after CAT, higher than that after IBM (8.3%) and that after OMT (5.8%).
CONCLUSION: IBM is a good choice for preserving or improving hearing based on
eradication of the focus among patients with chronic suppurative otitis media.

PMID: 12425807 [PubMed - indexed for MEDLINE]

1829: J Vet Med Sci. 2002 Oct;64(10):957-9.

A unique isolate of Malassezia from a cat.

Hirai A, Kano R, Makimura K, Yasuda K, Konishi K, Yamaguchi H, Hasegawa A.

Department of Pathobiology, Nihon University School of Veterinary Medicine,
Fujisawa, Kanagawa, Japan.

An isolate of Malassezia from a cat with otitis externa was examined
mycologically as well as molecularly. The isolate was similar to M. sympodialis
in morphological and biochemical characteristics. In molecular analysis, however,
it differed from the 7 species of Malassezia previously reported. Therefore, this
clinical isolate from a cat might be a new species of Malassezia.

Publication Types: 
    Case Reports

PMID: 12419877 [PubMed - indexed for MEDLINE]

1830: Am J Manag Care. 2002 Oct;8(14 Suppl):S353-60.

Ototopical agents in the treatment of the draining ear.

Denneny JC 3rd.

Otorrhea is the result of several pathologic conditions of the ear, including
bacterial, fungal, and viral acute external otitis (AOE), acute otitis media with
perforation (AOM), posttympanostomy tube otorrhea (PTTO), and chronic suppurative
otitis media (CSOM). The significant differences among these conditions
necessitate a thorough knowledge of the pathogenesis of each prior to the
selection of a treatment regimen likely to succeed. Consideration must be given
to the accelerating process of antimicrobial resistance, rising concern over
ototoxicity, and limits on the resources available for healthcare in general.
This article reviews the pathophysiology of AOE, AOM, PTTO, and CSOM and proposes
treatment options that demonstrate the value of ototopical therapy as the
first-line treatment option for AOE, PTTO, and CSOM with consideration given to
efficacy as well as cost effectiveness. The growing concern with ototoxicity and 
resultant recent litigation issues are also discussed.

Publication Types: 
    Review

PMID: 12408221 [PubMed - indexed for MEDLINE]

1831: Am J Manag Care. 2002 Oct;8(14 Suppl):S345-52.

Strategies for decreasing multidrug antibiotic resistance: role of ototopical
agents for treatment of middle ear infections.

Klein JO.

Boston University School of Medicine, Maxwell Finland Laboratory for Infectious
Diseases, Boston Medical Center, Massachusetts, USA.

Change in the susceptibility of bacterial pathogens to antimicrobial agents is
constant. The efficacy of a new drug may change as it is used in clinical
settings, and resistant bacterial clones result from the encounter of drug and
organism. Soon after the introduction of the sulfonamides in the mid-1930s, the
first effective agents of the antimicrobial era, resistance of pneumococci and
group A streptococci was evident. In each of the following decades, a different
problem in multidrug resistance occurred among common bacterial pathogens:
beta-lactamase-producing staphylococci in the 1950s; highly resistant
gram-negative enteric bacteria in the 1960s; beta-lactamase-producing Haemophilus
influenzae and Moraxella catarrhalis in the 1970s; and multidrug-resistant
pneumococci in the 1980s. Antimicrobial resistance among respiratory pathogens is
now a common clinical problem throughout the world, and its management is a part 
of routine office practice. Currently in the United States, about 25% of
pneumococci are resistant to penicillin, and 25% of H influenzae and 90% of M
catarrhalis produce beta-lactamase and would be inactivated by organisms
producing the enzyme. The emergence of penicillin and multidrug-resistant
pneumococci and beta-lactamase-producing strains of H influenzae and M
catarrhalis have special importance for the management of infections of the
middle ear. The widespread use of oral and parenteral antimicrobial drugs for
appropriate and inappropriate uses has driven the emergence and spread of
resistant organisms. This article discusses current susceptibility patterns of
organisms involved in middle ear infections, risk factors associated with
development of resistant strains, strategies for limiting the incidence and
spread of resistant organisms and, as part of the strategy, use of ototopical
rather than systemic antimicrobial drugs for chronic suppurative otitis media
(CSOM) and acute otitis media (AOM) in children with tympanostomy tubes. Although
many ototopical agents are approved by the Food and Drug Administration for the
indication of otitis externa, only ofloxacin otic is approved for treatment of
CSOM in patients older than 12 years of age and AOM in children with tympanostomy
tubes who are 1 year of age or older.

Publication Types: 
    Review

PMID: 12408220 [PubMed - indexed for MEDLINE]

1832: Ear Nose Throat J. 2002 Oct;81(10):718-20, 722, 725-6 passim.

Revision tympanomastoid surgery.

Megerian CA, Cosenza MJ, Meyer SE.

Department of Otolaryngology-Head and Neck Surgery, University of Massachusetts
Medical School, Worcester, USA. cliff.megerian@uhhs.com

We conducted a retrospective study of 50 ears in 48 patients in whom we performed
revision tympanomastoid surgery for chronic otitis media. We found that the most 
common probable causes for the failure of previous surgery were incomplete
lowering of the facial ridge (94% of cases), persistent sinodural-angle air-cell 
disease (92%), persistent tegmental air-cell disease (88%), recurrent or
persistent cholesteatoma (66%), persistent mastoid-tip air-cell disease (62%), a 
small meatus (60%), and persistent hypotympanic air-cell disease (56%). After a
mean postoperative follow-up of 26 months, we found no appreciable difference in 
success rates between patients who had undergone only one previous surgery (93%) 
and those who had undergone more than one previous surgery (95%) prior to
referral to our center. Follow-up hearing data revealed a statistically
significant improvement in air and bone conduction and a nonsignificant reduction
in the air-bone gap. We conclude that revision mastoid surgery following multiple
earlier surgical failures does not carry an appreciably higher risk of failure
than does initial revision surgery. Moreover, there appears to have been no
change in the causes of failure following mastoid surgery over the past 3
decades.

Publication Types: 
    Comparative Study

PMID: 12405093 [PubMed - indexed for MEDLINE]

1833: West Afr J Med. 2002 Apr-Jun;21(2):117-20.

A blind parallel comparative study of the efficacy and safety of rovamycin versus
augmentin in the treatment of acute otitis media.

Mgbor NC, Umeh RE.

Department of Otolaryngology, University of Nigeria Teaching Hospital, Enugu.

A single blind randontised controlled parallel clinical trial of Rovamycin was
conducted in which (Rovamycin Rhone-Poulenc Rorer) was compared with Augmentin in
patients with acute otitis media. Forty patients were randomised to treatment
with either Rovamycin or Augmentin and the drugs were evaluated for efficacy and 
safety. The efficacy parameters used were fever clearance, symptom clearance and 
cure rate after 8 days of treatment Our study showed that fever regressed in 19
(95%) of the 20 patients in both groups; otalgia in 19 (95) patients for the
Augmentin and 18 (90%) for Rovamycin after 8 days of application of the trial
drugs in these parameters. There was also no significant difference between them 
in their safety and tolerability profiles. These results showed that Rovamycin is
a useful addition to our armamentarium in the fight against bacterial otitis
media. Operationally, Rovamycin has an advantage over Augmentin for the reason
that is given only twice a day as against thrice-daily dosage f orAugmentin.
Compliance and consequently effectiveness in practices should therefore be better
for Rovamycin.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 12403032 [PubMed - indexed for MEDLINE]

1834: Yonsei Med J. 2002 Oct;43(5):573-8.

Acute bacterial meningitis as a complication of otitis media and related
mortality factors.

Geyik MF, Kokoglu OF, Hosoglu S, Ayaz C.

Department of Infectious Diseases and Clinical Microbiology, Dicle University
Hospital, Diyarbakir, Turkey. mefgeyik@dicle.edu.tr

The aim of this study was to evaluate the characteristics of patients with acute 
bacterial meningitis (ABM) developed secondary to acute and chronic otitis media 
(OM). Between 1991 and 2001, among 269 adult patients with ABM, 56 who were
secondary to OM were included in the study. We reviewed the charts of patients
who were diagnosed as ABM following acute or chronic OM. Risk factors associated 
with mortality were determined by using a logistic regression model. The mean age
of the patients, 38 male and 18 female, was 25.8 +/- 10.8 years (range 14 - 65). 
Forty-four of these cases (79%) have had chronic OM, of whom 19 (43% of the 44)
have also had chronic mastoiditis and 12 (27% of the 44) acute OM. Twenty-three
patients (41%) died, during either hospitalization or the follow-up period.
Univariate analysis revealed comatose mental status on admission, inappropriate
antibiotic treatment before admission, and elevated erythrocyte sedimentation
rate (ESR) as significant risk factors for mortality. In multifactorial analysis,
comatose mental status (OR=42.5, CI=6.4-280.1, p=0.001) and elevated ESR (OR=1.0,
CI=1.01-1.07; p=0.005) remained as significant predictors for mortality. In
conclusion, the primary sources of infection leading to the development of ABM
should be investigated carefully to reduce the morbidity and mortality rates. It 
is hoped that this study will raise awareness among general practitioners and
otolaryngologists concerning the role of ABM as one of the most important
complications of OM.

PMID: 12402369 [PubMed - indexed for MEDLINE]

1835: Int J Pediatr Otorhinolaryngol. 2002 Nov 11;66(2):167-73.

Quantity of aerobic bacteria in the bony portion of the external auditory canal
of children.

Stenfors LE, Räisänen S.

Department of Otolaryngology, Institute of Clinical Medicine, University of
Tromsø, N-9037 Tromsø, Norway. larseric@fagmed.iut.no

OBJECTIVE: the human external auditory canal (EAC) hosts a commensal bacterial
flora of mainly non-pathogens, but bacterial pathogens may also be present. The
latter are important in the aetiopathogenesis of external otitis and middle ear
cholesteatoma with discharge. The purpose of this study was to quantify the
bacteria normally harboured in the healthy EAC and on a well-defined region of
the cavum conchae (CC) of children. METHODS: bacterial samples were collected
from the CC and bony portion of the EAC of 32 children (18 boys, 14 girls; median
age 5 years). Prior to sampling, the EACs were either left untreated,
anaesthetized with Bonain's solution, or washed with 70% alcoholic solution. The 
samples were incubated at 37 degrees C and evaluated regarding bacterial species 
and number. RESULTS: the predominant bacterial non-pathogens were
coagulase-negative Staphylococci and coryneforms (diphtheroids) and pathogens
Staphylococcus aureus and Pseudomonas aeruginosa. Total bacterial counts of the
CC ranged between 2 x 10(3) and 4.6 x 10(4) CFU/cm(2) (median value 7 x 10(3); n 
= 14). Total bacterial counts from the bony portion of the EAC ranged between 0
and 5.7 x 10(7) CFU/EAC (median value 8 x 10(3); n = 32). Pre-treatment of the
EACs with Bonain's solution containing the highly bactericidal substance phenol
or with 70% alcoholic solution did not sterilize the EAC. CONCLUSIONS: small
numbers of bacterial non-pathogens (and sometimes pathogens) are found in the EAC
of children. Neither phenol nor 70% alcoholic solution can inhibit or eradicate
all these microorganisms. Copyright 2002 Elsevier Science Ireland Ltd.

PMID: 12393252 [PubMed - indexed for MEDLINE]

1836: Int J Pediatr Otorhinolaryngol. 2002 Nov 11;66(2):143-8.

Acute mastoiditis: a 10 year retrospective study.

Tarantino V, D'Agostino R, Taborelli G, Melagrana A, Porcu A, Stura M.

ENT Department, Divisione di Otorinolaringoiatria, Istituto G Gaslini, Largo G
Gaslini 5, Genova 16148, Italy. vincenzotarantino@ospedale-gaslini.ge.it

This retrospective study reviews our experience in the management of acute
otomastoiditis over 10 years. During the study period we identified 40 cases in
children aged 3 months-15 years with a peak incidence in the second year of life.
Sixty per cent of them had a history of acute otitis media (AOM). All the
children were already receiving oral antibiotic therapy. Otalgia, fever, poor
feeding and vomiting were the most common symptoms, all the children had evidence
of retroauricolar inflammation. Computerized tomography (CT) and magnetic
resonance imaging (MRI) were used to support the diagnosis and to evaluate
possible complications. Streptococcus pneumoniae was the most common isolated
bacterium. All the patients received intravenous antibiotics, 65% of children
received only medical treatment, 35% also underwent surgical intervention. Mean
length of hospital stay was 12.3 days. Cholesteathoma was diagnosed in one child.
We conclude from our study that acute otomastoiditis is a disease mainly
affecting young children, that develops from AOM resistant to oral antibiotics.
Adequate initial management always requires intravenous antibiotics, conservative
surgical treatment with miryngotomy is appropriate in children not responding
within 48 h from beginning of therapy. Mastoidectomy should be performed in all
the patients with acute coalescent mastoiditis or in case of evidence of
intracranial complications. Copyright 2002 Elsevier Science Ireland Ltd.

PMID: 12393248 [PubMed - indexed for MEDLINE]

1837: Ann Otol Rhinol Laryngol. 2002 Oct;111(10):933-8.

Prospective study on the incidence of chronic ear complaints related to
gastroesophageal reflux and on the outcome of antireflux therapy.

Poelmans J, Tack J, Feenstra L.

Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals
Leuven, Belgium.

Over a 2-year period (1997 to 1999), 5 consecutive adult patients with chronic
refractory secretory otitis media (CSOM) and 16 with a chronic refractory feeling
of pressure in the ear(s) (CRFP) thought to be related to concomitant eustachian 
tube dysfunction were prospectively studied for coexisting gastroesophageal
reflux (GER). All patients underwent an extensive standardized
otorhinolaryngological examination, ambulatory 24-hour dual-probe esophageal pH
monitoring with a distal pH probe 5 cm and a proximal probe 20 cm above the lower
esophageal sphincter, and upper gastrointestinal endoscopy. Most of them also
underwent esophageal manometry. All patients with CSOM and 12 of the 16 patients 
with CRFP had evidence of GER. Only 5 patients experienced heartburn or
regurgitation. All patients responded very well to antireflux therapy with
omeprazole 20 mg twice per day (40 mg twice per day in 2 patients) accompanied by
conservative antireflux measures, ie, complete cessation of their middle ear
complaints. This study demonstrates the role of GER in the pathogenesis of
refractory CSOM and CRFP and the effectiveness of sustained antireflux therapy.

Publication Types: 
    Comparative Study

PMID: 12389864 [PubMed - indexed for MEDLINE]

1838: Ann Otol Rhinol Laryngol. 2002 Oct;111(10):926-32.

Cellular proliferation of mucosa-associated lymphoid tissue with otitis media: a 
preliminary study.

Haginomori S, Balaban CD, Miura M, Takasaki K, Sando I.

Department of Otolaryngology, University of Pittsburgh School of Medicine,
Pennsylvania 15213, USA.

Histopathologic and immunohistochemical analyses were used to investigate the
cellular proliferation of mucosa-associated lymphoid tissue (MALT) in human
temporal bones with and without evidence of otitis media (OM). Anti-proliferating
cell nuclear antigen (PCNA) antibody (clone PC10) was applied after the antigen
retrieval procedure. Positive PCNA expression was observed in temporal bones that
had been stored for 10 to 31 years in 80% ethanol. In specimens with purulent OM,
the MALT had faint germinal centers (GCs). Positive PCNA expression in the MALT
was moderate and scattered. In specimens with mucous OM, the MALT had complete
GCs. Positive PCNA expression in the MALT was moderate to strong, and the
distribution of PCNA-positive cells was associated predominantly in the GCs, the 
mucosal epithelial layer, and/or the subepithelial layer. In specimens with
serous OM, the MALT also had complete GCs. However, the PCNA expression was weak 
and scattered, and appeared to be similar to that of the MALT in the temporal
bones without OM. These results indicate that the cellular proliferation of MALT 
in the temporal bone might reflect the activity that produces secretory IgA
against invasion of foreign antigens. However, further studies are needed to
elucidate whether the PCNA expression within MALT in the eustachian tube and
middle ear is associated with a mucosal immune response to inflammation as in OM.

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 12389863 [PubMed - indexed for MEDLINE]

1839: J Sch Nurs. 2002 Oct;18(5):287-92.

A comparison of audiometry and audiometry with tympanometry to determine middle
ear status in school-age children.

Yockel NJ.

Irvine Unified School District, USA.

Otitis media with effusion is the most common cause of fluctuating hearing loss
in children. Pure-tone audiometry is the current mandated standard to determine
hearing loss in public-school children in most states. Students who fail pure
tone audiometry are at risk for otitis media with effusion because it is
asymptomatic. Tympanometry, which assesses middle ear status, is used to detect
hidden otitis media with effusion. This longitudinal study evaluated pure tone
audiometry and tympanometry in preschool and elementary children (n = 141).
Results found 12 children (23 ears) who failed either a second threshold or
tympanometry. The study also showed that a greater number of ears were identified
with otitis media with effusion (n = 19) by using pure tone audiometry and
tympanometry than byusing pure tone audiometry alone (n = 4).

Publication Types: 
    Comparative Study
    Validation Studies

PMID: 12387595 [PubMed - indexed for MEDLINE]

1840: J Laryngol Otol. 2002 Jun;116(6):440-2.

Paediatric acute mastoiditis: the Alder Hey experience.

De S, Makura ZG, Clarke RW.

Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK.
sude@doctors.org.uk

Acute mastoiditis was a common condition in the pre-antibiotic era, but has
become rare now with the widespread use of antibiotics. A retrospective study was
carried out of patients with acute mastoiditis who were seen at Alder Hey
Children's Hospital, Liverpool over a five-year period. Their case records were
identified and details of gender, age at presentation, symptoms, signs and
clinical management were noted and analysed. Twenty-one patients who presented
with acute mastoiditis were identified. The patients' age at presentation ranged 
from three months to 14 years. Five cases out of 21 (23.8 per cent) were under
one year of age. Eighteen cases (85.7 per cent) presented with post-aural
swelling while 12 (57.1 per cent) had aural discharge. All patients were treated 
with intravenous antibiotics and only five patients (23.8 per cent) required
surgical intervention in the form of a cortical mastoidectomy with, or without,
myringotomy. A significant number of cases can be treated conservatively with
intravenous antibiotics. Surgery in the form of cortical mastoidectomy can be
reserved for complicated cases and in those in whom conservative treatment has
failed.

PMID: 12385355 [PubMed - indexed for MEDLINE]

1841: J Laryngol Otol. 2002 Jun;116(6):415-9.

Randomized trial on the treatment of oedematous acute otitis externa using ear
wicks or ribbon gauze: clinical outcome and cost.

Pond F, McCarty D, O'Leary S.

Department of Otolaryngology, Royal Victorian Eye and Ear Hospital, Melbourne,
Australia.

Acute otitis externa is a common condition that can be extremely painful. When
there is considerable canal oedema, packing is necessary to facilitate the
passage of medication. The experience at the Royal Victoria Eye and Ear Hospital 
is that ear wicks generally require removal in two to three days by medical staff
and can be labour intensive as they often involve serial removals following
re-insertions. Alternatively, medicated ribbon gauze is cheap and can be removed 
by the patient at home. Ear wick and mediated ribbon gauze were investigated by a
prospective randomized trial involving 94 patients. Fewer out-patient visits were
required for the ribbon gauze group (two vs. three, p<0.0001) with considerably
less material and labour costs than the wick group. Similar resolution rates were
achieved (70 per cent vs. 64 per cent, p = 0.58). Following development of
guidelines, the proportion of otitis externa patient reviews in the accident and 
emergency department declined from 49 per cent to 36 per cent. Compared with the 
ear wick, medicated ribbon gauze is a cost-effective method of treating
oedematous acute otitis externa.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 12385350 [PubMed - indexed for MEDLINE]

1842: Lancet Infect Dis. 2002 Oct;2(10):593-604.

Bacterial eradication in the treatment of otitis media.

Dagan R, Leibovitz E.

Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, 
Israel. rdagan@bgumail.bgu.ac.il

Drugs differ in their ability to eradicate various pathogens from the middle-ear 
cavity during acute otitis media (AOM), and these differences clearly affect
clinical outcome. Outcome is derived from differences in the association between 
concentrations of the drugs at the site of infection and the antimicrobial effect
(termed pharmacodynamics). These differences are even more marked in the present 
era of antimicrobial resistance. However, since AOM is a self-limiting disease in
most cases, difference in clinical outcome is more difficult to ascertain than
that of bacteriological outcome, which is measured within 3-5 days. A favourable 
clinical outcome regardless of the bacteriological effect of the drug can result 
in false optimism when less-effective antibiotic drugs are used. Inappropriate
study design and manipulation of clinical results add to this confusion. In this 
review we attempt to highlight the evidence regarding bacteriological response to
antibiotics in AOM and to draw attention to potential flaws that may mislead
clinicians.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 12383609 [PubMed - indexed for MEDLINE]

1843: Clin Otolaryngol Allied Sci. 2002 Oct;27(5):378-83.

Long-term ventilation tubes: results of 726 insertions.

Van Heerbeek N, De Saar GM, Mulder JJ.

Department of Otorhinolaryngology, University Medical Center Nijmegen, The
Netherlands. N.vanHeerbeek@kno.azn.nl

Patients with chronic or recurrent otitis media with effusion who do not respond 
to treatment with conventional ventilation tubes are often treated with long-term
ventilation tubes. The aim of this retrospective study was to determine the
extrusion and complication rates of long-term ventilation tubes. The median
ventilation time of the tubes was 31.5 months. The most common complication was
otorrhoea. One episode of otorrhoea occurred after 24% of all tube insertions,
and recurrent otorrhoea occurred in 29%. A persisting perforation developed in
19% after extrusion or removal of the tube. Other, mostly minor, complications
occurred in 36% with the tube in situ and in 3% after extrusion or removal of the
tube. Long-term ventilation tubes provided prolonged ventilation of the middle
ear, but also resulted in a considerable number of complications. For each
individual case, one should therefore determine whether the advantages of
long-term ventilation tubes outweigh the possible complications in view of the
available alternatives for middle ear ventilation.

PMID: 12383301 [PubMed - indexed for MEDLINE]

1844: Singapore Med J. 2002 Jun;43(6):296-9.

Microbiology of chronic suppurative otitis media in Singapore.

Loy AH, Tan AL, Lu PK.

Department of Otolaryngology, Singapore General Hospital, Singapore.
a_loy@hotmail.com

The objective of the study was to study the microflora and the antibiograms of
patients with chronic suppurative otitis media (CSOM) in Singapore. Ninety
patients with CSOM were prospectively studied. They had chronic ear discharge and
had not received antibiotics for the previous five days. Swabs were taken, and
cultured for bacteria. Antibiotic testing was done using modified Kirby Bauer
disk diffusion method. In addition to the usual antibiotics, the three most
common topically available antibiotics (chloramphenicol, gentamicin and neomycin)
were tested. There were 135 positive cultures for organisms from the 90
patients.The most common causal organisms isolated were Pseudomonas aeruginosa
(33.3%) and Staphylococcus aureus (33.3%) followed by coagulase negative
Staphylococcus (21.1%). Fungi accounted for 8.8% of isolates while 6.6% were
anaerobes. Of the three antibiotics commonly available as topical eardrops,
gentamicin has the highest susceptibility rate (82.6%), followed by neomycin
(67.8%) and chloramphenicol (62.8%).

PMID: 12380726 [PubMed - indexed for MEDLINE]

1845: Pediatr Infect Dis J. 2002 Sep;21(9):882-5.

Daily home tympanometry to study the pathogenesis of otitis media.

Antonio SM, Don D, Doyle WJ, Alper CM.

House Ear Clinic and Institute Los Angeles CA, USA.

A study was conducted to define the temporal relationship between a
parent-identified cold episode and the diagnosis of otitis media. Forty children 
were studied in their homes with the use of daily tympanometry, symptom diaries
and weekly otoscopy. A total of 136 patients identified colds, and 43 episodes of
otitis media were recorded. New episodes of otitis media were observed in 22% of 
all colds, and 63% of all otitis media episodes occurred during a cold.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12380590 [PubMed - indexed for MEDLINE]

1846: Asian J Surg. 2002 Apr;25(2):170-4.

Complications of otitis media requiring surgical intervention.

Long YT, Mahmud R, Sani A, Saim L.

Department of Otorhinolaryngology, Universiti Kebangsaan Malaysia, Jalan Yaacob
Latif, 5000, Cheras, Kuala Lumpur, Malaysia. ytlong@tm.net.my

BACKGROUND: Although the incidence of complications of otitis media that require 
surgical interventions has decreased substantially over the past few years, it is
a prevailing condition for which clinicians should remain vigilant. METHODS: We
conducted a 3-year review [June 1998 to June 2001] in our hospital of surgical
records of patients with complications of otitis media that were treated
surgically. RESULTS: There were 16 patients with complications of otitis media,
of which nine [56%] were intracranial; brain abscess and lateral sinus thrombosis
were the most common intracranial complications. Extracranial complications were 
present in 15 [94%] of the patients; mastoid abscess [40%] was the most common
extracranial complication. Seven [44%] patients had two or more concomitant
complications. All patients with intracranial complications recovered well with
no neurological deficits after aggressive antibiotic therapy and initial surgical
treatment by neurosurgeons. Modified radical mastoidectomy was the most common
surgical otological procedure that was performed in these cases.CONCLUSIONS:
Aggressive antibiotic therapy and combined management of cases by otologists and 
neurosurgeons are the key to reducing the morbidity and mortality of the serious 
complications of otitis media.

PMID: 12376240 [PubMed - indexed for MEDLINE]

1847: Scand J Infect Dis. 2002;34(9):694-6.

Venous sinus thrombosis after Proteus vulgaris meningitis and concomitant
Clostridium abscess formation.

Bodur H, Colpan A, Gozukucuk R, Akinci E, Cevik MA, Balaban N.

Department of Infectious Diseases and Clinical Microbiology, Ankara Numune
Education and Research Hospital, Turkey.

A 19-y-old woman presented with Proteus vulgaris meningitis as a complication of 
chronic otitis media. Despite treatment with ceftazidime and amikacin no clinical
improvement was observed. Cranial MRI revealed right-sided mastoiditis/otitis
media and venous sinus thrombosis. After mastoidectomy, repeat cranial MRI
demonstrated abscess formation in the venous sinuses. The abscess was drained.
Clostridium spp. was isolated from the abscess culture.

Publication Types: 
    Case Reports

PMID: 12374367 [PubMed - indexed for MEDLINE]

1848: Scand J Infect Dis. 2002;34(9):657-9.

Educational intervention for parents and healthcare providers leads to reduced
antibiotic use in acute otitis media.

Småbrekke L, Berild D, Giaever A, Myrbakk T, Fuskevåg A, Ericson JU, Flaegstad T,
Olsvik O, Ringertz SH.

Regional Drug Information Centre, Tromsø University Hospital, Norway.
lars.smabrekke@unn.no

We used a controlled before-and-after design with the aims of reducing both the
total consumption of antibiotics and the use of broad-spectrum antibiotics
against acute otitis media (AOM), and to study to what extent prescriptions for
antibiotics against AOM were dispensed. Information on evidence-based treatment
of uncomplicated AOM was provided to doctors and nurses, and written guidelines
were implemented. Pamphlets and oral information concerning symptomatic treatment
and the limited effect of antibiotic use in AOM were given to parents. Eligible
patients were 819 children aged 1-15 y. The proportion of patients receiving a
prescription for antibiotics was reduced from 90% at baseline to 74% during the
study period. The proportion of prescriptions for penicillin V increased from 72%
at baseline to 85% during the study period. There were no significant changes at 
the control site. The proportion of dispensed prescriptions was 70% both at
baseline and during the study period. Educational efforts reduced the total
consumption of antibiotics and the use of broad-spectrum antibiotics for AOM in
children aged 1-15 y at an emergency call service. Data on antibiotic use in AOM 
based only on prescribing overestimates the use of antibiotics.

PMID: 12374355 [PubMed - indexed for MEDLINE]

1849: J Am Vet Med Assoc. 2002 Oct 1;221(7):1000-6.

Breed variations in histopathologic features of chronic severe otitis externa in 
dogs: 80 cases (1995-2001).

Angus JC, Lichtensteiger C, Campbell KL, Schaeffer DJ.

Department of Veterinary Clinical Medicine, College of Veterinary Medicine,
University of Illinois, Urbana 61802, USA.

OBJECTIVE: To compare pathologic changes of the horizontal ear canal associated
with chronic severe otitis externa between Cocker Spaniels and dogs of other
breeds. DESIGN: Retrospective study. ANIMALS: 80 dogs with severe otitis externa 
that required total ear canal ablation with lateral bulla osteotomy. PROCEDURE:
Medical records were reviewed for breed, sex, and age at time of surgery.
Histologic specimens from the horizontal ear canal were evaluated by a single
examiner for overall tissue response pattern and scored for sebaceous gland
hyperplasia, ceruminous gland hyperplasia, ceruminous gland ectasia, fibrosis,
pigment-laden macrophages, and osseous metaplasia. RESULTS: 48 of 80 (60%) dogs
were Cocker Spaniels. Thirty-five of 48 (72.9%) Cocker Spaniels had a
predominately ceruminous tissue response pattern; only 9 of 32 (28.1 %) dogs of
other breeds had the same pattern. Other breeds most commonly had a pattern
dominated by fibrosis (n = 13 [40.6%]); fibrosis was the predominant pattern in
only 4 of 48 (8.3%) Cocker Spaniels. Discriminant analysis and K-means clustering
of 4 histopathologic criteria correctly classified 75% of the dogs as Cocker
Spaniels or all other breeds. CONCLUSIONS AND CLINICAL RELEVANCE: Cocker Spaniels
are at increased risk for chronic severe otitis externa requiring total ear canal
ablation with lateral bulla osteotomy, indicating that earlier and more
aggressive management of the primary otitis externa and secondary inflammation is
warranted in this breed. Cocker Spaniels with chronic severe otitis externa have 
distinct differences in pathologic characteristics of the horizontal ear canal,
compared with other breeds.

PMID: 12369678 [PubMed - indexed for MEDLINE]

1850: Laryngoscope. 2002 Oct;112(10):1726-9.

Otogenic sigmoid sinus thrombosis: what is the role of anticoagulation?

Bradley DT, Hashisaki GT, Mason JC.

Department of Otolaryngology-Head and Neck Surgery, University of Virginia
Hospitals, Charlottesville, Virginia 22908, USA.

OBJECTIVES: The treatment of otogenic sigmoid sinus thrombosis with surgery and
antibiotics is well established. However, the role of anticoagulation remains
unstudied. The study reviews the signs, symptoms, radiological evaluation,
surgical treatment, and medical management of patients with otogenic sigmoid
sinus thrombosis treated with or without anticoagulation. STUDY DESIGN:
Retrospective review of nine patients from 1995 to 2001 with sigmoid sinus
thrombosis. METHODS: Patients were identified by a review of all medical and
radiological records. Signs, symptoms, diagnostic studies, treatments, and
outcomes were recorded. In addition, telephone follow-up was performed.RESULTS
Nine patients were identified over a 6-year period from 1995 to 2001. Patients
had a mean follow-up time of 9 months (range, 1-24 mo). Of the nine patients
identified, eight patients (89%) had tympanostomy tube placement, six patients
(67%) had canal wall intact mastoidectomy, and one patient (11%) had canal wall
down mastoidectomy. Needle aspiration of the sinus was performed in four of nine 
patients (44%), and incision of the sinus in two of nine (22%). Treatment with
broad-spectrum antibiotics occurred in all patients with a mean duration of 12
days (range, 2-22 d) intravenously and 7 days (range, 0-21 d) orally. Sixty-seven
percent of patients (six of nine) were anticoagulated: Five patients received
low-molecular-weight heparin, and one patient received heparin-coumadin. No
mortality occurred in either the anticoagulated or non-anticoagulated group. One 
anticoagulated patient did have persistent headaches and otorrhea. CONCLUSIONS:
Surgery and antibiotic therapy are the cornerstones of the management of otogenic
sigmoid sinus thrombosis. However, the role of anticoagulation remains unclear.
Because complications of embolization and persistent sepsis are low in otogenic
sigmoid sinus thrombosis patients treated with or without anticoagulation,
withholding anticoagulation in selected patients is reasonable. Serial imaging to
monitor for thrombus progression is advisable.

PMID: 12368604 [PubMed - indexed for MEDLINE]

1851: Med Decis Making. 2002 Sep-Oct;22(5):394-402.

Does choosing a treatment depend on making a diagnosis? US and French physicians'
decision making about acute otitis media.

Sorum PC, Stewart TR, Mullet E, González-Vallejo C, Shim J, Chasseigne G, Sastre 
MT, Grenier B.

Department of Medicine, Albany Medical Center, New York, USA. sorump@mail.amc.edu

BACKGROUND: The classic sequential processing model of clinical decision
making-in which the treatment choice follows and depends on the diagnostic
judgment-may in some cases be replaced by a processing model in which the
treatment choice depends on an independent assessment of the diagnostic and other
cues. The aim of this study was to determine which processing model would better 
describe physicians' treatment choices in a simulated clinical task. METHODS:
Seventy-five US and French primary care physicians were presented twice, in a
different order, with the same set of 46 scenarios of 15-month-old children
suspected of having acute otitis media (AOM). They rated in one set the
probability of AOM and in the other set whether they would treat the child with
antibiotics (and how confident they felt in their decision). Linear regression
analyses revealed the individuals' 2 judgment policies. Hierarchical discriminant
analysis was used to analyze the variance explained in the treatment choice by,
1st, the diagnostic judgment, 2nd, the cues specific to treatment, and 3rd, the
cues specific to diagnosis. RESULTS: Even when choosing treatment, the
participants placed greatest weight on diagnostic cues, especially the ear
findings. Only 28% used the cues that reflected parental issues. For 36%, the
diagnostic cues had an effect on the treatment choice independent of the effect
(if any) of the diagnostic judgment. CONCLUSION: In deciding how to treat AOM,
the majority of the participating US and French primary care physicians followed 
the classic sequential processing model, but a substantial minority used instead 
an independent processing model.

PMID: 12365481 [PubMed - indexed for MEDLINE]

1852: Int J Pediatr Otorhinolaryngol. 2002 Oct 21;66(1):55-62.

Use of hearing aids in the management of children with cleft palate.

Maheshwar AA, Milling MA, Kumar M, Clayton MI, Thomas A.

Department of Otorhinolaryngology and Head and Neck Surgery, Royal Gwent
Hospital, Newport NP20 2UB, UK. maheshwar_arcot@hotmail.com

OBJECTIVE: The incidence of otitis media with effusion in children with cleft
palate is high. There are numerous reports looking at early insertion of
ventilation tubes (VT) with associated complications. We believe that this is the
first paper that discusses the use of hearing aids (HA) as the first line of
management. METHODS: Children with cleft palate are managed in a special
multidisciplinary clinic in our hospital. Detailed records of these children are 
maintained. We studied the otological management of 70 children with repaired
cleft palate. RESULTS: 12 of the 70 (17.1%) had VT inserted, 17 (24.3%) were
provided with HA, 14 (20%) had both grommets and HA and 27 (38.6%) had neither.
Of the 31 (44.3%) children who had HA, 16 (51.6%) had good compliance with the
HA. The hearing, speech and language developments in these children have been
good. Twelve of the 70 patients (17.1%) have had one or more otological
complications. These were significantly higher in children treated with VT.
CONCLUSION: We have successfully treated 62.9% of our patients with non-surgical 
intervention, and show a low incidence of long term complications.

Publication Types: 
    Comparative Study

PMID: 12363423 [PubMed - indexed for MEDLINE]

1853: Int J Pediatr Otorhinolaryngol. 2002 Oct 21;66(1):41-8.

The clinical role of Alloiococcus otitidis in otitis media with effusion.

Leskinen K, Hendolin P, Virolainen-Julkunen A, Ylikoski J, Jero J.

Department of Otolaryngology, Helsinki University Central Hospital,
Haartmaninkatu 4 E, PO Box 220, FIN-00029 HUCH, Helsinki, Finland.
kimmo.leskinen@hus.fi

OBJECTIVE: To investigate the presence of Alloiococcus otitidis (A. otitidis) in 
MEEs from patients with otitis media with effusion (OME) using PCR and to
correlate the findings with the clinical picture of children with OME for
assessing the clinical role of A. otitidis in OME. METHODS: Bacterial culture and
PCR were used to detect A. otitidis, Streptococcus pneumoniae, Haemophilus
influenzae and Moraxella catarrhalis in MEE samples from 123 patients with OME.
The culture and PCR results and the clinical picture of the patients were
compared. RESULTS: Bacteria were cultured in 55 (45%) of the 123 MEEs, and major 
pathogens (S. pneumoniae, H. influenzae and M. catarrhalis) were found in 40
(33%); A. otitidis was not found in culture. PCR of the MEEs yielded positive
results for one or more of the four tested pathogens in 108 (88%) of the samples 
and 25 (20%) were positive for A. otitidis. The effusions that persisted 3 months
or longer had a higher prevalence of A. otitidis than those with shorter
durations (P=0.03). A. otitidis was found to be more often positive in PCR in
mucoid MEEs than in mucoserous MEEs (30 vs. 9%; P=0.015). CONCLUSIONS: While A.
otitidis is extremely difficult to detect with bacterial culture, PCR provides a 
sensitive and specific means for detecting it. A. otitidis is associated with a
more prolonged course and mucoid MEEs in OME. Thus, its existence seems to be
related to a more chronic stage of OME, but its pathogenic potential should be
the subject of further investigation.

PMID: 12363421 [PubMed - indexed for MEDLINE]

1854: Int J Pediatr Otorhinolaryngol. 2002 Oct 21;66(1):37-40.

Characterization of cytokines present in pediatric otitis media with effusion:
comparison of allergy positive and negative.

Jang CH, Kim YH.

Department of Otolaryngology, Wonkwang Medical School, Iksan 570-711, South
Korea. chul@wonkwang.ac.kr

To investigate the possible relationship between allergy and otitis media with
effusion (OME), we investigated the cytokine level in the middle ear effusion
(MEE)s of children with persistent OME. Interleukin (IL)-2, IL-4, IL-6 and tumor 
necrosis factor (TNF)-alpha in the MEEs were measured by devised sensitive
sandwich enzyme-linked immunosorbent assay (ELISA) and compared allergy positive 
group with allergy negative group. The mean levels of IL-4, IL-6 and TNF-alpha in
MEE were significantly higher in allergy positive group than allergy negative
group (P<0.05). Elevation of Th-2-driven cytokines (IL-4, IL-6) and TNF-alpha in 
MEEs may be a contributing factor in the persistence of OME with allergy.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12363420 [PubMed - indexed for MEDLINE]

1855: Pediatrics. 2002 Oct;110(4):696-706.

Otitis media in early childhood in relation to children's school-age language and
academic skills.

Roberts JE, Burchinal MR, Zeisel SA.

Frank Porter Graham Child Development Institute, University of North Carolina at 
Chapel Hill, Chapel Hill, North Carolina 27599-8180, USA. joanne_roberts@unc.edu

OBJECTIVE: To examine whether otitis media with effusion (OME) and associated
hearing loss during the first 4 years of life are related to the language
development and academic achievement of children between 4 years of age and
second grade. METHODS: In a prospective cohort study, 83 black children,
primarily from low-income families and recruited from community-based child care 
programs, were examined repeatedly between the ages of 6 months and 4 years for
the presence of OME and hearing loss, both when well and when ill with OME.
Children's child-rearing environments at home were assessed annually from infancy
through second grade, whereas children's language and academic skills were
assessed repeatedly between 4 years of age and second grade. RESULTS: We did not 
find in our longitudinal analyses a relationship between OME and hearing loss
during the first 4 years of life and later academic skills in early reading and
recognition of words heard. We did find that children with greater incidence of
OME and hearing loss during the first 4 years of life scored lower in verbal math
problems between kindergarten and second grade, even after partialing out
important background factors. Children with more OME tended to score lower in
math at the younger ages but caught up once they entered school. Follow-up
analyses indicated also that children with more OME during the first 2 years of
life scored lower in expressive language during the preschool and early
elementary school years but caught up by second grade. In contrast, children from
homes that were rated as more stimulating and responsive scored higher on every
measure of language and academic skills than did children from less responsive
homes. The home environment was related more strongly to all of the outcomes
examined than was OME or hearing loss. CONCLUSIONS: There was no evidence of a
significant relationship between a history of OME or hearing loss and children's 
later academic skills in reading or word recognition during the early elementary 
school years. Children with greater incidence of OME and hearing loss scored
lower in math and expressive language at the younger ages but caught up in math
with their peers on entering school and in expressive language by second grade.
Furthermore, a child's home environment was more related to early math and
expressive language skills than was OME or hearing loss, and the home environment
continued to be predictive of all of the language and academic outcomes through
second grade. These study results should be interpreted cautiously when
generalizing to other populations.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 12359782 [PubMed - indexed for MEDLINE]

1856: J Infect Dis. 2002 Oct 15;186(8):1106-14. Epub 2002 Sep 16.

Pneumococcal carriage and otitis media induce salivary antibodies to pneumococcal
capsular polysaccharides in children.

Simell B, Kilpi TM, Käyhty H.

Department of Vaccines, National Public Health Institute, Mannerheimintie 166,
00300 Helsinki, Finland. birgit.simell@ktl.fi

Mucosal immunity likely plays an important role in the defense against
Streptococcus pneumoniae. This study examined whether pneumococcal carriage and
acute otitis media induce mucosal antibodies to pneumococcal capsular
polysaccharides (Pnc-PSs) of types 1, 6B, 11A, 14, 19F, and 23F. Immunoglobulin
(Ig) A, IgG, and secretory (S) Ig anti-Pnc-PS antibodies were measured by enzyme 
immunoassay in the saliva of children at ages 6, 12, 18, and 24 months and were
analyzed in relation to the previous pneumococcal findings. A larger proportion
of IgA-positive samples and higher concentrations of type-specific IgA antibodies
were detected in samples of children with pneumococci of the given types cultured
before sampling from nasopharyngeal samples or middle-ear fluid, compared with
children who had cultures negative for pneumococci of the indicated types or of
all types. The IgA and S-Ig concentrations correlated strongly, which suggests
that the anti-Pnc-PS IgA was secretory. Salivary anti-Pnc-PS IgG was detected
only rarely.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12355361 [PubMed - indexed for MEDLINE]

1857: Pediatr Infect Dis J. 2002 Sep;21(9):859-65.

Pneumococcal serotypes from acute otitis media in rural Kentucky.

Block SL, Hedrick J, Harrison CJ, Tyler R, Smith A, Findlay R, Keegan E.

Kentucky Pediatric Research, Inc., Bardstown, Luisville, KY, USA.

OBJECTIVE: Acute otitis media (AOM) accounts for most infections caused by, but
few data are available regarding the incidence of pneumococcal serotypes
recovered from children with AOM in the United States. METHODS: Between January
1992 and March 1998, 777 middle ear pathogens from AOM were obtained from 701
patients by tympanocentesis (84.6%) or by culture of otorrhea (15.4%) from
spontaneous perforation or draining tubes. The ambulatory patient population was 
mostly white and cared for by a sole private pediatric practice in rural
Kentucky. RESULTS: Penicillin-nonsusceptible (penicillin MIC > or = 0.1
microg/ml) (PNSP) isolates accounted for 18% [6% resistant PNSP (rPNSP) and 12%
intermediate resistant PNSP], and penicillin-susceptible strains accounted for
35% of the pathogens recovered from children with culture-proved AOM. Comparing
the frequency of isolates between 1992 and 1993 with those between 1994 and 1998,
overall rates of PNSP strains remained remarkably stable (32.2% 37.3%), but
intermediate resistant PNSP strains doubled from 14% to 27% ( < 0.01), whereas
rPNSP strains fell by one-third. Serotypes 19F (34%), 23F (30%), 6B (26%) and 14 
(8%) accounted for nearly all rPNSP isolates. Two cross-reactive serotypes (6A
and 19A) not included in the available pneumococcal conjugate vaccine comprised
8.4 and 15% of all serotypes and PNSP serotypes, respectively. Nearly all PNSP
strains recovered in children < or =24 months are included in the vaccine
serogroups. CONCLUSION: Depending on rates of efficacy and serotype
cross-protection, the current pneumococcal conjugate vaccine could potentially
protect against most PNSP strains in all ages, particularly in those < or =24
months.

PMID: 12352810 [PubMed - indexed for MEDLINE]

1858: Laryngoscope. 2002 Sep;112(9):1684-90.

Otologic manifestations of Wegener's granulomatosis.

Takagi D, Nakamaru Y, Maguchi S, Furuta Y, Fukuda S.

Department of Otolaryngology--Head and Neck Surgery, Hokkaido University Graduate
Shool of Medicine, Sapporo, Japan. daita@med.hokudai.ac.jp

OBJECTIVE/HYPOTHESIS: To evaluate the clinical features, treatment, and outcomes 
of otologic manifestations in Wegener's granulomatosis (WG) treated at Hokkaido
University Graduate School of Medicine, Sapporo, Japan. STUDY DESIGN: We
retrospectively reviewed 15 cases of WG with ear involvement. METHODS:
Twenty-five patients with WG were treated at Hokkaido University Graduate School 
of Medicine between 1992 and 2001. Fifteen of these patients had otologic
symptoms. We evaluated the clinical course, method of therapy, and outcomes in
all cases. Diagnosis of WG was made when the patients had clinical findings and a
positive titer of cytoplasmic pattern antineutrophil cytoplasmic antibodies
(c-ANCA), or when there were clear histologic findings. We also present three
case reports. RESULTS: In 15 cases, the most frequent finding was chronic otitis 
media. Sensorineural hearing loss was present in 2 patients. In 7 patients whose 
otologic manifestations were the primary involvement of WG, all were confirmed
positive for c-ANCA and were treated with glucocorticoids and immunosuppressive
drugs. Three patients who could be treated within 1 month of symptom onset showed
marked improvement. CONCLUSIONS: In localized cases, biopsy specimens are often
small, and it is frequently difficult to make a histologic diagnosis. The
prognosis for hearing was poor when appropriate treatment was not given in the
early stages of the disease. Therefore, WG should be included in the differential
diagnosis in cases of atypical inflammatory states of the ear. Early diagnosis
and appropriate treatment are important to prevent irreversible changes in the
middle ear and inner ear.

Publication Types: 
    Case Reports

PMID: 12352687 [PubMed - indexed for MEDLINE]

1859: Laryngoscope. 2002 Sep;112(9):1657-62.

Cytokine profiles in a rat model of otitis media with effusion caused by
eustachian tube obstruction with and without Streptococcus pneumoniae infection.

Hebda PA, Piltcher OB, Swarts JD, Alper CM, Zeevi A, Doyle WJ.

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh,
Pennsyvania 15213, USA.

OBJECTIVE: Cytokine expression was studied in a rat model of otitis media with
effusion. METHODS: The left eustachian tube was obstructed (eustachian tube
obstruction [ETO]) in 84 rats. Forty-two ears were challenged with, and those
rats were treated from day 2 to day 7 with ampicillin. Twelve rats (6 per group) 
were killed on days 1, 2, 7, 21, 35, 56, and 112; mucosa was harvested and
assayed for interleukin-1beta (IL-1beta), tumor necrosis factor-alpha
(TNF-alpha), interleukin-6 (IL-6), interleukin-10 (IL-10), interferon-gamma
(IFN-gamma), transforming growth factor-beta (TGF-beta), monocyte chemoattractant
protein-1 (MCP-1), and interleukin-8 (IL-8) gene expression, and effusion was
assayed for IL-1beta, TNF-alpha, IL-6, IL-10, and macrophage inflammatory
protein-2 (MIP-2) protein. RESULTS: Most cytokines were detectable in the
effusion from infected ears with ETO on days 1 and 2 only. MIP-2 exhibited a
biphasic response. Only effusion MIP-2 was consistently detected in uninfected
ears with ETO. Three patterns of mucosal cytokine messenger RNA (mRNA)
upregulation were observed: isolated early (IL-1beta, IL-8), isolated late
(TNF-alpha, IFN-gamma), and biphasic (MCP-1, IL-6, TGF-beta) responses. Early
cytokine mRNA upregulations were observed only in the infected ears with ETO,
whereas late upregulations were observed in both groups. CONCLUSIONS: Early
expression of the assayed cytokines occurred only in ears with active infection. 
For both groups, a late upregulation of cytokine message but not protein was
documented. The profile of cytokine expression during otitis media episodes may
be useful in defining etiology, disease stage, and prognosis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12352682 [PubMed - indexed for MEDLINE]

1860: Laryngoscope. 2002 Sep;112(9):1619-22.

Evolving resistant pseudomonas to ciprofloxacin in malignant otitis externa.

Berenholz L, Katzenell U, Harell M.

Department of Otolaryngology, E. Wolfson Medical Center, Holon and Sackler
Faculty of Medicine, Tel Aviv University, Israel. Leonard@netvision.net.il

OBJECTIVE: To determine whether there has been an increase in
ciprofloxacin-resistant pseudomonas malignant otitis externa, and if this has
increased the morbidity of the disease. STUDY DESIGN: Retrospective. SETTING:
Tertiary referral center. PATIENTS: Twenty-eight patients over 13 years. RESULTS:
The records of a total of 28 patients who were admitted between 1988 and 2001
with the diagnosis of malignant otitis externa were reviewed. Seven patients had 
ciprofloxacin-resistant pseudomonas on their hospital culture and sensitivity
test. Five of the 7 resistant cases appeared in the last 3 years, as opposed to 2
of the 7 who appeared in the 10 years before that period. In our series, there is
a significant trend developing over time of pseudomonas resistant to treatment
with ciprofloxacin. No increased morbidity or mortality was found in the
ciprofloxacin-resistant pseudomonas group compared with the remaining patients
who were sensitive to ciprofloxacin. CONCLUSIONS: In our series, resistance to
ciprofloxacin in patients with malignant otitis externa is increasing over time. 
This may have an impact on the relatively successful outpatient treatment of
these patients in the past decade. A return to inpatient or outpatient
intravenous treatment with third-generation cephalosporins/antipseudomonal
penicillins and more frequent debridement will be required in these patients.

PMID: 12352675 [PubMed - indexed for MEDLINE]

1861: Otolaryngol Head Neck Surg. 2002 Sep;127(3):169-76.

The role of soluble interleukin-4 receptor and interleukin-5 antibody in
preventing late-phase allergy-induced eustachian tube dysfunction.

Pollock HW, Ebert CS, Dubin MG, White DR, Prazma J, Pillsbury HC 3rd.

Department of Surgery, Division of Otolaryngology/HNS, University of North
Carolina Hospitals, Chapel Hill 27599-7070, USA. hpollock@med.unc.edu

OBJECTIVES: We investigated the role of soluble interleukin (IL)-4 receptors
(sIL-4R) and IL-5 antibodies (IL-5Ab) in preventing allergic eustachian tube
dysfunction (ETD) and middle ear effusion (MEE). STUDY DESIGN: Brown-Norway rats 
were sensitized to ovalbumin (OVA) and challenged transtympanically. Two groups
of rats received either IL-4R or IL-5Ab transtympanically 1 hour before
challenge. Three additional groups were used as controls. Following the second
transtympanic challenge, the ventilatory and clearance functions of the
eustachian tube (ET) were assessed at 0, 2, and 8 hours. Histology was prepared
using cut paraffin sections stained with hematoxylin and eosin. RESULTS:
sIL-4R-pretreated rats showed no significant changes in ventilatory or clearance 
functions of the ET or inflammatory changes in ET mucosa, whereas IL-5Ab
pretreatment showed significant late ventilatory and clearance dysfunction as
well as inflammatory mucosal changes. CONCLUSION: These data demonstrate that the
late-phase allergic inflammatory response that leads to subsequent formation of
ETD and MEE is prevented by pretreatment with sIL-4R and, more modestly, with
IL-5Ab.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12297806 [PubMed - indexed for MEDLINE]

1862: Otolaryngol Head Neck Surg. 2002 Sep;127(3):163-8.

Laser therapy for refractory myringitis in children.

Fechner FP, Cunningham MJ, Eavey RD.

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard
Medical School, Boston 02114, USA.

OBJECTIVE: We present the application and initial results of a CO(2) laser
technique for the treatment of medically refractory chronic granular myringitis
(CGM). STUDY DESIGN AND SETTING: Retrospective case series of 15 treated ears in 
13 consecutive patients between the ages of 6 and 14 years (median age, 9.0
years) cared for in a tertiary care specialty hospital. RESULTS: Eleven of 15
treated ears had total resolution of CGM and associated symptoms; median
follow-up time was 10 months. Three ears were improved, and 1 ear remained
unchanged. Three of 5 preoperative tympanic membrane perforations healed after
laser treatment; 1 patient developed a postoperative, dry perforation. Hearing
was not impaired in any patient tested. CONCLUSION: Preliminary results suggest
that CGM, when refractory to medical treatment, can often be treated effectively 
by a single laser treatment.

PMID: 12297805 [PubMed - indexed for MEDLINE]

1863: Vaccine. 2002 Oct 4;20(29-30):3590-7.

Detection and characterization of pediatric serum antibody to the OMP
P5-homologous adhesin of nontypeable Haemophilus influenzae during acute otitis
media.

Novotny LA, Pichichero ME, Denoël PA, Neyt C, Vanderschrick S, Dequesne G,
Bakaletz LO.

Department of Pediatrics, College of Medicine & Public Health, Children's
Research Institute, The Ohio State University, Rm W302, 700 Children's Drive,
Columbus, OH 43205-2696, USA.

We reported earlier that antibody in sera collected from seven children with
acute otitis media (AOM) due to nontypeable Haemophilus influenzae (NTHI)
recognized immunodominant regions of P5-fimbrin just as we had observed in a
chinchilla model of experimental NTHI-induced AOM. To expand upon those
preliminary findings, we further characterized pediatric serum antibodies
directed against this adhesin during AOM. Collectively, the data show that
children respond immunologically to P5-fimbrin and they do so in a manner that
allows for the distinction of sequence diversity within short linear peptides
representing a focused region of this surface-exposed protein. The immune
recognition we observed encourages us to further develop a P5-fimbrin based
vaccine component.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12297406 [PubMed - indexed for MEDLINE]

1864: Fam Med. 2002 Sep;34(8):598-603.

Otitis media in children: use of diagnostic tools by family practice residents.

MacClements JE, Parchman M, Passmore C.

Department of Family Practice, University of Texas Health Center at Tyler,
75708-3154, USA. jonathan.macclements@uthct.edu

BACKGROUND AND OBJECTIVES: Although otitis media is a common problem in primary
care, little is known about the use of diagnostic tools such as pneumatic
otoscopy, tympanometry, acoustic reflectometry, or tympanocentesis by family
physicians in training. METHODS: This was a self-reported observational study of 
family practice residents' use of otitis media diagnostic tools. Twenty-three
family practice programs in Texas and Oklahoma were surveyed during November and 
December 2000. Residents were asked about their use of diagnostic tools, and, if 
tools were not used, they were asked the reason for not using them. Residents
were also asked about the criteria they used to diagnose otitis media, and their 
responses were compared to criteria recommended by national guideline panels.
RESULTS: The response rate was 61% (n = 316). The percentage of residents using
pneumatic otoscopy was 66%, tympanometry 29%, acoustic reflectometry 2%, and
tympanocentesis 0%. The most common reasons cited for not using tools were lack
of training or unavailability of equipment. Fifty-five percent of family practice
residents do not report pneumatic otoscopy for diagnosing otitis media and thus
did not use recommended criteria. Faculty training of residents in the use of
diagnostic tools was associated with a higher rate of using these tools.
DISCUSSION: Few residents believed that diagnostic tools had no value in the
diagnosis of otitis media, but lack of training or equipment problems were
reported as contributing to their not using these tools. Half of family practice 
residents may be inadequately diagnosing middle ear problems since they did not
report that pneumatic otoscopy was necessary for diagnosing otitis media. Because
training was associated with higher rates of using appropriate diagnostic tools, 
family medicine faculty can play a significant role in improving the residents'
diagnostic skills.

Publication Types: 
    Comparative Study

PMID: 12269536 [PubMed - indexed for MEDLINE]

1865: Int J Pediatr Otorhinolaryngol. 2002 Sep 24;65(3):233-40.

Causes for massive bacterial colonization on mucosal membranes during infectious 
mononucleosis: implications for acute otitis media.

Stenfors LE, Bye HM, Räisänen S.

Department of Otolaryngology, Institute of Clinical Medicine, University of
Tromsø, N-9037, Tromso, Norway. larseric@fagmed.uit.no

OBJECTIVE: A common complication of virus-induced upper respiratory tract
infections is acute otitis media caused by bacterial pathogens. Simultaneously,
increased bacterial colonization in the nasopharynx occurs. Our intention in this
study was to identify the causes of this increased colonization of bacteria by
evaluating their coating with the antibacterial substances lysozyme, lactoferrin 
and immunoglobulins IgG, S-IgA and IgM and their ability to penetrate epithelial 
cells during infectious mononucleosis (IM) caused by Epstein-Barr virus. METHODS:
Cellular samples were collected from the oropharynx of 21 patients (16 males,
five females; age range 10-21 years) with current IM. An immunocytochemical assay
using gold-labelled antiserum to human lysozyme, lactoferrin, IgG, S-IgA and IgM 
followed by gold particle and epithelial cell tracing in the transmission
electron microscope. RESULTS: A significant reduction in bacterial coating with
IgG (P<0.05) and S-IgA (P<0.01) was noted, whereas there was a significant
increase in coating with lactoferrin (P<0.01) and IgM (P<0.01). No significant
change in lysozyme coating of the bacteria was noted, compared with healthy
controls. Bacterial penetration into epithelial cells was seen particularly in
patients culture-positive for beta-haemolytic streptococci. CONCLUSIONS: Reduced 
bacterial coating with IgG and S-IgA immunoglobulins, combined with bacterial
penetration into epithelial cells, may exacerbate the bacterial colonization on
oropharyngeal mucosal membranes observed during IM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12242139 [PubMed - indexed for MEDLINE]

1866: Int J Pediatr Otorhinolaryngol. 2002 Sep 24;65(3):203-11.

Analysis by cDNA microarrays of altered gene expression in middle ears of rats
following pneumococcal infection.

Lin J, Tsuboi Y, Pan W, Giebink GS, Adams GL, Kim Y.

Department of Otolaryngology, University of Minnesota Otitis Media Research
Center, University of Minnesota School of Medicine, 2001 Sixth Street S.E., Room 
216, Minneapolis, MN 55455, USA. linxx004@tc.umn.edu

Objective: Streptococcus pneumoniae is the most common pathogen in otitis media. 
Infection of the middle ear with S. pneumoniae potentiates development of thick
effusion in the middle ear which frequently causes hearing loss and communication
disorders in children. What has changed immediately in the middle ear cleft
following pneumococcal infection is extensively studied and characterized but
what has changed ever after remains elusive. The purpose of this study is to
explore the cellular and molecular basis that remains on a longer time after
acute pneucmococcal middle ear infection and potentiates development of thick
effusion in the middle ear. METHODS: 12 rats were intrabullarly inoculated with
pneumococcus at 2.5x10(6) CFU/ear and profiles of gene expression in the middle
ear were examined by cDNA microarrays in combination with reverse
transcription-polymer chain reaction (RT-PCR) 6 weeks after infection while the
morphologic changes in middle ear were simultaneously characterized by
histopathologic techniques. Twelve rats receiving phosphate-buffered saline (PBS)
served as controls. RESULTS: it demonstrated that pneumococcus infected ears had 
the expression of the following genes at a high level compared to the controls:
mitogenic signaling proteins (mitogen-activated protein kinase [MEK1 and MEK2],
helix-loop-helix transcriptional regulators (Id3 and Id1), ion channels (sodium
channel beta 1 and sodium channel 2), and mucin glycoproteins (Muc2 and Muc5).
The morphology demonstrated a thickened mucosa and submucosa with increased
expression of macroglycoconjugates compared to the controls. CONCLUSION: the
expression of several genes remains high even after the acute episode of
pneumococcal otitis media has been resolved. The up-regulated expression of these
genes may serve as the basis for the development of thick effusion and mucous
cell metaplasia/hyperplasia once it is complicated with other factors such as
dysfunction of the Eustachian tube.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12242135 [PubMed - indexed for MEDLINE]

1867: J Laryngol Otol. 2002 Jul;116(7):541-2.

Group-A streptococcal meningitis in an adult, secondary to purulent otitis media.

Cohen-Kerem R, Lavon H.

Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Centre,
Haifa, Israel.

Group A streptococcal meningitis is rarely encountered today, although group A
streptococcal severe infections are on the increase. We present here a case of an
adult male with bacterial meningitis as a complication of otitis media induced by
Group A Streptococcus. The approach to diagnosis and treatment considerations are
discussed.

Publication Types: 
    Case Reports

PMID: 12238676 [PubMed - indexed for MEDLINE]

1868: J Laryngol Otol. 2002 Jul;116(7):499-501.

A new technique (the NOW test) for the detection of Streptococcus pneumoniae in
the effusions of otitis media.

Faden H, Poje C, Pizzuto M, Nagy M, Brodsky L.

Department of Pediatrics, State University of New York School of Medicine and
Biomedical Sciences at Buffalo, Children's Hospital of Buffalo,14222, USA.
hfaden@upa.chob.edu

The presence of Streptococcus pneumoniae in chronic otitis media was determined
with a new antigen detection kit, the NOW test. The NOW test was originally
designed as a urinary antigen test but was adapted to middle-ear effusions for
the present study. Middle-ear effusions from 52 children were studied.
Streptococcus pneumoniae was cultured from 10 per cent of the effusions. The NOW 
test was positive in 23 per cent of the effusions, 80 per cent of culture
positive and 17 per cent of culture negative effusions. The NOW test proved to be
rapid, simple, reliable and relatively inexpensive for the detection of
pneumococcal antigen in the middle-ear effusions. This test may prove valuable
for the management of children with acute otitis media who undergo
tympanocentesis.

Publication Types: 
    Evaluation Studies
    Research Support, Non-U.S. Gov't

PMID: 12238667 [PubMed - indexed for MEDLINE]

1869: Pediatr Infect Dis J. 2002 Jul;21(7):709-11.

Reactivation of varicella-zoster virus in facial palsy associated with infectious
mononucleosis.

Mori T, Nagai K, Asanuma H.

Department of Pediatrics, Otaru Kyokai Hospital, Hokkaido, Japan.
tosmori@po.otarukyokai.or.jp

Facial palsy with infectious mononucleosis, although well-recognized, is rare in 
children, and its pathogenesis is uncertain. To our knowledge there has been no
previous report describing varicella-zoster virus reactivation as a cause of
facial palsy associated with infectious mononucleosis. We report such a patient
in whom serology showed reactivation of varicella-zoster virus.

Publication Types: 
    Case Reports

PMID: 12237611 [PubMed - indexed for MEDLINE]

1870: Pediatr Infect Dis J. 2002 Jul;21(7):669-74.

Acute otitis media in infants younger than two months of age: microbiology,
clinical presentation and therapeutic approach.

Turner D, Leibovitz E, Aran A, Piglansky L, Raiz S, Leiberman A, Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center and the
Faculty of Health Scienes, Ben-Gurion University of the Negev, Beer-Sheva,
Israel.

BACKGROUND: Information on the causative agents of acute otitis media (AOM) in
infants <2 months of age is limited. OBJECTIVES OF THE STUDY: To analyze the
etiology, pathogen susceptibility patterns, clinical presentation and frequency
of serious bacterial infections in infants <2 months of age with AOM and to
determine the relationship between the organisms isolated systemically and those 
isolated from the middle ear fluid in the patients with serious bacterial
infections in the presence of AOM. METHODS: The medical records of 137 infants <2
months of age with AOM who underwent tympanocentesis in the emergency room of
Soroka University Medical Center between January 1, 1995, and May 30, 1999, were 
reviewed. The main variables analyzed included demography, frequency of serious
bacterial infections, bacteriologic results, susceptibility patterns of the
pathogens and clinical presentation. RESULTS: Median age was 38.7 +/- 13 days;
112 of 137 (82%) infants were hospitalized. Six (4%), 27 (20%), 46 (34%) and 58
(42%) episodes were recorded at age 0 to 2, 3 to 4, 5 to 6 and 7 to 8 weeks,
respectively. Fever (temperature >38 degrees C) was present in 96 (70%) of the
cases. Culture-negative (bacterial) meningitis was diagnosed in 3 cases. Blood
and urine cultures were positive in 1 and 6 infants, respectively. None of the
afebrile infants developed serious bacterial infection. One hundred twenty-two
bacterial pathogens were isolated from the middle ear fluid of 109 of 137 (80%)
patients: Streptococcus pneumoniae in 56 (46%), Haemophilus influenzae in 41
(34%), group A Streptococcus in 12 (10%), enteric gram-negative bacilli in 9
(7%), Moraxella catarrhalis in 3 (2%) and Streptococcus faecalis in 1 (1%).
Eleven (20%) of the 56 S. pneumoniae isolates were nonsusceptible to penicillin. 
Serious bacterial infections were diagnosed in 6 of 137 (4%) patients. Whereas
blood and urine grew pathogens typical for blood and urinary tract infections,
the middle ear fluid isolates represented different pathogens usually isolated in
AOM without any correlation between these 2 groups of pathogens. CONCLUSIONS: (1)
Most cases of AOM in infants <2 months of age are caused by pathogens similar to 
those causing AOM in older children; (2) antibiotic resistance may already be
present at early age and should be considered in the empiric treatment of AOM in 
infants <2 months of age; (3) the presence of AOM does not predict a higher risk 
for serious bacterial infections in afebrile and febrile infants <2 months of
age.

Publication Types: 
    Comparative Study

PMID: 12237601 [PubMed - indexed for MEDLINE]

1871: Pediatr Infect Dis J. 2002 Jul;21(7):642-7.

Dynamics of pneumococcal nasopharyngeal carriage in children with nonresponsive
acute otitis media treated with two regimens of intramuscular ceftriaxone.

Haiman T, Leibovitz E, Piglansky L, Press J, Yagupsky P, Leiberman A, Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center and the
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,
Israel.

BACKGROUND: A 3-day intramuscular ceftriaxone regimen was superior to a 1-day
regimen in the treatment of nonresponsive acute otitis media caused by resistant 
Streptococcus pneumoniae. However, the effect of various regimens of
intramuscular cefriaxone on the nasopharyngeal carriage of S. pneumoniae and
especially that of resistant strains during and after therapy has not been
thoughtfully studied. OBJECTIVES: To compare the effect of one dose and three
dose intramuscular ceftriaxone regimens on the nasopharyngeal carriage of S.
pneumoniae in patients with nonresponsive acute otitis media treated with these
two regimens and to document the dynamics of nasopharyngeal colonization with S. 
pneumoniae during and after completion of these two therapeutic regimens.
PATIENTS AND METHODS: In a prospective study performed during January, 1998,
through September, 1999, 170 evaluable patients ages 3 to 36 months with
nonresponsive acute otitis media were randomized to receive the 1 (n = 83)- or 3 
(n = 87)-day intramuscular ceftriaxone regimen (50 mg/kg/day), respectively.
Nasopharyngeal cultures for S. pneumoniae were obtained on Days 1, 4 to 5, 11 to 
14 and 28 to 30. Susceptibility of S. pneumoniae to penicillin and ceftriaxone
was determined by E-test. RESULTS: On Day 1 nasopharyngeal S. pneumoniae carriage
was found in 108 (64%) patients, 54 in each treatment group. Forty-seven of 54
(87%) and 9 of 54 (17%) S. pneumoniae isolates from the one dose group were
nonsusceptible to penicillin and ceftriaxone, respectively; the respective values
in the three dose group were 49 of 54 (91%) and 8 of 54 (15%). On Days 4 and 5
negative nasopharyngeal cultures were achieved in 43 of 83 (52%) and 70 of 87
(80%) cases from the one dose and three dose group, respectively (P < 0.001).
Eradication of penicillin-nonsusceptible S. pneumoniae was achieved on Day 4 to 5
in 18 of 49 (37%) and 39 of 49 (80%) organisms isolated from the one dose and
three dose groups, respectively (P < 0.001). Nasopharyngeal S. pneumoniae
carriage among evaluable patients on Days 11 to 14 and Days 28 to 30 was 43 of 69
(62%) and 31 of 45 (69%) for the one dose group and 42 of 73 (58%) and 31 of 50
(62%) for the three dose group, respectively (P not significant). A decrease was 
observed during the study period in the proportion of highly penicillin-resistant
S. pneumoniae isolated in the three dose group compared with the one dose group
(30, 24, 17 and 13% vs. 30, 27, 19 and 26% at Days 1, 4 to 5, 11 to 14 and 28 to 
30, respectively; P = 0.05). CONCLUSIONS: A marked reduction in the carriage of
penicillin-nonsusceptible S. pneumoniae (including highly penicillin-resistant
organisms) was achieved on Days 4 to 5 of therapy with both ceftriaxone regimens.
The 3-day intramuscular ceftriaxone regimen was significantly superior to the
1-day regimen in the reduction of carriage during the treatment period. The
reduction of overall S. pneumoniae nasopharyngeal carriage by both ceftriaxone
regimens was a short-lived phenomenon followed by rapid recolonization of the
nasopharynx.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 12237596 [PubMed - indexed for MEDLINE]

1872: Pediatr Infect Dis J. 2002 Jul;21(7):636-41.

Evaluation of the role of respiratory viruses in acute myringitis in children
less than two years of age.

Kotikoski MJ, Palmu AA, Nokso-Koivisto J, Kleemola M.

Tampere University Hospital, Finland.

BACKGROUND: The etiology of acute myringitis remains controversial although it is
usually encountered in connection with acute otitis media (AOM). In most cases of
acute myringitis a bacterial pathogen has been detected in the middle ear fluid, 
but the role of respiratory viruses has remained unclear. Our objective was to
investigate the etiologic role of viruses in the pathogenesis of acute bullous
and hemorrhagic myringitis in children <2 years of age. METHODS: A prospective
longitudinal cohort study of 2028 children ages 7 to 24 months in primary care in
the Finnish Otitis Media Vaccine Trial. Nasopharyngeal aspirate (NPA) and middle 
ear fluid (MEF) samples taken at the time of the diagnosis were examined by a
time-resolved fluoroimmunoassay for antigen detection of adenoviruses; influenza 
viruses A and B; parainfluenza viruses 1, 2 and 3; and respiratory syncytial
virus and by reverse transcription polymerase chain reaction for human rhinovirus
and human enterovirus. RESULTS: Eighty-two children with bullous myringitis and
37 children with hemorrhagic myringitis were diagnosed during the 18-month
follow-up period. In bullous myringitis a respiratory virus was detected in 70%
of NPA samples and in 27% of MEF samples. In hemorrhagic myringitis 57% of NPA
samples and 28% of MEF samples were virus-positive. The viral distribution was
similar to that of AOM (virus positive 64% of NPA and 37% of MEF). CONCLUSIONS:
We could not confirm any specific respiratory virus to be the etiologic agent in 
acute myringitis. The etiology of acute myringitis is similar to that of AOM in
children <2 years of age.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12237595 [PubMed - indexed for MEDLINE]

1873: Matern Child Health J. 2002 Sep;6(3):189-93.

A longitudinal study of risk factors for otitis media in African American
children.

Zeisel SA, Roberts JE, Burchinal M, Neebe E, Henderson FW.

Frank Porter Graham Child Development Institute, University of North Carolina at 
Chapel Hill, 27599-8180, USA. susan_zeisel@unc.edu

OBJECTIVE: Otitis media with effusion (OME) is a common health care problem for
children. The purpose of this study was to examine factors that place children at
risk for OME such as age, type of child care, number of people in the household, 
and smoking in the household. METHODS: Eighty-six African American children,
enrolled in center-based child care in infancy, entered the study at a mean age
of 8.2 months and were followed prospectively until 48 months of age. Ear status 
was documented biweekly using pneumatic otoscopy and tympanometry. Data on risk
factors were collected every 6 months. RESULTS: Results indicated that children
had a marked decrease in the proportion of time with OME between 6 and 48 months.
The rate of OME decline was faster in the first 2.5 years than in subsequent
years. Children in center-based child care showed a slightly slower rate of
decline than did children in non-center-based care. Longitudinal analysis
indicated that the age of the child and the number of other children in the
household were significant predictors of OME. For each additional child under 12 
years of age in the home, there was a 2% increase in the proportion of time with 
OME. CONCLUSION: While attendance in group child care predicted a risk for OME,
children's age and the number of other children in the household were still
contributing risk factors for OME.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12236666 [PubMed - indexed for MEDLINE]

1874: Curr Microbiol. 2002 Nov;45(5):350-4.

Transcription levels of Pseudomonas aeruginosa exotoxin a gene and severity of
symptoms in patients with otitis externa.

Matar GM, Ramlawi F, Hijazi N, Khneisser I, Abdelnoor AM.

Department of Microbiology and Immunology, Faculty of Medicine, American
University of Beirut, Beirut, Lebanon.

Polymerase chain reaction (PCR)-based detection and transcription of the gene
encoding a potent virulence factor, the exotoxin A, were done on 32 isolates of
Pseudomonas aeruginosa belonging to 23 genotypes. These isolates were obtained
from 22 patients who were admitted to the emergency room in a medical center
during a 5-month period with the diagnosis of either unilateral or bilateral
otitis externa. Patients showed symptoms that ranged from mild to severe. PCR
amplification of a 396-bp fragment of the gene encoding the exotoxin A was done
on extracted DNA. Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) was
performed on extracted RNA to detect exotoxin A gene mRNA transcripts.
Quantitation of RT-PCR amplicons from P. aeruginosa isolates associated with mild
and severe symptoms was determined by end-point titration of c-DNA and scanning
of amplicons with the Storm Gel and Blot Imaging System. Data have shown that all
of the 32 isolates of P. aeruginosa carry the exotoxin A gene, and all isolates
with the exception of two had the exotoxin A transcription demonstrated by the
production of a 396-bp amplicon from RT-PCR-amplified RNA. The remaining two
isolates amplified fragments that were slightly smaller than the expected size.
Additional studies are needed to characterize these two mRNA transcripts.
Transcription levels of exotoxin A gene associated with severe symptoms were
significantly more elevated than those associated with mild to moderate symptoms.
Studies are under way to determine expression of P. aeruginosa exotoxin A by
detecting quantitatively levels of the translated exotoxin A protein produced by 
isolates associated with severe and mild to moderate symptoms.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12232666 [PubMed - indexed for MEDLINE]

1875: ORL Head Neck Nurs. 2002 Summer;20(3):11-3.

Laser assisted myringotomy for otitis media with effusion in children.

Bucknam JA, Weber PC.

Medical University of South Carolina, Charleston, USA.

Otitis media with effusion (OME) is a common childhood illness/disease and a
major health care priority in the United States. This article describes a
minimally invasive, office-based procedure, effectively used to treat OME.

PMID: 12227150 [PubMed - indexed for MEDLINE]

1876: Arch Otolaryngol Head Neck Surg. 2002 Sep;128(9):1040-3.

Anesthetic complications of tympanostomy tube placement in children.

Hoffmann KK, Thompson GK, Burke BL, Derkay CS.

Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, USA. 
derkaycs@chkd.com

OBJECTIVE: To determine the incidence of perioperative anesthesia complications
during bilateral myringotomy with tympanostomy tube placement (BMTT). SETTING:
Tertiary care children's hospital where otolaryngology attending physicians and
residents performed surgical procedures. Anesthesia providers included pediatric 
anesthesiologists, residents, nurse anesthetists, and students. METHODS: Medical 
record review was performed for a consecutive series of 3198 children undergoing 
BMTT (1000 prospectively, 2198 retrospectively). For the prospectively studied
patients, major adverse events, which included laryngospasm and stridor, and
minor adverse events, including upper airway obstruction, prolonged recovery,
emesis, and persistent postprocedural agitation, were noted. Also recorded were
the patient's American Society of Anesthesiologists (ASA) physical class status, 
age, concurrent medical conditions, and type of anesthesia provider. RESULTS:
Fewer than 9% of prospectively studied pediatric patients experienced a minor
adverse event, whereas a major event occurred in 1.9%. Eighty-one percent of the 
events experienced were attributable to agitation or prolonged recovery. Neither 
ASA status (P =.38), age (P =.15), nor type of anesthesia provider (P =.06) were 
significantly related to the occurrence of an adverse event. However, a child
with an acute or chronic illness has 2.78 times the odds of experiencing an
adverse event compared with a child with no illness (P<.001). CONCLUSIONS:
Anesthesia administered for placement of tympanostomy tubes by physicians who
specialize in the care of children in a tertiary care children's hospital is
safe. The most significant predictor of a minor anesthetic event during BMTT is
the presence of a preexisting medical condition or concurrent acute illness.

PMID: 12220208 [PubMed - indexed for MEDLINE]

1877: Acta Otolaryngol. 2002 Jul;122(5):488-94.

Suppression of epithelial ion transport transcripts during pneumococcal acute
otitis media in the rat.

Li HS, Doyle WJ, Swarts JD, Hebda PA.

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh,
Pennsylvania 15213, USA. shengli@pitt.edu

Until recently, it was not feasible to conduct genome-wide screening for gene
transcript variations that play key roles in the pathogenesis of otitis media. In
this study microarray technology was used to profile differential gene expression
patterns from rat middle ear mucosa at 12 and 48 h after Streptococcus pneumoniae
challenge. Real-time polymerase chain reaction was performed for independent
verification of the microarray results. Three ion transport mRNAs were
simultaneously suppressed more than 4-fold at 12 h in bacteria-challenged ears,
including Na,K-ATPase alpha I subunit (SPATPa1), sodium channel beta 2 subunit
(SCNB2) and sodium-hydrogen exchange protein isoform 2 subunit (NHE2). At 48 h
after infection, the mRNA levels of SCNB2 and NHE2 had decreased 7- and 10-fold, 
respectively, whereas the relatively abundant SPATPa1 transcript showed recovery.
The downregulation of Na(+)-transporting transcripts suggests a reduced number of
epithelial cells and transporting proteins and/or the dysfunction of sodium
transporters secondary to the bacterial infection. These changes can disrupt the 
coupling of the apical Na + entry and basolateral Na + extrusion, deplete the
electrochemical Na+ transmembrane gradient, disrupt the intracellular osmotic
equilibrium and lead to intracellular acidification and the accumulation of
excess sodium, water and other organic and inorganic molecules in the middle ear 
cavity. Any or all of these changes may contribute to the initiation and
persistence of middle ear mucosa inflammation and effusion during an episode of
bacterial acute otitis media.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12206256 [PubMed - indexed for MEDLINE]

1878: Acta Otolaryngol. 2002 Jul;122(5):479-87.

Early structural tympanic membrane reactions to myringotomy: a study in an acute 
otitis media model.

Spratley J, Hellström S, Eriksson PO, Pais-Clemente M.

j.spratley@mail.telepac.pt

Myringotomy (Myr) is one of the most frequently performed surgical procedures in 
children. However, events occurring in the early phases, i.e. a matter of hours, 
following Myr in the acute otitis media (AOM) model have not been described. The 
aim of the present study was to evaluate the early otomicroscopic and
histopathologic reactions of the tympanic membrane (TM) after Myr during the
course of AOM (AOM-Myr). The left tympanic bulla from 36 healthy Sprague-Dawley
rats was inoculated with Streptococcus pneumoniae type 3. Forty-eight h later, at
Day 0, 4 randomized animals were immediately sacrificed and the remaining animals
were treated with bilateral Myr. Otomicroscopy and sacrifices were performed in
series of 4 animals at 3, 6, 9, 12, 24 and 48 h, and 4 and 7 days. The AOM-Myr
TMs were compared to non-infected Myr TMs (non-AOM-Myr). The TMs were then
dissected free and routinely processed for light and electron microscopy. AOM
developed in all inoculated ears at Day 0. In the pars tensa of the AOM-Myr TMs
the reaction of the keratinocyte layer of the perforation border was already
evident at 6 h. The lamina propria exhibited a strong inflammatory reaction,
which became more organized from 12 h onwards. At Day 4 the perforations were
closed in three-quarters of cases. At Day 7 all perforations were healed with a
distorted scar. In the non-AOM Myr TMs a strong degranulation of mast cells and
edema were found in the pars flaccida at 6 h. A keratin spur at the perforation
border was not seen until 24 h. All perforations were patent on Day 7 and
myringosclerotic deposits were abundant in these TMs. The infected TMs
regenerated faster and closed their perforations at an earlier stage. These
findings favor the hypothesis that there is a low risk of chronic perforations
when myringotomizing AOM TMs.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12206255 [PubMed - indexed for MEDLINE]

1879: Otol Neurotol. 2002 Sep;23(5):647-52.

Expression of epidermal growth factor, tumor necrosis factor-alpha, and
interleukin-1alpha in chronic otitis media with or without cholesteatoma.

Yetiser S, Satar B, Aydin N.

Department of Otorhinolaryngology and Head and Neck Surgery, Gulhane Medical
School, Ankara, Turkey. syetiser@yahoo.com

OBJECTIVE: The object of this study was to compare the expression of epidermal
growth factor, interleukin-1alpha, and tumor necrosis factor-alpha in chronic
otitis media with or without cholesteatoma. BACKGROUND: It has been reported that
cytokines and epidermal growth factor are effective in the bone resorption
process in chronic otitis media. Bone resorption can also occur in chronic otitis
media without cholesteatoma. However, comparative analysis is lacking. This issue
has been investigated in a blind, controlled and prospective analysis. METHOD:
The activities of interleukin-1alpha, tumor necrosis factor-alpha, and epidermal 
growth factor were determined by commercially available enzyme-linked
immunosorbent assay kits in tissue biopsy samples from 16 patients without
cholesteatoma and from 23 patients with cholesteatoma (cholesteatoma epithelium).
To establish a control group, external auditory canal skin was randomly collected
from two groups (21 patients). The Mann-Whitney and Kruskal-Wallis tests were
used for statistical analysis. RESULTS: The levels of interleukin-1alpha, tumor
necrosis factor-alpha, and epidermal growth factor in tissue samples from the
group with cholesteatoma were significantly greater than those in the group
without cholesteatoma and the control group. No correlation was observed with
other clinical factors such as age, sex, and antibiotic coverage. CONCLUSION:
Higher levels of cytokines in patients with cholesteatoma confirm that the
destructive behavior of cholesteatoma is likely mediated by cytokines and
epidermal growth factor and is the result of keratinocyte activity. Antibiotic
treatment does not affect the level of cytokine concentration in patients with
chronic otitis media and cholesteatoma, although the ear discharge subsides and
inflammation-related symptoms regress in some cases.

Publication Types: 
    Clinical Trial

PMID: 12218613 [PubMed - indexed for MEDLINE]

1880: J Clin Neurosci. 2002 Jul;9(4):447-50.

Cholesterol granuloma in the middle fossa presenting 30 years after surgery for
chronic otitis media: a case report.

Muzumdar DP, Goel A, Desai K, Chagla A.

Department of Neurosurgery, King Edward Memorial Hospital and Seth GS Medical
College, Parel, Mumbai, India. dmuzumdar@hotmail.com

A massive left subtemporal extradural cholesterol granuloma in a 45 year old male
patient is reported. The lesion communicated with the petrous temporal bone and
was diagnosed after it became symptomatic 30 years following surgery for left
chronic otitis media. The case is analysed and the literature on the subject is
reviewed. Copyright 2002 Elsevier Science Ltd.

Publication Types: 
    Case Reports

PMID: 12217677 [PubMed - indexed for MEDLINE]

1881: J Small Anim Pract. 2002 Aug;43(8):350-4.

Ulcerative otitis externa responsive to immunosuppressive therapy in two dogs.

Hendricks A, Brooks H, Pocknell A, Bond R.

Veterinary Clinical Sciences Department, The Royal Veterinary College, North
Mymms, Hatfield.

Two middle-aged dogs were presented with bilateral severe ulcerative otitis
externa without previous history of disease or evidence of other skin disease.
Based on the exclusion of microbial infection and other primary causes,
histopathological findings and response to immunomodulatory treatment, a
diagnosis of presumed immune-mediated ulcerative otitis externa was made in both 
cases. However, the two cases differed with regard to their histopathological
characteristics and the course of the disease. This report indicates that primary
ulcerative disease needs to be considered in cases of ulcerative otitis externa
which are unresponsive to appropriate antimicrobial therapy.

Publication Types: 
    Case Reports

PMID: 12201444 [PubMed - indexed for MEDLINE]

1882: Scand J Infect Dis. 2002;34(7):543-4.

Fusobacterium necrophorum: a rare cause of meningitis in children.

Voie H, Turid M, Wathne KO.

Department of Paediatrics, Ullevaal University Hospital, Oslo, Norway.
hilde.voie@ulleval.no

We report a case of non-fatal meningitis secondary to suppurative otitis media in
a previously healthy young boy. Fusobacterium necrophorum was isolated from
blood; spinal fluid was cultured aerobically only but yielded no growth. After
treatment with intravenous antibiotics and surgery the patient recovered, with a 
mild sequela of hypoglossus paresis.

Publication Types: 
    Case Reports

PMID: 12195886 [PubMed - indexed for MEDLINE]

1883: Aust Fam Physician. 2002 Aug;31(8):701-4, 716.

Childhood ENT disorders. When to refer to specialists.

Harris C.

Research and Education Unit, Royal Children's Hospital Melbourne, Victoria.

BACKGROUND: Ear, nose and throat (ENT) are among the commonest reasons for
attendance in general practice. Acute problems are managed by the general
practitioner, but chronic and recurrent conditions are often referred for
surgical intervention. Tonsillectomy and insertion of tympanostomy tubes are two 
of the most frequently performed paediatric surgical procedures in Australia yet 
rates of admission vary across geographic areas and socioeconomic strata.
Referral patterns and criteria for surgery vary widely. OBJECTIVE: This article
reviews the natural history of some common childhood ENT conditions and the
evidence of effectiveness of traditional surgical interventions in order to
address the question: 'When should GPs refer to an ENT surgeon (or conversely,
when should they not refer)?' DISCUSSION: Recurrent and chronic ear and throat
conditions in children will usually resolve spontaneously. There is no good
evidence of long term benefit from surgical interventions for several common ENT 
conditions. General practitioners need to weigh up the disadvantages and risks of
the surgery with the likely benefit to the individual patient.

Publication Types: 
    Review

PMID: 12189658 [PubMed - indexed for MEDLINE]

1884: Ann Otol Rhinol Laryngol. 2002 Aug;111(8):696-700.

Interference of nontypeable Haemophilus influenzae and Moraxella catarrhalis by
Streptococcus oralis in adenoid organ culture: a possible strategy for the
treatment of the otitis-prone child.

Bernstein JM, Faden HS, Scannapieco F, Belmont M, Dryja D, Wolf J.

Division of Infectious Diseases, Children's Hospital of Buffalo, New York, USA.

The role of viridans group streptococci (Streptococcus oralis) in the prevention 
of colonization with nontypeable Haemophilus influenzae and Moraxella catarrhalis
was investigated in an adenoid organ culture system. The adenoids from 100
patients who were undergoing adenoidectomy for either hypertrophy or recurrent
otitis media were used. Streptococcus oralis Parker uniformly inhibited
colonization with nontypeable H. influenzae or M. catarrhalis over a 24-hour
period of incubation in adenoid organ culture. Streptococcus oralis Booth, a
noninhibitory strain, did not significantly reduce colonization with nontypeable 
H. influenzae and M. catarrhalis. The results indicate that some strains of S.
oralis may inhibit colonization with potential pathogens in the nasopharynx. It
is therefore possible that colonization with inhibitory strains of viridans
streptococci may be used in the nasopharynx as a relatively safe and inexpensive 
approach to prevention of recurrent otitis media in some children.

PMID: 12184590 [PubMed - indexed for MEDLINE]

1885: Pediatr Infect Dis J. 2002 Jun;21(6):599-604; discussion 613-4.

Acute otitis media in an era of increasing antimicrobial resistance and universal
administration of pneumococcal conjugate vaccine.

Pelton SI.

Boston University School of Medicine, and Department of Pediatrics, Boston
Medical Center, MA 02118, USA. spelton@bu.edu

The last decade has witnessed a shift in the epidemiology of acute otitis media
(AOM) with an earlier onset of disease and a greater proportion of children with 
recurrent episodes before 1 year of age. In addition antimicrobial resistance to 
beta-lactams, macrolides and trimethoprim-sulfamethoxazole among otopathogens has
increased significantly. Most recently universal administration of a seven valent
pneumococcal conjugate vaccine has been endorsed by the American Academy of
Pediatrics and the Advisory Committee on Immunization Practices. Earlier onset of
disease and the decrease in antimicrobial susceptibility among pediatric
respiratory bacterial pathogens is likely to increase the risk of failure among
young children with AOM. A seven valent pneumococcal conjugate vaccine (PCV7) has
demonstrated efficacy for prevention of serotype-specific pneumococcal otitis;
however, increase in disease caused by nonvaccine serotypes and Haemophilus
influenzae has been reported. With these events as the background, I have
reviewed the strategies most likely to be successful for the treatment of AOM in 
2002.

Publication Types: 
    Review

PMID: 12182397 [PubMed - indexed for MEDLINE]

1886: Niger Postgrad Med J. 2002 Jun;9(2):63-6.

Prevalence of chronic suppurative otitis media (CSOM) among school children in a 
rural community in Nigeria.

Ologe FE, Nwawolo CC.

Department of Otorhinolaryngology, University of Ilorin Teaching Hospital,
Nigeria.

One thousand, one hundred and thirty-five pupils were examined for CSOM in a
rural community of Kwara State of Nigeria. The prevalence of CSOM was 73 per 1000
pupils. The highest is seen among the age group of 2-5 years. Unilateral disease 
was most prevalent (79.5%); 99% of the pupils had tubotympanic disease. Active
disease was observed in 27.7% of the cases of CSOM.

PMID: 12173583 [PubMed - indexed for MEDLINE]

1887: Laryngoscope. 2002 Aug;112(8 Pt 1):1474-81.

Myringotomy delays the tympanic membrane recovery in acute otitis media: a study 
in the rat model.

Spratley J, Hellström S, Eriksson PO, Pais-Clemente M.

Department of Clinical Sciences, Otorhinolaryngology, University Hospital of
Northern Sweden, Umeå, Sweden. j.spratley@mail.telepac.pt

BACKGROUND/HYPOTHESIS: Acute otitis media is a major cause of visits to pediatric
health care providers. Myringotomy in uncomplicated acute otitis media is
debatable today. The study addressed this problem through the otomicroscopic and 
histopathological observations of the events occurring in the tympanic membrane
during the first week after myringotomy. STUDY DESIGN: Randomized study in an
experimental animal model. METHODS: Under anesthesia, the left middle ear of 36
Sprague-Dawley rats was inoculated with Streptococcus pneumoniae type 3.
Forty-eight hours later, at day 0, four animals were immediately killed and the
remaining animals were randomly assigned into a myringotomy group (n = 16,
myringotomy on the left ear) and a non-myringotomy group (n = 16, otomicroscopy
without myringotomy). Otomicroscopy and killings were performed in series of four
animals from each group at days 1, 2, 4, and 7 after myringotomy. Tympanic
membranes were collected after fixation and processed for light and electron
microscopy. RESULTS: All inoculated ears showed a manifest acute otitis media at 
day 0. An intense infiltration by inflammatory cells and edema distorted severely
the tympanic membrane structure. These findings decreased the following days.
However, inflammation as evaluated by the thickness and the cytoarchitecture of
the tympanic membrane layers, recovered significantly faster in the membranes in 
the non-myringotomy group. At day 7, all tympanic membranes in the myringotomy
group were closed by a hypertrophic keratinizing epithelium and a remodeling
connective tissue layer, whereas the animals in the non-myringotomy group had a
residual edema in the lamina propria. CONCLUSIONS: The present infectious model
induced an intense inflammatory reaction within the entire structure of the
tympanic membrane. Myringotomy provoked a delayed recovery from the inflammatory 
process within the tympanic membrane. Therefore, if applicable to human
conditions, the use of myringotomy in the management of acute otitis media should
be restricted to selected cases of acute otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12172265 [PubMed - indexed for MEDLINE]

1888: Laryngoscope. 2002 Aug;112(8 Pt 1):1342-5.

Opening plugged tympanostomy tubes.

Westine JG, Giannoni CM, Gajewski B, Antonelli PJ.

Department of Otolaryngology, University of Florida, Gainesville, Florida 32610, 
USA.

OBJECTIVE: To determine the most effective solvents for dissolving plugged
tympanostomy tubes. STUDY DESIGN: In vitro laboratory study. METHODS: Twelve
solvents (including ototopical antibiotics and water) were applied to
fluoroplastic tympanostomy tubes (n = 260) plugged with dried mucoid middle ear
effusion in an ear canal-tympanic membrane model. Time to clearance of the
tympanostomy tubes was both visually and tympanometrically determined. RESULTS:
Vinegar (P =.0030) and hyaluronidase solutions (P =.0030) were significantly
better solvents than water. CONCLUSION: Vinegar and hyaluronidase solutions are
more likely to clear plugged tympanostomy tubes than water and ototopical
antibiotics, but vinegar is the preferred solution because of its known relative 
safety for use in the ear.

Publication Types: 
    Comparative Study

PMID: 12172242 [PubMed - indexed for MEDLINE]

1889: Otol Neurotol. 2002 Jul;23(4):580-8.

Facial nerve paralysis due to chronic otitis media.

Yetiser S, Tosun F, Kazkayasi M.

Department of Otorhinolaryngology-Head and Neck Surgery, Gülhane Medical School, 
Etlik, 06018 Ankara, Turkey. syetiser@gata.edu.tr.com

OBJECTIVE: To present the characteristics of facial paralysis caused by chronic
otitis media. The role of cholesteatoma, bony dehiscence, the duration of the
disease, and the results of surgical therapy in facial paralysis were reviewed.
STUDY DESIGN: Retrospective case review. SETTING: Tertiary care referral center. 
PATIENTS: A total of 24 patients (6 women, 18 men; age range, 17-74 yr) with
facial paralysis were included in the study. INTERVENTION: Canal wall down
mastoidectomy was performed in 14 patients (58.3%), modified radical
mastoidectomy was performed in seven patients (25%), and intact canal wall
mastoidectomy was performed in three patients (16.7%). All patients had
decompression of the fallopian canal from the geniculate ganglion to the
stylomastoid foramen without opening the epineural sheath. RESULTS: Eighteen
patients (75%) had gradual onset of facial paralysis. The most common associated 
symptom with facial paralysis was vertigo in six patients. Twelve patients (50%) 
had no associated symptoms. Facial paralysis was the sole complication in 21
patients (87.9%). Three patients had multiple complications. Labyrinthitis was
the most common associated complication. Facial paralysis was associated with
congenital cholesteatoma in one patient. Fourteen patients (58.3%) demonstrated
dramatic recovery within 3 months after surgery. Intraoperatively, cholesteatomas
were found in 17 of the patients (70.8%). The fallopian canal was intact in four 
patients (none of them had a cholesteatoma), and 20 patients had bone destruction
or dehiscence (three patients had no cholesteatoma). The tympanic segment was the
most common site of involvement in 14 patients (58.3%). CONCLUSION: A middle ear 
cholesteatoma was present in the majority of patients with facial paralysis
caused by chronic otitis media. Gradual onset of facial paralysis was the most
frequent pattern. Facial paralysis presented poor prognosis regardless of the
presence of a cholesteatoma. There was no statistical difference among the
results of surgical techniques.

PMID: 12170164 [PubMed - indexed for MEDLINE]

1890: Laryngoscope. 2002 Jul;112(7 Pt 1):1166-77.

Microbiology of acute otitis externa.

Roland PS, Stroman DW.

University of Texas Southwestern Medical Center at Dallas, Department of
Otolaryngology, Dallas, Texas 75235-9035, U.S.A.

OBJECTIVE: To isolate and characterize bacteria and fungi from acute otitis
externa (AOE) and to obtain susceptibility profiles on each bacterial isolate.
STUDY DESIGN: Prospective core series. METHODS: Specimens were collected from the
external canals of subjects with clinically diagnosed acute otitis externa.
Species-level identification for each bacterial isolate recovered was obtained by
combining phenotypic and genotypic data. End point mean inhibitory concentration 
(MIC) testing was performed using National Committee for Clinical Laboratory
Standards (NCCLS) recommended methods. RESULTS: In Alcon-sponsored clinical
studies conducted in 1998 to 2000, microbiology specimens were collected from
2039 subjects (2240 diseased ears) by 101 investigators throughout the United
States. A total of 2838 bacteria, 32 yeast, and 17 molds were recovered from 2048
ears clinically diagnosed as acute otitis externa. Of the 202 bacterial species
recovered, the species most frequently isolated was Pseudomonas aeruginosa (38%).
The next 10 species most frequently isolated were: Staphylococcus epidermidis,
9.1%; Staphylococcus aureus, 7.8%; Microbacterium otitidis, 6.6%; Microbacterium 
alconae, 2.9%; Staphylococcus caprae, 2.6%; Staphylococcus auricularis, 2.0%;
Enterococcus faecalis, 1.9%; Enterobacter cloacae, 1.6%; Staphylococcus capitis
subsp. Ureolyticus,1.4%; and Staphylococcus haemolyticus, 1.3%. Susceptibility
profiles of S. epidermidis isolates revealed the greatest frequency of high-level
resistance to selected antibiotics (>/=8 microg/mL): 23%, neomycin-resistant;
11%, oxacillin-resistant; and 12%, ofloxacin-resistant. Susceptibility profiles
of S. aureus isolates revealed a lower frequency of high-level resistance: 6.3%, 
neomycin-resistant; 2.7%, oxacillin-resistant; and 4.5%, ofloxacin-resistant. P. 
aeruginosa with high-level resistance to quinolones (>/=128 mcg/mL for ofloxacin)
was recovered from only 1 subject. Likewise, resistance of P. aeruginosa to
aminoglycosides was rare. Twenty isolates had neomycin MICs >/=64 mcg/mL and 10
isolates had gentamicin MICs >/=16 mcg/mL. The coryneform isolates identified as 
Microbacterium otitidis had an intrinsic lack of susceptibility to quinolones
(ofloxacin MICs >/=16 mcg/mL) and aminoglycosides (tobramycin MICs >/=32 mcg/mL
and gentamicin MICs >/=8 mcg/mL). CONCLUSIONS: Bacterial infections of the
external ear canal are most often caused by P. aeruginosa. However, there are a
great number of other gram-positive and gram-negative bacterial species that are 
recovered from patients with acute otitis externa. Because of this diverse
etiology, the best topical therapeutic choice for topical therapy is for the most
potent, broad-spectrum (especially anti-P. aeruginosa) antibiotic available.

PMID: 12169893 [PubMed - indexed for MEDLINE]

1891: Clin Otolaryngol Allied Sci. 2002 Aug;27(4):260-2.

Comment in:
    Clin Otolaryngol Allied Sci. 2003 Aug;28(4):379.

Are topical antibiotics necessary in the management of otitis externa?

Tsikoudas A, Jasser P, England RJ.

Department of Otolaryngology Head and Neck Surgery, Hull Royal Infirmary, Hull,
UK.

Otitis externa is an inflammatory disorder of the skin of the outer ear canal
frequently associated with bacterial or fungal infection. It is normally treated 
with aural toilet and topical preparations containing antibiotic/antifungal and
steroid preparations. A group of 39 patients presenting with otitis externa were 
randomized in a double-blind manner into those receiving drops containing an
aminoglycoside and steroid preparation and those receiving the same preparation
without the aminoglycoside. All patients were reviewed on days 0, 3, 7 and 11 of 
a 14-day course of drops and their response to medication monitored. Patients
documented their symptoms at each appointment and clinical response was also
measured by a blinded observer. The study suggests that an aminoglycoside
antibiotic conveys no significant benefit in this condition.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 12169127 [PubMed - indexed for MEDLINE]

1892: Clin Otolaryngol Allied Sci. 2002 Aug;27(4):233-6.

Allergic otitis externa.

Sood S, Strachan DR, Tsikoudas A, Stables GI.

Department of Otolaryngology-Head & Neck Surgery, Bradford Royal Infirmary,
Bradford, UK.

Chronic otitis externa is a common condition, which is usually successfully
treated by topical medications and aural toilet. In cases that persist despite
conventional treatment, a diagnosis of allergic otitis externa should be
considered. Sensitization to otic medications (secondary contact otitis) is not
uncommon. Topical aminoglycosides are the most common sensitizers although many
components of topical preparations can cause sensitization. Patients who may have
developed allergic otitis externa should undergo patch testing. Otolaryngologists
should consider using topical antibiotics with a low allergenic potential and
avoiding neomycin when treating patients with otitis externa. Primary contact
otitis may occur to metals used in earrings and also to hearing aid moulds.
Treatment of both primary and secondary contact otitis consists of identifying
the allergen, avoiding further contact and use of simple preparations avoiding
common sensitizers.

Publication Types: 
    Review

PMID: 12169122 [PubMed - indexed for MEDLINE]

1893: Auris Nasus Larynx. 2002 Jul;29(3):253-6.

Antiemetic effects of granisetron, droperidol and dexamethasone in otologic
surgery.

Goksu S, Kocoglu H, Bayazit YA, Yüksek S, Karci Y, Kanlikama M, Oner U.

Department of Anesthesiology and Reanimation, Faculty of Medicine, University of 
Gaziantep, 27310 Gaziantep, Turkey. sitkigoksu@turk.net

The objective was to assess the antiemetic activity of granisetron, dexamethasone
and droperidol in the otologic surgeries. Sixty patients in ASA (American Society
of Anesthesiologists) I and II risk groups who underwent surgery for chronic
otitis media were assessed in a double blind and randomized trial. The patients
were divided into three equal groups. Single intravenous dose of granisetron (3
mg), granisetron (3 mg) plus dexamethasone (8 mg) and droperidol (1.25 mg) were
prophylactically administered to the patients in group 1, group 2 and group 3,
respectively, and their antiemetic actions were compared. The antiemetic effects 
of the drugs were not significantly different between the groups (P>0.05). The
antiemetic effects also did not differ significantly in the early and late
postoperative periods (P>0.05). In conclusion, the results of prophylactic use or
side effects of granisetron, granisetron plus dexamethasone or droperidol are
similar in middle ear surgery. Therefore, cost effectivity of the antiemetic
prophylaxis should be reconsidered in otologic surgery in the light of the
results of this study.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 12167446 [PubMed - indexed for MEDLINE]

1894: Clin Pediatr (Phila). 2002 Jul-Aug;41(6):373-90.

Treatment of acute otitis media consensus recommendations.

Hoberman A, Marchant CD, Kaplan SL, Feldman S.

University of Pittsburgh School of Medicine and Children's Hospital of
Pittsburgh, PA 15213-2583, USA.

The objective of this paper is to provide consensus recommendations for the
management of acute otitis media (AOM) that pediatricians can incorporate into
their daily practices. These recommendations were developed during a roundtable
meeting that convened clinicians versed in the management of AOM. This meeting
was sponsored by an educational grant from SmithKline Beecham Pharmaceuticals. In
addition, clinical studies on AOM identified via MEDLINE search were considered
in the development of these recommendations. The Drug-Resistant Streptococcus
pneumoniae Therapeutic Working Group guidelines for the management of AOM are
reviewed in detail. All of the articles identified from the data sources were
evaluated and all information deemed relevant was included in this review. AOM is
one of the most common infectious diseases affecting infants and children and one
of the leading causes of office visits and antibiotic prescriptions for this
population. The incidence of AOM has increased during the past 25 years, probably
the result of an increased utilization of day care facilities in the United
States. The predominant pathogens in AOM include S. pneumoniae, Haemophilus
influenzae, and Moraxella catarrhalis. The high prevalence of drug-resistant S.
pneumoniae and beta-lactamase-producing organisms presents a clinical challenge
for practitioners in the selection of empiric antimicrobial therapy.
Pharmacokinetic/pharmacodynamic principles should be considered in addition to
minimum inhibitory concentrations in selecting antibiotics for AOM. Amoxicillin
at conventional or high doses (80-90 mg/kg/day) remains an appropriate choice for
first-line therapy for AOM. For patients in whom amoxicillin is unsuccessful,
second-line therapy should have demonstrated activity against
penicillin-resistant S. pneumoniae as well as beta-lactamase-producing pathogens.
Appropriate options for second-line therapy include high-dose
amoxicillin/clavulanate (90 mg/kg/day based on the amoxicillin component) and
ceftriaxone. Cefuroxime has been suggested as a second-line agent in the past,
but recent surveillance data suggest it may no longer be active against
penicillin-resistant strains of S. pneumoniae. Tympanocentesis is useful for
identifying the causative pathogen, and it may be beneficial for patients who
have failed multiple courses of antibiotics. The pneumococcal conjugate vaccine
recently was approved for use in children and should be administered to all
children less than 2 years old and those at risk for recurrent AOM (e.g., day
care attendance, siblings with a history of recurrent AOM). Consensus
recommendations are provided for the management of AOM, with a focus on
antimicrobial therapy. The current challenges in the management of AOM include
the need for an increased understanding of epidemiology, increasing resistance
among common middle ear pathogens, use of pharmacokinetic/pharmacodynamic
principles in designing treatment strategies, and understanding the potential
impact of the pneumococcal conjugate vaccine.

Publication Types: 
    Consensus Development Conference
    Review

PMID: 12166789 [PubMed - indexed for MEDLINE]

1895: J Am Vet Med Assoc. 2002 Aug 1;221(3):378-80.

Measurement of body temperature by use of auricular thermometers versus rectal
thermometers in dogs with otitis externa.

González AM, Mann FA, Preziosi DE, Meadows RL, Wagner-Mann CC.

Veterinary Centers of America, Westerville East Animal Hospital, OH 43081, USA.

OBJECTIVE: To compare measurements of body temperature obtained with auricular
thermometers versus rectal thermometers in dogs with otitis externa. DESIGN:
Prospective study. ANIMALS: 100 client-owned dogs: 50 with and 50 without
clinical evidence of otitis externa. PROCEDURE: Dogs were evaluated for the
presence of otitis externa on the basis of clinical signs, otoscopic examination,
and cytologic evaluation of ear exudate. Auricular and rectal temperatures were
obtained simultaneously in all dogs prior to and following ear examination.
RESULTS: There was a high correlation between auricular and rectal temperatures
in dogs with otitis externa both prior to and after ear manipulation. Significant
differences were not detected in temperature measurements among dogs with
different degrees of otitis externa. CONCLUSIONS AND CLINICAL RELEVANCE:
Auricular temperature readings obtained by use of an auricular thermometer in
dogs with otitis externa are accurate measurements of body temperature, compared 
with rectal temperature measurements. Temperature measurements are reliable
before and after examination of the ear canal.

Publication Types: 
    Comparative Study

PMID: 12164534 [PubMed - indexed for MEDLINE]

1896: Otolaryngol Head Neck Surg. 2002 Jul;127(1):67-72.

Comment in:
    Otol Neurotol. 2006 Jun;27(4):582.

A new absorbable pressure-equalizing tube.

D'eredità R, Marsh RR, Lora S, Kazahaya K.

Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia,
and the Institute of Photochemistry and High Energy Radiation, National Institute
of Nuclear Energy, Legnaro, Padua, Italy. rderedita@hotmail.com

OBJECTIVE: We investigated pressure-equalizing (PE) tubes made of biodegradable, 
absorbable material in an animal model. METHODS: PE tubes, made of
poly-bis(ethylanate)phosphazene (PBE) were inserted in 55 ears of 28 Hartley
guinea pigs, with survival times of 10, 30, and 60 days after tube insertion. In 
vivo reactions between the PBE-PE tube and the tympanic membrane (TM) were
studied. Tubes, TMs, and middle ears were examined by scanning electron
microscopy and light microscopy. RESULTS: There was neither infection nor an
inflammatory reaction to the tube within the middle ear in any animal. At 30
days, 53% of the tubes had disintegrated. At 60 days, tubes were still
functioning in the 25% of ears. CONCLUSION: More research must be performed
before these new PBE PE tubes can be considered for clinical use. Nonetheless,
these tubes are promising. The disintegration rate can be controlled by varying
the formulation of the polymer, so treatment can be adjusted to the needs of each
patient.

Publication Types: 
    Comparative Study
    Duplicate Publication

PMID: 12161733 [PubMed - indexed for MEDLINE]

1897: Otolaryngol Head Neck Surg. 2002 Jul;127(1):60-6.

Laser office ventilation of ears with insertion of tubes.

Siegel GJ, Chandra RK.

Department of Otolaryngology-Head and Neck Surgery, Northwestern University
Medical School, Il 60611, USA.

OBJECTIVE: Myringotomy with insertion of pressure equalization tubes has proven
to be extremely effective in treating persistent serous otitis media (SOM). This 
study compares the advantages and disadvantages of this procedure when performed 
in the operating room or with a laser in an office setting. PATIENTS AND METHODS:
Patients selected either traditional myringotomy and tube (M & T; n = 29) done in
an operating room under general anesthesia or Laser Office Ventilation of Ears
with Insertion of Tubes (LOVE IT; n = 35) done in an office setting with only
topical anesthesia. The reasons for selecting either M&T or LOVE IT and
satisfaction with the procedure chosen were evaluated by survey, the results of
which were compared statistically. Chart review was performed to determine the
time and cost of the procedures, time interval from diagnosis to treatment, tube 
longevity, and complications. RESULTS: Overall satisfaction was similar with both
procedures. Patients and families were more likely to choose LOVE IT based on the
anesthetic technique involved (P < 0.001, chi(2)). M&T required less time to
perform, whereas the cost of LOVE IT was less. Tube longevity and complication
rates were similar between the two procedures, and all complications were minor. 
CONCLUSIONS: LOVE IT is a potential alternative to traditional M&T in the
treatment of SOM. LOVE IT is most likely to be selected by patients/parents who
wish to avoid a general anesthetic and provides a level of satisfaction similar
to that of traditional M&T.

Publication Types: 
    Comparative Study

PMID: 12161732 [PubMed - indexed for MEDLINE]

1898: J Neuroimmunol. 2002 Aug;129(1-2):10-7.

Inflammatory signals increase Fas ligand expression by inner ear cells.

Bodmer D, Brors D, Pak K, Keithley EM, Mullen L, Ryan AF, Gloddek B.

Department of Surgery, Division of Otolaryngology, UCSD School of Medicine and VA
Medical Center, La Jolla, CA 92093, USA.

There is considerable evidence that hearing and vestibular function can be
influenced by immune processes. The inner ear has evolved mechanisms, such as the
blood-labyrinthine barrier that limit immune responses and autoimmune processes
to reduce the potential for damage to cochlear cells. Recently, expression of Fas
ligand (FasL) in some non-lymphoid tissue, as in the anterior chamber of the eye,
has been hypothesized to play a role in protection of sensitive organs from
activated T-cells. We show that under resting conditions, cochlear cells express 
little or no FasL. However, after exposure to interferon-gamma in vitro, FasL is 
induced in many neonatal cochlear cells. In addition, we show that FasL is
upregulated in adult cochlear cells after induction of a sterile labyrinthitis in
vivo. The induction of FasL by inflammation may serve to limit cochlear immune
responses, and to protect sensorineural tissue from immune and autoimmune damage.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 12161015 [PubMed - indexed for MEDLINE]

1899: Expert Opin Pharmacother. 2002 Aug;3(8):1073-90.

Otitis media.

Pichichero ME, Casey JR.

Elmwood Pediatric Group, University of Rochester Medical Center, Rochester, NY
14642, USA. michael_pichichero@urmc.rochester.edu

Bacterial pathogens are isolated from middle ear fluid in up to 90% of children
with acute otitis media (OM). Streptococcus pneumoniae, Haemophilus influenzae
and Moraxella catarrhalis predominate. Acute OM can be classified as
uncomplicated, persistent, recurrent or chronic. Patient age, symptom severity,
prior treatment history and exposure through day-care attendance in children
influences pathogen distribution, antimicrobial susceptibility and anticipated
clinical and microbiological responses to empirical and pathogen-directed
therapies. The natural history of acute OM without intervention is favourable.
However, meta-analysis of clinical trials shows an improvement in symptom and
middle ear effusion resolution with antimicrobials. Aminopenicillins,
cephalosporins and macrolides are often selected as therapy for acute OM. The
various agents have differing activity against acute OM pathogens, particularly
organisms with resistance mechanisms and they differ in dosing schedule, side
effects and compliance enhancing factors. Consideration should be given to
pharmacokinetic and pharmacodynamic principles in antibiotic selection. Selection
criteria include antibiotic activity against drug-resistant S. pneumoniae and
efficacy against beta-lactamase-producing Gram-negative organisms. The necessary 
duration of treatment for acute OM varies according to multiple factors,
including local preferences, but there is growing, compelling data to support
short-course therapy. Tympanocentesis has been endorsed in various guidelines as 
a diagnostic and therapeutic procedure. Best-practice for management of acute OM 
continues to advocate antibiotic therapy with careful, accurate diagnosis and
consideration of the major pathogens and their mechanisms of resistance.

Publication Types: 
    Review

PMID: 12150687 [PubMed - indexed for MEDLINE]

1900: Laryngoscope. 2002 May;112(5):802-7.

Over-under tympanoplasty.

Kartush JM, Michaelides EM, Becvarovski Z, LaRouere MJ.

Michigan Ear Institute, Farmington Hills 48334, USA. JKartush@comcast.net

OBJECTIVE: Common techniques of tympanic membrane repair include underlay and
overlay grafting. The over-under tympanoplasty, an innovative method for tympanic
membrane repair, will be described as a reliable alternative that has advantages 
over traditional procedures. STUDY DESIGN: This study was a retrospective case
review. SETTING: Tertiary referral center with hospital-setting surgery and
outpatient ambulatory patient visits. PATIENTS: One hundred twenty patients who
underwent over-under tympanoplasty were included in this study. Average follow-up
was 1.8 years. INTERVENTION: Over-under tympanoplasty is performed by placing the
graft over the malleus and under the annulus. This technique was used for
patients undergoing ear surgery for chronic otitis media, perforations,
cholesteatoma, and/or conductive hearing loss. All degrees of ear pathology were 
included. MAIN OUTCOME MEASURES: Main outcome measures were graft success (no
perforation, atelectasis, or lateralization within 6 mo) and improvement of
hearing. Patients were stratified by severity of disease (according to the Middle
Ear Risk Index), cholesteatoma presence, and type of mastoidectomy. RESULTS: All 
120 patients had successful grafts. Lateralization of the grafted drum did not
occur. Seventeen patients had late atelectasis, and 12 patients had late
perforations; nearly all of these were noted more than 1 year after surgery and
were attributed to persistent eustachian tube dysfunction or infections. Average 
improvement in air-bone gap for all patients was 5.3 dB, whereas speech reception
threshold improved by 5.9 dB. CONCLUSION: Over-under tympanoplasty has an
excellent success rate while being technically easier than lateral tympanoplasty.
Thus, it is a useful method for practitioners of all levels.

PMID: 12150610 [PubMed - indexed for MEDLINE]

1901: Laryngoscope. 2002 Apr;112(4):681-5.

Management of chronic otitis media in the only hearing ear.

Battaglia AS, Sabri AN, Jackson CG.

Otology Group, Nashville, Tennessee 37203-2138, USA. ozcycle2@aol.com

OBJECTIVE: Chronic ear surgery is difficult. The management of such a disease
either with or without cholesteatoma and in an only hearing ear is particularly
challenging. Consequences of disease or unintended outcomes of therapy can both
result in patient lifestyle alterations of major proportion. This report offers a
diagnostic and treatment plan for chronic otitis media with and without
cholesteatoma in the only hearing ear. METHODS: More than 10,000 charts of
patients with chronic otitis media were retrospectively reviewed. Twenty-seven
charts of patients with chronic otitis media in an only hearing ear who underwent
surgical treatment were identified. The patients were followed for an average
time of 43 months. RESULTS: Overall, the chronic otitis media was well
controlled, and there was no change in the average discrimination or hearing
thresholds when comparing preoperative and postoperative results. CONCLUSIONS:
Chronic otitis media with and without cholesteatoma in an only hearing ear can be
treated successfully with hearing preservation. Canal wall down
tympanomastoidectomy is performed in most cases. Manipulation of the ossicular
chain is avoided, and cholesteatoma that lies over a potential fistula is
exteriorized.

PMID: 12150523 [PubMed - indexed for MEDLINE]

1902: Laryngoscope. 2002 Apr;112(4):676-80.

Effect of bacterial endotoxin and middle ear effusion on ciliary activity:
implications for otitis media.

Mason PS, Adam E, Prior M, Warner JO, Randall CJ.

Department of Otorhinolaryngology, Southampton University Hospitals Trust, UK.

OBJECTIVES/HYPOTHESIS: Otitis media with effusion (OME) is the most common cause 
of childhood deafness. The pathogenesis is not fully understood, especially the
reasons for failure of mucociliary clearance of the middle ear. It is not clear
whether the cilia function normally in the middle ear and eustachian tube in the 
chronic phase of otitis media with effusion. However, impaired ciliary function
in primary ciliary dyskinesia is known to be frequently associated with the
development of otitis media with effusion. We hypothesized that endotoxin or the 
bacterial products in middle ear fluid in otitis media with effusion would
adversely affect ciliary activity, thereby contributing to the pathogenesis of
the disease. STUDY DESIGN: Laboratory-based study of human ciliary activity with 
reference to otitis media with effusion. METHODS: We have studied the activity of
human adenoidal cilia under various conditions. Ciliary activity in the presence 
of Haemophilus influenzae endotoxin additions (at varying concentrations) to
cultured adenoidal explants has been measured. In addition, ciliary activity of
these explants was also observed after addition of middle ear effusion aspirated 
from patients. RESULTS: We have shown that endotoxin in concentrations far in
excess of those found in the middle ear with chronic otitis media with effusion
had no effect on ciliary activity. Furthermore, ciliary activity was completely
unaffected by the presence of middle ear effusion. CONCLUSION: There is no
evidence that ciliary activity is reduced by the constituents of middle ear fluid
in chronic otitis media with effusion.

PMID: 12150522 [PubMed - indexed for MEDLINE]

1903: Laryngoscope. 2002 Apr;112(4):669-75.

Otological and audiological outcomes five years after tympanostomy in early
childhood.

Valtonen HJ, Qvarnberg YH, Nuutinen J.

Department of Otorhinolaryngology, Kuopio University Hospital, Finland.
hannu.valtonen@kuh.fi

OBJECTIVE: Ventilation tubes in the treatment of otitis media in young children
remain controversial. Despite abundant research, few prospective long-term
follow-up studies have included even a minority of patients under 1 year old. We 
investigated long-term otological and audiological outcomes in children with
recurrent acute otitis media and otitis media with effusion, who were treated
early with ventilation tubes. STUDY DESIGN: Prospective follow-up. METHODS: Three
hundred five children under 17 months of age received a primary tympanostomy in
the Central Hospital of Central Finland (Jyväskylä, Finland), and those 281
(92.1%) who were monitored prospectively for 5 years made up the study group. At 
the final examination, pneumatic otoscope and otomicroscope were used and
pure-tone audiometric thresholds of air and bone conduction were measured to
define the hearing levels (mean of 0.5, 1.0, and 2.0 KHz thresholds). RESULTS: Of
ears, 67.3% were healed, 7.1% had a retraction of tympanic membrane in pars
flaccida and 9.6% in pars tensa, 7.5% had an ongoing otitis media with effusion, 
3.9% had a ventilation tube in place, and 4.6% had a tympanic membrane
perforation with mean hearing levels of 7.6, 9.0, 16.0, 18.5, 10.5, and 17.7 dB, 
respectively. CONCLUSIONS: Hearing in general was well preserved, and no ear
presented with adhesive otitis media or cholesteatoma. Adverse otological and
audiological outcomes of these young children did not exceed those presented by
others for older counterparts. Tympanic membrane perforations, ongoing otitis
media with effusion, and pars tensa retractions were causes of mild conductive
hearing loss. Because one third of ears continued to have middle ear disease or
sequelae, we emphasize the proper follow-up and restoration of middle ear
ventilation with repeat ventilation tubes if not otherwise achieved.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12150521 [PubMed - indexed for MEDLINE]

1904: Laryngoscope. 2002 Apr;112(4):661-8.

Ventilation time of the middle ear in otitis media with effusion (OME) after CO2 
laser myringotomy.

Sedlmaier B, Jivanjee A, Gutzler R, Huscher D, Jovanovic S.

Ear, Nose and Throat Department, Medical Center Benjamin Franklin, Free
University of Berlin, Germany. sedlhno@zedat.fu-berlin.de

OBJECTIVE: The aim of this study was to investigate the transtympanic ventilation
time, the healing course of the tympanic membrane, the early and late
complications, and the recurrence rate of otitis media with effusion (OME) within
6 months after CO2 laser myringotomy with the CO2 laser otoscope Otoscan. STUDY
DESIGN: Prospective clinical study. MATERIALS AND METHODS: In this study, laser
myringotomy was performed with the CO2 laser otoscope Otoscan in a patient
population comprising 81 children (159 ears) with a history of otitis media with 
effusion (OME) associated with adenoidal and sometimes tonsillar hyperplasia. The
procedure on the tympanic membrane was accordingly combined with an
adenoidectomy, a CO2 laser tonsillotomy, or a tonsillectomy and therefore
performed under insufflation anesthesia. In all ears, approximately 2 mm circular
perforations were created in the lower anterior quadrants with a power of 12 to
15 W, a pulse duration of 180 msec, and a scanned area of 2.2 mm in diameter.
RESULTS: None of the children showed postoperative impairment of
cochleovestibular function such as sensorineural hearing loss or nystagmus.
Otomicroscopic and videoendoscopic monitoring documented the closure time and
healing pattern of tympanic membrane perforations. The mean closure time was
found to be 16.35 days (minimum, 8 days; maximum, 34 days). As a rule, an
onion-skin-like membrane of keratinized material was seen in the former
myringotomy perforations at the time of closure. At the follow-up 6 months later,
the condition of the tympanic membrane of 129 ears (81.1%) could be checked by
otomicroscopy and videoendoscopy and the hearing ability by audiometry and
tympanometry. The CO2 laser myringotomy sites appeared normal and
irritation-free. Two of the tympanic membranes examined (1.6%) showed atrophic
scar formation, and 1 (0.8%) had a perforation with a diameter of 0.3 mm. The
perforation was seen closed in a control otoscopy 15 months postoperatively. OME 
recurred in 26.3% of the ears seen intraoperatively with mucous secretion (n =
38) and in 13.5% of the ears with serous secretion (n = 37; P <.05). CONCLUSION: 
The most important principle in treating OME is ventilation of the tympanic
cavity. CO2 laser myringotomy achieves this through a self-healing perforation in
which its diameter roughly determines the duration of transtympanic ventilation. 
Laser myringotomy competes with ventilation tube insertion in the treatment of
OME. It may be a useful alternative in the surgical management of secretory
otitis media.

PMID: 12150520 [PubMed - indexed for MEDLINE]

1905: Laryngoscope. 2002 Mar;112(3):420-3.

Growth factors and their receptors in the middle ear mucosa during otitis media.

Palacios SD, Pak K, Rivkin AZ, Bennett T, Ryan AF.

Department of Surgery, University of California, San Diego School of Medicine and
Veterans Affairs Medical Center, La Jolla 92093, USA.

OBJECTIVE: The hyperplastic response of the middle ear mucosa during bacterial
otitis media is thought to be mediated by the actions of growth factors and their
respective receptors. The purpose of the study was to explore the expression of
growth factors known to stimulate epithelial cells in other systems, as well as
their receptors, in the middle ear mucosa during otitis media. STUDY DESIGN:
Expression of mRNA growth factors and receptors was measured over time after
inoculation of the rat middle ear with bacteria. METHODS: The middle ears of 12
male Sprague-Dawley rats were injected with 10(5)/mL Haemophilus influenzae
strain 3655 (nontypeable, biotype II). Three rats were killed at 6, 24, 48, and
72 hours. Three untreated rats were also killed to serve as negative controls.
The middle ear mucosa samples were surgically removed and homogenized. Reverse
transcription-polymerase chain reaction was performed on each sample with primers
for rat epidermal growth factor, epidermal growth factor receptor (ErbB), heparin
binding epidermal-like growth factor, hepatocyte growth factor, hepatocyte growth
factor receptor, keratinocyte growth factor, betacellulin, amphiregulin, and
neuregulin-alpha. RESULTS: Hepatocyte growth factor and epidermal growth factor
receptor primers demonstrated polymerase chain reaction products of the expected 
size that were not displayed in the normal middle ear mucosa. Keratinocyte growth
factor and hepatocyte growth factor receptor demonstrated polymerase chain
reaction products at all time points tested. Betacellulin and neuregulin-alpha
products were present at all time points except 72 hours after infection.
CONCLUSIONS: The results of the study support a role for growth factors in the
middle ear mucosa during otitis media. These bioactive ingredients contribute to 
mucosal hyperplasia.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 12148846 [PubMed - indexed for MEDLINE]

1906: Int J Pediatr Otorhinolaryngol. 2002 Aug 1;65(1):59-63.

Tuberculous mastoiditis: when is surgery indicated?

Saunders NC, Albert DM.

Department of Paediatric Otolaryngology, Great Ormond Street Hospital, Great
Ormond Street, London WC1N 3JH, UK. n.c.sanders@talk21.com

Mycobacterium tuberculosis is a rare cause of mastoiditis, but diagnosis is often
delayed, with potentially serious results. We present the case of a 7-year-old
child who failed to improve even once the diagnosis was made and appropriate
medical treatment initiated. At mastoidectomy, a bony sequestrum was found which 
had not been evident on CT scanning. We review the diagnosis and management of
this condition and suggest that failure to respond to drug therapy even in the
absence of demonstrable complications be added to the list of indications for
surgical intervention.

Publication Types: 
    Case Reports

PMID: 12127224 [PubMed - indexed for MEDLINE]

1907: Ann Otol Rhinol Laryngol. 2002 Jul;111(7 Pt 1):642-52.

Lemon-flavored cod liver oil and a multivitamin-mineral supplement for the
secondary prevention of otitis media in young children: pilot research.

Linday LA, Dolitsky JN, Shindledecker RD, Pippenger CE.

Department of Otolaryngology, The New York Eye and Ear Infirmary, and The College
of Physicians and Surgeons, Columbia University, New York, USA.
lal14@columbia.edu

We measured blood levels of fatty acids, vitamin A, and trace metals in children 
undergoing ambulatory surgery for placement of tympanostomy tubes and a
comparison group having other ambulatory surgical procedures. We then performed a
small, outpatient, secondary prevention study using nutritional supplements
chosen on the basis of those blood levels. The study subjects had lower levels of
red blood cell eicosapentaenoic acid (EPA) than did adult controls. Consistent
with previous reports, the levels of vitamin A were < or = 40 microg/dL for 69%
of our subjects, and the plasma selenium levels for children were lower than
published values for adults. We then studied one otitis media (OM) season; 8
children (0.8 to 4.4 years of age) received 1 teaspoon of lemon-flavored cod
liver oil (containing both EPA and vitamin A) and 1 half-tablet of a
selenium-containing children's chewable multivitamin-mineral tablet per day.
During this OM season, study subjects received antibiotics for OM for 12.3% +/-
13.4% (SD; p < .05) fewer days during supplementation than before
supplementation. Larger, controlled trials are warranted to assess the utility of
cod liver oil (of acceptable purity and taste) and a children's
multivitamin-mineral preparation containing selenium, both for the prevention of 
OM and for the acceptance of delayed prescription of antibiotics for this
disorder.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 12126022 [PubMed - indexed for MEDLINE]

1908: Ann Otol Rhinol Laryngol. 2002 Jul;111(7 Pt 1):598-602.

Otologic facial palsy: etiology, onset, and symptom duration.

Kvestad E, Kvaerner KJ, Mair IW.

Department of Otorhinolaryngology, Ullevål University Hospital, Oslo, Norway.

To estimate the occurrence of otogenic facial palsy, we performed a retrospective
case record study of all patients hospitalized for otogenic facial palsy in the
period 1989 to 1999 at Ullevål University Hospital, which is the only referral
hospital for patients with otologic sequelae in Oslo. The facial palsy was a
complication of acute otitis media in 10 patients (56%), of acute mastoiditis in 
3 patients (17%), of secretory otitis media in 3 patients (17%), and of chronic
otitis media in 2 patients (11%). In half of the patients, complete facial palsy 
was found at the time of diagnosis. Sixteen patients (89%) reported a gradual
onset of the facial palsy. The mean duration of otologic symptoms before the
onset of facial palsy was 3 days (range, 1 to 9 days), and the median time to
remission was 9 weeks (range, 2 to 96 weeks). Total remission was achieved in all
patients who received follow-up. Although most patients recover within a few
weeks, some patients have long-lasting facial palsy. Multicenter studies are
needed to increase the sample size and to identify predictors of facial palsy
duration.

PMID: 12126015 [PubMed - indexed for MEDLINE]

1909: Semin Pediatr Infect Dis. 2002 Apr;13(2):129-33.

Influenza virus vaccines in children and their impact on the incidence of otitis 
media.

Rafei K.

Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, 
TX 77030, USA.

Otitis media has been identified as the most frequent reason for outpatient
antibiotic therapy. Several studies have linked viral respiratory infections with
bacterial otitis media. In light of rising concerns about antibiotic resistance, 
the possibility of reducing the incidence of otitis media through vaccination
against respiratory viruses has received increasing attention. This article
reviews inactivated and live attenuated influenza virus vaccines and their
possible impact on the incidence of otitis media. Inactivated and live attenuated
influenza virus vaccines are safe and immunogenic in children older than 6 months
and are linked to a decrease in the incidence of otitis media. Influenza
vaccination of infants younger than 6 months has resulted in less predictable
immunogenicity and deserves further investigation.

Publication Types: 
    Review

PMID: 12122951 [PubMed - indexed for MEDLINE]

1910: J Pediatr Health Care. 2002 Jul-Aug;16(4):161-9.

Diagnosis and treatment of the child with a draining ear.

Ramsey AM.

Section of Pediatric Otolaryngology, 2458 Taubman Center, University of Michigan 
Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0313, USA.

Treating a child with a draining ear is a common occurrence in the pediatric
primary office. The symptoms of otorrhea are broad, and a multitude of factors
must be considered in arriving at a diagnosis. The assessment begins with a
thorough history of the frequency, duration, and characteristics of the drainage.
Physical examination of the affected ear requires cleansing of the external
auditory canal before the tympanic membrane can be accurately assessed. The ear
must be adequately visualized for accurate diagnosis and treatment. Differential 
diagnoses include acute suppurative otitis media, otitis externa, granuloma, and 
bullous myringitis. The acutely draining ear is frequently an uncomplicated
suppurative event that will respond well to a regimen of aural hygiene and
topical therapy. Patients with a chronically draining ear should be referred to
an otolaryngologist for further diagnostics and aggressive therapy. Children with
tympanostomy tubes are especially at high risk for suppurative complications.
Avoiding the introduction of water into the ear, protecting the ear from water,
and prophylactic topical treatment are options that have been suggested for
prevention of otorrhea.

Publication Types: 
    Review

PMID: 12122378 [PubMed - indexed for MEDLINE]

1911: Br J Gen Pract. 2002 Jul;52(480):549-53.

Selecting persistent glue ear for referral in general practice: a risk factor
approach.

[No authors listed]

BACKGROUND: Glue ear (otitis media with effusion) is the most common reason for
surgical intervention in children. AIM: To determine the yield and predictive
value of a set of risk factors that predict persistence of glue ear over the
interval from general practice referral to ear, nose and throat (ENT)
consultation to ensure the appropriateness of referrals. DESIGN OF STUDY: Nested 
case control study SETTING: Sixteen ENT departments in the UK. METHOD: With the
aid of audiometry and tympanometry, diagnostic information was collected on 548
children from 16 ENT departments after referral by their general practitioner
(GP), as a lead-in to a clinical trial, the Trial of Alternative Regimens in Glue
Ear Treatment (TARGET). Using cases and controls, children were classified as
either having or not having persistent glue ear. Parental reports on an extensive
list of risk factors were also collected. RESULTS: After adjustment for time
waiting to be seen from GP referral and age at referral, four main significant
factors emerged for persistence of glue ear. These were: referral between July
and December (OR [odds ratio] = 1. 73, 95% CI = 1.15 to 2.6); having a mother who
smokes ten or more cigarettes per day (OR = 1.7, 95% CI = 1.1 to 2.8); multiple
upper airway symptoms (OR = 2.2, 95% CI = 1.5 to 3.2; and siblings with a history
of glue ear (OR = 1.6 for one sibling versus none). CONCLUSION: For a child who
is referred between July and December; who has two or more upper airway symptoms,
who has a sibling who has had glue ear, and who has a mother who smokes ten or
more cigarettes per day, the odds of having persistent glue ear are over ten
times that of a child without adverse values on these factors.

Publication Types: 
    Multicenter Study

PMID: 12120726 [PubMed - indexed for MEDLINE]

1912: Infect Immun. 2002 Aug;70(8):4292-301.

Comparison of alteration of cell surface carbohydrates of the chinchilla
tubotympanum and colonial opacity phenotype of Streptococcus pneumoniae during
experimental pneumococcal otitis media with or without an antecedent influenza A 
virus infection.

Tong HH, Grants I, Liu X, DeMaria TF.

Department of Otolaryngology, College of Medicine and Public Health, The Ohio
State University, Columbus 43210, USA.

Experimental and clinical studies suggest that influenza A virus promotes
Streptococcus pneumoniae-induced otitis media; however, the mechanism underlying 
this synergistic interaction has not been completely defined. In this study,
glycoconjugate expression patterns were evaluated on the cell surface in the
chinchilla eustachian tube (ET) lumen of a cohort challenged intranasally (i.n.) 
with S. pneumoniae type 6A, which is predominantly transparent and a cohort with 
an antecedent influenza A virus infection, followed by i.n. inoculation with S.
pneumoniae. The labeling patterns obtained with six lectin probes revealed that
the binding of Bandeiraea simplicifolia lectin II, succinylated wheat germ
agglutinin, and peanut agglutinin were significantly increased in the lumenal
surface of the ET in the cohort infected with both pathogens compared to the
cohort inoculated with only S. pneumoniae, which indicated that
N-acetylglucosamine (GlcNAc) and D-galactose residues were exposed. A significant
decreased labeling with Sambucus nigra agglutinin in the combined influenza A
virus and pneumococcus infection cohort suggested that there were few sialic acid
residues remaining in the ET epithelium. In addition, the colonial opacity of S. 
pneumoniae during the disease course was examined. The opaque phenotype was
predominant among the pneumococcus isolates from the middle-ear fluid in the
cohort infected with the both pathogens. Together, these data suggest that the
synergic effect of influenza A virus and S. pneumoniae on the changes of the
carbohydrate moieties in the ET epithelium and that the selection of the opaque
variant may facilitate the pneumococcal invasion of the middle ear.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12117938 [PubMed - indexed for MEDLINE]

1913: Hear Res. 2002 May;167(1-2):28-32.

DPOAEs in young normal-hearing subjects with histories of otitis media: evidence 
of sub-clinical impairments.

Job A, Nottet JB.

Centre de Recherches du Service de Santé des Armées, 24 Avenue des maquis du
Grésivaudan, P.O. Box 87, 38702 La Tronche Cedex, France.
agnes_job@compuserve.com

To investigate the origin of the susceptibility to noise in subjects with
histories of otitis media (OM), we assessed early sub-clinical impairments in
normally hearing subjects with a history of OM using distortion product
otoacoustic emissions (DPOAEs). DPOAEs of 213 normal-hearing subjects aged 18-24 
years were obtained and comparisons of DPOAE levels in several groups as a
function of OM past infections were tested by ANOVA. A main finding was that
young normal-hearing subjects with a history of OM had significantly lower DPOAEs
over all octaves tested compared to normal-hearing subjects without antecedent of
OM. The mean difference was 3.5+/-1.1 dB in the 2-4 kHz zone, which was
especially marked in subjects (n=21) that had undergone a myringotomy (6.6+/-1.5 
dB) in the 4 kHz zone. The level of impairment seemed to depend on the severity
of the past infection as characterised by the importance and the duration of the 
infectious effusions.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12117527 [PubMed - indexed for MEDLINE]

1914: Arch Otolaryngol Head Neck Surg. 2002 Jul;128(7):776-82.

Quality-of-life outcomes after surgical intervention for otitis media.

Richards M, Giannoni C.

Department of Otolaryngology, University of Florida, Box 100264, 1600 SW Archer
Rd, Gainesville, FL 32610-0264, USA.

OBJECTIVE: To assess the change in disease-specific quality of life in children
with recurrent acute otitis media and/or chronic otitis media with effusion
treated with surgical intervention. DESIGN: Prospective questionnaire-based
outcome study. SETTING: An academic pediatric otolaryngology practice.
PARTICIPANTS: Consecutive series of 123 children referred for surgical treatment 
of recurrent acute otitis media and/or chronic otitis media with effusion.
INTERVENTION AND METHODS: Surgery included bilateral myringotomy and tympanostomy
tube placement either alone or with adenoidectomy. An otitis media
disease-specific questionnaire was administered before and after surgical
intervention. MAIN OUTCOME MEASURES: Comparison of the mean percentage change in 
total ear symptom score between presurgery and postsurgery scores at 1 and 6
months after surgery. RESULTS: The mean percentage change in total ear symptom
score was a 74.5% improvement (P<.001) at the 1-month follow-up and a 59.8%
improvement (P<.001) at the 6-month follow-up. Parental worry related to the
child's ear problems was also significantly decreased, with a mean otitis media
disease-specific questionnaire score of 3.43 (P<.001) at 1 month and 2.64
(P<.001) at 6 months after surgery. When caregivers were asked if they would have
their child undergo tympanostomy tube placement if they had to make the decision 
again, 91% and 84% responded yes at the 1- and 6-month follow-up, respectively.
CONCLUSIONS: The disease-specific quality of life of children with recurrent
acute otitis media and/or chronic otitis media with effusion with appropriate
surgical indications significantly improved after surgical intervention. The
amount of parental worry concerning their children's ear problems also
significantly improved following surgery, and most caregivers would opt again for
tube placement.

PMID: 12117333 [PubMed - indexed for MEDLINE]

1915: J Allergy Clin Immunol. 2002 Jul;110(1):125-30.

T(H)2 cytokine expression in atopic children with otitis media with effusion.

Sobol SE, Taha R, Schloss MD, Mazer BD, Manoukian JJ, Tewfik TL, Hamid Q.

Department of Otolaryngology, McGill University, Montreal, Quebec, Canada.

BACKGROUND: Otitis media with effusion (OME) is more common in atopic children.
Few studies have looked for the presence of inflammatory mediators in the
middle-ear effusions of this population. OBJECTIVE: We hypothesize that atopic
children with OME have a different inflammatory cell and cytokine profile than
nonatopic patients with the disease. METHODS: Twenty-six patients with OME
undergoing myringotomy and ventilation tube placement were recruited at the
McGill University Hospital Center. The atopic status was determined for each
patient by using standard skin testing. By means of immunocytochemistry, fluid
specimens were assessed for T lymphocytes (CD3), eosinophils (major basic
protein), neutrophils (elastase), mast cells (tryptase), and basophils (BB1). By 
using in situ hybridization, the expression of IL-4, IL-5, and IFN-gamma was
assessed. RESULTS: There is a higher percentage of eosinophils and T lymphocytes 
in atopic patients with OME (n = 8) compared with that seen in nonatopic patients
(n = 18, P <.01). There is a higher percentage of neutrophils in nonatopic
patients with OME compared with that seen in atopic patients (P <.01). In
examining cytokine profiles, there is a higher percentage of cells expressing
IL-4 and IL-5 in atopic patients with OME compared with that seen in nonatopic
patients (P <.01). CONCLUSION: The predominance of eosinophils, T lymphocytes,
and T(H)2 mediators in the middle-ear effusions of atopic children provides
evidence that allergy might play a role in the pathogenesis of OME.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12110831 [PubMed - indexed for MEDLINE]

1916: Am J Otolaryngol. 2002 Jul-Aug;23(4):203-8.

Dural herniations, encephaloceles: an index of neglected chronic otitis media and
further complications.

Manolidis S.

Bobby R. Alford Department of Otolaryngology and Communicative Sciences, Baylor
College of Medicine, Houston, TX, USA.

A retrospective review of 110 consecutive cases of chronic otitis media surgery
was carried out in a large metropolitan public teaching hospital in the United
States that serves the inner-city population. The purpose was to identify dural
herniations and encephaloceles (DHE) as well as complications associated with
these entities. Twenty-nine such patients (26.4%) were identified, 7 of which
(6.4%) were encephaloceles. In patients with DHE, cholesteatoma was found in 83%,
a labyrinthine fistula in 48%, preoperative facial paralysis in 14% (4 patients),
facial nerve involvement by cholesteatoma in 24%, and suppurative intracranial
complications in 21%. DHEs were repaired through the mastoid, via a
mini-craniotomy or a formal middle cranial fossa approach. The incidence of DHEs 
in this patient population is very high, which reflects neglected chronic ear
disease. The associated complications require extensive surgery for eradication, 
and the potential for morbidity and mortality is significant. Copyright 2002,
Elsevier Science (USA). All rights reserved.)

PMID: 12105784 [PubMed - indexed for MEDLINE]

1917: Eur Cytokine Netw. 2002 Apr-Jun;13(2):161-72.

Role of the pro-inflammatory cytokines tumor necrosis factor-alpha, interleukin-1
beta, interleukin-6 and interleukin-8 in the pathogenesis of the otitis media
with effusion.

Smirnova MG, Kiselev SL, Gnuchev NV, Birchall JP, Pearson JP.

Department of Physiological Sciences, University of Newcastle, Medical School,
Framlington Place, Newcastle upon Tyne, NE2 4HH, UK. Marina.Smirnova@ncl.ac.uk

Inflammation in the middle ear mucosa, caused usually by bacterial and viral
pathogens, is the primary event in the middle ear predisposing the development of
otitis media with effusion (OME). Numerous inflammatory mediators have been
identified in OME. However, cytokines play a central role as initiators,
mediators and regulators of middle ear inflammation and subsequent
molecular-pathological processes in middle ear tissues, leading to
histopathological changes in the middle ear cavity and the pathogenesis of OME.
In this article, we aim to present an overview of current research developments
in the pro-inflammatory cytokine involvement in the aetiology of otitis media
with effusion.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 12101072 [PubMed - indexed for MEDLINE]

1918: J Basic Clin Physiol Pharmacol. 2002;13(1):33-40.

The role of free oxygen radicals in experimental otitis media.

Döner F, Delibaş N, Dogru H, Yariktaş M, Demirci M.

Department of Otorhinolaryngology, Süleyman Demirel University, Medical Faculty, 
Isparta, Turkey. fehmidoner@hotmail.com

Free oxygen radicals (FORs); have been implicated as important pathologic
mediators in many diseases. Under physiological conditions FORs are part of
normal regulatory circuits and neutralized by antioxidants, but an increased flux
of FORs can cause tissue damage. Infections are one cause of increased FORs
production. An important mechanism of tissue damage produced by FORs is the
peroxidation of membrane lipids, which can be estimated by malondialdehyte (MDA) 
levels. The purpose of this study was to determine in 24 albino rabbits whether
FORs play a role in the pathogenesis of otitis media experimentally induced by
inoculating Streptococcus pneumonia into the right ear, with the left ear serving
as a control. We examined the mucosa of each middle ear histopathologically and
measured MDA levels in mucosa and serum. Serum MDA levels in infected rabbits
were significantly higher than those in preoperative blood specimens (p<0.05).
The MDA levels in mucosa were significantly higher in infected ears than in
control ears (p<0.01). In the experimentally infected group, a correlation was
found between MDA levels in serum and mucosa (p<0.05). In conclusion, serum and
mucosa MDA indicating FORs production increased significantly in experimental
otitis media. We considered that FORs might play a role in tissue damage caused
by otitis media.

PMID: 12099403 [PubMed - indexed for MEDLINE]

1919: BMJ. 2002 Jul 6;325(7354):22; discussion 22.

Comment in:
    J Fam Pract. 2003 Jan;52(1):12-5.

Predictors of poor outcome and benefits from antibiotics in children with acute
otitis media: pragmatic randomised trial.

Little P, Gould C, Moore M, Warner G, Dunleavey J, Williamson I.

Community Clinical Sciences (Primary Medical Care Group), University of
Southampton, Aldermoor Health Centre, Southampton SO15 6ST. psl3@soton.ac.uk

OBJECTIVES: To identify which children with acute otitis media are at risk of
poor outcome and to assess benefit from antibiotics in these children. DESIGN:
Secondary analysis of randomised controlled trial cohort. SETTING: Primary care. 
PARTICIPANTS: 315 children aged 6 months to 10 years. INTERVENTION: Immediate or 
delayed (taken after 72 hours if necessary) antibiotics. MAIN OUTCOME MEASURE:
Predictors of short term outcome: an episode of distress or night disturbance
three days after child saw doctor. RESULTS: Distress by day three was more likely
in children with high temperature (adjusted odds ratio 4.5, 95% confidence
interval 2.3 to 9.0), vomiting (2.6,1.3 to 5.0), and cough (2.0, 1.1 to 3.8) on
day one. Night disturbance by day three was more likely with high temperature 2.4
(1.2 to 4.8), vomiting (2.1,1.1 to 4.0), cough (2.3,1.3 to 4.2), and ear
discharge (2.1, 1.2 to 3.9). Among the children with high temperature or
vomiting, distress by day three was less likely with immediate antibiotics (32%
for immediate v 53% for delayed, chi2=4.0; P=0.045, number needed to treat 5) as 
was night disturbance (26% v 59%, chi2=9.3; P=0.002; number needed to treat 3).
In children without higher temperature or vomiting, immediate antibiotics made
little difference to distress by day three (15% v 19%, chi2=0.74; P=0.39) or
night disturbance (20% v 27%, chi2=1.6; P=0.20). Addition of cough did not
significantly improve prediction of benefit. CONCLUSION: In children with otitis 
media but without fever and vomiting antibiotic treatment has little benefit and 
a poor outcome is unlikely.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 12098725 [PubMed - indexed for MEDLINE]

1920: Drugs. 2002;62(10):1441-5.

Prevention of otitis media by vaccination.

Russell F, Mulholland K.

Centre for International Child Health, University of Melbourne, Royal Children's 
Hospital, Flemington Road, Parkville, Victoria 3051, Australia.
mulhollk@cryptic.rch.unimelb.edu.au

Otitis media (OM) is one of the commonest infections in childhood and a frequent 
reason for prescribing antibacterials in infancy. However, the increase in
prevalence of antibacterial-resistant respiratory bacterial pathogens has not
been matched by the development of new antibacterial agents. Bacterial vaccine
strategies aim to prevent OM directly and to reduce nasopharyngeal carriage of
pneumococci, thereby reducing the likelihood of developing acute OM. Complete
protection against OM would require an approach targeting both bacterial and
viral agents. Immunisation with a pneumococcal conjugate vaccine provides
protection against acute OM caused by pneumococcal serotypes included in the
vaccine, reduces serotype-specific pneumococcal carriage, and reduces carriage of
penicillin-resistant pneumococci. However, an increase in non-vaccine serotype OM
has been observed in vaccinated children, which may limit the overall
effectiveness of this vaccine. New vaccines targeting non-typable Haemophilus
influenzae and Mycoplasma catarrhalis are in the early stages of development.
Efficacy studies with influenza vaccine have shown the most promising results to 
date in terms of overall reduction in OM episodes. A more substantial reduction
in the burden of OM in childhood would require a combination of vaccines that are
effective against the bacterial and viral pathogens involved and that can be
administered early in infancy.

Publication Types: 
    Review

PMID: 12093313 [PubMed - indexed for MEDLINE]

1921: J Am Vet Med Assoc. 2002 Jun 15;220(12):1807-12.

Comparison of pulse administration versus once daily administration of
itraconazole for the treatment of Malassezia pachydermatis dermatitis and otitis 
in dogs.

Pinchbeck LR, Hillier A, Kowalski JJ, Kwochka KW.

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The
Ohio State University, Columbus 43210, USA.

OBJECTIVE To compare clinical efficacy of pulse administration with itraconazole 
versus once daily administration for the treatment of cutaneous and otic M
pachydermatis infection in dogs. DESIGN: Randomized controlled trial. ANIMALS: 20
dogs. PROCEDURE: Dogs were treated with itraconazole orally (n = 10/group), using
a pulse administration regimen (5 mg/kg [2.3 mg/lb], PO, q 24 h for 2 consecutive
days per week for 3 weeks) or once daily administration (5 mg/kg, PO, q 24 h for 
21 days). No other treatment was permitted. On days 0 and 21, clinical severity
of cutaneous and otic disease was assessed, and samples were collected for
cytologic examination and yeast culture. Cytology (sum of the mean number of
yeast organisms per oil immersion field for affected sites) and culture (mean of 
the score for extent of yeast growth for samples from affected sites) scores were
calculated. RESULTS: For dogs in both treatment groups, clinical severity of
cutaneous and otic disease was significantly decreased by day 21, but decrease in
severity was not significantly different between groups. Similarly, skin
cytology, skin culture, and ear culture scores were significantly decreased on
day 21, compared with day 0, for both groups, but decreases were not
significantly different between groups except that dogs in the pulse
administration group had a significantly greater decrease in ear culture scores
than did dogs in the daily administration group. However, when cytology scores
only for ear samples were analyzed, day 21 score was not significantly decreased,
compared with day 0 score, for either group. CONCLUSIONS AND CLINICAL RELEVANCE: 
Results suggested that both pulse administration and once daily administration of
itraconazole were efficacious in the treatment of M pachydermatis cutaneous
infection in dogs. However, adjunctive treatment may be needed in dogs with M
pachydermatis otitis.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 12092953 [PubMed - indexed for MEDLINE]

1922: Clin Infect Dis. 2002 Jul 15;35(2):168-74. Epub 2002 Jun 19.

Efficacy of intranasal virosomal influenza vaccine in the prevention of recurrent
acute otitis media in children.

Marchisio P, Cavagna R, Maspes B, Gironi S, Esposito S, Lambertini L, Massimini
A, Herzog C, Principi N.

Pediatric Department 1, University of Milan, 20122 Milan, Italy.

To evaluate the efficacy of an intranasal, inactivated, virosomal subunit
influenza vaccine for prevention of new episodes of acute otitis media (AOM) in
children with recurrent AOM, 133 children aged 1-5 years were randomized to
receive the vaccine (n=67) or no vaccination (n=66). During a 6-month period, 24 
(35.8%) vaccine recipients had 32 episodes of AOM; 42 (63.6%) control subjects
had 64 episodes. The overall efficacy of vaccination in preventing AOM was 43.7% 
(95% confidence interval, 18.6-61.1; P=.002). Children vaccinated before
influenza season had a significantly better outcome than did those vaccinated
after the onset of influenza season. The cumulative duration of middle ear
effusion was significantly less in vaccinated children than in control subjects. 
Data suggest that the intranasal virosomal influenza vaccine might be considered 
among the options for the prevention of AOM in children <5 years old with
recurrent AOM.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 12087523 [PubMed - indexed for MEDLINE]

1923: Scand J Prim Health Care. 2002 Mar;20(1):35-9.

Parents' perspectives on otitis media and antibiotics. A qualitative study.

Jónsson H, Haraldsson RH.

Lágmúli Primary Care Centre, Reykjavík, Iceland. halldorj@hgl4.hr.is

BACKGROUND: Judicious use of antibiotics is an important factor in decreasing the
current increase in bacterial resistance. Discussion with patients and their
guardians on whether to use antibiotics or not can be expected to increase in the
future. OBJECTIVE: To explore the views and feelings of parents of children with 
acute otitis media towards the disease and its treatment. DESIGN: A qualitative
study with semi-structured interviews. SUBJECTS: Twenty-one parents of pre-school
children with newly diagnosed acute otitis media who had attended a primary care 
centre in Reykjavik. RESULTS: The parents did not consider the disease a threat. 
They generally thought the disease was caused by environmental factors or by a
disturbance in body mechanism. The majority thought that treatment with
antibiotics could harm their children. CONCLUSION: The parents of young children 
hold views on acute otitis media and antibiotics which are markedly different
from the medical model.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12086282 [PubMed - indexed for MEDLINE]

1924: West Afr J Med. 2002 Jan-Mar;21(1):34-6.

Treatment outcome of otomycosis in Ilorin, Nigeria.

Ologe FE, Nwabuisi C.

Department of Otorhinolaryngology, Faculty of Health Sciences, University of
Ilorin, Nigeria.

Among 141 patients suspected of having otomycosis, 76 (53.9%) were mycologically 
confirmed. The fungi isolated were Aspergillus sp (63.4%), Candida (35.5%) and
Mucor (1.3%). Ninety-six per cent were symptom free within 2 weeks of topical
application of 1% clotrimazole cream, after thorough failures in the cleaning of 
debri in the ear canal. Treatment failures were minimal, including recurrence
(2.6%), acute otitis externa (1.3%), foreign body in the ear (1.3%) and blocking 
of ear by therapeutic agent (2.6%). This treatment regimen is simple,
efficacious, cost effective and safe; hence it is recommended for adoption in the
management of otomycosis.

PMID: 12081339 [PubMed - indexed for MEDLINE]

1925: Cochrane Database Syst Rev. 2002;(2):CD001480.

Update in:
    Cochrane Database Syst Rev. 2004;(1):CD001480.

Pneumococcal vaccines for preventing otitis media.

Straetemans M, Sanders EA, Veenhoven RH, Schilder AG, Damoiseaux RA, Zielhuis GA.

Department of Epidemiology and Biostatistics, UMC Nijmegen, Geert Grooteplein 21,
Nijmegen, Netherlands, 6525 EZ. M.Straetemans@mie.kun.nl

BACKGROUND: Acute otitis media (AOM) is one of the most common diseases in early 
infancy and childhood. Long term effects of recurrent episodes of otitis media,
rapid emergence of drug resistant bacteria associated with AOM worldwide and huge
estimated direct and indirect annual costs associated with otitis media have
emphasized the need for an effective vaccination program to prevent episodes of
AOM. OBJECTIVES: The object of this review was to assess the effect of
pneumococcal vaccination in preventing AOM in children up to 12 years of age.
SEARCH STRATEGY: We searched the Cochrane Acute Respiratory Infection Group
specialised register (last update, 26th April 2001), the Cochrane Library (Issue 
4, 2000), MEDLINE (January 1966-August 2000) and reference list of all studies
and review articles retrieved. We also contacted two vaccine manufacturers and
first or corresponding authors of some included studies. SELECTION CRITERIA:
Randomised controlled clinical trials of pneumococcal vaccination with prevention
of AOM as outcome in children aged 12 years or younger and a follow-up of at
least six months. DATA COLLECTION AND ANALYSIS: Five reviewers independently
assessed trial quality and two reviewers extracted data. Two study authors were
contacted. MAIN RESULTS: Eight trials on pneumococcal polysaccharide vaccine
(PPV) and two trials on pneumococcal conjugate vaccine (PCV) were included. The
highest efficacy of PPV was found in children aged 24 months and older: the rate 
ratio after adjustment for study was 0.833 [95%CI: 0.625-0.970]. The PPV has
little effect on the prevention of AOM in children without documented prior
episodes of AOM and only a moderate effect in the group of children with
documented AOM episodes prior to vaccination. The results of the two PCV trials
in healthy infants, which followed children from the age of two months until two 
years of age, could not be pooled because of lack of data. Both studies showed
that the risk of recurrent disease decreased with 9% in the group of children
receiving the PCV together with other childhood vaccinations at 2,4,6 and 14
months of age: Study Black et al 2000 : risk ratio=0.91[95%CI:0.86-0.96]; Study
Eskola et al 2001: risk ratio=0.90 [95%CI:0.73-1.12]. REVIEWER'S CONCLUSIONS:
Based on the currently available results of the effectiveness of pneumococcal
vaccination for the prevention of AOM, a large scale use of pneumococcal
vaccination for this indication is not recommended. The results of currently
ongoing trials could provide more information whether pneumococcal vaccines are
effective in specific high-risk (otitis-prone) populations.

Publication Types: 
    Review

PMID: 12076412 [PubMed - indexed for MEDLINE]

1926: Pediatr Infect Dis J. 2002 Apr;21(4):348-50.

Population-based, age-specific myringotomy with tympanostomy tube insertion rates
in Calgary, Canada.

Desai SN, Kellner JD, Drummond D.

Department of Pediatrics, University of Calgary, Alberta, Canada.

Population-based rates of myringotomy with tympanostomy tube insertions in
Calgary from 1997 to 2000 were determined with the use of administrative
databases. Age-specific rates (procedures per 1,000 people per year) were 12.8,
54.2 and 11.1 for ages 0 to 11 months, 12 to 23 months and 0 to 15 years,
respectively. Repeated procedures were performed on 7.1% of children <5 years of 
age.

PMID: 12075770 [PubMed - indexed for MEDLINE]

1927: Otolaryngol Head Neck Surg. 2002 May;126(5):490-8.

A rat model of otitis media with effusion caused by eustachian tube obstruction
with and without Streptococcus pneumoniae infection: methods and disease course.

Piltcher OB, Swarts JD, Magnuson K, Alper CM, Doyle WJ, Hebda PA.

Department of Otolaryngology, Children's Hospital of Pittsburgh, PA 15213, USA.

OBJECTIVE: To describe the clinical and histopathologic progression of a rat
model of otitis media with effusion caused by eustachian tube obstruction (ETO)
with and without Streptococcus pneumoniae infection. METHODS: In 164 rats, the
left, bony eustachian tube was approached via a ventral incision and obstructed
with dental material. Then 108 rats were infected via an intrabullar injection
with S pneumoniae. At 48 hours, the infected rats were treated for 5 days with
ampicillin. All ears were evaluated by weekly otomicroscopy. On each of days 1,
2, 7, 21, 35, 56, and 112, four rats were killed for histologic study. All
effusions were cultured for bacteria. RESULTS: Fourteen rats died of surgical
complications; effusion resolved by 2 weeks in 9 rats. During the first few days,
infected ears with ETO had bulging tympanic membranes, followed by tympanic
membrane retraction, purulent effusion, and otorrhea (50%) over the next few
weeks, whereas uninfected ears with ETO developed retraction and serous effusion 
during the same time frame. At later times, all ears with ETO presented with
retraction and serous or serous-mucoid effusion. S pneumoniae was recovered only 
from the infected ears with ETO (days 1 and 2), with some colonization by
nonpathogenic microorganisms observed equally in both groups of ears. Histology
showed a typical acute inflammatory reaction in the challenged ears with ETO
through day 14 and then a chronic inflammation for all ears with ETO. CONCLUSION:
The experimental methods provoked reproducible pathologic signs similar to those 
for otitis media with effusion. Given the availability of rat-specific reagents, 
this model is well suited for studies of cytokine elaboration during disease
pathogenesis.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12075222 [PubMed - indexed for MEDLINE]

1928: Vet Dermatol. 2002 Jun;13(3):151-6.

A semiquantitative cytological evaluation of normal and pathological samples from
the external ear canal of dogs and cats.

Ginel PJ, Lucena R, Rodriguez JC, Ortega J.

Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine,
University of Córdoba, Spain. pginel@uco.es

Numbers of desquamated epithelial cells, yeast cells and bacterial organisms were
counted in samples collected from the external ear canal of 37 normal dogs and 16
normal cats, and from 24 dogs and 22 cats with otitis externa. The aims of the
study were to establish quantitative reference ranges and to correlate these data
with the clinical status of the dogs and cats. Numbers of yeast cells and
bacterial organisms were significantly increased in dogs (P = 0.05; P = 0.0001)
and cats (P = 0.0001; P = 0.0001) with otitis externa, and in most cases high
counts were correlated with clinical signs. Mean Malassezia counts per high-power
dry field of > or = 5 in the dog and > or = 12 in the cat were considered
abnormal. Mean bacterial counts per high-power dry field of > or = 25 in the dog 
and > or = 15 in the cat were considered abnormal. When used to differentiate
normal from inflamed external ear canals, these figures provided a low
sensitivity but a specificity of > or = 95%.

PMID: 12074704 [PubMed - indexed for MEDLINE]

1929: Saudi Med J. 2002 Jun;23(6):708-10.

Point prevalence of type B tympanogram in children.

Zakzouk SM, AbdulJawad KA.

Department of ORL, College of Applied Medical Sciences, King Saud University,
Riyadh, Kingdom of Saudi Arabia. profzakzouk@hotmail.com

OBJECTIVE: Otitis media with effusion is a common disease; it is primarily a
disease of children. Otitis media with effusion was found as the most common
cause of hearing impairment among children. The prevalence varied in different
populations. Using otoscopy and tympanometry usually gives a valuable indication 
of the presence of otitis media with effusion. The aim of this study is to
determine the point prevalence of type B tympanogram as a diagnostic and
indication of the presence of otitis media with effusion. METHODS: This study was
carried out during the period September 1997 through to May 2000. The study
population consisted of 9540 children aged one year to 12 years from the 4
provinces of the country. Otoscopic examination and audiologic assessment were
carried out using Grason Stadler Incorporation 30-33. The tympanograms were
divided into A, B, C one, and C2 groups. RESULTS: The point prevalence rate of
type B tympanograms among children was 8.2%. The prevalence of otitis media with 
effusion was 7.5% CONCLUSION: This study indicates that tympanogram has a
significant role in otis media effusion.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12070553 [PubMed - indexed for MEDLINE]

1930: Antimicrob Agents Chemother. 2002 Jul;46(7):2194-9.

Experimental acute otitis media due to nontypeable Haemophilus influenzae:
comparison of high and low azithromycin doses with placebo.

Babl FE, Pelton SI, Li Z.

Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston
University School of Medicine, Boston, Massachusetts 02118, USA.

Treatment of acute otitis media (AOM) with azithromycin results in apparent
clinical success, but tympanocentesis performed 4 to 6 days after initiation of
therapy in children with nontypeable Haemophilus influenzae (NTHI) recovered from
initial middle ear cultures demonstrates persistence of infection in more than
50% of episodes. We sought to determine the effect of azithromycin at different
doses on the density of middle ear infection due to NTHI to provide additional
understanding of this dichotomy between clinical and microbiologic outcome
measures in AOM. In a chinchilla model of experimental otitis media (EOM),
animals treated with placebo were compared to animals receiving a single daily
dose 30 or 120 mg of azithromycin per kg of body weight per day for 5 days.
Microbiologic outcome was assessed by obtaining quantitative cultures from the
middle ear during a 5-day course and for 1 week following therapy. Azithromycin
concentrations were measured to ascertain whether a concentration-dependent
effect was present. Azithromycin at 30 and 120 mg/kg/day demonstrated a
dose-dependent effect on the quantitative assessment of middle ear infection due 
to NTHI. A 30-mg/kg dose of azithromycin daily resulted in levels in serum and
areas under the serum concentration-time curve at 24 h comparable to published
data obtained with children given azithromycin at 5 to 10 mg/kg in multiday
regimens. Increased doses of azithromycin (120 mg/kg) achieved 2.5- to
4-fold-higher levels in serum and 3- to 6-fold-higher total levels and levels in 
extracellular middle ear fluid as well as more rapid reduction in bacterial
density and a greater proportion of middle ears with complete sterilization than 
either placebo or the 30-mg/kg/day regimen.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12069974 [PubMed - indexed for MEDLINE]

1931: Infect Immun. 2002 Jul;70(7):3551-6.

Identification of the lipooligosaccharide biosynthesis gene lic2B as a putative
virulence factor in strains of nontypeable Haemophilus influenzae that cause
otitis media.

Pettigrew MM, Foxman B, Marrs CF, Gilsdorf JR.

Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
48109-2029, USA.

Nontypeable (NT) strains of Haemophilus influenzae are an important cause of
acute otitis media (OM). The pathogenic process by which NT H. influenzae strains
cause OM is poorly understood. In order to identify specific virulence factors
important for OM pathogenesis, genomic subtraction of the NT H. influenzae middle
ear isolate G622 against H. influenzae strain Rd was conducted and the resulting 
subtraction products were used to screen a panel of H. influenzae isolates.
Subtraction identified 36 PCR fragments unique to strain G622, which were used in
a preliminary screen of 48 middle ear isolates and 46 nasopharyngeal and throat
isolates to identify genes found more frequently among middle ear isolates. These
experiments identified a PCR fragment with high homology to the
lipooligosaccharide biosynthesis gene lic2B (originally identified in an H.
influenzae type b strain) among 52% of the middle ear isolates and 9% of
nasopharyngeal and throat isolates. The lic2B gene cloned from NT H. influenzae
strain G622 was 99% identical at the amino acid level to that of the H.
influenzae type b strain RM7004. The lic2B gene was used to screen a larger panel
of H. influenzae isolates including the original 48 middle ear isolates, 40
invasive type b isolates, 90 NT H. influenzae throat isolates from children
attending day care, and 32 NT H. influenzae nasopharyngeal clinical isolates. The
lic2B gene was found 3.7 times more frequently among middle ear isolates than in 
throat isolates from children attending day care. These data suggest that a
specific NT H. influenzae gene is associated with OM.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12065495 [PubMed - indexed for MEDLINE]

1932: Paediatr Anaesth. 2002 Jun;12(5):429-37.

Side-effects after inhalational anaesthesia for paediatric cerebral magnetic
resonance imaging.

Sandner-Kiesling A, Schwarz G, Vicenzi M, Fall A, James RL, Ebner F, List WF.

Department of Anaesthesiology and Intensive Care Medicine, Karl Franzens
University, Graz, Austria. andreas.sandner@uni-graz.at

BACKGROUND: The aim of this study was to evaluate the type, incidence and
duration of postprocedure side-effects in 168 children within the first 72 h
after inhalational anaesthesia for magnetic resonance imaging (MRI). METHODS:
Premedication and induction followed standardized routines. Maintenance of
anaesthesia was performed with inhalational anaesthetics solely: isoflurane (n=60
of 112; 53%), sevoflurane (n=32 of 112; 29%), desflurane (n=12 of 112; 11%) or
halothane (n= 8 of 112; 7%) using a strapped on face mask (FiO2=0.4; flow 5
l.min-1). When indicated, gadolinium was administered (n=45; OF 112; 40%).
RESULTS: One hundred and twelve of 168 parents (67%) responded to questionnaires.
In these 112 children, pathological MR findings were found supratentorially
(n=31; 28%), infratentorially (n=9; 8%), extracerebrally (n=12; 11%) or combined 
(n=9; 8%). In 56 of these 112 children (50%), 14 different side-effects were
reported. One hour after anaesthesia, 55 children suffered between one and four
side-effects. Neurological side-effects were associated with age > or = 5 years
(P < 0.01) or infratentorial pathophysiology (P < 0.01) and abdominal
side-effects (P < 0.02), especially nausea (P < 0.001) with age > or = 5 years.
CONCLUSIONS: Our findings indicate the need to inform parents of the incidence
and variability of side-effects after inhalational anaesthesia for minimally
invasive, diagnostic procedures, such as MRI.

PMID: 12060330 [PubMed - indexed for MEDLINE]

1933: Med Mycol. 2002 Apr;40(2):115-21.

Occurrence of Malassezia spp. in the external ear canals of dogs and cats with
and without otitis externa.

Crespo MJ, Abarca ML, Cabañes FJ.

Department de Sanitat i d'Anatomia Animals (Microbiologia), Facultat de
Veterinària, Universitat Autònoma de Barcelona, Spain.

We studied the lipophilic microbiota of the external ear canals of 332 animals
(264 dogs and 68 cats), with and without otitis externa, over an 11-year period
from 1988 to 1999. Malassezia pachydermatis was isolated from 62.2% and 50% of
dogs with and without otitis externa, respectively, and from 41.2% and 17.6% of
cats with and without otitis externa, respectively. In the group of animals
studied for lipid-dependent species, these yeasts were isolated from 4.5% of dogs
with otitis externa and from 23.1% and 8.9% of cats with and without otitis
externa, respectively. M. sympodialis and M. furfur were isolated from cats and
M. furfur and M. obtusa from dogs. Our findings show that lipid-dependent
Malassezia species may contribute to the etiology of otitis externa in dogs and
cats.

PMID: 12058723 [PubMed - indexed for MEDLINE]

1934: Int J Pediatr Otorhinolaryngol. 2002 Jun 17;64(2):165-70.

Carhart's notch: a finding in otitis media with effusion.

Ahmad I, Pahor AL.

Department of Otolaryngology, Birmingham City Hospital, Dudley Road, Birmingham, 
UK. ijazamad@hotmail.com

INTRODUCTION: Carhart's notch (CN) is a false depression of bone conduction (BC) 
thresholds at 2-4 kHz initially described in cases of stapes fixation. This study
was designed to estimate the incidence and assess the clinical significance of CN
in cases of otitis media with effusion (OME) in children. PATIENTS AND METHODS:
Clinical records of 50 patients of OME that showed CN were analysed,
retrospectively. First 24 were identified as seen in outpatients and 26 were
found out of 100 consecutive cases of OME. The criteria of CN were a minimum 10
dB depression in BC at any frequency 500-4000 Hz. RESULTS: Fifty patients showed 
CN, with mean age of 8.8 years. All had myringotomies with or without insertion
of grommets. The CN ranged from 10 to 20 dB in the majority and up to 30 dB in
few cases. In 85 ears studied, the affected frequencies comprised of 2000 Hz in
80 (94%), 4000 Hz in 4 and 1000 Hz in one ear. Pre-operative tympanograms were of
type B in 68 (80%), type C in 16 (18.8%) and type A in one ear. Middle ear fluid 
was thick glue in 57 (67%), serous in 5 (5.8%), and no fluid found in 23 (27%)
cases. Oedematous, granular or polypoidal appearances of middle ear mucosa were
noted in 57 (67%) of the ears. A normal mucosa was seen in 17 (20%), and no
details were available in 11 (13%) ears. Post-operative audiograms showed
improvements of BC thresholds in 72 (84.7%) of the ears. CONCLUSION: Our results 
show 26% incidence of CN in paediatric cases of OME, with evidence of thick fluid
and abnormal middle ear mucosa in about two-thirds of cases. This suggests that
CN may be of prognostic value for myringotomy outcomes. Statistically there is a 
significant correlation between presence of fluid on myringotomy and CN, and type
of tympanogram and post-operative BC threshold improvement. There is no
predictive value of CN in terms of character of the middle ear fluid. Studies
with larger numbers may be required to determine this with more certainty. It can
help clinically, however, in pre-operative assessment of these cases. It is our
opinion that BC should be an essential part of routine audiometry in all cases of
OME.

Publication Types: 
    Comparative Study

PMID: 12049829 [PubMed - indexed for MEDLINE]

1935: Int J Pediatr Otorhinolaryngol. 2002 Jun 17;64(2):133-41.

Deficient IgA and IgG2 anti-pneumococcal antibody levels and response to
vaccination in otitis prone children.

Dhooge IJ, van Kempen MJ, Sanders LA, Rijkers GT.

Department of Otolaryngology, University Hospital Ghent, De Pintelaan 185, B-9000
Ghent, Belgium. ingeborg.dhooge@rug.ac.be

OBJECTIVE: To evaluate the isotype and IgG subclass distribution of
anti-pneumococcal antibodies and response to polysaccharide vaccination in otitis
prone children. METHODS: IgG1, IgG2 and IgA antibodies to pneumococcal serotypes 
3, 4, 6B, 9V, 14, 19F and 23F were determined in otitis prone children and in an 
age-matched healthy control population. Patients were immunized with a 23-valent 
pneumococcal polysaccharide vaccine. The antibody response was measured 4 weeks
later. RESULTS: Geometric mean IgA and IgG2 antibody levels for all seven
pneumococcal serotypes tested were significantly lower in otitis prone children
than in the control population. After immunization, there was no significant
increase in geometric mean IgG2 anti-serotype 6B, 19F and 23F pneumococcal
polysaccharide (weak immunogenic), but also no increase for IgG2 anti-serotype 4 
and 14. Post immunization IgG2 antibody titers for serotypes 6B, 9V and 19F even 
remained below titers of non-vaccinated controls. Nine out of 29 otitis prone
children were colonized nasopharyngeally with Streptococcus pneumoniae during the
time of vaccination; these children had an even more severely impaired systemic
antibody response. CONCLUSIONS: Otitis prone children, while having normal IgG1
antibody levels, have low IgG2 and IgA anti-polysaccharide antibody levels and
fail to respond in these subclasses upon vaccination with pneumococcal
polysaccharide vaccine.

Publication Types: 
    Comparative Study

PMID: 12049826 [PubMed - indexed for MEDLINE]

1936: Int J Pediatr Otorhinolaryngol. 2002 Jun 17;64(2):89-95.

Diagnostic certainty for acute otitis media.

Rosenfeld RM.

Department of Otolaryngology, Long Island College Hospital and State University
of New York (SUNY), Downstate Medical Center, 339 Hicks Street, Brooklyn, NY
11201, USA. richrosenfeld@msn.com

Our primary objective was to assess diagnostic accuracy for acute otitis media
(AOM) relative to the criterion standard established by the United States Agency 
for Healthcare Research and Quality: middle-ear effusion (MEE) plus onset in the 
past 48 h of signs or symptoms of middle-ear inflammation. A secondary objective 
was to assess the potential reduction in antibiotic usage that could be achieved 
if clinicians managed AOM according to a consensus guideline developed by the New
York Region Otitis Project (NYROP). A convenience sample of primary care
practitioners were surveyed after diagnosing AOM in 135 children aged 0.3-11.8
years (median 2.4 years). Clinicians expressed high certainty for AOM diagnosis
in 122/135 episodes (90%). The prevalence of true AOM was 70% with a positive
predictive value for high certainty of 76%. Of the 40 false-positive diagnoses,
35 did not have MEE and 5 did not have acute signs or symptoms. The relative risk
for receiving an antibiotic was 1.50 times higher when clinicians expressed
certainty (P=0.005), which produced 31/120 (26%) potentially unnecessary
antibiotic prescriptions. Initial antibiotics would not have been prescribed for 
29% of episodes using the NYROP guidelines. More judicious use of antibiotics may
result if clinicians deferred initial therapy in children without definitive AOM,
particularly when the presence of MEE is uncertain.

PMID: 12049821 [PubMed - indexed for MEDLINE]

1937: Arch Otolaryngol Head Neck Surg. 2002 Jun;128(6):660-3.

Suppurative complications of acute otitis media in the era of antibiotic
resistance.

Zapalac JS, Billings KR, Schwade ND, Roland PS.

Department of Otolaryngology-Head and Neck Surgery, The University of Texas
Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA.

OBJECTIVE: To review our experience with suppurative complications of acute
otitis media (AOM) in the era of antibiotic resistance, given a perceived
increase in the number of such cases in recent years requiring surgical
intervention. DESIGN: Retrospective review of pediatric patients presenting with 
suppurative complications of AOM from January 1993 to June 2000. SETTING:
Academic tertiary care children's medical center. PATIENTS: A total of 90
pediatric patients, ranging in age from 3 months to 16 years (mean age, 45
months). RESULTS: A total of 104 suppurative complications of AOM occurred in 90 
patients over the 7.5-year study period. The incidence of noncoalescent,
coalescent, and total cases of mastoiditis and total number of suppurative
complications all increased over the study period, with coalescent outpacing
noncoalescent disease during the last 3 years of the study. A trend toward an
increasing number of cases requiring surgical intervention was noted during the
study period, corresponding to an increasing number of resistant Streptococcus
pneumoniae isolates. Ten of 16 S pneumoniae isolates were resistant, primarily
collected from younger children ranging in age from 4 to 24 months (mean age,
11.9 months). CONCLUSION: The rising incidence of resistant S pneumoniae
corresponded to the increasing number of suppurative complications of AOM during 
the study period and seemed to contribute to more aggressive infectious processes
requiring surgical intervention.

PMID: 12049560 [PubMed - indexed for MEDLINE]

1938: Curr Allergy Asthma Rep. 2002 Jul;2(4):309-15.

Immunologic aspects of otitis media.

Bernstein JM.

Department of Otolaryngology, School of Medicine and Biomedical Sciences, State
University of New York at Buffalo, 2430 North Forest Road, Getzville 14068, USA. 
jbernste@acsu.buffalo.edu

The middle ear cleft is a modified gas pocket which functions normally when the
gas contents are regulated by a normal eustachian tube, resulting in equalization
of middle ear pressure to that of the environment. The most important regulator
of this middle ear pressure is the eustachian tube, a critical passageway from
the nasopharynx into the middle ear. Any alteration of eustachian tube
mucociliary function caused by virus, allergy, pollutants, or alteration of the
normal homeostasis of the nasopharynx will result in eustachian tube obstruction.
This, in turn, leads to underventilation of the middle ear, and transudation of
fluid. If bacteria or virus or viral-bacterial interaction leads to infectious
disease of the middle ear, an immune response is produced as a result of the
inflammatory response, allowing lymphocytes and antigen-presenting cells to enter
into the middle-ear mucosa. This article summarizes the immunologic reactivity in
the middle ear following a viral-bacterial inflammatory reaction in the
middle-ear mucosa. Although secretory IgA is critical for protection of the
nasopharynx, its function in the middle ear has still not been resolved. The
evidence strongly suggests that IgG1 and IgG3 subclasses are responsible for
eradication of middle ear pathogens. Finally, a review of alternative approaches 
to the prevention of otitis media is briefly discussed in this critical period of
emergence of resistant bacteria to available antibiotics.

Publication Types: 
    Review

PMID: 12044266 [PubMed - indexed for MEDLINE]

1939: Curr Allergy Asthma Rep. 2002 Jul;2(4):304-8.

The genetics of otitis media.

Goodwin JH, Post JC.

Allegheny General Hospital, Pediatric Otolaryngology, MCP-Hahnemann School of
Medicine, 320 East North Avenue, 7th Floor, South Tower, Pittsburgh, PA 15212,
USA.

Almost every child will suffer at least one episode of otitis media (OM).
Therefore, it is not immediately obvious that there is a genetic predisposition
to the development of the disease. However, evidence from a variety of studies
has shown that there is a clear genetic component to susceptibility to OM.
Methodologies for discovering these genes are described within this article. The 
identification of OM susceptibility genes allows the development of molecular
diagnostic assays that will inform the clinician as to which child is at
increased risk and warrants more aggressive intervention. Delineating the OM
genes not only provides a deeper understanding of the pathophysiology of this
common disease, but also of acute and chronic bacterial disease in general.

Publication Types: 
    Review

PMID: 12044265 [PubMed - indexed for MEDLINE]

1940: Curr Allergy Asthma Rep. 2002 Jul;2(4):297-303.

Otitis media: diagnosis, management, and judicious use of antibiotics.

Stool S, Carlson LH, Johnson CE.

The Children's Hospital and University of Colorado School of Medicine, 1056 E.
19th Avenue, B455, Denver 80218, USA. stool.sylvan@tchden.org

Otitis media continues to present a major challenge to practitioners in the
clinical setting. With the ever-increasing trend toward the use of a sound
research-structured approach to health care and the use of evidence-based
guidelines, it is important to have an understanding of these findings related to
otitis media. A review of research-supported literature regarding the diagnosis
and management of this disease, and suggestions for the judicious use of
antibiotics, are presented in this paper.

Publication Types: 
    Review

PMID: 12044264 [PubMed - indexed for MEDLINE]

1941: Pediatrics. 2002 Jun;109(6):993-8.

Pediatric residents' clinical diagnostic accuracy of otitis media.

Steinbach WJ, Sectish TC, Benjamin DK Jr, Chang KW, Messner AH.

Division of General Pediatrics, Stanford University School of Medicine, Stanford,
California, USA. stein022@mc.duke.edu

OBJECTIVE: Pediatric resident physicians' clinical diagnostic accuracy of otitis 
media is unknown. We attempted to correlate the clinical examination of pediatric
house staff with pediatric otolaryngologists and tympanometry. METHODS: Pediatric
residents evaluated patients who were scheduled in the pediatric acute care
clinic and completed a provider examination form detailing their otoscopic
findings, interpretation, and treatment plan. Patients were then immediately
reevaluated by a pediatric otolaryngologist using an identical form. Tympanometry
was also performed by a pediatric audiologist. We used kappa statistics to
calculate correlation of clinical findings and interpretation. RESULTS: A total
of 103 patients consented for the study; 70 patients were examined by 27
different pediatric residents with 43 patients (86 ears) examined by all 3
providers. Correlation of clinical findings between all pediatric residents and
the pediatric otolaryngologists was a kappa statistic of 0.30 (fair agreement).
The individual diagnostic finding with the greatest correlation was tympanic
membrane erythema (kappa statistic: 0.40 [fair agreement]), and the worst
correlate was tympanic membrane position (kappa statistic: 0.16 [slight
agreement]). Resident interpretation and tympanometry yielded a kappa statistic
of 0.20 (slight agreement), and the otolaryngologist interpretation and
tympanometry yielded a kappa statistic of 0.32 (fair agreement). CONCLUSIONS:
Otitis media is the most common disease seen by practicing general pediatricians,
but there is a paucity of formalized resident education. We demonstrated only a
slight to moderate correlation between the clinical diagnostic examinations of
pediatric residents and pediatric otolaryngologists and tympanometry.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12042534 [PubMed - indexed for MEDLINE]

1942: J Small Anim Pract. 2002 May;43(5):203-7.

Food sensitivity in the dog: a quantitative study.

Chesney CJ.

Over a period of one year, 251 dogs were presented to a UK-based dermatology
referral clinic. Eighty-five of these were either diagnosed as having symptoms
compatible with atopy (58 dogs), or suffered from chronic otitis or recurrent
pyoderma. All 85 were placed on a carefully restricted diet for eight to nine
weeks in an attempt to establish whether the symptoms were due to food
sensitivity. In total, 19 were shown to have food sensitivity, representing 7.6
per cent of all dogs presented to the clinic, and one-third (32.7 per cent) of
those dogs with signs compatible with a diagnosis of atopy. In five dogs with
proven food sensitivity, otitis was the principal clinical sign and, in two
others, recurrent pyoderma. In the population studied, labradors appeared to be
predisposed to the condition. Improvement was monitored by asking owners to
assess their dog's symptoms on an ordinal scale of pruritus. In those cases in
which food sensitivity was confirmed, significant reduction in pruritus occurred.
Most of these could be maintained long term on a commercial restricted-component 
diet. Particular effort was made to ensure owner compliance with the diet trials,
using an explanation and model based upon a Venn diagram showing assumed links
between atopy and several 'flare factors'. It was found that this approach
significantly enhanced client understanding and cooperation. It is concluded that
a careful approach, monitored by active clinical audit, will help to establish
the true incidence of food sensitivity.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12038852 [PubMed - indexed for MEDLINE]

1943: Acta Otolaryngol. 2002 Apr;122(3):262-9.

Maternal pneumococcal conjugate immunization protects infant chinchillas in the
pneumococcal otitis media model.

Hajek DM, Quartey M, Giebink GS.

Otitis Media Research Center and the Department of Pediatrics, University of
Minnesota School of Medicine, Minneapolis 55455, USA.

Infant immunization with pneumococcal polysaccharide-protein conjugate vaccines
(PCVs) is unlikely to elicit protective serum antibody concentrations during the 
first 4-6 months of life, when recurrent pneumococcal otitis media (POM) often
begins. We therefore investigated a maternal pneumococcal immunization strategy
to prevent early infant POM. Pregnant chinchillas (dams) received injections of
heptavalent PCV or saline. Post-partum maternal and infant (kits) blood samples
were obtained, and kits were subsequently challenged by intranasal inoculation of
a vaccine-type pneumococcal strain (19F). Anti-pneumococcal capsular
polysaccharide IgG antibody (Ab) concentration was measured using an ELISA in
maternal and kit serum samples. Immunized dams and their kits had significantly
higher Ab titers than control dams and their kits. Antibody titer in kits
declined with a half-life of 12 days. Maternal immunization significantly reduced
both the incidence (p = 0.05) and severity (p <0.01) of experimental POM in
chinchilla kits, and was 82% effective at preventing mortality from invasive
pneumococcal disease. Pre-challenge serum Ab concentration in kits was the single
best predictor of POM severity (r = -0.66). This experiment strongly supports the
hypothesis that maternal immunization with PCV will reduce the burden of early
infant POM and invasive pneumococcal disease.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12030572 [PubMed - indexed for MEDLINE]

1944: Acta Otolaryngol. 2002 Apr;122(3):255-61.

Effect of 10 pharmacologic probes on mRNA levels of inducible nitric oxide
synthetase and selected inflammatory cytokines in a rat model of acute otitis
media.

Hebda PA, Burckar GJ, Alper CM, Swarts JD, Moody-Antonio S, Zeevi A, Doyle WJ.

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh,
University of Pittsburgh, Pennsylvania 15213-2583, USA. hebda@pitt.edu

Ten drugs were screened for their ability to decrease inflammatory mediator
(IL-6, inducible nitric oxide synthetase [iNOS], IL-1beta and monocyte
chemotactic protein [MCP-1]) expression in a rat model of acute otitis media
caused by Streptococcus pneumoniae. Six adult rats were randomly assigned to each
of 12 groups corresponding to uninfected controls and treatments with saline,
aminoguanidine, anisomycin, dexamethasone, ketorolac, L-N(G)-nitroarginine
methylester, methylprednisolone, mycophenolic acid, pentoxiphylline, tacrolimus
or WEB2086. Forty-eight h after the start of treatment, the ears of the animals
in the 11 treatment groups were challenged with S. pneumoniae. Forty-eight h
later, all animals were killed and middle ear mucosa was harvested and assayed
for RNA message. Messages for IL-6, iNOS and MCP-1 were significantly increased
as a result of infection. Most treatments decreased MCP-1 and four decreased IL-6
and iNOS. Tacrolimus and dexamethasone decreased IL-6, iNOS and MCP-1. These
results show that pharmacological agents can modify the expression of
inflammatory mediators in this model and may have clinically relevant effects.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12030571 [PubMed - indexed for MEDLINE]

1945: Scand J Infect Dis. 2002;34(3):227-9.

Conservative treatment of malignant (invasive) external otitis caused by
Aspergillus flavus with oral itraconazole solution in a neutropenic patient.

Finer G, Greenberg D, Leibovitz E, Leiberman A, Shelef I, Kapelushnik J.

Pediatric Department, Soroka University Medical Center, and Faculty of Health
Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Aspergillus flavus causes invasive external otitis associated with severe
infection of the skull base. A combination of amphotericin B, surgical
debridement and long-term itraconazole is considered the therapy of choice. We
report a case of invasive external otitis due to A. flavus that was treated
successfully with a short course of amphotericin B and long-term oral
itraconazole without surgical intervention.

Publication Types: 
    Case Reports

PMID: 12030404 [PubMed - indexed for MEDLINE]

1946: Prof Nurse. 2001 Dec;17(4):256-8.

Nurse-led ear care: training needs and the latest techniques.

Fox A, Bartlett P.

Bournemouth University.

Patients requiring ear care have reported higher levels of satisfaction when this
was provided by nurses. The wisdom of ear syringing, the traditional method of
cleaning the ear, is now being questioned for many patients, and the aural toilet
should be used as an alternative when appropriate. Nurses should remember that
good communications skills are vital.

Publication Types: 
    Review

PMID: 12030182 [PubMed - indexed for MEDLINE]

1947: Arch Otolaryngol Head Neck Surg. 2002 May;128(5):561-6.

The impact of atopy on neutrophil activity in middle ear effusion from children
and adults with chronic otitis media.

Hurst DS, Venge P.

Department of Medical Sciences, Laboratory for Inflammation Research, University 
Hospital, Uppsala University, Sweden. meear@earthlink.net

OBJECTIVE: To identify the relationship of neutrophil activity to allergy as
reflected by the level of myeloperoxidase (MPO) in ears of atopic patients with
chronic otitis media with effusion (OME) by objective testing. DESIGN: Evidence
of neutrophils was measured in the effusion of atopic patients with chronic OME. 
Atopy was determined by intradermal and/or in vitro testing of allergic reaction 
to 10 inhalants, 2 molds, and 5 foods. SUBJECTS: Effusion MPO was measured
prospectively in 138 ears from 106 consecutive patients with chronic OME.
RESULTS: A total of 86 (81%) of 106 patients with OME tested atopic by in vitro
or in vivo testing. Excluding 36 ears with purulence, the mean MPO level was 3132
microg/L in 84 atopic vs 142 microg/L in 18 nonatopic ears (P<.001). A total of
78 (90%) of 87 patients with OME were atopic. CONCLUSIONS: The surprising finding
of marked elevation of effusion MPO in atopic patients but very low levels in
nonatopic patients (P < .001) suggests that atopy may contribute to elevated
levels of neutrophil activity in OME. An atopic patient may respond differently
from a nonatopic one to the microbial or viral products of acute inflammation
owing to the presence of primed inflammatory cells. This study provides
confirmation on a cellular level that neutrophils are an integral part of the
inflammatory process in OME to a disproportionate degree among atopic patients.

Publication Types: 
    In Vitro

PMID: 12003588 [PubMed - indexed for MEDLINE]

1948: Am J Otolaryngol. 2002 May-Jun;23(3):142-7.

The use of otic powder in the treatment of acute external otitis.

Goldenberg D, Golz A, Netzer A, Joachims HZ.

Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center, and
Technion Faculty of Medicine, Haifa, Israel. g.david@tx.technion.ac.il

BACKGROUND: Acute external otitis (AEO) is a painful condition that results as a 
secondary infection of macerated skin and subcutaneous tissues of the external
auditory canal. The most commonly causative microorganisms are Pseudomonas
aeruginosa and Staphylococcus aureus. Classic management strategies include
moisture prevention, cleansing of the canal and administration of topical
antimicrobial agents in drop form, such as aminoglycosides and quinolones, at
times in combination with steroid solutions. The objective of this study was to
evaluate and compare the efficacy of topical otic powder, tobramycin drops and
ciprofloxacin drops in patients suffering from AEO. MATERIALS AND MEASURES: A
randomized prospective trial was performed to determine the efficacy of
Auricularum powder (dexamethasone 10 mg, oxytetracycline HCl 90,000 U, polymyxin 
B Sulfate 100,000 U, nystatin 1,000,000 U; Trima, Serolam Laboratories, Germany) 
compared with ciprofloxacin (Ciloxan, Alcon Laboratories, Fort Worth, TX) and
tobramycin (Tobrex, Alcon Laboratories) drops for the treatment of AEO. One
hundred twenty patients who presented with signs and symptoms of AEO were
enrolled. Inclusion criteria were: AEO diagnosed by an otolaryngologist, patient 
age 18 years, no prior treatment with other drops or systemic antibiotics, no
sensitivity to any of the drugs used or their contents, and no perforation of the
tympanic membrane. All patients were instructed to avoid moisture and wetness of 
the ear during the course of their treatment. After we received informed consent,
a swab culture was taken, and the patient was randomly assigned topical treatment
for 14 days. RESULTS: Eighty-six percent of those treated with Auricularum powder
were cured at day 3-4 after initial treatment. Seventy-seven percent of those
treated with ciprofloxacin drops, and fifty-six percent of those treated with
tobramycin were cured at that time. All 120 patients were cured by day 14.
CONCLUSION: The results show that topical treatment with Auricularum powder is an
effective and rapid method for the treatment of AEO. Ciloxan also was effective
in the treatment of AEO and relieved symptoms quickly and efficiently in a short 
period of time. Tobrex was effective in treating AEO, but our results show that
relief of symptoms was slower than with the other drugs. Copyright 2002, Elsevier
Science (USA). All rights reserved.)

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 12019482 [PubMed - indexed for MEDLINE]

1949: Ann Otol Rhinol Laryngol. 2002 May;111(5 Pt 1):430-40.

Anaerobic bacteria in upper respiratory tract and other head and neck infections.

Brook I.

Department of Pediatrics, Georgetown University School of Medicine, Washington,
DC, USA. ib6@georgetown.edu

Anaerobic bacteria are common in chronic upper respiratory tract and head and
neck infections. Anaerobes are the most predominant components of the normal
human oropharyngeal bacterial flora, and are therefore a common cause of
bacterial infections of the upper respiratory tract that are of endogenous
origin. Because of their fastidious nature, anaerobes are difficult to isolate
from infectious sites and are often overlooked. Anaerobic bacteria can be
recovered in chronic otitis media and sinusitis, and play a role in tonsillitis. 
They are also important in complications of these infections. Anaerobes
predominate in deep oral and neck infections and abscesses. In addition to their 
direct pathogenicity in these infections, they possess an indirect role through
their ability to produce the enzyme beta-lactamase. In this fashion, they are
capable of "shielding" non-beta-lactamase-producing bacteria from penicillins.
The lack of directing adequate therapy against these organisms may lead to
clinical failures. Their isolation requires appropriate methods of collection,
transportation, and cultivation of specimens. Treatment of anaerobic infections
is complicated by the slow growth of these organisms, by their polymicrobial
nature, and by the growing resistance of anaerobic bacteria to antimicrobials.
Antimicrobial therapy is often the only form of therapy required, whereas in
other cases, it is an important adjunct to a surgical approach. Because anaerobic
bacteria generally are recovered mixed with aerobic organisms, the choice of
appropriate antimicrobial agents should provide for adequate coverage of both
types of pathogens.

Publication Types: 
    Comparative Study
    Review

PMID: 12018328 [PubMed - indexed for MEDLINE]

1950: Ann Otol Rhinol Laryngol. 2002 May;111(5 Pt 1):415-22.

Induction of mucous cell metaplasia by tumor necrosis factor alpha in rat middle 
ear: the pathological basis for mucin hyperproduction in mucoid otitis media.

Kawano H, Haruta A, Tsuboi Y, Kim Y, Schachern PA, Paparella MM, Lin J.

University of Minnesota Otitis Media Research Center, Department of
Otolaryngology, University of Minnesota School of Medicine, Minneapolis, USA.

Mucoid otitis media (MOM), one of the leading causes of acquired hearing loss in 
children, is characterized by mucous cell hyperplasia in the middle ear cleft
associated with mucin accumulation in the middle ear cavity. The factors that
stimulate mucous cell metaplasia-hyperplasia and mucin hyperproduction are poorly
understood. Recent studies demonstrated that tumor necrosis factor alpha
(TNF-alpha), present in human middle ear effusion, stimulated mucin production in
vitro and up-regulated mucin gene expression in vivo. These findings suggest that
TNF-alpha is important in the development of mucous cell metaplasia-hyperplasia. 
This study demonstrated that inoculation of TNF-alpha into the middle ear cavity 
followed by eustachian tube obstruction stimulated mucous cell
metaplasia-hyperplasia in the middle ear cleft, accompanied by abundant mucin or 
mucin-like glycoproteins in the middle ear effusion--a phenotype of MOM in
humans. This finding suggests that TNF-alpha plays a key role in the pathogenesis
of MOM through induction of mucous cell metaplasia-hyperplasia and mucin
production.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12018326 [PubMed - indexed for MEDLINE]

1951: ORL J Otorhinolaryngol Relat Spec. 2002 Mar-Apr;64(2):95-107.

Bone resorption in chronic otitis media: the role of the osteoclast.

Jung JY, Chole RA.

Department of Otolaryngology, Washington University, St. Louis, Mo., USA.

Most of the pathology associated with cholesteatoma is the result of
osteoclast-mediated bone resorption in the middle ear. Cytokines, prostaglandins,
nitric oxide, neurotransmitters and growth factors are associated with chronic
inflammation and have been implicated in cholesteatoma-induced bone resorption.
Although many different factors are known to regulate osteoclast activation,
there is a final common pathway of osteoclast differentiation and resorption.
Recent advances in molecular techniques and the increasing availability of
genetically altered mice have provided valuable insight into the molecular
mechanism of osteoclastic bone resorption. This review focuses on osteoclast
biology, lessons from genetically altered mice, and their contribution to our
understanding of cholesteatoma-induced bone resorption. Copyright 2002 S. Karger 
AG, Basel

Publication Types: 
    Review

PMID: 12021500 [PubMed - indexed for MEDLINE]

1952: ORL J Otorhinolaryngol Relat Spec. 2002 Mar-Apr;64(2):86-94.

Mucous glands in the middle ear - what is known and what is not.

Tos M, Caye-Thomasen P.

Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Gentofte University
Hospital of Copenhagen, Denmark. mirko.tos@dadlnet.dk

A review of acquired and lacking knowledge on mucous glands in the human middle
ear is presented. Investigations on whole-mount and section preparations from
fetuses, prematures and infants, normal and slightly abnormal children and adults
are reviewed in detail. It is concluded that mucous glands are not a normal, but 
a pathological component of the middle ear mucosa. Gland formation and
degeneration are described. Theories on pathogenesis are discussed and new ideas 
for further research are indicated. Copyright 2002 S. Karger AG, Basel

PMID: 12021499 [PubMed - indexed for MEDLINE]

1953: ORL J Otorhinolaryngol Relat Spec. 2002 Mar-Apr;64(2):80-5.

Vaccination and otitis media.

Karma P.

Department of Otorhinolaryngology, Helsinki University Central Hospital,
Helsinki, Finland. pekka.karma@hus.fi

Acute otitis media (AOM) caused by Streptococcus pneumoniae, Haemophilus
influenzae or Moraxella catarrhalis may induce specific systemic and/or local
immune responses, which may protect from otitis media caused by the same
bacteria. However, earlier clinical trials with pneumococcal capsular
polysaccharide vaccines have not been successful in preventing AOM. Recently
developed pneumococcal polysaccharide-protein conjugates proved immunogenic even 
in infants, and a heptavalent pneumococcal CRM 197 conjugate vaccine gave a 57%
reduction in the number of pneumococcal AOM episodes caused by the vaccine
serotypes in infants in Finland. H. influenzae causing AOM is noncapsulated, and 
like M. catarrhalis, calls for another kind of vaccine development. Suitable
vaccine candidates are not yet available but are under development and being
tested for immunogenicity and safety. In some trials influenza vaccines have
shown protection from AOM during respective viral epidemics. Passive
immunoprophylaxis might be an important alternative for immunocompromised
children, although this approach has not been successful so far. Mucosal
immunization and the advent of DNA and gene technology will open new interesting 
prospects in the future. Copyright 2002 S. Karger AG, Basel

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 12021498 [PubMed - indexed for MEDLINE]

1954: ORL J Otorhinolaryngol Relat Spec. 2002 Mar-Apr;64(2):65-72.

Chronic silent otitis media.

Paparella MM, Schachern PA, Cureoglu S.

Department of Otolaryngology, University of Minnesota, Minneapolis 55454-1449,
USA.

Otitis media occurs along a continuum. For example, otitis media with effusion
characterized by fluid pathology can lead to chronic otitis media plus chronic
mastoiditis, characterized by the presence of intractable tissue pathology such
as cholesteatoma, cholesterol granuloma or granulation tissue. The literature
defines chronic otitis media as having a tympanic membrane perforation and
otorrhea. Amongst many other sequelae, which can result from the continuum, an
important common one is chronic silent otitis media. This overlooked entity which
includes pathology beneath an intact tympanic membrane is commonly seen in our
human temporal bone laboratory and in patients. The clinical pathological
correlates of this important disease are discussed herein. Copyright 2002 S.
Karger AG, Basel

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 12021496 [PubMed - indexed for MEDLINE]

1955: Int J Pediatr Otorhinolaryngol. 2002 May 31;64(1):51-60.

Transient evoked otoacoustic emissions in children studying in special schools.

Driscoll C, Kei J, Bates D, McPherson B.

Department of Speech Pathology and Audiology, The University of Queensland, St.
Lucia, Brisbane, Queensland 4072, Australia. carlie.driscoll@mailbox.uq.edu.au

OBJECTIVES: The present study aimed to investigate the feasibility and
practicalities of testing children in special school settings using transient
evoked otoacoustic emissions (TEOAE) and tympanometry. Children studying in
special schools, particularly those with intellectual impairment, may be highly
susceptible to hearing pathologies and can be difficult to assess using
traditional test batteries. Researchers have recently suggested the possible
applicability of TEOAE testing, in lieu of conventional behavioral methods, as a 
hearing screening device for persons with intellectual impairment. However, to
date, few publications have detailed the particulars and results of such testing.
METHODS: A total of 489 children, with a mean age of 9.6 years, were tested in 15
special schools. Case information was obtained regarding birth history, medical
history and type/degree of impairment, for later comparison with screening
results. TEOAEs were collected using Quickscreen mode of the ILO292 Otodynamics
Analyzer, whilst tympanometry was performed utilizing a Madsen Zodiac 901 Middle 
Ear Analyzer. RESULTS: In total, 80% of students were able to be tested using
TEOAEs. Average test time per ear was 2 min. However, a large proportion (40% of 
those able to be tested) failed TEOAE testing in at least one ear. No significant
effects were found between could-not-test (CNT) cases and case history factors. A
significant difference in TEOAE failure rates was found across history of
neonatal special care nursery residency and history of parental concern regarding
possible hearing impairment. Failure rates were higher for those who indicated
positive histories. A total of 74% of subjects could be tested using
tympanometry, with 25% of those able to be tested failing in at least one ear.
Notably, neither type nor degree of impairment had any significant bearing on CNT
or failure rates for tympanometry or TEOAE screening. CONCLUSIONS: Findings of
the present investigation lend support to the review of hearing screening
programs for children in special schools, with TEOAEs presenting as a potential
alternative procedure. Further examination of the performance measures of
protocols incorporating TEOAEs would now be advantageous.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12020914 [PubMed - indexed for MEDLINE]

1956: Int J Pediatr Otorhinolaryngol. 2002 May 31;64(1):35-40.

Resistant bacteria in the adenoid tissues of children with otitis media with
effusion.

Karlidağ T, Demirdağ K, Kaygusuz I, Ozden M, Yalçin S, Oztürk L.

Firat University Medical Faculty Otorhinolaryngology Department, Firat
Universitesi, Tip Fakültesi, KBB Anabilim Dali, 23119 Elaziğ, Turkey.
turgut_karlidag@yahoo.com

OBJECTIVE: To investigate the relationship between the resistant bacteria in the 
adenoid tissue and the middle ear effusion of children who underwent myringotomy 
and adenoidectomy with the diagnosis of otitis media with effusion (OME).
METHODS: This study was performed in the ENT Clinic, Firat University between
January 2001 and June 2001. Forty-one subjects who were enrolled in the study
were diagnosed as OME, their age ranged from 1 to 11 years, and they underwent a 
myringotomy together with an adenoidectomy because of adenoid hyperthrophy.
Bacteriological cultures were performed on the samples obtained from adenoid
tissues and middle ear fluids, in the bacteria that were cultured; the resistance
to oxacilline sodium and beta-lactamase were investigated. The resistance of
penicillin was confirmed by MIC test. The control group composed of individuals
who did not have OME but who underwent adenotonsillectomy due to adenotonsillary 
hyperthrophy. RESULTS: In the adenoid tissue cultures; Haemophilus influenzae,
Streptococcus pneumoniae and Moraxella catarrhalis species were isolated from the
70% (29/41) of the study group and 40% (20/41) of the control group (P<0.01). In 
the isolated bacteria, the resistance rates for oxacilline or beta-lactamase were
found to be 48% (20/41) in the study group and 16% (4/25) in the control group
(P<0.05). We observed that bacterial growth in 29% (9/31) of the middle ear
cultures of the study group and resistant bacteria were isolated in 77% (7/9) of 
them. The same pathogens which have grown in the middle ear cultures were also
present in the adenoid tissue cultures. CONCLUSION: The isolation of resistant
bacteria in most of the adenoid tissue samples of the children with OME, makes us
to consider the possible role of these bacteria in the development of OME.

PMID: 12020912 [PubMed - indexed for MEDLINE]

1957: Pediatr Infect Dis J. 2002 Mar;21(3):264-5.

Tularemia of the middle ear.

Luotonen L, Tapiainen T, Kallioinen M, Luotonen J.

Department of Otorhinolaryngology, Oulu University Central Hospital, Finland.

We report the case of a 10-year-old boy with prolonged fever who was found to
have tularemia of the middle ear. Otolaryngologic cases including oropharyngeal
and glandular or ulceroglandular forms of the head and neck region are estimated 
to account for 12% of all tularemia cases, but to date we have not seen a report 
of tularemia in the middle ear. The possibility of tularemia may not occur to a
physician because of the wide variation of clinical manifestations.

Publication Types: 
    Case Reports

PMID: 12005098 [PubMed - indexed for MEDLINE]

1958: Pediatr Infect Dis J. 2002 Mar;21(3):186-92.

Antibody response to pneumococcal capsular polysaccharides in children with acute
otitis media.

Soininen A, Lahdenkari M, Kilpi T, Mäkelä PH, Käyhty H.

Department of Vaccines, National Public Health Institute, Helsinki, Finland.

BACKGROUND: To describe the antibody response to pneumococcal capsular
polysaccharides in children <2 years of age with pneumococcal acute otitis media 
(AOM) caused by serotypes 6A, 6B, 11A, 14, 19F or 23F. These serotypes were
commonly found in both nasopharyngeal carriage and AOM in children of the study
population in Finland. METHODS: Serum antibody concentrations to pneumococcal
capsular polysaccharides of types 6B, 11A, 14, 19F and 23F were measured by
enzyme immunoassay in acute and convalescent sera from children with AOM.
RESULTS: Responses (at least 2-fold increase of antibody concentration) were
relatively infrequent and varied with both the age of the child and the serotype 
of the Streptococcus pneumoniae isolated from the middle ear fluid. Children
older than 12 months were more likely to have antibody responses than were
younger children. Responses were seen only infrequently to types 6A, 6B or 19F (1
of 14, 1 of 9 and 2 of 25, respectively), more often to types 11A and 14 (2 of 8 
and 3 of 8) and relatively frequently to type 23F (8 of 18). However, the
convalescent antibody concentrations to type 23F were low and usually declined
after the infection, whereas responders to 14 AOM had antibodies that persisted
at a high concentration through the follow-up. CONCLUSIONS: The results emphasize
the differences between Streptococcus pneumoniae serotypes in their
immunogenicity and quantitative and qualitative differences of antibodies
produced after infection.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12005079 [PubMed - indexed for MEDLINE]

1959: Indian J Pediatr. 2002 Mar;69(3):223-4.

Myringoplasty for chronic otitis media.

Goyal N, Kakkar V, Goyal P, Yadav SP.

Department of Otolaryngology, Pt. Bhagwat Dayal Sharma Post Graduate Institute of
Medical Sciences, Rohtak, Haryana, India. drngoyal@rediffmail.com

METHODS: 25 children in the age group of 8-14 years suffering from chronic
suppurative otitis media were taken up for myringoplasty using onlay technique
under general anaesthesia. RESULTS: All selected cases had a central type of dry 
perforation, good cochlear reserve and healthy middle ear mucosa. Cases having
enlarged adenoids, infection in nose or throat, any traumatic perforation or
previous attempt at closure were excluded from the study. It was found that there
was 76% take up of graft after two months who also had improvement in hearing.
CONCLUSION: We conclude that myringoplasty stands a good chance in children.

PMID: 12003296 [PubMed - indexed for MEDLINE]

1960: Otolaryngol Head Neck Surg. 2002 Apr;126(4):417-22.

Tumor necrosis factor-alpha and interleukin-1beta levels in recurrent and
persistent otitis media with effusion.

Yetiser S, Satar B, Gumusgun A, Unal F, Ozkaptan Y.

Department of Otolaryngology-Head and Neck Surgery, Gulhane Military Medical
Academy, Turkey. syetiser@yahoo.com

OBJECTIVE: Based on interleukin (IL)-1beta and tumor necrosis factor (TNF)-alpha 
levels in effusions, our goals were to specify either recurrent or persistent
otitis media with effusion (OME) is a mid stage in the development of chronic
disease and to identify the factors that have an influence on cytokine levels.
STUDY DESIGN: Samples from groups with recurrent (n = 15) and persistent (n = 39)
OME were assayed for IL-1beta and TNF-alpha. Children were also grouped with
respect to age, sex, quality of effusion, and the presence of pharyngeal adenoid 
tissue. SETTING: Tertiary referral center. RESULTS: In recurrent and persistent
OME groups, IL-1beta was higher than TNF-alpha (P < 0.01). IL-beta was higher in 
recurrent OME than in persistent OME (P < 0.05). CONCLUSION: Recurrent OME seems 
to be closer to the chronic stage of the disease relative to persistent OME in
terms of higher IL-1beta levels. Each exacerbation of acute disease in recurrent 
otitis media is likely to be mediated by IL-1beta. SIGNIFICANCE: We were able to 
clarify that recurrent OME is a stage that occurs before chronic OME. Therefore, 
the prevention of acute attacks in recurrent disease would also impede long-term 
damage to the middle ear.

PMID: 11997784 [PubMed - indexed for MEDLINE]

1961: Int J Pediatr Otorhinolaryngol. 2002 May 15;63(3):219-22.

beta-Lactamase-producing Moraxella catarrhalis may prevent the emergence of
penicillin-resistant Streptococcus pneumoniae in children with recurrent acute
otitis media.

Joki-Erkkilä VP, Aittoniemi J, Vuento R, Puhakka H.

Department of Otolaryngology, Tampere University Hospital, PO Box 2000,
FIN-33521, Tampere, Finland. vp.jokierkkila@nokianlaakariassema.fi

We studied the effect of concomitant nasopharyngeal carriage of beta-lactamase
producing Moraxella catarrhalis and Haemophilus influenzae on the occurrence of
penicillin resistance of Streptococcus pneumoniae. We took nasopharyngeal samples
from 306 children with recurrent otitis media and a history of several antibiotic
treatments. We could isolate at least one of the pathogens in 89 subjects. Of
these children 13% carried more than one pathogen. Of the isolated M. catarrhalis
and H. influenzae strains 93% and 43% produced beta-lactamase, respectively. Of
the S. pneumoniae strains 25% were non-susceptible (I/R) to penicillin. However, 
in patients carrying beta-lactamase-producing M. catarrhalis together with
pneumococci all strains were susceptible to penicillin (P=0.0353). This finding
suggests that beta-lactamase producing M. catarrhalis may hinder the emergence of
penicillin resistance of S. pneumoniae in children with recurrent acute otitis
media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11997157 [PubMed - indexed for MEDLINE]

1962: Int J Pediatr Otorhinolaryngol. 2002 May 15;63(3):189-98.

Effect of intranasal histamine challenge on Eustachian tube function.

Ebert CS Jr, Pollock HW, Dubin MG, Scharer SS, Prazma J, McQueen CT, Pillsbury HC
3rd.

Department of Otolaryngology - Head and Neck Surgery, CB# 7070, Burnett - Womack 
Clinical Science Building, University of North Carolina School of Medicine,
Chapel Hill, NC 27599-7070, USA. cebert@med.unc.edu

OBJECTIVE: To show a relationship between intranasal histamine challenge, the
development of middle ear effusion and Eustachian tube (ET) dysfunction in a rat 
model. METHODS: Non-allergic Sprague-Dawley rats weighing between 450-600 g were 
randomly assigned to receive an intranasal infusion of 16 microl of 10% histamine
or normal saline. ET function was assessed by using the forced-response test to
measure passive and active opening and closing pressures at time intervals of 6, 
10, 14, 18, 22, and 26 min and 24 h post-infusion. Mucociliary clearance times
(MCCTs) of the tubotympanum at 18 min post-infusion were measured by timing the
transit of dye from the middle ear to the nasopharynx. Outcome measures were ET
dysfunction and evidence of clinical effusion. RESULTS: Intranasal histamine
caused acute ET dysfunction when introduced into the nasopharynx demonstrated by 
significant elevations in passive and active opening and closing pressures (P <
or = 0.001) compared to controls. The largest difference was seen at 26 min
post-infusion. Furthermore, MCCTs were 2.4 times longer after infusing intranasal
histamine than after saline infusion. No clinically significant effusions were
evident in either group at any time interval. CONCLUSION: These data demonstrate 
a successful development of an intranasal histamine rat model, in addition to a
relationship between intranasal histamine challenge and development of acute ET
dysfunction.

Publication Types: 
    Evaluation Studies

PMID: 11997154 [PubMed - indexed for MEDLINE]

1963: Int J Pediatr Otorhinolaryngol. 2002 May 15;63(3):185-8.

Mastoid subperiosteal abscess management in children.

Bauer PW, Brown KR, Jones DT.

Department of Otolaryngology and Communication Disorders, Children's Hospital,
Boston University School of Medicine, 300 Longwood Avenue, Boston, MA 02115, USA.
bauerp@msnotes.wustl.edu

The management of a mastoid subperiosteal abscess has traditionally required
mastoidectomy. With the improvement of antibiotic therapy current literature
supports the treatment of uncomplicated acute mastoiditis with myringotomy and
intravenous antibiotics. Treatment of a mastoid subperiosteal abscess with
tympanostomy tube insertion, intravenous antibiotics, and postauricular incision 
and drainage of the abscess avoids the morbidity and potential complications of
mastoid surgery in young children. Three patients diagnosed with a mastoid
subperiosteal abscess were managed in this way. The outcome of their treatment
has been documented with lengthy otologic follow-up. Complete resolution of the
acute infectious process was achieved in all cases with no evidence of recurrent 
disease.

Publication Types: 
    Case Reports

PMID: 11997153 [PubMed - indexed for MEDLINE]

1964: Am J Epidemiol. 2002 May 15;155(10):958-64.

Heritability of symptom domains in otitis media: a longitudinal study of 1,373
twin pairs.

Rovers M, Haggard M, Gannon M, Koeppen-Schomerus G, Plomin R.

MRC Institute of Hearing Research, University Park, Nottingham, England.

Research on risk factors and pathogenesis of otitis media has emphasized the
environment, but previous twin studies suggest a strong genetic component. In
those studies, no attempt was made to differentiate the role of initial acute
infection from the chronic airway blockage that frequently accompanies persistent
effusion. The authors estimated genetic and environmental determination of both
of these aspects of otitis media histories at three time points. A large and
representative subset of a total population cohort of all twins born in England
and Wales in 1994, was studied prospectively at ages 2, 3, and 4 years
(monozygotic, n = 715; dizygotic, n = 658). For the total symptom score, the
estimated heritabilities at ages 2, 3, and 4 years were 0.49, 0.66, and 0.71,
respectively. All correlations for the total score found in monozygotic twins
were about 0.9, but correlations were lower for dizygotic twins (p < 0.65).
Shared environmental influences declined in importance over time (0.41, 0.22, and
0.16 at ages 2, 3, and 4 years, respectively). No gender differences were found
in parameter estimates. Symptoms of acute infections showed lower heritability
(0.57 on average) and higher shared environment (0.18) than did chronic airway
blockage (0.72 heritability and 0.10 shared environment). The strong genetic
component, which this study confirms, is not unitary but distributes differently 
across the phenotypic aspects of otitis media and probably across pathogenetic
stage.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Twin Study

PMID: 11994236 [PubMed - indexed for MEDLINE]

1965: Clin Otolaryngol Allied Sci. 2002 Apr;27(2):95-7.

Comment in:
    Clin Otolaryngol Allied Sci. 2003 Oct;28(5):476.

The role of computerized tomography in the preoperative assessment of chronic
suppurative otitis media.

Walshe P, McConn Walsh R, Brennan P, Walsh M.

Department of Otolaryngology/Head and Neck Surgery Beaumont Hospital, Dublin,
Ireland.

Twenty patients awaiting mastoid surgery for chronic suppurative otitis media
underwent preoperative high resolution computerized tomography (CT) of the
temporal bones. The CT scans were compared with the intraoperative findings. CT
was helpful in determining the anatomy of the middle ear and mastoid, and
accurately predicted the extent of the disease process in the sinus tympani and
facial recess. However, it was unable to distinguish between cholesteatoma,
mucosal disease and fluid, and it contributed little to the surgical management
of the patients. This suggests that routine preoperative CT scanning of patients 
before uncomplicated virgin mastoid surgery is of questionable value.

PMID: 11994113 [PubMed - indexed for MEDLINE]

1966: Soc Sci Med. 2002 Apr;54(8):1153-65.

Beliefs about and responses to childhood ear infections: a study of parents in
eastern North Carolina.

Curry MD, Mathews HF, Daniel HJ 3rd, Johnson JC, Mansfield CJ.

Center for Health Services Research and Development, Physicians Quadrangle, East 
Carolina University, Greenville, NC 27858, USA. currym@mail.ecu.edu

Middle ear infection, also known as otitis media (OM), is a major public health
problem among American children. Although clinical and epidemiological aspects of
OM have been intensely studied, cultural factors that may be contributing to the 
problem of OM have received less attention. This article presents findings from
an ethnographic study exploring beliefs about OM and responses to the illness
among parents from eastern North Carolina. In-depth interviews were conducted
with a convenience sample of nine mothers in order to learn more about parents'
explanatory models of OM, the source of their beliefs, and how they respond to
the illness. A survey instrument based on their statements was then constructed
and administered to a convenience sample of 79 parents. The survey consisted of
belief statements about OM, as well as questions pertaining to sources of
beliefs, the home management of the disease, and the effects of the illness on
families. A cultural consensus analysis of responses to belief statements
indicates that parents shared a common model of OM. Beliefs about risks,
symptoms, and causes of OM were similar to the current biomedical model of the
illness, but their divergent beliefs about the diagnosis, prognosis and treatment
of OM could lead to unnecessary use of health care services. Clinicians, family, 
and friends were reported to be important sources of information about OM.
Parents also reported using similar home management strategies and care seeking
behaviors to minimize the impact of the illness on their children and families.
While these findings need to be replicated in studies with larger, more
representative samples, this study suggest that ethnographic approaches may
provide new insights into the cultural dimension of the problem of OM.

PMID: 11993452 [PubMed - indexed for MEDLINE]

1967: Ann Otol Rhinol Laryngol. 2002 Apr;111(4):357-63.

Incidence of regeneration of the chorda tympani nerve after middle ear surgery.

Saito T, Shibamori Y, Manabe Y, Yamagishi T, Igawa H, Ohtsubo T, Saito H.

Department of Otolaryngology, Fukui Medical University, Yoshida-gun, Japan.

We retrospectively reviewed 52 patients who underwent middle ear surgery during
which the chorda tympani nerves were severed and who then underwent secondary
surgery 1 to 5 years later. In 22 patients (42.3%), regenerated chorda tympani
nerves (entire length of the tympanic segment) were detected in the submucosal
layer of the reconstructed eardrum during the secondary surgery. Before the
secondary surgery, 16 patients (30.8%) showed threshold recovery on
electrogustometry. When 5 regenerated nerves were observed by transmission
electron microscopy, myelinated nerve fibers were detected in a small fascicle or
connective tissue, but the number of myelinated axons was significantly decreased
(7.4% to 84.6%; p = .01) compared with that in normal subjects (1,911 +/- 324; n 
= 4). There was a significant difference in the incidence of regeneration between
the group with end-to-end anastomosis (5/5 or 100%) and that with nerve gap
defects (17/47 or 36.2%; p <.05); this finding suggests that repair of the
sectioned nerve produces a better incidence of regeneration than leaving the
nerve unrepaired.

Publication Types: 
    Comparative Study

PMID: 11991589 [PubMed - indexed for MEDLINE]

1968: Inflammation. 2002 Apr;26(2):89-95.

Effects of Allergina on the treatment of otitis media with effusions.

Jeong HJ, Hong SH, Kim SC, Park EJ, Jang CH, Kim KS, Kim HM.

Department of Oriental Pharmacy, College of Pharmacy, Wonkwang University, Iksan,
Chonbuk, Republic of Korea.

The number of pediatric patients with recurrent otitis media with effusions
(ROMEs) is increasing because of the frequency of recurrence. The herbal
combination Allergina is used for inflammatory-disease treatment in the Republic 
of Korea; in our study, the patients with ROME were treated with either Allergina
(11 ears) or antibiotics (13 ears). We analyzed the levels of cytokines in
middle-ear effusions (MEEs) and compared these levels in the Allergina-treated
patients with those in the antibiotics-treated patients. The mean levels of
interleukin (IL)-2 and IL-4 in MEEs were significantly higher in the
Allergina-treated patients than in the antibiotics-treated patients, whereas
levels of IL-1beta, IL-6, IL-8, and tumor necrosis factor (TNF)-alpha in MEEs
were significantly lower in the Allergina-treated patients than in the
antibiotics-treated patients. Clinical signs of ROME disappeared markedly after
all the patients were given an oral administration of Allergina. Our experimental
studies provide evidence that Allergina may be beneficial in the treatment of
ROME by regulating cytokine production.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11989792 [PubMed - indexed for MEDLINE]

1969: Microbiology. 2002 May;148(Pt 5):1483-91.

In vivo characterization of the psa genes from Streptococcus pneumoniae in
multiple models of infection.

Marra A, Lawson S, Asundi JS, Brigham D, Hromockyj AE.

Protein Design Labs, Inc., 34801 Campus Drive, Fremont, CA 94555, USA.
andrea_marra@groton.pfizer.com

Differential fluorescence induction technology was used to identify promoters of 
Streptococcus pneumoniae genes that are expressed during lung infection of the
mouse. Among the promoter clones that were identified multiple times was the psa 
promoter, which drives expression of the psaBCA operon. These genes have been
identified previously and shown to encode a manganese permease system as well as 
play a role in the virulence of this organism. Mutations in psaB, psaC or psaA
result in growth limitation in low manganese. The expression of the psa operon
was examined in vivo and the virulence of deletion mutants of psaB, psaC, psaA
and psaBCA was assessed in four different animal models of infection. The psa
promoter was induced more than ten-fold in vivo using an intraperitoneal chamber 
implant model. The psaB, psaC and psaA mutants were completely attenuated in
systemic, respiratory tract and otitis media infections. In addition, these
mutants were unable to grow in an implanted peritoneal chamber, but growth was
restored by the addition of manganese to the chambers.

PMID: 11988523 [PubMed - indexed for MEDLINE]

1970: Otol Neurotol. 2002 May;23(3):262-6.

Total middle ear reconstructive surgery for the radicalized ear.

Ishimoto S, Ito K, Sasaki T, Shinogami M, Kaga K.

Department of Otolaryngology, Faculty of Medicine, University of Tokyo, 7-3-1
Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.

OBJECTIVE: To evaluate the efficacy of total middle ear reconstructive surgery
(TMRS) for patients with open cavity problems. STUDY DESIGN: Retrospective study 
of patients treated between 1994 and 1997. SETTING: Tertiary care, referral
medical center. PATIENTS: Fifty-nine consecutive patients (62 ears) with open
cavity problems (draining ears) who underwent TMRS. MAIN OUTCOME MEASURES:
Postoperative states of the ears and complications were evaluated in two groups, 
with and without persistent purulent otorrhea at the time of surgery. RESULTS: In
the noninfected group, ears without otorrhea were maintained in 12 (100%) of 12
ears in the short term and 10 (83%) of 12 ears in the long term. In the infected 
group, the proportions were 40 (80%) of 50 ears and 35 (73%) of 48 ears, for the 
short and long terms, respectively. Hollowing and/or retraction of the
reconstructed canal wall was observed in 1 (8%) of 12 ears of the noninfected
group and in 15 (31%) of 48 ears of the infected group after long-term follow-up.
Postoperative complications were encountered in 9 ears (14.5%) in the infected
group only. CONCLUSIONS: Total middle ear reconstructive surgery is considered
useful for the management of persistent discharge from radicalized cavities. It
was found important to minimize infection at the time of surgery to achieve
satisfactory results.

PMID: 11981379 [PubMed - indexed for MEDLINE]

1971: J Clin Microbiol. 2002 May;40(5):1851-3.

Household transmission of Streptococcus pneumoniae among siblings with acute
otitis media.

Shimada J, Yamanaka N, Hotomi M, Suzumoto M, Sakai A, Ubukata K, Mitsuda T,
Yokota S, Faden H.

Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, 
811-1 Kimidera, Wakayama City, Wakayama 641-0012, Japan.

Nasopharyngeal transmission of Streptococcus pneumoniae was evaluated among 23
siblings with acute otitis media (AOM). Restriction fragment length polymorphism 
revealed that the nasopharyngeal strains were identical between siblings in 12 of
13 clusters of AOM experienced in 11 families. This study demonstrated
person-to-person transmission of S. pneumoniae, especially drug-resistant
strains, among siblings with AOM.

PMID: 11980976 [PubMed - indexed for MEDLINE]

1972: Indian J Pediatr. 2001 Jul;68 Suppl 3:S24-31.

Otitis media.

Gupta BD, Singh A.

Umaid Hospital, Regional Institute of Mother and Child Health and Dr. S.N.
Medical College, Jodhpur. brahmadgupta@hotmail.com

There is a high rate of use of antimicrobial drugs for otitis media in children. 
This article reviews the diagnostic considerations for acute otitis media. An
extensive review of literature on this subject has been carried out in order to
address the issues of indications, choice, appropriate doses of antimicrobial
agents and the duration for which they should be used. It is important to
distinguish acute otitis media from otitis media with effusion because
antibiotics are seldom indicated for the latter condition. Oral amoxicillin
remains first-line therapy for uncomplicated acute otitis media, a short course
of antimicrobial therapy (five to seven days) may be appropriate in children two 
years of age or older with uncomplicated presentations. For clinical treatment
failures after 3 days of amoxicillin, recommended antimicrobial agents include
oral amoxicillin/clavulanate, cefuroxime axetil, cefprozil, cefpodoxime proxetil,
and intramuscular (i.m.) ceftriaxone. Tympanocentesis for identification of
pathogens and susceptibility to antimicrobial agents is recommended for selection
of third-line agents.

Publication Types: 
    Review

PMID: 11980456 [PubMed - indexed for MEDLINE]

1973: Br J Community Nurs. 2002 Apr;7(4):206, 208-11.

Does pacifier use cause ear infections in young children?

Hanafin S, Griffiths P.

Health Research Board, Ireland.

The aim of this review was to identify whether, in children under 2 years of age,
pacifier (dummy) use results in an increased risk of ear infection (acute otitis 
media). The Cochrane Library, Medline, CINAHL and Embase databases were searched 
for cohort studies and randomised controlled trials that compared infants who
used pacifiers with those who didn't or examined the effect of reducing pacifier 
use in a group of infants. One cluster randomised trial and two cohort studies
met the review criteria and were available to be included in the body of the
review. These studies show a clear increase in risk of ear infection to be
associated with use of a pacifier that may well be causal. The risk of ear
infections is up to three times higher in those who use a pacifier and there does
appear to be a 'dose response' with continual users more at risk than occasional 
users. However, this relationship may be confounded by socio-demographic factors.
Rather than advising a parent not to use a pacifier for fear of causing otitis
media, advice in relation to this issue might best be restricted to pacifier
users suffering from the problem in order to reduce the chances of recurrence.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 11979200 [PubMed - indexed for MEDLINE]

1974: J Pediatr Gastroenterol Nutr. 2002 Mar;34(3):278-80.

Comment in:
    J Pediatr Gastroenterol Nutr. 2002 Mar;34(3):269-73.

Prolonged esophageal pH monitoring in the evaluation of gastroesophageal reflux
in children with chronic tubotympanal disorders.

Rozmanic V, Velepic M, Ahel V, Bonifacic D, Velepic M.

Pediatric Clinic and Clinic of Otorhinolaryngology, Rijeka University Medical
School, Rijeka, Croatia. vojko.rozmanic@ri.tel.hr

BACKGROUND: Children with ear, nose and throat disorders are believed to have a
high incidence of pathologic gastroesophageal reflux (GER). This study was
designed to establish the frequency and ratio of pathologic GER in the
development of chronic tubotympanal disorders. METHODS: Twenty-seven children
with chronic tubotympanal disorders (mean age, 2 to 13 years; average age, 6.8
years) underwent 24-hour continuous pH monitoring. Fourteen of the examined
patients had secretory otitis, whereas 13 patients had recurrent otitis. From
each 24-hour pH monitoring, 12-hour daytime and nighttime periods were selected. 
Eleven patients were tested using simultaneous dual pH monitoring (distal and
proximal pH monitoring). RESULTS: Fifteen (55.6%) of 27 patients had pathologic
GER. The authors did not find a relation between pathologic GER and different
types of ear disorders. Daytime pH monitoring yielded significantly more episodes
of reflux than did nighttime monitoring. The reflux index was substantially
higher during the day. In the current study, distal pH monitoring showed that 6
of 11 patients had pathologic GER, whereas proximal pH monitoring showed that
only only 3 of 11 patients had pathologic GER. CONCLUSIONS: The authors recommend
that a pH study be performed in children with chronic tubotympanal disorders when
standard treatment is ineffective. The method of choice for the diagnosis of
pathologic GER in patients with chronic tubotympanal disorders should be pH
monitoring of the esophagus and throat.

PMID: 11964951 [PubMed - indexed for MEDLINE]

1975: Curr Opin Infect Dis. 2001 Jun;14(3):337-42.

Current approaches to otitis media.

Cohen R, Ovetchkine P, Géhanno P.

Department of Pediatrics, Intercommunal Hospital, Créteil, France.
robert.cohen@wanadoo.fr

Acute otitis media is the most commonly diagnosed illness in children, and is one
of the most common reasons for antibiotic prescription. In many countries,
antibiotic resistance is increasing among the bacteria that are implicated in
acute otitis media, particularly Streptococcus pneumoniae. This evolution should 
stimulate changes in the management of acute otitis media, particularly the
following: improvement in diagnostic accuracy; reduction in antibiotic use;
selection of the most appropriate drugs at the appropriate dosage; reduction in
duration of treatment, when possible; and implementation of new vaccines.

Publication Types: 
    Review

PMID: 11964853 [PubMed - indexed for MEDLINE]

1976: Curr Opin Allergy Clin Immunol. 2002 Feb;2(1):21-5.

The link between allergic rhinitis and otitis media.

Doyle WJ.

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 3705
Fifth Avenue, Pittsburgh, PA 15213, USA. Docdoyle2@aol.com

Past studies implicated allergy in the pathogenesis of otitis media. However,
definitive proof of the assertion is lacking. Epidemiologic studies, including
one recently published by Rylander and Megevand, consistently identify allergy as
a risk factor for otitis media. Also, higher than expected frequencies of allergy
are reported for patients with otitis media, but it is unclear if this is an
epiphenomenon associated with referral bias. This possibility is exemplified by
the results of two reviewed papers where Velepic and colleagues reported a 25%
prevalence of allergy in otitis media patients while Alles and colleagues
reported a prevalence of 89%. Other studies documented biochemical components of 
allergic inflammation in the effusions recovered from children with otitis media,
and Hurst and colleagues published a recent paper continuing on that theme.
However, it is not known if a local allergic reaction is required for the
production of these components and if they are produced exclusive of other
inflammatory products. Three published studies explored mechanisms by which
allergy could cause otitis media. Tikkanen and colleagues reexamined at age 10 a 
group of 56 subjects with previously diagnosed milk allergy and showed that
despite decreased reactivity to milk protein a high prevalence of otitis media
was retained. This suggests that it is the allergic condition, not the specific
allergy to milk that increases otitis media risk. Downs and colleagues exposed
the middle ears of rats to histamine and provoked changes in the pressure
regulating and clearance functions of the Eustachian tube. Those changes could
prolong an otitis media episode, but middle ear histamine is not limited to the
allergic condition. Gentile and colleagues challenged the nose of allergic and
nonallergic subjects with histamine followed by interleukin-6 or placebo and
measured nasal, pulmonary, Eustachian tube and middle ear functions.
Interleukin-6 did not change the Eustachian tube or middle ear functions but did 
cause increased secretions in allergic patients.

Publication Types: 
    Comparative Study
    Review

PMID: 11964746 [PubMed - indexed for MEDLINE]

1977: J Korean Med Sci. 2002 Apr;17(2):230-5.

Ultrastructural characteristics of the round window membrane during pneumococcal 
otitis media in rat.

Yoon YJ, Hellstrom S.

Department of Otorhinolaryngology, Chonbuk National University Hospital, Chonju, 
Korea. yjyoon@moak.chonbuk.ac.kr

To understand better the pathogenesis of inner ear (IE) damage caused by otitis
media (OM), the round window membrane(RWM) structure was investigated in a rat
model for pneumococcal otitis media (POM). The RWM of 25 rats were evaluated
light and electron microscopically on 1 day, 3 days, 6 days, 10 days, and 20 days
after the unilateral inoculation of type 3 pneumococcus suspension into their
middle ear cavities. The thickness of the RWM increased in various stages of the 
pneumococcus-evoked otitis media, compared with that of the normal. The
thickening was most pronounced on day 1, being about 4 to 5 times greater than
that of the normal RWM. All layers of the RWM were affected by the pneumococcal
infection, but the major changes were confined to the subepithelial space close
to the basement membrane (BM). Together with alterations to the BM, the most
distinct pathological features were characterized by an increase and hypertrophy 
of fibroblasts in association with abundant collagen fibers. Elastic fibers
observed close to the inner mesothelial layer under a high power magnification
also increased during the experiment. These results will be relevant to a better 
understanding of the histologic implication of RWM in stages of acute otitis
media involving pneumococcus-evoked otitis media.

PMID: 11961309 [PubMed - indexed for MEDLINE]

1978: Arch Environ Health. 2001 Nov-Dec;56(6):485-92.

Infections and atopic disorders in childhood and organochlorine exposure.

Karmaus W, Kuehr J, Kruse H.

Department of Epidemiology, Michigan State University, East Lansing 48823, USA.

The authors investigated whether organochlorine exposure is associated with
prevalence of otitis media, pneumonia, pertussis, asthma, and increased
immunoglobulin E levels in children. Organochlorine concentrations and histories 
of infection and atopic manifestation were available for 343 children, and
immunoglobulin E levels were available for 340 children. The authors applied
logistic and linear regressions and controlled for confounders. In general, the
prevalence of infections in children was not related to organochlorine exposure. 
However, for the combined effect of dichlorodiphenyldichloroethene with
polychlorinated biphenyls or hexachlorobenzene, a significantly increased
relative risk (odds ratios = 3.70 and 2.38, respectively) was found for otitis
media. Exposure to dichlorodiphenyldichloroethene resulted in a significantly
higher odds ratio for asthma (odds ratio = 3.71; 95% confidence interval = 1.10, 
12.56) and in immunoglobulin E concentrations above 200 kU/l (odds ratio = 2.28; 
95% confidence interval = 1.20, 4.31). This is the first study in which
dichlorodiphenyldichloroethene has been identified as a substantial risk factor
for asthma and for increased immunoglobulin E blood levels.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11958547 [PubMed - indexed for MEDLINE]

1979: Otolaryngol Head Neck Surg. 2002 Mar;126(3):273-80.

Sympathetic cochleolabyrinthitis in revision stapedectomy surgery.

Richards ML, Moorhead JE, Antonelli PJ.

Department of Otolaryngology, University of Florida, Gainesville 32610-0264, USA.

OBJECTIVE: The purpose of this study was to determine whether revision
stapedectomy could precipitate sensorineural hearing loss in the contralateral
ear. METHODS: We conducted a retrospective review of 148 patients undergoing
primary or revision stapedectomy at an academic, tertiary care facility. RESULTS:
Stapedectomy resulted in significant improvements in mean air conduction
thresholds in the ipsilateral ear. Overall, there were no significant changes in 
either the air or bone conduction values of the contralateral ear. Two patients
demonstrated a >20-dB decline in speech reception threshold and/or >20% decrease 
word recognition in the contralateral ear. Both of these patients demonstrated
the decline only after revision surgery. CONCLUSION: Revision stapedectomy is on 
rare occasions associated with hearing loss in the contralateral ear.
Contralateral hearing loss after revision stapedectomy may be due to sympathetic 
cochleolabyrinthitis.

PMID: 11956535 [PubMed - indexed for MEDLINE]

1980: Int J Pediatr Otorhinolaryngol. 2002 Apr 25;63(2):149-54.

Possible inflammatory mediators in tympanosclerosis development.

Forséni Flodin M, Hultcrantz M.

Department of Plastic and Reconstructive Surgery/Otorhinolaryngology, Karolinska 
Hospital, Karolinska Institute, 171 76, Stockholm, Sweden.
marie.forseni@ood.ki.se

OBJECTIVE: Tympano/myringosclerosis is a sequelae following otitis media, causing
hearing disability. There is no curative treatment for this condition. In order
to illuminate the correlation of inflammatory mediators in otitis media and
tympanosclerosis development, the present study was performed. METHODS: In an
animal model, Streptococcus pneumonia bacteria were inoculated to the middle ear.
Furthermore, biopsies were harvested during surgery, from children suffering from
secretory otitis media and from patients with already established
tympanosclerosis. The early inflammatory parameters were investigated in the rat 
model as well as in the patient material. The lymphocytic population,
macrophages, interleukin-6, inducible nitric oxide synthase and MHC class II were
studied by immunohistochemistry and by mRNA in situ hybridization. RESULTS:
Myringosclerosis was produced in 30% of the rats studied. Macrophages were the
first cells to invade the middle ear after induction of otitis media, followed by
B-cells and T-cells. IL-6 m-RNA was found as early as 1 h after inoculation.
Cells, expressing inducible nitric oxide synthase, seemed to be activated
macrophages. Osteoclast like cells, positive in immunohistechemical macrophage
staining, were found close to the insertion of the tympanic membrane. The human
specimens showed a more immunological active stage in the secretory otitis media 
group as compared to the specimens with tympanosclerosis. CONCLUSIONS: The
immunocompetent cells and some mediators are presented time dependently in otitis
media and a possible reaction sequence, leading to differentiation of macrophages
into osteoclasts is presented. This may lead to tympanosclerosis development.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11955606 [PubMed - indexed for MEDLINE]

1981: Int J Pediatr Otorhinolaryngol. 2002 Apr 25;63(2):111-8.

A preventive measure for otitis media in children with upper respiratory tract
infections.

Mora R, Barbieri M, Passali GC, Sovatzis A, Mora F, Cordone MP.

Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa,
Italy. renzomora@libero.it

Recurrent upper respiratory tract infections (URTI) are very common in patients
of all ages. Rhinitis, bronchitis, chronic sinusitis and otitis appear to be the 
prevalent forms of recurrent respiratory infections in the paediatric population.
The aim of treatment is so the solution of the respiratory pathology and the also
the prevention of their complications. Antibacterial therapy is still the
classical treatment approach in patients both with respiratory tract infections
and with otitis media, despite the fact that antibacterials have several well
known drawbacks, especially when used to treat recurrent infections. Eighty-four 
paediatric patients of both sexes (range: 4-14 years) with otitis were enrolled
in the study. Patients were included if they had a >2 years' history of recurrent
or chronic respiratory infections, and/or had experienced at least three episodes
requiring medical consultations and/or treatment during the winter prior to the
study. The young patients were randomised to receive Immucytal (group A) or
placebo (group B) treatment according to the following protocol: (1) starting
therapy (1 month): one tablet daily in the morning 4 days per week for 3
consecutive weeks; (2) maintenance period (5 months): one tablet daily in the
morning 4 days per week for 1 week every month. Placebo and Immucytal tablets
were identical in shape and size, in order to maintain double-blind conditions.
Patients of group A with recurrent URTI had a significantly decreased incidence
of ENT infections, fever and shorter duration of illness, decreased requirement
for ancillary medications and fewer work-days lost. The reduction in the
incidence of infectious episodes became significant vs. placebo. A significantly 
improved outcome vs. placebo was also observed on the incidence of fever,
frequency and duration of infectious episodes, ancillary therapies. Immucytal
treatment was associated with significant changes in both immunological and
auditory function parameters. Serum concentrations of immunoglobulins were
significantly increased in Immucytal. For both evaluations, a significant
difference between treatment groups was found (P>0.001). Preventive strategies,
such as ribosomal immunotherapy, may represent a valid alternative approach.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 11955602 [PubMed - indexed for MEDLINE]

1982: Int J Pediatr Otorhinolaryngol. 2002 Apr 25;63(2):99-110.

Histopathologic differences due to bacterial species in acute otitis media.

Cayé-Thomasen P, Tos M.

Department of Oto-rhino-laryngology, Head and Neck Surgery, Gentofte University
Hospital of Copenhagen, DK-2900 Hellerup, Denmark. pcaye@dadlnet.dk

OBJECTIVE: To compare selected features of histopathology in acute otitis media
caused by various bacteria and examine potential differences due to bacterial
species, as well as possible correlation to experimental and human clinical
findings. METHODS: Rat models of acute otitis media caused by Streptococcus
pneumoniae (MC), non-typeable or type b Haemophilus influenzae (NTHI/HIB) or
Moraxella catarrhalis (MC) were studied longitudinally up to 6 months after
bacterial challenge. Findings related to dynamics of goblet cell density,
modeling and remodeling of bone tissue structures and polyp, as well as fibrous
adhesion formation and persistence are presented. RESULTS: Middle ear goblet cell
density progressed to peak 2 weeks after bacterial inoculation, thereafter
gradually normalizing. However, density and accordingly middle ear secretory
capacity was still significantly increased after 6 months in all bacteria, except
MC. The HI species induced the highest increase. Initial osteoresorption was
followed by massive osteoneogenesis, progressing to a peak after 2-3 months,
followed by some degree of normalization, concurrently classic remodeling.
Primarily SP, but also the HI species induced more new bone formation than MC.
Mucosal polyp and fibrous adhesion formation occurred regardless of bacterial
species. Most polyps appeared in the early phases and the HI species induced
formation of more polyps and adhesions than the other bacteria. CONCLUSION: Acute
middle ear infection with the Haemophilus species induce the highest increase of 
mucosal secretory capacity, lasting for at least 6 months after the acute
incident. Thus, a subsequent development of secretory otitis media seems more
likely following infection with these bacteria. Equivalently, mucosal scarring
observed as polyp and fibrous adhesion formation was more severe following
Haemophilus infection. S. pneumoniae induced the most marked changes of bone
tissue structures, seen as initial osteoresorption and subsequent
osteoneogenesis. Overall, infection with M. catarrhalis induced the mildest
changes.

Publication Types: 
    Comparative Study

PMID: 11955601 [PubMed - indexed for MEDLINE]

1983: Eur Arch Otorhinolaryngol. 2002 Feb;259(2):67-72.

Purulent otitis media in children and adults.

Tekin M, Schachern PA, Mutlu C, Jaisinghani VJ, Paparella MM, Le CT.

The Otitis Media Research Center, Department of Otolaryngology, University of
Minnesota Medical School, Minneapolis, USA.

This study was designed to compare tympanic membrane (TM) and middle ear (ME)
pathologies of temporal bones from children and adults with purulent otitis media
(POM). Thirty-four temporal bones were used from 22 subjects ages 2 days to 76
years with histopathologic evidence of POM. There were 55 age-matched controls.
Histopathologic findings of the TM and ME in children and adults with POM were
compared. Clinical histories and the presence of complications were recorded. The
incidence of POM was more common in male children than in females. There was a
significant increase in the thickness of the posterosuperior and posteroinferior 
quadrants in children with POM compared to non-OM children. In adults with POM,
there was a significant decrease in the thickness of the posteroinferior and
anteroinferior quadrants compared to non-OM adults. Children with POM showed a
significant increase in the anterioinferior and posteroinferior quadrants and the
umbo compared to adults with POM. Pathology of the TM and ME occurred in adults
and children, but severity was greater in children. Residual mesenchyme was
frequently observed in temporal bones of children. Serious complications such as 
labyrinthtis and meningitis were observed more frequently in children. All cases 
with meningitis had labyrinthitis, previous histories of otitis media and had
been treated with antibiotics. Although POM occurs in both children and adults,
pathologic changes of the middle ear are more severe, and complications
(labyrinthitis and meningitis) occur more often in children. Our findings suggest
the need to monitor children carefully under the age of 2 years who have POM.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11954935 [PubMed - indexed for MEDLINE]

1984: J Vet Diagn Invest. 2002 Mar;14(2):159-62.

Isolation of Arcanobacterium (Actinomyces) pyogenes from cases of feline otitis
externa and canine cystitis.

Billington SJ, Post KW, Jost BH.

Department of Veterinary Science and Microbiology, The University of Arizona,
Tucson 85721, USA.

Arcanobacterium pyogenes is a normal inhabitant of the mucous membranes of
domestic animals, such as cattle, sheep, swine, and goats. It is also an
opportunistic pathogen in these animals, where it causes a variety of purulent
infections involving the skin, joints, and visceral organs. Two recent cases of
isolation of A. pyogenes from companion animals are reported. In the first case, 
a cat presented with a chronic otitis externa, from which A. pyogenes was
isolated in pure culture. The second case involved a dog with a urinary tract
infection, where A. pyogenes was isolated from urine as the predominant bacterial
species. In both cases, the A. pyogenes isolates were presumptively identified by
macrobiochemical tests, and then their identities were confirmed by polymerase
chain reaction analysis and 16S rRNA gene sequencing.

Publication Types: 
    Case Reports

PMID: 11939339 [PubMed - indexed for MEDLINE]

1985: Rev Laryngol Otol Rhinol (Bord). 2001;122(4):263-7.

A histopathologic evaluation of mucosa obtained from mastoidectomy cavity by
mastoidoscopy.

Ileri F, Sabri Uslu S, Sargon M, Gençay S, Ozbilen S, Hamdi Celik H, Köyba A.

Gazi University, School of Medicine, Department of Otorhinolaryngology, Beevler, 
Ankara, Turkey.

Despite the routine application of intact canal wall mastoidectomy for chronic
suppurative otitis media, the outcome of mucosa within the mastoidectomy cavity
is not wellknown. The purpose of this was to evaluate the mastoidectomy cavity
and obtain mucosal study specimens from the mastoidectomy cavities in order to
reveal any residual pathology. Mastoidoscopy under local anaesthesia was
performed to evaluate the mastoidectomy cavity and obtain mucosal specimens from 
the mastoid antrum. The procedure was carried out in 12 patients. Four (33%)
patients had wide cavities, 6 (50%) had their cavities narrowed down to the
antrum, and 2 (17%) patients had obliterated cavities. Mucosal specimens examined
with transmission electron microscopy revealed findings like swelling of some of 
the mitochondria, decrease in the number of organelles, intracellular oedema,
changes in the nuclei, decrease in cilia and fibrosis. In conclusion, even if
there may be some pathology at a microscopic level, this does not necessarily
lead to any clinical problem.

PMID: 11938529 [PubMed - indexed for MEDLINE]

1986: Acta Otolaryngol. 2002 Mar;122(2):153-60.

Induction of mucous cell metaplasia in the middle ear of rats using a three-step 
method: an improved model for otitis media with mucoid effusion.

Tsuboi Y, Kim Y, Giebink GS, Le C, Paparella MM, Chen N, Schachern PA, Juhn SK,
Lin J.

Department of Otolaryngology, University of Minnesota Otitis Media Research
Center, University of Minnesota School of Medicine, Minneapolis, USA.

Otitis media with mucoid effusion, characterized by mucous cell metaplasia in the
middle ear cleft and thick fluid accumulation in the middle ear cavity, is a
common otological disease that frequently affects young children. Multiple
factors are involved in the development of this disease, especially middle ear
infection and Eustachian tube dysfunction. In this study, in order to induce
otitis media with effusion in rats, we introduced a three-step method, namely
inoculation of Streptococcus pneumoniae at 10(7) colony-forming units (CFU)/ear
or Haemophilus influenzae at 5 x 10(7) CFU/ear into the middle ear cavity twice
at 2-week intervals, followed by Eustachian tube obstruction (ETO) for 4 and 8
weeks. Animals inoculated with phosphate-buffered saline (PBS) twice in the same 
manner followed by ETO served as controls. Middle ear effusion and mucosa were
harvested for evaluation of carbohydrate concentrations and mucous cell density, 
respectively. We found that rats inoculated with S. pneumoniae twice, followed by
ETO at 8 weeks, yielded the highest carbohydrate concentration in middle ear
effusion and the highest goblet cell density in the middle ear cavity compared to
the H. influenzae and PBS groups. It is tentatively concluded that inoculation of
S. pneumoniae at 10(7) CFU/ear into the middle ear cavity of rats twice at 2-week
intervals, followed by ETO for 8 weeks, is a promising animal model for otitis
media with mucoid effusion which may be valuable for studying the human
counterpart.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11936906 [PubMed - indexed for MEDLINE]

1987: Acta Otolaryngol. 2002 Mar;122(2):146-52.

In vitro study of IL-8 and goblet cells: possible role of IL-8 in the aetiology
of otitis media with effusion.

Smirnova MG, Birchall JP, Pearson JP.

Department of Physiological Sciences, Medical School, University of Newcastle,
Newcastle upon Tyne, UK. Marina.Smirnova@ncl.ac.uk

One of the main characteristics of otitis media with effusion (OME) is the
differentiation of basal cells into goblet cells with subsequent proliferation in
a modified respiratory epithelium leading to the formation of mucin-rich effusion
in the middle ear cleft. In order to determine the effect of pro-inflammatory
cytokines identified in OME, e.g. IL-1beta, tumour necrosis factor (TNF)-alpha,
IL-6 and IL-8, on goblet cells, and to clarify the role of IL-8 in particular, we
used the human goblet cell line HT29-MTX, which secretes two OME-related mucins: 
MUC5AC and MUC5B. IL-1beta and TNF-alpha stimulated the secretion of IL-8 in
HT29-MTX goblet cells. Dose- (2-200 ng/ml) and time- (0-5 days) response studies 
of IL-8-induced mucin secretion were carried out. IL-8 upregulated the secretion 
of MUC5AC and MUC5B mucins in a concentration-dependent manner, with a maximum
response at an IL-8 concentration of 20 ng/ml. IL-8 (20 ng/ml)-mediated mucin
secretion persisted for up to 5 days, with a peak response 72 h after the
addition of cytokine. These results suggest that: (i) goblet cells are target
cells for the pro-inflammatory cytokines IL-1beta, TNF-alpha and IL-8 and can
contribute to the pathogenesis of OME by increasing both the concentration of
IL-8 and the secretion of mucin; and (ii) IL-8 stimulates prolonged mucin
secretion from goblet cells and may be involved in the maintenance of the disease
in the chronic stage.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11936905 [PubMed - indexed for MEDLINE]

1988: Lippincotts Prim Care Pract. 2000 Sep-Oct;4(5):508-14.

Tobacco smoke exposure and pediatric otitis media: an empirical basis for
practice.

Gaffney KF.

College of Nursing and Health Science, George Mason University, 3C4, 4400
University Drive, Fairfax, VA 22030, USA. Kgaffney@gmu.edu

Tobacco smoke exposure has been attributed to a myriad of pediatric clinical
outcomes, with a staggering financial burden to society. This article is an
examination of published research that has focused on the relationship between
tobacco smoke exposure and pediatric otitis media. The weight of evidence
presented supports a positive relationship between the two clinical entities.
Further clinical studies are needed so primary care providers may continue to
build a strong empirical base for interventions directed at helping parents
reduce tobacco smoke exposure in their children's home environments.
Interventions based on the Ask, Advise, and Assist framework are recommended.

Publication Types: 
    Review

PMID: 11933440 [PubMed - indexed for MEDLINE]

1989: J Emerg Med. 2002 Apr;22(3):267-71.

Unilateral facial paralysis occurring in an infant with enteroviral otitis media 
and aseptic meningitis.

Hostetler MA, Suara RO, Denison MR.

Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee,
USA.

We report the case of a four month old infant presenting to the Emergency
Department (ED) with irritability and facial asymmetry following a recent bout of
gastroenteritis. Physical examination revealed a unilateral peripheral facial
nerve paralysis. Common in older children and adults, facial nerve palsy has
rarely been described in infancy. Although historically associated with a variety
of inflammatory and infectious causes, the pathogenesis remains unclear. In this 
infant we were able to successfully identify an underlying acute enteroviral
infection. Coxsackie B5 was isolated from the middle ear fluid, cerebrospinal
fluid (CSF), nasopharyngeal and rectal swabs. After myringotomy drainage of the
middle ear fluid and placement of pneumatic equalization tubes, there was rapid
and complete resolution of facial paralysis.

Publication Types: 
    Case Reports

PMID: 11932090 [PubMed - indexed for MEDLINE]

1990: J Am Acad Nurse Pract. 2001 Nov;13(11):524-9.

Assessing diagnostic accuracy and tympanocentesis skills by nurse practitioners
in management of otitis media.

Sorrento A, Pichichero ME.

University of Rochester Medical Center, Rochester, NY, USA. tsorrento@yahoo.com

PURPOSE: To assess healthcare provider accuracy in recognizing the physical
examination findings of acute otitis media (AOM) and otitis media with effusion
(OME) and technical competence in performing tympanocentesis using a simulation
model. DATA SOURCES: A descriptive study of 1,271 pediatricians and 206 nurse
practitioners (NPs) who viewed 9 different video-recorded pneumatic otoscopic
examinations of tympanic membranes (TMs) during a continuing medical education
(CME) course. Diagnostic differentiation of AOM, OME and normal was ascertained. 
A mannequin model of a one-two year old child was used to assess technical
proficiency of performing tympanocentesis on artificial tympanic membranes.
CONCLUSIONS: Overall, the average correct diagnosis by all healthcare providers
was 46% (range = 25% to 71%); by pediatricians it was 50% (25% to 71%) and by NPs
42% (25% to 68%). Pediatricians and NPs correctly recognized the absence of
normality 86% to 99% and 68% to 99% of the time; they over-diagnosed AOM in 7% to
58% (average 27%) and 10% to 65% of examinations (average 31%), respectively.
Performance of tympanocentesis was optimally performed by 73% of NPs.
IMPLICATIONS FOR PRACTICE: The distinction between AOM and OME is important for
antibiotic management decisions; tympanocentesis may be useful in diagnosis of
AOM in selected patients. Healthcare providers may misdiagnose AOM and OME with
some frequency. Nurse practitioners and pediatricians have the skills to be
trained in the tympanocentesis procedure. Interactive CME courses with simulation
technology may enhance skills and lead to a willingness to change and improve
diagnostic accuracy and treatment paradigms.

Publication Types: 
    Comparative Study

PMID: 11930518 [PubMed - indexed for MEDLINE]

1991: Ir Med J. 2002 Jan;95(1):14-6.

Malignant otitis externa--a high index of suspicion is still needed for
diagnosis.

Walshe P, Cleary M, McConn WR, Walsh M.

Department of Otolaryngology/Head and Neck Surgery, RCSI Education and Research
Centre, Beaumont Hospital, Dublin. rmwalsh@rcsi.ie

Malignant otitis externa is a destructive inflammatory process of the petrous
temporal bone which if untreated leads to osteomyelitis of the skull base and can
be fatal. It is more common in immunocompromised and elderly insulin-dependant
diabetic patients and is caused by infection with Pseudomonas species. Despite a 
range of laboratory and radiological tests it still remains difficult to
diagnose, particularly in the early stages when it can be treated medically. We
describe three cases which presented to this department in the past twelve
months. In all cases the diagnosis was made clinically and confirmed
per-operatively. Interestingly all three cases were relatively young patients who
did not have an immunocompromised status and were not diabetic.

Publication Types: 
    Case Reports

PMID: 11928781 [PubMed - indexed for MEDLINE]

1992: J Fam Pract. 2002 Jan;51(1):51-7.

Do parents and physicians differ in making decisions about acute otitis media?

Sorum PC, Shim J, Chasseigne G, Mullet E, Sastre MT, Stewart T, Gonzalez-Vallejo 
C.

Albany Med Primary Care Network, 724 Watervliet-Shaker Rd, Latham, NY 12110, USA.
sorump@mail.amc.edu

OBJECTIVES: We wanted to discover how parents differ from physicians in making
decisions about how to treat a child who may have acute otitis media (AOM). STUDY
DESIGN: We used questionnaires that required participants to judge the
probability of AOM or choose treatment for 2 sets of 46 paper scenarios of
hypothetical children aged 15 months who might have AOM, and they subsequently
rated the importance of individual cues and described their attitudes and
opinions related to health care and AOM. POPULATION: Convenience samples of 19 US
family physicians, 35 French generalists, 21 French pediatricians, 52 US parents,
and 86 French parents were included. OUTCOMES MEASURED: The primary outcomes were
the judgment policies-the weights placed on each of the scenario cues when making
decisions-that were derived for each individual and each group by multiple linear
regression. RESULTS: The mean judged probabilities of AOM were nearly the same
for all groups: 50% for the US physicians, 51% for the US parents, 52.5% for the 
French physicians, and 52% for the French parents. The percentages of cases
treated with antibiotics did not differ: 53% for US physicians, 45% for US
parents, 53% for French physicians, and 51% for French parents. All groups gave
greatest weight to the physical examination cues for decisions about both
diagnosis and treatment. The parents paid little attention to the cues that
reflected parental concerns. CONCLUSIONS: US and French parents were very similar
to physicians in their judgments and treatment choices regarding AOM. They appear
to be able to adopt the physician's point of view and to be selective in the use 
of antibiotics.

Publication Types: 
    Comparative Study
    Multicenter Study

PMID: 11927064 [PubMed - indexed for MEDLINE]

1993: JAMA. 2002 Apr 3;287(13):1710-5.

Mucosal biofilm formation on middle-ear mucosa in the chinchilla model of otitis 
media.

Ehrlich GD, Veeh R, Wang X, Costerton JW, Hayes JD, Hu FZ, Daigle BJ, Ehrlich MD,
Post JC.

Center for Genomic Sciences, Allegheny Singer Research Institute, Pittsburgh, PA 
15212, USA. gehrlich@wpahs.org

CONTEXT: Chronic otitis media with effusion (OME) has long been considered to be 
a sterile inflammatory process. The previous application of molecular diagnostic 
technologies to OME suggests that viable bacteria are present in complex
communities known as mucosal biofilms; however, direct imaging evidence of
mucosal biofilms associated with OM is lacking. OBJECTIVE: To determine whether
biofilm formation occurs in middle-ear mucosa in an experimental model of otitis 
media. DESIGN AND MATERIALS: A total of 48 research-grade, young adult
chinchillas weighing 500 g were used for 2 series of animal experiments: one to
obtain specimens for scanning electron microscopy and the other to obtain
specimens for confocal laser scanning microscopy using vital dyes. In each
series, 21 animals were bilaterally injected with viable Haemophilus influenzae
bacteria and 1 was inoculated to account for expected mortality. Three served as 
negative controls. Effusions and mucosal specimens were collected from 2 infected
animals that were euthanized at 3, 6, 12, and 24 hours and at days 2, 4, 5, 10,
16, and 22 after inoculation. MAIN OUTCOME MEASURES: Images were analyzed for
biofilm morphology, including presence of microcolony formation and for presence 
of bacteria on tissue surfaces. RESULTS: Scanning electron microscopy
demonstrated that biofilm formation was evident in all specimens from animals
beginning 1 day after infection and was present through 21 days. Confocal laser
scanning microscopy indicated that bacteria within the biofilms are viable.
CONCLUSION: These preliminary findings provide evidence that mucosal biofilms
form in an experimental model of otitis media and suggest that biofilm formation 
may be an important factor in the pathogenesis of chronic otitis media with
effusion.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 11926896 [PubMed - indexed for MEDLINE]

1994: Scand J Plast Reconstr Surg Hand Surg. 2002;36(1):9-15.

Otitis media and feeding with breast milk of children with cleft palate.

Aniansson G, Svensson H, Becker M, Ingvarsson L.

Department of Plastic and Reconstructive Surgery, Malmö University Hospital, SE
205 02 Malmö, Sweden.

The purpose of the present study was to analyse the incidence of acute and
secretory otitis media (OM), and feeding with breast milk, and the use of a
grommet in children with a cleft palate (CP/CLP) or cleft lip (CL), compared with
controls. A total of 84 children between 6 and 10 years of age were studied. The 
CP/CLP group consisted of 48 children with an isolated cleft palate (n = 28), or 
a cleft lip and palate (n = 20). The CL group consisted of 15 children with an
isolated cleft lip. The controls were 21 children without clefts. Children with
CP/CLP had acute OM significantly more often than children without clefts (43/48 
compared with 10/21), and secretory OM (40/48 compared with 4/21), despite the
use of grommets. CP/CLP children were breast fed for a mean of 2.8 months (range 
0-13), compared with 3.6 months (0-12) for CL, and 7.5 (0-24) months for
controls. There was a significant correlation during the first 18 months of life 
between longer duration of feeding with breast milk and a lower incidence of
acute and secretory OM in the three study groups combined. The incidence of
otitis media was not affected by care in a day centre, having a sibling attending
a day care centre, or by the family's medical history. Despite cleft repair and
early treatment with grommets, both secretory and acute OM are common among
children with cleft palate, presumably as a result of their eustachian tube
dysfunction. The present study suggests that premature cessation of feeding with 
breast milk may contribute to an increased incidence of acute and secretory OM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11925834 [PubMed - indexed for MEDLINE]

1995: West Afr J Med. 2001 Jul-Sep;20(3):187-90.

Clinical profile of acute otitis media among Nigerian children.

Nwawolo CC, Odusanya OO, Ezeanolue BC, Lilly-Tariah BD.

ENT Unit, Lagos University Teaching Hospital.

A one-year prospective clinical study to assess principal clinical symptoms,
signs and bacteriological isolates in Nigerian children with acute otitis media. 
This is a multicentre study conducted from January-December, 1998 in three
University Teaching Hospitals. A strict recruitment protocol was followed.
Patient symptoms had to be less than one week before enrollment. Eighty-one
children were recruited into the study. The major findings indicative of acute
otitis media were ear pain (92.6%), fever (88.9%), redness of the tympanic
membrane (89.9%) and loss of light reflex (84%). Rupture of the tympanic membrane
occurred in 15 patients (18.5%) Staphylococcus aureus was the most common
pathogen (50%) isolated from the ear swabs. A high index of suspicion is
necessary to diagnose acute otitis media early in children especially those who
may have fever as the main symptom. This will minimise the frequency of tympanic 
membrane perforations.

Publication Types: 
    Multicenter Study

PMID: 11922149 [PubMed - indexed for MEDLINE]

1996: Ann Emerg Med. 2002 Apr;39(4):413-21.

Diagnosis and management of acute otitis media in the urgent care setting.

McCracken GH Jr.

Department of Pediatrics, University of Texas Southwestern Medical Center,
Dallas, TX 75390-9063, USA. George.McCracken@UTSouthwestern.edu

The prevalence of otitis media is increasing, which affects health care resource 
utilization across all segments, including the urgent care setting. One of the
greatest challenges in the management of acute otitis media (AOM) is the
effective treatment of cases caused by pathogens that are resistant to commonly
used antibiotics. Whereas the production of beta-lactamases among strains of
Haemophilus influenzae and Moraxella catarrhalis is an important consideration
for antimicrobial therapy, the high prevalence of resistance to penicillin and
other classes of antibiotics among strains of Streptococcus pneumoniae represents
a greater clinical concern. The Centers for Disease Control and Prevention (CDC) 
recently convened the Drug Resistant S. pneumoniae Therapeutic Working Group to
develop evidence-based recommendations for the treatment of AOM in an era of
prevalent resistance. The recommendations from this group included amoxicillin as
the preferred first-line drug because of the demonstrated activity against
penicillin-intermediate and -resistant strains of S. pneumoniae, using higher
dosages of up to 90 mg/kg per day in certain settings. For patients in whom
initial treatment is unsuccessful after 3 days, the recommended agents included
high-dose amoxicillin-clavulanate (for activity against beta-lactamase-producing 
pathogens), clindamycin, cefuroxime axetil, or 1 to 3 doses of intramuscular
ceftriaxone. The principles set forth in these guidelines can assist the
therapeutic decisionmaking process for practitioners in the urgent care setting.

Publication Types: 
    Review

PMID: 11919528 [PubMed - indexed for MEDLINE]

1997: Med Hypotheses. 2001 Dec;57(6):784-91.

A comprehensive model for the aetiology of otitis media with effusion.

Straetemans M, van Heerbeek N, Tonnaer E, Ingels KJ, Rijkers GT, Zielhuis GA.

Department of Epidemiology and Biostatistics, University Medical Centre,
Nijmegen, The Netherlands. M.Straetemans@mie.kun.nl

Otitis media with effusion is highly prevalent among young children. Adverse
effects of this disorder are mainly restricted to the group of children with a
history of recurrent or persistent otitis media with effusion. Early
identification, assessment and intervention might prevent these adverse effects. 
Up to now it is not possible to distinguish these children from those with
transient otitis media with effusion. This article presents a comprehensive model
for the aetiology of otitis media with effusion. Eustachian tube functioning and 
the immunological response to environmental pathogens are the two core elements. 
This model can be used to formulate specific hypotheses about the interaction of 
several factors that may lead to the early identification of children who are
likely to develop persistent or recurrent otitis media with effusion.

PMID: 11918448 [PubMed - indexed for MEDLINE]

1998: Aust Fam Physician. 2002 Feb;31(2):141-4.

Comment in:
    Aust Fam Physician. 2002 May;31(5):410; author reply 410-1.    Aust Fam Physician. 2002 May;31(5):410; author reply 410-1.

A child with earache. Are antibiotics the best treatment?

Del Mar C, Glasziou P.

Centre for General Practice, University of Queensland. C.DelMar@cgp.uq.edu.au

BACKGROUND: Conventional management of acute otitis media, deduced from
pathophysiology, embodies scant regard to analgesia, but concentrates on the
microbiological cure by the use of antibiotics. OBJECTIVE: A commonly encountered
case of uncomplicated acute otitis media in a child of three is presented. An
evidence based approach to management is offered. RESULTS: The search for
empirical evidence of patient relevant benefits and harms challenges the
conventional approach. A Cochrane review of the literature on the use of
antibiotics for acute otitis media shows that the benefits of antibiotic use
(reduced pain in those children who go on to suffer pain beyond 24 hours) are
offset by adverse events from the antibiotics themselves (gastrointestinal
symptoms and rashes). There is insufficient information to be sure about rare
complications of not using antibiotics as well using them, but it seems that in
either case, catastrophe is very rare. DISCUSSION: Thinking in terms of a balance
of harms and benefits would result in a decreased proportion of children
prescribed antibiotics for acute otitis media.

Publication Types: 
    Case Reports
    Review

PMID: 11917824 [PubMed - indexed for MEDLINE]

1999: N Z Med J. 2002 Feb 22;115(1148):67-9.

Management of acute otitis media by New Zealand general practitioners.

Ryan J, Giles M.

Waikato Hospital, Hamilton. jamier@healthotago.co.nz

AIMS: To determine the current management of acute otitis media by New Zealand
general practitioners (GPs). METHODS: A reply-paid questionnaire was sent to 2000
New Zealand GPs. The questions relate to management of a three year old child
presenting with her first episode of acute otitis media. RESULTS: 95% of
respondents reported they would usually or always use antibiotics. Amoxicillin
was the antibiotic of choice, followed by amoxicillin/clavulanate. Cotrimoxazole 
was the antibiotic of choice in the case of allergy to amoxicillin. 82% of
respondents recommended follow-up, with a broad range of follow-up times (24
hours to 12 weeks). Approximately half of practitioners considered 5-6 episodes
of acute otitis media in a year as an appropriate threshold for referral for
grommets. Most GPs had received an update on otitis media within the previous two
years. CONCLUSIONS: There is considerable variation in the management of acute
otitis media by New Zealand GPs. Use of a national guideline may result in a more
standardised, rational approach to the treatment of acute otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11913935 [PubMed - indexed for MEDLINE]

2000: Ann Otol Rhinol Laryngol. 2002 Mar;111(3 Pt 1):261-6.

Auditory consequences of recurrent acute purulent otitis media.

Ryding M, Konradsson K, Kalm O, Prellner K.

Department of Otorhinolaryngology, University Hospital, Lund, Sweden.

To investigate whether recurrent purulent otitis media results in permanent
hearing loss, we studied 2 subgroups of children from a cohort, earlier
prospectively followed from birth to the age of 3 years. One subgroup had
recurrent acute otitis media (n = 12), and the other had no acute otitis media at
all ("healthy" children; n = 21). At follow-up of these subgroups at the age of
10, no child had acute otitis media or secretory otitis media. There was no
difference between the groups in hearing level thresholds at the frequencies 125 
Hz to 8 kHz. However, in the children with recurrent acute otitis media, as
compared with the controls, the hearing levels at high frequencies (8 to 16 kHz) 
and the acoustic middle ear reflex thresholds were elevated, the middle ear
compliance was higher, and click-evoked otoacoustic emission response levels and 
middle ear pressures were lower. The results suggest that the middle ear
mechanics of children with recurrent acute otitis media are affected, and also
that their cochlear function might be disturbed.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11913687 [PubMed - indexed for MEDLINE]

2001: Eur J Clin Microbiol Infect Dis. 2002 Jan;21(1):53-5.

Xylitol concentrations in the saliva of children after chewing xylitol gum or
consuming a xylitol mixture.

Tapiainen T, Renko M, Kontiokari T, Uhari M.

Department of Paediatrics, University of Oulu, Finland. ttapiai@paju.oulu.fi

Xylitol prevents otitis media when given to children regularly five times per
day. To find a more convenient dosing schedule, an enzymatic assay was used to
measure xylitol concentrations in the saliva of 65 children after giving them
xylitol chewing gum or syrup in doses equal to those used in clinical trials.
Although concentrations high enough to have an antimicrobial effect were
attained, the xylitol disappeared from the saliva within 15 min. This finding
indicates that high peak concentrations are more important for efficacy than the 
amount of time the xylitol concentration exceeds that needed to produce an
antimicrobial effect. A schedule with the same single doses given less frequently
could be clinically effective in preventing otitis media.

Publication Types: 
    Clinical Trial
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11913502 [PubMed - indexed for MEDLINE]

2002: Ann Plast Surg. 2002 Feb;48(2):202-4.

Mafenide acetate allergy presenting as recurrent chondritis.

Pickus EJ, Lionelli GT, Charles EW 3rd, Korentager RA.

Division of Plastic Surgery, University of Kansas Medical Center, Kansas City
66160, USA.

Acute chondritis has a strong predilection for recurrence. Mafenide acetate has
been implicated in causing reactions that mimic this condition; however, these
hypersensitivity reactions lack fever, fluctuance, and pain. The authors report a
case of mafenide acetate allergy presenting as recurrent chondritis in a patient 
who had previously been treated successfully for this condition. In this patient,
the allergic response resolved within 3 days after cessation of mafenide acetate.
If unappreciated, it may have led to unnecessary operative intervention.
Therefore, auricular edema and erythema, without fever, fluctuance, and pain,
must be recognized by surgeons as a possible mafenide acetate allergy and must be
considered in the differential diagnosis for patients who present with recurrent 
acute suppurative chondritis.

Publication Types: 
    Case Reports

PMID: 11910229 [PubMed - indexed for MEDLINE]

2003: J Paediatr Child Health. 2001 Dec;37(6):529-30.

Perspectives on infective ear disease in indigenous Australian children.

Leach AJ, Morris PS.

Ear Health and Education Unit, Menzies School of Health Research, Casuarina,
Northern Territory, Australia. amanda@menzies.edu.au

Australian Aboriginal children experience the highest rates of bacterial
respiratory diseases reported in the literature. Neonatal acquisition of multiple
bacterial pathogenic species and strains predicts persistent and severe disease
throughout childhood, particularly infective ear disease. The dynamics of
bacterial nasopharyngeal colonization and transmission are poorly understood. The
importance of host factors, bacterial competition and co-operation in the
transition from asymptomatic carriage to disease are also uncertain. Treatment
outcomes are poor, possibly due to the high density of bacterial infection
following early age exposure, poor compliance and increasing levels of antibiotic
resistance. The relationship between antibiotic use, clinical outcomes and
bacterial resistance needs to be better understood in high-risk populations if
the benefits associated with treatment are to be maximized. While there is an
urgent need for vaccines, the early age of infection and the high rates of
transmission and bacterial antigenic diversity mean these may also be less
effective than predicted from studies in low-risk populations.

Publication Types: 
    Review

PMID: 11903828 [PubMed - indexed for MEDLINE]

2004: Clin Otolaryngol Allied Sci. 2002 Feb;27(1):50-6.

Therapeutic improvement of Eustachian tube function: a review.

van Heerbeek N, Ingels KJ, Rijkers GT, Zielhuis GA.

Department of Otorhinolaryngology, University Medical Centre St. Radboud,
Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
N.vanHeerbeek@kno.azn.nl

An impaired Eustachian tube is assumed to be an important factor in the
pathogenesis of different middle ear diseases. Therefore, several investigators
have studied different treatment strategies to improve Eustachian tube function. 
The aim of this review is to provide a comprehensive summary of the results of
these studies on improvement of tubal function. The English language literature
was searched systematically to identify all articles that described the effect of
different interventions on Eustachian tube function. Although the results were
not uniform throughout the different studies and despite several restrictions of 
the reviewed studies, the results of this review indicate that the function may
be improved by medical intervention. However, it seems premature to recommend any
of the interventions reviewed in this paper to improve function in humans. More
studies, preferably randomized, placebo-controlled trials, should be conducted to
assess the efficacy of different interventions.

Publication Types: 
    Meta-Analysis

PMID: 11903373 [PubMed - indexed for MEDLINE]

2005: Acta Otorhinolaryngol Belg. 2002;56(1):61-4.

Carcinoembryonic antigen in chronic otitis media: an immunohistochemical study of
the middle ear mucosa.

Sankovic S, Sofronic L.

ORL. Clinic, Clinical Hospital Centre Zvezdara, Belgrade, Institute for
Application of Nuclear Energy-INEP, Zemun. sofronic@inep.co.yu

Carcinoembryonic antigen (CEA) has an important role as a tumor marker and also
as a cell adhesion molecule. The expression and the role of CEA in chronic
inflammation of middle ear mucosa has not been studied previously.
Immunohistochemical analysis with monoclonal antibodies against human CEA was
performed in order to detect CEA in formalin fixed and paraffin embedded biopsy
specimens of middle ear mucosa in chronic otitis media. In this study 118
specimens of middle ear mucosa from different regions of the middle ear cleft
were analysed. All specimens were taken during surgery of otitis media with and
without cholesteatoma. The results showed that CEA expression was present in
mucosal samples in chronic otitis media with cholesteatoma, predominantly in
squamous epithelium, as well as in the subepithelial layer and among the
connective tissue, especially on collagen fibres of fibroproliferative stroma.
CEA was seen on endothelial cells of blood vessels. Occasionally it was present
on the surface of columnar epithelium of the middle ear mucosa in chronic otitis 
media without cholesteatoma. The expression patterns of CEA in chronic
inflammation of middle ear mucosa suggest potential functional activities similar
to adhesion molecules and signal regulatory proteins which will be the subject of
further study.

PMID: 11894632 [PubMed - indexed for MEDLINE]

2006: Am J Otolaryngol. 2002 Mar-Apr;23(2):70-5.

Nasal and otologic effects of experimental respiratory syncytial virus infection 
in adults.

Buchman CA, Doyle WJ, Pilcher O, Gentile DA, Skoner DP.

Department of Otolaryngology, University of North Carolina at Chapel Hill School 
of Medicine, Chapel Hill, NC, USA.

PURPOSE: Upper respiratory tract viral infections continue to cause substantial
patient morbidity and complications including sinusitis, otitis media, and
pneumonia. This study was conducted to more clearly define the extent and
frequency of nasal and otologic effects of respiratory syncytial virus infection 
in healthy adult volunteers. MATERIALS AND METHODS: Thirty-two healthy,
susceptible adult volunteers were cloistered for a 9-day period. During this
time, subjects underwent nasal inoculation with respiratory syncytial virus.
Monitoring included daily self-assessment of general health, as well as nasal and
otologic symptoms. Objective measurements of nasal and otologic function included
expelled nasal secretion weight, saccharin-dye mucociliary clearance,
sonotubometry, tympanometry, and physical examination. A nasal lavage was done
each morning, and fluids were submitted for viral detection. Twenty-one days
after viral inoculation, all subjects had convalescent blood samples drawn for
assay of virus-specific antibody titres. RESULTS: Eighteen subjects (56%) became 
infected with the challenge as determined by either viral shedding (47%) or
antigen detection (41%) from the nose or a 4-fold rise in virus-specific antibody
titer (34%). Infected subjects more frequently reported adverse nasal
(congestion, rhinorrhea) and general symptoms (fever, malaise, illness). By day
6, only 46% of infected subjects had normal middle ear pressure (> -100 mm H2O). 
Nasal secretion also increased substantially after infection. No patterned
changes in mucociliary clearance or sonotubometry occurred, and no subjects
developed otitis media. CONCLUSIONS: Nasal inoculation of healthy, susceptible
adult volunteers with respiratory syncytial virus results in detectable infection
in only about half of the subjects challenged. Infected subjects experience
substantial symptoms and signs of a viral upper respiratory tract illness. As in 
our previous studies using rhinovirus and influenza A virus, respiratory
syncytial virus disrupted the maintenance of normal middle ear pressures. These
findings provide further support for the relationship between viral upper
respiratory tract infections and otitis media. Copyright 2002, Elsevier Science
(USA). All rights reserved.)

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 11893972 [PubMed - indexed for MEDLINE]

2007: Auris Nasus Larynx. 2002 Apr;29(2):127-32.

Experimental otitis media with effusion induced by leukotriene D4.

Tada N, Furukawa M, Ogura M, Arai S, Adachi Y, Ikehara S, Yamashita T.

Department of Otorhinolaryngology, Kansai Medical University, 10-15 Fumizono,
570-8506, Moriguchi, Japan. naoki-t@db3.so-net.ne.jp

OBJECTIVE: inflammatory mediators such as prostaglandins (PGs), leukotrienes
(LTs), and platelet-activating factor (PAF) have been identified in human middle 
ear effusions (MEEs), as well as in the experimentally induced MEEs of animals.
However, the exact function of LTs in the middle ear cavity is still unknown. In 
this study, the role of LTs was investigated using an experimental model in which
OME was induced by LTD4. METHODS: to examine whether leukotrienes (LTs) induce
otitis media with effusion (OME), 2x10(-6), 2x10(-5), 1x10(-4) and 2x10(-4) M of 
LTD4 was injected into the rat ear. The severity of OME was assessed based on the
histological findings. The concentrations of IL1-beta, TNF-alpha, and GRO/CINC-1 
in MEE were also measured. Additionally the therapeutic efficacy of a specific
LTs antagonist, pranlukast on experimental OME was investigated. RESULTS: all
ears developed middle ear effusion (MEE) within 24 h and about 50% of the animals
continued to demonstrate MEE for 14 days in the 1x10(-4) and 2x10(-4) M groups.
The cytokine levels seemed to correspond well with the persistence of OME. The
oral administration of a specific LTs antagonist, pranlukast, was found to
alleviate the experimental OME. CONCLUSION: these findings suggest that LTs
appear to plays an important role in the pathogenesis of OME.

PMID: 11893446 [PubMed - indexed for MEDLINE]

2008: J Laryngol Otol. 2002 Mar;116(3):176-80.

Vinegar treatment in the management of granular myringitis.

Jung HH, Cho SD, Yoo CK, Lim HH, Chae SW.

Department of Otolaryngology - Head and Neck Surgery, Korea University College of
Medicine, Seoul, Korea.

To compare the therapeutic efficacy in the management of granular myringitis, 15 
patients with chronic granular myringitis were treated with antibiotic ear drops 
that were used twice to four times a day, and another 15 patients were treated
with daily irrigation of the external canal with dilute vinegar solution. All
patients treated with dilute vinegar solution had resolution of their original
otorrhoea within three weeks, whereas two-thirds of patients recovered within
three weeks when treated with antibiotic ear drops. The disadvantages of dilute
vinegar therapy were canal irritation with pain and dizziness. When the
therapeutic efficacy was compared statistically, a dry ear was attained in the
dilute vinegar-treated group at six weeks and six months in the antibiotic ear
drop treated group (p<0.01). These results suggest that very low pH therapy using
dilute vinegar solution is definitely effective in the management of granular
myringitis.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11893257 [PubMed - indexed for MEDLINE]

2009: Curr Allergy Asthma Rep. 2001 Jul;1(4):364-72.

Antibiotic theory in otitis media.

Gungor A, Bluestone CD.

Department of Pediatric Otolaryngology, University of Pittsburgh School of
Medicine, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA
15213, USA.

Otitis media is currently the most common diagnosis made by clinicians, which has
a major impact on managed care. The emergence of resistant bacterial pathogens
has caused controversy over the use of antibiotics when acute otitis media (AOM) 
is diagnosed. All infants with AOM and all older children with severe AOM should 
be treated with antibiotics, despite concerns about rising rates of resistant
bacterial pathogens. Some older children with nonsevere AOM may be candidates for
initial observation, although this is not confirmed by clinical trials.
Antimicrobial agents are not required for otitis media with effusion of recent
onset but may be considered if this effusion becomes chronic; in these cases,
tympanostomy tube placement may be indicated. Antimicrobial prophylaxis for
prevention of recurrent AOM should be reserved for selected patients because of
the possible emergence of resistant organisms. Tympanostomy tube placement is a
more reasonable option today.

Publication Types: 
    Review

PMID: 11892060 [PubMed - indexed for MEDLINE]

2010: Curr Allergy Asthma Rep. 2001 Jul;1(4):358-63.

Vaccine prevention of acute otitis media.

Greenberg DP, Hoberman A.

Department of Pediatrics, University of Pittsburgh School of Medicine, Division
of Allergy, Immunology and Infectious Diseases, Children's Hospital of
Pittsburgh, Room 4B-320, 3705 Fifth Avenue, Pittsburgh, PA 15213-2583, USA.
greenbd@chplink.chp.edu

The incidence of acute otitis media (AOM) in infants and young children has
increased dramatically in recent years in the United States. AOM often follows
upper respiratory tract infections due to pathogens such as respiratory syncytial
virus (RSV), influenza virus, and parainfluenza virus (PIV). These viruses cause 
eustachian tube dysfunction that is critical to the pathogenesis of AOM. Vaccines
against these viruses would likely reduce the incidence of AOM. In three previous
studies, influenza virus vaccines reduced the incidence of AOM by 30% to 36%.
Vaccines to prevent infections with RSV and PIV type 3 are undergoing clinical
testing at this time. Streptococcus pneumoniae, nontypeable Haemophilus
influenzae (NTHi), and Moraxella catarrhalis are the three most common AOM
pathogens. Heptavalent pneumococcal conjugate vaccine is effective in preventing 
invasive disease and AOM caused by serotypes contained in the vaccine. Vaccine
candidates for NTHi and M. catarrhalis are under development.

Publication Types: 
    Clinical Trial
    Comparative Study

PMID: 11892059 [PubMed - indexed for MEDLINE]

2011: Curr Allergy Asthma Rep. 2001 Jul;1(4):353-7.

The genetics of otitis media.

Casselbrant ML, Mandel EM.

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh,
Departments of Otolaryngology and Pediatrics, University of Pittsburgh School of 
Medicine, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA. casselm@chplink.chp.edu

There is significant evidence from epidemiologic, anatomic, physiologic, and
immunologic studies that susceptibility to recurrent episodes of acute otitis
media (OM) and persistent OM with effusion is largely genetically determined. The
genetics of OM are most likely complex, i.e., many genes are probably
contributing to the overall phenotype. The knowledge of a hereditary component
has important implications because closer surveillance of children at risk for OM
could result in earlier detection and treatment. Further, once OM susceptibility 
genes have been identified it may be possible to develop molecular diagnostic
assays that could enable the clinician to identify the child at high risk for OM 
and to develop more focused treatments in the future.

Publication Types: 
    Review

PMID: 11892058 [PubMed - indexed for MEDLINE]

2012: Ambul Pediatr. 2001 Mar-Apr;1(2):87-90.

Association of early bilateral middle ear effusion with language at age 5 years.

McCormick DP, Baldwin CD, Klecan-Aker JS, Swank PR, Johnson DL.

University of Texas Medical Branch, Galveston, TX 77555-1119, USA.
david.mccormick@utmb.edu

OBJECTIVE: This study tested the hypothesis that children with early persistent
middle ear effusion (MEE) are at risk for later language deficit. METHOD: We
recruited 698 newborns and monitored them for MEE every 2 to 4 weeks at home
until age 3 years. Language skills were assessed on 294 subjects at age 5, while 
controlling for 8 demographic and environmental factors. Language outcomes at age
5 years were studied as a function of duration of bilateral MEE from birth to age
3 years. RESULTS: A significant relation was found between duration of bilateral 
MEE and speech sound sensitivity (Carrow Elicited Language Inventory) and
articulation (Goldman-Fristoe Articulation). Children's ability to discriminate
speech sounds in a quiet environment (Carrow Auditory Visual Abilities Test) was 
less affected by early prolonged MEE in homes that provided more cognitive
stimulation. CONCLUSIONS: These exploratory results indicate that prolonged early
MEE may predispose children to language deficits at age 5 years. The language
deficits are of small magnitude and may or may not be clinically significant.
Language stimulation at home may protect against some of the effects of prolonged
MEE.

PMID: 11888378 [PubMed - indexed for MEDLINE]

2013: J Otolaryngol. 2002 Feb;31(1):23-30.

Clinical decision analysis in the treatment of acute otitis media in a child over
2 years of age.

Manarey CR, Westerberg BD, Marion SA.

Department of Health Care and Epidemiology, University of British Columbia.

Acute otitis media (AOM) is the most common infection diagnosed in children. In
Canada and the United States, the standard of care for treatment of children over
2 years of age diagnosed with AOM is a course of antibiotics for 5 to 10 days.
However, in other countries, treatment is primarily symptomatic, and antibiotics 
are prescribed only if symptoms fail to resolve. Clinical decision analysis is a 
process whereby different treatment options are assessed systematically. All
clinical pathways are incorporated into a model, probabilities for each event are
determined from the literature, and clinical outcomes are quantified as to the
preference of patients. The decision analysis then determines the most
appropriate treatment option for the disease process. For AOM in a child over 2
years of age, four treatment options were considered including observation
followed by 10 days of antibiotic therapy if required for failure of symptoms to 
resolve, observation followed by 5 days of antibiotic therapy if required, 10
days of antibiotic therapy when the child was initially diagnosed with AOM, and 5
days of antibiotic therapy when the child was initially diagnosed with AOM. Using
a clinical decision analysis model for the treatment of AOM in a child over 2
years of age, the most appropriate treatment was found to be initial observation 
followed by 5 days of an antibiotic if the child failed to improve spontaneously.
The decision analysis model developed was designed to be free of construction
bias and was found to be robust in multiple sensitivity analysis.

PMID: 11883437 [PubMed - indexed for MEDLINE]

2014: Int J Pediatr Otorhinolaryngol. 2002 Mar 15;63(1):49-56.

Treatment of chronic suppurative otitis media with ofloxacin in hydroxypropyl
methylcellulose ear drops: a clinical/bacteriological study in a rural area of
Malawi.

van Hasselt P, van Kregten E.

Ear Clinic, Bamalete Lutheran Hospital, Ramotswa, Botswana. pvhasselt@planet.nl

Chronic suppurative otitis media in young children is a major problem in Africa, 
with socio-economic consequences at a later age. Common treatment regimens with
antibiotics are expensive and often not practically feasible. Therefore, a
project was started to develop a low-cost and effective treatment in a rural area
of Malawi by studying the clinical efficacy of an inexpensive application regimen
of ofloxacin (0.075%) in hydroxypropyl methylcellulose (1.5%) ear drops. In
earlier studies with this treatment regimen, it was possible to cure
approximately 70% of ears. The aim of this study was to find out whether the
bacteriological spectrum cultured from wet ears before and after treatment, and
patterns of resistance to antibiotics, played a role in the percentage of cures. 
Patients with long-standing chronic suppurative otitis media were clinically
assessed and treated with suction cleaning and instillation of ear drops on days 
1, 3, 7 and 10. Bacterial swabs were taken for culture and sensitivity tests for 
ofloxacin were on days 1 and 10 from the ears that were still discharging. After 
21 weeks, the ears were assessed again clinically. Clinical cure was considered
to be complete cessation of otorrhea. Ninety of 104 tested patients (124 ears)
completed the study. About 73% of the ears had become dry by day 10. This dropped
to 42% after 21 weeks. Before treatment, most ears (91%) harbored fecal bacteria,
Proteus mirabilis (74%) and enterococci (60%) being the most frequently isolated 
microbes. The second group of frequently cultured bacteria were water bacteria
e.g. Pseudomonas species and other non-fermenters (69%), whereas the classical
otitis media pathogens were detected only in 15% of ears. Before treatment, 9.7% 
of strains were resistant to ofloxacin, most (30/35) of which were cultured from 
ears that were eventually cured. After treatment, fecal and water bacteria were
still the most frequently found, with 36% new strains and an overall sensitivity 
to ofloxacin of 58%. Bacterial resistance did not appear to play an important
role in the outcome of treatment. These data rather suggest a very high risk of
infection due to poor hygiene conditions. Medical treatment can only have a
longer-lasting effect if accompanied by community-based programs that focus on
improvement of hygiene. A public health approach is necessary alongside a medical
approach for the management of CSOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11879929 [PubMed - indexed for MEDLINE]

2015: Acta Otolaryngol. 2002 Jan;122(1):78-85.

Bacterial interference between pathogens in otitis media and alpha-haemolytic
Streptococci analysed in an in vitro model.

Tano K, Håkansson EG, Holm SE, Hellström S.

Department of Clinical Sciences, Umeå University, Sweden. Krister.Tano@nll.se

Bacterial interference studied by means of agar methods has shown a decreased
number of inhibitory alpha-haemolytic Streptococci among otitis-prone children.
Additional information was gained regarding the interplay between
alpha-haemolytic Streptococci (AHS) and otitis media (OM) pathogens by comparing 
the bacterial interference in broth with the interference activity studied using 
agar overlay methods. We found, that non-typeable Haemophilus influenzae (NTHI)
and Moraxella catarrhalis are readily inhibited by AHS in broth. Streptococcus
pneumoniae was more bacteriostatically inhibited. If two OM pathogens were
inoculated simultaneously, an isolate of AHS with poor inhibitory activity was
not able to inhibit the growth, in contrast to an isolate of AHS with good
inhibitory activity. The initial amount of AHS inoculated with M. catarrhalis
seemed to play a decisive role with respect to the inhibitory activity. M.
catarrhalis developed reduced susceptibility against AHS both in vivo and in
vitro. In vivo studies showed that children with secretory otitis media had fewer
isolates of AHS in their nasopharynx with the ability to inhibit all the test
pathogens than healthy children (p < 0.001). Although the factor(s) responsible
for the inhibitory activity have thus far not been defined, we could exclude low 
pH and nutrition depletion as the inhibitory mechanism of AHS with good
inhibitory activity.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11876603 [PubMed - indexed for MEDLINE]

2016: Acta Otolaryngol. 2002 Jan;122(1):72-7.

Nasopharyngeal carriage of drug-resistant Streptococcus pneumoniae in children
with acute otitis media evaluated by polymerase chain reaction-based genotyping
of penicillin-binding proteins.

Hotomi M, Yamanaka N, Faden H, Shimada J, Suzumoto M, Sakai A, Saito T, Kuki K.

Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, 
Japan. mhotomi@wakayama-med.ac.jp

A polymerase chain reaction (PCR)-based genotyping of the penicillin-binding
protein (PBP) genes pbp1a, pbp2x and pbp2b was used to characterize Streptococcus
pneumoniae isolated from the nasopharynx of children with acute otitis media
(AOM). Mutations were observed in pbp1a, pbp2x and pbp2b genes in 36.5% of the
strains. Decreased susceptibility to beta-lactam antibiotics was closely
associated with the frequency of mutations in the three PBP genes. Of
penicillin-intermediately-resistant S. pneumoniae strains, 54.5% appeared to be
genetically similar to penicillin-resistant S. pneumoniae strains. Of
penicillin-susceptible S. pneumoniae strains, 33.3% had mutations in the pbp2x
gene and showed relatively high MICs to cephalosporins. Strains with mutations in
the three PBP genes were often isolated from children < or = 2 years old.
Evaluation of mutations in PBP genes using PCR will prove useful for studying the
epidemiology of antibiotic resistance.

PMID: 11876602 [PubMed - indexed for MEDLINE]

2017: Pediatrics. 2002 Mar;109(3):E41-1.

Outpatient and hospital visits associated with otitis media among American Indian
and Alaska native children younger than 5 years.

Curns AT, Holman RC, Shay DK, Cheek JE, Kaufman SF, Singleton RJ, Anderson LJ.

Office of the Director, Division of Viral and Rickettsial Diseases, National
Center for Infectious Diseases, Centers for Disease Control and Prevention, US
Department of Health and Human Services, Atlanta, Georgia 30333, USA.
acurns@cdc.gov

OBJECTIVE: To describe the burden of otitis media (OM) among American Indian and 
Alaska Native (AI/AN) children. METHODS: OM morbidity among AI/AN younger than 5 
years was evaluated using OM-associated outpatient visit and hospitalization
rates. These rates were compared with outpatient and hospitalization rates for
the general US population of children younger than 5 years. AI/AN children who
were younger than 5 years and receiving care through the Indian Health Service or
tribally operated facilities and US children younger than 5 years of age were
studied. RESULTS: From 1994--1996, the average annual rate of AI/AN OM-associated
outpatient visits was 138 per 100 children younger than 5 years. Among AI/AN
children younger than 1 year (infants), these rates were almost 3 times greater
than those for US infants (318 vs 110 visits per 100 infants, respectively).
AI/AN children 1 to 4 years of age had rates 1.5 times greater than US children
of the same age (107 vs 65 visits per 100 children, respectively). AI/AN children
also experienced higher rates of OM-associated hospitalization than did US
children (5643 vs 2440 per 100 000 infants, 823 vs 665 per 100 000 1- to
4-year-olds). CONCLUSION: We found that AI/AN children, especially AI/AN infants,
have higher OM-associated outpatient and hospitalization rates than those for the
general US population of children. The disparity in rates suggests that
additional prevention programs and continued resources are needed to reduce OM
morbidity among AI/AN children.

PMID: 11875169 [PubMed - indexed for MEDLINE]

2018: Pediatrics. 2002 Mar;109(3):404-8.

Comment in:
    Pediatrics. 2003 Jan;111(1):217-8; author reply 217-8.

Pediatric resident training in the diagnosis and treatment of acute otitis media.

Steinbach WJ, Sectish TC.

Department of Pediatrics, Stanford University School of Medicine, Stanford,
California, USA. stein022@mc.duke.edu

OBJECTIVE: To investigate the presence and characteristics of formalized
curricula for pediatric resident education for the diagnosis and treatment of
acute otitis media. DESIGN: A survey was mailed to the program directors of all
224 accredited US and Canadian pediatric residency programs. Questions focused on
the development, components, and teaching of any otitis media curriculum. Program
directors were also questioned about their approach towards evaluating resident
competency of otitis media and their future plans for otitis media-related
training. RESULTS: A total of 144 program directors (64%) responded to the
survey. Among respondents, 59% had some form of formalized education related to
the diagnosis or treatment of otitis media. These curricula primarily consisted
of lectures by general pediatricians <3 times per year. CONCLUSIONS: Although
otitis media is the most common disease seen by practicing general pediatricians,
the Residency Review Committee in Pediatrics does not mandate formal otitis
media-related training. Aside from informal case-by-case education, this survey
demonstrated that only slightly more than half of all pediatric residency
programs have some formalized resident education of this common pediatric
problem, and most of those curricula are infrequent lectures.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11875132 [PubMed - indexed for MEDLINE]

2019: Cochrane Database Syst Rev. 2002;(1):CD001727.

Update in:
    Cochrane Database Syst Rev. 2004;(3):CD001727.

Update of:
    Cochrane Database Syst Rev. 2001;(2):CD001727.

Decongestants and antihistamines for acute otitis media in children.

Flynn CA, Griffin G, Tudiver F.

Department of Family Medicine, State University of New York Upstate Medical
University, Suite 200, 475 Irving Avenue, Syracuse, New York 13210, USA.
flynnc@upstate.edu

BACKGROUND: Acute otitis media (AOM) is a common and important source of
morbidity in children, although most cases resolve spontaneously. While
frequently recommended, decongestant and antihistamine therapy is of unclear
benefit. OBJECTIVES: To determine the efficacy of decongestant and antihistamine 
therapy in children with AOM on outcomes of AOM resolution, medication side
effects, and complications of AOM. SEARCH STRATEGY: Comprehensive search of
Cochrane's Controlled Trials Registry, Medline and Embase was conducted.
Bibliographic review and requests for information from study authors and
pharmaceutical companies supplemented this. SELECTION CRITERIA: Randomized
controlled trials evaluating decongestant (DC) or antihistamine (AH) treatment
for children with AOM were included. Patient-oriented outcomes were considered
most relevant. There were no quality or language restrictions. DATA COLLECTION
AND ANALYSIS: Investigators independently evaluated studies for inclusion,
performed validity assessments, and completed data extraction. Dichotomous data
were pooled to generate relative risks and numbers needed to treat, and
homogeneity was assessed using approximate chi-square tests. MAIN RESULTS: For
the combined control groups, healing rates at 2 weeks were high, with rates of
persistent AOM <23%. No additional benefit was demonstrated from intervention
subgroupings DC, AH, or any medication (DC and/or AH). Only the combined
treatment (DC + AH) group demonstrated statistically lower rates of persistent
AOM at the 2-week period (RR 0.76, 95% CI, NNT 10.5, 95% CI). No benefit was
found for other outcomes including early or late cure rates, symptom resolution, 
prevention of surgery or other complications. There was an increased risk of
medication side effects for those receiving an intervention, which reached
statistical significance for the "any medication" and decongestant groupings (NNH
16.6, 14.3 respectively, 95% CI ). Validity subanalyses demonstrated that lower
quality studies found benefit, but analysis of those studies with higher validity
scores found no benefit to treatment. REVIEWER'S CONCLUSIONS: Given lack of
benefit and increased risk of side effects, these data do not support the use of 
decongestant, antihistamine, or combined DC/AH treatment in children with AOM.
The small statistical benefit found in the combination medication group is of
small clinical significance and study design may be biasing the results.

Publication Types: 
    Review

PMID: 11869604 [PubMed - indexed for MEDLINE]

2020: J Trop Pediatr. 2002 Feb;48(1):15-23.

The characterization of bacterial isolates from acute otitis media in Ile-Ife,
southwestern Nigeria.

Ako-Nai AK, Oluga FA, Onipede AO, Adejuyigbe EA, Amusa YB.

Department of Microbiology, Obafemi Awolowo University, Ile-Ife, Osun State,
Nigeria. aakonai@oauife.edu.ng

The incidence of acute otitis media (AOM) in a comprehensive healthcare setting
was investigated in Ile-Ife, Nigeria. Out of the 617 children examined, 53 (11.64
per cent) suffered from the condition based on the criteria used. Staphylococci
constituted the predominant organisms associated with the condition with
Staphylococcus aureus (25.0 per cent) being the most frequent single microbe
recovered from the subjects. This was followed by Proteus mirabilis (16.2 per
cent), Staphylococcus sp. (8.8 per cent), Streptococcus pneumoniae (8.8 per
cent), Pseudomonas aeruginosa and Haemophilus influenzae (7.4 per cent each).
Most isolates tested were multiply resistant to the antibiotics commonly employed
in treating infections caused by these organisms. The study highlights the
prevalence of multi-resistant organisms amongst the subjects and recommends
prompt therapeutic intervention to avert ineffectiveness of antibiotics when used
in treating infections caused by these organisms in the community.

PMID: 11866331 [PubMed - indexed for MEDLINE]

2021: Pathol Res Pract. 2002;198(1):31-5.

Tuberculous otitis media: a difficult diagnosis and report of four cases.

Vital V, Printza A, Zaraboukas T.

Aristotle University of Thessaloniki, Greece. vvital@med.auth.gr

Tuberculous otitis media is a rare disease. Due to the condition's rarity and its
usually indolent course, the diagnosis is often delayed. This can lead to
irreversible complications, such as permanent hearing loss or facial nerve
paralysis. Tuberculosis of the middle ear cleft, as this disease's first
presentation, is indeed very rare. Surgery may be carried out prior to diagnosis 
occasionally, i.e., middle ear exploration for chronic middle ear disease. We
present four cases of tuberculous otitis media which occurred as the first
presentation of the disease. The patients did not present with the classic
symptoms of middle ear tuberculosis. The diagnosis was based on the histology
following middle ear exploration for chronic middle ear disease. None of the
patients presented any other systemic involvement. We present a review of this
disease's clinical symptoms and the diagnostic tests available.

Publication Types: 
    Case Reports

PMID: 11866208 [PubMed - indexed for MEDLINE]

2022: Contemp Top Lab Anim Sci. 2002 Jan;41(1):43-5.

Otitis interna as a result of Pasteurella multocida infection in a laboratory
woodchuck.

McCrory WP, Fish RE.

Department of Clinical Sciences, North Carolina State University, College of
Veterinary Medicine, 4700 Hillsborough Street, Raleigh, North Carolina 27606,
USA.

A laboratory woodchuck presented clinically with left-sided torticollis and a
purulent exudate within the external auditory meatus of the left ear. Bacterial
culture of the exudate resulted in a heavy growth of Pasteurella multocida.
Treatment was initiated with topical and systemic antimicrobial compounds. There 
was no clinical improvement after 72 h of treatment, and euthanasia was elected. 
Radiographs correlated well with necropsy findings, confirming a diagnosis of
otitis media; otitis interna was not confirmed but was suggested by the clinical 
presentation. To the authors knowledge, this is the first description of otitis
media/interna as a result of P. multocida infection in a laboratory woodchuck.

Publication Types: 
    Case Reports

PMID: 11860258 [PubMed - indexed for MEDLINE]

2023: Lancet. 2002 Feb 9;359(9305):493.

Reflux of gastric juice and glue ear in children.

Tasker A, Dettmar PW, Panetti M, Koufman JA, Birchall JP, Pearson JP.

Otitis media with effusion (glue ear) is the most frequent cause of deafness in
children. We investigated the role of gastric juice reflux in this disease. We
measured pepsin concentrations in middle ear effusions from children using ELISA 
and enzyme activity assays. 45 (83%) of 54 effusions contained pepsin/pepsinogen 
at concentrations of up to 1000-fold greater than those in serum. Our data
suggest that reflux of gastric juice could be a major cause of glue ear in
children.

Publication Types: 
    Letter
    Research Support, Non-U.S. Gov't

PMID: 11853797 [PubMed - indexed for MEDLINE]

2024: Int J Pediatr Otorhinolaryngol. 2002 Feb 25;62(3):237-42.

Acute mastoiditis in a Norwegian population: a 20 year retrospective study.

Vassbotn FS, Klausen OG, Lind O, Moller P.

Department of Otolaryngology/Head and Neck Surgery, Haukeland University
Hospital, N-5021 Bergen, Norway. flemming.vassbotn@haukeland.no

We have retrospectively examined the nature of acute mastioditis (in western
Norway) during a 20 year period (1980-2000). Sixty-one cases of AM were
identified in 57 patients with a mean age of 3.6 years. We found no significant
change in the incidence of AM during the last 20 years. Seven patients were
treated solely with intravenous antibiotics and myringotomies. Fifty patients
also underwent cortical mastoidectomy, four cases with bilateral surgery.
Antibiotic treatment was given to 31 of the patients before admission to hospital
and this group had a significant longer duration of symptoms (12.4 days) compared
to untreated patients (7.3 days). Streptococcus pneumoniae was the most common
organism recovered from patient cultures. Surgery was found to correlate to
patients with retroauricular fluctuation or to children with at least two of the 
three clinical signs: protrusion of the ear, retroauricular oedema and swelling
of the ear canal. Our data show that clinical examination only reveal 50% of the 
cases with surgically proven retroauricular subperiostal abscess. We therefore
recommend a CT scan of patients treated conservatively.

PMID: 11852127 [PubMed - indexed for MEDLINE]

2025: Int J Pediatr Otorhinolaryngol. 2002 Feb 25;62(3):219-22.

Epidemiology of acute otitis media among Saudi children.

Zakzouk SM, Jamal TS, Daghistani KJ.

Security Forces Hospital, Riyadh and King Abdulaziz University Hospital, Jeddah, 
Saudi Arabia. profzakzouk@hotmail.com

An epidemiological survey was carried out with 9540 children aged up to 12 years 
to study the prevalence of acute suppurative otitis media and the rate of hearing
impairment. A total of 100 (1.05%) were diagnosed with acute otitis media (AOM). 
The incidence was found to be higher among young children up to 4-years-old and
lower in the age group 8-12 years. The male children had slightly higher rate of 
AOM as compared with female (1.36 and 0.80%), respectively, (P < 0.01). The
prevalence of AOM in the children from the different provinces varied, being
higher in those from the Southern and Central regions. Also it was found that the
prevalence of ASOM was higher among children whose parents were cousins compared 
with non-relative parents (1.38 and 0.74%) (P > 0.001). Those with poor
socio-economic condition showed higher rate especially those living in the
Southern part with poor or inadequate health services provided. ASOM was
significantly associated with hearing impairment (P < 0.00001).

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11852124 [PubMed - indexed for MEDLINE]

2026: Int J Pediatr Otorhinolaryngol. 2002 Feb 25;62(3):215-8.

Epidemiology of chronic suppurative otitis media among Saudi children--a
comparative study of two decades.

Zakzouk SM, Hajjaj MF.

profzakzouk@hotmail.com

An epidemiological survey to study the prevalence of chronic suppurative otitis
media (CSOM) was completed in February 2000. About 9540 children aged up to 12
years were examined clinically by an otolaryngologist. All 125 children (1.3%)
suffered from CSOM, nine with cholesteatoma. The prevalence of CSOM in the
Central province of the Kingdom was found to be 1.15%. During the first study
done in 1982, the prevalence was 5.5% among 293 children aged 6-18 years. In the 
second study done and completed in 1991 where 6421 children were surveyed, 94
children found to suffer from CSOM i.e. 1.5% with six children having
cholesteatoma. These results showed a decrease in incidence of CSOM in the
Central province, although in other parts of the Kingdom, the prevalence was
found to be as high as 2.89%. The factors predisposing to or associated with
chronic ear disease will be discussed, and the results will be compared with
results published from other centers.

Publication Types: 
    Comparative Study

PMID: 11852123 [PubMed - indexed for MEDLINE]

2027: Int J Pediatr Otorhinolaryngol. 2002 Feb 25;62(3):207-14.

The role of laser assisted tympanostomy (LAT) in treating allergic children with 
chronic serous otitis media.

Prokopakis EP, Hajiioannou JK, Velegrakis GA, Christodoulou PN, Scordalakis C,
Helidonis ES.

Department of Otolaryngology, University of Crete School of Medicine, Heraklion, 
Greece. epro@med.uoc.gr

OBJECTIVES: To assess various prognostic factors influencing the outcome in
paediatric patients with serous otitis media, who have undergone laser assisted
tympanostomy without ventilation tube placement. Emphasis is given to children
with allergies who underwent the procedure. METHOD: Laser assisted tympanostomy
was performed on a total of 130 ears (92 individuals) with chronic otitis media
with effusion. To determine the quality of patient outcome, the following
parameters were evaluated: external auditory canal anatomy, type of anaesthesia
used, tympanic membrane and middle ear fluid characteristics, myringotomy size, a
history of allergies and the laser device parameters. RESULTS: Multivariable
statistical analysis demonstrated that the presence of allergies in children with
chronic serous otitis media is significantly correlated with a poor outcome (P < 
0.0047). Moreover, the presence of a thick tympanic membrane and/or high
viscosity (glue) fluid in the middle ear cavity can also independently influence 
patient outcome (P < 0.025). Simultaneous adenoidectomy and/or tonsillectomy,
type of anaesthesia (general versus local), external canal anatomy (wide or
narrow) and sex, were not statistically important prognostic factors. The type of
anaesthesia used, myringotomy size and the laser device parameters were not found
to be associated with patient outcome. CONCLUSION: A history of allergies, the
presence of a thick tympanic membrane and/or high viscosity fluid in the middle
ear cavity are all contraindications for laser assisted tympanostomy without
tympanostomy tubes, in children who suffer from chronic serous otitis media. The 
selection criteria for this procedure in the paediatric population are addressed 
in detail.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 11852122 [PubMed - indexed for MEDLINE]

2028: Antimicrob Agents Chemother. 2002 Mar;46(3):859-62.

Optimal dose of amoxicillin in treatment of otitis media caused by a
penicillin-resistant pneumococcus strain in the gerbil model.

Parra A, Ponte C, Cenjor C, García-Calvo G, Giménez MJ, Aguilar L, Soriano F.

Department of Medical Microbiology, Fundación Jiménez Díaz, Madrid, Spain.

Amoxicillin at doses of 0.2 to 5 mg/kg of body weight was administered for the
treatment of pneumococcal otitis media in a gerbil model. Doses greater than or
equal to 2.5 mg/kg, which resulted in concentrations in middle ear fluid of > or 
= 1.4 microg/ml and concentrations in serum higher than the MIC (1 microg/ml) for
> or = 14% of the dosing interval, were both clinically and bacteriologically
effective.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11850273 [PubMed - indexed for MEDLINE]

2029: Vet Dermatol. 2001 Dec;12(6):327-32.

Erratum in:
    Vet Dermatol. 2004 Oct;15(5):339.

Serum antibodies to Malassezia yeasts in canine atopic dermatitis.

Nuttall TJ, Halliwell RE.

University of Edinburgh Hospital for Small Animals, Easter Bush Veterinary
Centre, Midlothian, UK.

Significant numbers of humans with atopic dermatitis develop Malassezia-specific 
IgE. Immediate skin-test reactivity to Malassezia has been demonstrated in atopic
dogs. The aim of this study was to compare the serum IgG and IgE response to
Malassezia in atopic dogs with and without clinical evidence of Malassezia
dermatitis and/or otitis, nonatopic dogs with clinical evidence of Malassezia
dermatitis and/or otitis and healthy dogs. Cytology was used to diagnose
clinically significant Malassezia dermatitis and otitis. Contact plate cultures
confirmed the validity of this technique. Reproducible enzyme-linked
immunosorbent assays for Malassezia-specific IgG and IgE in canine serum were
established. Atopic dogs had significantly higher serum IgG and IgE levels than
either healthy dogs or nonatopic dogs with clinical evidence of Malassezia
dermatitis and/or otitis. There was no significant difference in IgG and IgE
levels between atopic dogs with and without clinical evidence of Malassezia
dermatitis and/or otitis. The implications of these findings in the pathogenesis 
and management of canine atopic dermatitis are discussed.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11844222 [PubMed - indexed for MEDLINE]

2030: Clin Otolaryngol Allied Sci. 2001 Dec;26(6):491-4.

Matrix metalloproteinases 2 and 9 in otitis media with effusion.

Jennings CR, Guo L, Collins HM, Birchall JP.

Department of Otorhinolaryngology and Head and Neck Surgery, Queen's Medical
Centre, University Hospital, Nottingham, UK.

A qualitative and quantitative study of the presence of matrix metalloproteinase 
2 (MMP 2) and matrix metalloproteinase 9 (MMP 9), in the effusions of otitis
media with effusion (OME), was performed. The activity of the above enzymes was
compared in thick and thin effusions, and concentrations compared in samples from
children with one, two, three and four sets of ventilation tubes. The activity of
both MMP 2 and MMP 9 was higher in thick than thin effusions, P = 0.07 and P =
0.04, respectively. The concentrations of MMP 9 did not vary with the number of
tube insertions but those of MMP 2 did (ANOVA P < 0.05). MMPs may be involved in 
tympanic membrane damage and prognosis of OME.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11843930 [PubMed - indexed for MEDLINE]

2031: New Microbiol. 2002 Jan;25(1):31-5.

Bacterial etiology of otitis media with effusion; focusing on the high positivity
of Alloiococcus otitidis.

Kalcioglu MT, Oncel S, Durmaz R, Otlu B, Miman MC, Ozturan O.

Department of Otolaryngology, Faculty of Medicine, Inonu University, Malatya,
Turkey.

The etiology of otitis media with effusion (OME) is unclear. The bacterial
analyses of middle ear effusion (MEE) in OME may reveal important information
regarding its etiology. Alloiococcus otitidis, Heamophilus influenzae,
Streptococcus pneumoniae and Moraxella catarrhalis were investigated by using
microbiologic culture and a multiplex PCR method in the middle ear fluid of 32
children (54 samples) with chronic OME. PCR yielded positive results in 18
(33.3%) middle ear effusions while culture resulted positive for 3 (5.6%). The
PCR method detected A. otitidis in 10 (18.5%) specimens, H. influenzae in 7
(13%), M. catarrhalis in 4 (7.4%) and S. pneumoniae in 2 (3.7%) specimens. The
multiplex PCR method enhances the detection rate significantly compared to that
of the conventional culture method. A. otitidis is the most common detected
pathogen in the MEE of the OME.

PMID: 11837388 [PubMed - indexed for MEDLINE]

2032: Arch Pediatr Adolesc Med. 2002 Feb;156(2):147-54.

Effect of gestational and passive smoke exposure on ear infections in children.

Lieu JE, Feinstein AR.

Robert Wood Johnson Clinical Scholars Program, Yale University School of
Medicine, New Haven CT, USA. lieuj@msnotes.wustl.edu

OBJECTIVE: To estimate the relative risk for otitis media (OM) in children from
environmental tobacco smoke (passive exposure), maternal smoking during pregnancy
(gestational exposure), or both. DESIGN: Analysis of data from a national
cross-sectional health survey, utilizing questionnaire information and serum
cotinine measurements. PARTICIPANTS: Children younger than 12 years (N = 11 728) 
in the Third National Health and Nutrition Examination Survey (NHANES III),
conducted from 1988-1994. MAIN OUTCOME MEASURES: Occurrence and recurrence of ear
infections. RESULTS: The cumulative incidence of ear infections was 69%. Of all
participants, 38% were exposed to passive smoke, 23% were exposed to gestational 
smoke, and 19% were exposed to combined passive and gestational smoke. The
occurrence of any ear infection was not increased by passive smoke exposure
(adjusted risk ratio [RR], 1.01; 95% confidence interval [CI], 0.95-1.06), but
was slightly increased by gestational (adjusted RR, 1.08; 95% CI, 1.01-1.14) and 
combined (adjusted RR, 1.07; 95% CI, 1.00-1.14) smoke exposures. The risk of
recurrent ear infections (> or = 6 lifetime episodes) was significantly increased
with combined smoke exposure (adjusted RR, 1.44; 95% CI, 1.11-1.81). Other risk
factors for ear infection identified in multivariable analysis were
race/ethnicity, poverty-income ratio of 2.00 or more, attendance in day care,
history of asthma, and presence of allergic symptoms. CONCLUSIONS: Passive smoke 
exposure was not associated with an increased risk of ever developing an ear
infection in this study. The increased risk found with gestational and combined
smoke exposures has marginal clinical significance. For recurrent ear infections,
however, combined smoke exposure had a clinically and statistically significant
effect.

PMID: 11814376 [PubMed - indexed for MEDLINE]

2033: Eur Arch Otorhinolaryngol. 2001 Dec;258(10):529-32.

The effect of chronic otitis media on the immunoreactivity of human inner ear.

Jókay I, Papp Z, Soós G, Sziklai I, Dezsö B.

Clinic of Otorhinolaryngology, University of Debrecen and Health Science Center
Medical School, Hungary. ijokay@jaguar.dote.hu

Twenty temporal bones (TBs) were removed from autopsy cases and prepared for
immunohistochemical examination. Ten TBs were free of ear disease whereas the
other ten TBs showed the signs of chronic otitis media. Expression of markers for
monocyte-macrophages (25F9, 27E10) and natural killer cells (anti-Leu-11) was
examined immunohistochemically. There were no specific positive stainings with
25F9 or anti-Leu-11 antibodies in any of the specimens. Staining for 27E10 was
found to be negative in each section obtained from normal cochlea. However, 27E10
positivity was detected in three of ten TBs with signs of chronic ear
inflammation. This positivity can be explained by two theories: (1) activated
monocytes can enter the inner ear from the systemic circulation as a consequence 
of chronic antigen challenge; (2) mesothelial cells could become activated as a
result of a cross-reaction, with resultant positivity. Development of
sensorineural hearing loss in some cases of chronic otitis media may be due to
these immunological reactions.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11829190 [PubMed - indexed for MEDLINE]

2034: Pediatrics. 2002 Feb;109(2):E19.

Xylitol administered only during respiratory infections failed to prevent acute
otitis media.

Tapiainen T, Luotonen L, Kontiokari T, Renko M, Uhari M.

Department of Pediatrics, University of Oulu, Oulu, Finland. ttapiai@paju.oulu.fi

OBJECTIVE: As regular administration of xylitol had been effective in preventing 
acute otitis media (AOM) in children, we tested whether xylitol administered only
at times of acute respiratory infection (ARI) reduces the occurrence of AOM.
METHODS: Healthy children (N = 1277) were recruited from child care centers and
randomized after screening with tympanometry to receive either control mixture (n
= 212), xylitol mixture (n = 212), control chewing gum (n = 280), xylitol chewing
gum (n = 286), or xylitol lozenges (n = 287) during an ARI. The trial was
randomized and double blinded within the mixture and chewing gum groups. The
parents began administering the products to their children at the onset of
symptoms of ARI. The follow-up lasted until resolution of the symptoms or up to 3
weeks. RESULTS: A total of 1253 of the 1277 randomized children were eligible for
the analysis. Altogether, 980 (78%) of 1253 children had at least 1 episode of
ARI during the 4 months that the trial lasted. The occurrence of AOM during this 
episode was 34 (20.5%) of 166 in the xylitol mixture group, as compared with 32
(20.4%) of 157 among the children who received the control mixture. Among the
older children who received control chewing gum, xylitol chewing gum, or xylitol 
lozenges, AOM was experienced by 24 (11.0%) of 218, 31 (14.1%) of 220, and 34
(15.5%) of 219, respectively. None of the differences between the groups was
statistically significant. CONCLUSIONS: Xylitol administered only during an ARI
was ineffective in preventing AOM.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11826229 [PubMed - indexed for MEDLINE]

2035: J Clin Nurs. 2001 May;10(3):305-10.

The public health problem of acute respiratory illness in childcare.

McCutcheon H, Fitzgerald M.

Department of Clinical Nursing, Adelaide University, South Australia.
helen.mccutcheon@adelaide.edu.au

Acute respiratory illness continues to be a significant problem for children
attending childcare. The problems for the child are in terms of prevalence,
incidence, and quality of life. Additional costs relate to parental absence from 
work and loss of earnings. This paper reports on the literature, and notes that
little research has been undertaken to determine whether there are long-term
risks or benefits to experiencing acute respiratory illness in early childhood.
Research to date is presented, and the role of public health nurses is discussed 
in relation to how they might assist in reducing the incidence/prevalence of
acute respiratory illness in children attending childcare.

Publication Types: 
    Review

PMID: 11820539 [PubMed - indexed for MEDLINE]

2036: Mycoses. 2001 Dec;44(11-12):472-9.

Otomycosis: prevalence, clinical symptoms, therapeutic procedure.

Kurnatowski P, Filipiak A.

Centre for Treatment of Parasitic Diseases and Mycoses, Medical University of
Lódź, Poland. pkurna@katedra.dofa.am.lodzpl

Local lesions observed in otitis, create favourable conditions for the growth of 
fungi and development of mycoses both in the external and middle ear, as well as 
in post-operative cavities, especially in cases of open-type surgery. The
objective of this study was: (1) to determine the prevalence of mycotic
infections in inflammatory conditions of the ear; (2) to evaluate the
relationship between the presence of fungi and clinical symptoms of inflammation;
and (3) to construct a model of therapeutic procedure. The study concerned 345
individuals, including 295 patients (381 ears) who presented with symptoms of
otitis. The mycological examinations revealed presence of fungi in 30.4% cases
(116 ears). Positive culture results were obtained predominantly in patients with
post-operative suppuration (52.8%). Otomycosis was more often associated with
fungi of the genus Candida (3/5) than with fungi of the genus Aspergillus (2/5). 
The analysis of symptoms in otomycoses showed that in bacteria-induced otitis,
pruritus, discharge, post-operative defective hearing and headaches are most
common; the analysis of signs showed that reddened epidermis and lining of the
tympanic cavity are statistically more frequent. The therapeutic protocol adopted
in otomycoses yields good results: 89%--complete cure.

PMID: 11820260 [PubMed - indexed for MEDLINE]

2037: Acta Otolaryngol. 2001 Dec;121(8):925-9.

A comparative study of azithromycin and pseudoephedrine hydrochloride for otitis 
media with effusion in children.

Safak MA, Kiliç R, Haberal I, Göçmen H, Ozeri C.

Ministry of Health, Ankara Training and Research Hospital, Turkey.
masafak@doctor.com

We compared the outcomes of two different regimens--azithromycin and
pseudoephedrine hydrochloride (PHCl)--for the treatment of otitis media with
effusion (OME) in children. In a double-blind randomized clinical study, a total 
of 90 children aged between 2 and 13 years with persistent OME were randomly
assigned to one of 3 treatment groups. The first group received azithromycin at a
dose of 10 mg/kg once daily for 3 days and this regimen was repeated weekly for
up to 12 weeks according to the results of tympanometry and pneumatic otoscopy.
The second group received azithromycin at a dose of 10 mg/kg once daily for 3
days for the first week, and this regimen was repeated for 1 day a week for the
following 11 weeks. The third group received PHCl, 4 mg/kg, 3 times daily for up 
to 12 weeks. Each patient underwent pneumatic otoscopic and tympanometric
investigations at baseline and at Weeks 4, 8 and 12. The outcomes in the
azithromycin-treated groups were superior to that in the decongestant group.
However, the difference between the outcomes in the azithromycin groups according
to the treatment protocol was not statistically significant. Azithromycin
therapy, particularly a once-weekly regimen, helps patients to comply with
treatment and also helps us to achieve good results with minimal therapy.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 11813896 [PubMed - indexed for MEDLINE]

2038: Acta Otolaryngol. 2001 Dec;121(8):908-14.

Outcome of acute otitis media and its relation to clinical features and
nasopharyngeal colonization at the time of diagnosis.

Harabuchi Y, Kodama H, Faden H.

Department of Otorhinolaryngology, Asahikawa Medical College, Japan.
hyasu@asahikawa-med.ac.jp

Children (n = 115; age range 1-9 years) with a diagnosis of acute otitis media
(AOM) were eligible for this study and were enrolled within 24 h of the onset of 
symptoms/signs. A nasopharyngeal culture was obtained at the initial visit.
Children were treated with a single oral antibiotic for 7 days. Changes in
symptoms/signs and tympanic membrane features assessed by a scoring system were
monitored for 1 month and related to the nasopharyngeal pathogen recovered on Day
1. More than 80% of children had no symptoms/signs by Day 3, and 60% of cases had
normal tympanic membranes by Day 29. Children without any symptoms/signs on Day 3
had significantly lower symptom/sign scores on Day 1 (p = 0.005). Seventy-nine
percent of cases carried middle ear pathogens in the nasopharynx at diagnosis:
Streptococcus pneumoniae (48%); Haemophilus influenzae (24%); and Moraxella
catarrhalis (16%). Children with S. pneumoniae showed significantly higher
tympanic membrane scores than children with no pathogen at Days 8, 15 and 29 (p <
0.01 for each comparison). Multivariate regression analysis revealed that lower
tympanic membrane score on Day 1, the absence of S. pneumoniae in the nasopharynx
and treatment with amoxillin were independent factors for rapid normalization of 
the tympanic membrane. These data suggest that the clinical course of AOM may be 
predicted, in part, at the time of diagnosis by means of careful evaluation of
symptoms/signs and the tympanic membrane as well as knowledge of pathogens
harbored in the nasopharynx.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11813893 [PubMed - indexed for MEDLINE]

2039: J Infect Chemother. 2001 Dec;7(4):239-42.

Random amplified polymorphic DNA analysis applied to acute otitis media caused by
penicillin non-susceptible Streptococcus pneumoniae.

Nakashima T, Fukushima K, Tahara M, Sugata KI, Ogawa T, Sugata A, Gunduz M, Ueki 
Y, Uno Y, Nishizaki K.

Department of Otolaryngology, Okayama University Medical School, 2-5-1
Shikata-cho, Okayama 700-8558, Japan.

The spread of penicillin non-susceptible Streptococcus pneumoniae (PNSSP) is an
emerging problem for the treatment of acute otitis media (AOM). Attendance of
children at day care centers, as well as the spread of PNSSP, is a risk factor
for AOM. The status of the spread of PNSSP during the acute infection phase of
AOM has not been evaluated. We examined the clonality of samples from seven
children in a day care center who simultaneously developed AOM caused by PNSSP.
The seven isolates from the children, and six control samples were grouped by
serotyping, by determining resistance to antimicrobial agents, and by genotyping,
carried out by sequencer-based random amplified polymorphic DNA (RAPD), and
validated by bootstrap analysis. There was no evidence to indicate the direct
dissemination of PNSSP among these patients in the day care center, although the 
simultaneous occurrence of PNSSP AOM had initially suggested a clonal outbreak.
The possible presence of a common ancestral strain suggested the importance of
surveillance during the carrier state. The result of RAPD genotyping was highly
reproducible, as validated by the high bootstrap score. The use of an automated
sequencer, in combination with a careful choice of primers, and commercially
established kits, played a significant role in the reproducibility of the
studies.

PMID: 11810590 [PubMed - indexed for MEDLINE]

2040: J Chemother. 2001 Dec;13(6):621-7.

A multicenter study on the clinical efficacy and safety of roxithromycin in the
treatment of ear-nose-throat infections: comparison with amoxycillin/clavulanic
acid.

Mira E, Benazzo M.

Dept. of Otorhinolaryngology, IRCCS Policlinico San Matteo, University of Pavia, 
Italy.

This multicenter, randomized open-label study compared the efficacy and safety of
roxithromycin tablets 300 mg once a day (Rx) and amoxicillin/clavulanic acid
tablets 875+125 mg twice a day (Acx), administered for a mean of 7 days. The
study was carried out in five centers on 100 in- or out-patients of both sexes,
aged between 18 and 91 years (mean 38+/-14). All patients suffered from ENT
diseases, 85% with acute otitis media, 31% pharyngotonsillitis and 11%
rhinosinusitis. The patients were divided into two randomized groups of 50
patients each. Clinical evaluations (signs and symptoms) were performed before,
during and at the end of therapy. At the end of therapy, for intent-to-treat and 
per-protocol populations, a satisfactory overall clinical response was achieved
by 82% of patients in the Rx group and 78% in the Acx group with similar
reductions in signs and symptoms of disease in both groups. Safety was good, with
only 2 patients of the Rx group and 4 patients of the Acx group presenting side
effects, involving mainly the gastrointestinal system. Rx appears to be active
and safe in the therapy of ENT diseases exhibiting similar effects on the
reduction of signs and symptoms as Amx but with better compliance because of
once-a-day administration.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial

PMID: 11806623 [PubMed - indexed for MEDLINE]

2041: Laryngoscope. 2002 Jan;112(1):152-5.

Compositional difference in middle ear effusion: mucous versus serous.

Chung MH, Choi JY, Lee WS, Kim HN, Yoon JH.

Department of Otorhinolaryngology, Yonsei University College of Medicine, 134
Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea.

OBJECTIVES: Serous otitis media is usually responsive to medical treatment,
whereas mucoid otitis media is not. The present study was undertaken to elucidate
the compositional difference between serous and mucoid effusion and to
investigate whether MUC5AC acts as a major mucin in the middle ear mucosa with
mucoid otitis media. STUDY DESIGN: This study involved a chemical analysis of
middle ear effusion and immunostaining of the middle ear mucosa. METHODS: Middle 
ear effusion samples were collected from 27 patients with mucoid otitis media and
18 patients with serous otitis media. The levels of mucin, lysozyme, secretory
immunoglobulin A, and interleukin-8 were measured by dot blotting or
enzyme-linked immunosorbent assay. Periodic acid-Schiff and immunohistochemical
staining with monoclonal anti-MUC5AC antibody were performed on the serial
sections of middle ear mucosa with mucoid otitis media. RESULTS: Mucoid effusions
contained higher levels of mucin, lysozyme, secretory immunoglobulin A, and
interleukin-8 than did serous effusions. Immunohistological study revealed that
MUC5AC mucin was expressed in only a small portion of the goblet cells of middle 
ear mucosa with mucoid otitis media. CONCLUSIONS: The study suggests that both
serous secretions and mucin might make the middle ear effusion more viscous and
that mucins other than MUC5AC might have a major role in the viscosity of middle 
ear effusion. Further study is necessary to identify the major mucins in the
middle ear effusion of otitis media with effusion.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11802055 [PubMed - indexed for MEDLINE]

2042: Laryngoscope. 2001 Dec;111(12):2083-94.

Direct evidence of bacterial biofilms in otitis media.

Post JC.

Department of Pediatric Otolaryngology, Allegheny General Hospital, Pittsburgh,
Pennsylvania 15212-4722, USA. cpost@wpahs.org

OBJECTIVES/HYPOTHESIS: Bacteriologic studies of otitis media with effusion (OME) 
using highly sensitive techniques of molecular biology such as the polymerase
chain reaction have demonstrated that traditional culturing methods are
inadequate to detect many viable bacteria present in OME. The presence of
pathogens attached to the middle-ear mucosa as a bacterial biofilm, rather than
as free-floating organisms in a middle-ear effusion, has previously been
suggested to explain these observations. The suggestion has been speculative,
however, because no visual evidence of such biofilms on middle-ear mucosa has
heretofore been collected. The hypotheses motivating the current study were: 1)
biofilms of nontypable Hemophilus influenzae will form on the middle-ear mucosa
of chinchillas in an experimental model of OME, 2) these biofilms will exhibit
changes in density or structure over time, and 3) biofilms are also present on
tympanostomy tubes in children with refractory post-tympanostomy otorrhea. The
objective of this study was to collect visual evidence of the formation of
bacterial biofilms in these situations. STUDY DESIGN: Laboratory study of
bacteriology in an animal model and on medical devices removed from pediatric
patients. METHODS: Experimental otitis media was induced in chinchillas by
transbullar injection of nontypable H. influenzae. Animals were killed in a time 
series and the surface of the middle-ear mucosa was examined by scanning electron
microscopy (SEM) for the presence of bacterial biofilms. Adult and fetal
chinchilla uninfected controls were similarly examined for comparison. In
addition, tympanostomy tubes that had been placed in children's ears to treat OME
and removed after onset of refractory otorrhea or other problems were examined by
SEM and by confocal scanning laser microscopy for bacterial biofilms, and
compared with unused control tubes. RESULTS: Bacterial biofilms were visually
detected by SEM on the middle-ear mucosa of multiple chinchillas in which H.
influenzae otitis media had been induced. Qualitative evaluation indicated that
the density and thickness of the biofilm might increase until at least 96 hours
after injection. The appearance of the middle-ear mucosa of experimental animals 
contrasted with that of uninjected control animals. Robust bacterial biofilms
were also visually detected on tympanostomy tubes removed from children's ears
for clinical reasons, in contrast with unused control tubes. CONCLUSIONS:
Bacterial biofilms form on the middle-ear mucosa of chinchillas in experimentally
induced H. influenzae otitis media and can form on tympanostomy tubes placed in
children's ears. Such biofilms can be directly observed by microscopy. These
results reinforce the hypothesis that the bacterial aggregates called biofilms,
resistant to treatment by antibiotics and to detection by standard culture
techniques, may play a major etiologic role in OME and in one of its frequent
complications, post-tympanostomy otorrhea.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11802002 [PubMed - indexed for MEDLINE]

2043: Clin Tech Small Anim Pract. 2001 Nov;16(4):236-41.

A review of techniques for the investigation of otitis externa and otitis media.

Murphy KM.

North Carolina State University, College of Veterinary Medicine, 4700
Hillsborough Street, Raleigh, NC 27606, USA.

Otitis externa, inflammation of the externa ear canal, is relatively easy to
diagnose based on the history and physical examination findings. The diagnosis of
otitis media, inflammation of the middle ear cavity, is more challenging, with
the work-up being both costly and, at times, invasive. The pathogenesis of otitis
externa has been classified into predisposing, primary, and perpetuating factors.
It is critical to the management of ear disease that the clinician recognize and 
investigate which factors are contributing to each individual patient's ear
disease. Failure to identify and address the primary and/or predisposing factors 
is the most common cause of chronic recurrent otitis externa. Chronic
inflammation of the ear canal leads to the development of the perpetuating
factors, which may be the major reason for treatment failure, regardless of the
primary cause of the ear disease. In this article, the predisposing, primary, and
perpetuating factors involved in ear disease will be presented, along with a
review of the techniques used in the diagnosis of otitis externa and otitis
media.

Publication Types: 
    Review

PMID: 11793879 [PubMed - indexed for MEDLINE]

2044: Pediatr Infect Dis J. 2002 Jan;21(1):57-61.

Comment in:
    Pediatr Infect Dis J. 2002 Oct;21(10):986-7.

Cytology of middle ear fluid during acute otitis media.

Broides A, Leibovitz E, Dagan R, Press J, Raiz S, Kafka M, Leiberman A, Yermiahu 
T.

Pediatric Infectious Disease Unit, Soroka University Medical Center and the
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,
Israel.

BACKGROUND: Limited information is available on the cellular characteristics of
the middle ear fluid (MEF) during acute otitis media (AOM). OBJECTIVES: To
determine the white blood cell (WBC) composition of the MEF in AOM before and
during antibiotic therapy. MATERIALS AND METHODS: Total WBC and differential
counts were determined in the MEF of 96 infants and children (ages 2 weeks to 3
years) with AOM who were receiving antibiotics. WBC counts were reported as
number of WBC/mg MEF (mean +/- sd). RESULTS: One hundred forty-five MEF samples
were obtained by tympanocentesis at enrollment (Day 1), and 36 samples were
collected on Days 4 to 5 after initiation of antibiotic therapy. Sixty-one
percent of the patients were <1 year of age, and 38% were receiving antibiotic
therapy at enrollment. Twenty-eight MEF samples were paired (same ear, Day 1 and 
Days 4 to 5). One hundred twelve pathogens were isolated from 95 of 145 (66%)
culture-positive samples obtained on Day 1: 67 Haemophilus influenzae, 40
Streptococcus pneumoniae and 5 others. MEF WBC counts were lower on Day 1 in
patients who had received previous antibiotic therapy than in those who had not
(432.4+/- 412.8 vs. 590.5 +/- 436.8, P = 0.03). WBC counts were higher on Day 1
in culture-positive than in culture-negative samples (603.9 +/- 504.9 vs.421.4
+/- 373.4, P = 0.02). WBC counts were higher on Day 1 in MEF samples positive for
S. pneumoniae than in those positive for H. influenzae (799.2 +/- 641.5 vs.506.4 
+/- 401.9, P = 0.04). There were no differences in the number of neutrophil WBC
present in the samples obtained on Day 1 vs.Days 4 to 5 or between samples
positive vs.samples negative for bacterial pathogens. CONCLUSIONS: WBC counts
were higher in the MEF of patients with culture-positive AOM than in those with
culture-negative AOM and in those with AOM caused by S. pneumoniae.

PMID: 11791101 [PubMed - indexed for MEDLINE]

2045: Int J Pediatr Otorhinolaryngol. 2002 Feb 1;62(2):135-42.

Predicting the development and outcome of otitis media by tympanometry.

Palmu A, Puhakka H, Rahko T, Takala A, Kilpi T.

National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki,
Finland. aapalmu@tays.fi

OBJECTIVE: Identification of children with high risk of development or
prolongation of otitis media would be highly useful in clinical practice. In this
study, tympanometry was assessed for its capability in predicting development and
resolution of acute otitis media (AOM). METHODS: Visits of 329 children followed 
in the Finnish Otitis Media Cohort Study from 2 to 24 months of age were
evaluated for this report. Tympanometry was routinely performed on all children
during their visits to a special study clinic. Adjacent consecutive visits were
used for analysis of development and resolution of middle ear fluid (MEF) between
the visits. Descriptive analysis utilized all data obtained during the
longitudinal follow-up; confirmatory statistical analysis was performed on data
of one randomly selected visit per subject to ensure independence of
observations. Presence of MEF at the second visit was used as the outcome.
RESULTS: Negative tympanometric peak pressure (<-100 daPa) was found to predict
the development of otitis media when observed during respiratory infection with
no concomitant ear disease. Otitis media developed within 20 days to 40% of
children with negative pressure compared with 20% of children without negative
pressure. The observed association was confirmed statistically (odds ratio 4.8,
95% confidence interval 2.4-9.6). Poor outcome of AOM at the subsequent follow-up
visit 3-5 weeks later was found in 9% of ears with negative pressure tympanogram 
compared with 24% with initial type B or normal pressure tympanogram during AOM. 
However, we could not confirm the finding in statistical analysis (odds ratio
0.6, 95% confidence interval 0.2-2.0). CONCLUSIONS: Profound negative
tympanometric peak pressure is a significant marker of increased risk for
development of otitis media. Children with negative pressure have to be
thoroughly followed for subsequent progress of the respiratory disease and
development of otitis media. For the prediction of resolution of AOM, the
findings remained inconclusive.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11788146 [PubMed - indexed for MEDLINE]

2046: Int J Pediatr Otorhinolaryngol. 2002 Feb 1;62(2):129-34.

Otitis media in children: seasonal changes and socioeconomic level.

Castagno LA, Lavinsky L.

Clínica Dr. Castagno, Rua General Osório, 1585, 96020 000, Pelotas, RS, Brazil.
castagno.sul@terra.com.br

OBJECTIVE: Our objective was to determine the frequency of otitis media (OM) in
relation to socioeconomic and seasonal factors in a city in southern Brazil.
METHODS: A prospective, longitudinal study was carried out with a 3-4-year-old
cohort of children randomly selected in schools serving populations of higher
socioeconomic status (AB; monthly family income >10 minimum wages, US$ 1000) or
lower socioeconomic status (CD; monthly family income < or = 3 minimum wages, US$
300). The children were assessed in the fall, winter, and spring of 1997 using
otoscopy and tympanometry. RESULTS: Among 156 children who finished the study,
53.8% belonged to socioeconomic group CD. Otoscopy suggested chronic suppurative 
otitis media (OM) (tympanic membrane perforation or otorrhea) in <6% of children 
in the CD group, with no seasonal variation. Alterations suggesting secretory
otitis media (SOM) were significantly more frequent in the CD group (P< or =
0.001), with a peak in the winter. The prevalence of SOM on otoscopy was: fall
(20.9% AB; 38.1% CD); winter (28.6% AB; 81% CD), and spring (23% AB; 49.3% CD).
The incidence of SOM in the winter according to tympanometry was 18.4% (group AB)
and 72.9% (group CD). Among children with a normal tympanogram in the fall, 44.7%
presented a type B tympanogram (presence of middle ear effusion) in the winter.
Only 17.6% still presented a type B tympanogram in the spring. From the ears with
type B tympanogram in the fall, 80% had the same result in the winter, and 60.9%,
in the spring. A sharp seasonal SOM peak was observed in the CD group in the
winter. CONCLUSION: Children in the lower socioeconomic group have a peak
incidence of serous otitis media (OM) in the winter. Presence of type B
tympanogram in the fall and belonging to socioeconomic group CD are indicators of
poor prognosis in terms of the spontaneous resolution of SOM.

PMID: 11788145 [PubMed - indexed for MEDLINE]

2047: Arch Otolaryngol Head Neck Surg. 2002 Jan;128(1):17-20.

Cytokine gene polymorphism in recurrent acute otitis media.

Joki-Erkkilä VP, Puhakka H, Hurme M.

Department of Otorhinolaryngology, Head and Neck Surgery, Tampere University
Hospital, PO Box 2000, FIN-33521 Tampere, Finland.
vp.jokierkkila@nokianlaakariasema.fi

BACKGROUND: There is increasing evidence that a strong genetic component is
involved in the predisposition to recurrent acute otitis media (rAOM). Cytokines 
play a key role in the pathogenesis of otitis media. Constitutional polymorphisms
in cytokine genes may lead to individual variations in cytokine secretion.
OBJECTIVE: To elucidate the role of cytokine gene polymorphisms in rAOM. SETTING:
University hospital. PARTICIPANTS AND METHODS: Blood samples for genetic analysis
were obtained from 63 individuals with rAOM from 20 different families and from
400 healthy blood donors. The medical history of the rAOM group was based on
medical records and interview data. We studied the polymorphisms of tumor
necrosis factor alpha, interleukin (IL) 1 alpha, IL-1 beta, and IL-1 receptor
antagonist genes. RESULTS: The distribution of cytokine alleles in the rAOM group
did not differ significantly from that of the control group. However, in patients
with rAOM without a history of allergic disorders, allele frequencies of IL-1
alpha-889 differed significantly from those of controls (P =.03). CONCLUSIONS:
There is no clear association between the polymorphism of studied cytokine genes 
and rAOM. However, the IL-1 alpha gene polymorphism may be associated with
recurrent middle ear infections in a subgroup of patients without allergic
disorders.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11784248 [PubMed - indexed for MEDLINE]

2048: Eur J Clin Microbiol Infect Dis. 2001 Nov;20(11):824-6.

Penicillin-susceptible and erythromycin-resistant Streptococcus pneumoniae in
children with acute mastoiditis.

del Castillo F, Ledesma F, García-Perea A.

Pediatric Infectious Disease Unit, Children's University Hospital La Paz, Madrid,
Spain. fdm02m@nacom.es

Resistance to erythromycin is usually associated with resistance to penicillin in
Streptococcus pneumoniae isolates. Over the last few years, however, an increase 
has been detected in the number of Streptococcus pneumoniae isolates obtained
from children with acute otitis media complicated by acute mastoiditis. These
isolates are characterized by a penicillin-susceptible and erythromycin-resistant
antibiotic profile. This observation prompted a review of the microbiology
database and analysis of all Streptococcus pneumoniae isolates with this peculiar
antibiotic profile at a university hospital in Madrid, Spain.

Publication Types: 
    Comparative Study

PMID: 11783702 [PubMed - indexed for MEDLINE]

2049: J Laryngol Otol. 2001 Dec;115(12):967-72.

Role of mastoid obliteration in patients with persistent cavity problems
following modified radical mastoidectomy.

Gopalakrishnan S, Chadha SK, Gopalan G, Ravi D.

Department of Otolaryngology, JIPMER, Pondicherry, India.

A randomized clinical trial was conducted to determine the efficacy of mastoid
obliteration in controlling persistent ear discharge, wax accumulation, fungal
infection and granulation tissue formation in patients with cavity problems
following modified radical mastoidectomy (MRM). Thirty patients underwent
revision mastoidectomy with mastoid obliteration using a temporoparietal fascial 
flap. They were then followed up over a one-year period and the stated parameters
observed. They were compared with 30 patients with similar complaints who were
treated conservatively and kept under observation for 12 months. On follow-up,
the number of patients in both the groups suffering from various cavity problems 
was compared. The chi-squared test was applied to the results and it was
determined that there was a significantly lower incidence of discharging ear and 
formation of granulations in the operative group. However, audiological status,
development of otomycosis and wax accumulation did not reveal any significant
variation between the two groups.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 11779325 [PubMed - indexed for MEDLINE]

2050: J Laryngol Otol. 2001 Dec;115(12):962-6.

Clinical features of newly presenting cases of chronic otitis media.

Sheahan P, Donnelly M, Kane R.

Department of Otolaryngology, Waterford Regional Hospital, Waterford City,
Ireland.

The clinical features of 58 consecutive patients presenting with a new case of
chronic otitis media were prospectively collected over a 15-month period.
Twenty-three ears had a keratin filled marginal or attic defect (14 with
cholesteatoma), 20 had a self-clearing marginal or attic defect, and 21 had a
central tympanic membrane perforation (including one cholesteatoma). Twenty
patients (35 per cent) had an abnormal finding in the opposite ear. The patients'
ages were dispersed over a wide range of age groups with a mean age of 34 years. 
Hearing loss was the most common presenting symptom (78 per cent), followed by
otorrhoea (64 per cent). A significant proportion of patients denied any history 
of otorrhoea. Our findings should alert the clinician to suspecting a new case of
COM in patients with hearing loss of any age, with, or without, a history of
otorrhoea, regardless of their background ear history or the duration of their
symptoms.

PMID: 11779324 [PubMed - indexed for MEDLINE]

2051: J Laryngol Otol. 2001 Nov;115(11):879-80.

Outcome of 22 cases of perforated tympanic membrane caused by otomycosis.

Hurst WB.

Department of Otolaryngology, Frankston Hospital, Victoria, Australia.

Twenty-two cases of perforated tympanic membrane due to fungal otitis externa
were observed over a five-year period. The diagnosis of fungal otitis externa was
made on clinical grounds due to the obvious presence of fungal bloom in the
external ear canal. Some perforations were noted at the first treatment after the
fungal debris had been removed from the external ear canal using a microscope.
Other perforations were observed to develop over a few days. Initially, a
discrete area of the tympanic membrane appeared white and opaque. As time
progressed the white area disintegrated, forming a perforation. Once the otitis
externa had resolved most perforations healed spontaneously. Two that were
observed to develop during treatment required a myringoplasty. Another one closed
significantly but a tiny persistent perforation required cauterization with
trichloracetic acid to encourage it to close over completely. The only residual
hearing loss was in a case with almost total disintegration of the tympanic
membrane requiring a myringoplasty. Treatment of fungal otitis externa for the
patients in this series was aural toilet using suction under a microscope and
insertion of a gauze wick saturated in a combination of hydrocortisone,
clotrimazole, framycetin and gramicidin.

PMID: 11779301 [PubMed - indexed for MEDLINE]

2052: J Laryngol Otol. 2001 Nov;115(11):874-8.

Adult-onset otitis media with effusion: results following ventilation tube
insertion.

Yung MW, Arasaratnam R.

Department of Otolaryngology, The Ipswich Hospital NHS Trust, Ipswich, UK.
yung@doctors.org.uk

The outcome of otitis media with effusion (OME) in children is generally good.
However, it is less clear in adults. All adult patients who had a ventilation
tube inserted for OME at the Ipswich Hospital between 1996 and 1997 were studied.
Of 53 patients studied, 28 had had a previous history of ventilation tube
insertion. Furthermore, at 15-27 months following ventilation tube insertion, the
ventilation tube had already extruded in 31 patients and the OME had already
recurred in 19 of these. Endoscopic examination revealed that many patients still
had evidence of inflammation at the lateral nasal wall (26.4 per cent) and at the
eustachian tube orifice (51 per cent). There is also a strong history of atopy in
the studied group and the skin prick test was positive in 57 per cent of the
patients. This study shows that many patients with adult-onset OME have
underlying pathology that could lead to recurrence of OME following ventilation
tube extrusion.

PMID: 11779300 [PubMed - indexed for MEDLINE]

2053: J Laryngol Otol. 2001 Nov;115(11):869-73.

Community ear care delivery by community ear assistants and volunteers: a pilot
programme.

Shrestha R, Baral K, Weir N.

Bheri Zonal Hospital, Nepalgunj, Nepal. dr_rks@npj.wlink.con.np

Hearing impairment is a major public health problem in Nepal. The present service
delivery, however, is mainly hospital based and is limited to large towns. Those 
people residing in rural areas lack many basic needs including ear care services.
The collaborative community volunteer-based ear care pilot programme implemented 
in Banke, Nepal aims to reach out to those rural areas by establishing
sustainable primary ear care services, empowering and utilizing local resources. 
The focus of the programme is to promote multi-sector improvement in sanitation, 
nutrition, immunization, breast-feeding and timely care and support to ear
patients to help prevent hearing impairment mainly from the sequelae of otitis
media.

PMID: 11779299 [PubMed - indexed for MEDLINE]

2054: Ear Nose Throat J. 2001 Dec;80(12):869-70.

Sigmoid sinus thrombosis with contralateral abducens palsy: first report of a
case.

Marzo SJ.

Department of Otolaryngology-Head and Neck Surgery, Loyola University, 2160 S.
First Ave., Maywood, IL 60153, USA. smarzo@luo.edu

Intracranial complications of acute and chronic otitis media can be difficult to 
recognize because the signs and symptoms are often subtle. This article describes
a case of one such complication--sigmoid sinus thrombosis--that was manifested by
a contralateral abducens palsy. The author believes that this is the first
reported case of such an occurrence. This article also reviews the differential
diagnosis of increased intracranial pressure and discusses the recognition and
management of lateral sinus thrombosis.

Publication Types: 
    Case Reports

PMID: 11775519 [PubMed - indexed for MEDLINE]

2055: Allergy Asthma Proc. 2001 Nov-Dec;22(6):353-7.

Update on the development and use of viral and bacterial vaccines for the
prevention of acute otitis media.

Greenberg DP.

Department of Pediatrics, University of Pittsburgh School of Medicine, Children's
Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Acute otitis media (AOM) is the most frequent diagnosis in physician offices
among children 1-4 years of age. Viruses that cause upper respiratory tract
infections (i.e., respiratory syncytial virus [RSV], influenza virus,
parainfluenza virus [PIV], and others) play an important role in the development 
of AOM. Prevention of infections with these viral pathogens likely would reduce
the incidence of AOM. In three previous studies, influenza virus vaccines showed 
30-36% efficacy against the development of AOM. Vaccines to prevent infections
with RSV and PIV type 3 are undergoing clinical testing at this time. The three
major bacterial pathogens causing AOM are Streptococcus pneumoniae, nontypeable
Haemophilus influenzae (NTHi), and Moraxella catarrhalis. Pneumococcal conjugate 
vaccine, licensed in the United States in 2000, was shown in two pivotal trials
to reduce the incidence of all causes of AOM by 6%, pneumococcal AOM by 34%, and 
pneumococcal AOM caused by serotypes contained in the vaccine by 57%. Currently, 
vaccines against NTHi and M. catarrhalis are under development.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 11775392 [PubMed - indexed for MEDLINE]

2056: Otol Neurotol. 2002 Jan;23(1):53-5.

Cochlear implantation in chronic suppurative otitis media.

El-Kashlan HK, Arts HA, Telian SA.

Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann
Arbor, Michigan 48109-0312, USA. hussam@umich.edu

OBJECTIVE: To evaluate management options for cochlear implantation in patients
with chronic suppurative otitis media. STUDY DESIGN: Retrospective case review.
SETTING: Tertiary referral center with a large cochlear implant program.
PATIENTS: Ten patients with chronic suppurative otitis media who received
cochlear implants were identified. Case history, etiology of hearing loss, and
management of the ear with the implant were evaluated. INTERVENTIONS: Cochlear
implantation and subsequent rehabilitation. MAIN OUTCOME MEASURES: Early and late
complications were evaluated. RESULTS: No early or late complications were
identified in this group of patients after an average follow-up period of about 4
years. CONCLUSION: Cochlear implantation can be safely achieved in patients with 
chronic suppurative otitis media. There are several options for the management of
these patients, and the approach chosen should be individualized on the basis of 
clinical findings.

PMID: 11773847 [PubMed - indexed for MEDLINE]

2057: Otol Neurotol. 2002 Jan;23(1):18-20.

Preoperative topical ofloxacin solution for tympanoplasty: a randomized,
controlled study.

Tong MC, Yue V, Ku PK, van Hasselt CA.

Division of Otorhinolaryngology, Department of Surgery, The Chinese University of
Hong Kong, Prince of Wales Hospital, Shatin, New Territory, Hong Kong, People's
Republic of China.

OBJECTIVE: To establish the efficacy of immediate preoperative ototopical
ofloxacin eardrops in eradicating middle ear pathogens and improving operative
outcome. STUDY DESIGN: Single-blind, randomized control study. SETTING: Tertiary 
referral center, ambulatory clinic, and hospital setting. PATIENTS: Consecutive
patients with chronic suppurative otitis media for Type I tympanoplasty
(myringoplasty). INTERVENTIONS: The patients were randomly assigned to 3 groups: 
Group A underwent 10-minute daily treatments with eardrops for 2 weeks before
surgery, Group B underwent 3-minute daily treatments for 2 weeks before surgery, 
and Group C underwent no treatment. MAIN OUTCOME MEASURES: Preoperative and
perioperative bacteriology and success of the surgery as defined by an intact
tympanic membrane in the eighth week postsurgery. RESULTS: There were 101
patients entered in the study. The preoperative, perioperative, and postoperative
observation of discharge and quantity of the discharge were compared, and no
differences were found among the groups (Kruskal-Wallis test). The perioperative 
culture results were analyzed and 18/21 (86%) became culture negative in Group A,
23/27 (85%) became culture negative in Group B, and 3/21 (14%) became culture
negative in the control group (Group C versus Group A or Group B, chi(2) tests p 
< 0.001). The success rates of surgery as defined by an intact tympanic membrane 
showed no difference: 28/33 (85%), 27/33 (82%), and 31/35 (89%) in Groups A, B,
and C, respectively. The preoperative positive bacteriology rate in the surgical 
failures was 10/15 (67%), compared with 16/76 (21%) for the successful procedures
(p < 0.001). CONCLUSION: Our study has shown that ofloxacin successfully
eradicates most bacterial flora preoperatively. We cannot, however, confirm the
benefits of its preoperative usage in improving the graft success rate.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11773839 [PubMed - indexed for MEDLINE]

2058: Otol Neurotol. 2002 Jan;23(1):3-7.

Comment in:
    Otol Neurotol. 2002 Jul;23(4):620; author reply 621.

Intranasal metered dose aerosolized surfactant reduces passive opening pressure
of the eustachian tube: comparison study in two animal models.

Chandrasekhar SS, Connelly PE, Venkatayan N, el-Sherif Ammar M, Tabor M, Mautone 
AJ.

Department of Otolaryngology, Mount Sinai School of Medicine, New York, New York 
10029, USA. sujana_chandrasekhar@mssm.edu

HYPOTHESIS: Intranasal metered dose aerosolized inhaler surfactant will reduce
opening pressure of the eustachian tube in gerbils and mice. BACKGROUND:
Eustachian tube opening pressure necessary to allow ventilation of the middle ear
must exceed the contractile force exerted by the tension on the curved surface of
the eustachian tube. When the active function of opening the eustachian tube is
inefficient, functional collapse of the tube persists, resulting in negative
middle ear pressure. Such dysfunction is the primary cause of otitis media with
effusion in children. METHODS: Surfactant in a metered dose aerosolized
intranasal delivery system was administered to 61 healthy Mongolian gerbils and
34 albino mice. In the first arm of the experiment, measurements of eustachian
tube passive opening pressure were taken at baseline, after the delivery of
propellant, and then at 5 and 10 minutes after surfactant administration. In the 
second arm of the experiment, the animals were divided into control, propellant, 
and experiment groups. At zero minutes, propellant was administered to the
propellant group and intranasal surfactant was administered to the experiment
group. Measurements of eustachian tube passive opening pressure were taken at 0, 
5, and 10 minutes. RESULTS: Surfactant administration in the gerbil reduced
eustachian tube passive opening pressure from a basal measurement of 40.5 mm Hg
to 32.5 mm Hg after 5 minutes and to 30.1 mm Hg after 10 minutes. In mice,
eustachian tube passive opening pressure reduced from a basal level of 41.8 mm Hg
to 31.3 mm Hg after 5 minutes and to 31.2 mm Hg after 10 minutes in the
surfactant group. Propellant placebo resulted in no change from basal level in
both animal models and in both arms of the experiment. CONCLUSION: Intranasal
metered dose inhaler aerosolized surfactant is effective in reducing eustachian
tube passive opening pressure.

PMID: 11773836 [PubMed - indexed for MEDLINE]

2059: Otol Neurotol. 2002 Jan;23(1):1-2.

Progress in the prevention of otitis media through immunization.

Snow JB Jr.

National Institute on Deafness and Other Communication Disorders, National
Institutes of Health, Bethesda, Maryland, USA. jsnow@crosslink.net

OBJECTIVE: To review the progress that has been made in developing effective
vaccines against the major bacterial pathogens responsible for acute otitis
media. DATA SOURCE: Review of the literature with the aid of the MEDLINE database
using the search terms otitis media and otitis media and vaccine. DATA
EXTRACTION: Data were collected from clinical trials and laboratory studies.
FINDINGS: The heptavalent pneumococcal conjugated vaccine, Prevnar, reduced the
incidence of acute otitis media from all causes by 7% in one study and by 6% in
another study. For culture-positive pneumococcal otitis media, the point estimate
of efficacy was 66.7% in one study, and the reduction in incidence was 34% in
another study. A Phase I clinical trial has been completed successfully for a
conjugated vaccine against nontypeable Haemophilus influenzae (NTHi), which has
high immunogenicity for mice and rabbits, induces complement-mediated
bactericidal activity against NTHi in rabbits, and is protective against NTHi
otitis media in chinchillas. A conjugated vaccine against Moraxella catarrhalis
elicits strong immune responses in mice and rabbits and induces
complement-mediated bactericidal activity in rabbits. CONCLUSION: The prevention 
of otitis media is likely to require multivalent pneumococcal, NTHi, and M.
catarrhalis vaccines, and these vaccines likely can be developed within a decade.

PMID: 11773835 [PubMed - indexed for MEDLINE]

2060: Auris Nasus Larynx. 2002 Jan;29(1):19-28.

Clinical characteristics of so called eosinophilic otitis media.

Nagamine H, Iino Y, Kojima C, Miyazawa T, Iida T.

Department of Otolaryngology, Teikyo University School of Medicine, 2-11-1, Kaga,
Itabashi-ku, Tokyo 173-8605, Japan.

OBJECTIVE: Although "eosinophilic otitis media" is not as uncommon a condition as
was previously believed, its cause and pathogenesis are not yet fully understood.
The purpose of this study was to describe the clinical characteristics in
patients with "eosinophilic otitis media" to clarify its pathogenesis. METHODS:
Seven adult patients with persistent and intractable otitis media with viscous
middle ear effusion containing many eosinophils, who were also under treatment
for bronchial asthma, were studied. The following examinations were conducted:
nasopharyngeal endoscopy, pure-tone audiometry, eustachian tube function test,
temporal bone CT scan, blood analysis, bacterial and fungal culture of middle ear
effusion, histological study of the middle ear and nasal specimens, and
measurement of eosinophilic cationic protein (ECP) in middle ear effusion.
RESULTS: Some patients had persistent perforation with papillomatous granulation 
tissue arising from the mesotympanic mucosa, and all the patients had nasal
polyposis. The pure-tone audiometry showed the mixed-type of hearing loss in all 
the patients, and the hearing level deteriorated progressively during the course 
in some patients. The eustachian tube function was not always poor but was
patulous in some cases. The most severely diseased areas were in the eustachian
tube and mesotympanum by temporal bone CT images. All the seven patients had the 
high levels of total serum IgE, but the RAST scores were negative in three
patients and low grade in three patients. The accumulation of eosinophils was
observed in middle ear effusion, middle ear mucosa and nasal polyps, and the
eosinophils were highly activated with degranulation. High level of ECP was also 
recovered from middle ear effusion. CONCLUSIONS: Active eosinophilic inflammation
occurs in the entire respiratory tract, including the middle ear in these
patients. From our present investigation, we propose the criteria and clinical
characteristics of "eosinophilic otitis media".

Publication Types: 
    Case Reports

PMID: 11772486 [PubMed - indexed for MEDLINE]

2061: J Otolaryngol. 2001 Jun;30(3):157-61.

Cathepsin L activity and its inhibitor in human otitis media.

Kusunoki T, Nishida S, Murata K, Kobashi K, Nakatani H, Hiwasa T, Tomura T.

Department of Otolaryngology, Kinki University School of Medicine, Osakasayama,
Osaka, Japan.

OBJECTIVE: We examined cathepsin L activity, expression of cystatin A, and
copper- and zinc-containing superoxide dismutase in human chronic otitis media.
The relationships of our findings to clinical findings (e.g., grade of bone
destruction) were also studied. DESIGN: Retrospective basic and clinical study.
SETTING: Department of Otolaryngology and First Department of Biochemistry, Kinki
University School of Medicine, Osaka, Japan. METHOD: The human middle ear tissues
evaluated in this study were surgically obtained from seven patients with
cholesteatoma epithelium, three patients with granulation tissues in
cholesteatoma, three patients with granulation tissues in noncholesteatoma, and
three patients with intact mucous membrane of the middle ear. MAIN OUTCOME
MEASURES: Cathepsin L activities in cholesteatoma epithelium, granulation tissues
in cholesteatoma, or granulation tissues in noncholesteatoma were measured using 
Barrett's method. Cystatin A expressions were observed by Western blot analysis. 
Copper- and zinc-containing superoxide dismutase in cholesteatoma was examined
immunohistochemically. RESULTS: Mean cathepsin L activity was higher in diseased 
tissues than in intact mucous membranes of the middle ear. Granulation tissues
with high cathepsin L activity resulted in extensive bone destruction in both
cholesteatomas and noncholesteatomas of the middle ear. All cases with intact
mucous membrane of the middle ear exhibited no expression of cystatin A. Seven of
10 cases with diseased tissues expressed cystatin A in cholesteatoma epithelium, 
granulation tissues in cholesteatoma, or granulation tissues in noncholesteatoma.
No relationships were found between cystatin A expression and grade of cathepsin 
L activity. Copper- and zinc-containing superoxide dismutase was more strongly
positive in cholesteatoma epithelium regions than in granulation tissues.
CONCLUSION: These results suggest that copper- and zinc-containing superoxide
dismutase in cholesteatoma epithelium prevents complications by suppressing
cathepsin L activity.

PMID: 11771045 [PubMed - indexed for MEDLINE]

2062: J Otolaryngol. 2001 Jun;30(3):154-6.

Ceruminolytic efficacy in adults versus children.

Carr MM, Smith RL.

Department of Pediatric Otolaryngology, Children's Hospital of Buffalo,New York, 
USA.

OBJECTIVES: An inexpensive, nontoxic ceruminolytic with reasonable efficacy that 
can be used by the patient or their caregivers at home could represent
significant financial saving for patients and health care systems. The purpose of
this study was to compare two simple ceruminolytics for in vitro efficacy. STUDY 
DESIGN: Randomized controlled trial. METHODS: Thirty-six children and 33 adults
presenting to a community family practice clinic who had cerumen occluding at
least one external auditory canal were randomly assigned to compare use of 10%
aqueous sodium bicarbonate and 2.5% aqueous acetic acid as ceruminolytics in
occlusive cerumen. RESULTS: We were unable to demonstrate a difference between in
vivo efficacy of these two ceruminolytic solutions, but both solutions were
significantly more efficacious in children than adults. CONCLUSIONS: There is a
role for these ceruminolytics in children with occlusive cerumen, but adults
would be better treated in another way.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 11771044 [PubMed - indexed for MEDLINE]

2063: Eur Arch Otorhinolaryngol. 2001 Nov;258(9):472-6.

Up-regulation of matrix metalloprotease-9 in middle ear
cholesteatoma--correlations with growth factor expression in vivo?

Schmidt M, Grünsfelder P, Hoppe F.

University of Wuerzburg, Department of Otorhinolaryngology, Germany.
marianne.schmidt@mail.uni-wuerzburg.de

The role of matrix metalloproteases and their regulation in the pathology of
middle ear cholesteatoma is still unclear. Recently we have demonstrated that
incubation of keratinocytes with cholesteatoma debris and granulation tissue
extracts causes induction of gelatinase B (matrix metalloproteinase-9, MMP-9)
secretion in vitro. Antibodies against a variety of growth factors revealed some 
inhibitory effect on MMP-9 induction, caused by debris or granulation tissue
extracts. In order to investigate the coherence of growth factor expression and
matrix metalloproteinase activity in vivo in middle ear cholesteatoma, we
performed quantitative gelatin zymographic analysis with tissue homogenates of 37
cholesteatoma and nine external ear canal skin (EACS) samples. Furthermore we
quantified levels of the cytokines IL-1alpha, IL-1beta, TNF-alpha, TGF-beta and
EGF present in tissue extracts, using enzyme-linked immunosorbent assays (ELISA),
and correlated cytokine concentrations with gelatinolytic activities. Zymographic
analysis revealed a highly heterogeneous expression of gelatinase A and B in
cholesteatoma specimens. As shown previously, MMP-9, but not MMP-2, was increased
in cholesteatoma when compared to EACS samples. ELISA studies revealed a
significantly elevated IL-1alpha level in cholesteatoma. Regression analysis
involving gelatinolytic activity and cytokine concentrations in tissue
homogenates showed no statistically significant correlation between expression of
gelatinases and the cytokines IL1-alpha, IL1-beta, TNF-alpha, TGF-beta or EGF.
The discrepancy between in vitro observations and the situation in vivo is
discussed critically.

Publication Types: 
    In Vitro

PMID: 11769995 [PubMed - indexed for MEDLINE]

2064: Ann Otol Rhinol Laryngol. 2001 Dec;110(12):1141-6.

Eustachian tube function in children after insertion of ventilation tubes.

van Heerbeek N, Ingels KJ, Snik AF, Zielhuis GA.

Department of Otorhinolaryngology, University Medical Center St Radboud,
Nijmegen, The Netherlands.

This study was performed to assess the effect of the insertion of ventilation
tubes and the subsequent aeration of the middle ear on eustachian tube (ET)
function in children. Manometric ET function tests were performed repeatedly for 
3 months after the placement of ventilation tubes in 83 children with otitis
media with effusion (OME). Opening and closing pressures (passive tubal function)
and active tubal function were measured. Analysis of the results showed a
significant increase in opening pressure over time, whereas the closing pressure 
did not change. The active tubal function did not change and remained at the same
poor level. Therefore, the opening pressure and closing pressure and, especially,
the poor active tubal function, were more likely to be a causal factor of OME
than a result. Certain children may have poor intrinsic ET function that makes
them more susceptible to OME.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11768705 [PubMed - indexed for MEDLINE]

2065: Int J Circumpolar Health. 2001 Nov;60(4):632-9.

Longitudinal observations (1987-1997) on the prevalence of middle ear disease and
associated risk factors among Inuit children of Inukjuak, Nunavik, Quebec,
Canada.

Bruneau S, Ayukawa H, Proulx JF, Baxter JD, Kost K.

Public Health Research Unit, Laval University Hospital Centre, Beauport, Quebec, 
Canada.

The prevalence of middle ear disease in 2-6 year old children in 1997 was
compared with that observed in 1987 in the same Inuit community in northern
Quebec. Risk and protective factors associated with middle ear disease were also 
assessed. A total of 122 children participated. The assessments included:
otological examination, cerumen sampling for analysis of organochlorine
compounds, medical file review, and parent questionnaire regarding environmental 
and lifestyle factors. Comparison of ear examination results in 1997 and 1987
showed that there had been no change in the prevalence of chronic otitis media
[9.4% to 10.8%] and proportion of ear drums with minimal scarring [45.6% to
45.4%], an increase in the proportion of normal ear drums [23.9% to 39.0%], a
decrease the proportion with maximal scarring [17.8% to 2.0%] and little
difference in the rate of serous otitis media [3.3% to 2.8%]. Factors found to be
significantly associated with middle ear disease included: number of
persons/bedroom, number of siblings with a history of ear disease, age at first, 
second and third visit to the nursing station for ear problems, and type of milk 
(formula vs. non-formula) in bottle fed children.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11768445 [PubMed - indexed for MEDLINE]

2066: West Afr J Med. 2001 Apr-Jun;20(2):131-5.

Bacterial agents of discharging ears and antimicrobial sensitivity patterns in
children in Ibadan, Nigeria.

Oni AA, Bakare RA, Nwaorgu OG, Ogunkunle MO, Toki RA.

Department of Microbiology, University College Hospital, Ibadan, Nigeria.

Bacteriological studies were carried out on ear swabs from 361 cases of children 
with discharging ears at the Microbiology Department of the University College
Hospital, Ibadan between March 1995 and February 1997. 308 (85.3%) had positive
cultures. 78.6% of these yielded one isolate, 19.2% yielded two isolates while
2.2% had three isolates. Pseudomonas spp. Was the predominant agent of CSOM and
ASOM. This was followed by Staphylococcus aureus. Other commonly isolated
organisms were Proteus and Klebsiella species. Ofloxacin and ciprofloxacin showed
the highest activity to all isolates, while two third of the isolates were
sensitive to azithromycin, cefuroxime, ceftriazone and gentimicin.

PMID: 11768012 [PubMed - indexed for MEDLINE]

2067: J Am Board Fam Pract. 2001 Nov-Dec;14(6):406-17.

Comment in:
    J Am Board Fam Pract. 2001 Nov-Dec;14(6):474-6.

A cross-national study of acute otitis media: risk factors, severity, and
treatment at initial visit. Report from the International Primary Care Network
(IPCN) and the Ambulatory Sentinel Practice Network (ASPN).

Froom J, Culpepper L, Green LA, de Melker RA, Grob P, Heeren T, van Balen F.

Department of Family Medicine, State University of New York at Stony Brook, USA.

BACKGROUND: Treatment of acute otitis media (AOM) differs worldwide. The Dutch
avoid antimicrobials unless fever and pain persist; the British use them for 5 to
7 days, and Americans use them for 10 days. If effects of therapies are to be
compared, it is necessary to evaluate rates of risk factors, severity of attacks,
and their influence on treatment decisions. We wanted to compare the prevalence
of risk factors for AOM and evaluate their association with severity of attacks
and of severity with antimicrobial treatment. METHODS: We undertook a prospective
cohort study of 2,165 patients with AOM enrolled by primary care physicians; 895 
were enrolled from North America, 571 were enrolled from the United Kingdom, and 
699 were enrolled from The Netherlands. The literature was searched using the key
words "acute otitis media," "severity," and "international comparisons." RESULTS:
The prevalence of several AOM risk factors differs significantly among patients
from the three country networks; these factors include race, parent smoking
habits, previous episodes, previous episodes without a physician visit,
tonsillectomy or adenoidectomy, frequency of upper respiratory tract infections, 
day care, and recumbent bottle-feeding. Dutch children have the most severe
attacks as defined by fever, ear discharge, decreased hearing during the previous
week, and moderate or severe ear pain. In country-adjusted univariate analyses,
increasing age, exposure to tobacco smoke, day care, previous attacks of AOM,
previous attacks without physician care, past prophylactic antimicrobials, ear
tubes, adenoidectomy, and tonsillectomy all contribute to severity. Only country 
network, age, history of AOM, previous episode without physician care, and
history of adenoidectomy and tympanostomy tubes are independently related to
increased severity, while current breast-feeding is protective. Severity of
attacks influences treatment decisions. Dutch children are least likely to
receive antimicrobials, and even for severe attacks the British and Dutch
physicians usually use amoxicillin or trimethoprim-sulfa; North American children
with severe attacks are more likely to receive a broad-spectrum second-line
antimicrobial. CONCLUSION: Dutch children have the highest ratings in all
severity measures, possibly reflecting parental decisions about care seeking for 
earaches. When comparing groups of patients with AOM, it is necessary to adjust
for baseline characteristics. Severity of episode affects physician treatment
decisions. Adoption of Dutch guidelines restricting use of antimicrobials for AOM
in the United States could result in annual savings of about $185 million.

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 11757882 [PubMed - indexed for MEDLINE]

2068: J Antimicrob Chemother. 2002 Jan;49(1):141-7.

The treatment of Haemophilus influenzae acute otitis media with amoxicillin
protects against reinfection but not against structural changes.

Westman E, Melhus A.

Department of Oto-Rhino-Laryngology, Umeå University Hospital, Umeå, Sweden.

Acute otitis media (AOM) is the most common reason for outpatient antimicrobial
therapy today. With increasing problems with antibiotic resistance, a more
restrictive use of antibiotics has been advocated for both single and recurrent
episodes. The arguments advanced have been immunological as well as ecological.
To study the effects of a 5 day course of amoxicillin on recurrent AOM caused by 
non-typeable Haemophilus influenzae, Sprague-Dawley rats were used. Amoxicillin
was introduced at the clinical peak of the first infection. One month later the
animals were rechallenged. Local and systemic changes were monitored by
otomicroscopy, bacterial cultures, and analyses of systemic IgG responses and
histological changes. Antibiotic treatment accelerated the resolution of the
primary infection. After resolution, only minor morphological changes were
observed. The protective rate at rechallenge was 100% in the treatment group,
compared with 80% in the untreated control group. Although the production of
serum IgG antibodies was initially slightly impeded by the treatment, it was
significantly higher in treated animals after rechallenge. Major structural
changes could not be avoided at the second infection, however, and a
significantly higher frequency of myringosclerosis was observed in treated
animals. These experimental findings constitute support for further studies of
antimicrobial drugs and recurrent AOM.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11751778 [PubMed - indexed for MEDLINE]

2069: Arch Otolaryngol Head Neck Surg. 2001 Dec;127(12):1471-6.

Economic evaluation of ventilation tubes in otitis media with effusion.

Hartman M, Rovers MM, Ingels K, Zielhuis GA, Severens JL, van der Wilt GJ.

Department of Medical Technology Assessment (253 MTA), University Medical Centre 
St Radboud, PO Box 9101, 6500 HB Nijmegen, the Netherlands. M.Hartman@mie.kun.nl

OBJECTIVE: To determine the costs and effectiveness of treatment with ventilation
tubes as compared with watchful waiting in children with persistent otitis media 
with effusion. DESIGN: Randomized controlled trial. SETTING: Institutional
practice. PATIENTS: A total of 187 young children (19 months old) with persistent
bilateral otitis media with effusion. INTERVENTIONS: Treatment with ventilation
tubes or watchful waiting. MAIN OUTCOME MEASURES: The time without effusion,
language development, and the costs from a societal perspective during 1-year
follow-up. RESULTS: The mean duration of effusion was 9.2 months in the watchful 
waiting group and 4.7 months in the ventilation tube group. The language
development was comparable in both groups (0.7 month of improvement difference
[95% confidence interval, -0.3 to 1.7 months] after correction for confounding
variables). Because no statistically significant differences were found in the
language development between the treatment groups, we performed a cost
minimization analysis. The mean costs per child during 1 year of follow-up were
454 US dollars in the ventilation tube group and 120 US dollars in the watchful
waiting group. On average, an additional investment of 334 US dollars per patient
was needed for ventilation tube treatment. CONCLUSION: In the absence of
differences in language development and in view of higher costs, treatment with
ventilation tubes is not recommended as standard treatment in all young children 
with persistent otitis media with effusion traced by a population-based screening
program.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11735817 [PubMed - indexed for MEDLINE]

2070: J Lab Clin Med. 2001 Nov;138(5):338-42.

Bacterial pathogens of otitis media and sinusitis: detection in the nasopharynx
with selective agar media.

Dudley S, Ashe K, Winther B, Hendley JO.

Department of Clinical Microbiology, University of Virginia Health System,
Charlottesville, 22908, USA.

Carriage rates for the bacterial pathogens associated with otitis media
(Streptococcus pneumoniae [SP], Hemophilus influenzae [HI], and Moraxella
catarrhalis [MC]) are of interest. Culture on three selective agars was compared 
with culture on two standard agars to determine the more accurate method for
detection of these species in the nasopharynx of healthy children. Weekly samples
were obtained in winter from 18 healthy children (ages 1 through 9 years) as part
of a longitudinal study. A 0.1-mL sample of 116 nasopharyngeal aspirate/washes
was inoculated onto each of five agars. Two were standard (sheep blood and
chocolate), and three were selective (blood with gentamicin for SP; chocolate
with vancomycin, bacitracin, and clindamycin for HI; blood with amphotericin B,
vancomycin, trimethoprim, and acetazolamide for MC). One technician read the
standard plates and another the selective; both were blinded to the results of
the other. SP was found in 44% of samples with selective agar versus 25% with
standard agar; HI was found in 31% with selective versus 9% with standard; MC was
found in 56% with selective versus 37% with standard. Overall, 80% of samples had
one or more pathogens detected with selective agars as compared with 58% with
standard agars (P =.0004). Selective agars were more accurate than standard agars
for detecting otitis pathogens in the nasopharynx, where they are a common part
of normal flora in healthy children.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11709658 [PubMed - indexed for MEDLINE]

2071: Ann Diagn Pathol. 2001 Dec;5(6):350-3.

Mycobacterium avium intracellulare otitis media.

Trupiano JK, Prayson RA.

Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, OH
44195, USA.

Atypical mycobacterial infections of the middle ear are extremely rare. To our
knowledge, only eight cases have been reported in the literature, five of which
involve Mycobacterium avium intracellulare. We present a case of culture-proven, 
M. avium intracellulare otomastoiditis in an 8-year-old boy with common variable 
immunodeficiency syndrome. The patient clinically presented with pain and
otorrhea. The histopathology was marked by acid-fast bacilli-laden histiocytes.
Consideration of this entity in the differential diagnosis of chronic,
recalcitrant otorrhea can lead to timely diagnosis, treatment, an decreased
morbidity. Copyright 2001 by W.B. Saunders Company

Publication Types: 
    Case Reports

PMID: 11745073 [PubMed - indexed for MEDLINE]

2072: Otolaryngol Head Neck Surg. 2001 Dec;125(6):628-30.

Reconstruction of the ossicular chain with titanium implants.

Dalchow CV, Grün D, Stupp HF.

HNO Klinik, Dominikus Krankenhaus, Am Heerdter Krankenhaus 2, 40549 Düsseldorf,
Germany. cdalchow@mail.isis.de

OBJECTIVES: Since 1994 more than 1300 titanium implants have been used to
reconstruct the ossicular chain of the middle ear for chronic otitis media. Two
different types of implants were used. First, a total and a partial implant of
fixed length, available in numerous different lengths. And second, a total and
partial implant that has an adjustable length. The implants are commercially
available from 2 different companies. Patients were followed for a postoperative 
term from 6 to 72 months. METHODS: A wide variety of patients aged 5 to 82 years 
received a tympanoplasty type III. Those patients whose ossicular chain had been 
reconstructed with titanium implants since 1994 were evaluated. As implants from 
one company are fixed in length; implants of a second company are trimmable in
length. All prostheses are lightweight and made of pure titanium, fitting most
anatomical situations. RESULTS: Earlier results already showed a very low
complication rate. Extrusions occurred only in cases of middle ear atalectasis
with resorption of interposed cartilage (<1%). No adverse reaction to the
prostheses could be seen, even in histologic reviews. An average air-bone gap
less than 20 dB(A) for all calculated frequencies of 0.5, 1, 2, and 4 kHz was
achieved for 76% of cases; 43% of cases showed a calculated air-bone gap of less 
than 10 dB(A), only 10% higher than 30 dB(A). CONCLUSION: All implants used offer
the proven benefits of titanium, namely high biocompatibility and high stability 
at a very low complication rate with excellent hearing results for the patients. 
Titanium implants can highly be recommended to reconstruct the ossicular chain of
the middle ear.

Publication Types: 
    Clinical Trial
    Comparative Study

PMID: 11743465 [PubMed - indexed for MEDLINE]

2073: Otolaryngol Head Neck Surg. 2001 Dec;125(6):623-7.

High incidence of complications encountered in chronic otitis media surgery in a 
U.S. metropolitan public hospital.

Greenberg JS, Manolidis S.

Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences,
Baylor College of Medicine, One Baylor Plaza, NA-102, Houston, Texas 77030, USA.

OBJECTIVES: To examine the incidence and nature of complicating factors in
surgery for chronic otitis media (COM) in a metropolitan public hospital in the
United States. METHODS: A retrospective review was performed over 2 years in a
metropolitan public hospital to identify cases of surgery for chronic ear disease
with the following complicating factors: intracranial or extracranial abscess,
labyrinthine fistula, dural dehiscence with or without associated encephalocele
or meningocele, or extensive involvement of the facial nerve by cholesteatoma
with or without paralysis. RESULTS: Thirty-three of 90 consecutive operations for
COM (37%) met criteria for complicated chronic otitis media (CCOM). The majority 
(85%) of patients had cholesteatoma involvement. Most patients (73%) were managed
by an extended modified radical mastoidectomy. An additional 31 procedures were
required in these 33 patients for control of complications. There was no
iatrogenic sensorineural hearing loss or facial paralysis. CONCLUSIONS: The
incidence of CCOM in this large, U.S. metropolitan public hospital is similar to 
that observed in developing nations. CCOM significantly complicates chronic ear
surgery and substantially increases the use of resources. Maintaining functional 
hearing is possible, but difficult, and should be considered secondary to
prevention of further complications and eradication of disease. Access to health 
care and proper follow-up are crucial in prevention of CCOM.

PMID: 11743464 [PubMed - indexed for MEDLINE]

2074: Int J Pediatr Otorhinolaryngol. 2002 Jan 11;62(1):63-7.

Acute coalescent mastoiditis and acoustic sequelae in an infant with severe
congenital neutropenia.

Matsubara K, Omori K, Baba K.

Department of Pediatrics, Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-Ku,
651-2273, Kobe, Japan. kskmatsu@portnet.ne.jp

We report a 2-month-old boy with severe congenital neutropenia (SCN), who
developed acute necrotizing otitis media and coalescent mastoiditis due to
methicillin-sensitive Staphylococcus aureus. The infection fulminantly progressed
within a day to a subtotal perforation of the tympanic membrane, destructive bony
changes of ossicles, lateral subperiosteal abscess, and suppurative
labyrinthitis. Despite the combined treatment with intravenous antibiotics and
granulocyte colony-stimulating factor, the infection resulted in mixed hearing
impairment. Much attention should be given to prompt diagnosis of otomastoiditis 
in SCN, a rare congenital disorder, since resultant acoustic sequelae may affect 
subsequent speech development and intellectual ability.

Publication Types: 
    Case Reports

PMID: 11738697 [PubMed - indexed for MEDLINE]

2075: Int J Pediatr Otorhinolaryngol. 2002 Jan 11;62(1):31-5.

The feasibility of office-based laser-assisted tympanic membrane fenestration
with tympanostomy tube insertion: the duPont Hospital experience.

Friedman O, Deutsch ES, Reilly JS, Cook SP.

Department of Otolaryngology, Thomas Jefferson University Hospital, 111 S. 11th
Street, Philadelphia, PA 19134, USA.

OBJECTIVE: To determine the feasibility of inserting tympanostomy tubes in
children using office-based laser-assisted tympanic membrane fenestration.
METHODS AND MATERIALS: Study consisted of a retrospective review of the charts of
all children who underwent office-based laser-assisted tympanic membrane
fenestration with tympanostomy tube insertion from July 1, 1998 to August 31,
2000. Tetracaine eardrops were used for topical anesthesia. Fenestration was
achieved with the OtoLAM flashscanner laser (ESC Sharplan, Yokneam, Israel).
RESULTS: Of the 127 patients (185 ears) who underwent laser-assisted tympanic
membrane fenestration, 61 ears underwent tympanostomy tube insertion. Ten ears
were treated for otitis media with effusion, 43 for recurrent acute otitis media,
and eight for acute otitis media not responding to antibiotics. Fifteen ears had 
purulent effusion, five had a serous effusion, and 23 had mucoid middle ear
fluid. Eighteen ears had no middle ear fluid. At the first follow-up visit, all
tested ears had hearing of 20 dB or better. Two children had tubes that were
blocked. Blockage occurred in ears that required more than one laser firing to
penetrate the tympanic membrane. Otorrhea was present in 13 ears (21%). Otorrhea 
occurred exclusively in ears with purulent or mucoid middle ear fluid.
CONCLUSIONS: Office-based laser-assisted tympanic membrane fenestration with
tympanostomy tube insertion is a safe and effective alternative to tube placement
in the operating room. The outcome compares favorably with previously published
data.

Publication Types: 
    Comparative Study

PMID: 11738691 [PubMed - indexed for MEDLINE]

2076: Int J Pediatr Otorhinolaryngol. 2002 Jan 11;62(1):17-23.

A nasal spray with alpha-haemolytic streptococci as long term prophylaxis against
recurrent otitis media.

Tano K, Grahn Håkansson E, Holm SE, Hellström S.

Department of Clinical Sciences, Otorhinolaryngology, Umeå University, S-971 80, 
Luleå, Sweden. krister.tano@nll.se

Previous studies have shown that children with recurrent acute otitis media
(rAOM) have significantly lower quantities of alpha-haemolytic streptococci (AHS)
in the nasopharynx than healthy children. Furthermore children with otitis media 
have AHS with lower inhibitory activity in vitro on Streptococcus pneumoniae and 
non-typable Haemophilus influenzae compared with healthy children. A randomised, 
placebo controlled and double blind clinical study among children with rAOM was
designed to determine whether or not a nasal spray, containing AHS with very good
inhibitory activity on the three most common OM pathogens, could be an
alternative to tympanostomy tube insertion. Forty three children under 4 years of
age were included in the study. The children sprayed once daily for 4 months and 
were monitored for 6 months. Sixteen children in the active group and 20 children
in the placebo group were evaluated. The result showed no significant differences
regarding the number of episodes of AOM, with seven recurrences in the active
group and eight in the placebo group. No significant changes of the
nasopharyngeal flora could be detected during the study period regarding the OM
pathogens. Nasal spray according to the performed schedule is not yet an
alternative to tympanostomy tubes in children with rAOM. The possibility of
increasing the efficacy of this ecological treatment, by using pre-treatment
antibiotics, more adhesive bacteria and alternative treatment schedules is
discussed.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11738689 [PubMed - indexed for MEDLINE]

2077: Clin Exp Immunol. 2001 Dec;126(3):421-5.

Proliferating macrophages, dendritic cells, natural killer cells, T and B
lymphocytes in the middle ear and Eustachian tube mucosa during experimental
acute otitis media in the rat.

Jecker P, Pabst R, Westermann J.

Department of Otorhinolaryngology, Head- and Neck-Surgery, University of Mainz,
Mainz, Germany. jecker@hno.klinik.uni-mainz.de

Although many studies focus on the increase of immunocompetent cells within the
middle ear mucosa during acute otitis media it is poorly understood how this
increase is mediated. The differentiation between two possible causes, i.e.
immigration and local proliferation, would help to better understand the
pathophysiology of this disease. Therefore, the number of proliferating
macrophages, dendritic cells, natural killer cells and T and B lymphocytes was
studied during acute otitis media in the rat middle ear mucosa (ME mucosa) and
Eustachian tube mucosa (ET mucosa) by labelling proliferating leucocytes with the
DNA precursor bromodeoxyuridine (BrdU). By removing the middle ear and Eustachian
tube 24 h after BrdU injection, the contribution of immigrated newly formed cells
was estimated. At this timepoint, many leucocytes in the ME and ET mucosa had
incorporated BrdU (between 15 and 25% within the subsets). By analysing these
tissues one hour after BrdU injection, the local proliferation rate was
determined (between 2 and 9% within the subsets). Thus, the inflamed ME and ET
mucosa are the destination of immunocompetent cells and, as our data show, the
inflamed microenvironment supports local proliferation of immunocompetent cells.

PMID: 11737056 [PubMed - indexed for MEDLINE]

2078: Pediatr Infect Dis J. 2001 Sep;20(9):829-37.

Bacteriologic and clinical efficacy of high dose amoxicillin/clavulanate in
children with acute otitis media.

Dagan R, Hoberman A, Johnson C, Leibovitz EL, Arguedas A, Rose FV, Wynne BR,
Jacobs MR.

Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion
University of the Negev, Beer-Sheva, Israel. rdagan@bgumail.bgu.ac.il

OBJECTIVES: To determine the bacteriologic and clinical efficacy of high dose
amoxicillin/clavulanate (90/6.4 mg/kg/day) against common bacterial pathogens
causing acute otitis media (AOM), including penicillin-resistant Streptococcus
pneumoniae (PRSP). METHODS: In this open label multicenter study, 521 infants and
children with AOM [mean age, 18.6 months; age < 24 months, n = 375 (72%)] were
treated with amoxicillin/clavulanate 90/6.4 mg/kg/day in two divided doses for 10
days. Bilateral otitis media, previous episodes of AOM, antibiotic treatment
within 3 months and day-care attendance were recorded in 60.1, 35.7, 50.2 and
38.2% of the children, respectively. Tympanocentesis was performed before the
first dose and repeated on Days 4 to 6 for all children with S. pneumoniae at 22 
centers and for all children with any pathogen at 3 centers. Clinical response
was assessed at end of therapy. RESULTS: Pathogens were isolated from 355 (68%)
of 521 enrolled children; 180 children underwent repeat tympanocentesis and were 
bacteriologically evaluable. Baseline pathogens were S. pneumoniae (n = 122
enrolled/93 bacteriologically evaluable), Haemophilus influenzae (n = 160/51),
both (n = 37/32) and others (n = 36/4). Pathogens were eradicated from 172 (96%) 
of 180 bacteriologically evaluable children. Overall 122 (98%) of 125 isolates of
S. pneumoniae were eradicated, including 31 (91%) of 34 PRSP isolates (penicillin
MICs 2 to 4 micrograms/ml). Seventy-eight (94%) of 83 isolates of H. influenzae
were eradicated. Symptoms and otoscopic signs of acute inflammation were
completely resolved or improved on Days 12 to 15 in 263 (89%) of 295 clinically
evaluable children with bacteriologically documented AOM. CONCLUSIONS: On the
basis of bacteriologic outcome on Days 4 to 6 and clinical outcome on Days 12 to 
15, we found that high dose amoxicillin/clavulanate (90/6.4 mg/kg/day) was highly
efficacious in children with AOM, including those most likely to fail treatment, 
namely children < 24 months of age and those with infectious caused by PRSP.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 11734759 [PubMed - indexed for MEDLINE]

2079: Pediatr Infect Dis J. 2001 Nov;20(11):1039-42.

Comment in:
    Pediatr Infect Dis J. 2002 Oct;21(10):989-90; author reply 990.

Short term oral cefixime therapy for treatment of bacterial conjunctivitis.

Wald ER, Greenberg D, Hoberman A.

Department of Pediatrics, University of Pittsburgh School of Medicine, Children's
Hospital of Pittsburgh, PA 15213, USA. Walde@chplink.chp.edu

BACKGROUND: There have been few controlled studies evaluating treatment of
bacterial conjunctivitis beyond the newborn period. Topical therapy of bacterial 
conjunctivitis achieves a clinical cure but does not prevent acute otitis media
(AOM). OBJECTIVES: The aim of this study was to compare systemic antibiotic
therapy (cefixime) with topical therapy with polymyxin-bacitracin for treatment
of acute bacterial conjunctivitis with regard to clinical and bacteriologic cure 
and prevention of AOM. METHODS: This study was a randomized, double blind,
placebo-controlled trial of polymyxin-bacitracin ointment and oral placebo vs.
topical placebo and oral cefixime in children with presumed acute bacterial
conjunctivitis. Topical therapy was administered for 7 days; oral therapy was
administered for 3 days. Bacterial cultures were obtained at entry and on Day 3
of treatment. Children were examined on Days 3 and 10 or if they worsened within 
15 days of entry. RESULTS: Eighty children were enrolled in the study. Bacterial 
cultures of the conjunctiva were positive in 70% of children: Haemophilus
influenzae (53.7%); Streptococcus pneumoniae (13.8%); H. influenzae and S.
pneumoniae (1.2%); and Moraxella catarrhalis (1.3%). There were 7 (17.5%)
bacteriologic failures among children receiving topical antibiotic and oral
placebo and 15 (37.5%) bacteriologic failures among children receiving topical
placebo and oral cefixime (P = 0.07 with Yates correction). There was no
difference between study groups with regard to either clinical cure or the
development of AOM. Nine children (11%), 5 who received active topical therapy
and 4 who received active oral drug, developed AOM either during or within 15
days of study entry. CONCLUSION: Cefixime was not more effective than topical
polymyxin-bacitracin in either the eradication of conjunctival colonization with 
respiratory pathogens or the prevention of AOM in children with acute bacterial
conjunctivitis.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11734708 [PubMed - indexed for MEDLINE]

2080: Pediatr Infect Dis J. 2001 Nov;20(11):1017-21.

Microbiology of acute otitis media recently treated with aminopenicillins.

Block SL, Hedrick JA, Tyler RD, Smith RA, Harrison CJ.

Kentucky Pediatric Research, University of Louisville, Louisville, KY, USA.
slblock@pol.net

INTRODUCTION: Sparse recent data are available in the United States regarding the
pathogens of acute otitis media (AOM) most likely to be recovered from children
recently treated with the two most frequently prescribed antibiotics, amoxicillin
or amoxicillin/clavulanate (AMC). METHODS: Of the 704 rural Kentucky children
with culture-positive AOM who underwent a single tympanocentesis or culture of
otorrhea between 1992 and 1998, 96 pathogens were recovered from 90 children
during therapy or within 7 days posttherapy with an aminopenicillin.
Identification and susceptibility testing of AOM pathogens were performed by
routine National Committee for Clinical Laboratory Standards methods. RESULTS:
Pathogens recovered from children with AOM recently treated (0 to 7 days) with
amoxicillin (n = 38) and AMC (n = 58), respectively, were as follows: Haemophilus
influenzae (beta-lactamase-negative), 16 and 29%; H. influenzae
(beta-lactamase-positive), 11 and 22%; penicillin-susceptible Streptococcus
pneumoniae, 26 and 12%; intermediately penicillin-nonsusceptible S. pneumoniae
(PNSP), 20 and 10%; resistant PNSP 13 and 17%; Moraxella catarrhalis
(beta-lactamase-positive), 13 and 7%; and Streptococcus pyogenes, 3 and 2%. H.
influenzae was also isolated from 8 (75%) of 12 children treated with high dose
AMC ( approximately 80 mg/kg/day amoxicillin component). Significantly fewer
children recently treated with amoxicillin were otitis-prone than those given AMC
(24% vs. 74%, P < 0.0001). CONCLUSIONS: The predominant pathogen recovered from
children with AOM recently treated with amoxicillin was S. pneumoniae (59%)
rather than beta-lactamase-producing organisms (24%). H. influenzae was the
predominant (51%) pathogen, rather than PNSP (27%), recovered from children
recently treated with AMC.

PMID: 11734704 [PubMed - indexed for MEDLINE]

2081: Clin Ther. 2001 Oct;23(10):1683-706.

Diagnosis and treatment of upper respiratory tract infections in the primary care
setting.

Fendrick AM, Saint S, Brook I, Jacobs MR, Pelton S, Sethi S.

University of Michigan School of Medicine, Ann Arbor, USA. amfen@umich.edu

BACKGROUND: Acute respiratory tract infections such as acute exacerbations of
chronic bronchitis (AECB), acute otitis media (AOM), and acute bacterial
rhinosinusitis (ABRS) account for approximately 75% of antibiotic prescriptions
written and are among the leading reasons for physician office visits in the
United States. Resistance of the predominant pathogens in respiratory tract
infections (Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella
catarrhalis) to available antibiotics has led clinicians to reevaluate the
diagnosis and management of these infections. OBJECTIVE: The purpose of this
review is to provide primary care practitioners with an accessible combined
resource for the management of AECB, AOM, and ABRS. METHODS: This review was
based on discussions from a roundtable meeting (sponsored by an educational grant
from GlaxoSmithKline) that convened clinicians versed in the management of upper 
and lower respiratory tract infections. In addition, primary articles were
identified by a MEDLINE search and through secondary sources. RESULTS: To reduce 
the prevalence of resistance, judicious and appropriate use of antibiotics must
be implemented in clinical practice. With accurate diagnosis of bacterial and
nonbacterial conditions, and patient education on antibiotic use and misuse, the 
excessive use of antibiotics and ensuing resistance can be reduced. The
incorporation of pharmacokinetic and pharmacodynamic data with minimum inhibitory
concentration values can provide a more comprehensive assessment of antibiotic
activity in vivo. Stratification of patients with AECB according to patient
characteristics and frequency of exacerbation can be used to determine which
patients will benefit from antibiotic treatment and to guide clinicians in their 
choice of antibiotic. The Drug-Resistant Streptococcus pneumoniae Therapeutic
Working Group has issued recommendations on the management of AOM based on prior 
antibiotic therapy, which is a risk factor for antimicrobial resistance. The
Sinus and Allergy Health Partnership guidelines for the treatment of ABRS in
adults and children are based on the predicted efficacy of various antibiotics as
well as patient age, severity of disease, likelihood of bacterial infection,
likelihood of spontaneous resolution, and in vitro susceptibility of the
predominant pathogens based on pharmacokinetic and pharmacodynamic breakpoints.
CONCLUSIONS: Guidelines for the management of AECB, AOM, and ABRS emphasize the
importance of differentiating between bacterial and nonbacterial infections,
choosing an antibiotic based on the likelihood of infection with resistant
pathogens, and providing coverage against the predominant pathogens. The
judicious use of antibiotics also has been identified as an instrumental part of 
controlling unnecessary antibiotic use and subsequent resistance.

Publication Types: 
    Review

PMID: 11726004 [PubMed - indexed for MEDLINE]

2082: Int J Circumpolar Health. 2001;60 Suppl 2:1-54.

Otitis media in Greenland. Studies on historical, epidemiological,
microbiological, and immunological aspects.

Homøe P.

This thesis describes the different aspects of otitis media (OM) in the
population of Greenland viewed in a historical and modern clinical perspective.
Chapter 1 outlines the addressed problems and aims while chapters 2 and 3 deal
with historical studies and an evaluation of the present knowledge based on the
literature. Physical anthropological studies, using skeletal samples of adult
Eskimo crania from before and after the colonization of Greenland in 1721 and
information about modern living Eskimos (Inuit), have shown that OM sequelae of
the temporal bones were significantly less common in pre-colonization Eskimos and
that the mean area size of the pneumatized cell system in the temporal bone was
significantly larger in pre-colonization Eskimos. These findings indicated an
increase in OM after the colonization most likely caused by the social, cultural,
habitary, and dietary changes due to increased contact with the outside world.
Historical reports after the colonization confirm a high prevalence of OM
especially in children. Modern epidemiological studies from the 1960's to 1980's 
in the Arctic region of Alaska, Canada, and Greenland along with reports from
visiting consultant otologists in Greenland almost uniformly mention prevalent OM
problems in children as well as in adults. The aim was therefore to further
describe the epidemiological pattern of the different OM disease entities (acute 
OM (AOM), chronic OM (COM), COM with suppuration (CSOM), secretory OM (SOM), and 
cholesteatoma) and investigate the potentially associated risk factors in
especially Greenlandic children because these diseases are primarily established 
and problematical in childhood. Chapter 4 describes the definitions used in the
thesis and chapter 5 describes the studies included. Section 5.1 describes a
study of cholesteatoma in Greenlanders. The study revealed an almost similar
incidence of hospital treated children with cholesteatoma (6.6 per 100,000) as
seen in comparable studies from other parts of the world. Furthermore, childhood 
cholesteatomas were the most aggressive. The frequency of residuals or
recurrences after otosurgical treatment was high with a trend for better results 
when using the extensive canal wall-down procedure. It could be concluded that
these patients urgently need close follow-up for at least five years
postoperatively, if not lifelong. Section 5.2 describes a hearing screening
survey of 167 school children using school registration charts. A high prevalence
of hearing loss (HL) was found. A total of 43% of the children had hearing
thresholds exceeding 20 dB at one or more frequencies between 250-8000 Hz in one 
or both ears, and 19% had the same type of HL in the frequencies 500-2000 Hz. HL 
was significantly associated with episodes of OM. These findings were in
accordance with reports from Alaska and Canada. It is therefore concluded that a 
hearing screening programme of school children is important and that OM seems to 
have an impact on hearing in school children in Greenland. In section 5.3 an
epidemiological survey is described concerning the prevalence of the different OM
disease entities. The survey was carried out in Nuuk and Sisimiut and involved
740 children aged 3, 4, 5, and 8 years. A total of 591 children participated and 
selection bias was not found when controlling for age, sex, and episodes of AOM. 
The survey revealed that 52% of children in Nuuk and 54% in Sisimiut had some
kind of pathological affection of their middle ear. COM and CSOM were found in
9%, but more prevalent among children in Sisimiut (12%) than in Nuuk (7%). Middle
ear effusion (MEE) diagnosed by tympanometry was found in 23% in Nuuk and 28% in 
Sisimiut while simple tubal dysfunction (STD) was found in 13% and 8%,
respectively. MEE and STD were associated with young age. Sequelae of OM was
apparent in 11% in both towns. When comparing the results with a 10-year-older,
almost similar survey of 142 children, it was evident that the OM situation had
not changed in the period between the studies. The survey underlines the need for
increased focus on the different OM entities in Greenlandic children. Section 5.4
deals with microbiological aspects. The nasopharyngeal microflora and ear
discharge microflora of potential pathogens were evaluated in 54 children with
AOM and in 201 control children without AOM. Very high carriage rates expressed
qualitatively and semiquantitatively of potentially pathogenio bacteria were
found in the nasopharynx of children with AOM (98%) but also in that of the
control children (91%) and even in children denoted as being very healthy (94%). 
However, the same bacterial species were cultured from the nasopharynx and ear
discharge as in comparable studies world-wide. Only S. pneumoniae was carried
significantly more often in the nasopharynx of AOM children compared with age
matched control children. Chlamydiae, M. pneumoniae, adenovirus, respiratory
syncytial virus, parainfluenza- type 1, 2, and 3 virus, and influenza- type A and
B virus were not major pathogens. In contrast, entero- and rhinoviruses were
detected significantly more frequent in nasopharyngeal specimens from AOM
children (59%) compared with age matched controls (33%) and also in 29% of the
examined ear discharge specimens. It is therefore concluded that the potentially 
pathogenic bacterial load is early and massive. This alone or in interplay with
entero- and rhinovirus infection and occasionally with other viruses may play an 
important role in the high prevalence of OM among children in Greenland. Section 
5.5 deals with an examination of potential risk factors for AOM, recurrent AOM
(rAOM), and COM in the same 591 children as studied in section 5.3. Early age at 
first AOM episode was associated with rAOM episodes (> or = 5 episodes since
birth). Thus, the relative risk of developing rAOM was eight times higher if the 
first episode of AOM occurred before 7 months of age than after 24 months of age.
Furthermore, compared with studies elsewhere in the world, a high proportion
(40%) of the children in this survey had their first AOM episode during their
first year of life and 41% of these children developed rAOM. It was also found
that children had an increased risk of AOM, rAOM, or COM when both parents were
born in Greenland, when parents also have had OM, when living in very crowded
households, and when having experienced a long period of exclusive breast
feeding, or when recalling of breast feeding was not possible. Gender, type, and 
size of housing, insulation standard of housing, daycare, exposure to passive
cigarette smoking, and dietary habits were not associated with AOM, rAOM, or COM 
in the surveyed children. It is concluded that early onset of AOM occurs
frequently in Greenlandic children and that a high proportion of these children
develop rAOM. The study confirms that AOM is a highly multifactorial disease
determined by a number of genetic and environmental factors. Finally, section 5.6
is a hypothesis generating study attempting to explain the high prevalence of
early episodes of AOM in community-based children in Nuuk. The hypothesis is
based on a possible association between findings of mannose-binding lectin
genotypes, early Epstein-Barr virus infections and episodes of AOM, rAOM, or
nasopharyngeal colonization with potentially pathogenic bacteria. However, the
study does not support any of this hypothesis. In chapter 6, future studies are
suggested and chapter 7 presents concluding remarks.

Publication Types: 
    Historical Article
    Research Support, Non-U.S. Gov't
    Review

PMID: 11725622 [PubMed - indexed for MEDLINE]

2083: Acta Otolaryngol. 2001 Oct;121(7):808-12.

Effects of antibiotics and steroid on middle ear mucosa in rats with experimental
acute otitis media.

Park SN, Yeo SW.

Department of Otolaryngology-Head and Neck Surgery, Kangnam St. Mary's Hospital, 
The Catholic University of Korea, College of Medicine, Seocho-Gu, Seoul, South
Korea.

The prevention of mucosal changes induced by experimental pneumococcal otitis
media by means of antibiotics has been demonstrated previously. However, the
effect of combined antibiotic and steroid therapy on the middle ear mucosa in
acute otitis media (AOM) has not been determined. The right middle ears of 27
rats were inoculated with a log-phase type 3 Streptococcus pneumoniae, with the
left ears serving as controls. Penicillin G was administered to nine rats and
penicillin G and dexamethasone in combination were administered to nine rats
after bacterial challenge; the remaining nine rats were not treated. Three
animals from each group were sacrificed on Days 4, 7 and 14 after challenge.
Tympanic membranes and middle ear mucosa were examined using otomicroscopy and
light microscopy. Structural changes were diminished in both the
antibiotic-treated and antibiotic + steroid-treated groups, compared with those
in the untreated infected controls. The antibiotic + steroid-treated group showed
the most marked decrease in structural change, especially in the mucosal
metaplasia to the secretory epithelium. The results suggest that combination
therapy with antibiotics and steroid in AOM is the most effective at reducing the
treatment period and preventing persistent mucosal changes, which may decrease
the risk of development of secretory otitis media as a sequela of AOM.

PMID: 11718243 [PubMed - indexed for MEDLINE]

2084: J Feline Med Surg. 2000 Mar;2(1):29-34.

Peripheral vestibular disease associated with cryptococcosis in three cats.

Beatty JA, Barrs VR, Swinney GR, Martin PA, Malik R.

Department of Veterinary Clinical Sciences, The University of Sydney, New South
Wales 2006, Australia. jbeatty@catstudy.demon.co.uk

Peripheral vestibular disease referable to otitis media/interna was the main
reason for presentation in three cats with cryptococcosis. In two cats,
Cryptococcus neoformans var neoformans was isolated from the tympanic bulla. In
the remaining cat, otitis media/interna was considered to be secondary to
occlusion of the auditory tube by a nasopharyngeal granuloma associated with a C 
neoformans var gattii infection. This report emphasises the importance of
maintaining an index of suspicion for a fungal aetiology in cats with signs of
otitis media/interna, particularly in countries with a high prevalence of
cryptococcosis. The presence of C neoformans may be overlooked with potentially
fatal consequences where only standard methods for bacterial isolation are used
to examine samples obtained from the middle ear. Copyright 2000 European Society 
of Feline Medicine.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 11716589 [PubMed - indexed for MEDLINE]

2085: Am J Otolaryngol. 2001 Nov-Dec;22(6):391-4.

The association between iron-deficiency anemia and recurrent acute otitis media.

Golz A, Netzer A, Goldenberg D, Westerman ST, Westerman LM, Joachims HZ.

Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center and the
Faculty of Medicine, Haifa, Israel.

PURPOSE: This study was designed to examine the association between
iron-deficiency anemia and the frequency of recurrent acute otitis media in
children, and to evaluate the effect of restoring normal hemoglobin levels on the
frequency of acute otitis media attacks. MATERIALS AND METHODS: A total of 680
children with frequent episodes of acute otitis media were enrolled in the study.
The levels of the hemoglobin were measured in both these children and in 200
healthy children with no history of infections. The correlation between
hemoglobin level and the frequency of middle ear infections was studied and
analyzed. All children with hemoglobin levels lower than 9.5 g/dL received iron
supplementation until they reached a level of at least 11 g/dL, and the
subsequent frequency of middle ear infections was recorded. RESULTS: The 680
children had an average of 8.3 +/- 2.7 episodes of acute otitis media per year
per child, and an average hemoglobin level of 11.4 +/- 2.7 g/dL, whereas the
controls had an average hemoglobin level of 13.1 +/- 2.5 g/dL. Twenty percent had
hemoglobin levels below 9.5 g/dL. These children had more episodes of acute
otitis media when compared with children with average levels. By increasing the
hemoglobin level in these children, the frequency of the episodes of acute otitis
media decreased significantly. CONCLUSIONS: This study confirms that anemic
children have higher prevalence of episodes of acute otitis media in comparison
to healthy, nonanemic children, and shows that there is a direct relationship
between the degree of the anemia and the number of the episodes.

Publication Types: 
    Comparative Study

PMID: 11713723 [PubMed - indexed for MEDLINE]

2086: ORL J Otorhinolaryngol Relat Spec. 2001 Nov-Dec;63(6):333-40.

Hearing loss in relation to round window membrane morphology in experimental
chronic otitis media.

Nordang L, Anniko M.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital 
(Akademiska sjukhuset), S-751 85 Uppsala, Sweden. leif.nordang@ent.uas.lul.se

The present study was performed to test the effect of single and repeated
Pseudomonas aeruginosa exotoxin A (PaExoA) instillations in the middle ear of the
rat. The hearing level was examined by the ABR technique, round window membrane
(RWM) thickness was measured and morphology was studied by light microscopy. The 
results showed both reversible and permanent hearing loss (HL). In animals that
received a single dose of PaExoA, the RWM thickness doubled initially and
remained thickened during the observation period. When PaExoA was instilled on
several occasions, RWM thickness doubled, before decreasing to near-control
levels. This study confirms the toxicity of PaExoA and the partially reversible
HL occurring after a single application of the toxin. The diminished effect of
repeated toxin instillations--despite the decreasing thickness of the RWM--is
discussed. Copyright 2001 S. Karger AG, Basel

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11713421 [PubMed - indexed for MEDLINE]

2087: J Vet Med B Infect Dis Vet Public Health. 2001 Oct;48(8):631-5.

Prevalence of yeasts and mycelial fungi in bovine parasitic otitis in the State
of Minas Gerais, Brazil.

Duarte ER, Resende JC, Rosa CA, Hamdan JS.

Department of Microbiology, Biological Science Institute, Federal University of
Minas Gerais, Belo Horizonte, Brazil.

Infestations by rhabditiform nematodes and acarids of the genus Raillietia are
considered the primary causes of external otitis in cattle in tropical regions.
Recently, yeasts of the genus Malassezia have been associated with a relatively
high percentage of otitis cases, but the occurrence of other yeasts and mycelial 
fungi has not yet been reported in the literature. This work studied the presence
of fungi in the ear canal of 45 cattle with external parasitic otitis. The
results were positive for yeasts of the genus Malassezia in 31 (68.9%) of the 45 
cultures in Mycosel medium supplemented with olive oil. The 45 cultures in
Sabouraud dextrose medium revealed the growth of seven (15.5%) yeasts of the
genus Candida, five (11.1%) Rhodotorula mucilaginosa, two (4.4%) fungi of the
genus Aspergillus and eight 'Micelia sterilia'. Future studies may confirm and
elucidate the importance of these agents in the aetiology of bovine otitis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11708682 [PubMed - indexed for MEDLINE]

2088: Infect Immun. 2001 Dec;69(12):7318-25.

Streptococcus pneumoniae causes experimental meningitis following intranasal and 
otitis media infections via a nonhematogenous route.

Marra A, Brigham D.

Protein Design Labs, Inc., Fremont, California 94555, USA.
andrea_marra@groton.pfizer.com

Using two different animal models of Streptococcus pneumoniae infection, we have 
demonstrated that this organism is able to spread to the central nervous system
and cause meningitis by bypassing the bloodstream. Following respiratory tract
infection induced via intranasal inoculation, bacteria were rapidly found in the 
bloodstream and brains in the majority of infected mice. A similar pattern of
dissemination occurred following otitis media infection via transbullar injection
of gerbils. However, a small percentage of animals infected by either route
showed no bacteria in the blood and yet did have significant numbers of bacteria 
in brain tissue. Subsequent experiments using a galU mutant of S. pneumoniae,
which is impaired in its ability to disseminate to the bloodstream following
infection, showed that this organism is able to spread to the brain and
cerebrospinal fluid. These results demonstrate that, unlike many bacterial
pathogens that cause meningitis, S. pneumoniae is able to do so independent of
bloodstream involvement upon different routes of infection. This may address the 
difficulty in treating human infections caused by this organism.

PMID: 11705903 [PubMed - indexed for MEDLINE]

2089: Eur J Radiol. 2001 Nov;40(2):113-8.

CT and MR imaging after middle ear surgery.

Kösling S, Bootz F.

Department of Radiology, Klinik für Diagnostische Radiologie, University of
Leipzig, Liebigstrasse 20a, D-04103 Leipzig, Germany.
sabrina.koesling@medizin.uni-halle.de

This article describes the current value of imaging in patients after stapes
surgery and surgery after chronic otitis media including cholesteatoma.
Possibilities and limits of computed tomography (CT) and MRI are described and
most important investigation parameters are mentioned. After otosclerosis
surgery, CT is the method of first choice in detection of reasons for vertigo
and/or recurrent hearing loss in the later postoperative phase. CT may show the
position and condition of prosthesis, scarring around the prosthesis and
otospongiotic foci. Sometimes, it gives indirect hints for perilymphatic fistulas
and incus necrosis. MRI is able to document inner ear complications. CT has a
high negative predictive value in cases with a free cavity after mastoidectomy.
Localized opacities or total occlusion are difficult to distinguish by CT alone. 
MRI provides important additional information in the differentiation of
cholesterol granuloma, cholesteatoma, effusion, granulation and scar tissue.

Publication Types: 
    Review

PMID: 11704358 [PubMed - indexed for MEDLINE]

2090: Otolaryngol Head Neck Surg. 2001 Nov;125(5):440-8; discussion 439.

Implications of the AHRQ evidence report on acute otitis media.

Rosenfeld RM, Casselbrant ML, Hannley MT.

Department of Otolaryngology, SUNY Health Science Center at Brooklyn, NY, USA.
richrosenfeld@msn.com

OBJECTIVE: To familiarize otolaryngologists with the Agency for Healthcare
Research and Quality (AHRQ) Evidence Report on Acute Otitis Media (AOM) that
reviews the natural history and role of antibiotics in management. The report, by
the Southern California Evidence-Based Practice Center (SC-EPC), is the most
recent of 15 literature syntheses published by the AHRQ. DATA SOURCES: MEDLINE
(1966 to present), Cochrane Library, EMBASE, BIOSIS, HealthSTAR, and other
computerized databases; manual reference search of proceedings, articles,
reports, and guidelines. STUDY SELECTION: Randomized trials and cohort studies
relevant to the natural history of AOM and the efficacy of antimicrobial therapy.
AOM was defined by the 11-member technical expert panel (including 2 authors, RMR
and MLC) as middle-ear effusion with the rapid onset of signs or symptoms of
middle ear inflammation. DATA EXTRACTION: Two physician reviewers at the Southern
California Evidence-Based Practice Center independently rated the articles and
extracted data. DATA SYNTHESIS: Children receiving placebo or no antimicrobial
had a pooled clinical success rate of 81% at 1 to 7 days (95% CI, 72% to 90%),
with no increase in suppurative complications when followed closely. Amoxicillin 
or ampicillin increased the absolute success rate by 12.3% (95% CI, 2.8% to
21.8%) in 5 studies pooled using random effects meta-analysis. The antimicrobial 
benefit was robust to sensitivity analysis. In contrast, success rates were not
influenced by the choice or duration of therapy. CONCLUSIONS: The AHRQ report
emphasizes middle-ear effusion as a preeminent criteria for AOM diagnosis and
provides extensive evidence tables on natural history and antimicrobial impact.
About 8 children must receive antibiotics to avoid 1 clinical failure, but
children younger than age 2 years or with severe symptoms may benefit more. The
report is a starting point for organizations seeking to develop AOM guidelines,
performance measures, and other quality improvement tools.

PMID: 11700439 [PubMed - indexed for MEDLINE]

2091: Int J Pediatr Otorhinolaryngol. 2001 Dec 1;61(3):223-32.

Prevalence and impact of chronic otitis media in school age children in Brazil.
First epidemiologic study concerning chronic otitis media in Latin America.

Godinho RN, Gonçalves TM, Nunes FB, Becker CG, Becker HM, Guimarães RE, Sanfins
F, Colosimo EA, Oliveira RG, Lamounier JA.

Department of Ophthalmology-Otorhinolaryngology, School of Medicine, Federal
University of Minas Gerais, Belo Horizonte, Brazil. ricardongodinho@netscape.net

OBJECTIVE: The first epidemiological study carried out in Latin America to
investigate the prevalence of otological disease and its impact in a
representative random sample of the school children population. METHODS: A cross 
sectional epidemiological survey to investigate the epidemiology of otitis in a
representative random sample of 1119 children and adolescents from a total of
486166 elementary and high-school students, aged 6-18 years, regularly registered
in one of the 521 public and private schools of the city of Belo Horizonte, in
the state of Minas Gerais, southern Brazil. The interviews were conducted
individually, in the school, by an otolaryngologist or a pediatrician. The
interview included all of the personal data and also detailed questions regarding
otological disorders and hearing. The otological examination was carried out with
Mini-Heine otoscopes and the audiometric evaluation with the AudioScope 3 with
25dB intensity. The questionnaire and basic procedures for medical examination
had been previously tested through a pilot test in two schools. RESULTS: The
prevalence of chronic otitis media was 0.94%. Impacted wax was found in 12.3% of 
the students. The prevalence of abnormalities (excluding wax) in the otoscopy
examination was 10.5%. It was found that 8.3% of students had a past history of
otitis and 7.7% had a past history of otorrhea. These two special groups
presented statistically significant associations with chronic otitis media,
hearing loss and otolaryngological surgeries (when compared with the other school
children). Parents and school children seemed significantly able to identify a
special group of children with past history of otitis during childhood.

PMID: 11700192 [PubMed - indexed for MEDLINE]

2092: Otol Neurotol. 2001 Nov;22(6):771-5.

Macrophages and possible osteoclast differentiation in the rat bullar bone during
experimental acute otitis media, with reference to tympanosclerosis.

Forséni Flodin M.

Department of Otorhinolaryngology, Karolinska Hospital, 171 76 Stockholm, Sweden.

HYPOTHESIS: Large osteoclast-like cells, labeled by using monoclonal antibodies
directed against macrophages, are participating in a bone remodeling process in
the rat bullar bone after induced experimental acute otitis media, leading to
tympanosclerosis. BACKGROUND: In humans, tympanosclerosis is a sequale of chronic
otitis media. It causes hearing disability, especially if the ossicles or the
inner ear are affected. No successful treatment is available. To evaluate the
inflammatory stages that may lead to tympanosclerosis, the current study was
performed. METHODS: Sprague-Dawley rats were exposed to a pneumococcus Type 3
solution into the middle ear. The rats were killed at 3, 6, and 10 days after
inoculation. Sections from the ear specimen were stained immunohistochemically.
Antibodies used were directed against macrophages. RESULTS: Positive cells were
seen in the tympanic membrane, in the middle ear mucosa, and close to the
tympanic membrane insertion into the bone. Macrophages appeared to be linearized 
adjacent to the bullar bone, both on the inner and on the outer bullar wall.
These cells had the appearance of osteoclasts. CONCLUSION: A differentiation of
macrophages to osteoclasts is possible during induced otitis media in the rat,
initiating a bone-remodeling process leading to tympanosclerosis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11698794 [PubMed - indexed for MEDLINE]

2093: Otol Neurotol. 2001 Nov;22(6):761-5.

Anterior subannular T-tube for prolonged middle ear ventilation during
tympanoplasty: evaluation of efficacy and complications.

Elluru RG, Dhanda R, Neely JG, Goebel JA.

Department of Otolaryngology, Washington University School of Medicine, 660 S.
Euclid Avenue, St. Louis, MO 63110, U.S.A.

OBJECTIVE: We previously described the use of anterior subannular T-tubes (n =
20) for long-term middle ear ventilation. In the current study, we examine a
larger patient population (n = 38) and a longer follow-up interval (average >2
years) to evaluate the efficacy and safety of anterior subannular tympanostomy.
STUDY DESIGN: Retrospective nonrandomized case review. SETTING: Tertiary referral
hospital. PATIENTS: Our series consisted of 38 consecutive patients with a
diagnosis of eustachian tube dysfunction, adhesive otitis media, or chronic
otitis media with a perforation who underwent a tympanoplasty. INTERVENTION: A
subannular T-tube was placed anteriorly at the time of tympanoplasty to provide
long-term middle ear ventilation. MAIN OUTCOME MEASURES: The main outcomes of
this study are tube position, tube patency, and middle ear ventilation. In
addition, hearing was evaluated both preoperatively and postoperatively and any
complications were noted. RESULTS: There were 38 patients and 38 ears that
received an anterior subannular T-tube at the time of tympanoplasty. The study
group consisted of 24 female patients and 14 male patents with a median age of 36
years (range, 10-75 yr). All 38 patients had eustachian tube dysfunction, 22 had 
adhesive otitis media, 23 had chronic otitis media, 13 had a cholesteatoma, 11
had tympanic membrane perforations, and 3 patients had a cleft palate. All
patients underwent tympanoplasty. Eighteen patients had a concomitant
ossiculoplasty and 7 had a mastoidectomy. Follow-up ranged from 1 month to 48
months (average, 26 mo). Three tubes had extruded within 2 years, in 1 case
resulting in a persistent perforation. Postoperative complications included 1
patient with a partially extruded prosthesis, 2 patients with tipped prosthesis
and persistent tympanic membrane retraction, and 1 patient with a plugged tube.
All other tubes were patent and showed no evidence of migration. Furthermore,
there were no cases of anterior canal blunting or ingrowth of epithelium around
the tube. CONCLUSION: Anterior subannular tympanostomy is a safe and effective
method for long-term middle ear ventilation in patients with chronic eustachian
tube dysfunction.

Publication Types: 
    Case Reports

PMID: 11698792 [PubMed - indexed for MEDLINE]

2094: Infection. 2001 Oct;29(5):286-8.

Meningitis in a girl with recurrent otitis media caused by Streptococcus
pyogenes--otitis media has to be treated appropriately.

Steppberger K, Adams I, Deutscher J, Müller H, Kiess W.

Children's Hospital, University of Leipzig, Germany.
kerstinsteppberger@hotmail.com

Streptococcus pyogenes rarely causes meningitis. A recent increase in the
incidence and severity of diseases due to S. pyogenes has been observed
worldwide, without an apparent increase in the incidence of S. pyogenes
meningitis. However, more recently severe and fulminant cases of S. pyogenes
meningitis have been reported in the literature. This case report emphasizes the 
fact that S. pyogenes can cause meningitis with severe clinical sequelae such as 
hygromas and right-sided third cranial nerve palsy. Most importantly, it is
concluded that recurrent otitis media has to be treated carefully following
appropriate identification of the causing organism in order to prevent severe
clinical courses of streptococcal infections.

Publication Types: 
    Case Reports

PMID: 11688910 [PubMed - indexed for MEDLINE]

2095: Paediatr Drugs. 2001;3(9):639-47.

The role of antibacterial therapy of acute otitis media in promoting drug
resistance.

Johnson CE, Belman S.

The Children's Hospital and University of Colorado School of Medicine, Denver
80218, USA. johnson.candice@tchden.org

Treatment of acute otitis media (AOM) is the leading cause of antibacterial use
in children in most developed countries. Rates of Streptococcus pneumoniae
strains resistant to many classes of antibacterial agents have risen dramatically
in many countries over the past 20 years. While more restricted use of
antibacterial agents for AOM would almost certainly slow the rise in resistance, 
AOM is a potentially painful disease and may have suppurative complications such 
as mastoiditis. In this review, we discuss the prudent use of antibacterial
agents for AOM and provide an overview of the epidemiology of S. pneumoniae
resistance worldwide. Data from 10 placebo-controlled studies in patients with
AOM show that antibacterial treatment is generally associated with a
significantly higher cure rate than placebo. Of the three studies which analysed 
children <2 years of age, cure rates were 28 to 48% for placebo and 41 to 74%
with antibacterial agents. Of the studies purporting to show no difference in
cure rates between placebo and antibacterial therapy, the diagnostic criteria
defining entry into the study were poor; therefore, the studies may have included
many children without bacterial disease. Accurate diagnosis of AOM is the key
element in reducing unnecessary antibacterial usage. Either pneumatic otoscopy or
tympanometry can provide evidence of an effusion and the presence of an opaque,
yellow or creamy white bulging eardrum will confirm AOM. Finally, the selection
of appropriate antibacterial agents will reduce the rise in resistance. Low
dosages of antibacterial agents used for prophylaxis select for resistance, and
certain classes of drugs such as the sulfonamides and macrolides appear to do the
same even at therapeutic doses. Amoxicillin at high dosages should remain the
first-line antibacterial agent. In the future, use of vaccination strategies
against pneumococci, influenza, respiratory syncytial virus and non-typeable
Haemophilus influenzae will also decrease antibacterial use.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 11688595 [PubMed - indexed for MEDLINE]

2096: Auris Nasus Larynx. 2001 May;28 Suppl:S29-32.

Therapy for otitis-prone children in Tenshi hospital.

Matsumura M, Fukuda S, Chida E, Mesuda Y, Hattori T, Ohta Y, Inuyama Y.

Department of Otolaryngology, Hokkaido University School of Medicine, Sapporo,
Japan. michey@med.hokudai.ac.jp

With the recent emergence and increases of multiple-drugs-resistant Streptococcus
pneumoniae, we have been seeing an increasing number of infants with intractable 
recurrent otitis media which is resistant to the general conservative out-patient
treatments such as oral administration of medicines or tympanotomy. In this
study, we investigated the inflammation-causing bacteria in the infants with
otitis media which were treated in our hospital from January to December in 1997,
and in six serious cases among them, we measured IgG subclass and specific IgG2
antibody to S. pneumoniae to examine them. As a result, S. pneumoniae was found
to be the cause in 45% of the cases of initial development of otitis media, and
in 88% of them the S. pneumoniae was penicillin-resistant. The level of specific 
IgG2 antibody to S. pneumoniae was low in all the cases, whereas IgG2 subclass
was deficient only in one out of the six cases; from these findings, the
selectively low level of immune status was thought to be the cause of the
recurrences of otitis media. In two cases, clinical condition was markedly
improved by immunoglobulin substitute therapy, which demonstrates that
immunoglobulin is effective for the intractable recurrent otitis media in
infants.

PMID: 11683338 [PubMed - indexed for MEDLINE]

2097: Br Homeopath J. 2001 Oct;90(4):180-2.

Comment in:
    Br Homeopath J. 2001 Oct;90(4):178-9.

Homeopathy in acute otitis media in children: treatment effect or spontaneous
resolution?

Frei H, Thurneysen A.

Spezialarzt FMH für Kinder and Jugendliche, FA Homöopathie SVHA, Laupen,
Switzerland. dr.heiner.frei@swissonline.ch

The conventional antibiotic treatment of acute otitis media (AOM) faces a number 
of problems, including antibiotic resistance. Homeopathy has been shown to be
capable of treating AOM successfully. As AOM has a high rate of spontaneous
resolution, a trial to prove any treatment-effect has to demonstrate very fast
resolution of symptoms. The purpose of this study was to find out how many
children with AOM are relieved of pain within 12 h after the beginning of
homeopathic treatment, making additional measures unnecessary. Two hundred and
thirty children with AOM received a first individualized homeopathic medicine in 
the paediatric office. If pain-reduction was not sufficient after 6 h, a second
(different) homeopathic medicine was given. After a further 6 h, children who had
not reached pain control were started on antibiotics. Pain control was achieved
in 39% of the patients after 6 h, another 33% after 12 h. This resolution rate is
2.4 times faster than in placebo controls. There were no complications observed
in the study group, and compared to conventional treatment the approach was 14%
cheaper.

Publication Types: 
    Clinical Trial

PMID: 11680801 [PubMed - indexed for MEDLINE]

2098: Clin Otolaryngol Allied Sci. 2001 Oct;26(5):417-24.

Surgery for persistent otitis media with effusion: generalizability of results
from the UK trial (TARGET). Trial of Alternative Regimens in Glue Ear Treatment.

Medical Research Council Multicentre Otitis Media Study Group.

TARGET (Trial of Alternative Regimens in Glue Ear Treatment) is a multicentre UK 
randomized controlled trial (RCT) comparing bilateral ventilation tubes with and 
without adjuvant adenoidectomy against non-surgical management in children with
bilateral, persistent otitis media with effusion (OME). This paper compares the
recruited and randomized children with those that, although eligible, were not
included in the RCT for various reasons. This is necessary to identify any
potential bias in the overall estimate of treatment effectiveness. At the first
visit, 1315 children with OME satisfied the criteria of age (3 years 3 months-6
years 9 months), no previous ear or adenoid surgery, tympanometric evidence of
fluid (bilateral B or B + C2) and a hearing loss (conductive loss in both ears of
> or =20 dBHL). Of these children, 151 (11%) were not followed up because of
overriding concern and 70 (5%) because of parental refusal. Of the 506 children
eligible for randomization, because of persistence over 12 weeks of watchful
waiting of bilateral OME with the same criteria, 20 (4%) were not randomized
because of overriding concern and 75 (15%) because of parental refusal. The
distribution of the potential effect modifiers was determined for each group. At 
the first visit, the only significant differences (P < 0.05), comparing those not
recruited because of overriding concern with those recruited, were in respect of 
sex (61% girls compared with 52% boys) and hearing level (34.6 compared with 33.0
dBHL). At the second visit, the only significant difference involved less
frequent upper respiratory tract infections (URTIs) in children whose parents
refused to allow randomization (8% compared with 18% had had episodic URTI more
often than once every 3 months). It is probable that the findings from the TARGET
trial will translate to the entire clinic population in this age group as long as
they meet the same audiometric and tympanometric criteria. The differences found 
can be handled by presentation of disaggregated results.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial

PMID: 11678951 [PubMed - indexed for MEDLINE]

2099: Acta Otolaryngol. 2001 Sep;121(6):673-8.

Th1: mediator lymphocytes in experimental autoimmune labyrinthitis.

Tomiyama S.

Department of Otolaryngology, Nippon Medical School, Tama-Nagayama Hospital,
Tokyo, Japan. Tomiyama_Shuncihi/ent@nms.ac.jp

A previous study on experimental autoimmune labyrinthitis (EAL) consistently
demonstrated transient infiltration of lymphocytes only into the inner ear of
mice. To clarify the profile of lymphocytes in the initiation of EAL, the present
study investigated cell surface antigens, as well as cytokines, from Day 4 to Day
35, using immunohistochemical techniques. Many CD4+ cells mainly infiltrated the 
endolymphatic sac as early as Day 4 and gradually spread to the rest of the inner
ear. Infiltration peaked on Day 12 and persisted in most animals until Day 35,
although the number of cells gradually decreased. In contrast, very few CD8+
cells were found to have appeared in the inner ear of all animals on Day 10, and 
the number of cells rapidly decreased. Many cells positive for IFN-gamma and IL-2
were identified in the endolymphatic sac on Day 4. These results suggest that
helper T1 lymphocytes, rather than cytotoxic T lymphocytes, may play a central
role in the initiation of EAL.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11678165 [PubMed - indexed for MEDLINE]

2100: J Int Med Res. 2001 Jul-Aug;29(4):349-54.

Clinical and pro-host effects of cefaclor in prophylaxis of recurrent otitis
media in HIV-infected children.

Zuccotti G, Dauria E, Torcoletti M, Lodi F, Bernardo L, Riva E.

Department of Paediatrics, San Paolo Hospital, University of Milan, Italy.
zuccottig@libero.it

The aim of this study was to evaluate the efficacy of cefaclor in the prophylaxis
of recurrent acute otitis media (AOM) in human immunodeficiency virus
(HIV)-infected children. The study was carried out in children born between 1
January 1986 and 31 December 1996 who had been vertically HIV infected Patients
who had experienced recurrent AOM between October 1997 and March 1998 (period 1) 
were eligible for the trial. Recurrent AOM was defined as the occurrence in the
same patient of three or more episodes of AOM within 6 months of the observation 
period. Patients recruited for this trial received cefaclor at a dose of 20 mg/kg
once daily for 6 months between April and September 1998 (period 2). Clinical
observation was carried out in periods 1 and 2 and for the first 6 months after
prophylaxis, i.e. October 1998 - March 1999 (period 3). Natural killer-cell
activity, phagocytosis and myeloperoxidase activity were determined before and at
the end of the prophylactic period. For each period, CD4-cell count measurement
and CD4-positive cell class were recorded. Seventeen children were recruited for 
this trial. No significant differences were observed in natural killer-cell
activity between periods 1 and 2, nor were any significant differences observed
in CD4-positive cell class or CD4-positive cell count between the three periods. 
However, cefaclor administration was associated with a reduction in the number of
AOM episodes in 100% of cases and a mean increase in myeloperoxidase activity in 
57% of cases. This suggests that cefaclor may be useful in the prophylaxis of
recurrent AOM in HIV-infected children.

Publication Types: 
    Clinical Trial

PMID: 11675909 [PubMed - indexed for MEDLINE]

2101: J Laryngol Otol. 2001 Oct;115(10):812-4.

Minimum dataset for recording myringotomy and ventilation tube insertion.

Dutt SN, Pahor AL.

Department of Otolaryngology and Head and Neck Surgery, City Teaching Hospitals
NHS Trust, Birmingham, UK.

A minimum dataset for recording of findings during myringotomy and ventilation
tube insertion for cases of otitis media with effusion is presented. With
increasing pressures on surgeons to audit existing practices and hence improve
standards of health care, it is appropriate to produce such a set of guidelines
for a surgery that is frequently performed world-wide. We believe that the data
presented is not too exhaustive and can be readily incorporated into the
operative notes.

PMID: 11667994 [PubMed - indexed for MEDLINE]

2102: Ann Otol Rhinol Laryngol. 2001 Oct;110(10):928-34.

Transient inflammation and dysfunction of the eustachian tube secondary to
multiple exposures of simulated gastroesophageal refluxant.

Heavner SB, Hardy SM, White DR, Prazma J, Pillsbury HC 3rd.

Department of Surgery, University of North Carolina School of Medicine,
University of North Carolina Hospitals, Chapel Hill, USA.

Gastroesophageal reflux is a common problem in the newborn and preschool periods.
Recent research suggests that it may be related to eustachian tube dysfunction
and otitis media with effusion. The purpose of this experiment was to investigate
the relationship between simulated gastroesophageal reflux and eustachian tube
dysfunction. Rat middle ears were repeatedly exposed (transtympanically) to
pepsin in hydrochloric acid or to phosphate-buffered saline solution. Their
eustachian tube function was evaluated by assessing passive opening and passive
closing pressures, and active clearance of positive and negative pressure. The
passive pressure function tests showed variable results. The rats exposed to
pepsin in hydrochloric acid had an impaired ability to clear positive and
negative pressure from the middle ear as compared to the rats exposed only to
phosphate-buffered saline solution. The results demonstrate that multiple middle 
ear exposures to pepsin in hydrochloric acid leads to eustachian tube dysfunction
in rats.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11642425 [PubMed - indexed for MEDLINE]

2103: Ann Otol Rhinol Laryngol. 2001 Oct;110(10):917-21.

Effect of inhibitor of tumor necrosis factor-alpha on experimental otitis media
with effusion.

Jeon EJ, Park YS, Choi YC, Yeo SW, Jung TT.

Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The
Catholic University of Korea, Seoul.

Tumor necrosis factor (TNF)-alpha is important in the pathogenesis of otitis
media with effusion (OME). The purpose of this study was to determine the effect 
of TNF-alpha antagonist on the outcome of lipopolysaccharide (LPS)-induced OME in
rats. Otitis media was induced by injecting Pseudomonas aeruginosa LPS
transtympanically. Another (combination) group was pretreated with TNF-alpha
antagonist, soluble TNF receptor type I (sTNF RI), before transtympanic injection
of LPS. Saline and phosphate-buffered saline solutions were used as controls.
Twelve hours after the transtympanic injection, otoscopic examination and
aspiration of middle ear effusion (MEE) were done. The temporal bones in each
group were examined histopathologically, and the vascular permeability of the
middle ear mucosa was measured by the Evans blue vital dye technique. In the LPS 
and combination groups, MEE developed in 90% and 0% of ears, respectively. The
combination group showed less inflammation, less mucosal thickening, and
significantly decreased vascular permeability as compared to the LPS group.
Transtympanic administration of sTNF RI appears to suppress the development of
LPS-induced OME. This study suggests that TNF-alpha antagonist, along with
antibiotics, may have an adjunctive role in the future treatment of MEE.

PMID: 11642423 [PubMed - indexed for MEDLINE]

2104: J Microbiol Immunol Infect. 2001 Sep;34(3):190-4.

Pathogens in the middle ear effusion of children with persistent otitis media:
implications of drug resistance and complications.

Li WC, Chiu NC, Hsu CH, Lee KS, Hwang HK, Huang FY.

Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, ROC.

Acute otitis media (AOM) is the most common disease for which pediatricians
prescribe antimicrobial agents. Middle ear fluid were collected from 243 children
with AOM that failed to respond to a previous course of antimicrobial therapy and
who had then received myringotomy from September 1997 through August 1999.
Bacterial cultures were done and antimicrobial susceptibilities were analyzed.
Streptococcus pneumoniae (21.8%) was the most common causative organism, followed
by Haemophilus influenzae (10.2%), Staphylococcus aureus (7%), and Pseudomonas
aeruginosa (1.8%), while Moraxella catarrhalis (0.7%) and group A beta-hemolytic 
streptococcus (0.2%) were rarely isolated. In patients whose condition failed to 
improve after a course of antibiotic treatment, drug resistance became a serious 
problem. Fourteen percent of the patients in this series had complications, which
included recurrent AOM, persistent middle ear effusion necessitating ventilation 
tube insertion, hearing impairment, mastoiditis, meningitis, chronic otitis
media, brain abscess, and sepsis. Possible risk factors such as young age, male
sex, underlying diseases, and a culture of S. pneumoniae or H. influenzae were
not significantly associated with an increased incidence of complications. More
stringent diagnosis and the correct choice of antibiotic treatment combined with 
the introduction of potential virus and bacterial vaccines are promising ways to 
reduce the morbidity of AOM in children.

PMID: 11605810 [PubMed - indexed for MEDLINE]

2105: Arch Pediatr Adolesc Med. 2001 Oct;155(10):1137-42.

Comment in:
    Arch Pediatr Adolesc Med. 2001 Oct;155(10):1097.

Assessing diagnostic accuracy and tympanocentesis skills in the management of
otitis media.

Pichichero ME, Poole MD.

Department of Microbiology, University of Rochester School of Medicine and
Dentistry, NY 14642, USA. michael_pichichero@urmc.rochester.edu

BACKGROUND: The distinction between acute suppurative otitis media (AOM) and
otitis media with effusion (OME) is important for antibiotic treatment decisions.
Tympanocentesis may be useful in the diagnosis of AOM in selected patients.
OBJECTIVES: To assess physician accuracy in diagnosing AOM and OME from physical 
examination findings and technical competence in performing tympanocentesis.
DESIGN AND SUBJECTS: Five hundred fourteen pediatricians and 188
otolaryngologists viewed 9 different videotaped pneumatic otoscopic examinations 
of tympanic membranes during a continuing medical education course. Diagnostic
differentiation of AOM, OME, and a normal tympanic membrane was ascertained. An
infant mannequin model was used to assess the technical proficiency of performing
tympanocentesis on artificial tympanic membranes. RESULTS: Overall, the average
correct diagnosis by pediatricians was 50% (range, 25%-73%) and by
otolaryngologists was 73% (range, 48%-88%). Pediatricians and otolaryngologists
correctly recognized the absence of normality 89% to 100% and 93% to 100% of the 
time, respectively, but overdiagnosed AOM in 7% to 53% (mean, 27%) and in 3% to
23% (mean, 10%) of examinations. Performance of tympanocentesis was optimally
performed by 89% of otolaryngologists and by 83% of pediatricians. CONCLUSIONS:
The use of video-presented examinations to assess diagnostic ability suggests
that AOM and OME may be misdiagnosed often. Interactive continuing medical
education courses with simulation technology may enhance skills and improve
diagnostic accuracy and treatment paradigms.

PMID: 11576009 [PubMed - indexed for MEDLINE]

2106: Otolaryngol Head Neck Surg. 2001 Oct;125(4):364-9.

Changes in external ear resonance after 3 types of surgery in the patients with
chronic otitis media.

Cho YS, Seo IS, Woo HC, Kang MK, Chung WH, Hong SH.

Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University 
School of Medicine, Samsung Medical Center, 50 Ilwon-Dong, Kangnam-Gu, Seoul,
Korea, 135-710.

OBJECTIVE: This study was designed to identify the external ear resonance
characteristics of patients with tympanic membrane perforation and to investigate
subsequent changes in external ear resonance, depending on the length of the
postoperative period and which of 3 different types of operation was performed:
tympanoplasty with canal wall-up mastoidectomy, epitympanoplasty, and canal
wall-down mastoidectomy. STUDY DESIGN AND SETTING: A total of 227 ears of 188
patients and 96 control ears comprised the study. We measured the gain and
frequency of the first peak of external ear resonance with a real ear analyzer.
RESULTS: Gain and frequency of the first peak recorded in the preoperative group 
did not differ from those of the control group. However, negative peaks appeared 
around 1 to 1.5 kHz in half of these ears. The gain increased markedly in all 3
postoperative groups. The canal wall-down mastoidectomy and epitympanoplasty
groups showed significantly lower frequencies compared with the tympanoplasty
with canal wall-up mastoidectomy and control groups, but there was no difference 
between them. The increased gain diminished over time, but the peak gain did not 
equalize with that of the controls, even after 15 months. CONCLUSIONS: Additional
gain should be considered of around 1 to 1.5 kHz for hearing aid users with
tympanic membrane perforation. Postoperative changes in external ear resonance
should be expected in patients with chronic otitis media, suggesting that fine
readjustments of the hearing aid may be necessary.

PMID: 11593173 [PubMed - indexed for MEDLINE]

2107: Otolaryngol Head Neck Surg. 2001 Oct;125(4):339-45.

Late-phase allergy and eustachian tube dysfunction.

Hardy SM, Heavner SB, White DR, McQueen CT, Prazma J, Pillsbury HC.

Department of Surgery, Division of Otolaryngology-Head and Neck Surgery,
University of North Carolina at Chapel Hill, 27599-7070, USA. hardys@med.unc.edu

OBJECTIVE: This study investigated the role of late-phase allergy in the
development of otitis media with effusion. METHODS: Brown Norway rats were
sensitized to ovalbumin and later challenged transtympanically. Eustachian tube
ventilatory function was assessed 2, 4, 8, 24, 28, and 32 hours postchallenge by 
measuring passive opening and closing pressures, active clearance of positive and
negative middle ear pressure, and mucociliary clearance. RESULTS: The results
demonstrate that exposure to transtympanic allergen induces eustachian tube
dysfunction and subsequent formation of effusion. Allergic animals showed
significant increases in passive and active opening pressures, as well as a
decreased ability to actively clear middle ear pressure. Finally, the mucociliary
was significantly impaired in all sensitized rats exposed to transtympanic
allergen. CONCLUSION: These findings demonstrate that late-phase allergy leads to
significant eustachian tube dysfunction and subsequent formation of effusion by
impairing the ventilatory and clearance functions of the eustachian tube.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11593168 [PubMed - indexed for MEDLINE]

2108: Int J Pediatr Otorhinolaryngol. 2001 Nov 1;61(2):173-7.

Bezold's abscess in children: case report and review of the literature.

Marioni G, de Filippis C, Tregnaghi A, Marchese-Ragona R, Staffieri A.

Department of Otolaryngology-Head and Neck Surgery, University of Padua, Via
Giustiniani 2, 35128, Padua, Italy. g_marioni@virgilio.it

The introduction of antibiotics in the treatment of suppurative otitis media has 
significantly decreased the incidence of complications. Reports of Bezold's
abscess secondary to this disorder are rare, particularly in infants and young
children, in whom mastoid bone pneumatization is not yet complete. We present a
case of Bezold's abscess occurring in a child aged 18 months. The literature is
reviewed and methods to accurately diagnose this complication are emphasized.

Publication Types: 
    Case Reports
    Review

PMID: 11589986 [PubMed - indexed for MEDLINE]

2109: Int J Pediatr Otorhinolaryngol. 2001 Nov 1;61(2):99-104.

A comparison of cortisporin and ciprofloxacin otic drops as prophylaxis against
post-tympanostomy otorrhea.

Morpeth JF, Bent JP, Watson T.

Medical College of Georgia, Department of Surgery/Division of Otolaryngology,
Augusta, GA, USA.

Myringotomy and tube insertion, a common pediatric surgical procedure, is
frequently complicated by purulent otorrhea. Many otolaryngologists routinely use
topical antibiotics as prophylaxis against post-tympanostomy otorrhea. The
aminoglycosides (neomycin sulfate, tobramycin and gentamicin) contained in
commonly used topical antibiotics as well as components of the solutions have
been shown to be ototoxic in animal studies. Although little reported evidence of
ototoxicity in humans exists, sporadic reports of sensorineural hearing loss
linked to topical antibiotic use do exist, and the potential for sensorineural
hearing loss must be considered. The purpose of this study is to compare the rate
of post-tympanostomy otorrhea in a double-blinded randomized trial using either
topical Ciprofloxacin, with no reported ototoxicity, or Cortisporin as
prophylaxis. One hundred patients (200 ears) between ages 7 months and 11 years
with a diagnosis of recurrent otitis media or chronic otitis media undergoing
tympanostomy tube insertion were randomized into two equal groups. Three drops of
either drop A or B were placed into each ear at the time of tube insertion and
then three times daily for 3 days. Patients were examined at 3 weeks and details 
of otorrhea were obtained. The rate of otorrhea was analyzed using chi-square.
The overall rate of otorrhea was 39 ears (19.5%), 17 (17%) ears for the
Cortisporin group and 22 (22%) for the Ciprofloxacin group. The difference in
rate of otorrhea was not statistically significant (P=0.372, 95% confidence
interval equals -6-16%). Our data suggest that topical Cortisporin offers no
benefit over Ciprofloxacin for post-operative otorrhea prophylaxis. Therefore we 
recommend topical quinolone prophylaxis, which should eliminate concerns about
ototoxicity, without sacrificing efficacy.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11589975 [PubMed - indexed for MEDLINE]

2110: Clin Infect Dis. 2001 Nov 1;33(9):1489-94. Epub 2001 Oct 4.

Pneumococcal conjugate vaccine serotypes of Streptococcus pneumoniae isolates and
the antimicrobial susceptibility of such isolates in children with otitis media.

Joloba ML, Windau A, Bajaksouzian S, Appelbaum PC, Hausdorff WP, Jacobs MR.

Department of Pathology, Case Western Reserve University and University Hospitals
of Cleveland, Cleveland, OH 44106, USA.

The ability of the recently licensed 7-valent pneumococcal conjugate vaccine to
cover isolates that cause otitis media, especially drug-resistant ones, was
assessed using 500 recently obtained US isolates. Of these isolates, 418 (84%)
belonged to vaccine-related serogroups, whereas 82 (16%) belonged to
non-vaccine-related serogroups. Serotype 3 accounted for 48 (59%) of the
non-vaccine-related serogroups. In addition, 93% of the isolates from patients < 
or =3 years of age belonged to serotypes that were included in or related to the 
heptavalent vaccine, compared with 49% of the isolates from older patients
(P=.001). Most of the isolates (98%-100%) that were resistant to the
antimicrobial agents tested were covered by the heptavalent vaccine, including
95.1% of the isolates from patients <2 years of age. The 7-valent pneumococcal
conjugate vaccine could therefore potentially provide protection against all but 
1 (type 3) of the common otitis media-associated pneumococcal serogroups
identified in this study as well as against 98% of antibiotic-resistant isolates.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11588694 [PubMed - indexed for MEDLINE]

2111: Vet Parasitol. 2001 Oct 31;101(1):45-52.

Epidemiological aspects of bovine parasitic otitis caused by Rhabditis spp.
and/or Raillietia spp. in the state of Minas Gerais, Brazil.

Duarte ER, Melo MM, Hamdan JS.

Department of Microbiology, Federal University of Minas, Biological Science
Institute, ICB/UFMG, Av. Antônio Carlos, 6627, 31270-901, Belo Horizonte, Minas
Gerais, Brazil.

The occurrence of bovine external otitis in tropical regions is predominantly
assigned to parasitic infections by rhabditiform nematodes and infestations by
mites of the genus Raillietia. This research had the purpose of investigating the
prevalence of parasitic otitis in the dry and rainy seasons of Minas Gerais and
correlating it with variables age, breed and the presence of horns. The secretion
or cerumen of 981 cattle was collected with sterile swabs, placed in test tubes
and exposed to sunlight for the identification of clinical infections caused by
rhabditiform nematodes. The ear canals of 109 animals were flushed to study the
occurrence of mites of the genus Raillietia. Clinical otitis caused by
rhabditiform nematodes was observed only in animals of the Gyr breed, affecting
169 (60.1%) of the total (278) of these cattle. The prevalence of otitis in this 
breed was significantly higher for mature adult cows (P<0.001) and in cows with
horns (P<0.001). In a total of nine animals suspected of raillietiosis, the
examinations revealed the presence of Raillietia spp. in two Dutch cows. These
results demonstrate that treatment must be focused on adult Gyr cattle with
horns. This and future studies with an emphasis on epidemiological aspects may
contribute to development of alternative approaches to reduce disease.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11587832 [PubMed - indexed for MEDLINE]

2112: Eur Arch Otorhinolaryngol. 2001 Aug;258(6):287-91.

A topical steroid without an antibiotic cures external otitis efficiently: a
study in an animal model.

Emgård P, Hellström S.

ENT-Clinic of Ystad Hospital, Sweden.

In an animal external otitis model, inflammatory reactions were evoked by
mechanical stimulation of the rat ear canal skin. The rats were in four groups:
group A treated with a group III steroid, betamethasone dipropionate; group B
treated with hydrocortisone combined with oxytetracycline; group C treated with
hydrocortisone with oxytetracycline and polymyxin B added; Group D, the controls,
treated with saline. All rats were observed otomicroscopically daily during the
first 7 days after treatment and then on days 10 and 20. A standardized scoring
system was used to evaluate colour, swelling and effusion of the ear canal.
Histological specimens were collected on days 3, 7, 10 and 20. The most rapid
improvement in the ear canal status occurred in the animals treated with
betamethasone dipropionate. The inflammatory reaction of the ear canal skin
caused by mechanical stimulation was characterized by oedema of the stroma but
few inflammatory cells were present. The surface of the epithelium towards the
connective tissue layer was smooth in the group III-treated animals (group A)
whereas other groups had irregularities of the basal membrane. From this study it
is inferred that the group III steroid betamethasone dipropionate alone heals
experimentally induced external otitis more rapidly than hydrocortisone with
oxytetracycline, with or without polymyxin B. These findings should be considered
in future clinical trials of external otitis.

Publication Types: 
    Evaluation Studies
    Research Support, Non-U.S. Gov't

PMID: 11583468 [PubMed - indexed for MEDLINE]

2113: Acta Otolaryngol. 2001 Jul;121(5):622-6.

Labyrinthine fistula detection: the predictive value of vestibular symptoms and
computerized tomography.

Kvestad E, Kvaerner KJ, Mair IW.

Department of Otorhinolaryngology, Ullevål University Hospital, Oslo, Norway.

A retrospective case record study of 20 patients in Oslo operated on for chronic 
otitis media with labyrinthine fistula between 1986 and 1999 was performed in
order to estimate the incidence of, and identify predictors for, labyrinthine
fistulas. The incidence of fistula was 0.3 per 100 000, with a median age at
diagnosis of 37 years. The median duration of chronic otitis media prior to
labyrinthine fistula detection was significantly correlated with age at surgery. 
Subjective hearing loss (90%), otorrhoea (65%) and dizziness (50%) were
presenting symptoms. Modified canal-wall-down mastoidectomy was performed in all 
patients. Preoperative hearing levels could not predict postoperative hearing
outcome. Positive signs of fistula were found in only 4 patients (20%).
Correspondingly, computerized tomography (CT) diagnosed the fistula in 11
patients (55%). The seven patients presenting without dizziness and with a
negative CT scan and fistula test were characterized by lower age, absence of
previous middle ear surgery, lower preoperative pure-tone thresholds for bone
conduction and better hearing outcome after surgery. In conclusion, the
identification of a younger group of patients presenting with fewer symptoms
indicates that fistulas should be suspected in all patients undergoing surgery
for chronic middle ear and mastoid disease.

Publication Types: 
    Case Reports

PMID: 11583397 [PubMed - indexed for MEDLINE]

2114: Acta Otolaryngol. 2001 Jul;121(5):596-601.

Induction of mucin and adhesion molecules in middle ear mucosa.

Schousboe LP, Rasmussen LM, Ovesen T.

Department of Otorhinolaryngology, Aarhus University Hospital, Denmark.
Schousboe@dadlnet.dk

We hypothesized that inflammation molecules induce the secretory hyperplasia
characteristic of otitis media with effusion (OME). The purpose of the present
study was to compare the location of inflammation molecules and mucin in the
middle ear mucosa of both normal and OME ears. OME was created by bisection of
the tensor veli palatini muscle in germ-free rabbits, and the development of
middle ear effusion was confirmed by otomicroscopy and tympanometry. Ventilation 
tubes (VTs) were inserted in half of the ears. The animals were decapitated after
8 weeks, and serial sections of the middle ear mucosae were either periodic
acid-Schiff (PAS)-stained or stained immunohistochemically for inflammation
molecules or mucins. The length of stained epithelium was measured and related to
the total epithelial length. There was a striking resemblance between mucin-type 
MUC5B- and PAS-positive epithelium and areas positive for the chemoattractant
inflammation molecules intercellular adhesion molecule-1 (ICAM-1) and RANTES
(reacted upon activation, normal T expressed and secreted). The percentages of
ICAM-1- and PAS-stained epithelium were significantly higher in OME ears than in 
normal ears. OME ears treated with VTs also contained significantly more
PAS-positive epithelium than normal ears, but less than OME ears. Based on the
spatial and temporal coincidence between ICAM-1 and mucin, it is suggested that: 
(i) inflammation may initiate and maintain the hypersecretory state of the middle
ear mucosa which is presumably responsible for the chronicity of OME; and (ii)
that MUC5B is a major mucin component of OME effusions.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11583392 [PubMed - indexed for MEDLINE]

2115: Acta Otolaryngol. 2001 Jul;121(5):565-8.

Are some ear drops ototoxic or potentially ototoxic?

Palomar García V, Palomar Asenjo V.

Department of Oto-Rhino-Laryngology, Hospital Universitario Arnau de Vilanova,
Universidad de Lleida, Spain. palomar@cirurgia.udl.es

In this article we review the literature concerning the capacity of certain
substances to cause ototoxicity when administered topically. The ototoxicity
experimentally observed in animals only occurs in humans under certain
circumstances. It is concluded that many of these products. which are commonly
used for treatment in humans, are ototoxic in animals and may also be ototoxic in
humans. Therefore, the use of other substances which have the same action but are
not ototoxic

Publication Types: 
    Review

PMID: 11583386 [PubMed - indexed for MEDLINE]

2116: BMC Fam Pract. 2001;2:3. Epub 2001 Sep 12.

S-carboxymethylcysteine in the treatment of glue ear: quantitative systematic
review.

Moore RA, Commins D, Bates G, Phillips CJ.

Pain Research and Nuffield Department of Anaesthetics, University of Oxford,
Oxford Radcliffe Hospitals, The Churchill Headington, Oxford, OX3 7LJ, UK.
andrew.moore@pru.ox.ac.uk

OBJECTIVE: To establish the clinical relevance of S-carboxymethylcysteine in the 
treatment of glue ear in children using measures approximating those saving a
child from operation for grommet insertion. DATA SOURCES: Cochrane Library,
MEDLINE, EMBASE, PubMed, reference lists and reviews were used for randomised
controlled trials comparing S-carboxymethylcysteine with placebo. Seven trials
involving 283 children and 146 ears were found. REVIEW METHODS: Studies were
randomised, double-blind comparisons of S-carboxymethylcysteine (any dose and
duration) with placebo in otitis media with effusion. Quality of trial reporting 
and validity of methods were assessed and used in sensitivity analysis. Main
outcomes were relative benefit and number-needed-to-treat to prevent one grommet 
operation compared with placebo. RESULTS: Successful outcomes were obtained in
17% of children given placebo (range 5% to 38% in individual studies) and in 35% 
of children given S-carboxymethylcysteine (range 22 to 80%). For combined data
(children and ears) the relative benefit was 2.0 (95%CI 1.4 to 2.8) and
number-needed-to-treat 5.5 (95% confidence interval 3.8 to 9.8). Pooled data from
trials of higher reporting quality (4/7) or methodological validity (3/7) tended 
to have lower efficacy but were not statistically different from those of lower
quality or validity. CONCLUSION: S-carboxymethylcysteine is effective in the
treatment of children with glue ear. For every five or six children treated with 
S-carboxymethylcysteine over one to three months, one will not undergo surgery
for grommet insertion who would have done had they been given placebo. The
confidence in this conclusion is limited because studies included relatively few 
children.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 11580867 [PubMed - indexed for MEDLINE]

2117: Ear Nose Throat J. 2001 Sep;80(9):647-50.

Use of adenoidectomy and adenotonsillectomy in children with otitis media with
effusion.

Abdul-Baqi KJ, Shakhatreh FM, Khader QA.

Department of Otolaryngology, Faculty of Medicine, Jordan University Hospital,
Amman, Jordan.

We conducted a prospective study of 48 children, aged 2 to 14 years, who had
persistent bilateral otitis media with effusion, enlarged adenoids, and a
bilateral conductive hearing loss. Half of these patients underwent adenoidectomy
and the other half adenotonsillectomy. All patients were followed every 2 weeks
for up to 6 months. At 2 months postoperatively, the overall success rate in
terms of the resolution of middle ear effusion was 85.1%. Success rates were
82.6% in the adenoidectomy group and 87.5% in the adenotonsillectomy group; the
difference was not statistically significant. Our findings demonstrate that both 
adenoidectomy and adenotonsillectomy are effective for the treatment of
persistent otitis media with effusion, and they confirm the findings of other
studies. Based on our findings and those of other investigators, we offer a
four-step approach to the management of these children.

PMID: 11579851 [PubMed - indexed for MEDLINE]

2118: Int J Pediatr Otorhinolaryngol. 2001 Oct 19;61(1):61-9.

Negative pressure tympanograms in children less than 2 years of age--different
bacterial findings in otitis media by tympanometric results.

Palmu A, Syrjänen R, Kilpi T, Pursiainen H, Puhakka H, Rahko T, Herva E, Takala
A.

National Public Health Institute, Helsinki, Finland. aapalmu@tays.fi

OBJECTIVE: The interpretation of negative pressure tympanograms as indicators of 
the presence of middle ear fluid has been ambiguous. Our purpose was to assess
the occurrence and implications of negative pressure tympanograms and to study
their association with bacterial pathogens in otitis media. METHODS: Altogether
329 infants were enrolled at a well-baby clinic for the Finnish Otitis Media
Cohort Study, a longitudinal prospective cohort study. The children were closely 
followed in a special study clinic from 2 to 24 months of age for respiratory
diseases, especially acute otitis media. Children were examined at the study
clinic with tympanometry and pneumatic otoscopy whenever visiting the study
clinic for respiratory disease. Myringotomy with aspiration was performed if
middle ear fluid was suspected in otoscopy. Occurrence of middle ear fluid in
ears with negative pressure tympanograms (less than -100 daPa) was assessed.
Nested case control design matched by visit type (acute or follow-up visit) and
month of visit was used for analysis of association of bacterial pathogens and
tympanometric results. RESULTS: Middle ear fluid was encountered in 15% of ears
with negative tympanometric peak pressure, a lower proportion than described
previously. In otitis media with a negative tympanometric peak pressure, 71% of
bacterial cultures remained negative for the main pathogens, compared to 36% in
matched controls (P<0.001). Especially Streptococcus pneumoniae but also
Haemophilus influenzae were rarely found in samples from negative pressure ears. 
Moraxella catarrhalis was equally often found. CONCLUSIONS: Negative pressure
tympanogram is a poor indicator for the presence of middle ear fluid.
Furthermore, if otitis media is diagnosed with negative tympanometric peak
pressure negative middle ear bacterial culture for the main pathogens is highly
probable. Expectant follow-up might be more appropriate than routine antibiotic
treatment.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11576632 [PubMed - indexed for MEDLINE]

2119: Int J Pediatr Otorhinolaryngol. 2001 Oct 19;61(1):47-60.

Restricted use of antibiotic prophylaxis for recurrent acute otitis media in the 
era of penicillin non-susceptible Streptococcus pneumoniae.

Block SL, Harrison CJ, Hedrick J, Tyler R, Smith A, Hedrick R.

FAAP, Kentucky Pediatric Research, Inc., 201 South 5th Street, Bardstown, KY
40004, USA. slblock@pol.net

OBJECTIVE/INTERVENTION: To compare the annual rates of acute otitis media (AOM)
episodes, antibiotic days, and ventilating tube insertion during the first 3
years of life before and after a practice change to restrict use of antibiotic
chemoprophylaxis for recurrent AOM. METHODS SETTING: The sole pediatric private
practice in a rural Kentucky community. PATIENTS: Population-based sample of all 
children born consecutively in two different 13 month intervals. Cohort 1 (n=251)
was born before and Cohort 2 (n=274) was born after restricted use of
chemoprophylaxis and documented emergence of widespread penicillin
non-susceptible Streptococcus pneumoniae (PNSP). DESIGN: Retrospective case
cohort comparison. MAIN OUTCOME MEASURES: Suppurative AOM diagnosed by validated 
experienced otoscopists using stringent tympanic membrane criteria. RESULTS:
Children were mostly white with the majority (50-65%) enrolled in daycare during 
each year. The first episode of AOM was experienced by 6 and 12 months of age in 
64 and 86%, respectively. Rates of children with recurrent AOM in Cohorts 1 and 2
were 28 and 31% in Year 1, 17 and 23% in Year 2, and 7 and 10% in Year 3,
respectively. Rates of new onset AOM and persistent AOM episodes were similar
between cohorts in the first 2 years. Number of days of antibiotic prophylaxis
were reduced from 11.2 to 3.4 days in Year 1, from 11.9 to 2.6 days in Year 2,
and from 6.9 to 0.7 days in Year 3, respectively (P<0.0001 for each year). Total 
antibiotic days for Years 1, 2 and 3 were reduced commensurately with
prophylactic days from 61.7 to 55.5 days (nonsignificant), from 56.3 to 45.8 days
(P=0.047), and from 38.7 to 25.7 days (P<0.0001), respectively. For each year a
non-significant trend for increased ventilating tube placement from Cohort 1 to
Cohort 2, respectively, was observed, 2 versus 2.2%, 4 versus 5.8%, and 0.8
versus 2.6%. Daycare attendance and white race were consistently significant risk
factors for AOM and recurrent AOM. CONCLUSIONS: In the era of PNSP, restricted
use of antibiotic chemoprophylaxis for recurrent AOM was not associated with
significantly increased rates of new onset AOM episodes or tube placement in the 
first 24 months of life. Total antibiotic days were also significantly reduced in
Cohort 2 during Years 2 and 3.

Publication Types: 
    Comparative Study

PMID: 11576631 [PubMed - indexed for MEDLINE]

2120: Int J Pediatr Otorhinolaryngol. 2001 Oct 19;61(1):23-30.

Pattern changes of mucin gene expression with pneumococcal otitis media.

Tsuboi Y, Kim Y, Paparella MM, Chen N, Schachern PA, Lin J.

Otitis Media Research Center, Department of Otolaryngology, School of Medicine,
University of Minnesota, 2001 Sixth Street S.E., Rm. 216, Minneapolis, MN 55455, 
USA. tsubo001@tc.umn.edu

OBJECTIVE: mucins, known to be important components of the mucociliary transport 
system in the middle ear and Eustachian tube, are subject to changes under
inflammatory conditions. Which mucin genes are up-regulated or activated during
an inflammatory reaction of the middle ear and Eustachian tube, however, is
poorly understood. The purpose of this study was to characterize mucin gene
expression in middle ears and Eustachian tubes with pneumococcal ear infection.
METHODS: sixteen rats received intrabullar inoculation of Streptococcus
pneumoniae type 6A at 2.5x10(6) colony forming units (CFU). Four animals were
sacrificed on days 1, 3, 7, and 14, respectively. The profile of mucin gene
expression in the middle ear and Eustachian tube was examined by reverse
transcription polymerase chain reaction (RT-PCR) at the above time points.
Sixteen rats that received intrabullar inoculation of phosphate-buffered saline
(PBS) served as controls. RESULTS: the Muc2 mucin gene was expressed in middle
ear mucosa of the control rats. Following pneumococcal inoculation, Muc1-Muc5
mucin genes were expressed in the middle ear mucosa in a time-dependent manner.
In the Eustachian tube, the Muc2, Muc4 and Muc5 mucin genes were expressed in
both control and pneumococcal inoculation groups. CONCLUSION: Muc1, Muc3, Muc4,
and Muc5 mucin genes were activated in the middle ear mucosa by pneumococci,
which may contribute to hyper-production of mucin in acute pneumococcal otitis
media.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11576628 [PubMed - indexed for MEDLINE]

2121: Laryngoscope. 2001 Sep;111(9):1636-8.

Tetracaine topical anesthesia for myringotomy.

Hoffman RA, Li CL.

Department of Otolaryngology/Head and Neck Surgery, Beth Israel Medical Center,
New York, NY 10003, USA.

OBJECTIVES/HYPOTHESIS: To study the efficacy and safety of topical tetracaine
anesthesia for office myringotomy and myringotomy with a tube. STUDY DESIGN:
Retrospective review of patients undergoing office myringotomy, with or without
tube insertion, performed over a 4-year period. METHODS: A topical solution of 8%
tetracaine base in 70% isopropyl alcohol was used in 381 ears. Five to 10 drops
of the solution were applied to the tympanic membrane for 10 to 15 minutes and
aspirated. Myringotomy was performed either with a myringotomy knife or with a
CO(2) laser (OtoLAM). RESULTS: Topical tetracaine was used in all 231 ears (100%)
undergoing myringotomy without a tube and 150 of 212 ears (71%) undergoing
myringotomy with a tube. Tetracaine alone was effective in providing tympanic
membrane anesthesia in 95% of myringotomy without a tube (220 ears) and in 93% of
myringotomy with a tube (139 ears). There were six complications, including five 
cases of severe vertigo and one unusual prolonged, transient facial nerve
weakness. CONCLUSION: Topical tetracaine is efficacious and safe for use in
office myringotomy.

PMID: 11568619 [PubMed - indexed for MEDLINE]

2122: Laryngoscope. 2001 Sep;111(9):1619-24.

Otological manifestations of Churg-Strauss syndrome.

Ishiyama A, Canalis RF.

Division of Head and Neck Surgery, University of California At Los Angeles School
of Medicine, Los Angeles, California 90095, USA. Ishiyama@ucla.edu

OBJECTIVES/HYPOTHESIS: To describe the clinical features, pathogenesis, and
management of the otological complications in Churg-Strauss syndrome (CSS). STUDY
DESIGN: Retrospective review of five patients with documented CSS who had
otological manifestations in the later stages of CSS. METHODS: The history,
treatment, and outcome were evaluated using office and hospital chart data in
these five cases. RESULTS: In all cases, otological manifestations occurred
during an advanced stage of CSS and was characterized by the presence of dense
aural discharge, granulomatous eosinophilic infiltration into mastoid and middle 
ear, and subacute severe to profound hearing loss. In all cases, the recurrent
aural discharge and granulomatous infiltrate was unresponsive to conventional
treatment including repeated myringotomies and aggressive antibiotics. Systemic
steroid administration resulted in a rapid, complete cessation of aural discharge
and reversal or stabilization of hearing loss. Otological manifestations have
been stable over a range of follow-up from 1 to 20 years on a maintenance regimen
of steroids. CONCLUSIONS: Temporal bone involvement in CSS is rare. Surgical
intervention of the temporal bone is relegated to complications that may include 
infectious mastoiditis and intracranial involvement. Recognition of the
association between CSS and otological disease is important because it is highly 
responsive to systemic steroids, and early steroid treatment may prevent
progression to irreversible hearing loss, infectious otomastoiditis, or
intracranial complications.

Publication Types: 
    Case Reports

PMID: 11568616 [PubMed - indexed for MEDLINE]

2123: Laryngoscope. 2001 Sep;111(9):1614-8.

Cochlear implantation in healthy and otitis-prone children: a prospective study.

Luntz M, Teszler CB, Shpak T, Feiglin H, Farah-Sima'an A.

Department of Otolaryngology-Head and Neck Surgery, Bnai Zion Medical Center,
Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
luntz@csts.net

OBJECTIVE: To evaluate and compare the timing of surgery, intraoperative
findings, and otitis media-related outcome of cochlear implantation in children
who are otitis-prone with their counterparts who are not otitis-prone. STUDY
DESIGN: Prospective. METHODS: Children referred for cochlear implantation were
assigned to a non-otitis-prone group (group A: normal otoscopy on their first
visit after referral) or an otitis-prone group (group B: current or a recent
history of otitis media at referral). Group B patients were managed using a
structured protocol aimed at preimplantation otitis media control. The study
reviewed pre-, intra-, and postoperative data. RESULTS: Of the 18 children
studied, 8 were assigned to group A (mean age at referral, 40.6 mo) and 10 to
group B (mean age at referral, 31.6 mo). For otitis media control, all
otitis-prone children underwent ventilating tube insertion (various numbers of
procedures before implantation). Only one otitis-prone child required cortical
mastoidectomy also. Time from referral to implantation was similar in the two
groups (mean, 6.6 mo). High-resolution computed tomography data showed mastoid
pneumatization to be significantly smaller in the otitis-prone group, but the
facial recess was not smaller in this group. During implantation, 10 children had
inflamed middle ear mucosa. Seven of these belonged to group B. All of these
seven children had a round window niche obliterated by the inflamed mucosa, which
had to be removed for round window membrane identification. After implantation,
only one child had drainage through the ventilating tube for more than 1 week.
Two children in group B developed otitis media (1 year postimplantation) that was
overcome within 1 week. There were no otitis media-related complications.
CONCLUSIONS: If a structured protocol is used for the control of otitis media
before cochlear implantation, otitis media should not require a delay in
implantation. In otitis media-prone children, the round window niche is often
obscured by inflamed mucosa. Its removal is mandatory for identification of the
round window membrane. After cochlear implantation, otitis media is not a
frequent occurrence.

PMID: 11568615 [PubMed - indexed for MEDLINE]

2124: Laryngoscope. 2001 Aug;111(8):1486-9.

Management of chronic otitis media with effusion: the role of glutathione.

Testa B, Testa D, Mesolella M, D'Errico G, Tricarico D, Motta G.

Department of Otolaryngology-Second University School of Medicine of Naples,
Italy.

BACKGROUND: The inflammatory cells documented in chronic otitis media with
effusion (OME) spontaneously release oxidants which can induce middle ear (ME)
epithelial cell damage. Glutathione (GSH), a major extracellular antioxidant in
humans, plays a central role in antioxidant defense. PURPOSE: To evaluate the
effects of GSH treatment on chronic otitis media with effusion (OME). SUBJECTS
AND INTERVENTION: Sixty children with chronic OME were enrolled, 30 of whom were 
randomly assigned to the treatment group and 30 to the placebo group. Patients in
the treatment group received 600 mg glutathione in 4 mL saline per day subdivided
into five 2-minute administrations given by nasal aerosol every 3 or 4 waking
hours for 2 weeks. Patients in the control group received 4 mL saline per day
following the same procedure as for GSH treatment. RESULTS: Three months after
therapy improvement had occurred in 66.6% of patients in the GSH-treated group
and in 8% of the control subjects (P <.01). CONCLUSION: On the basis of these
results, GSH treatment could be considered for the nonsurgical management of
chronic OME.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11568588 [PubMed - indexed for MEDLINE]

2125: Laryngoscope. 2001 Jul;111(7):1264-70.

Degranulation of mast cells provokes a massive inflammatory reaction in the
tympanic membrane.

Eriksson PO, Hellström S.

Department of Clinical Sciences, Otorhinolaryngology, University Hospital of
Northern Sweden, Umeå, Sweden.

OBJECTIVE: The pars flaccida is extremely rich in mast cells. On stimulation the 
mast cells release preformed and de novo synthesized inflammatory substances. The
purpose of this study was to examine how these mast cell substances provoke
inflammatory changes in the tympanic membrane. STUDY DESIGN: In vivo, murine
model. METHODS: In a rat model, the mast cell secretagogue compound 48/80 was
applied locally to the tympanic membrane on 4 consecutive days and the ensuing
inflammatory changes were evaluated by otological, light, and electron microscopy
3, 6, 9, 12, 18, 24, 36, and 48 hours and 4, 6, and 8 days later. RESULTS:
Degranulation of the mast cells occurred within 3 hours of applying compound
48/80. Release of the mast cell substances coincided with an inflammatory event
characterized by a two-stage reaction: an edema stage, peaking 6 hours after
application, followed by a massive invasion of inflammatory cells, peaking at 24 
and 48 hours. Pars flaccida and pars tensa were both involved, pars flaccida
showing the earliest changes. Pars tensa exhibited the same biphasic reaction as 
pars flaccida, but approximately 6 hours later. CONCLUSIONS: The mast cells of
the pars flaccida have the capacity to elicit an intense inflammation of the
tympanic membrane. The biphasic reaction pattern resembles that observed in
experimental otitis media, suggesting involvement of the mast cells in this
inflammatory condition of the middle ear.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11568552 [PubMed - indexed for MEDLINE]

2126: J Laryngol Otol. 2001 Sep;115(9):699-703.

Medium-term middle ear ventilation with self-manufactured polyethylene T-tubes
for the treatment of children with middle ear effusion.

Talmon Y, Gadban H, Samet A, Gilbey P, Letichevsky V.

Department of Otolaryngology - Head and Neck Surgery, The Western Galilee
Hospital, Nahariya, Israel.

We present the results of the insertion of self-made polyethylene T-tubes for a
period of 15-24 months for the treatment of chronic middle-ear effusion. We
compare the outcome of our patients to the reported outcome of patients treated
with other commonly used ventilation tubes for either shorter or longer periods
of time. In a retrospective review of 603 T-tubes inserted in 306 children up to 
the age of 12 years, charts were reviewed for age, sex, surgical procedure
performed, duration of ventilation and complications. In all cases the indication
for surgery was chronic middle-ear effusion. The tubes were electively removed by
the authors after 15-24 months of ventilation. Spontaneous extrusion was
considered a complication. The mean period of ventilation was 20 months.
Post-operative otorrhoea was experienced in 6.6 per cent of ears; 4.8 per cent of
tubes extruded spontaneously, whereas 3.15 per cent had to be removed earlier
than originally planned; 4.9 per cent of ears were re-ventilated at a later date,
and 1.49 per cent of ears developed a persistent perforation. We demonstrate that
the outcome of patients treated with our self-manufactured tubes for a period of 
15-24 months is, in many respects, better or at least comparable to the reported 
outcome of patients treated with other commonly used ventilation tubes for either
shorter or longer periods of time, and that the many complications associated
with the conventional T-tube can be reduced. We suggest that our favourable
outcome may be due to the duration of ventilation, which was controlled to be
shorter than the conventional long-term T-tubes and longer than that of grommets.

PMID: 11564294 [PubMed - indexed for MEDLINE]

2127: FEMS Microbiol Lett. 2001 Sep 11;203(1):55-61.

Survival of nontypeable Haemophilus influenzae in macrophages.

Craig JE, Cliffe A, Garnett K, High NJ.

University of Manchester, School of Biological Sciences, 1.800, Stopford
Building, Manchester M13 9PT, UK.

In this study we have investigated the ability of nonencapsulated, nontypeable
Haemophilus influenzae, NT477 to survive in the J774 mouse macrophage-like cell
line. Viable, intracellular nontypeable H. influenzae could still be recovered
from macrophages 72 h after phagocytosis. In contrast, H. influenzae strain Rd,
an avirulent, nonencapsulated variant of a serotype d strain, was killed within
24 h. These differences suggest that NT477, in comparison to Rd, possesses unique
attributes that enable it to survive in macrophages for prolonged periods. To
determine whether this trait is ubiquitous amongst nontypeable H. influenzae, 33 
primary clinical isolates obtained from children with otitis media were screened 
for their ability to survive in macrophages. Of these isolates, 82% were able to 
persist in an intracellular environment for periods of at least 24 h. The number 
of viable organisms recovered at this time ranged from 2x10(4) to 50
colony-forming units per strain indicating that the extent to which nontypeable
H. influenzae can resist macrophage-mediated killing varies between strains.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11557140 [PubMed - indexed for MEDLINE]

2128: Int J Pediatr Otorhinolaryngol. 2001 Sep 28;60(3):227-37.

Intracranial complications of acute and chronic mastoiditis: report of two cases 
in children.

Kuczkowski J, Mikaszewski B.

Gdansk, Poland. jerzyk@amedec.amg.pl

OBJECTIVE: The clinical picture of mastoiditis, sigmoid sinus thrombosis and
brain abscess has changed with the advent of antibiotics. A delay in the
recognition of intracranial complications in children and in the institution of
appropriate therapy may result in morbidity and mortality. Increased mortality of
the children has been correlated with the neurological status of the patient on
admission to hospital. METHOD: A retrospective study was made of two children
with acute mastoiditis and sigmoid sinus thrombosis and chronic mastoiditis with 
cerebellar abscess treated in 1997 in the ENT Department of the Medical
University of Gdansk. RESULTS: We present two cases of intracranial complications
in children (13 and 11 years old) originating from acute and chronic otitis
media. The first case, of a 13-year-old boy with sigmoid sinus thrombosis as a
complication of acute otitis media took its course as a typical Symonds Syndrome.
Mastoidectomy, thrombectomy and jugular vein ligation associated with antibiotics
and edema-reducing drugs and anticoagulants proved to be successful. The second
case of an 11-year-old boy with exacerbated chronic otitis media with
cholesteatoma and mastoiditis, was complicated by suppurative meningitis,
cerebellar abscess, perisinual abscess and sigmoid sinus thrombophlebitis.
Neurosurgical approach by suboccipital craniotomy and abscess drainage was
ineffective. Otological treatments of modified radical mastoidectomy,
thrombectomy, jugular vein ligation, perisinual and cerebellar abscess drainage
associated with wide-spectrum antibiotics and edema-reducing drugs were performed
with a very good outcome. After 3 years of follow-up the patients remain without 
any neurological and psychiatric consequences. CONCLUSION: The authors show
different courses of both presented complications and imaging techniques and
surgical procedures performed in these children. The sigmoid sinus trombosis with
Symonds Syndrome may be difficult to diagnose due to previous antibiotics
valuable in establishing the diagnosis and the extent of disease. The successful 
therapy is based on understanding of pathogenesis of the intracranial
complication and the cooperation of an otolaryngologist, a neurologist, a
neurosurgeon and an ophthalmologist.

Publication Types: 
    Case Reports

PMID: 11551614 [PubMed - indexed for MEDLINE]

2129: Int J Pediatr Otorhinolaryngol. 2001 Sep 28;60(3):205-11.

Quantitation and prevalence of tympanosclerosis in a pediatric otolaryngology
clinic.

Friedman EM, Sprecher RC, Simon S, Dunn JK.

Department of Otorhinolaryngology and Communicative Sciences, Baylor College of
Medicine/Texas Children's Hospital, MC 3-2600, 6621 Fannin Street, Houston, TX
77030, USA. ellenf@bcm.tmc.edu

OBJECTIVE: To determine the incidence and prevalence of tympanosclerosis (TS) in 
patients seen in a pediatric otolaryngology clinic. DESIGN: Prospective
observational study. SETTING: Tertiary care, ambulatory care clinic. Patients and
other participants: We conducted a prospective observational study to determine
the incidence of TS in 218 patients seen consecutively in a pediatric
otolaryngology clinic for otologic and nonotologic reasons. The patient age range
was 3 weeks to 30 years; 63% were male and 37% female. Of the 218 patients, 37%
(81) had undergone bilateral myringotomy and tube placement (BM&T), and 35% (21) 
of the 81 showed signs of TS; 63% (137) of the 218 patients had no history of
otologic surgery, but 12% (15) of the 137 showed signs of TS. METHOD: The area of
the tympanic membrane affected by TS was determined by otoscopy performed by one 
viewer, who drew the otoscopic findings on a standardized tympanic membrane
template. The area of TS was quantified in terms of percentages by digital image 
analysis of the scaled drawings. RESULTS: There was a range of 0.5-59.9%
involvement of the tympanic membrane with TS, with the median percentage of
involvement being 4.95%. There was an increased percentage of TS with repeat
BM&T. CONCLUSION: This observational study shows that patients who have had BM&T 
have a higher incidence of TS than those who have not had the surgery. However
our findings also show that 38% of the patients in this study who had TS had
never undergone BM&T.

PMID: 11551611 [PubMed - indexed for MEDLINE]

2130: FEMS Immunol Med Microbiol. 2001 Aug;31(2):137-43.

Modelling of endemic carriage of Haemophilus influenzae in Aboriginal infants in 
Northern Australia.

Smith-Vaughan HC, McBroom J, Mathews JD.

Menzies School of Health Research, Darwin, Australia. heidi@menzies.edu.au

Aboriginal infants and children in rural communities in Northern Australia have
high rates of nasopharyngeal carriage of nonencapsulated Haemophilus influenzae
(NCHi), with positive swab rates of 76%. In this population, the acquisition of
NCHi from soon after birth is associated with the onset of otitis media and with 
muco-purulent nasal discharge, while the long-term persistence of NCHi carriage
is associated with the acquisition and turnover of large numbers of antigenically
diverse strains. Mathematical models have been fitted to data on the acquisition 
and loss of encapsulated strains of H. influenzae and 43 different strains of
NCHi in 10 children followed from early infancy for up to 2 years. Subject to
plausible assumptions, the preferred model estimated the mean time to acquisition
of a H. influenzae strain to be 7 days after first becoming exposed after birth. 
For an infant already carrying H. influenzae, each additional strain was acquired
after a mean waiting period of 45 days. On average, 1.50 different strains of H. 
influenzae were detected in four colonies routinely typed from each positive
swab, but it was estimated that another 2.55 strains were 'hidden' behind these
more frequent strains. With an average of 4.05 strains per carrier, it was
estimated that each strain was carried for an average of 137 days, although
detected on only 37% of occasions. Thus we have developed mathematical models
that provide estimates for duration of colonisation, time to colonisation, and
number of colonising strains in a population in which H. influenzae is highly
endemic, characterised by sequential and concurrent carriage of multiple strains 
in each infant.

PMID: 11549421 [PubMed - indexed for MEDLINE]

2131: J Antimicrob Chemother. 2001 Sep;48(3):397-402.

Effects of amoxicillin on the expression of cytokines during experimental acute
otitis media caused by non-typeable Haemophilus influenzae.

Melhus A.

Department of Medical Microbiology, Malmö University Hospital, S-205 02 Malmö,
Sweden. asa.melhus@mikrobiol.mas.lu.se

Antibiotics are frequently prescribed when a diagnosis of acute otitis media
(AOM) is made in childhood, but the effects of antibiotics on host-parasite
interactions in the middle ear are not well defined. A rat model and PCR
techniques were used to explore host responses during amoxicillin treatment of
AOM caused by non-typeable Haemophilus influenzae (NTHi). The 5 day course of
amoxicillin initiated at the otomicroscopic peak of the infection eradicated the 
bacteria and induced significant changes in the expression of cytokines.
Interleukin (IL)-6, tumour necrosis factor-alpha and IL-10 were upregulated by
the treatment, and the downregulation was slower than during the natural course. 
Amoxicillin inhibited the upregulation of transforming growth factor-beta,
whereas IL-1alpha expression remained unaffected by the treatment. By comparing
inflammatory host responses during treated and untreated NTHi AOM, new targets
for modification of the course, or more specified and individualized treatments, 
may evolve.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11533005 [PubMed - indexed for MEDLINE]

2132: J Clin Laser Med Surg. 2001 Aug;19(4):185-7.

Office-based CO2 laser-assisted tympanic membrane fenestration addressing otitis 
media with effusion.

Garin P, Ledeghen S, Van Prooyen-Keyser S, Remacle M.

Université Catholique de Louvain, Cliniques Universitaires U.C.L., ENT
Department, Mont-Godinne, Belgium. pierre.garin@orlo.ucl.ac.be

OBJECTIVE: To use the CO2 laser-assisted tympanic membrane fenestration in office
settings, under local anesthesia, as the sole treatment for patients with chronic
otitis media with effusion (OME). BACKGROUND DATA: This new treatment ensures
artificial ventilation of the middle ear for several weeks, and provides an
intermediate solution between ordinary lancet-made tympanocentesis and
transtympanic ventilation tube insertion. The operative technique is already well
codified, and preliminary studies have demonstrated that tympanic membrane
fenestration does not expose patients to any major hazard. METHODS: We treated 30
ears in 21 children and 29 ears in 24 adults. All patients had presented with OME
persistent for more than 3 months. The laser tympanostomy was performed under
local anesthesia, as an outpatient procedure, using a CO2 flash-scanning laser in
conjunction with a handpiece (OTOLAM). Using a power of 12 W to 17 W, a single
laser pulse usually sufficed to create a 2-mm-diameter circular perforation in
the anteroinferior quadrant of the eardrum. RESULTS: The tympanic membrane
fenestration allows avoiding ventilation tube insertion in 63% of children and
75% of adults. CONCLUSIONS: The CO2 laser-assisted tympanic membrane fenestration
seems a valid therapeutic option addressing OME. This study should be pursued on 
a larger scale to define more precisely the indications of the laser
tympanostomy.

PMID: 11523861 [PubMed - indexed for MEDLINE]

2133: Ear Nose Throat J. 2001 Aug;80(8):529.

Treatment of chronic suppurative otitis media with Broncasma Berna.

Nakatani M.

Nakatani Clinic, 91, 2-chome, Suginobaba, Wakayama 640-8212, Japan.
mnakatan@naxnet.or.jp

Broncasma Berna, an inactivated bacterial vaccine, has been safely used
throughout the world for 30 years for the prevention or treatment of various
infectious processes. Until now, there has been no published report regarding its
use as a treatment for chronic suppurative otitis media. In this small study,
five such patients (median age: 57 years) underwent a series of seven 0.05-ml
injections of Broncasma Berna. In all cases, their otorrhea diminished markedly
and their tympanic membranes were almost completely dry. The cost of treatment
was extremely low.

PMID: 11523469 [PubMed - indexed for MEDLINE]

2134: Int J Pediatr Otorhinolaryngol. 2001 Aug 20;60(2):141-5.

Malignant otitis externa in an infant with selective IgA deficiency: a case
report.

Paul AC, Justus A, Balraj A, Job A, Kirubakaran CP.

Department of Child Health, Christian Medical College and Hospital, Vellore
632004, Tamil Nadu, India.

The occurrence of malignant otitis externa (MOE) in infancy is rare. We report a 
case of MOE in a neonate who was later identified to have selective IgA
deficiency. She was successfully treated with oral ciprofloxacin, but developed
external auditory canal stenosis, a deformed pinna, persistent facial nerve
palsy, temporal bone erosion and hearing loss. No cases of MOE in selective IgA
deficiency have been reported in literature. This is also the first report on the
use of ciprofloxacin in infants with MOE.

Publication Types: 
    Case Reports

PMID: 11518592 [PubMed - indexed for MEDLINE]

2135: Ann Otol Rhinol Laryngol. 2001 Aug;110(8):746-8.

Failure of grommet insertion in post-irradiation otitis media with effusion.

Chen CY, Young YH, Hsu WC, Hsu MM.

Department of Otolaryngology, National Taiwan University Hospital, Taipei.

Nasopharyngeal carcinoma (NPC) survivors with post-irradiation otitis media with 
effusion (OME; 100 ears) were divided into 2 groups. One group underwent grommet 
insertion, and the other group was treated by repeated myringotomies plus
aspiration to evaluate the outcome of the OME. Computed tomography, magnetic
resonance imaging, audiometry, and local checks of the ear, nose, and
nasopharyngeal fields were performed to evaluate the sinus and middle ear
conditions over a long-term (more than 10 years) follow-up period. The results in
these NPC survivors with OME indicated that the prevalence of middle ear
complications in the myringotomized group (33%) was less than that in the
grommeted group (90%). Grommets alone cannot eradicate inflammation outside the
middle ear cavity, but rather, they can aggravate it by superinfection. We
therefore recommend that controlling the radiation-induced inflammation in areas 
such as the ears, nose, sinuses, and nasopharynx is most important. In
conclusion, post-irradiation OME should be treated in a different way from
conventional OME. Restated, grommet insertion is contraindicated in
post-irradiation OME.

PMID: 11510732 [PubMed - indexed for MEDLINE]

2136: APMIS. 2001 Jun;109(6):441-6.

RANTES in otitis media with effusion: presence, role and correlation with
cytokines and microbiology.

Schousboe LP, Rasmussen LM, Ovesen T.

Department of Otolaryngology, Aarhus University Hospital, Denmark.
Schousboe@dadlnet.dk

Various inflammatory cells and cytokines have been identified in otitis media
with effusion (OME). The presence of neutrophils has been linked to
interleukin-8, but no chemotactic factor has as yet been identified for
monocytes. The chemokine RANTES (Regulated upon Activation, Normal T Expressed
and Secreted) attracts and activates primarily monocytes and may contribute to
the pathogenesis of middle ear inflammation. We investigated the presence of
RANTES by: 1) ELISA measurement in 114 middle ear effusions from children
suffering from OME, 2) immunohistochemical localisation in experimental OME
rabbit middle ear mucosa, and 3) expression in cultured rabbit middle ear
epithelium in response to proinflammatory stimuli. RANTES was detectable in 94
(82%) of 114 effusions with a median concentration of 79.7 pg/mg total protein
content. The concentration of RANTES was positively correlated with the endotoxin
content. Immunohistochemically, RANTES was localized to the epithelial layer in
experimental OME. In vitro, RANTES was expressed in middle ear epithelium in
response to proinflammatory stimuli (TNF-alpha) in a dose-dependent manner. The
expression of RANTES may explain the recruitment of monocytes in OME, possibly as
a result of TNF-alpha-mediated endotoxin stimulation.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11506476 [PubMed - indexed for MEDLINE]

2137: Acta Med Croatica. 2001;55(2):77-9.

Changes of intratympanic pressure in secretory otitis media.

Sprem N, Branica S, Dawidowsky K.

University Department of Othorhinolaryngology, Medical Faculty, University of
Zagreb, Zagreb, Croatia.

A thick, gluey effusion was observed to out of the middle ear after myringotomy
only in some cases of secretory otitis media. Cytologic analysis of intratympanic
transudate in 321 cases of secretory otitis media in children showed the cellular
infiltration to result in increased viscosity of the middle ear content. It
caused gradual change in the middle ear pressure, from the initially negative to 
positive pressure in the advanced stages of the disease.

PMID: 11505632 [PubMed - indexed for MEDLINE]

2138: J Wildl Dis. 2001 Jul;37(3):626-9.

Otodectic otoacariasis in free-ranging Eurasian lynx in Sweden.

Degiorgis MP, Segerstad CH, Christensson B, Mörner T.

Department of Wildlife, National Veterinary Institute, Uppsala, Sweden.
mpdegiorgis@swissonline.ch

An infestation with Otodectes cynotis, the ear mite of cats and dogs, was
observed in three free-ranging Eurasian lynx (Lynx lynx) killed in Sweden. The
ear canals were obstructed by waxy secretions and exfoliated epithelium.
Histologically, there were hyperkeratosis and acanthosis, and the epithelial
surface was overlained by hyperkeratotic and parakeratotic crusts with mites,
mite detritus and cerumen. In the subcutis there was a slight to moderate
infiltration of lymphocytes and macrophages. The ceruminous glands were
bypertrophic and hyperplastic, and there was also an hyperplasia of the sebaceous
glands. The lesions seemed to correlate with the degree of infestation. To our
knowledge, this is the first report of otoacariasis in free-ranging lynx.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 11504239 [PubMed - indexed for MEDLINE]

2139: Ethiop Med J. 2001 Apr;39(2):113-21.

Otitis media seen in Yekatit 12 Hospital.

Tessema G.

Yekatit 12 Hospital, P.O. Box 257, Addis Ababa.

Two thousand three hundred and thirty four selected patients with ear problem
were seen in one of the ENT out patients department of Yekatit 12 Hospital from
September 1994 to August 1996 were prospectively studied. Most of the patients
came from Addis Ababa. Major clinical presentations were ear pain, purulent ear
discharge, uni or bilateral decreased hearing ability. Patients were carefully
evaluated by physical examination, otoscopy examination of the ear, schuilers
view of the mastoid bone, audiometry findings and pus culture results. Diagnosis 
of these patients revealed that 1,630 (69.8%) had otitis while the rest 704
(30.16%) had other ear problems like ear wax, tinnitus and otitis external. One
hundred two hundred thirty two patients (52.8%) had chronic otitis media with
purulent discharge and decreased hearing ability, while 245 patients (10.5%) had 
chronic otitis media with out purulent discharge but with decreased hearing
ability. Ninety six patients (4.1%) had acute otitis media and 57 patients (2.4%)
had chronic seromucinous otitis media with decreased hearing ability. The
micro-organisms identified include klebsiella spp. (28.97%), E. coli (10.7%),
Citrobacter (3.6%), Acinetobacter (4.7%), S. aureus (3.57%), P. Valgaris (4.3%), 
S. Epidermidis (4.54%) and Dephtheroids (7.3%). Eighty nine patients with acute
otitis media were completely cured and regained their hearing ability, the rest
did not regain their hearing ability despite treatment. A combination of
antibiotics and surgical treatment is recognized as the most effective
intervention in this situation. The management of the chronic draining ear are:
1). To achieve a clean healed dry ear, 2) to obtain an air-containing middle ear 
space, 3) to rehabilitate hearing. The prevention of deafness and treatment of
chronic draining ear disease especially in children is surgery which is not yet
fully practiced in our centers.

PMID: 11501288 [PubMed - indexed for MEDLINE]

2140: J Infect Dis. 2001 Sep 1;184(5):577-81. Epub 2001 Jul 30.

Do antibodies to pneumococcal surface adhesin a prevent pneumococcal involvement 
in acute otitis media?

Rapola S, Kilpi T, Lahdenkari M, Takala AK, Mäkelä PH, Käyhty H.

National Public Health Institute, Department of Vaccines, 00300 Helsinki,
Finland. satu.rapola@ktl.fi

Antibodies to the pneumococcal (Pnc) surface protein PsaA are immunogenic and
protective in experimental animal models, but their role in protection from Pnc
disease in humans is not known. In the present study, the ability of antibodies
to PsaA to prevent the progression of Pnc carriage to Pnc acute otitis media (Pnc
AOM) was evaluated. Antibodies to PsaA were measured in acute-phase serum samples
of children with AOM and with Streptococcus pneumoniae cultured from the
nasopharynx. The risk of Pnc AOM was evaluated by a logistic regression model
with anti-PsaA concentration as the predictive variable. Higher concentrations of
antibodies to PsaA were associated with lower risk of the Pnc nasopharyngeal
carriage progression to Pnc AOM. This was true in children 9-24 months old (odds 
ratio [OR], 0.49; 95% confidence interval [CI], 0.31-0.78) but not in children <9
months old (OR, 0.81; 95% CI, 0.48-1.35).

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11494164 [PubMed - indexed for MEDLINE]

2141: J Infect Dis. 2001 Sep 1;184(5):569-76. Epub 2001 Aug 2.

Natural development of antibodies to pneumococcal capsular polysaccharides
depends on the serotype: association with pneumococcal carriage and acute otitis 
media in young children.

Soininen A, Pursiainen H, Kilpi T, Käyhty H.

Department of Vaccines, National Public Health Institute, 00300 Helsinki,
Finland. anu.soininen@ktl.fi

To study the natural development of antibodies to pneumococcal capsular
polysaccharides of types 1, 6B, 11A, 14, 19F, and 23F and its association with
pneumococcal carriage and acute otitis media (AOM), 329 children were followed-up
prospectively during their first 2 years of life. Nasopharyngeal carriage was
determined by cultures of nasopharyngeal swab samples, and etiology of AOM was
determined by cultures of middle ear fluid. Antibodies were measured in serum
samples collected at 6, 12, 18, and 24 months by EIA. Antibodies increased
modestly but significantly with age. Contact with serotypes 11A and 14 was
associated with increased antibody concentration as early as age 6 months.
Children with contact with serotypes 6B, 19F, and 23F had antibody levels similar
to those in children without contact. Antibodies increased modestly, even in
children without known contact with Streptococcus pneumoniae and in children with
contact with heterologous serotypes. Antibody concentrations were equal after
carriage or AOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11494163 [PubMed - indexed for MEDLINE]

2142: Auris Nasus Larynx. 2001 Aug;28(3):241-3.

Tuberculous otitis media -- a diagnostic dilemma.

Bhalla RK, Jones TM, Rothburn MM, Swift AC.

Department of Otolaryngology, University Hospital Aintree, Lower Lane, Liverpool 
L9 7AL, UK.

Tuberculous otitis media can provide a diagnostic challenge even to the most
astute and experienced clinician. The rarity of the condition and its propensity 
to masquerade as commoner otological conditions further delays diagnosis and
treatment. We present the case of a 22-year-old female who presented with chronic
aural discharge, unilateral hearing loss and recurrent hemifacial paralysis. The 
paper highlights the difficulty in diagnosis and stresses the need for a high
index of suspicion in cases resistant to the common methods of treatment.

Publication Types: 
    Case Reports

PMID: 11489368 [PubMed - indexed for MEDLINE]

2143: Ear Nose Throat J. 2001 Jun;80(6 Suppl):12-6.

Comment in:
    Ear Nose Throat J. 2001 Oct;80(10):759-60.

Chronic external otitis.

Roland PS.

Division of Pediatric Otology, Children's Medical Center, Dallas, TX, USA.
prolan@mednet.swmed.edu

Chronic external otitis is probably a disease of mixed etiology; infection and
hypersensitivity both play an important role. As such, these two components must 
be recognized and respected. Steroids are the mainstay of medical management.
Antibiotics should be used cautiously and probably on an intermittent basis. The 
disease appears to be exacerbated by any manipulation of the canal, including
aggressive cleansing. Medical therapy will slow the development of fibrosis in
some cases, but it does not always prevent it. Once stenosis has progressed to
the point that conductive hearing loss develops, surgery will restore hearing and
prevent restenosis in at least 80% of cases.

Publication Types: 
    Review

PMID: 11488077 [PubMed - indexed for MEDLINE]

2144: Arch Pediatr Adolesc Med. 2001 Jul;155(7):796-9.

Efficacy of naturopathic extracts in the management of ear pain associated with
acute otitis media.

Sarrell EM, Mandelberg A, Cohen HA.

Pediatric and Adolescent Ambulatory Community Clinic of General Health Services, 
Hairis 7 Moshav Gan-Haim, 44910 Israel. sarrell@netvision.net.il

OBJECTIVE: To determine the efficacy and tolerance of Otikon Otic Solution
(Healthy-On Ltd, Petach-Tikva, Israel), a naturopathic herbal extract (containing
Allium sativum, Verbascum thapsus, Calendula flores, and Hypericum perforatum in 
olive oil), compared with Anaesthetic (Vitamed Pharmaceutical Ltd, Benyamina,
Israel) ear drops (containing ametocaine and phenazone in glycerin) in the
management of ear pain associated with acute otitis media (AOM). DESIGN: Children
between the ages of 6 and 18 years who experienced ear pain (otalgia) and who
were diagnosed with eardrum problems associated with AOM were randomly assigned
to be treated with Otikon or Anaesthetic ear drops, which were instilled into the
external canal(s) of the affected ear(s). Ear pain was assessed using 2 visual
analog scales: a linear scale and a color scale. Pain assessment took place
throughout the course of 3 days. The mean score of pain reduction was used to
measure outcome. SETTING: Primary pediatric community ambulatory centers.
PARTICIPANTS: One hundred three children aged 6 to 18 years who were diagnosed
with otalgia associated with AOM. RESULTS: Each of the 2 treatment groups were
comparable on the basis of age, sex, laterality of AOM, and the effectiveness of 
ameliorating symptoms of otalgia. The 2 groups were also comparable to each other
in the initial ear pain score and in the scores at each application of Otikon or 
Anaesthetic drops. There was a statistically significant improvement in ear pain 
score throughout the course of the study period (P =.007). CONCLUSIONS: Otikon,
an ear drop formulation of naturopathic origin, is as effective as Anaesthetic
ear drops and was proven appropriate for the management of AOM-associated ear
pain.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11434846 [PubMed - indexed for MEDLINE]

2145: Pediatrics. 2001 Aug;108(2):248-54.

Comment in:
    Pediatrics. 2002 Apr;109(4):717-8; author reply 717-8.

Evidence assessment of management of acute otitis media: II. Research gaps and
priorities for future research.

Chan LS, Takata GS, Shekelle P, Morton SC, Mason W, Marcy SM.

Division of Biostatistics and Outcomes Assessment, Los Angeles County-University 
of Southern California Medical Center, Los Angeles, California 90033, USA.
lschan@hsc.usc.edu

OBJECTIVES: To report research gaps and priorities of future research identified 
during an evidence assessment process on the management of acute otitis media
(AOM). METHODS: A conceptual framework for management of AOM was developed to
guide the evidence assessment. An 11-member technical expert panel guided the
selection of key questions, prioritization of influencing factors, development of
scope, definition of AOM, and search strategy through polling processes and
conference calls. Quality of clinical trials was evaluated using established
scales. Outcome measures were abstracted from each study. RESULTS: A total of
3461 titles and abstracts were screened, and 760 full-length articles were
reviewed. Of the 760 articles, 80 studies addressed the key questions. In
defining AOM, 42 (52.5%) of the 80 studies included the middle-ear effusion
component, only 2 (2.5%) included the rapid onset component, and 26 (32.5%)
included the signs/symptoms of inflammation component. None of the 80 studies
used all 3 components. Of the 74 controlled trials, 39 (53%) were of acceptable
quality (Jadad score of 3 or higher). The technical experts did not agree in the 
ranking of the importance of the 41 influencing factors (Kendall's coefficient of
concordance was 0.0022). Another poll also indicated diverse opinions of the
experts on the importance of 7 key questions derived from the conceptual
framework (Kendall coefficient of concordance is 0.21). Furthermore, our review
found that the type and definition of outcome measure varied. CONCLUSIONS:
Despite the large body of literature on AOM, its quality is uneven and its
findings are not generalizable. Future research should try to answer all key
questions and investigate all risk factors in well-designed, scientific studies.

Publication Types: 
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11483784 [PubMed - indexed for MEDLINE]

2146: Pediatrics. 2001 Aug;108(2):239-47.

Evidence assessment of management of acute otitis media: I. The role of
antibiotics in treatment of uncomplicated acute otitis media.

Takata GS, Chan LS, Shekelle P, Morton SC, Mason W, Marcy SM.

Division of General Pediatrics, Childrens Hospital, Los Angeles, California
90027, USA. gtakata@chla.usc.edu

CONTEXT: In 1995, >5 million episodes of acute otitis media (AOM) accounted for
$3 billion in health care expenditures. OBJECTIVES: To synthesize the literature 
on the natural history of AOM, the effectiveness of antibiotic treatment in
uncomplicated AOM, and the relative effectiveness of specific antibiotic
regimens. DATA SOURCES: Seven electronic databases for articles published between
1966 and March 1999 and reference lists in proceedings, published articles,
reports, and guidelines. STUDY SELECTION: Two physicians independently assessed
each article. Studies addressing AOM in children 4 weeks to 18 years old were
included; those addressing children with immunodeficiencies or craniofacial
abnormalities were excluded. Randomized, controlled trials (RCTs) were used to
assess antibiotic effectiveness, and RCTs and cohort studies were used to assess 
the natural history of AOM. Among the 3491 citations identified, 80 (2.3%) met
our inclusion criteria. DATA EXTRACTION: Two physicians independently abstracted 
data and assessed the quality of studies using a validated scale for RCTs and 8
quality components for cohort studies. DATA SYNTHESIS: Random-effects estimates
of pooled absolute rate differences of outcomes were derived, and heterogeneity
of both the rates and rate differences was assessed. Children with AOM not
treated with antibiotics experienced a 1- to 7-day clinical failure rate of 19%
(95% confidence interval: 0.10-0.28) and few suppurative complications. When
patients were treated with amoxicillin, the 2- to 7-day clinical failure rate was
reduced to 7%, a 12% (95% confidence interval: 0.04-0.20) reduction. Adverse
effects, primarily gastrointestinal, were more common among children on cefixime 
than among those on ampicillin or amoxicillin. They were also more common among
children on amoxicillin-clavulanate than among those on azithromycin.
CONCLUSIONS: The majority of uncomplicated cases of AOM resolve spontaneously
without apparent suppurative complications. Ampicillin or amoxicillin confers a
limited therapeutic benefit. There is no evidence to support any particular
antibiotic regimens as more effective at relieving symptoms. Certain antibiotics 
are more likely than others to cause diarrhea and other adverse events.

Publication Types: 
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11483783 [PubMed - indexed for MEDLINE]

2147: Eur J Pediatr. 2001 Jul;160(7):449.

Endogenous endophthalmitis and necrotising pneumonia caused by Klebsiella
pneumoniae in a child with beta-thalassaemia major.

Yao TC, Hung IJ, Su LH, Chiu CH.

A case beta-thalassaemia major complicated with Klebsiella pneumoniae endogenous 
endophthalmitis is presented to increase physician awareness of the association
of the two clinical conditions. Severe morbidity including subretinal abscess and
retinal detachment may develop despite aggressive intravenous and intravitreal
ceftriaxone therapy, along with vitrectomy and external drainage.

Publication Types: 
    Case Reports
    Letter

PMID: 11475586 [PubMed - indexed for MEDLINE]

2148: Eur J Pediatr. 2001 Jul;160(7):407-13.

The microbiologic and immunologic basis for recurrent otitis media in children.

Faden H.

Division of Infectious Diseases, Children's Hospital of Buffalo, 219 Bryant St., 
Buffalo, New York 14222, USA. hfaden@upa.chob.edu

Otitis media is very common in children. A subpopulation of children,
representing 5-10% of the general population, are otitis prone and they
experience 4 or more episodes of acute otitis media (AOM) in the first year of
life. Nasopharyngeal colonization with the three major middle ear pathogens, S.
pneumoniae, nontypeable H. influenzae and M. catarrhalis is frequent in otitis
prone children and is directly related to the frequency of AOM. Colonization
stimulates the production of mucosal as well as serum antibodies to the
pathogens. Specific IgA mucosal antibody limits the duration and frequency of
colonization. Serum IgG antibody protects children against the development of
otitis media but does not affect colonization. Antibody detected in the middle
ear often reflects passive transfer from serum rather than local production.
Antibody responses to the three pathogens following AOM are generally reduced in 
the first 2 years of life and rise rapidly thereafter. There are many different
strains of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella
catarrhalis. Among the different strains, there are heterologous surface antigens
and some conserved antigens. Conserved antigens induce broadly protective
antibodies while strain specific antigens induce limited protection. Although
otitis prone children may display strain specific immunity, they often fail to
develop a broadly protective antibody response. This subtle immunologic defect
makes them susceptible to recurrent and persistent otitis media. CONCLUSIONS:
Otitis media is common. Otitis prone children appear to display a subtle
immunologic abnormality that predisposes them to recurrent infections. Recent
advances in vaccine development may reduce the frequency of otitis media in the
general population but the impact on otitis prone children remains unknown.

Publication Types: 
    Comparative Study
    Review

PMID: 11475577 [PubMed - indexed for MEDLINE]

2149: Clin Exp Immunol. 2001 Jun;124(3):369-76.

Cytolytic complement activity in otitis media with effusion.

Närkiö-Mäkelä M, Meri S.

Department of Bacteriology and Immunology, Haartman Institute, University of
Helsinki, Finland.

Otitis media with effusion (OME) is a chronic inflammation persisting in the
middle ear cavity of at least 8 weeks duration. Middle ear effusion (MEE; n =
38), samples from children suffering from OME were investigated for their direct 
cytolytic activity or an ability to enhance complement lysis of unsensitized
bystander cells. Thirteen of the 38 MEEs had direct endogenous haemolytic
activity and 27 samples had an ability to enhance serum-initiated lysis. Using an
enzyme immunoassay, high levels of terminal complement complexes (TCC) were
detected in the MEE samples (mean 34.1 microg/ml, range 5--89 microg/ml). This
indicated strong local complement activation that had progressed to the terminal 
stage. As one potential factor promoting complement activation we identified both
monomeric and trimeric properdin in MEE by Western blotting. By stabilizing C3
and C5 convertases properdin accelerates the alternative and terminal pathways of
complement. On the other hand, the membrane attack complex (MAC) inhibitor CD59, 
which was found to be extensively shed into the MEE in a functionally active
form, may control excessive cytotoxicity of the MEE. In conclusion, intense
complement activation, up to the terminal level, maintains ongoing inflammation
in the middle ear cavity and can pose a threat to the local epithelium.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11472396 [PubMed - indexed for MEDLINE]

2150: J Clin Epidemiol. 2001 Aug;54(8):789-94.

Generalizability of trial results based on randomized versus nonrandomized
allocation of OME infants to ventilation tubes or watchful waiting.

Rovers MM, Straatman H, Ingels K, van der Wilt GJ, van den Broek P, Zielhuis GA.

Department of Otorhinolaryngology, University Medical Centre Nijmegen, P.O. Box
9101, 6500 HB, Nijmegen, The Netherlands. M.Rovers@mie.kun.nl

The objective was to study the generalizability of trial results by comparing
randomized patients to eligible but nonrandomized patients who received the same 
management. Implementation of trial results is only justifiable when the results 
can be generalized to the total domain population. The design was a multicentre
randomized controlled trial on the effect of early screening and treatment with
ventilation tubes on infants with otitis media with effusion. Randomized (n =
187) and nonrandomized eligible patients (n = 133) were followed up. The study
population comprised children who were detected by auditory screening at the age 
of 9-12 months and who were subsequently diagnosed with persistent bilateral
otitis media with effusion for 4-6 months. A significant difference was found in 
the distribution of some prognostic factors: more randomized children had older
siblings, did not attend day care and had mothers with a lower educational level 
than the nonrandomized children. These factors, however, did not modify the
outcome. No differences were found in mean hearing levels between the randomized 
and nonrandomized children: in both the randomized and nonrandomized children
ventilation tubes improved the hearing level, especially after 6 months. However,
in the long term (12 months), the hearing levels were equal again. The results of
the randomized and nonrandomized patients were comparable. The results of this
trial appear to be generalizable to the total domain population. The procedure of
following up both randomized and nonrandomized patients is recommended when there
is concern about selective participation and reduced generalizability.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11470387 [PubMed - indexed for MEDLINE]

2151: J Clin Epidemiol. 2001 Aug;54(8):782-8.

Impact of different definitions on estimates of accuracy of the diagnosis data in
a clinical database.

Woods CR.

Department of Pediatrics, Wake Forest University School of Medicine, Medical
Center Blvd., Winston-Salem, NC 27157, USA. cwoods@wfubmc.edu

Computerized medical databases are increasingly used for research. The influence 
of different definitions of the accuracy of matching on the estimated accuracy of
diagnosis data was assessed in a database of visits to a public pediatric clinic.
Differences between definitions involved 1) unit of analysis, 2) number of
diagnoses required to match per visit, and/or 3) whether database contents are
required to match the medical record or medical record contents are required to
be matched in the database. Overall, 90% of diagnoses in the database (391/435)
were accurately coded relative to the medical record. Alternatively, 77% of
diagnoses listed in the medical record (391/506) were accurately coded in the
database. When individual visits were used as the unit of analysis, estimates of 
accuracy using six definitions ranged from 65% to 92%. The most appropriate
definition to use for estimating accuracy of diagnosis data likely depends on the
purpose of the study. Use of two or more such definitions may enhance portrayal
of the accuracy of diagnosis data.

PMID: 11470386 [PubMed - indexed for MEDLINE]

2152: Clin Exp Allergy. 2001 Jul;31(7):1135-43.

Eosinophils are activated in middle ear mucosa and middle ear effusion of
patients with intractable otitis media associated with bronchial asthma.

Iino Y, Nagamine H, Yabe T, Matsutani S.

Department of Otolaryngology, Teikyo University School of Medicine, 2-11-1 Kaga, 
Itabashi-ku, Tokyo 173-8605, Japan. yiorl@med.teikyo-u.ac.jp

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.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11468006 [PubMed - indexed for MEDLINE]

2153: J Health Serv Res Policy. 2001 Jul;6(3):139-44.

Improving referrals for glue ear from primary care: are multiple interventions
better than one alone?

Bennett K, Haggard M, Churchill R, Wood S.

MRC Institute of Hearing Research, University of Nottingham, UK.

OBJECTIVES: To evaluate the effect of a risk factor checklist and training video 
for general practitioners in reducing inter-practice variation and improving the 
appropriateness of referrals (assessed by their positive predictive value or PPV)
of patients with suspected otitis media with effusion (OME or 'glue ear') to
secondary care. METHODS: Fifty general practices (177 practitioners) from the NHS
Trent region and the West of Scotland were cluster-randomised either to a control
group (n = 12) or to one of three intervention groups (training video (n = 16),
checklist (n = 11), or both (n = 11)). Data on all paediatric ear, nose and
throat (ENT) referrals and diagnostic results at ENT clinics were collected for a
one-year period pre- and post-intervention. Referral rates for OME and for
closely related conditions were calculated for children aged 0-15 years, based on
each practice's list size. PPV was defined as the proportion of referrals
resulting in bilateral hearing loss > or = 20 dB at the ENT outpatient
department. RESULTS: There was a significant improvement in the PPV, adjusted for
patients' waiting time between general practitioner (GP) referral and being seen 
at the ENT department. The improvement in PPV pre- and post-intervention was 15% 
(95% confidence interval, CI: -12.1% to 41.7%) for the practices receiving both
interventions, compared with a degradation of 20% pre- and post-intervention (95%
CI: -32.9% to -6.4%) for practices receiving only one intervention and a
degradation of 34% for those receiving no intervention. CONCLUSIONS:
Disseminating a risk factor checklist and training video on glue ear to GPs using
a multi-channel approach can improve the quality of referrals to ENT.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11467270 [PubMed - indexed for MEDLINE]

2154: Arch Dis Child. 2001 Aug;85(2):96-103.

Does early detection of otitis media with effusion prevent delayed language
development?

Butler CC, MacMillan H.

Department of Family Medicine, McMaster University, Faculty of Health Sciences,
1200 Main Street West, HSC 2V14, Hamilton, Ontario L8N 3Z5, Canada.
cbutler@mcmaster.ca

OBJECTIVE: To consider whether earlier detection of otitis media with effusion
(OME) in asymptomatic children in the first 4 years of life prevents delayed
language development. METHODS: MEDLINE and other databases were searched and
relevant references from articles reviewed. Critical appraisal and consensus
development were in accordance with the methods of the Canadian Task Force on
Preventive Health Care. RESULTS: No randomised controlled trials assessing the
overall screening for OME and early intervention to prevent delay in acquiring
language were identified, although one trial evaluated treatment in a screened
population and found no benefit. The "analytic pathway" approach was therefore
used, where evidence is evaluated for individual steps in a screening process.
The evidence supporting the use of tools for early detection such as
tympanometry, microtympanometry, acoustic reflectometry, and pneumatic otoscopy
in the first 4 years of life is unclear. Some treatments (mucolytics,
antibiotics, steroids) resulted in the short term resolution of effusions as
measured by tympanometry. Ventilation tubes resolved effusions and improved
hearing. Ventilation tubes in children with hearing loss associated with OME
benefited children in the short term, but after 18 months there was no difference
in comparison with those assigned to watchful waiting. Most prospective cohort
studies that evaluated the association between OME and language development
lacked adequate measurement of exposure or outcome, or suffered from attrition
bias. Findings with regard to the association were inconsistent. CONCLUSIONS:
There is insufficient evidence to support attempts at early detection of OME in
the first 4 years of life in the asymptomatic child to prevent delayed language
development.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 11466181 [PubMed - indexed for MEDLINE]

2155: Arch Dis Child. 2001 Aug;85(2):91-5.

Behaviour and developmental effects of otitis media with effusion into the teens.

Bennett KE, Haggard MP, Silva PA, Stewart IA.

MRC Institute of Hearing Research, University Park, Nottingham, UK.
kbennett@stjames.ie

OBJECTIVE: To examine whether behavioural or cognitive sequelae of otitis media
with effusion (OME) continue into late childhood and the early teens (11-18
years). SETTING: Data from a large multipurpose birth cohort study: the Dunedin
multidisciplinary health and development study. PARTICIPANTS: Around 1000
children from the study. The main independent variable of interest was otological
status of the child up to age 9. MAIN OUTCOME MEASURES: Parent and teacher rated 
behaviour problems, including antisocial, neurotic, hyperactive, and inattentive 
behaviours, and tests of academic achievement including intelligence quotient
(IQ), reading, and spelling were available in a high proportion of the cohort at 
ages 11 to 18 years. RESULTS: After adjustments for covariates such as
socioeconomic status, hyperactive and inattentive behaviour problems were evident
as late as 15 years, and lower IQ associated with OME remained significant to 13 
years. The largest effects were observed for deficits in reading ability between 
11 and 18 years. CONCLUSIONS: No previous study considering behaviour problems as
an outcome has followed children long enough to determine whether some of the
early sequelae of OME are still present in the early to late teens. Some
developmental sequelae of OME, particularly deficits in reading ability, can
persist into late childhood and the early teens.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11466180 [PubMed - indexed for MEDLINE]

2156: Pediatr Infect Dis J. 2001 Jul;20(7):654-62.

Bacteriology of acute otitis media in a cohort of Finnish children followed for
the first two years of life.

Kilpi T, Herva E, Kaijalainen T, Syrjänen R, Takala AK.

National Public Health Institute, Helsinki, Finland.

BACKGROUND: Timely information on the bacteriology of primary, noncomplicated
acute otitis media (AOM) may today be needed more than ever, because of the
increasing antimicrobial resistance of its major bacterial causes and because of 
the potential of new pneumococcal and other bacterial vaccines for prevention of 
AOM. METHODS: The study followed 329 children from 2 to 24 months of age at
scheduled healthy visits and sick visits at the study clinic. Whenever AOM was
diagnosed during the follow-up, myringotomy was performed and middle ear fluid
was aspirated for bacterial culture. RESULTS: At least one middle ear fluid
sample was available from 772 AOM events; Streptococcus pneumoniae (Pnc) was
isolated in 201 (26%), Moraxella catarrhalis (Mc) in 177 (23%) and Haemophilus
influenzae (Hi) in 174 events (23%). The incidence of Pnc AOM peaked at 12 months
of age, whereas the incidence of Mc AOM showed the first peak at 6 months and Hi 
AOM at 20 months. Pnc AOM showed less prominent seasonality in occurrence than Mc
and Hi AOM. Hi was a rare cause of the first 2 AOM episodes (13%) but became
increasingly common from the third episode on (32% on average). CONCLUSIONS: Pnc,
Mc and Hi were almost equally common findings in AOM. Pnc seems to be the most
pathogenic of these three, the role of Mc is increasing and Hi is clearly
associated with recurrent AOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11465836 [PubMed - indexed for MEDLINE]

2157: Ann Otol Rhinol Laryngol. 2001 Jul;110(7 Pt 1):662-6.

Acute otitis media in Brazilian children: analysis of microbiology and
antimicrobial susceptibility.

Sih TM.

Division of Bacterial and Mycotic Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA. tsih@amcham.com.br

Between 1990 and 1995, a total of 300 children, ages 2 months to 5 years,
received diagnoses of acute otitis media (AOM) in a hospital emergency room in
São Paulo, Brazil, and were recruited for this study. The investigation was
undertaken, first, to identify microorganisms and antimicrobial susceptibilities 
of pathogens from AOM in Brazilian children; next, to ascertain, by comparison,
whether the isolates of Streptococcus pneumoniae have the same serotypes as those
included in the new conjugated heptavalent pneumococcal vaccine; and last, to
determine whether additional and/or different serotypes are needed in the vaccine
to ensure an immunogenic response against pneumococcal pathogens for the
indigenous children in this study. Microorganisms were isolated from ear fluid of
192 patients (64%). The 5 most prevalent pathogens were S pneumoniae (48
isolates; 16%), Haemophilus influenzae (21 isolates; 7%), Moraxella catarhalis
(15 isolates; 5%), Pseudomonas aeruginosa (6 isolates; 2%), and Staphylococcus
aureus (3 isolates; 1%). These 5 represented 93 of the 192 total isolates.
Resistance to antibiotics was found in the 3 primary pathogens. No high-level
resistance of S pneumoniae to penicillin was found; instead, there was high-level
resistance to trimethoprim-sulfamethoxazole. Ten serotypes of S pneumoniae were
isolated: 6B, 9V, 11A, 16, 18C, 19A, 19F, 23A, 23B, and 23F. Only 5 of the 10
serotypes isolated were included in the conjugated heptavalent pneumococcal
vaccine. Therefore, the other 5 serotypes (24 of 48 strains) should be considered
in selecting antigens for the new vaccine.

PMID: 11465826 [PubMed - indexed for MEDLINE]

2158: Surg Radiol Anat. 2001;23(2):91-5.

Significance of the auditory tube angle and mastoid size in chronic ear disease.

Sirikci A, Bayazit YA, Bayram M, Kanlikama M.

Department of Radiology, Faculty of Medicine, Gaziantep University, 27310
Gaziantep, Turkey. sirikci@yahoo.com

The aim of this study was to determine whether a relationship exists between
mastoid size and auditory tube angle (ATA) and chronic ear disease. A
radiological and clinical study was undertaken of the temporal bones of 36
subjects. There were 24 patients with unilateral chronic otitis media (COM) and
12 healthy controls (HC): the contralateral healthy ears of the COM patients were
also used as control (CLHC). From each CT scan the distance between Henle spine
and the sigmoid sinus (H-SS) and the ATA was assessed. The angle between a
longitudinal line bisecting the transverse length of the external auditory canal 
and the longitudinal axis of the AT was calculated. A direct correlation between 
H-SS and ATA, both in COM and HC (p < 0.01), was observed, but not in CLHC (p >
0.05). There was no significant difference in the ATA results between COM and
CLHC, or between COM and HC (p > 0.05), however there was a significant
difference between CLHC and HC (p = 0.02). H-SS distances were not significantly 
different between COM and CLHC, or COM and HC, or CLHC and HC (p > 0.05). An
association between ATA and mastoid size in both healthy and diseased ears was
observed. The anatomical relationships of the AT, mastoid and middle ear, which
form a functional unit, are not significantly important in chronic ear disease.

Publication Types: 
    Comparative Study

PMID: 11462868 [PubMed - indexed for MEDLINE]

2159: Br J Gen Pract. 2001 Jul;51(468):533-8.

Comment in:
    Br J Gen Pract. 2001 Nov;51(472):930.

Otitis externa in UK general practice: a survey using the UK General Practice
Research Database.

Rowlands S, Devalia H, Smith C, Hubbard R, Dean A.

Division of Respiratory Medicine, Clinical Sciences Building, City Hospital,
Nottingham. sam.rowlands@epic-uk.org

BACKGROUND: Otitis externa is a common clinical problem in general practice and
yet there are remarkably few data available on the demographic characteristics of
patients with this condition and the approaches used by general practitioners
(GPs) in the United Kingdom (UK) to manage it. AIM: To define the descriptive
epidemiology of otitis externa in the general population, to describe the
first-line drug treatment used by UK GPs, and to determine factors related to
second disease episodes. DESIGN OF STUDY: Epidemiological data survey. SETTING:
All cases of otitis externa occurring in 1997 in practices contributing data to
the UK General Practice Research Database. METHOD: Data were extracted on age,
sex, date of episode of otitis externa, treatment prescribed, co-existing
diagnoses of eczema and diabetes, referral to ear, nose, and throat departments
and occurrence of subsequent episodes of disease. Arbitrarily a second episode of
disease was defined as persistence if it occurred at 28 days or fewer after the
first episode and recurrence if it occurred at more than 28 days after the first 
episode. RESULTS: A diagnosis of otitis externa was common in all age groups and,
except in the elderly, was more common in females than males. There was an
increase in disease episodes at the end of the summer in all age groups except
the 60 years and over group. In the majority of cases GPs prescribed ear drops
(85%), but a significant proportion of patients were also prescribed oral
antibiotics (21%). Referral to secondary care was uncommon (3%). Among patients
prescribed ear-drop formulations, those containing both steroid and antibiotic or
steroid alone were used most commonly and were associated with the lower rates of
disease persistence but not recurrence. Among patients prescribed antibiotics,
penicillins were prescribed most commonly. Disease persistence rates, and to a
lesser extent disease recurrence rates, were higher in patients prescribed oral
antibiotics. CONCLUSION: Otitis externa is a common condition and GPs can expect 
to see an excess of cases at the end of the summer. Topical ear drops are the
most common treatment used in the UK. Patients prescribed steroid or
steroid/antibiotic combination ear drops have fewer subsequent consultations for 
otitis externa over the following 28 days.

PMID: 11462312 [PubMed - indexed for MEDLINE]

2160: J Vet Med Sci. 2001 Jun;63(6):667-9.

Attachment of Malassezia pachydermatis to the ear dermal cells in canine otitis
externa.

Masuda A, Sukegawa T, Tani H, Miyamoto T, Sasai K, Morikawa Y, Baba E.

Veterinary Internal Medicine, Department of Veterinary Medicine, Graduate School 
of Agriculture and Biological Sciences, Osaka Prefecture University, Sakai,
Japan.

To investigate the predominance of Malassezia pachydermatis (M. pachydermatis) as
a causative agent of canine otitis externa, ear cerumen samples were observed for
adhesion of M. pachydermatis to the cornified epithelial cells by light and
electron microscopes. The yeasts appeared not to adhere to the cornified
epithelial cells directly, but they seemed to exist in the proximity of the
epithelial cells with an electron opaque halo-like space around them.
Polysaccharide and lipid staining techniques were conducted to identify the
substances existing in that space. Lipid substances, not saccharides, were
observed around the yeasts and the cornified epithelial cells. These results
suggested that in the canine ear canal malassezia yeast attachment to the
cornified epithelial cells is mediated by lipids.

PMID: 11459014 [PubMed - indexed for MEDLINE]

2161: Arch Pediatr Adolesc Med. 2001 Jun;155(6):641-7.

Comment in:
    Arch Pediatr Adolesc Med. 2001 Jun;155(6):636.

Steroids for otitis media with effusion: a systematic review.

Butler CC, van Der Voort JH.

Department of Family Medicine, McMaster University, Faculty of Health Sciences,
1200 Main St W, HSC-2V14, Hamilton, Ontario, Canada L8N 3Z5. cbutler@mcmaster.ca

BACKGROUND: Otitis media with effusion (OME) is common and may cause hearing loss
with associated delayed language development in children. Treatment remains
controversial. OBJECTIVE: To examine evidence for or against treating OME with
systemic or topical nasal steroids. DATA SOURCES: We searched the Cochrane
Controlled Trials Register using the terms otitis media; otitis media with
effusion; glue ear; or OME and steroids; glucocorticoids; glucocorticoids,
synthetic; glucocorticoids, topical; or anti-inflammatory agents, steroidal; or
various combinations of these terms. EMBASE and MEDLINE were also searched. STUDY
SELECTION: Randomized controlled trials of oral and topical nasal steroids,
either alone or in combination with another agent such as an antibiotic, were
included. Ten studies met the inclusion criteria. DATA EXTRACTION: Data
extraction and methodological quality assessment were performed by the 2 of us
(C.C.B. and J.H.v.d.V.) independently, using standardized methods described in
the Cochrane Collaboration Handbook. DATA SYNTHESIS: The odds ratio for OME
persisting after short-term follow-up in children treated with oral steroids
compared with a control was 0.22 (95% confidence interval, 0.08 = 0.63), and was 
0.32 (95% confidence interval, 0.20 = 0.52) for children treated with oral
steroids plus an antibiotic compared with a control plus an antibiotic. Trends
favored steroids for most other comparisons, but confidence intervals included
unity. Trends favored steroids for most other comparisons, but confidence
intervals included unity. CONCLUSIONS: Steroids alone or combined with an
antibiotic lead to a quicker resolution of OME in the short-term. However, there 
is no evidence for a long-term benefit from treating hearing loss associated with
OME with either oral or topical nasal steroids. These treatments are, therefore, 
not recommended.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 11386950 [PubMed - indexed for MEDLINE]

2162: Otol Neurotol. 2001 Jul;22(4):457-60.

M-meatoplasty: results and patient satisfaction in 125 patients (199 ears).

Rombout J, van Rijn PM.

Department of Otorhinolaryngology, St. Lucas-Andreas Hospital, Amsterdam, The
Netherlands.

OBJECTIVE: Is M-meatoplasty the solution for chronic otitis externa caused by wax
retention? This study discusses acceptance of this operation and whether sedation
is necessary. STUDY DESIGN: Between October 1994 and October 1997, 199 successive
M-meatoplasties (125 patients) were studied, and 79% of the patients completed a 
questionnaire in which patient satisfaction with the procedure and outcome was
assessed. SETTING: Local hospital, functioning as a secondary referral center.
PATIENTS: All patients had narrowing of the lateral part of the outer ear canal
resulting from anterior displacement of the cavum conchae cartilage.
INTERVENTION: The aim of M-meatoplasty is to increase the lumen of the entrance
to the external ear canal by reducing the conchal cartilage on the posterior wall
MAIN OUTCOME MEASURES: Reduction of visits to the outpatient clinic, patient
satisfaction on a scale from 1 (very bad) to 10 (excellent). RESULTS: The number 
of preoperative visits was 7 (range 1-153). The median number of postoperative
visits for the same problems more than 3 months after surgery was 1 (range 0-14).
The patient score for the surgery and the final result was a median of 9 (very
good). CONCLUSIONS: Wax obstruction and related external otitis can be cured by
M-meatoplasty if the conchal cartilage is too prominent on the posterior wall. It
is a simple outpatient operation and is very well tolerated. After the operation,
there is an enormous reduction in outpatient visits.

PMID: 11449099 [PubMed - indexed for MEDLINE]

2163: Otol Neurotol. 2001 Jul;22(4):451-6.

Canal-down mastoidectomy: experience in 81 cases.

Garap JP, Dubey SP.

Department of Otolaryngology, Port Moresby General Hospital, Papua New Guinea.

OBJECTIVES: To identify the common presentation(s) and the clinical and operative
finding(s) in patients with cholesteatomatous and long-term noncholesteatomatous 
chronic suppurative otitis media and to adapt a surgical management best suited
to ensure long-term safety in these Papua New Guinean patients for whom
postoperative follow-up is minimal. DESIGN: Retrospective case series. SETTING:
Port Moresby General Hospital, the tertiary referral center for otolaryngologic
services. PATIENTS: Eighty-one patients in all age groups who received a clinical
diagnosis of chronic suppurative otitis media, with or without cholesteatoma,
with or without its associated complications. INTERVENTION: Canal-down (modified 
radical) mastoidectomy with wide meatoplasty. MAIN OUTCOME MEASURE AND RESULTS:
Adults were more commonly affected than adolescent or pediatric cases, and there 
was a male preponderance. The median age was 24 years (range, 13 months to 73
years). Otorrhea remained the most common presentation in all age groups.
Postauricular abscesses and fistulae were seen frequently. Cholesteatoma and
granulation with polypoidal mucosa were frequent operative findings; a high
incidence involved both the attic space and the antrum. Five (6%) patients had
preoperative facial paralysis; in addition, postoperative facial paralysis
developed in three (4%) patients. The incidence of postoperative "wet ear" was
high in all age groups. Meningitis was the most common intracranial complication,
followed by lateral sinus thrombosis. There were seven (9%) deaths altogether,
and all the deaths occurred as a direct result of otogenic intracranial
complication. CONCLUSION: Lack of health consciousness, poor socioeconomic
status, and lack of health care delivery system resulted in late presentations
and poor postoperative follow-up. Hence, the canal-wall-down technique with wide 
meatoplasty is recommended to ensure a best possible one-time treatment in Papua 
New Guinean patients with cholesteatomatous or long-term "dangerous" chronic
suppurative otitis media with or without complications.

PMID: 11449098 [PubMed - indexed for MEDLINE]

2164: Otol Neurotol. 2001 Jul;22(4):447-50.

Chronic middle ear disease and gastroesophageal reflux disease: a causal
relation?

Poelmans J, Tack J, Feenstra L.

Department of Otorhinolaryngology-Head Neck Surgery, University Hospitals,
Leuven, Belgium.

OBJECTIVE: To describe one patient with a puzzling therapy-resistant unilateral
chronic otitis media, analyze his diagnosis, and describe three similar patients 
with the same symptoms and signs, i.e., a chronic ear problem together with
gastroesophageal reflux disease (GERD). STUDY DESIGN: Thorough analysis of one
patient with a chronic ear problem and GERD, both of which responded favorably
after antireflux therapy consisting of omeprazole and conservative antireflux
measures (raising the head of the bed by 20 to 25 cm, avoiding meals and drinks 3
hours before retiring, and other dietary and lifestyle modifications), and a
search for more patients with similar coexisting conditions. SETTING: Tertiary
referral center. METHODS: Patients with chronic ear problems and GERD were
thoroughly analyzed by the otorhinolaryngologist and the gastroenterologist. The 
latter used endoscopy and Savary-Miller's classification of esophagitis, a
24-hour ambulatory dual esophageal pH monitoring, and esophageal manometry.
RESULTS: Four patients were identified who had a chronic ear problem and
simultaneous GERD. It is reasoned that the GERD leads to nasopharyngitis and this
to a chronic ear problem. All the patients responded favorably to anti-GERD
therapy. CONCLUSIONS: GERD may manifest itself as an extraesophageal
manifestation, such as nasopharyngitis, leading to ear disease. Therapy-resistant
chronic middle ear disease may be caused by GERD.

Publication Types: 
    Case Reports

PMID: 11449097 [PubMed - indexed for MEDLINE]

2165: Otol Neurotol. 2001 Jul;22(4):433-43.

Foreign body neonatal otitis media in infants.

Palva T, Northrop C, Ramsay H.

Department of Otolaryngology, University of Helsinki, Finland.

HYPOTHESIS: An influx of amniotic fluid cellular content (AFCC) into the middle
ears during birth may lead to the development of a chronic inflammatory process
in the form of varying amounts of granulation tissue even if signs of otitis
media are absent. This foreign body neonatal otitis media may predispose the
child to recurrent otitis media. BACKGROUND: Foreign body neonatal otitis media
caused by AFCC was described by Aschoff and elaborated by Wittmaack 100 years
ago. Recent studies have shown how AFCC spreads to various middle ear
compartments and causes histologic changes, the severity of which is related to
the amount of AFCC. Specific elements become phagocytized after the first months 
of life but have caused the formation of inflammatory polyps and granulation
tissue with round cell secretions in the meantime. METHODS: Ten temporal bones
from the Temporal Bone Foundation, derived from infants aged 5 months to 1 year
11 months, were serially sectioned at 20 microm, saved at 0.2-mm intervals,
numbered, and stained with hematoxylin and eosin. Every slide was studied for the
presence, nature, and stage of pathologic tissue changes of the middle ear and
the mastoid antrum. RESULTS: Pseudocystic granulation tissue was massive in the
temporal bone of the 8-month-old child born through thick meconium. Severe
changes were present in the temporal bones of two infants aged 5 months, one of
which showed traces of AFCC. In the temporal bones of two older children,
long-standing changes were minor, one of them still showed traces of AFCC. Fresh 
acute changes and long-standing histologic changes occurred side by side.
CONCLUSIONS: Neonatal otitis media caused by AFCC can give rise to extensive
granulation tissue and round cell secretion, which is likely to make the ear
susceptible to infectious otitis media. Cumulative development of granulation
tissue as a result of infection may lead to blockage of attic aeration and
drainage pathways, causing irreversible adhesive otitis media. A data base should
be formed of all neonates born through meconium-stained amniotic fluid to allow a
comparison with those born through clear fluids. Surgery with the creation of
auxiliary aeration pathways becomes advisable in the treatment of ears with
massive development of granulation tissue.

Publication Types: 
    Case Reports

PMID: 11449095 [PubMed - indexed for MEDLINE]

2166: Ir Med J. 2001 Apr;94(4):117-8.

Sigmoid sinus thrombosis: an old foe revisited.

Keogh IJ, Hone SW, Colreavy M, Gaffney R.

Department of Otolaryngology and Head and Neck Surgery, Beaumont Hospital,
Dublin, Ireland. Ivank@oceanfree.net

Sigmoid sinus thrombosis (SST) has become increasingly uncommon. In the
pre-antibiotic era this condition had a mortality rate of over 90%.1 A high index
of suspicion is required to make the diagnosis. We present a rare case of sigmoid
sinus thrombosis secondary to mastoiditis, which illustrates the problems of
delayed diagnosis. This report highlights the importance of rapid diagnosis and
early surgical intervention. We emphasis the need for scanning and otolaryngology
referral in all cases of middle ear disease associated with pain or vertigo which
does not resolve rapidly on appropriate antibiotic therapy.

Publication Types: 
    Case Reports

PMID: 11440048 [PubMed - indexed for MEDLINE]

2167: J Natl Cancer Inst. 2001 Jul 4;93(13):1021-7.

Erratum in:
    J Natl Cancer Inst. 2001 Nov 7;93(21):1661.

Cancer mortality after nasopharyngeal radium irradiation in the Netherlands: a
cohort study.

Ronckers CM, Land CE, Verduijn PG, Hayes RB, Stovall M, van Leeuwen FE.

Department of Ear-Nose and Throat Medicine, Reinaert Kliniek, Maastricht, The
Netherlands. cmronckers@worldmail.nl

BACKGROUND: Nasopharyngeal radium irradiation (NRI) was used widely from 1940
through 1970 to treat otitis serosa in children and barotrauma in airmen and
submariners. We assessed whether NRI-exposed individuals were at higher risk for 
cancer-related deaths than were nonexposed individuals. METHODS: We conducted a
retrospective cohort study of all-cause and cancer-related mortality in 5358
NRI-exposed subjects and in 5265 frequency-matched nonexposed subjects, who as
children were treated at nine ear, nose, and throat clinics in The Netherlands
from 1945 through 1981. We recorded personal and medical data from original
patient medical records and assessed vital status through follow-up at municipal 
population registries. Risk of mortality was evaluated by standardized mortality 
ratios (SMRs). All statistical tests were two-sided. RESULTS: The average
radiation doses were 275, 10.9, 1.8, and 1.5 cGy for the nasopharynx, pituitary, 
brain, and thyroid, respectively. The median follow-up was 31.6 years. Three
hundred two NRI-exposed subjects had died, with 269.2 deaths expected (SMR = 1.1;
95% confidence interval [CI] = 1.0 to 1.3); among nonexposed subjects, 315 died, 
with 283.5 deaths expected (SMR = 1.1; 95% CI = 0.99 to 1.2). Cancer-related
deaths of 96 exposed subjects (SMR = 1.2; 95% CI = 0.95 to 1.4) and 87 nonexposed
subjects (SMR = 1.0; 95% CI = 0.8 to 1.3) were documented. There were no excess
deaths from cancers of the head and neck area among exposed subjects. However,
there were excess deaths from cancers of lymphoproliferative and hematopoietic
origin (SMR = 1.9; 95% CI = 1.1 to 3.0), mainly from non-Hodgkin's lymphoma (SMR 
= 2.6; 95% CI = 1.0 to 5.3). We found no evidence that breast cancer deaths were 
less than expected (SMR = 1.7; 95% CI = 0.9 to 2.8) in contrast to an earlier
study. CONCLUSIONS: Our findings do not indicate an increased cancer mortality
risk in a population exposed to NRI in childhood. More prolonged follow-up of
this and other NRI cohorts is recommended.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11438568 [PubMed - indexed for MEDLINE]

2168: Clin Otolaryngol Allied Sci. 2001 Jun;26(3):218-20.

A worrying development in the microbiology of otitis externa.

Walshe P, Rowley H, Timon C.

Royal Victoria Eye and Ear Hospital, Dublin, Ireland.

Methicillin-resistant Staphylococcus aureus (MRSA) is causing growing concern in 
hospitals. There has been a steady increase in the number of cases of nosocomial 
MRSA infections recently and this will no doubt apply to otitis externa, one of
the most common ENT infections. The total number of cases of otitis externa
presenting to the Accident and Emergency Department over a 3-month period was
recorded and the offending microbes cultured and tested for drug sensitivities.
Although Pseudomonas aeruginosa was the most frequent organism, 30% of patients
grew S. aureus. Of these, 6% (15 patients) were MRSA cultures. The contact
histories, antibiotic sensitivities and treatment of these 15 patients were
studied. Recommendations as a result of this study include the routine culture
and sensitivity in otitis externa and where MRSA is cultured, a full contact
history should be elicited and appropriate precautions taken. Specifically, a
history of hospital contact should be sought. Treatments used successfully in the
treatment of MRSA otitis externa were aural toilet and fucidic acid-betamathasone
0.5% wicks where the organism was gentamycin-resistant (GMRSA), whereas aural
toilet with aminoglycoside-steroid drops was sufficient if it was
gentamycin-sensitive.

Publication Types: 
    Case Reports

PMID: 11437845 [PubMed - indexed for MEDLINE]

2169: Int J Pediatr Otorhinolaryngol. 2001 Jul 30;60(1):55-8.

Concentration of nitric oxide metabolites in middle ear effusion.

John EO, Russell PT, Nam BH, Jinn TH, Jung TT.

Division of Otolaryngology-Head and Neck Surgery, Loma Linda University School of
Medicine, Loma Linda, CA 92354, USA.

Free radicals such as nitric oxide (NO) seem to be important in the pathogenesis 
of otitis media with effusion (OME). NO can be quantitated by measuring its
metabolites, nitrate (NO(3)(-)) and nitrite (NO(2)(-)). The purpose of this study
is to determine the concentrations of NO in human middle ear effusion (MEE).
Samples of human MEE were collected at the time of myringotomy and tympanostomy
tube insertions. The type of MEE was classified as serous (SOM), mucoid (MOM) or 
purulent (POM) at the time of surgery. Samples of MEE were assayed for NO
metabolites (nitrate and nitrite) with colorimetric assay (Griess method).
Concentrations of NO metabolites were highest in MOM followed by SOM and POM.
This study suggests that NO is present in human MEE and may play an important
role in the pathogenesis of OME.

PMID: 11434954 [PubMed - indexed for MEDLINE]

2170: Int J Pediatr Otorhinolaryngol. 2001 Jul 30;60(1):49-54.

Bacteriological and PCR analysis of clinical material aspirated from otitis media
with effusions.

Gok U, Bulut Y, Keles E, Yalcin S, Doymaz MZ.

Department of Otorhinolaryngology, College of Medicine, Firat (Euphrates)
University, Elazig 23119, Turkey. uzeyirgok@yahoo.com

Otitis media with effusions (OME) can lead to significant hearing loss in
childhood. Although previous studies have shown that bacterial DNA is present in 
a significant percentage of effusions sterile by culture, whether the DNA
represents viable organisms or 'fossilized remains' is unknown. The aim of the
present study was the determination of Streptococcus pneumonia, Moraxella
catarrhalis and Haemophilus influenza in the clinical materials from OME. For
this purpose, effusion samples aspirated from the mid-ear were analyzed
bacteriologically. Samples were also tested with polymerase chain reaction (PCR) 
assay. A total of 37 samples obtained from 20 patients aging between 4 and 14
were analyzed. In 17 patients, both ears demonstrated effusions, whereas in three
patients, only one ear had effusions. In aerobic bacterial culture assays, nine
samples (24.3%) showed bacterial growth. None of the samples were positive for
anaerobic culture experiments. PCR analysis of the samples showed that 35 samples
(94.5%) contained bacterial DNA. In 19 samples, only one bacterial species and in
16 samples more than one bacterial species were detected. The results of this
study demonstrate that effusion fluid from otitis media cases contain a battery
of bacterial species and these bacteria might play roles in the pathogens of OME.
Our results indicate the PCR technique is more specific and sensitive in
detection of bacteria in middle-ear effusion of OME, compared with conventional
methods.

PMID: 11434953 [PubMed - indexed for MEDLINE]

2171: Int J Pediatr Otorhinolaryngol. 2001 Jul 30;60(1):29-40.

Generalisability of clinical trials in otitis media with effusion.

Rovers MM, Zielhuis GA, Bennett K, Haggard M.

MRC Institute of Hearing Research, Nottingham, UK. m.rovers@mie.kun.nl

OBJECTIVE: The impact of a randomised controlled trial (RCT) upon practice
depends on its external validity (generalisability). This paper summarises and
illustrates a framework for judging and augmenting external validity, emphasising
its application to treatment trials in otitis media with effusion (OME) so as to 
permit stronger inferences in the future. METHODS: The external validity of two
surgical trials in the field of OME (TARGET, UK and KNOOP-3, the Netherlands) has
been examined within a framework emphasising effect modification, in four
specific ways: (1) comparison of the demographic characteristics of the trial
population with the domain population; (2) studying the distributions on possible
effect modifiers (i.e. variables conditioning the benefit from intervention); (3)
studying whether effect modification occurs in the analyses; and (4) comparing
outcome measures between the randomised and the eligible but non-randomised
children. RESULTS: For neither KNOOP-3 and TARGET were large discrepancies found 
between randomised and non-randomised children for any of the demographic
variables. Differences in distributions along possible effect modifiers were
found, but the overlaps were large enough for it still to be possible to study
whether these factors indeed modified the outcome. Results for the randomised and
non-randomised but eligible patients were similar. The results of both trials
therefore appear to be generalisable to their domain populations. CONCLUSIONS: A 
superficial contrast in the results (KNOOP null, TARGET positive) does not amount
to a contradiction, because of differences in the clinical question appropriate
to the respective age and populations defined. Attention to quality of design and
external validity of randomised controlled trials should achieve higher
applicability.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't
    Validation Studies

PMID: 11434951 [PubMed - indexed for MEDLINE]

2172: Acta Med Okayama. 2001 Jun;55(3):167-74.

Genetic alteration of penicillin non-susceptible Streptococcus pneumoniae
observed throughout recurrence of acute otitis media detected by amplified
fragment length polymorphism analysis.

Sugata K, Fukushima K, Ogawa T, Nakashima T, Sugata A, Kasai N, Gunduz M, Ueki Y,
Nishizaki K.

Department of Otolaryngology, Okayama University Medical School, Japan.

The prevalence of penicillin non-susceptible Streptococcus pneumoniae (PNSSP) is 
increasing among isolates from acute otitis media (AOM). Repeated episodes of
antibiotic exposure are a well-known risk factor for the isolation of PNSSP
although otitis-prone or recurrent AOM cases frequently require repeated courses 
of antibiotic treatment. In order to evaluate the chronological alteration of S. 
pneumoniae during recurrences of AOM, strains of S. pneumoniae were isolated from
11 patients, each of whom had experienced 2-4 episodes of AOM, were examined.
Every bacterial specimen obtained from a single episode of recurrent AOM was
examined by PCR-based penicillin-binding protein (PBP) assay, serotyping, and
amplified fragment length polymorphism (AFLP), then compared to other samples
from the same case. Two cases (18.2%) showed strain diversity during repeated
antibiotic treatments by serotyping or PBP-assay. By AFLP analysis, 6 cases
(54.5%) demonstrated heterogeneous strains during recurrent AOM. Clonal survivors
of previous episodes of AOM were not always the cause of subsequent episodes of
AOM, even in otitis-prone cases.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11434429 [PubMed - indexed for MEDLINE]

2173: J Laryngol Otol. 2001 Jun;115(6):475-8.

Comment in:
    J Laryngol Otol. 2002 Jun;116(6):488.

Management of paediatric otitis media with effusion in the UK: a survey conducted
with the guidance of the Clinical Effectiveness Unit at the Royal College of
Surgeons of England.

Ryan R, Harkness P, Fowler S, Topham J.

Department of Otolaryngology, Northwick Park Hospital, Harrow, UK.

A survey was undertaken of the practice of all Otorhinolaryngologists in England 
and Wales looking both at practice in general and at management of individual
patients, including a patient satisfaction questionnaire, under the auspices of
the Clinical Effectiveness Unit at the Royal College of Surgeons. Postal
questionnaires enquired about practice in general and management in particular of
20 sequential patients per consultant. Parent questionnaires were sent six weeks 
and one year post-operatively. Ninety consultants took part and 1503 individual
patient proformas were returned. Results showed that these consultants are
managing children with otitis media with effusion (OME) in a manner very close to
the recommendations of the Effective Healthcare Bulletin (1992) and consistent
with the recent Clinical Effectiveness Statement of the BAOHNS, and that the
intervention is popular with parents.

PMID: 11429071 [PubMed - indexed for MEDLINE]

2174: J Laryngol Otol. 2001 Jun;115(6):444-6.

Stapedectomy following tympanoplasty.

Berenholz LP, Lippy WH, Burkey JM, Schuring AG, Rizer FM.

Lippy Group for Ear, Nose and Throat, 3893 East Market Street, Warren, Ohio
44484, USA. Leonard@Netvision.net.il

The aim of this study was to evaluate the success of stapedectomy in patients who
have previously had a tympanoplasty because of chronic otitis media (COM).
Fourteen patients from a private otology practice had undergone tympanoplasty for
COM and subsequently underwent stapedectomy. Measurements were taken of the
air-bone gap (ABG) closure and pure tone average (PTA) which showed hearing
improvement. Patients had a mean 36.9 dB PTA hearing gain with 79 per cent
closing the ABG to within 20 dB. The need for stapedectomy alone is a rare
occurrence for patients with a history of COM requiring a tympanoplasty. Hearing 
improvement following stapedectomy in these cases was significant, although
somewhat less than following traditional stapedectomy in otosclerosis alone.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11429064 [PubMed - indexed for MEDLINE]

2175: Acta Otolaryngol. 2001 Apr;121(3):364-70.

Up-regulation of MUC5AC mRNA expression in endotoxin-induced otitis media.

Kim YT, Jung HH, Ko TO, Kim SJ.

Graduate School of Biotechnology, Korea University, Seoul, South Korea.

We investigated the expression levels of MUC5AC in endotoxin-induced otitis media
with effusion (OME) in the rat using competitive polymerase chain reaction (PCR) 
and the morphology of middle ear mucosa using transmission electron microscopy
(TEM). Experimental OME in the rat was induced after middle ear instillation of
Escherichia coli lipopolysaccharides (LPS). Middle ear mucosa were obtained at 0 
h, 12 h, Day 1, Day 3, Day 7 and Day 14 and reverse transcriptase (RT)-PCRs were 
then performed for the identification of MUC1, MUC2, MUC5AC and submandibular
mucin 1 expression, followed by competitive PCRs for MUC5AC and
beta2-microglobulin expression. Normal middle ear mucosa revealed no expression
of mucin genes, whereas endotoxin upregulated the expression of MUC5AC mRNA
between 12 h and Day 7, with maximal expression at Days 1 and 3. Middle ears
treated three times with LPS upregulated more MUC5AC mRNA expression, by a factor
of approximately 3.5, than those 1 day after one instillation. On TEM, dark
granulated cells were observed at Day 3 after endotoxin instillation, but mixed
granulated cells were seen on the ears treated three times with LPS. These
results suggest that MUC5AC could be one of the major mucin genes in the middle
ear mucosa related to otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11425202 [PubMed - indexed for MEDLINE]

2176: Am J Manag Care. 2001 Jun;7(6 Suppl):S178-82.

Appropriate antibiotic use in treating respiratory tract infections.

Poole MD.

The emergence of drug-resistant pathogens, especially Streptococcus pneumoniae
and Haemophilus influenzae, has complicated empiric treatment of both upper and
lower respiratory tract infections. Clinicians are now forced to reevaluate their
choices of first-line antibiotics. Although some bacterial respiratory infections
may resolve spontaneously, the use of antibiotics has demonstrated a faster
resolution of symptoms and prevention of sequelae and recurrences, thereby
improving the patient's quality of life and ability to function. Therefore, it is
recommended that all diagnosed bacterial respiratory infections be treated with
an antibiotic. Factors that clinicians need to consider in prescribing an
antibiotic are the predominant causative pathogens, rates of pathogen resistance,
patient history, the bacteriologic and clinical efficacy, safety profile, dosing 
regimen, and cost effectiveness of available antibiotic choices.

Publication Types: 
    Review

PMID: 11424586 [PubMed - indexed for MEDLINE]

2177: Am J Manag Care. 2001 Jun;7(6 Suppl):S163-9.

Challenges of managed care organizations in treating respiratory tract infections
in an age of antibiotic resistance.

Mogyoros M.

Managing respiratory tract infections (RTIs) presents many challenges to managed 
care organizations (MCOs). RTIs are among the most common illnesses treated by
primary care clinicians; they seriously impact patient quality of life and are a 
leading cause of health-related absences from the workplace. The total direct
costs of treating conditions such as acute otitis media, sinusitis, and acute
exacerbations of chronic bronchitis are estimated to be $10.1 billion. The
development of drug resistance has compounded these challenges by increasing
treatment failures and costs and limiting treatment options. MCOs can meet these 
challenges by implementing clinical practice guidelines for acute respiratory
infections, conducting focused studies of antibiotic use, and educating both
healthcare clinicians and patients about appropriate antibiotic use.

Publication Types: 
    Review

PMID: 11424584 [PubMed - indexed for MEDLINE]

2178: Clin Microbiol Infect. 2001 May;7(5):230-7.

Ecological effects on the oro- and nasopharyngeal microflora in children after
treatment of acute otitis media with cefuroxime axetil or amoxycillin-clavulanate
as suspensions.

Lund B, Edlund C, Rynnel-Dagöö B, Lundgren Y, Sterner J, Nord CE.

Huddinge University Hospital, Karolinska Institutet, Södertörns högskola,
University College, Dalens Sjukhus and Farsta Medical Consulting, Stockholm,
Sweden.

OBJECTIVE: To evaluate if the extent of normal microflora disturbances differed
between treatment with amoxycillin-clavulanate administered in an active form and
cefuroxime axetil administered as an inactive prodrug. METHODS: Twenty-eight
children, 0.5-5 years old, diagnosed with acute otitis media (AOM), were treated 
with either amoxycillin-clavulanate (13.3 mg/kg 3 times daily) or cefuroxime
axetil (15 mg/kg twice daily) for 7 days. Saliva samples and nasopharyngeal swabs
were collected before, directly after and 2 weeks after treatment. The saliva
samples were quantitatively and qualitatively analyzed and the nasopharyngeal
swabs were qualitatively analyzed. All isolated strains were tested for
beta-lactamase production. RESULTS: Both treatment regimens gave rise to similar 
alterations of the normal oropharyngeal microflora. In both groups, the amount of
Streptococcus salivarius was significantly reduced (P < 0.05). The most common
causative pathogens of acute otitis were S. pneumoniae, Haemophilus influenzae
and Moraxella catarrhalis. On the day of enrollment, approximately half of the
patients, in both groups, were infected with more than one pathogen. The rate of 
infection or colonization with more than one potential pathogen was low on day 7 
but recurred 2 weeks after treatment to similar levels as on day 0. The total
number of patients with reinfection, recolonization or recurrence of pathogens on
day 21 was 11/12 in the amoxycillin-clavulanate group and 4/7 in the cefuroxime
axetil group. The most common beta-lactamase producer was M. catarrhalis.
CONCLUSION: The local high concentration of antibiotics in the oropharynx
immediately after intake of antibiotic suspensions seem to have little or no
impact on the extent of disturbance of the microflora in this region. Children of
this age group seem prone to either reinfection, recolonization or persistence of
pathogens within 2 weeks after treatment. Furthermore, co-infection with more
than one pathogen seems common in children with AOM and infection with
beta-lactamase producing microorganisms occurs frequently.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 11422249 [PubMed - indexed for MEDLINE]

2179: Pediatr Infect Dis J. 2001 Jun;20(6):607-11.

Bacterial etiology of acute myringitis in children less than two years of age.

Palmu AA, Kotikoski MJ, Kaijalainen TH, Puhakka HJ.

National Public Health Institute, Helsinki, Finland.

BACKGROUND: Acute myringitis is an inflammation of the tympanic membrane that
occurs alone or in association with external otitis or otitis media. The two
clinical entities, based on physical examination, are bullous myringitis and
hemorrhagic myringitis. OBJECTIVES: To investigate the association of concomitant
middle ear disease with acute myringitis and to analyze the bacteriologic
findings of the middle ear fluid in children with acute myringitis. METHODS: A
prospective longitudinal cohort study of 2028 children age 7 to 24 months at
primary care level in the Finnish Otitis Media Vaccine Trial. Matched
case-control design for analysis of bacterial pathogen distribution. RESULTS:
There were 82 children in whom 92 ears were diagnosed with acute bullous
myringitis and 37 children in whom 40 ears were diagnosed with hemorrhagic
myringitis during the follow-up. Middle ear disease was associated with bullous
myringitis in 97% of ears and with hemorrhagic myringitis in 82% of ears.
Bacterial pathogen distribution was similar to that of acute otitis media,
although a higher proportion of Streptococcus pneumoniae was detected in both
bullous and hemorrhagic acute myringitis. CONCLUSIONS: Middle ear fluid was
present in vast majority of ears with acute myringitis in young children. The
same etiologic bacteria were found in acute myringitis as in acute otitis media, 
but S. pneumoniae was the major pathogen. Acute bullous myringitis should be
treated as acute otitis media in children <2 years of age.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11419504 [PubMed - indexed for MEDLINE]

2180: Pediatr Infect Dis J. 2001 Jun;20(6):574-81.

Epidemiology of documented viral respiratory infections and acute otitis media in
a cohort of children followed from two to twenty-four months of age.

Vesa S, Kleemola M, Blomqvist S, Takala A, Kilpi T, Hovi T.

Department of Vaccines, National Public Health Institute, Helsinki, Finland.

BACKGROUND: Viral upper respiratory infections (URIs) are considered major risk
factors for acute otitis media (AOM) in young children. We studied the
epidemiology and relative roles of different viruses in respiratory infections in
a cohort of 329 Finnish children followed from 2 months to 2 years of age.
METHODS: A nasopharyngeal aspirate (NPA) was collected whenever the child had
signs and/or symptoms of URI and tested for the presence of common respiratory
virus antigens or infectivity/nucleic acid (only rhinoviruses). Possible repeated
detections of a given virus during a 30-day period were considered to represent a
single designated virus-specific episode. AOM and URI episodes were defined in a 
similar way. RESULTS: At least one virus was detected in 837 (41.7%) of the 2005 
NPA specimens examined. Rates of URI and virus-specific episodes showed expected 
seasonal variation with major peak occurrences coinciding with or preceding those
of AOM. The proportions of rhinoviruses, respiratory syncytial (RS) virus,
parainfluenza virus (PIV) type 3, influenza virus A and adenoviruses were 63.1,
14.7, 6.7, 6.7 and 6.2% of the total of 761 virus-specific episodes. Influenza
virus B, PIV1 and PIV2 were each responsible for approximately 1% of the
episodes. AOM was diagnosed in 870 URI cases (43.4%) and in 43.3% of cases
associated with a virus-positive NPA. The latter figure was clearly higher
(57.7%) for RS virus-positive specimens. CONCLUSIONS: The seasonal coincidence of
URI and AOM demonstrated the obvious role of URI in the pathogenesis of AOM. The 
occurrence of rhinoviruses and RS virus in URI was strikingly more common than
that of any other virus tested. Although rhinoviruses were definitely the most
frequently found viruses in NPA specimens, the association of RS virus with
concurrent AOM was relatively higher than that of any other virus.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11419498 [PubMed - indexed for MEDLINE]

2181: Pediatr Infect Dis J. 2001 Jun;20(6):570-3.

Microbiology of otitis media in the Paris, France, area from 1987 to 1997.

Gehanno P, Panajotopoulos A, Barry B, Nguyen L, Levy D, Bingen E, Berche P.

Service ORL, Hĵpital Bichat-Claude Bernard, Paris, France.
pierre.gehanno@bch.ap-hop-paris.fr

PURPOSE OF THE STUDY: To investigate epidemiologic trends in the bacteriology of 
acute otitis media, data were recorded during a 10-year period by the same group 
of investigators during clinical studies in pediatric outpatients. METHODS:
Bacterial samples were obtained before antibiotic treatment from 2149 children
(age 3 to 36 months) with acute otitis media. All samples were transported,
handled and cultured in the same way throughout the 10-year period. RESULTS: From
the study patients 1862 samples of middle ear secretion were collected by
tympanocentesis and 287 samples were collected from spontaneous otorrhea
occurring within 24 h. Pathogens were isolated from 70% of patients. Pathogens
included Haemophilus influenzae (40%), Streptococcus pneumoniae (31%) and
Moraxella catarrhalis (8%). The incidence of beta-lactamase-producing H.
influenzae was approximately 20% from 1987 to 1989, was approximately 35% from
1990 to 1995 and increased to 60 and 70% during the last 2 years. The rate of S. 
pneumoniae with decreased susceptibility to penicillin gradually increased from
7% in 1987 to 70% in 1996 and 1997. CONCLUSION: The very high incidence of
antimicrobial resistant strains reached during a short period in pediatric acute 
otitis media in our area, emphasizes the need for frequent epidemiologic studies.

PMID: 11419497 [PubMed - indexed for MEDLINE]

2182: Clin Immunol. 2001 Jul;100(1):118-26.

Complement-regulator factor H and related proteins in otitis media with effusion.

Närkiö-Mäkelä M, Hellwage J, Tahkokallio O, Meri S.

Department of Bacteriology and Immunology, University of Helsinki, Helsinki,
Finland.

Otitis media with effusion (OME) is a common disease in childhood. It is
characterized by chronic inflammation in which the proinflammatory activity of
the complement (C) system is one of the underlying factors. The C system becomes 
strongly activated in the middle ear effusion (MEE) fluid, but the reasons for
this are not known. Here we demonstrate by using complement Bb fragment ELISA
that MEE specimens strongly activate the alternative C pathway (AP) in normal
human serum (NHS). Some of the MEEs were also found to promote lysis of rabbit
erythrocytes by NHS. These findings indicated a disturbance in the fluid-phase
regulation of the AP in MEE. The main regulator of the AP, factor H (FH), and
proteins structurally related to it (FHL-1, FHR-1, -2, -3, and -4) were present
in the MEE fluids of OME patients. Relative to serum, the FHR proteins were more 
abundant in the MEEs. In addition, we detected the recently discovered 65-kDa
FH-related protein FHR-5 in the MEE. The FHR proteins share binding sites with FH
in the C3d region of C3b. Thus they may compete with FH in binding to C3b and
interfere with the regulatory activity of FH. Consequently, a disturbance in AP
control in the MEE may lead to an ongoing excessive C activation and inflammation
in OME. Copyright 2001 Academic Press.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11414752 [PubMed - indexed for MEDLINE]

2183: J Laryngol Otol. 2001 May;115(5):363-8.

Nebulized surfactant as a treatment choice for otitis media with effusion: an
experimental study in the rabbit.

Koten M, Uzun C, Yagiz R, Adali MK, Karasalihoglu AR, Tatman-Otkun M, Altaner S.

Departments of Otorhinolaryngology, Clinical Bacteriology and Infectious
Diseases, Trakya University, Faculty of Medicine, Edirne, Turkey.

Exogenous surfactant can improve eustachian tube function in experimentally
induced otitis media with effusion (OME). Performing tympanometric recordings,
the efficacy of inhaled nebulized surfactant, as compared with inhaled nebulized 
physiological saline was investigated, for the treatment of OME experimentally
induced in the rabbit by intrabullar inoculation of heat-killed Streptococcus
pneumoniae. In addition, the histological changes in middle ears after the
treatment were investigated in order to establish whether the pathological
findings correlated with the results. Middle-ear pressure values before, and
after, treatment were analyzed by the Wilcoxon statistical method, and the
Mann-Whitney U test was used to compare the post-treatment values between groups.
In all ears with OME in the affected animals, which were treated with nebulized
surfactant inhalation, a positively significant (p<0.05) increase of pressure
more than 20 daPa was recorded. In the control group, after inhalation of
nebulized physiological saline, there was no positive increase in the affected
middle-ear pressures; on the contrary, more negative pressure changes were
recorded. In the histological evaluation, middle-ear epithelia and sub-epithelial
space were normal in surfactant-treated ears with OME, whereas mucosal thickening
with an oedematous sub-epithelial space containing occasional inflammatory cells 
and increases in connective tissue and vascularity, and effusions on the
epithelial surface were present in the ears with OME in the control group. The
significant improvement in the negative middle-ear pressure after nebulized
surfactant treatment and the histological findings shown in our study can support
the theory that surface-active agents are of importance in eustachian tube
function even under pathologic conditions, such as OME.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11410125 [PubMed - indexed for MEDLINE]

2184: Ear Hear. 2001 Jun;22(3):191-9.

The effect of short-term ventilation tubes versus watchful waiting on hearing in 
young children with persistent otitis media with effusion: a randomized trial.

Rovers MM, Straatman H, Ingels K, van der Wilt GJ, van den Broek P, Zielhuis GA.

Department of Otorhinolaryngology, University Medical Centre, Nijmegen, The
Netherlands.

OBJECTIVE: To study the effect of short-term ventilation tubes in children aged 1
to 2 yr with screening-detected, bilateral otitis media with effusion (OME)
persisting for 4 to 6 mo, as compared with watchful waiting. DESIGN: Multi-center
randomized controlled trial (N = 187) with two treatment arms: short-term
ventilation tubes versus watchful waiting. Young children underwent auditory
screening; those with persistent (4 to 6 mo) bilateral OME were recruited.
RESULTS: The mean duration of effusion over 1-yr follow-up was 142 days (36%) in 
the ventilation tube (VT) group versus 277 days (70%) in the watchful waiting
(WW) group. After 6 mo of follow-up, the pure-tone average in the VT group was
5.6 dB A better than that in the WW group. After 12 mo, most of the advantage in 
the VT group had disappeared. After the insertion of ventilation tubes, the
children with poorer hearing levels at randomization improved more than the
children with better hearing levels. The largest difference in hearing levels was
found between the children in the VT group whose ventilation tubes remained in
situ and the children in the WW group. In the VT children with recurrence of OME,
the hearing levels again increased, but remained slightly lower than those in the
infants with persistent OME in the WW group. CONCLUSIONS: Ventilation tubes have 
a beneficial effect on hearing in the short run (6 mo); this effect, however,
largely disappears in the long run (12 mo). This is probably due to partial
recurrent OME in the VT group and to partial spontaneous recovery in the WW
group.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11409855 [PubMed - indexed for MEDLINE]

2185: Brain Res. 2001 Jun 22;904(2):208-17.

Reactive nitrogen species contribute to blood-labyrinth barrier disruption in
suppurative labyrinthitis complicating experimental pneumococcal meningitis in
the rat.

Kastenbauer S, Klein M, Koedel U, Pfister HW.

Department of Neurology, Klinikum Grossetahadern, Ludwig-Maximilians University, 
Munich, Germany.

Sensorineural hearing damage is a frequent complication of bacterial meningitis, 
affecting as many as 30% of survivors of pneumococcal meningitis. There is a
substantial body of evidence that oxidants, such as reactive nitrogen species
(RNS), are central mediators of brain damage in experimental bacterial
meningitis. In the present study, we investigated whether RNS also contribute to 
the pathophysiology of suppurative labyrinthitis in our well-established rat
model of pneumococcal meningitis. In all infected rats, but not in uninfected
controls, we observed suppurative labyrinthitis. Cochlear inflammation was
accompanied by severe blood-labyrinth barrier (BLB) disruption as evidenced by
increased Evans Blue extravasation. Furthermore, increased cochlear expression of
endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase
(iNOS) was detected by immunohistochemistry. Colocalization of iNOS and tyrosine 
nitration (a marker of RNS attack) indicated that nitric oxide (NO) produced by
iNOS contributes to oxidative cochlear damage through the action of RNS. To
determine the pathophysiological role of RNS in BLB disruption, rats were treated
with peroxynitrite scavengers (MnTBAP and uric acid, UA). Six h after adjunctive 
treatment with 300 mg/kg i.p. UA or 15 mg/kg i.p. MnTBAP+100 mg/kg i.p.
ceftriaxone, BLB disruption was significantly reduced compared with that in
infected animals treated only with ceftriaxone. Therefore, we conclude that RNS
are involved in the breaching of the BLB during meningogenic pneumococcal
labyrinthitis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11406118 [PubMed - indexed for MEDLINE]

2186: Cochrane Database Syst Rev. 2001;(2):CD001727.

Update in:
    Cochrane Database Syst Rev. 2002;(1):CD001727.

Decongestants and antihistamines for acute otitis media in children.

Flynn CA, Griffin G, Tudiver F.

Department of Family Medicine, State University of New York Upstate Medical
University, Suite 200, 475 Irving Avenue, Syracuse, New York 13210, USA.
flynnc@upstate.edu

BACKGROUND: Acute otitis media (AOM) is a common and important source of
morbidity in children, although most cases resolve spontaneously. While
frequently recommended, decongestant and antihistamine therapy is of unclear
benefit. OBJECTIVES: To determine the efficacy of decongestant and antihistamine 
therapy in children with AOM on outcomes of AOM resolution, medication side
effects, and complications of AOM. SEARCH STRATEGY: Comprehensive search of
Cochrane's Controlled Trials Registry, Medline and Embase was conducted.
Bibliographic review and requests for information from study authors and
pharmaceutical companies supplemented this. SELECTION CRITERIA: Randomized
controlled trials evaluating decongestant (DC) or antihistamine (AH) treatment
for children with AOM were included. Patient-oriented outcomes were considered
most relevant. There were no quality or language restrictions. DATA COLLECTION
AND ANALYSIS: Investigators independently evaluated studies for inclusion,
performed validity assessments, and completed data extraction. Dichotomous data
were pooled to generate relative risks and numbers needed to treat, and
homogeneity was assessed using approximate chi-square tests. MAIN RESULTS: For
the combined control groups, healing rates at 2 weeks were high, with rates of
persistent AOM <23%. No additional benefit was demonstrated from intervention
subgroupings DC, AH, or any medication (DC and/or AH). Only the combined
treatment (DC + AH) group demonstrated statistically lower rates of persistent
AOM at the 2-week period (RR 0.76, 95% CI, NNT 10.5, 95% CI). No benefit was
found for other outcomes including early or late cure rates, symptom resolution, 
prevention of surgery or other complications. There was an increased risk of
medication side effects for those receiving an intervention, which reached
statistical significance for the "any medication" and decongestant groupings (NNH
16.6, 14.3 respectively, 95% CI ). Validity subanalyses demonstrated that lower
quality studies found benefit, but analysis of those studies with higher validity
scores found no benefit to treatment. REVIEWER'S CONCLUSIONS: Given lack of
benefit and increased risk of side effects, these data do not support the use of 
decongestant, antihistamine, or combined DC/AH treatment in children with AOM.
The small statistical benefit found in the combination medication group is of
small clinical significance and study design may be biasing the results.

Publication Types: 
    Review

PMID: 11406002 [PubMed - indexed for MEDLINE]

2187: Ann Otol Rhinol Laryngol. 2001 Jun;110(6):574-80.

Role of interleukin-1beta in a murine model of otitis media with effusion.

Watanabe T, Hirano T, Suzuki M, Kurono Y, Mogi G.

Department of Otolaryngology, Oita Medical University, Japan.

To clarify the role of interleukin-1beta (IL-1beta) in the pathogenesis of otitis
media with effusion (OME), we developed and investigated a murine model of this
disease. Specific pathogen-free male BALB/c mice received intratympanic
injections of 20 microg of endotoxin derived from nontypeable Haemophilus
influenzae. Three days after injection, middle ear effusions were observed
through the eardrum. Similar pathological changes were observed after inoculation
with 100 ng of recombinant IL-1beta. Anti-IL-1 receptor antibodies inhibited the 
pathological changes induced by the endotoxin. In situ hybridization showed
expression of IL-1beta messenger RNA in the epithelium of the middle ear mucosa. 
These results suggest that IL-1beta might be associated with endotoxin-induced
inflammation in the middle ear and might play an important role in the induction 
of otitis media with effusion.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11407850 [PubMed - indexed for MEDLINE]

2188: Eur Arch Otorhinolaryngol. 2001 May;258(4):164-7.

Expression of myeloperoxidase and cochlear dysfunction in the
lipopolysaccharide-treated guinea pig.

Watanabe K, Jinnouchi K, Pawankar R, Yagi T.

Department of Oto-Rhino-Laryngology, Nippon Medical School, Tokyo, Japan.
bxp02646@nifty.ne.jp

In this study, the effect of endotoxin on the guinea pig cochlea was examined by 
electrophysiology and immunohistochemistry. Bacterial lipopolysaccharide (LPS)
was injected into the middle ear transtympanically. Electrocochleograms were
measured immediately and 48 h after the injection with an electrode inserted into
the facial canal. After the electrophysiological measurement, the animals were
killed with an intracardiac perfusion of fixative and the temporal bones were
removed and processed for immunohistochemistry with anti-myeloperoxidase (MPO)
antibody. MPO could be detected after 48 h in the lateral wall and the organ of
Corti. After injection of LPS, the threshold of the compound action potential
worsened significantly at 48 h in the LPS group. These results suggest that MPO
and reactive oxygen species are involved in cochlea dysfunction under
inflammatory conditions.

PMID: 11407446 [PubMed - indexed for MEDLINE]

2189: Aviat Space Environ Med. 2001 Jun;72(6):586-9.

Cases from the Aerospace Medicine Residents' Teaching File: acute onset of
dizziness in a USAF aviator.

Clark RA.

USAF School of Aerospace Medicine, Brooks AFB, TX, USA.

An Air Force F-15 pilot develops the sudden onset of incapacitating dizziness
with nausea and vomiting not associated with flight. Presentation, diagnosis,
treatment, and aeromedical issues surrounding the symptom complex of acute onset 
vertigo is discussed.

Publication Types: 
    Case Reports

PMID: 11398820 [PubMed - indexed for MEDLINE]

2190: Int J Pediatr Otorhinolaryngol. 2001 Jul 2;59(3):195-200.

Infrared transtympanic temperature measurement and otitis media with effusion.

Robb PJ, Shahab R.

Department of Otolaryngology, Epsom & St. Helier NHS Trust, Epsom General
Hospital, KT18 7EG, Epsom, UK. robb@uk-consultants.co.uk

Body temperature is an important clinical measurement. It can be estimated by
sublingual, rectal, axillary or skin measurement. Pulmonary artery temperature
measurement is the gold standard in the research setting, but is obviously
inapplicable for routine clinical use. Infrared estimation of core temperature at
the tympanic membrane has been proposed as an effective and accurate method. We
investigate whether the common condition of childhood otitis media with effusion 
(OME) interferes with this mode of body temperature measurement. Ninety-five
children undergoing grommet tube insertion were assessed preoperatively by
axillary and transtympanic routes. The presence or absence of middle ear fluid
was noted at the time of surgery. Analysis of the data showed no influence of OME
on the measurement of body temperature by the transtympanic route compared with
axillary measurement.

PMID: 11397501 [PubMed - indexed for MEDLINE]

2191: J Am Vet Med Assoc. 2001 May 15;218(10):1619-23, 1582.

Otitis media in a llama.

Koenig JB, Watrous BJ, Kaneps AJ, Adams JG, Parker JE.

Department of Large Animal Clinical Sciences, College of Veterinary Medicine,
Oregon State University, Corvallis 97331-4802, USA.

A 7-month-old female llama was examined because of chronic otitis media and
externa of 7 months' duration. Radiographically, the tympanic bullae appeared
thicker than normal, and the ventral borders were poorly defined; the left
external acoustic meatus (ear canal) appeared to be narrower than the right. The 
llama was treated with penicillin, and the ear canals were lavaged daily.
Contrast radiography was performed on day 15 to determine the shape and size of
the ear canals and evaluate the integrity of the tympanic membranes. Contrast
medium was visible radiographically in the left tympanic bulla, indicating that
the left tympanic membrane was ruptured, but the right tympanic membrane appeared
to be intact. The left ear canal was narrower than the right, and the bony ear
canals had a well-defined sigmoid shape. The right ear improved with medial
treatment alone, but the left ear did not. Therefore, lateral ear canal resection
was performed. After surgery, however, exudate was still evident in the left ear 
canal, and the llama became more lethargic and more reluctant to eat. Lateral
bulla osteotomy was attempted, but no purulent material was obtained, and
curettage of the bulla resulted in hemorrhage. Because of this and because of the
llama's poor physical condition, a decision was made to euthanatize the llama.
The sigmoid shape of the bony ear canal and the multicompartmental nature of the 
tympanic bulla make surgical treatment of otitis media and externa in llamas
difficult. Further study of surgical treatments for otitis media in llamas is
needed.

Publication Types: 
    Case Reports

PMID: 11393377 [PubMed - indexed for MEDLINE]

2192: Pediatrics. 2001 Jun;107(6):1251-8.

Comment in:
    Pediatrics. 2002 Feb;109(2):349-50.

Otorrhea in young children after tympanostomy-tube placement for persistent
middle-ear effusion: prevalence, incidence, and duration.

Ah-Tye C, Paradise JL, Colborn DK.

Department of Pediatrics, Pittsburgh, Pennsylvania, USA.

OBJECTIVE: To characterize the occurrence of tube otorrhea after
tympanostomy-tube placement (TTP) for persistent middle-ear effusion (MEE) in a
group of otherwise healthy infants and young children. METHODS: In a long-term,
prospective study of child development in relation to early-life otitis media, we
enrolled by 2 months of age healthy infants who presented for primary care at 1
of 2 urban hospitals or 1 of 2 small-town/rural and 4 suburban private pediatric 
group practices. We monitored their middle-ear status closely. Children who
developed persistent MEE of specified durations within the first 3 years of life 
became eligible for random assignment to undergo TTP either promptly or after an 
extended period if MEE persisted. The present report concerns 173 randomly
assigned children who underwent bilateral TTP between ages 6 and 36 months and
were followed for at least 6 months thereafter. Episodes of tube otorrhea were
treated with oral antimicrobial drugs and, if persistent, with ototopical
medication. RESULTS: Socioeconomic status, as estimated from maternal education
and type of health insurance, was lowest at the urban sites and highest at the
suburban sites. The tenure of the 230 tubes that were extruded during the
observation period ranged from 19 days to 38.5 months (mean = 13.8 months; median
= 13.5 months). During the first 18 months after TTP, the proportion of children 
who had tubes in place and who developed 1 or more episodes of otorrhea increased
progressively, reaching 74.8% after 12 months and 83.0% after 18 months. The mean
number of episodes per child was 0.79 in the first 6 months, 1.50 in the first 12
months, 2.17 in the first 18 months, and 2.82 in the first 24 months. Overall,
otorrhea occurred earliest and was most prevalent among urban children and
occurred latest and was least prevalent among suburban children. The mean
estimated duration of episodes of tube otorrhea was 16.0 days (standard deviation
= 16.9 days), the median was 10 days, and the range was 3 to 131 days. The
duration was >30 days in 13.2% of the episodes. Six of the 173 children (3.5%)
developed on 1 or more occasions tube otorrhea that failed to improve
satisfactorily with conventional outpatient management. Five of these children
were hospitalized to receive parenteral antibiotic treatment, 1 child twice and 1
three times, and 1 also underwent tube removal. The sixth child underwent tube
removal as an outpatient. CONCLUSIONS: Tube otorrhea is a common and often
recurrent and/or stubborn problem in young children who have undergone tube
placement for persistent MEE. The extent of the problem seems to be related
inversely to socioeconomic status. Tube otorrhea does not always respond
satisfactorily to outpatient management and for resolution may require parenteral
antimicrobial treatment and/or tube removal.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11389239 [PubMed - indexed for MEDLINE]

2193: Clin Pediatr (Phila). 2001 May;40(5):265-9.

Comment in:
    Clin Pediatr (Phila). 2001 May;40(5):271-2.

The use of dietary supplements in pediatrics: a study of echinacea.

Mark JD, Grant KL, Barton LL.

Department of Pediatrics, College of Pharmacy, University of Arizona, Tucson
85724, USA.

Alternative medical therapies are commonly used and have increased in popularity.
Although patients may not always disclose the use of alternative therapies, they 
may seek advice regarding their use, especially for children. Regulation and
standardization of these modalities, especially botanicals, is incomplete. The
University of Arizona has initiated a study of the use of echinacea in the
prevention of recurrent otitis media. A review of echinacea preparations was
undertaken, and this report discusses the complexities surrounding the use of
this dietary supplement. The number and diversity of echinacea preparations are
detailed; the role of the physician as "botanical" advisor to patients and
families is examined.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 11388676 [PubMed - indexed for MEDLINE]

2194: Int J Pediatr Otorhinolaryngol. 2001 Jun 7;59(2):147-50.

Otorhinolaringologic manifestation of Smith-Magenis syndrome.

Di Cicco M, Padoan R, Felisati G, Dilani D, Moretti E, Guerneri S, Selicorni A.

Otorhinolaryngologic Department, AO ICP-University of Milan, Milan San Felice
20090, Italy. maurimdc@yahoo.com

Smith-Magenis syndrome (SMS) is a multiple congenital anomaly/mental retardation 
(MCA/MR) syndrome link to a contiguous-gene deletion syndrome, involving
chromosome 1 7p 11.2,whose incidence is estimated to be 1:25,000 livebirth. SMS
is characterised by a specific physical, behavioural and developmental pattern.
The main clinical features consist of a broad flat midface with brachycefaly,
broad nasal bridge, brachydactily, speech delay, hoarse deep voice and peripheral
neuropathy. Behavioural abnormalities include hypermotility, self-mutilation and 
sleep disturbance. This report defines the otorhinolaryngological aspects of a
new case of SMS, confirmed by cytogenetic-molecular analysis, in a 9 year old
girl affected by chronic otitis media, deafness and sinusitis, who presented with
typical clinical signs and symptoms.

Publication Types: 
    Case Reports

PMID: 11378192 [PubMed - indexed for MEDLINE]

2195: Int J Pediatr Otorhinolaryngol. 2001 Jun 7;59(2):119-23.

Short-term penicillin-V prophylaxis did not prevent acute otitis media in
infants.

Foglé-Hansson M, White P, Hermansson A, Prellner K.

Department of Otorhinolaryngology, S-541 85 Central Hospital, Skövde, Sweden.
margaretha.fogle-hansson@vgregion.se

OBJECTIVE: To determine whether prophylactic, short-term penicillin V treatment
during upper respiratory tract infections can prevent the occurrence of recurrent
acute otitis media in young children. METHODS: Seventy children were studied in a
prospective, double-blind, placebo-controlled study. All children had suffered
their first episode of acute otitis media before the age of 6 months. After
inclusion in the study group, administration of penicillin V or placebo was
initiated by the parents at subsequent upper respiratory tract infections. The
children were examined by otomicroscopy within 3 days after treatment was
initiated. The children were scheduled for a total follow-up period of 12 months,
including bimonthly visits for check-up irrespective of treatment periods.
RESULTS: There were 304 treated episodes of upper respiratory tract infection.
There was no significant difference in the number of acute otitis episodes
between groups. CONCLUSION: Initiation of penicillin V prophylaxis at upper
respiratory tract infection in small children did not prevent recurrent acute
otitis media in this study.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11378187 [PubMed - indexed for MEDLINE]

2196: Eur Arch Otorhinolaryngol. 2001 Mar;258(3):106-8.

Fungal mastoiditis in an immunocompetent adult.

Ohki M, Ito K, Ishimoto S.

Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Tokyo,
Japan.

Manifest fungal infection of the middle ear, fungal mastoiditis, is a very rare
entity, which is almost exclusively seen in immunocompromised patients. The
authors present a case of fungal mastoiditis in a 52-year-old woman without
immunocompromise. The patient presented with acutely progressing symptoms of
hearing loss and dysequilibrium. Bony fistula of the semicircular canal was noted
on CT scans and a marginal perforation of the tympanic membrane was also seen.
Her hearing recovered following the surgery, which revealed massive granulations 
and proliferation of fungi but no cholesteatoma in the mastoid cavity. Fungal
infection of the middle ear is rare, but can cause serious complications. The
possibility should be considered even in immunocompetent patients.

Publication Types: 
    Case Reports

PMID: 11374248 [PubMed - indexed for MEDLINE]

2197: Saudi Med J. 2000 Oct;21(10):928-30.

Otitis externa in a localized area at the South of Jordan.

Al-Asaaf SM, Farhan MJ.

Department of Ear, Nose & Throat, Royal Medical Service, PO Box 66, Tlaa' Al-Ali 
11953, Amman, Jordan.

OBJECTIVE: To investigate the clinical findings and to identify the
microorganisms in the pathogenesis of otitis externa. METHODS: The symptoms and
signs, as well as the bacterial flora, from the auditory canals of 70 Jordanian
patients (94 ears) suffering from otitis externa were studied during the period
from February 1999 to February 2000. RESULTS: Pain was the most common symptom
(82%). The most common sign was erythema (65%), while oedema was the least common
(42%). Pseudomonas aeruginosa was found in 39%, Aspergillus in 27%, Candida
albicans in 18%, Staphylococcus aureus in 18% and no growth in 8.5%. Ninety three
percent of healthy ears revealed normal skin flora. CONCLUSION: Gram-negative
microorganisms (Pseudomonas aeruginosa) were the most frequently isolated
pathogenic microorganisms.

PMID: 11369954 [PubMed - indexed for MEDLINE]

2198: Saudi Med J. 2000 Oct;21(10):924-7.

Microbiology of chronic suppurative otitis media with cholesteatoma.

Attallah MS.

Department of Otorhinolaryngology, King Abdulaziz University Hospital, PO Box
245, Riyadh 11411, Kingdom of Saudi Arabia.

OBJECTIVE: To report the result of causative organisms in chronic suppurative
otitis media with cholesteatoma. METHODS: Eighty eight patients clinically
diagnosed with chronic suppurative otitis media with cholesteatoma, and confirmed
intra-operatively and by histological examination were pre-operatively studied
for the causative bacteria and fungi. RESULTS: A single isolate was obtained in
42 (48%) cases, no growth was isolated in 11 (12.5%) cases. Most common bacteria 
isolated were, Pseudomonas aeruginosa in 51%, Staphylococcus aureus in 31%, and
Proteus species in 17%. Among the 15 fungal isolates, 9 (10%) were Aspergillus
species and the remaining 6 (7%) were Candida albicans. CONCLUSION: Conventional 
ear swabs taken under direct vision using an operating microscope are reliable in
establishing the microbiological profile of chronic suppurative otitis media.

PMID: 11369953 [PubMed - indexed for MEDLINE]

2199: Pediatr Infect Dis J. 2001 May;20(5):501-7.

Bacterial and viral etiology of acute otitis media in Chilean children.

Rosenblüt A, Santolaya ME, González P, Corbalán V, Avendanõ LF, Martínez MA,
Hormazabal JC.

Otorhinolaryngology Service, Hospital Dr. Sótero del Río, Santiago, Chile.
cmackenna@difrecalcine.cl

BACKGROUND: Acute otitis media (AOM) is a main cause for antimicrobial
prescription in Latin America. Pathogen diversity in different geographic regions
underscores the need for updated knowledge on AOM microbiology. AIM: To
prospectively determine the role of bacteria and viruses in Chilean children with
AOM. METHODS: Between July, 1998, and June, 1999, children >3 months with a
presumptive diagnosis of AOM were referred to the study ear, nose and throat
physician. Middle ear fluid and nasopharyngeal aspirates were obtained from
children with confirmed AOM and processed for common bacteria, Mycoplasma
pneumoniae, Chlamydia pneumoniae and viruses. Antimicrobial susceptibility
patterns and serotypes of Streptococcus pneumoniae strains were determined.
RESULTS: An ear, nose and throat physician confirmed diagnoses for 222 (42%) of
529 children referred with diagnosis of AOM, and 170 children met eligibility
criteria for the study. One or more pathogens were detected in 140 of 170 (82%)
children. Predominant bacteria were S. pneumoniae (37%), Haemophilus influenzae
(24%) and Streptococcus pyogenes (13%). M. catarrhalis was detected in 2
children, C. pneumoniae was found in 1 and M. pneumoniae was not detected.
Viruses were detected in 22 children (13%) from nasopharyngeal aspirates, and in 
6 of them the same virus was detected in middle ear fluid. Penicillin-resistant
(intermediate and high) S. pneumoniae represented 40% of isolates and 10% of H.
influenzae were beta-lactamase producers. All 10 penicillin-resistant S.
pneumoniae strains were resistant to cefuroxime. Eighteen S. pneumoniae serotypes
were detected and 19F was associated with high level penicillin resistance.
CONCLUSION: This study can impact local management of AOM, and it should
encourage continuous surveillance of AOM microbiology in Chile and other
developing countries.

PMID: 11368107 [PubMed - indexed for MEDLINE]

2200: Pediatr Infect Dis J. 2001 May;20(5):482-7.

Antibody response to the pneumococcal proteins pneumococcal surface adhesin A and
pneumolysin in children with acute otitis media.

Rapola S, Kilpi T, Lahdenkari M, Mäkelä PH, Käyhty H.

National Public Health Institute, Helsinki, Finland.

BACKGROUND: Pneumococcal surface adhesin A (PsaA) and pneumolysin (Ply) are
common to virtually all Streptococcus pneumoniae isolates, and they are
immunogenic and protective against pneumococcal challenge in experimental
animals. We have recently shown production of antibodies to PsaA and Ply in young
children, but data on the immune response to these antigens during
culture-confirmed pneumococcal infection are lacking. OBJECTIVES: To evaluate
whether young children respond to S. pneumoniae by producing antibodies to PsaA
and Ply during acute otitis media (AOM). SUBJECTS AND METHODS: A cohort of 329
children was followed prospectively from the age of 2 months to the age of 2
years. Paired sera were obtained during episodes of AOM and used to measure
antibodies to PsaA and Ply by enzyme-linked immunosorbent assay. S. pneumoniae
cultured from the middle ear fluid was taken as evidence of pneumococcal AOM. The
presence of S. pneumoniae in the nasopharyngeal aspirate collected in connection 
of AOM or any other respiratory infection or in the nasopharyngeal swab collected
at scheduled visits was taken to indicate pneumococcal carriage and thus a
history of previous contact with S. pneumoniae. RESULTS: Children with previous
pneumococcal contacts had high anti-PsaA and anti-Ply concentrations in the acute
phase sera regardless of the nature (AOM or carriage) of the current pneumococcal
contact. Of the children with no previous pneumococcal contact, those with
current pneumococcal AOM had lower antibody concentrations than those with
current pneumococcal carriage only. Anti-PsaA and anti-Ply responses were found
in children with current pneumococcal contact. The antibody response was strongly
associated with low acute phase antibody concentration, but not significantly
with age and the nature of the current pneumococcal contact. CONCLUSIONS: We
showed that infants are capable of developing a specific antibody response to the
pneumococcal proteins PsaA and Ply during AOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11368104 [PubMed - indexed for MEDLINE]

2201: Pediatrics. 2001 May;107(5):1037-42.

Comment in:
    Pediatrics. 2001 May;107(5):1175-6.

Early childhood otitis media in relation to children's attention-related behavior
in the first six years of life.

Minter KR, Roberts JE, Hooper SR, Burchinal MR, Zeisel SA.

Frank Porter Graham Child Development Center, Department of Allied Health
Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North
Carolina 27599-8180, USA.

OBJECTIVE: This study examined whether otitis media with effusion (OME) and
associated hearing loss during the first 4 years of life were related to the
ratings of parents, teachers, and clinicians of children's attention and behavior
in the first 6 years of life. METHODS: In a prospective study, 85 black children 
were recruited from community-based child care programs when they were between 6 
and 12 months old. OME and hearing status were monitored repeatedly from 6 months
to 4 years old. Measures of attention and behavior were collected from parents,
teachers, and clinicians when the children were infants, preschoolers, and first 
graders. RESULTS: On average, children experienced either bilateral or unilateral
OME 30% of the time and hearing loss 19.9% of the time between 6 months and 4
years old. Descriptive and inferential analyses revealed no significant
associations between OME or hearing loss and the measures of attention or
behavior completed by parents, teachers, and clinicians. CONCLUSIONS: In this
sample of children, there was no relationship between amount of early childhood
OME or hearing loss and measures of attention or behavior in the first 6 years of
life as reported by parents, teachers, and clinicians.otitis media, hearing,
attention, behavior.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11331683 [PubMed - indexed for MEDLINE]

2202: Laryngoscope. 2001 Apr;111(4 Pt 1):728-33.

Effect of tumor necrosis factor-alpha on experimental otitis media with effusion.

Lee DH, Park YS, Jung TT, Yeo SW, Choi YC, Jeon E.

Department of Otolaryngology-Head and Neck Surgery College of Medicine, The
Catholic University of Korea, Seoul, Korea.

OBJECTIVES/HYPOTHESIS: Up to the present, many reports have demonstrated that
local immune response is associated with maintenance and persistence of effusion 
in the middle ear cavity. Resulting retention of inflammatory cells and mediators
in the middle ear results in ongoing effusion. The purpose of this study was to
clarify the role of tumor necrosis factor in experimental otitis media with
effusion, which was induced by transtympanic injection of tumor necrosis factor
in the rats. STUDY DESIGN: Four groups were designed in two experiments. The
purpose of experiment 1 was to confirm that transtympanic injection of TNF-alpha 
produces the middle ear effusion. In experiment 2, TNFsolRI was used to evaluate 
the possibility as an inhibitor in otitis media with effusion. METHODS: The
histopathological changes were observed under light microscope, and the changes
in microvascular permeability were examined using Evans blue vital dye technique.
RESULTS: Middle ear effusion was developed in 70% of specimens, and
histopathological changes, such as subepithelial edema and marked infiltration of
neutrophils, were present in 100% at 24 hours after administration of tumor
necrosis factor-alpha through transtympanic approach. Extravasation of Evans blue
dye was found in all specimens injected by tumor necrosis factor-alpha, which was
qualified using a fluorescence microscope and quantified using a
spectrophotometer. These histopathological findings and changes in microvascular 
permeability were significantly reduced by tumor necrosis factor soluble receptor
type I. CONCLUSIONS: Neutrophil infiltration, subepithelial edema, increased
microvascular permeability, and resultant effusion were indirectly proved to be
induced by tumor necrosis factor-alpha. We hope that this study may contribute to
understanding the role of tumor necrosis factor-alpha in otitis media with
effusion and clarifying the future role of tumor necrosis factor soluble receptor
type I in preventing otitis media with effusion.

PMID: 11359148 [PubMed - indexed for MEDLINE]

2203: Laryngoscope. 2001 Apr;111(4 Pt 1):724-7.

Histopathological changes of chorda tympani in chronic otitis media.

Gedikli O, Doğru H, Aydin G, Tüz M, Uygur K, Sari A.

Departments of Otolaryngology-Head and Neck Surgery, Süleyman Demirel University 
School of Medicine, Isparta, Turkey.

OBJECTIVE: To investigate whether histopathological changes of chorda tympani
might exist in patients with chronic otitis media without facial paralysis. STUDY
DESIGN: The study was designed as a prospective trial. METHODS: Twenty of 107
patients with chronic otitis media, in whom the chorda tympani were injured
inadvertently during middle ear surgery, were enrolled into the study. The cases 
were divided into two groups based on the activity of chronic infection at the
time of surgery. Twelve cases with suppurative disease were included in group I, 
and 8 cases with dry ear in group II. RESULTS: Histopathological examinations of 
the specimens revealed findings such as thickening of perineural and epineural
connective tissue, vacuolar degeneration of Schwann cells, and proliferation of
fibroblasts in endoneurium. Disorganization of the axons of some nerve fibers was
also determined. CONCLUSION: Based on the histopathological changes of chorda
tympani in chronic middle ear disease, it is postulated that chronic otitis media
may give rise to functional loss of the nerve.

PMID: 11359147 [PubMed - indexed for MEDLINE]

2204: Arch Otolaryngol Head Neck Surg. 2001 May;127(5):517-22.

Low cord blood pneumococcal antibody concentrations predict more episodes of
otitis media.

Becken ET, Daly KA, Lindgren BR, Meland MH, Giebink GS.

Otitis Media Research Center, MMC 396, University of Minnesota, Minneapolis
55455, USA.

OBJECTIVE: To determine if cord blood anticapsular polysaccharide pneumococcal
IgG antibody concentration was related to the number of otitis media (OM) and
acute OM episodes during the first year of life. DESIGN: Prospective study
following infants from birth to 24 months. SETTING: Health maintenance
organization. PATIENTS: The study population consisted of 415 infants whose
mothers volunteered for the study during pregnancy. Cord blood samples were
collected and infants were followed up for OM in the health maintenance
organization. Ninety-seven percent of the infants were white, 49% male, 3% from
households with annual incomes of less than $20 000, and 30% from households with
annual incomes of more than $60 000. MAIN OUTCOME MEASURE: Number of
physician-diagnosed OM episodes, including both OM with effusion and acute OM,
and acute OM episodes from birth to 12 months. RESULTS: With univariate analysis,
low cord blood antibody concentrations against serotypes 3 and 19F predicted more
acute OM episodes (P =.04 and P =.05, respectively), and low antibody
concentrations against serotypes 19F and 23F predicted more OM episodes (P =.04
and P =.05, respectively) over the first year of life. With Poisson regression,
which adjusted for variables related to the recurrence of OM and having low cord 
blood antibody concentrations, serotype 19F remained significantly related to the
number of OM episodes (relative risk for lowest quartiles vs upper 3 quartiles
1.23; 95% confidence interval, 1.02-1.50; P =.03). CONCLUSIONS: Low cord blood
antibody concentrations to serotype 19F predicted more OM episodes over the first
12 months of life. These results suggest the potential benefit of maternal
immunization to raise neonatal antipolysaccharide pneumococcal antibody
concentration and delay the onset and reduce the number of OM episodes.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11346426 [PubMed - indexed for MEDLINE]

2205: Clin Resour Manag. 2001 Apr;2(4):59-61, 49.

Getting physicians to adopt guidelines for otitis media.

[No authors listed]

Guidelines for the treatment of otitis media in children have been out for
several years, and shown to be effective. Why, then, aren't more physicians using
them? Researchers at Baylor College in Houston discuss the national guidelines
and why physicians don't follow them more often.

PMID: 11351754 [PubMed - indexed for MEDLINE]

2206: Am J Physiol Lung Cell Mol Physiol. 2001 Jun;280(6):L1157-67.

Characterization of mucins in human middle ear and Eustachian tube.

Lin J, Tsuprun V, Kawano H, Paparella MM, Zhang Z, Anway R, Ho SB.

Department of Otolaryngology, University of Minnesota School of Medicine,
Minneapolis, MN 55455, USA. linxx004@tc.umn.edu

Mucins are important glycoproteins in the mucociliary transport system of the
middle ear and Eustachian tube. Little is known about mucin expression within
this system under physiological and pathological conditions. This study
demonstrated the expression of MUC5B, MUC5AC, MUC4, and MUC1 in the human
Eustachian tube, whereas only MUC5B mucin expression was demonstrated in
noninflamed middle ears. MUC5B and MUC4 mucin genes were upregulated 4.2- and
6-fold, respectively, in middle ears with chronic otitis media (COM) or mucoid
otitis media (MOM). This upregulation of mucin genes was accompanied by an
increase of MUC5B- and MUC4-producing cells in the middle ear mucosa. Electron
microscopy of the secretions from COM and MOM showed the presence of chainlike
polymeric mucin. These data indicate that the epithelium of the middle ear and
Eustachian tube expresses distinct mucin profiles and that MUC5B and MUC4 mucins 
are highly produced and secreted in the diseased middle ear. These mucins may
form thick mucous effusion in the middle ear cavity and compromise the function
of the middle ear.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 11350794 [PubMed - indexed for MEDLINE]

2207: Acta Otolaryngol. 2001 Jan;121(2):182-4.

Gland formation in otitis media. An ultrastructural study in humans.

Goycoolea MV.

Clínica Las Condes, Santiago, Chile.

In an effort to evaluate mechanisms of new gland formation in otitis media, 14
human middle ear mucoperiostial tissue samples were obtained from 7 patients with
a history of this disease. In areas of inflammatory reaction, especially in the
promontory and anterior wall, the mucoperiosteum acquires polyploidal
characteristics, with occasional epithelial breaks. The epithelium becomes
thicker and the cells develop increased secretory activity. The invaginated
portion of these polyploidal formations can be observed as pits lined by
secretory epithelium. The cells in these invaginated areas: (i) fuse in areas of 
epithelial ruptures, leaving spaces into which cells secrete; (ii) develop dense 
cellular nests that bud off the epithelium, leaving empty spaces into which cells
secrete. It is proposed that new gland formation can occur by means of fusion and
formation of cellular nests that bud off the epithelium.

PMID: 11349774 [PubMed - indexed for MEDLINE]

2208: Infect Immun. 2001 Jun;69(6):3827-36.

Recombinant PhpA protein, a unique histidine motif-containing protein from
Streptococcus pneumoniae, protects mice against intranasal pneumococcal
challenge.

Zhang Y, Masi AW, Barniak V, Mountzouros K, Hostetter MK, Green BA.

Department of Immunology, Wyeth Lederle Vaccines, West Henrietta, New York
14586-9728, USA. zhangy4@war.wyeth.com

The multivalent pneumococcal conjugate vaccine is effective against both systemic
disease and otitis media caused by serotypes contained in the vaccine. However,
serotypes not covered by the current conjugate vaccine may still cause
pneumococcal disease. To address these serotypes and the remaining otitis media
due to Streptococcus pneumoniae, we have been evaluating antigenically conserved 
proteins from S. pneumoniae as vaccine candidates. A previous report identified a
20-kDa protein with putative human complement C3-proteolytic activity. By
utilizing the publicly released pneumococcal genomic sequences, we found the gene
encoding the 20-kDa protein to be part of a putative open reading frame of
approximately 2,400 bp. We recombinantly expressed a 79-kDa fragment (rPhpA-79)
that contains a repeated HxxHxH motif and evaluated it for vaccine potential. The
antibodies elicited by the purified rPhpA-79 protein were cross-reactive to
proteins from multiple strains of S. pneumoniae and were against surface-exposed 
epitopes. Immunization with rPhpA-79 protein adjuvanted with monophosphoryl lipid
A (for subcutaneous immunization) or a mutant cholera toxin, CT-E29H (for
intranasal immunization), protected CBA/N mice against death and bacteremia, as
well as reduced nasopharyngeal colonization, following intranasal challenge with 
a heterologous pneumococcal strain. In contrast, immunization with the 20-kDa
portion of the PhpA protein did not protect mice. These results suggest that
rPhpA-79 is a potential candidate for use as a vaccine against pneumococcal
systemic disease and otitis media.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11349048 [PubMed - indexed for MEDLINE]

2209: Otol Neurotol. 2001 May;22(3):291-8.

Pars tensa and pars flaccida retractions in persistent otitis media with
effusion.

[No authors listed]

OBJECTIVE: In children with otitis media with effusion (OME), to investigate the 
incidence of, and any association, between retractions of the pars tensa and pars
flaccida; to assess the effect of pars tensa and pars flaccida retractions on the
hearing; to investigate risk factors for retractions; and to document the natural
history of such retractions over a 12-week 'watchful aiting" period. STUDY
DESIGN: Prospective, observational study. SETTING: Sixteen departments of
otolaryngology in hospitals in the U.K. PATIENTS: A cohort of 1,267 children aged
3.25 to 6.75 years with confirmed OME. None had previously received surgical
intervention. INTERVENTIONS: Follow-up over a "watchful waiting" period of 12
weeks. MAIN OUTCOME MEASURES: Otoscopy and pure-tone audiometry. RESULTS:
Retraction of the pars tensa to the incus or promontory occurred in 8% of the
better-hearing ears and 10% of the poorer-hearing ears. Pars flaccida retraction 
to the malleus or farther occurred in 4.5% of the better-hearing ears and 5.5% of
the poorer-hearing ears. Retractions were not associated with a longer history of
hearing problems. Pars tensa or pars flaccida retraction in association with OME 
did not materially affect the hearing. Pars tensa retractions, followed up over a
12-week period, resolved in 69% of the better-hearing ears and 65% of the
poorer-hearing ears. In 14% and 10% of ears, respectively, the OME had also
resolved. CONCLUSIONS: There is minimal evidence to support the concept that pars
tensa or pars flaccida retractions are a strong or relevant marker for the
severity or evolution of OME in children. Prospective studies over a longer
period of follow-up are required to confirm this.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11347629 [PubMed - indexed for MEDLINE]

2210: Med Mycol. 2001 Apr;39(2):229-32.

A case of feline otitis externa due to Microsporum canis.

Guedeja-Marron J, Blanco JL, Garcia ME.

Departamento Patología Animal I, Facultad de Veterinaria, Universidad
Complutense, Madrid, Spain.

We describe a case of a 3-month-old Persian male cat with a persistent waxy,
ceruminous, otic discharge in both external auditory canals. After
microbiological culture, only Microsporum canis was isolated with no concurrent
fungal or bacterial flora. Fungal otitis due to dermatophytes was diagnosed and
specific treatment with griseofulvin was administered. After 4 weeks of
treatment, no M. canis colonies were isolated and clinical recovery had occurred.
In view of this case, dermatophytosis should be included in the differential
diagnosis of feline otic conditions, particularly when otitis becomes chronic or 
is refractory to treatment.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 11346273 [PubMed - indexed for MEDLINE]

2211: Pediatr Dent. 2001 Mar-Apr;23(2):103-7.

Pacifier use and the occurrence of otitis media in the first year of life.

Warren JJ, Levy SM, Kirchner HL, Nowak AJ, Bergus GR.

Department of Preventive & Community Dentistry, University of Iowa, USA.
john-warren@uiowa.edu

PURPOSE: The purpose of this study was to assess pacifier use as a risk factor
for otitis media during the first year of life. METHODS: A volunteer cohort of
1,375 infants was recruited from eight hospital postpartum units in Iowa. Parents
were asked to provide detailed information on their child's health at 6 weeks, 3,
6, 9 and 12 months of age. Questions were posed concerning occurrence of specific
childhood illnesses, including otitis media, at each time point, as well as other
factors. RESULTS: Over 70% of children were reported to have experienced one or
more episodes of otitis media during their first year of life, with its
occurrence much more common during the second six months. Multivariate analyses
using Generalized Estimating Equations assessed factors associated with otitis
media during the entire 12-month period. These analyses showed that pacifier use,
age, male sex, greater number of childcare days, and higher family incomes were
significantly associated with occurrence of otitis media. CONCLUSIONS:
Multivariate analyses found that the occurrence of otitis media was associated
with pacifier use, one of few modifiable risk factors for otitis media.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11340716 [PubMed - indexed for MEDLINE]

2212: Pediatr Allergy Immunol. 2001 Apr;12(2):102-6.

The prevalence of atopic disorders in children with chronic otitis media with
effusion.

Alles R, Parikh A, Hawk L, Darby Y, Romero JN, Scadding G.

Glue Ear Clinic, Royal National Throat, Nose and Ear Hospital, Gray's Inn Road,
London, UK.

We studied 209 children, referred to a multi-disciplinary 'Glue ear/Allergy'
clinic at our hospital with a history of chronic or recurrent otitis media with
effusion (OME), in order to determine the prevalence of atopic disease in this
population. Referrals were made either from within the hospital by Ear, Nose and 
Throat (ENT) Surgeons and Audiological Physicians (internal), or by General
Practitioners (external). Assessment of atopic status was based on medical
history, physical examination, nasal smears and skin-prick testing (SPT) in all
children; and on blood eosinophil counts and total immunoglobulin E (IgE) levels 
in a randomly selected subset. The main outcome measures were number of children 
with rhinitis, asthma, eczema, positive SPT, raised IgE level (> 100 IU/l), and
nasal and blood eosinophilia. We found allergic rhinitis in 89%, asthma in 36%,
and eczema in 24%. SPTs were positive to one or more of eight common inhalant
aeroallergens in 57% of children. Blood tests in the selected subset revealed
eosinophilia in 40% and a raised serum IgE in 28%. The worldwide prevalence of
allergic rhinitis in children has been estimated to be 20%. The 89% prevalence
found in this study is very high and there are a number of reasons which suggest 
that there may be a causal relationship. Whole-population studies will be
required to confirm these findings, which could have important therapeutic
implications for OME.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11338283 [PubMed - indexed for MEDLINE]

2213: Otolaryngol Head Neck Surg. 2001 May;124(5):489-95.

Practice patterns versus practice guidelines in pediatric otitis media.

Stewart MG, Manolidis S, Wynn R, Bautista M.

Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences,
Baylor College of Medicine, Houston. Texas 77030, USA. mgstew@bcm.tmc.edu

OBJECTIVE: To study the practice patterns of physicians and their adherence to an
evidence-based practice guideline (PG) on pediatric otitis media with effusion.
We hypothesized that overall knowledge of the recommendations from the guidelines
would be less than 75%, and that specialist physicians would have better
knowledge of the recommendations than generalist physicians. METHODS: We
performed a survey study of 1167 otolaryngologists, pediatricians, and pediatric 
otolaryngologists. Each physician was sent a 6-item survey asking about their
practice patterns and treatment preferences for young children with otitis media 
with effusion. We compared responses between different specialties. RESULTS: The 
overall response rate was 48%. Only 8 (1.4%) of the 558 responding physicians
answered all 6 items congruent with the PG. Overall, pediatricians,
otolaryngologists, and pediatric otolaryngologists had similar total scores, but 
different scores on individual items. CONCLUSIONS: These results indicate that
the practice patterns of pediatricians, otolaryngologists, and pediatric
otolaryngologists differ from the recommendations of an evidence-based PG. In
particular, 2 items covering key treatment recommendations were answered in
agreement with the PG by fewer than half of the physicians. It is not clear from 
this study whether these discrepancies were due to poor dissemination or
knowledge concerning the PG, or disagreement with its recommendations.

PMID: 11337650 [PubMed - indexed for MEDLINE]

2214: Pediatr Infect Dis J. 2001 Apr;20(4):376-80.

Acute mastoiditis in children: a seventeen-year experience in Dallas, Texas.

Ghaffar FA, Wördemann M, McCracken GH Jr.

Department of Pediatrics, University of Texas Southwestern Medical Center at
Dallas, USA.

BACKGROUND: In the preantibiotic era acute mastoiditis was the most common
complication of acute otitis media, often resulting in substantial morbidity and 
mortality. Since 1989 several investigators have documented an increased
frequency of acute mastoiditis in children. METHODS: The medical records of all
children with a discharge diagnosis of acute mastoiditis, managed at Children's
Medical Center, Dallas, TX, from 1983 through 1999 were reviewed. RESULTS: There 
were 57 cases of acute mastoiditis during the 17-year period of 1983 through 1999
compared with 57 cases in a 25-year period of 1955 through 1979 reported
previously at the same institution. The number of cases of acute mastoiditis per 
10,000 hospital admissions increased significantly (regression analysis P =
0.003) during the more recent 17 years. From 1993 through 1999 there were 4.5
cases or more per 10,000 admissions each year, whereas from 1983 through 1992,
the incidence never exceeded 4.3 cases per 10,000 admissions (P = 0.018). The
median age of the patients was 48 months. Twenty-two patients (38.5%) were
younger than 24 months; 17 of these were 12 months of age or younger. Twenty-two 
(38.5%) patients had no history of previous episodes of acute otitis media.
Streptococcus pneumoniae was the pathogen most often isolated from the cultures. 
Complications of mastoiditis occurred in 20 children (35%). CONCLUSIONS: We
conclude that acute mastoiditis continues to be a problem in the post antibiotic 
era. It occurs mainly in young children and can be the first evidence of ear
disease.

PMID: 11332661 [PubMed - indexed for MEDLINE]

2215: Scand Audiol. 2001;30(1):24-9.

The change in the acoustic admittance phase angle: a study in children suffering 
from acute otitis media.

Vlachou SG, Tsakanikos M, Douniadakis D, Apostolopoulos N.

ENT Department, P & A Kyriakou Children's Hospital, Athens, Greece.
tvlachou@hotmail.com

Middle ear mechanics, in normal and in pathological conditions, is the subject of
this research, with acoustic impedance measurements as the cornerstone. Previous 
studies have established the importance of admittance-phase tympanograms, mainly 
in frequencies higher than the conventional 226 Hz. The purpose of the present
study was to record how acute otitis media (AOM) affects the middle ear system
and function by evaluating the recordings of the change in phase angle parameter 
(deltatheta) provided by an automated tympanometer using the sweep-frequency
technique. Multifrequency and conventional tympanograms were obtained from 70
children suffering from AOM on consecutive visits. Values of deltatheta from
these subjects were compared to normative data previously acquired in our
Department. It appears that changes in the mechanical status of the middle ear
after AOM are reflected in abnormal deltatheta values, despite the normal
findings of conventional tympanometry. A positive history of AOM did not seem to 
influence the behaviour of the middle ear. In most cases, abnormal deltatheta
values coexisted with abnormal values of resonance frequency (RF), i.e. the
frequency at which mass and stiffness of the middle ear are in balance, and total
susceptance (deltaB) reaches 0mmhos and the converse. The deltatheta seems to be 
an important indicator of middle ear mechanical status that can record changes
occurring in the system after AOM and undetected by low probe-tone tympanometry.

PMID: 11330915 [PubMed - indexed for MEDLINE]

2216: Clin Diagn Lab Immunol. 2001 May;8(3):632-6.

Elastase deficiency phenotype of Pseudomonas aeruginosa canine otitis externa
isolates.

Petermann SR, Doetkott C, Rust L.

Department of Veterinary and Microbiological Sciences, North Dakota State
University, Fargo, North Dakota 58105, USA.

Pseudomonas aeruginosa veterinary isolates were assayed for elastase and total
matrix protease activity. The elastase activity of canine ear isolates was much
less than that of strain PAO1 and that of all other veterinary isolates (P <
0.0001). The results indicate that canine ear isolates have a distinct elastase
phenotype.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11329471 [PubMed - indexed for MEDLINE]

2217: J Laryngol Otol. 2001 Feb;115(2):87-90.

Improving standards in the treatment of acute otitis externa by the use of a
treatment protocol and open access to aural toilet.

Tierney PA, Price T, Gillet D, Oyarzabal MO, Salama N.

Department of Otolaryngology-Head and Neck Surgery, University Hospital,
Lewisham, London, UK. ptierney10@hotmail.com

A prospective audit of the procedure and outcome in the management of acute
otitis externa was undertaken in our unit. The first cycle demonstrated a
heterogeneous approach and clinical isolation of junior staff. A questionnaire
survey of local general practitioners highlighted clinical confusion over the use
of topical medication and a need for improved access to facilities for aural
toilet. General practitioner liaison and education was an essential component in 
formulating a change in practice. In particular, open access for aural toilet was
introduced and utilization encouraged. Following changes in practice, the second 
cycle of the audit showed that treatment protocols were effective and adhered to 
by junior staff.

PMID: 11320843 [PubMed - indexed for MEDLINE]

2218: Br J Audiol. 2001 Feb;35(1):77-85.

Erratum in:
    Br J Audiol 2001 Jun;35(3):219.

Prediction of 8-month MEE from neonatal risk factors and test results in SCBU and
full-term babies.

Gliddon ML, Sutton GJ.

Audiology Unit, Royal Berkshire Hospital, Reading, UK.

The incidence and persistence of middle ear effusion (MEE) may be affected by
children's birth history and environment. Factors such as bottle-feeding,
presence of parental smoking, admission to special care and a history of colds
are all thought to increase the risk of persistent MEE. The aim of the present
study was to determine those risk factors and neonatal test results that best
predict presence of MEE (as measured by 220 Hz tympanometry) at 8 months of age. 
One hundred Special Care Baby Unit (SCBU) and non-SCBU babies were assessed
neonatally and at 8 months of age with tympanometry. At each assessment, various 
risk factors were collected. Failure of 8-month tympanometry was best predicted
by neonatal (660 Hz) tympanometry and the presence or absence of breast-feeding
for SCBU babies. This provides further evidence that 660 Hz tympanometry may
provide information about neonatal MEE. For non-SCBU babies the risk of failing
8-month tympanometry was most significantly affected by a history of colds and
parental smoking. The number of babies with each combination of risk factors in
the present study is rather small and this has caused confidence intervals (CIs) 
to be wide and some unexpected results. However, an extended study with a larger 
and more balanced sample may facilitate accurate prediction neonatally of those
children at risk of 8-month MEE.

PMID: 11314914 [PubMed - indexed for MEDLINE]

2219: Otol Neurotol. 2001 Jan;22(1):11-4.

Goblet cell density in acute otitis media caused by Moraxella catarrhalis.

Cayé-Thomasen P, Hermansson A, Tos M, Prellner K.

Department of Otorhinolaryngology, Gentofte University Hospital of Copenhagen,
Denmark.

HYPOTHESIS AND BACKGROUND: Secretory otitis media is associated with a highly
increased goblet cell density, confirming the secretory pathogenesis of this
disease. Previous studies have shown that the middle ear goblet cell density, and
thus the secretory capacity, are massively increased during experimental acute
otitis media and at least 6 months thereafter, conceivably predisposing to the
subsequent development of secretory otitis media. These studies used middle ear
inoculation of either Streptococcus pneumoniae, nontypeable Haemophilus
influenzae, or H. influenzae type b. The present study aimed at determining the
goblet cell density during and after acute otitis media caused by Moraxella
catarrhalis to clarify whether this bacterium induces an equivalently enhanced
secretory capacity. METHODS: Twenty-five 25 rat middle ears were inoculated with 
M. catarrhalis. Five rats were killed on days 4, 8, 16, 60, and 180 after
inoculation, followed by staining, dissection, and whole-mount embedding of the
middle ear mucosae. The goblet cell density was determined by counting in 24
fields, covering the entire middle ear. RESULTS: In comparison with 25 normal
middle ears, the goblet cell density was significantly increased in almost all
counting localities, from day 4 and < or = 2 months after inoculation. The goblet
cell density peaked on day 16, subsided thereafter, and in some areas reached a
normal level 6 months after the acute incident. Mucosal areas containing goblet
cells were consistently enlarged, thus leaving the middle ear with an increased
secretory capacity during and 6 months after inoculation. CONCLUSION: The goblet 
cell density of the middle ear mucosa is increased during acute otitis media
caused by M. catarrhalis and up to several months thereafter. This may predispose
to the subsequent development of secretory otitis media. However, in comparison
with acute otitis media caused by other bacteria, M. catarrhalis induced only
modest changes in goblet cell density.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11314704 [PubMed - indexed for MEDLINE]

2220: Ann Med. 2001 Feb;33(1):1-3.

Otitis media with effusion: the role of Alloiococcus otitidis.

Fraise AP, Pahor AL, Beswick AJ.

Otitis media with effusion (OME) is a common condition that can cause deafness as
well as speech and behavioural disturbance. It has long been considered to be a
noninfective process resulting from Eustachian tube dysfunction; however,
molecular biological techniques have implicated bacteria in the aetiology of this
condition. One such organism is Alloiococcus otitidis, which has been detected in
middle ear fluid of patients with OME which has not yielded micro-organisms with 
conventional microbiological culture methods. The exact role of this infectious
agent in the pathogenesis of otitis media has yet to be elucidated.

Publication Types: 
    Editorial

PMID: 11310934 [PubMed - indexed for MEDLINE]

2221: N Engl J Med. 2001 Apr 19;344(16):1188-95.

The role of adjuvant adenoidectomy and tonsillectomy in the outcome of the
insertion of tympanostomy tubes.

Coyte PC, Croxford R, McIsaac W, Feldman W, Friedberg J.

Department of Health Administration, and Home Care Evaluation and Research
Centre, University of Toronto, ON, Canada. peter.coyte@utoronto.ca

BACKGROUND: Otitis media is the most common medical problem in young children.
The usual surgical treatment is myringotomy with insertion of tympanostomy tubes.
There is debate about the usefulness of concomitant adenoidectomy or
adenotonsillectomy. We examined the effects of these adjuvant procedures on the
rates of reinsertion of tympanostomy tubes and rehospitalization for conditions
related to otitis media. METHODS: Using hospital discharge records for the period
1995 through 1997, we examined the results of surgery for all 37,316 children
(defined as persons 19 years of age or younger) in Ontario, Canada, who received 
tympanostomy tubes as their first surgical treatment for otitis media. We
determined the time to the first readmission for conditions related to otitis
media and the time to the first reinsertion of tympanostomy tubes. RESULTS: As
compared with treatment involving the insertion of tympanostomy tubes alone,
adjuvant adenoidectomy was associated with a reduction in the likelihood of
reinsertion of tympanostomy tubes (relative risk, 0.5; 95 percent confidence
interval, 0.5 to 0.6; P<0.001) and the likelihood of readmission for conditions
related to otitis media (relative risk, 0.5; 95 percent confidence interval, 0.5 
to 0.6; P<0.001). The risk of these outcomes was further reduced if an adjuvant
adenotonsillectomy was performed. The effect was age-related. Children as young
as one year appeared to benefit from adjuvant adenotonsillectomy; the benefit of 
an adjuvant adenoidectomy was apparent in two-year-olds and was greatest for
children three years of age or older. CONCLUSIONS: Performing an adenoidectomy at
the time of the initial insertion of tympanostomy tubes substantially reduces the
likelihood of additional hospitalizations and operations related to otitis media 
among children two years of age or older.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 11309633 [PubMed - indexed for MEDLINE]

2222: N Engl J Med. 2001 Apr 19;344(16):1179-87.

Comment in:
    ACP J Club. 2001 Nov-Dec;135(3):108.    N Engl J Med. 2001 Apr 19;344(16):1241-2.    N Engl J Med. 2001 Aug 9;345(6):465; author reply 465-6.    N Engl J Med. 2001 Aug 9;345(6):465; author reply 465-6.

Summary for patients in:
    Curr Allergy Asthma Rep. 2002 Jul;2(4):295-6.

Effect of early or delayed insertion of tympanostomy tubes for persistent otitis 
media on developmental outcomes at the age of three years.

Paradise JL, Feldman HM, Campbell TF, Dollaghan CA, Colborn DK, Bernard BS,
Rockette HE, Janosky JE, Pitcairn DL, Sabo DL, Kurs-Lasky M, Smith CG.

Department of Pediatrics, University of Pittsburgh School of Medicine, and
Children's Hospital of Pittsburgh, PA 15213-2538, USA. jpar@pitt.edu

BACKGROUND: A main indication for the insertion of tympanostomy tubes in infants 
and young children is persistent otitis media with effusion, reflecting concern
that this condition may cause lasting impairments of speech, language, cognitive,
and psychosocial development. However, evidence of such relations is
inconclusive, and evidence is lacking that the insertion of tympanostomy tubes
prevents developmental impairment. METHODS: We enrolled 6350 healthy infants from
2 to 61 days of age and evaluated them regularly for middle-ear effusion. Before 
the age of three years 429 children with persistent effusion were randomly
assigned to have tympanostomy tubes inserted either as soon as possible or up to 
nine months later if effusion persisted. In 402 of these children we assessed
speech, language, cognition, and psychosocial development at the age of three
years. RESULTS: By the age of three years, 169 children in the early-treatment
group (82 percent) and 66 children in the late-treatment group (34 percent) had
received tympanostomy tubes. There were no significant differences between the
early-treatment group and the late-treatment group at the age of three years in
the mean (+/-SD) scores on the Number of Different Words test, a measure of word 
diversity (124+/-32 and 126+/-30, respectively); the Percentage of Consonants
Correct-Revised test, a measure of speech-sound production (85+/-7 vs. 86+/-7);
the General Cognitive Index of McCarthy Scales of Children's Abilities (99+/-14
vs. 101+/-13); or on measures of receptive language, sentence length, grammatical
complexity, parent-child stress, and behavior. CONCLUSIONS: In children younger
than three years of age who have persistent otitis media, prompt insertion of
tympanostomy tubes does not measurably improve developmental outcomes at the age 
of three years.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11309632 [PubMed - indexed for MEDLINE]

2223: Clin Otolaryngol Allied Sci. 2001 Apr;26(2):147-56.

Comment in:
    Clin Otolaryngol Allied Sci. 2001 Aug;26(4):263-4.

Risk factors for persistence of bilateral otitis media with effusion.

MRC Multi-centre Otitis Media Study Group.

Otitis media with effusion (OME) is a common, episodic condition in childhood.
The subset that has persistent bilateral OME is important to identify so that
their management can be targeted. Most guidelines suggest a watchful-waiting
period before a decision is made on the appropriateness of surgical intervention.
In the UK this usually takes place in a specialist setting (otorhinolaryngology) 
over a period of 12 weeks. A cohort of children (n = 639), between the ages of
3.25 and 6.75 years with bilateral OME that had no previous ear or throat
surgery, was followed up over 12 weeks during the recruitment phase of a
multi-centre, randomised controlled study. This allowed multiple factors for
persistence to be assessed. The overall spontaneous resolution rate in this
cohort was between 26% and 65%, depending on the audiometric cut-off by which a
persisting condition was defined. Three significant risk factors-time of year
when first seen (July to December); hearing level (>or= 30 dB HL in the better
ear); and a route of referral that included prior audiometry--were identified in 
the multivariate analysis for persistent OME both in isolation and when
accompanied by each of three audiometric cut-offs (>or= 15, >or= 20 and >or= 25dB
HL). In this age group, parental report of duration of OME, history of acute
otitis media, parental smoking and pars tensa retractions were not significant
factors for persistence. These risk factors in combination can increase the odds 
ratio of persistence more than sixfold. However, the proportion persisting is
insufficient to bypass a period of watchful waiting, except perhaps in extreme
combinations which apply to less than 7% of the cohort.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial

PMID: 11309057 [PubMed - indexed for MEDLINE]

2224: Ann Otol Rhinol Laryngol. 2001 Apr;110(4):377-80.

Fungal malignant otitis externa due to Scedosporium apiospermum.

Yao M, Messner AH.

Division of Otolaryngology-Head and Neck Surgery, Stanford University Medical
Center, California 94305-5328, USA.

Malignant otitis externa (MOE) is an infection of the external auditory canal
that invades the skull base. Aspergillus species fungi were the pathological
organism in 21 of 23 reported cases of fungal MOE. We report on a 21-year-old man
with end-stage acquired immunodeficiency syndrome (AIDS) and fungal MOE caused by
Scedosporium apiospermum. Fungal MOE is most common in patients with end-stage
AIDS and hematologic malignancies. Granulation tissue is not a common finding in 
these patients, and the infectious process often starts in the mastoid air cells 
or middle ear space, as opposed to the external auditory canal. Surgical
debridement and amphotericin B are the mainstays of therapy; resolution of the
infection depends greatly on the severity of the underlying disease.

Publication Types: 
    Case Reports
    Review

PMID: 11307916 [PubMed - indexed for MEDLINE]

2225: Pediatr Infect Dis J. 2001 Mar;20(3):260-4.

Bacteriologic and clinical efficacy of trimethoprim-sulfamethoxazole for
treatment of acute otitis media.

Leiberman A, Leibovitz E, Piglansky L, Raiz S, Press J, Yagupsky P, Dagan R.

Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical
Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev,
Beer-Sheva, Israel. alberto@bgumail.bgu.ac.il

BACKGROUND: Trimethoprim-sulfamethoxazole (T/S) has often been used as first and 
second line of treatment for acute otitis media (AOM). Because of the increasing 
resistance of Streptococcus pneumoniae and Haemophilus influenzae to T/S, we
undertook the present study to investigate the bacteriologic and clinical
efficacy of this drug in AOM. METHODS: Fifty-four culture-positive evaluable
patients ages 3 to 32 months with AOM were treated with T/S 4/20 mg/kg in two
divided daily doses for 10 days. Middle ear fluid (MEF) was cultured at
enrollment (Day 1) and on Days 4 and 5 after initiation of treatment. Additional 
MEF cultures were obtained if clinical relapse occurred. Clinical failure was
determined when the symptoms and signs of AOM did not improve or recurred during 
therapy. Bacteriologic failure was defined by positive culture on Days 4 and 5,
or negative on Days 4 and 5 but positive again before the end of treatment.
Patients were followed until Day 28 +/- 2. RESULTS: A total of 67 organisms were 
isolated from MEF specimens of the 54 study patients: S. pneumoniae, 24; H.
influenzae, 40; and Streptococcus pyogenes, 3. Fifteen (63%) of 24 S. pneumoniae 
were nonsusceptible to T/S (trimethoprim MIC, >0.5 microg/ml), of which 10 (67%) 
were highly resistant to T/S (trimethoprim MIC, > or = 4.0 microg/ml). Twelve
(30%) of 40 H. influenzae and all 3 S. pyogenes isolates were nonsusceptible to
T/S (MIC > or = 4.0 microg/ml). Bacteriologic eradication occurred in 9 of 9
(100%) and 27 of 27 (100%) T/S-susceptible S. pneumoniae and H. influenzae,
respectively, vs. 4 of 15 (27%) and 6 of 12 (50%) T/S-nonsusceptible S.
pneumoniae and H. influenzae, respectively (P < 0.001). The 3 patients with S.
pyogenes failed bacteriologically. Nine new organisms, not initially isolated,
emerged during treatment, 7 of which (77%) were resistant to T/S. Altogether
bacteriologic failure (organisms not eradicated plus newly emerged) occurred in
29 (53%) of 54 patients. Clinical failures occurred in 8 (15%) of 54 patients,
and in 7 of these 8 cases the clinical failures occurred in those with
bacteriologic failures. Ten patients relapsed clinically after completion of
treatment and in 8 of them tympanocentesis for MEF culture was performed. Six of 
these 8 cultures were positive, and the initial pathogen was isolated in 4 of 6
(67%). CONCLUSIONS: A high bacteriologic failure rate as well as a considerable
clinical failure rate occurred among patients with AOM treated with T/S. We
believe that T/S is no longer an appropriate empiric choice for the treatment of 
AOM in regions where high T/S resistance among respiratory pathogens is reported.

PMID: 11303827 [PubMed - indexed for MEDLINE]

2226: Otol Neurotol. 2001 Mar;22(2):183-7.

Reliability of manometric eustachian tube function tests in children.

van Heerbeek N, Ingels KJ, Snik AF, Zielhuis GA.

Department of Otorhinolaryngology, University Medical Center St. Radboud,
Nijmegen, The Netherlands.

OBJECTIVE: To assess the reliability of manometric eustachian tube function tests
in children with ventilation tubes in situ. STUDY DESIGN: Repeated manometric
eustachian tube function tests during one session. SETTING: The study took place 
at a secondary referral hospital and a tertiary referral hospital. PATIENTS:
Ninety-nine children with ventilation tubes in situ because of persistent otitis 
media with effusion. MAIN OUTCOME MEASURES: Opening pressure (Po), closing
pressure (Pc), and tubal function group. RESULTS: Analysis of Po and Pc showed a 
decrease with repeated measurement (p = 0.0001 and p = 0.001, respectively). The 
effect of repeated measurement on Po was more pronounced than the effect on Pc.
The results of the first and second pressure equilibration tests showed 99%
agreement. CONCLUSIONS: This study showed good reproducibility of the categorized
results of the pressure equilibration test, whereas the results of the
forced-response test seemed to be less reproducible and showed a downward shift
with repeated measurement. A single measurement using wet swallowing and starting
pressures of 100 and -100 daPa and the mean of the first three measurements of
the Po and Pc are sufficient to determine tubal function. Further studies are
needed to determine the discriminative power of these tests in children with
different degrees of middle ear disease.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11300266 [PubMed - indexed for MEDLINE]

2227: Clin Ther. 2001 Feb;23(2):193-204.

Cefprozil versus high-dose amoxicillin/clavulanate in children with acute otitis 
media.

Hedrick JA, Sher LD, Schwartz RH, Pierce P.

Kentucky Pediatric/Adult Research, Bardstown 40004, USA.
jhedrick@bardstowncable.net

BACKGROUND: The recommendation of the Drug-Resistant Streptococcus pneumoniae
Therapeutic Working Group that high-dose amoxicillin, with or without
clavulanate, be used to treat acute otitis media (AOM) addressed concerns about
the efficacy of existing therapies against drug-resistant S. pneumoniae. This
recommendation relied on pharmacodynamic predictions of concentrations of
amoxicillin in middle-ear fluid remaining higher than minimum inhibitory
concentrations against intermediately resistant S. pneumoniae for >40% of the
dosing interval. OBJECTIVE: This study compared the tolerability and efficacy of 
cefprozil and high-dose amoxicillin/clavulanate in patients with AOM. METHODS:
Patients were randomized to receive 10 days of investigator-blinded oral
treatment with either cefprozil suspension (30 mg/kg/d in 2 divided doses) or
amoxicillin/clavulanate (45/6.4 mg/kg/d) plus amoxicillin (45 mg/kg/d) in 2
divided doses. The primary efficacy end point was the clinical cure rate 4 to 7
days after the end of treatment. Clinical response by age (6 months-<2 years vs >
or =2-7 years), disease severity, and unilateral versus bilateral ear infection
was also examined. The primary measures of tolerability were the frequency and
severity of adverse events and their relation to study drug. Adverse events were 
either spontaneously reported or elicited during examination and questioning of
the patient. Identified adverse events were coded and recorded using the COSTART 
(Coding Symbols for Thesaurus of Adverse Reaction Terms) system. RESULTS: Three
hundred four children between the ages of 6 months and 7 years with > or =1 sign 
or symptom of AOM were enrolled in the study, and 303 (150 cefprozil, 153
amoxicillin/clavulanate) were treated. Twenty-three patients in each treatment
group were not evaluable; thus, 257 children were included in the analysis of
evaluable patients. Clinical cure rates were 87% (110/127) with cefprozil and 89%
(116/130) with amoxicillin/clavulanate (95% CI for the difference in cure rate,
-10.7% to 4.1%). No between-group differences in efficacy were noted by age,
disease severity, or unilateral or bilateral involvement. The overall incidence
of drug-related adverse events was significantly lower with cefprozil than with
amoxicillin/clavulanate (19% vs 32%, respectively; P = 0.008), as was the
incidence of diarrhea (9% vs 19%, respectively; P = 0.021). Adverse events
prompted discontinuation of therapy in 4 (3%) cefprozil patients and 8 (5%)
amoxicillin/clavulanate patients. CONCLUSIONS: Based on a search of MEDLINE, this
study is the first direct comparison of cefprozil versus high-dose
amoxicillin/clavulanate. Cefprozil was as effective as high-dose
amoxicillin/clavulanate, with a lower incidence of adverse events.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11293553 [PubMed - indexed for MEDLINE]

2228: Infect Immun. 2001 May;69(5):2964-71.

Intranasal immunization enhances clearance of nontypeable Haemophilus influenzae 
and reduces stimulation of tumor necrosis factor alpha production in the murine
model of otitis media.

Sabirov A, Kodama S, Hirano T, Suzuki M, Mogi G.

Department of Otolaryngology, Oita Medical University, Hasama-machi, Oita
879-5593, Japan.

Nontypeable Haemophilus influenzae (NTHi) is a major pathogen causing otitis
media (OM). One of the outer membrane proteins of NTHi, P6, is a common antigen
to all strains and is considered a candidate for mucosal vaccine. We have
previously reported that intranasal immunization with P6 and cholera toxin (CT)
could induce P6-specific immunoglobulin A (IgA) antibodies in the middle ear. In 
the present study, we assessed the effect of intranasal immunization for the
protection against NTHi-induced OM. Mice were immunized intranasally with P6 and 
CT as an adjuvant on days 0, 7, and 14. Control mice were given
phosphate-buffered saline (PBS) without antigen. One week after the final
immunization, a suspension of live NTHi (10(7) CFU) was injected into the
tympanic cavity to induce experimental OM. On days 3 and 7 after bacterial
challenge, mice were killed and middle ear effusions (MEEs) were collected. All
immunized mice showed elevated titers of P6-specific antibodies in MEEs. The rank
order of specific antibody included, from highest to lowest levels, IgG, IgA, and
IgM. In addition, immunized mice showed enhanced clearance of NTHi from the
middle ear and the number of NTHi in MEEs of immunized mice was reduced by 97% on
day 3 and by 92% on day 7 after bacterial challenge relative the number in the
MEEs of control mice. The protective effect of intranasal immunization on the
incidence of NTHi-induced experimental OM was evident on day 7 after challenge.
By day 7, the number of MEEs in immunized mice was 64% less than that in control 
mice and the incidence of NTHi culture-positive MEEs in immunized mice was 56%
less than that in control mice. Less stimulation of tumor necrosis factor alpha
(TNF-alpha) production in the middle ear was evident on day 3 after challenge.
Immunized mice showed lower concentrations of TNF-alpha in MEEs. These results
indicate that intranasal immunization affords protection against experimental OM 
as evidenced by enhanced clearance of NTHi and less stimulation of TNF-alpha
production in the middle ear. These findings suggest that a nasal vaccine might
be useful for preventing OM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11292713 [PubMed - indexed for MEDLINE]

2229: J Lab Clin Med. 2001 Apr;137(4):303-9.

Efficacy of bactericidal/permeability-increasing protein in experimental otitis
media with effusion in rats: a new therapy for mucosal infections.

Nell MJ, Grote JJ.

Department of Otorhinolaryngology, Leiden University Medical Center, The
Netherlands.

Otitis media with effusion (OME) is characterized by the presence of fluid in the
middle ear without signs or symptoms of acute infection and by persistent changes
in the middle ear mucosa. These are mainly induced by gram-negative bacterial
infection and dysfunction of the eustachian tube (ET). Gram-negative bacteria
(GNB) contain lipopolysaccharide (LPS) in their outer membrane that is
responsible for inflammatory reactions in the middle ear. In this study we
investigated the therapeutic effect of a recombinant LPS-binding protein,
bactericidal/permeability-increasing protein (rBPI21), on the repair of mucosal
damage in rats with experimentally induced OME. OME was induced by obstruction of
the eustachian tube in combination with LPS injection. Twelve weeks after OME
induction, secretory cells in the tympanic orifice of the middle ear were
increased from an average of 14 +/- 2 to 31 +/- 5, ciliated cells were decreased 
from 24 +/- 4 to 6 +/- 4, and the number of macrophages in the subepithelial
layer increased from 13 +/- 4 to 27 +/- 3. A single dose of rBPI21 was
administered directly into the middle ear cavity 2 weeks after the induction of
OME. Histologic examination of the middle ear mucosa at 4 and 12 weeks after OME 
induction showed that mucosal changes were restored by rBPI21 treatment. These
results demonstrate that the middle ear mucosa recovers from inflammatory changes
associated with OME after treatment with rBPI21. This suggests that rBPI21 may be
useful in the treatment of OME and of mucosal infections of the respiratory
tract.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11283526 [PubMed - indexed for MEDLINE]

2230: Otolaryngol Head Neck Surg. 2001 Apr;124(4):388-93.

Dosage regimens of intranasal aerosolized surfactant on otitis media with
effusion in an animal model.

Venkatayan N, Connelly PE, Mautone AJ, Troublefield YL, Chandrasekhar SS.

Division of Otolaryngology--Head and Neck Surgery, UMDNJ-New Jersey Medical
School, Newark, 07103-2714, USA.

OBJECTIVE: To determine optimal dosage regimens of intranasal metered dose
aerosolized surfactant with and without other medications in the treatment of
otitis media with effusion (OME). STUDY DESIGN: Resolution of experimental OME in
gerbils was determined based on otomicroscopy and tympanometry. Experimental
intranasal drugs were: surfactant, surfactant with betamethasone, surfactant with
phenylephrine, and a normal saline solution placebo. Medications were
administered once or twice daily via a metered dose inhaler. RESULTS: For
twice-daily dosing, mean days to OME resolution were 8.5 for the aerosolized
surfactant, 6.3 for the surfactant with betamethasone, 18.7 for the surfactant
with phenylephrine, and 16 each for control and placebo. Resolution with the
once-daily dosage was longer for all conditions. Results were comparable using
tympanometry. CONCLUSION: OME resolved faster than the natural course when
treated with intranasal surfactant with and without steroids. Twice-daily dosing 
was statistically superior. SIGNIFICANCE: This study reiterates the effectiveness
of OME treatment with an aerosolized synthetic surfactant with and without
steroids and establishes a superior twice-daily dosage schedule.

PMID: 11283495 [PubMed - indexed for MEDLINE]

2231: Otolaryngol Head Neck Surg. 2001 Apr;124(4):381-7.

A prospective observational study of 5-, 7-, and 10-day antibiotic treatment for 
acute otitis media.

Pichichero ME, Marsocci SM, Murphy ML, Hoeger W, Francis AB, Green JL.

Elmwood Pediatric Group, University of Rochester Medical Center, New York 14642, 
USA. mepo@uhura.cc.rochester.edu

OBJECTIVE: To compare 5-, 7- and 10-day duration of antibiotic therapy for acute 
otitis media (AOM) in children. STUDY DESIGN AND SETTING: Prospective
nonrandomized 1-year evaluation of 3 treatment durations for AOM in a private
pediatric setting. Outcomes assessed at 14 +/- 4 days after start of therapy with
clinical response categorized as cure, improvement, or failure. RESULTS: A total 
of 2172 children were studied; 46.4% were < or =2-years-old. Antibiotics used
were amoxicillin (61.9% of patients), trimethoprim/sulfamethoxazole (11.7%),
cephalosporins (14.2%), amoxicillin/clavulanate (5.2%), and macrolides/azalides
(4.8%). No overall difference in outcome was observed comparing the 5-day (n =
707), 7-day (n = 423), or 10-day (n = 1042) treatments, including children < or
=2-years-old. However, in the subset who had an episode of AOM in the preceding
month, outcome differed; 5-day treatment was followed by more frequent failure
than 10-day treatment (P < 0.001). In logistic regression analysis, variables
identified as contributing to a cure were: >2-years-old (P < 0.0001), no AOM in
the preceding month (P = 0.07), or preceding 12 months (P = 0.03). CONCLUSIONS:
Our study supports the transition from 10 to 5 days for standard AOM antibiotic
treatment duration in most patients. A 10-day regimen may be superior in children
who have experienced an episode of AOM within the preceding month, a known risk
factor for resistant bacterial infection in the otitis-prone patient.

PMID: 11283494 [PubMed - indexed for MEDLINE]

2232: Otolaryngol Head Neck Surg. 2001 Apr;124(4):368-73.

Safety and efficacy of topical mitomycin C in myringotomy patency.

Jassir D, Buchman CA, Gomez-Marin O.

Department of Otolaryngology, University of Miami School of Medicine, FL, USA.

OBJECTIVE: To develop an alternative method for prolonged middle ear ventilation 
using topical mitomycin C. STUDY DESIGN AND SETTING: Twenty guinea pigs with
normal ears had bilateral myringotomies performed using the argon laser. After
myringotomy, either mitomycin C (0.4 mg/mL) or saline pledgets were applied
topically. Monitoring consisted of otomicroscopy and distortion-product
otoacoustic emissions. RESULTS: Before myringotomy, all tympanic membranes were
intact, and distortion-product otoacoustic emissions were measurable. After
myringotomy, none (0%) of the saline-treated myringotomies were patent at day 7
as compared with 100% of the mitomycin C-treated myringotomies. At day 42, 10
(52.6%) of 19 mitomycin-treated myringotomies remained patent and 4 (28.6%) of 14
were patent at 131 days. Five (13.1%) ears developed purulent otorrhea; 3 were
mitomycin C-treated and 2 were treated with saline solution.- Distortion-product 
otoacoustic emissions testing did not document any evidence of ototoxicity.
CONCLUSION: Topical mitomycin C appears to be safe and effective at prolonging
the duration of myringotomy patency in the guinea pig. SIGNIFICANCE: Mitomycin C 
may be useful as an adjunct for preventing myringotomy closure.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11283493 [PubMed - indexed for MEDLINE]

2233: Otolaryngol Head Neck Surg. 2001 Apr;124(4):374-80.

Comment in:
    Otolaryngol Head Neck Surg. 2003 Dec;129(6):759; author reply 759-60.

Meta-analysis of tympanostomy tube sequelae.

Kay DJ, Nelson M, Rosenfeld RM.

Department of Otolaryngology, SUNY Health Science Center at Brooklyn, Brooklyn,
New York, USA.

OBJECTIVE: To estimate the incidence of tympanostomy tube sequelae based on
systematic review of published case series and randomized studies. DATA SOURCES: 
English-language MEDLINE search from 1966 through April 1999 with manual
reference search of proceedings, articles, reports, and guidelines. STUDY
SELECTION: Cohort studies with otitis media as the primary indication for tube
placement. DATA EXTRACTION: Two reviewers independently extracted data from 134
articles. DATA SYNTHESIS: Transient otorrhea occurred in 16% of patients in the
postoperative period and later in 26%; recurrent otorrhea occurred in 7.4% of
patients and chronic otorrhea in 3.8%. Sequelae of indwelling tubes included
obstruction (7% of ears), granulation tissue (5%), premature extrusion (3.9%),
and medial displacement (0.5%). Sequelae after tube extrusion included
tympanosclerosis (32%), focal atrophy (25%), retraction pocket (3.1%),
cholesteatoma (0.7%), and perforation (2.2% with short-term tubes, 16.6% with
long-term tubes). Meta-analysis showed that long-term tubes increased the
relative risk of perforation by 3.5 (95% CI, 1.5 to 7.1) and cholesteatoma by 2.6
(95% CI, 1.5 to 4.4). Similarly, intubation increased the relative risk of
tympanosclerosis by 3.5 (95% CI, 2.6 to 4.9) and focal atrophy by 1.7 (95% CI,
1.1 to 2.7) over nonintubated control ears (baseline tympanosclerosis and atrophy
rates of 10% and 14%, respectively). CONCLUSIONS: Sequelae of tympanostomy tubes 
are common but are generally transient (otorrhea) or cosmetic (tympanosclerosis, 
focal atrophy). Nonetheless, the high incidence suggests a need for ongoing
otologic surveillance of all patients with indwelling tubes and for a reasonable 
time period after tube extrusion. Long-term tubes should be used on a selective
and individualized basis.

Publication Types: 
    Meta-Analysis

PMID: 11283489 [PubMed - indexed for MEDLINE]

2234: Vet Pathol. 2001 Mar;38(2):190-5.

Otitis interna is a frequent sequela to Streptococcus suis meningitis in pigs.

Madsen LW, Svensmark B, Elvestad K, Jensen HE.

Laboratory of Veterinary Pathology, Royal Veterinary and Agricultural University,
Copenhagen, Denmark. lwm@kvl.dk

Twenty-eight histologically confirmed cases of porcine leptomeningitis were
examined retrospectively, with focus on the pathology of the inner and middle
ear, brain, and vestibulocochlear nerve. Tissues were evaluated by histology and 
immunohistochemistry for Streptococcus suis serotype 2 antigen, and the
bacteriologic results were recorded. Exudative otitis interna was diagnosed in
20/28 pigs (71%). The lesions primarily affected the perilymphatic ducts, with
consistent involvement of the scala tympani. Perineuritis of the
vestibulocochlear nerve was seen in all but four of the ears affected with otitis
interna. Immunohistochemically, S. suis serotype 2 antigen was demonstrated in
the leptomeningeal, perineural, and labyrinthine exudates in 11 cases. Otitis
media was diagnosed in 10/28 pigs (34%), but evidence of extension to the inner
ear was not observed. The findings were highly similar to descriptions of
meningogenic labyrinthitis in humans and in laboratory animal models. Otitis
interna in pigs can also develop via the meningogenic route and is not always, as
generally stated, tympanogenic.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11280375 [PubMed - indexed for MEDLINE]

2235: Int J Pediatr Otorhinolaryngol. 2001 Apr 27;58(2):147-52.

Changes in external ear resonance after ventilation tube (Grommet) insertion in
children with otitis media with effusion.

Hong SH, Cho YS, Chung WH, Koh SJ, Seo IS, Woo HC.

Department of Otorhinolaryngology--Head and Neck Surgery, Sungkyunkwan University
School of Medicine, Samsung Medical Center, 50 Ilwon-Dong, Kangnam-Gu, Seoul,
South Korea.

OBJECTIVE: As otitis media with effusion is common in children, the effects of a 
ventilation tube should be taken into account in the prescription of hearing aids
for children. In ears with a ventilation tube, the external auditory canal
communicates directly with the middle ear space, and so the impedance of the
middle ear may change. Consequently, this will affect external-ear resonance. The
aim of this study is to observe the effects of the tympanic membrane perforations
caused by the ventilation tube on external-ear resonance. We selected 30 ears
with otitis media with effusion to measure external-ear resonance before and
after ventilation tube insertion. We compared the external-ear resonance of a
control group with that of the otitis media with the effusion group and two types
of ventilation-tube groups, respectively. In the subjects who have otitis media
with effusion, the average gain of the peak resonance was larger than that in the
control group. After ventilation-tube insertion, the amplitude of the gain
decreased to the same level as the control group, but a characteristic negative
gain appeared around 1000 Hz in about half of all cases. This negative gain was
observed more frequently in the ventilation tube with a larger diameter. The
raised peak resonance gain in the otitis media with effusion group decreased to a
level roughly the same as that of the control group after ventilation-tube
insertion. Provision of an additional gain in the low frequencies around 1000 Hz 
should be considered for patients with a ventilation tube when prescribing
hearing aids.

PMID: 11278023 [PubMed - indexed for MEDLINE]

2236: J Laryngol Otol. 2001 Apr;115(4):316-8.

Recurrent temporal petrositis.

Al-Ammar AY.

Department of Otolaryngology, King Saud University, Faculty of Medicine, Riyadh, 
Kingdom of Saudi Arabia.

The objective of this paper is to present and discuss the common features of
temporal petrositis and the different approaches to its management. Petrositis
used to be common before the antibiotic era. It can be associated with
life-threatening complications. The management of this problem used to be by an
aggressive surgical approach. However, recent reports are describing good results
with more conservative medical treatment and minimal surgical intervention, with 
the reservation of more aggressive surgical interventions for chronic or
refractory cases.

Publication Types: 
    Case Reports

PMID: 11276339 [PubMed - indexed for MEDLINE]

2237: J Laryngol Otol. 2001 Apr;115(4):307-10.

Combined risk factors contributing to cerebral venous thrombosis in a young
woman.

Ram B, Meiklejohn DJ, Nunez DA, Murray A, Watson HG.

Department of Otolaryngology, Aberdeen Royal Infirmary, Aberdeen, UK.

Cerebral venous thrombosis is a rare condition affecting predominantly
adolescents or young adults. The presentation is often non-specific, and delay in
diagnosis is common. The otolaryngologist may be consulted about the radiological
findings of lateral sinus thrombosis and mastoid changes. The association of
congenital thrombophilia with unusual presentations of venous thrombosis,
especially in young individuals is now well documented. We present a case of
lateral and sagittal sinus thrombosis complicated by cerebral venous infarction
in a girl with protein C deficiency and masked mastoiditis. Unusual forms of
venous thrombosis, including cerebral venous thrombosis may develop in
association with a single risk factor for thrombosis, but additional risk factors
should be sought especially when thrombosis presents in very young individuals.
This case draws attention to the multi-causal nature of cerebral venous
thrombosis in young adults, and highlights the issue of masked mastoiditis. A
coordinated approach by otolaryngological and haematological teams is recommended
in such cases.

Publication Types: 
    Case Reports

PMID: 11276336 [PubMed - indexed for MEDLINE]

2238: J Laryngol Otol. 2001 Apr;115(4):304-6.

Facial paralysis in Wegener's granulomatosis of the middle ear.

Bibas A, Fahy C, Sneddon L, Bowdler D.

Department of Otorhinolaryngology, University Hospital Lewisham, London, UK.

A case of Wegener's granulomatosis, which presented as chronic otitis media with 
facial nerve palsy, is described. Early diagnosis is vital if unnecessary
surgical exploration is to be avoided. A false negative cANCA may delay the
diagnosis, especially in cases of locoregional disease, and a policy of repeated 
titres should be adopted, if clinical suspicion is high.

Publication Types: 
    Case Reports

PMID: 11276335 [PubMed - indexed for MEDLINE]

2239: J Laryngol Otol. 2001 Apr;115(4):274-9.

Hearing aids versus ventilation tubes in persistent otitis media with effusion: a
survey of clinical practice.

Ahmmed AU, Curley JW, Newton VE, Mukherjee D.

Fulwood Paediatric Audiology Centre, University of Manchester, Manchester, UK.
ahmmed@man.ac.uk

A postal survey was carried out to determine the current clinical practice
amongst consultant otolaryngologists in the UK, regarding re-insertion of
ventilation tubes or recommendation of hearing aids in cases of recurrence of
otitis media with effusion (OME) after ventilation tube extrusion. Amongst the
319 respondents, 15 (4.70 per cent) routinely, 146 (45.77 per cent) sometimes,
and 158 (49.53 per cent) either never, or very rarely, recommend hearing aids.
Hearing aids and ventilation tubes were both suggested to be equally good options
by some consultants but they preferred surgery for a number of reasons. There
were inconsistencies in practice and some of the reasons for re-inserting
ventilation tubes are not evidence-based. A hearing aid is a non-invasive option 
and this survey shows a need for a randomized control trial of hearing aids and
ventilation tubes in the management of persistent and recurrent OME.

PMID: 11276327 [PubMed - indexed for MEDLINE]

2240: Microb Pathog. 2001 Mar;30(3):111-20.

Expression of molecular markers for bone formation increases during experimental 
acute otitis media.

Melhus A, Ryan AF.

Department of Surgery/Otolaryngology, University of California at San Diego
School of Medicine and Veterans Affairs Medical Center, La Jolla, California,
USA. asa.melhus@mikrobiol.mas.lu.se

Bony tissues are integral parts of the function of the middle ear and the
protection of adjacent vital structures. To explore the reaction of middle ear
bone to acute otitis media, rats were challenged with Streptococcus pneumoniae
and Haemophilus influenzae. Local changes were monitored for up to 1 month. After
reverse transcription, competitive polymerase chain reaction was used to
determine the expression levels of two molecular markers of bone formation,
osteocalcin and procollagen I, and the two cytokines interleukin (IL)-6 and tumor
necrosis factor (TNF)-alpha, in the bone. Middle ear bone responded rapidly to
bacterial challenge, and the reaction depended upon the causative agent. On day
1, IL-6 and TNF-alpha transcripts were detected in the bone from all middle ears.
After a short period of decreased expression of osteocalcin, during which the
otitis diagnosis could not be made clinically, the levels of bone formation
markers increased dramatically. The maximum levels of these markers were reached 
on days 6 and 14 for animals challenged with H. influenzae and pneumococci,
respectively. Infections induced by pneumococci had a longer duration, and after 
the initial phase the production of osteocalcin and procollagen transcript were
significantly higher in the pneumococcus-infected animals. The results indicate
that even in an uncomplicated infection, the bone of the bulla reacts to an acute
otitis media with a short period of inhibited osteoblast activity followed by a
longer period of new bone formation. Copyright 2001 Academic Press.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 11273736 [PubMed - indexed for MEDLINE]

2241: Indian J Med Sci. 2000 Feb;54(2):65-6.

Salmonella senftenberg: ear infection. A case report.

Bairy I, Bhaskaranand N, Shivananda PG.

Deptt of Microbiology, Kasturba Medical College, Manipal 576 119.

A case of Otitis media, a rare complication of Salmonella senftenberg infection
is reported.

Publication Types: 
    Case Reports

PMID: 11271728 [PubMed - indexed for MEDLINE]

2242: Eur Arch Otorhinolaryngol. 2001 Jan;258(1):13-5.

Tympanoplasty with and without mastoidectomy for non-cholesteatomatous chronic
otitis media.

Mishiro Y, Sakagami M, Takahashi Y, Kitahara T, Kajikawa H, Kubo T.

Department of Otolaryngology and Sensory Organ Surgery, Osaka University Graduate
School of Medicine, Suita City, Japan. misiro@ent.med.osaka-u.ac.jp

OBJECTIVES: Cases of non-cholesteatomatous chronic otits media (COM) were
reviewed to determine whether mastoidectomy is helpful when combined with
tympanoplasty for these conditions. STUDY DESIGN: A retrospective analysis of 251
ears with non-cholesteatomatous COM operated on by one surgeon (Y.M.) in an
11-year period was conducted. METHODS: Patients in group A (n = 147) were treated
by tympanoplasty with mastoidectomy. Patients in group B (n = 104) were operated 
on without mastoidectomy. RESULTS: Graft success rates were 90.5% in group A and 
93.3% in group B. There was no statistically significant difference. Graft
success rates of discharging ears were 90.0% in group A and 85.7% in group B.
Graft success rates of dry ears were 90.7% in group A and 94.4% in group B. There
was no statistically significant difference between discharging ears and dry
ears. The rates of the postoperative air-bone gap within 20dB were 81.6% in group
A and 90.4% in group B, without a statistically significant difference.
CONCLUSIONS: Mastoidectomy is not helpful in tympanoplasty for
non-cholesteatomatous COM, even if the ear is discharging.

Publication Types: 
    Comparative Study

PMID: 11271427 [PubMed - indexed for MEDLINE]

2243: Curr Microbiol. 2001 Mar;42(3):190-3.

Comparative analysis between Pseudomonas aeruginosa genotypes and severity of
symptoms in patients with unilateral or bilateral otitis externa.

Matar GM, Harakeh HS, Ramlawi F, Khneisser I, Hadi U.

Department of Microbiology and Immunology, American University of Beirut,
Lebanon. gmatar@aub.edu.lb

Random amplified polymorphic DNA (RAPD) analysis was done on 32 isolates of
Pseudomonas aeruginosa. These isolates were obtained from 22 patients who
presented to the emergency room in a major medical center in Beirut, Lebanon,
during a 5-month period with the diagnosis of either unilateral or bilateral
otitis externa. Patients had yellowish to greenish discharge, moderate to severe 
external auditory canal swelling, moderate to severe pain, and periauricular
cellulitis. None of these patients had intrinsic predisposing factors. An ear
swab was obtained from both ears of patients, cultured on trypticase soy agar. P.
aeruginosa was identified on the basis of pyocyanine production and API
identification kits. RAPD analysis was done by using two primers (10 mer and 21
mer primers) and appropriate PCR conditions on extracted DNA. Our data have shown
23 RAPD patterns (A-W) distributed among the 32 P. aeruginosa isolates. RAPD
patterns were reproducible. Twenty of 32 isolates were recovered from 10 patients
with bilateral otitis externa. The remaining 12 of 32 isolates were recovered
from 12 different patients with unilateral otitis externa. Eleven RAPD patterns
(A,B,C,D,E,F,H,I,R,U,V) were associated with severe clinical symptoms, including 
severe pain, severe external auditory canal swelling, periauricular cellulitis,
and a yellowish discharge. The remaining RAPD patterns were not associated with
severe infections. This denotes a possible association between certain genotypes 
and severity of symptoms.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11270653 [PubMed - indexed for MEDLINE]

2244: Ann Acad Med Singapore. 2000 Nov;29(6):753-6.

Otogenic lateral sinus thrombosis--a case report.

See KC, Leong JL, Tan HK.

National University of Singapore.

INTRODUCTION: We portray and discuss a case of lateral sinus thrombosis following
acute otitis media and mastoiditis. CLINICAL PICTURE: The patient presented with 
otorrhoea, otalgia, neck pain, fever and chills. TREATMENT: Cortical
mastoidectomy was performed. Intravenous antibiotics and heparin were
administered. OUTCOME: The patient had a complete recovery with no sequelae.
CONCLUSIONS: Neurotologic complications of suppurative otitis media like
meningitis, cerebral abscess, extradural abscess and dural sinus thrombosis are
rare in the antibiotic era. Hence, doctors today have to maintain extra vigilance
and a high index of suspicion for such complications.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 11269983 [PubMed - indexed for MEDLINE]

2245: J Microbiol Immunol Infect. 2000 Dec;33(4):237-40.

Mastoiditis: a disease often overlooked by pediatricians.

Cheng MF, Chiou CC, Hsieh KS.

Department of Pediatrics, Veterans General Hospital-Kaohsiung, Taiwan, ROC.

Although mastoiditis can be a life threatening disease, clinicians often overlook
it because it is uncommon. We reviewed the presentation and management of all
children younger than 15 years of age with the discharge diagnosis of mastoiditis
in our hospital from January 1994 through December 1999. Nineteen patients that
fulfilled the case definition were included. The most common clinical
presentation in this series was fever. More specific findings, such as otorrhea, 
postauricular pain, swelling, and redness of mastoid could be found in less than 
half of these patients. Only two patients had characteristic physical findings,
and mastoiditis was diagnosed in only three patients upon admission. Plain
radiographic evidence of mastoiditis was usually not apparent early in the
course. In this series, the majority of patients were diagnosed by computed
tomography (CT) scans. The present study demonstrates that mastoiditis most
commonly presents without a clearly diagnostic set of physical examination and
laboratory findings. Mastoiditis should be considered in patients with otitis
media or with fever of unknown origin (FUO). The empirical antibiotic treatment
should cover organisms commonly found in acute otitis media (AOM), including
Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis.

PMID: 11269368 [PubMed - indexed for MEDLINE]

2246: J Med Liban. 2000 May-Jun;48(3):143-6.

Bacterial etiology of otitis media with effusion in a group of Lebanese children.

Hadi U, Matar GM.

Department of Otolaryngology-Head & Neck Surgery, American University of Beirut
Medical Center (AUBMC) Lebanon. uhadi@dm.net.lb

Identification of the main bacteria causing otitis media with effusion (OME) in a
given population is essential. It indicates the degree of involvement of a given 
bacterium in a particular disease of that population. Knowledge of the most
prevalent bacteria would initiate the search for the mode of acquisition of such 
bacteria and may aid in establishing appropriate control and prevention programs,
which may decrease the incidence of OME. The rapid response of most OME to a
variety of broad-spectrum antimicrobials deprives the clinician from knowing the 
particular bacteriologic agent prevailing in a community. With the emergence of
resistant strains and the change over time of the relative distribution of
bacteriologic agents known to cause OME, the identification of the bacterial
etiology of OME in Lebanese children was initiated.

PMID: 11268567 [PubMed - indexed for MEDLINE]

2247: Vet Parasitol. 2001 Apr 19;96(4):309-15.

Factors affecting the frequency of ear canal and face infestation by Otodectes
cynotis in the cat.

Sotiraki ST, Koutinas AF, Leontides LS, Adamama-Moraitou KK, Himonas CA.

Laboratory of Parasitology and Parasitic Diseases, Faculty of Veterinary
Medicine, Department of Infectious and Parasitic Diseases, Aristotle University, 
GR 54006, Thessaloniki, Greece. sotiraki@vet.auth.gr

Otodectes cynotis is responsible for at least 50% of canker cases diagnosed in
cats world-wide. The role of Demodex cati in the pathogenesis of otitis and acne 
is still obscure. The aims of this study were to estimate the prevalence of O.
cynoyis and D. cati infestations in clinically normal cats in northern Greece, to
determine the factors that are associated with the probability and severity of
infestation in the cat, and to examine the importance of these mites in the
pathogenesis of feline acne. Samples from 161 cats were examined by flushing the 
ear canals and by taking skin scrapings of the chin and lip area. The results
were combined with various factors (sex, age, living style, hair coat type and
presence of pruritus, of ear discharge, of acne-like lesions) in order to carry
out a risk analysis. Two separate logistic regression analyses were performed.
One, on the infestation/non-infestation potential with O. cynotis and the other, 
on the degree of such infestation as mild-to-moderate (< or =5 mites/field) or
severe (>5 mites/field). D. cati was not detected in any of the 161 cats. The
prevalence of O. cynotis was estimated at 25.5% (95% confidence interval (CI)
19-32). The rate of mite infestation was higher with the presence of ear
discharge (odds ratio 9, 95% CI 3.3-24.5), periaural pruritus (odds ratio 3.6,
95% CI 1.8-8) and acne-like lesions (odds ratio 3.3, 95% CI 1.2-9). Cats with
mild-to-moderate degree of infestation had 18 times higher chance of exhibiting
an ear discharge than those with a severe infestation. The log-odds of
mild-to-moderate parasitism were linearly related to the age.

PMID: 11267757 [PubMed - indexed for MEDLINE]

2248: Am Fam Physician. 2001 Mar 1;63(5):927-36, 941-2.

Otitis externa: a practical guide to treatment and prevention.

Sander R.

Department of Family and Community Medicine, Medical College of Wisconsin,
Milwaukee 53226, USA. robert.sander@phci.org

Otitis externa is most commonly caused by infection (usually bacterial, although 
occasionally fungal), but it may also be associated with a variety of
noninfectious systemic or local dermatologic processes. The most characteristic
symptom is discomfort that is limited to the external auditory canal, while the
most characteristic signs are erythema and swelling of the canal with variable
discharge. Excessive moisture and trauma, both of which impair the canal's
natural defenses, are the two most common precipitants of otitis externa, and
avoidance of these precipitants is the cornerstone of prevention. Thorough
cleansing of the canal is essential for diagnosis and treatment, but flushing
should be avoided. Acidification with a topical solution of 2 percent acetic acid
combined with hydrocortisone for inflammation is effective treatment in most
cases and, when used after exposure to moisture, is an excellent prophylactic.
Other prophylactic measures such as drying the ears with a hair dryer and
avoiding manipulation of the external auditory canal may help prevent recurrence.

Publication Types: 
    Review

PMID: 11261868 [PubMed - indexed for MEDLINE]

2249: Vaccine. 2001 Mar 21;19(17-19):2323-8.

Peptide and recombinant antigens for protection against bacterial middle ear
infection.

Bakaletz LO.

The Ohio State University College of Medicine and Public Health, Department of
Pediatrics, Division of Molecular Medicine, Children's Research Institute,
Columbus, OH 43205-2696, USA. bakaletl@pediatrics.ohio-state.edu

Passive immunization of chinchillas with serum specific for either LB1 or for
LPD-LB1 (f)(2,1,3) prior to challenge with heterologous NTHI isolates (relative
to diversity in region three of P5-fimbrin), significantly inhibited the signs
and incidence of otitis media (P < or = 0.01) induced by any of the challenge
isolates. The ability of these antisera to induce total eradication of NTHI from 
the nasopharynx was not however equivalent among challenged cohorts. The data
thus suggested that while early, complete eradication of NTHI from the
nasopharynx was highly protective, reduction of the bacterial load to below a
critical threshold level appeared to be similarly effective. Both immunogens thus
remain strong vaccine candidates.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11257356 [PubMed - indexed for MEDLINE]

2250: Acta Otorhinolaryngol Belg. 2001;55(1):83-6.

Turnover of Haemophilus influenzae isolates in otitis-prone children.

van Kempen M, Dhooge I, Vaneechoutte M, Claeys G.

Department of Otolaryngology, Ghent University Hospital, Belgium.

Arbitrarily primed PCR with primer ERIC2 and RAPD Ready-to-Go beads was applied
to study the epidemiology of non-typable Haemophilus influenzae (NTHI) isolated
from the nasopharynx of children with recurrent otitis media (otitis-prone
children). Thirty-five otitis-prone children (OP-children) were included. Three
pairs of siblings were identified in the study population. This study is part of 
a large prospective multicentric trial investigating the efficacy of a new
conjugated pneumococcal vaccine in OP-children (OMAVAX trial). During a 2-year
study period, NTHI strains were isolated from nasopharyngeal swabs and, when
possible, middle ear aspirates were collected in OP-children between 1 and 6
years of age. In 20 out of the 35 children, 48 H. influenzae isolates were
obtained simultaneously from different sites (left and/or right ear and/or
nasopharynx) of the same child as well as from siblings or during initial and
follow-up visits of the same child. Subsequent genotyping indicated substantial
genetic diversity among the H. influenzae isolates studied, since for a total of 
48 isolates in 20 OP-children, 29 different genotypes were observed. Simultaneous
isolation for different sampling sites (ear or nasopharynx) as well as for
siblings resulted mostly in identical fingerprints. Longitudinal follow-up of H. 
influenzae isolates in the nasopharynx almost always resulted in different
genotypes. We can therefore conclude that both cross colonization (between
sampling sites within the same patient and between siblings) and turnover of H.
influenzae isolates are high in OP-children.

PMID: 11256197 [PubMed - indexed for MEDLINE]

2251: Arch Otolaryngol Head Neck Surg. 2001 Mar;127(3):260-4.

Laser myringotomy in different age groups.

Cohen D, Shechter Y, Slatkine M, Gatt N, Perez R.

Department of Otolaryngology/Head and Neck Surgery, Shaare Zedek Medical Center, 
PO Box 3235, Jerusalem, Israel 91031.

OBJECTIVE: To study the qualities of laser myringotomy (LM) as a treatment for
middle ear ventilation problems. DESIGN: Prospective study and follow-up of
consecutive cases of adults, children, and infants. Patients were observed for up
to 2 years. SETTING: Children underwent LM, with or without adenoidectomy, under 
general anesthesia in the operating room. Adults and infants underwent LM under
topical anesthesia, as an outpatient procedure. PATIENTS: All consecutive
patients with either secretory otitis media (SOM) (adults and children) or acute 
otitis media (AOM) (infants) who agreed to participate were included without
selection. INTERVENTION: Myringotomy was performed using new laser equipment,
enabling a 0.1-second ablation with changeable diameter. OUTCOME MEASURES: Close 
follow-up, with microscopic examination of all ears. Findings were noted on the
medical charts. RESULTS: Among all age groups, 136 ears were followed up.
Perforation lasted a mean 22 days in adults, 17 days in children, and 11 days in 
infants. Patient age was found to be a significant determining factor for
duration of perforation (P =.002). Laser myringotomy in the anterior and inferior
areas lasted longer than posterior LM (P<.001). In patients with SOM, during the 
time the LM was patent, all ears were ventilated. In children, 38% of SOM cases
resolved after a single LM treatment. All infants with AOM recovered promptly
without antibiotic treatment. CONCLUSIONS: Laser myringotomy is a convenient,
quick procedure that can be performed in the medical office with the use of
topical anesthesia and is suitable for patients with AOM or for those who need
short-term ventilation for SOM. It was found to be a safe alternative to
ventilation tubes in these patients. In AOM, it was used instead of antibiotics
and gave prompt relief from symptoms and cure of the AOM.

PMID: 11255469 [PubMed - indexed for MEDLINE]

2252: Int J Pediatr Otorhinolaryngol. 2001 Apr 6;58(1):59-64.

Optimizing effectiveness of laser tympanic membrane fenestration in chronic
otitis media with effusion. Clinical and technical considerations.

Brodsky L, Cook S, Deutsch E, Brookhouser P, Bower C, Waner M, Reilly J, Chait D,
Poje C, Shaha S.

Department of Otolaryngology, State University of New York at Buffalo, School of 
Medicine and Biomedical Sciences, and The Children's Hospital of Buffalo/Kaleida 
Health, 219 Bryant Street, Buffalo, NY 14222, USA. lbrodsky@kaleidahealth.org

OBJECTIVE: To describe the patient, disease and clinical characteristics that
optimize the effectiveness of laser tympanic membrane fenestration (LTMF) to
treat chronic otitis media with effusion (OME). SETTING: Four pediatric
otolaryngology tertiary referral centers. IRB approved; participation by informed
consent. METHODS: An observational clinical effectiveness trial was conducted in 
164 ears (94 children), who had chronic OME. All patients were candidates for
insertion of pressure equalization tubes (PETs) but agreed to undergo LTMF
instead. Clinical and audiologic follow-up are reported at 90 days after LTMF.
OUTCOME MEASURES: Clinical effectiveness was defined as an effusion free middle
ear at otoscopy with A or C1 tympanogram and normal hearing. RESULTS: At 90 days,
66% of the 95 evaluable ears were effusion free, all with normal hearing.
Children younger than 4 years (P<0.04), who had shorter durations of effusion
(P<0.009), and who experienced longer duration of fenestration patency (FP)
(P<0.009) correlated to improved outcomes. CONCLUSIONS: The use of LTMF to create
2--3 weeks of middle ear ventilation in patients with chronic OME (middle ear
effusion (MEE) for 3 months or greater) is effective in 66% of 95 (58%) of ears
evaluable at 90 days follow-up. This study provides basic information needed to
optimize the use of LTMF today and enhance research efforts in the future.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 11249981 [PubMed - indexed for MEDLINE]

2253: Int J Pediatr Otorhinolaryngol. 2001 Apr 6;58(1):47-51.

Comparison of amoxicillin and azithromycin in the prevention of recurrent acute
otitis media.

De Diego JI, Prim MP, Alfonso C, Sastre N, Rabanal I, Gavilan J.

Department of Otorhinolaryngology, La Paz Hospital, Autonomous University,
Madrid, Spain. jidediegompprim@retemail.es

OBJECTIVE: To compare the outcome of patients with recurrent acute otitis media
(AOM) treated either with amoxicillin or with azithromycin. METHODS: This
prospective, controlled, and randomized study, compares the outcome of 71
patients with recurrent AOM treated with azithromycin (31 patients) or
amoxicillin (40 patients) for the prevention of AOM. azithromycin was given at a 
dose of 10 mg/kg once a week, whereas amoxicillin was administered daily as a
single intake of one third of the therapeutic dosage (20 mg/kg per day). All
treatments were prescribed for 3 months. Both groups were homogeneous with regard
to the currently accepted predisposing factors of recurrent AOM. Mean age of
children was 35.3 months, and average follow-up was 11.5 months. The treatment
was considered effective when the number of episodes of AOM dropped to less than 
50% after the prophylaxis. RESULTS: Patients in the azithromycin group had a
clinical response to prophylaxis (80.6%) comparable to those treated with
amoxicillin (89.5%) (P=0.300). The incidence of adverse effects was similar in
both groups. CONCLUSION: According to these results, a prophylaxis with
azithromycin is as useful as amoxicillin to prevent recurrent AOM.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 11249979 [PubMed - indexed for MEDLINE]

2254: Int J Pediatr Otorhinolaryngol. 2001 Apr 6;58(1):1-8.

Observation option toolkit for acute otitis media.

Rosenfeld RM.

Department of Otolaryngology, State University of New York, Health Science Center
at Brooklyn, 339 Hicks Street, Brooklyn, NY 11201, USA. richrosenfeld@msn.com

The observation option for acute otitis media (AOM) refers to deferring
antibiotic treatment of selected children for up to 3 days, during which time
management is limited to analgesics and symptomatic relief. With appropriate
follow-up complications are not increased, and clinical outcomes compare
favorably with routine initial antibiotic therapy. Although used commonly in the 
Netherlands and certain Scandinavian countries, this approach has not gained wide
acceptance in Europe and the United States. This article describes an
evidence-based toolkit developed by the New York Region Otitis Project for
judicious use of the observation option. The toolkit is not intended to endorse
the observation option as a preferred method of management, nor is it intended as
a rigid practice guideline to supplant clinician judgement. Rather, it presents
busy clinicians with the tools needed to implement the observation option in
everyday patient care should they so desire.

Publication Types: 
    Comparative Study

PMID: 11249974 [PubMed - indexed for MEDLINE]

2255: ORL J Otorhinolaryngol Relat Spec. 2001 Mar-Apr;63(2):96-101.

Viral co-infection does not reduce the efficacy of vaccination against
non-typeable Haemophilus influenzae middle ear infection in a rat model.

Moore R, Lidbury BA, Cripps AW, Kyd JM.

Gadi Research Centre, Division of Science and Design, University of Canberra,
Australia.

The mucosal vaccination of rodents with killed non-typeable Haemophilus
influenzae (NTHi) has been previously shown to enhance live NTHi clearance
following middle ear challenge. This study assessed the efficacy of mucosal
anti-NTHi vaccination during a concomitant viral infection of the respiratory
tract. Animals were mucosally immunised with killed NTHi by intra-Peyer's patch
primary inoculation and lung (intratracheal) boost. At the time of both
immunisations rats were also infected intra-nasally with Sendai virus.
Concomitant Sendai virus infection did not influence the efficacy of anti-NTHi
vaccination mediated clearance of NTHi from the middle ear. This would suggest
that immunisation strategies to prevent bacterial middle ear infection would be
effective despite the presence of concomitant viral agents. Copyright 2001 S.
Karger AG, Basel

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11244369 [PubMed - indexed for MEDLINE]

2256: J Infect Dis. 2001 Mar 15;183(6):887-96. Epub 2001 Feb 21.

Pneumococcal carriage and otitis media induce salivary antibodies to pneumococcal
surface adhesin a, pneumolysin, and pneumococcal surface protein a in children.

Simell B, Korkeila M, Pursiainen H, Kilpi TM, Käyhty H.

Department of Vaccines, National Public Health Institute, Helsinki, Finland.

Local antibodies probably contribute to defense against Streptococcus pneumoniae.
This study examined whether pneumococcal carriage and acute otitis media (AOM)
induce mucosal antibodies to potential vaccine candidates pneumococcal surface
adhesin A (PsaA), pneumolysin (Ply), and pneumococcal surface protein A (PspA).
IgA to all 3 proteins was detected by EIA in saliva of 329 children at ages 6,
12, 18, and 24 months and of 17 adults. A higher proportion of IgA-positive
samples and higher antibody concentrations were seen in children with
pneumococci-positive cultures of nasopharyngeal samples or middle ear fluid than 
in children with all cultures negative for pneumococci. The strong correlation
between IgA and the presence of the secretory component suggests that the IgA was
secretory. The findings indicate that pneumococcal carriage and AOM induce local 
production of anti-PsaA, anti-Ply, and anti-PspA antibodies early in life.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11237805 [PubMed - indexed for MEDLINE]

2257: J Infect Dis. 2001 Mar 15;183(6):880-6. Epub 2001 Feb 9.

Antibiotic treatment in acute Otitis Media promotes superinfection with resistant
Streptococcus pneumoniae carried before initiation of treatment.

Dagan R, Leibovitz E, Cheletz G, Leiberman A, Porat N.

Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of
Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.
rdagan@bgumail.bgu.ac.il

Antibiotic-resistant pneumococci are difficult to eradicate from middle ear fluid
(MEF) and the nasopharynx (NP). Bacteriologic eradication from the NP and MEF
during acute otitis media (AOM) by 3 common antibiotic drugs was prospectively
evaluated. In 19 (16%) of 119 MEF culture-positive patients, an organism
susceptible to the treatment drug (Haemophilus influenzae, Streptococcus
pneumoniae, or both) was isolated from the initial MEF, whereas resistant S.
pneumoniae was present in the NP; in 9 (47%) patients, the initial resistant NP
organism (identified by serotyping, resistance to the administered drug, and
pulsed-field gel electrophoresis) replaced the susceptible MEF organism within
only a few days after initiation of treatment. In regions where resistant
pneumococci are prevalent, antibiotics may not only fail to eradicate the
organisms, but they may often induce MEF superinfection with resistant
pneumococci initially carried in the NP. This is an important mechanism by which,
in recently treated patients, AOM infections often become refractory to
treatment.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 11237804 [PubMed - indexed for MEDLINE]

2258: Scand J Infect Dis. 2001;33(2):132-6.

Demonstration of Chlamydia pneumoniae in the adenoid from children with and
without secretory otitis media using immunohistochemistry and PCR.

Engstrand I, Augustsson I, Bergemalm PO, Falck G, Gnarpe J, Gnarpe H.

Department of Otorhinolaryngology and Head and Neck Surgery, Lindesberg General
Hospital, Sweden.

Chlamydia pneumoniae has been found in patients with middle ear inflammation. The
adenoid, which has a central role in the development of secretory otitis media
(SOM), may act as a reservoir for bacteria causing ear infection. Adenoid tissue 
was examined for the presence of C. pneumoniae. Twenty children undergoing
adenoidectomy because of hyperplastic adenoids, 10 with SOM and 10 without SOM,
were examined with nasopharyngeal swabs for routine bacteriological culture,
serology for C. pneumoniae and throat swabs for C. pneumoniae PCR. The removed
tissues were analyzed for C. pneumoniae using immunohistochemical (IHC) analysis 
and PCR. In the group of children with SOM samples were also taken from the
middle ear fluid for routine bacteriological culture and PCR for C. pneumoniae.
C. pneumoniae was found in the adenoid by PCR in 3 cases from each group and from
all 20 children by IHC. Four children in each group had increased levels of
specific antibodies to C. pneumoniae. Two children with SOM had high antibody
titers and a positive PCR from a throat swab. Two children were PCR-positive for 
C. pneumoniae in fluid from the middle ear. The significance of these findings is
not yet clear.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11233849 [PubMed - indexed for MEDLINE]

2259: Int J Lang Commun Disord. 2001 Jan-Mar;36(1):21-42.

A preliminary account of phonological and morphophonological perception in young 
children with and without otitis media.

Petinou KC, Schwartz RG, Gravel JS, Raphael LJ.

City University of New York, USA. kpetinou@logos.cy.net

This investigation examined the effects of otitis media with effusion (OME) and
its associated fluctuating conductive hearing loss on the perception of
phonological and morphophonological /s/ and /z/ in young children. We predicted
that children free of OME (OME-) would perform better than children with
histories of OME (OME+). We also predicted that for the OME+ group morphological 
perception would be harder than phonological perception, because the former
category carries an additional linguistic load (i.e., plurality). Sixteen
children, ages 26 to 28 months (M = 26.5, SD = 0.6) were divided into two groups,
the OME- (n = 8) and OME+ (n = 8) based on OME history during the first year of
life. Subjects in the OME- group were free of the disease for 4/5 visits and pure
tone average (PTA) was 12.6 dB HL (SD = 4.8). Subjects in the OME+ group had the 
disease on 3/5 visits and PTA was 23 dB HL (SD = 2.7). Experimental stimuli were 
six monosyllabic novel word-pairs. Members of each word-pair differed only in the
presence of final voiced or voiceless fricative, marking the targets
phonologically (e.g., [g [symbol: see text]]/[g [symbol: see text] s] as in
'law', 'loss') or morphophonologically (e.g., [daep]/[daeps] as in 'map' 'maps').
Subjects were taught the unfamiliar word pairs using a fast mapping procedure.
Perception was tested with the bimodal preferential looking paradigm. Children in
the OME- group performed significantly better than their OME+ counterparts.
Individual word-pair analyses showed that OME+ group performed more poorly than
the OME- group on one phonological and on two morphological targets, all ending
with [s]. For the OME+ group, targets with final [s] posed greater difficulty
than those with final [z], especially on morphophonological plural-(s) targets.
The results suggested that the fluctuating hearing loss associated with OME might
have a negative impact on speech perception.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11221432 [PubMed - indexed for MEDLINE]

2260: Pediatr Infect Dis J. 2001 Feb;20(2):177-83.

Homeopathic treatment of acute otitis media in children: a preliminary randomized
placebo-controlled trial.

Jacobs J, Springer DA, Crothers D.

Department of Epidemiology, School of Public Health and Community Medicine,
University of Washington, Seattle, USA. jjacobs@igc.org

BACKGROUND: The use of antibiotics in the initial treatment of acute otitis media
is currently being questioned. Homeopathy has been used historically to treat
this illness, but there have been no methodologically rigorous trials to
determine whether there is a positive treatment effect. METHODS: A randomized
double blind placebo control pilot study was conducted in a private pediatric
practice in Seattle, WA. Seventy-five children ages 18 months to 6 years with
middle ear effusion and ear pain and/or fever for no more than 36 h were entered 
into the study. Children received either an individualized homeopathic medicine
or a placebo administered orally three times daily for 5 days, or until symptoms 
subsided, whichever occurred first. Outcome measures included the number of
treatment failures after 5 days, 2 weeks and 6 weeks. Diary symptom scores during
the first 3 days and middle ear effusion at 2 and 6 weeks after treatment were
also evaluated. RESULTS: There were fewer treatment failures in the group
receiving homeopathy after 5 days, 2 weeks and 6 weeks, with differences of 11.4,
18.4 and 19.9%, respectively, but these differences were not statistically
significant. Diary scores showed a significant decrease in symptoms at 24 and 64 
h after treatment in favor of homeopathy (P < 0.05). Sample size calculations
indicate that 243 children in each of 2 groups would be needed for significant
results, based on 5-day failure rates. CONCLUSIONS: These results suggest that a 
positive treatment effect of homeopathy when compared with placebo in acute
otitis media cannot be excluded and that a larger study is justified.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11224838 [PubMed - indexed for MEDLINE]

2261: Pediatr Infect Dis J. 2001 Feb;20(2):140-4.

Comment in:
    Pediatr Infect Dis J. 2001 Oct;20(10):1012-3.

National differences in incidence of acute mastoiditis: relationship to
prescribing patterns of antibiotics for acute otitis media?

Van Zuijlen DA, Schilder AG, Van Balen FA, Hoes AW.

Department of Otorhinolaryngology, University Medical Center Utrecht, The
Netherlands.

BACKGROUND: Operating on the principle that most acute otitis media (AOM)
episodes resolve without antibiotics, doctors in the Netherlands usually manage
AOM in children with initial observation. Prescription of antibiotics is limited 
to children with a complicated course of AOM and those categorized as high risk. 
Consequently only 31% of patients with AOM receives antibiotics, compared with
>90% in most other countries. OBJECTIVE: To substantiate the suggestion that this
restrictive use of antibiotics leads to a higher incidence of acute mastoiditis. 
METHODS: A comparative study across several European countries, Canada, Australia
and the United States was performed in the period 1991 to 1998. The incidence
rate of acute mastoiditis was defined as the total number of patients age 14
years and younger discharged from all hospitals with the primary diagnosis of
acute mastoiditis, during a specified period (usually 5 years), divided by the
number of person years (py) in that same age range and period. The latter was
calculated by totaling the midyear population estimate of children age 14 years
and younger of each year. The 95% confidence intervals and incidence rate ratios 
were calculated to compare the observed rates. RESULTS: The incidence rate of
acute mastoiditis in the Netherlands, with a low antibiotic prescription rate for
AOM, was 3.8/100,000 py; in Norway and Denmark, with high prescription rates, the
incidence rate was comparable at 3.5/100,000 py and 4.2/100,000 py, respectively.
In all other countries with very high prescription rates, incidence rates were
considerably lower, ranging from 1.2 to 2.0/100,000 py. The incidence rate in the
Netherlands was about twice that in the United States (rate ratio, 0.5).
CONCLUSION: The incidence rate of acute mastoiditis in the Netherlands is higher 
than in many countries with higher antibiotic prescription rates. Although the
potential benefits of restricted use of antibiotics (i.e. cost reduction, fewer
side effects from antibiotics and less antimicrobial resistance) are beyond
dispute, such strategy may be associated with a somewhat higher incidence of
acute mastoiditis.

Publication Types: 
    Comparative Study

PMID: 11224830 [PubMed - indexed for MEDLINE]

2262: Hear Res. 2001 Mar;153(1-2):100-7.

Expression of osteopontin by exudate macrophages in inflammatory tissues of the
middle ear: a possible association with development of tympanosclerosis.

Makiishi-Shimobayashi C, Tsujimura T, Sugihara A, Iwasaki T, Yamada N, Terada N, 
Sakagami M.

Department of Otolaryngology, Hyogo College of Medicine, Nishinomiya, Japan.

Tympanosclerosis is a condition leading to a calcification process in the middle 
ear, and often develops after chronic inflammation of the middle ear. Since
osteopontin (OPN) has been shown to participate in the pathological
calcification, we here investigated whether OPN is involved in the process of
calcification in tympanosclerosis. The tympanic membrane and middle ear mucosa,
obtained from patients of tympanosclerosis and chronic otitis media, were
histologically classified depending on the calcification degree. In hyalinized
tissues with macroscopic calcification and fibrous tissues with microscopic
calcification, OPN was immunohistochemically found in the calcification sites. In
inflammatory tissues with microscopic calcification, OPN was also found in the
calcifying foci, and many OPN mRNA-expressing cells, determined by in situ
hybridization, located around their foci. Moreover, immunohistochemical double
staining of OPN and CD68 showed that the OPN-expressing cells were CD68-positive,
indicating these cells were macrophages. In inflammatory tissues without
calcification, immunohistochemistry of CD68 and in situ hybridization of OPN mRNA
revealed that most OPN mRNA-expressing cells were CD68-positive. The expression
of OPN mRNA in inflammatory tissues was also shown by reverse transcriptase
polymerase chain reaction. These results suggest that OPN secreted by exudate
macrophages might be an important regulator in the calcification of
tympanosclerosis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11223300 [PubMed - indexed for MEDLINE]

2263: Br J Gen Pract. 2001 Feb;51(463):132-3.

Comment in:
    Br J Gen Pract. 2001 Apr;51(465):315.

Treatment of acute otitis media: are children entered into clinical trials
representative?

Bain J.

Tayside Centre for General Practice, University of Dundee, Kirsty Semple Way,
Dundee DD2 4AD.

This study involved a meta-analysis of randomised control studies of the
treatment of acute otitis media and judged the characteristics of these trials on
the basis of methods, age groups, interventions, and outcomes. An investigation
of the eight trials reported in the meta-analysis of clinical trials revealed
that the number of children entered per doctor in all practices was low and that 
the recruitment rate was probably lower than 44%. Low recruitment rates indicate 
that the type of children entered into trials may only relate to those with mild 
to moderate symptoms and signs, which could explain why the results of these
trials show that antibiotics are not essential in treating acute otitis media.

Publication Types: 
    Meta-Analysis

PMID: 11217628 [PubMed - indexed for MEDLINE]

2264: Dev Biol (Basel). 2000;103:201-4.

Properties of recombinant HtrA: an otitis media vaccine candidate antigen from
non-typeable Haemophilus influenzae.

Cates GA, Yang YP, Klyushnichenko V, Oomen R, Loosmore SM.

Aventis Pasteur, Toronto, Ontario, Canada.

Non-encapsulated or non-typable Haemophilus influenzae (NTHi) is a major cause of
middle ear infections in young children. HtrA has been identified as a vaccine
candidate antigen from NTHi; therefore physicochemical characterization of this
antigen is important for vaccine development. Recombinant NTHi HtrA has been
expressed in E. coli and shown to have serine protease activity. Several mutant, 
recombinant HtrA proteins were expressed and purified to obtain suitable vaccine 
antigens lacking protease activity. Two mutants with alterations at the putative 
active site His91 and Ser197, designated H91A and S197A were examined by circular
dichroic spectropolarimetry (CD) to evaluate secondary structure. The S197A
mutant had a more random secondary structure compared to wild-type rHtrA or H91A.
It is likely that improper folding of S197A accounts for its lack of
immunoprotective properties in a chinchilla model of otitis media.

PMID: 11214237 [PubMed - indexed for MEDLINE]

2265: J Med Liban. 2000 Jul-Aug;48(4):264-9.

Community-acquired respiratory infections: spectrum of organisms and treatment.

McKellar PP.

Department of Internal Medicine, University of Arizona Medical School, Phoenix
85006, USA. peter@samaritan.edu

The respiratory infections addressed in this paper include otitis media,
sinusitis, and community-acquired pneumonia. The morbidity and mortality of
respiratory infections are assessed from the American standpoint ; their
worldwide significance is even greater. The emphasis is on specific diagnosis.
Treatment options vary from country to country. Therapeutic decisions are usually
easy once a specific etiologic organism is isolated. Since in many of these
common respiratory infections a specific microorganism is not documented and
empiric therapy is designed based on past clinical studies, resistance patterns
need to be known for each country.

Publication Types: 
    Review

PMID: 11214199 [PubMed - indexed for MEDLINE]

2266: Laryngoscope. 2001 Feb;111(2):310-6.

The relationship between dental overbite and eustachian tube dysfunction.

McDonnell JP, Needleman HL, Charchut S, Allred EN, Roberson DW, Kenna MA, Jones
D.

Children's Hospital, Boston, Massachusetts, USA.

OBJECTIVE: The purpose of this study was to investigate the association between
deep dental overbite and eustachian tube dysfunction (ETD). DESIGN: Case-control 
study. SETTING: Tertiary care pediatric otolaryngology outpatient clinic at the
Children's Hospital, Boston, Massachusetts. PATIENTS: 105 patients between the
ages of 2 and 6 years. STUDY MEASUREMENTS: Dental overbite, overjet, and occlusal
relationships were measured by an observer who was unaware of ETD status. ETD was
defined as having ventilation tubes in place or having the recommendation for
ventilation tube placement by an attending pediatric otolaryngologist. In
addition, demographic information and medical and social histories were
prospectively recorded. RESULTS: In a multivariate logistic regression model,
children with deep bites were 2.8 times more likely to have ETD than those
without deep bites (P = .03). Other independent risk factors for ETD identified
in this model were family history of otitis media (OM) and age less than 3 years.
CONCLUSIONS: Children with deep dental overbites are at a significantly increased
risk for developing ETD.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11210881 [PubMed - indexed for MEDLINE]

2267: Laryngoscope. 2001 Feb;111(2):301-5.

Nitric oxide contributes to control of effusion in experimental otitis media.

Ryan AF, Bennett T.

Department of Surgery/Otolaryngology, UCSD School of Medicine and VA Medical
Center, La Jolla, California 92093, USA. aryan@ucsd.edu

OBJECTIVES/HYPOTHESIS: Nitric oxide (NO) is a small, short-lived free radical
involved in cellular signaling and known to play a role in inflammation. It is
generated on demand by the enzyme nitric oxide synthase (NOS) on arginine. We
have previously found that mRNA encoding NOS is produced in the middle ear during
otitis media. The role of NO was therefore explored in an experimental model of
immune-mediated otitis media. STUDY DESIGN AND METHODS: Guinea pigs were
systemically immunized and later challenged in the middle ear with the same
antigen. One ear of each animal was challenged with antigen alone. In the
opposite ear, antigen was combined with a potent inhibitor of NOS,
N(G)-amino-L-arginine (L-NAA). After survival for 24, 48, or 72 hours, the middle
ears were evaluated for otitis media. RESULTS: Inhibition of NOS resulted in
significantly increased middle ear effusion at all three time periods. This
increase was blocked by the addition of excess 1-arginine, which bypasses the
inhibitory effects of L-NAA. The infiltration of cells into the middle ear lumen 
and the hyperplasia of the middle ear mucosa were unaffected by L-NAA
administration. CONCLUSIONS: The results suggest that NO is involved in
regulating the permeability of the middle ear vascular, the transudation of serum
into the middle ear mucosa, and/or the movement of extracellular fluid across the
middle ear mucosal epithelium.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 11210879 [PubMed - indexed for MEDLINE]

2268: Laryngoscope. 2001 Feb;111(2):297-300.

How does endotoxin trigger inflammation in otitis media with effusion?

Schousboe LP, Ovesen T, Eckhardt L, Rasmussen LM, Pedersen CB.

Department of Otolaryngology, Aarhus University Hospital, Denmark.
Schousboe@dadlnet.dk

OBJECTIVES: The relationship among microorganisms, endotoxin, and inflammatory
mediators in otitis media with effusion (OME) was examined. STUDY DESIGN:
Analysis of 152 middle ear effusions aspirated at the time of ventilation tube
insertion from children with OME. METHODS: Effusion samples were cultured for
pathogenic bacteria The two primary cytokines, interleukin-1beta (IL1beta) and
tumor necrosis factor (TNFalpha), and the adhesion molecules, intercellular and
vascular adhesion molecule (ICAM-1 and VCAM-1), were quantified using the
enzyme-linked immunosorbent assay (ELISA) technique. Endotoxin concentration was 
measured with a limulus amebocyte lysate assay, and total protein concentration
was quantified using the Biorad microassay. RESULTS: The cultures of pathogenic
bacteria were positive in 33 of the 152 effusions (22%), which contained more
endotoxin and more of the primary cytokines than the 119 culture-negative
effusions. Endotoxin and the primary cytokines were positively correlated, both
in the whole material and in the sterile effusions alone. The adhesion molecules 
were positively correlated with each other, but not with endotoxin or the primary
cytokines. CONCLUSIONS: We found a positive correlation between endotoxin and the
primary cytokines TNFalpha and IL1beta in culture-positive OME effusions as well 
as in culture-negative ones, suggesting endotoxin-induced local production of
TNFalpha and IL1beta in the middle ear. ICAM-1 and VCAM-1 were also present in
the middle ear, but their concentrations were not directly correlated to
endotoxin or the primary cytokines.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11210878 [PubMed - indexed for MEDLINE]

2269: Laryngoscope. 2001 Feb;111(2):283-9.

Free radical production by antibiotic-killed bacteria in the guinea pig middle
ear.

Takoudes TG, Haddad J Jr.

Department of Otolaryngology--Head and Neck Surgery, Columbia University, College
of Physicians and Surgeons, New York, New York, USA.

OBJECTIVES: Oxygen free radicals are implicated in the pathogenesis of otitis
media Recent investigations with animal models have demonstrated that free
radical-mediated damage of the middle ear mucosa, measured as lipid
hydroperoxide, occurs when the middle ear cavity is inoculated with Streptococcus
pneumoniae. The present study was conducted to examine the effect of antibiotics 
on free radical-mediated damage in pneumococcal acute otitis media. STUDY DESIGN:
Animal model of acute otitis media. METHODS: Seventy-eight guinea pigs underwent 
bilateral middle ear inoculation with 100 microl of 1) sterile saline as a
control, 2) 50 microg/mL amoxicillin, 3) 10(7) colony forming units (CFU)/mL
Streptococcus pneumoniae killed with 50 microg/mL amoxicillin, or 4) 10(7) CFU/mL
S. pneumoniae. Animals were killed on postoperative day 1 or 5, and the middle
ear mucosa was examined for lipid peroxidation as evidence of free radical
damage. RESULTS: Mucosal lipid hydroperoxide was significantly elevated compared 
with control subjects on day 1 in both the antibiotic-killed S. pneumoniae group 
and the S. pneumoniae-infected group. On day 5, the S. pneumoniae-infected mucosa
had significantly higher lipid hydroperoxide levels compared with the
antibiotic-killed group and the control subjects. Histological studies confirmed 
mucosal edema and the presence of inflammatory cells in the infected groups.
CONCLUSIONS: Antibiotic-killed bacteria seem to produce free radical-mediated
damage to the middle ear mucosa in the early phase of acute otitis media. The
clinical implication of this study is that free radical damage to the middle ear 
mucosa may occur in otitis media despite appropriate antibiotic therapy.

PMID: 11210876 [PubMed - indexed for MEDLINE]

2270: Laryngoscope. 2001 Feb;111(2):251-4.

Effectiveness of adenoidectomy and laser tympanic membrane fenestration.

Cook SP, Brodsky L, Reilly JS, Deutsch E, Waner M, Brookhouser P, Pizzuto M, Poje
C, Nagy M, Shaha SH, Chait D, Bower C.

Division of Otolaryngology, Alfred I DuPont Hospital for Children, Wilmington,
Delaware 19899, USA. scook@nemours.org

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 Oto-LAM 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.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 11210870 [PubMed - indexed for MEDLINE]

2271: Acta Otorhinolaryngol Belg. 2000;54(4):443-50.

What future in the 21st century for tibial bone allografts in ossicular chain
reconstruction: the state of the issue.

Vilain J, Courtmans I.

Service ORL, Clinique Saint-Pierre, Ottignies.

After using tibial cortical bone allografts in reconstructing the middle ear over
a period of ten years, the authors analyze their results. They compare the
functional and anatomical outcome at 4 years of 24 patients who received this
allografts with a series of 25 patients who underwent incus transposition.
Results were analyzed in two different ways: the Air Bone Gap and the Glasgow
Benefit Plot. The discussion addresses the techniques used to reduce risks of
iatrogenic transmission of viruses and prions, the current legislation in Belgium
and the comparative costs, after refunding of the various reconstruction
materials. The authors conclude that, because the present-day preparation
techniques offer a certain security with regard to transmission risks and because
of its numerous advantages (mechanical properties, tolerance, cost and
availability), tibial cortical bone still has a promising future.

PMID: 11205446 [PubMed - indexed for MEDLINE]

2272: Ann Otol Rhinol Laryngol. 2001 Jan;110(1):87-90.

Microbiology of serous otitis media in children: correlation with age and length 
of effusion.

Brook I, Yocum P, Shah K, Feldman B, Epstein S.

School of Medicine, George Washington University, Washington, DC, USA.

The purpose of this study was to correlate the microbiology of serous otitis
media in children with the duration of the condition and the patient's age.
Aspirates of serous ear fluids from 114 children were examined for aerobic and
anaerobic bacteria. Bacterial growth was noted in 47 patients (41%). Aerobic
organisms only were recovered in 27 aspirates (57% of the culture-positive
aspirates); anaerobic bacteria only in 7 (15%); and mixed aerobic and anaerobic
bacteria in 13 (28%). A total of 83 bacterial isolates were recovered, accounting
for 1.8 isolates per specimen (1.2 aerobes and 0.6 anaerobe). There were a total 
of 57 aerobic isolates, including Haemophilus influenzae (15 isolates),
Streptococcus pneumoniae (13), and Staphylococcus sp (12). Twenty-six anaerobes
were recovered, including anaerobic gram-positive cocci (10), Prevotella spp (8),
and Propionibacterium acnes (4). The rate of positive cultures (20 of 36; 56%)
was higher in patients younger than 2 years of age than in those older than 2
years of age (27 of 78; 35%). Streptococcus pneumoniae and H influenzae were more
often isolated in children younger than 2 years of age and those with effusion
for 3 to 5 months, whereas anaerobes were recovered more often in those older
than 2 years of age and those with effusion for 6 to 13 months. These data
illustrate the effects of the length of effusion and age on the recovery of
aerobic and anaerobic bacteria in serous otitis media.

PMID: 11201816 [PubMed - indexed for MEDLINE]

2273: Laryngoscope. 2001 Jan;111(1):90-5.

Middle ear effusions and structure of the tympanic membrane.

Wielinga EW, Peters TA, Tonnaer EL, Kuijpers W, Curfs JH.

Department of Otorhinolaryngology, Rijnland Hospital, Leiderdorp, The
Netherlands.

OBJECTIVE: To study the effect of various middle ear effusions on the structure
of the lamina propria of the tympanic membrane. METHODS: Sterile and infective
middle ear effusions were induced by obstruction of the eustachian tube in
specific pathogen-free (SPF) rats and in rats with upper airway infections (URI),
respectively. The condition of the tympanic membrane was monitored at regular
intervals. After varying survival times, the animals were killed and the tympanic
membranes processed for light and electron microscopy. RESULTS: Sterile effusions
always resulted in tympanosclerotic lesions. These lesions did not develop in the
presence of primary-infected effusions. These effusions had a severe destructive 
effect on the lamina propria, followed by fibrosis. Generally, secondary
infection did not markedly affect preexisting tympanosclerotic lesions. Moreover,
calcification disappeared when re-aeration of the middle ear occurred, but the
abnormal collagen depositions persisted. CONCLUSIONS: Both sterile and infective 
effusions result in comprehensive irreversible changes in the lamina propria of
the pars tensa. The development of tympanosclerosis is confined to sterile
effusions. Mechanical injury and compromised vascularization of the lamina
propria are likely to be important etiological factors in the development of
tympanosclerosis.

PMID: 11192907 [PubMed - indexed for MEDLINE]

2274: Laryngoscope. 2001 Jan;111(1):163-7.

Evaluation of the effect of passive smoking on otitis media in children by an
objective method: urinary cotinine analysis.

Ilicali OC, Keleş N, De er K, Sa un OF, Güldíken Y.

Department of Otorhinolaryngology, Instanbul Muncipality Hospital, Turkey.

OBJECTIVES: We aimed to determine objectively the effect of the passive smoking
on otitis media with effusion (OME) and recurrent otitis media (ROM) by using the
method of cotinine urinalysis. STUDY DESIGN: We designed a prospective
case-control study with follow-up of the case group for 1 year after insertion of
tympanostomy tubes to evaluate postoperative complications such as otorrhea and
early extrusion (<6 months), in case a significant risk factor was found.
Methods: One hundred fourteen children between 3 and 8 years of age requiring
tympanostomy tubes because of OME and ROM were chosen and compared with 40
age-matched children. Exposure to environmental tobacco smoke was assessed by
cotinine urinalysis, which was performed by means of the radioimmunoassay method.
RESULTS: In this study, 73.7% (84 of 114) of the children in the case group and
55.0% (22 of 40) of the children in the control group were found to be "exposed" 
(P = .0461). This difference was statistically significant. Comparing the
cotinine urinalysis results with parental smoking histories, 23.1% (9 of 39) of
the children without parental smoking histories were "exposed" to tobacco smoke
versus 84.3% (97 of 115) of the children with parental smoking histories (at
least one person smoking). CONCLUSIONS: Our results indicate that sidestream
smoking increases the risk of OME and ROM. Legal regulations and guidelines must 
be established to protect children from passive smoking. Because cotinine
urinalysis is a noninvasive and reliable method for the determination of passive 
smoking, it can be used for that purpose.

Publication Types: 
    Comparative Study
    Evaluation Studies

PMID: 11192887 [PubMed - indexed for MEDLINE]

2275: Laryngoscope. 2001 Jan;111(1):114-8.

Chronic otitis media sequelae in skeletal material from medieval Denmark.

Qvist M, Grøntved AM.

Department of Otorhinolaryngology, Head and Neck Surgery, Odense University
Hospital, Denmark.

OBJECTIVES: Chronic otitis media sequelae (COMS) have been identified in
archaeological skeletal materials from various ages. COMS reflecting episodes of 
upper respiratory tract infection may be used as a paleopathological indicator of
general health. Estimation of the frequency of COMS may be useful in the gross
evaluation of general standard of living. MATERIALS AND METHODS: Temporal bones
and auditory ossicles from 659 individuals from two Danish medieval rural parish 
cemeteries, dated to 1050-1200 and 1150-1350, respectively, were examined
otomicroscopically. RESULTS: Osseous fistulae from mastoid abscesses, remodelling
of the hypotympanon, and erosion of the incus were among the convincing
indications of COMS. A minimum frequency of COMS of 1% to 7% was found. The
youngest material displayed the highest frequency of pathological changes.
CONCLUSION: Indications of a rising incidence of infectious middle ear disease in
early medieval Denmark were found. This may reflect a deterioration of living
conditions from the 11th through the 14th centuries.

Publication Types: 
    Historical Article

PMID: 11192878 [PubMed - indexed for MEDLINE]

2276: J Trop Pediatr. 2000 Dec;46(6):365-7.

Persistent rhinorrhoea in rural Indian children: prevalence and consequences.

Cherian T, Bhattacharji S, Brahmadathan KN, Lalitha MK, Raghupathy P, Steinhoff
MC.

Departments of Child Health, Christian Medical College and Hospital, Vellore,
India. cheri@cmcvellore.ac.in

To determine whether persistent rhinorrhoea constitutes a significant problem
requiring intervention, 17 rural day care centres (Balwadis) in Tamilnadu, India,
were visited. Among 414 children in the Balwadis 92 (22 per cent) children with
persistent rhinorrhoea (15 days duration or longer) were identified. Demographic 
and clinical data and nasopharyngeal swabs for bacterial culture were obtained
from 56 such children and 91 age-matched controls from the same Balwadi. Type of 
housing or nutritional status did not appear to be significant risk factors.
There was a significantly higher number of children aged 5-15 years in the
household of cases as compared to controls (1.23 +/- 1.08 vs. 0.83 +/- 0.95, p = 
0.02). Other illnesses were noted in 25 (44.6 per cent) cases and seven (7.7 per 
cent) controls (OR 11.5; CI, 4.13-33.4; p < 0.00001). Notably, chronic ear
discharge was noted in 6 (11.7 per cent) cases but in none of the controls (p =
0.007). Streptococcus pneumoniae was isolated from nasopharyngeal swabs in 42/49 
(85.7 per cent) cases and 44/80 (55 per cent) controls (p < 0.001) and H.
influenzae from seven cases and five controls; S. pneumoniae was isolated in all 
children with chronic ear discharge and H. influenzae from one child. Serotypes
of pneumococci commonly associated with otitis media, i.e., types 6, 14, 19, and 
23 were isolated from 25 (51 per cent) cases and 16 (20 per cent) controls (OR
4.17; 95% CI, 1.78-9.85; p < 0.001). Persistent rhinorrhoea, presumably due to
pneumococcus, is a common condition among rural Indian children and appears to be
associated with chronic otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11191150 [PubMed - indexed for MEDLINE]

2277: Clin Perform Qual Health Care. 2000;8(2):93-9.

An evidence-based patient information leaflet about otitis media with effusion.

Kubba H.

Monklands District General Hospital, Scotland.

Leaflets are a useful resource for information provision. Many otolaryngology
patients have poor reading skills, and may have difficulty understanding medical 
jargon. The aim of this project was to produce a patient information leaflet on
otitis media with effusion whose content is based on the best available research 
evidence, and which is presented in a clear format with simple language. Patients
were involved at the planning stage, and in testing the final draft. The leaflet 
was preferred by the majority compared to existing information material and was
felt to be more informative and easier to understand. The leaflet has been given 
the Crystal Mark for clarity of language by the Plain English Campaign. This
study shows that existing guidelines can be used to improve the quality of
written information provision.

PMID: 11184057 [PubMed - indexed for MEDLINE]

2278: Am J Manag Care. 2000 Jul;6(10 Suppl):S526-35.

Childhood vaccination against pneumococcal otitis media and pneumonia: an
analysis of benefits and costs.

Weycker D, Richardson E, Oster G.

Policy Analysis Inc, Brookline, Massachusetts, USA.

OBJECTIVE: To examine the economic benefits and costs of routine vaccination of
children younger than 5 years of age against pneumococcal otitis media and
pneumonia with the pneumococcal conjugate vaccine. STUDY DESIGN: A
decision-analytic model of the cumulative numbers of cases and costs to age 10
years of acute otitis media (AOM), tympanostomy and related procedures (TRP), and
community-acquired pneumonia (CAP) in children who either did or did not receive 
the pneumococcal conjugate vaccine. PATIENTS AND METHODS: Seven hypothetical
cohorts of 1000 children, stratified by age at initial vaccination, were
followed. Outcome measures include costs of vaccination, cumulative numbers of
cases of AOM, TRP, and CAP to age 10 years, and related disease costs, including 
medical treatment and parental work loss. RESULTS: Routine vaccination of 1000
children against pneumococcal infection would cost between $57,000 and $226,000, 
depending on age (the recommended number of doses varies by age at initial
vaccination). Acute otitis media, TRP, and CAP to age 10 years would decline by
139 to 330, 8 to 22, and 15 to 30 cases, respectively; costs of medical treatment
and work loss would correspondingly decline by $56,000 to $138,000. Expected net 
economic benefits (benefits minus costs) of vaccination against pneumococcal
otitis media and pneumonia range from -$88,000 to $15,000 for children less than 
2 years of age, and from -$1,000 to $31,000 for those aged 2 to 5 years at
vaccination. CONCLUSION: Routine vaccination against pneumococcal otitis media
and pneumonia appears to be cost-increasing for children less than 2 years of age
who require multiple doses, but cost-saving for children aged 2 to 5 years who
would require only a single dose of the vaccine.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11183904 [PubMed - indexed for MEDLINE]

2279: Arch Otolaryngol Head Neck Surg. 2001 Feb;127(2):180-3.

Erratum in:
    Arch Otolaryngol Head Neck Surg. 2005 Jul;131(7):582. Kim HY [corrected to Kim,
HH].

Preventing labyrinthitis ossificans: the role of steroids.

Hartnick CJ, Kim HH, Chute PM, Parisier SC.

Department of Pediatric Otolaryngology, Children's Hospital Medical Center, 3333 
Burnet Ave, Cincinnati, OH 45229,USA. harq4k@chmcc.org

OBJECTIVE: To identify a possible relationship between the administration of
steroids at the time of diagnosis of bacterial meningitis and the development of 
labyrinthitis ossificans. DESIGN: Retrospective analysis of the charts of 38
children requiring cochlear implantation who presented with bacterial meningitis 
and then developed bilateral profound deafness. The patients' charts were
reviewed for age at diagnosis, the type of antibiotic administered, and the
administration, dosage, and duration of steroid (dexamethasone) therapy.
Labyrinthitis ossificans was established by preoperative computed tomographic
and/or magnetic resonance imaging and by the intraoperative findings as described
in the operative report. PATIENTS AND METHODS: Patients were 38 children who
received cochlear implantation by a single senior otolaryngologist for bacterial 
meningitis-related deafness. Ten patients' charts (26%) were available for full
review; 9 of these 10 patients had documented pneumococcal meningitis and the
other patient had Haemophilus influenzae-type meningitis. RESULTS: One of the 6
patients who received steroid therapy at the time of initial illness had
documented evidence of labyrinthitis ossificans either radiographically or at the
time of surgery. All 4 patients who failed to receive steroid therapy developed
labyrinthitis ossificans. The results achieve statistical significance by chi2
analysis and a t test (P<.01). CONCLUSION: The results of this retrospective
study are highly suggestive of a role for steroids in preventing the development 
of labyrinthitis ossificans in children with pneumococcal meningitis.

PMID: 11177035 [PubMed - indexed for MEDLINE]

2280: Pediatr Infect Dis J. 2001 Jan;20(1):116-9; discussion 120-2.

Efficacy of ofloxacin and other otic preparations for acute otitis media in
patients with tympanostomy tubes.

Goldblatt EL.

Department of Pediatrics, University of Alabama School of Medicine, Birmingham,
USA. Goldblatte@aol.com

Otorrhea occurs in 21 to 50% of all children with tympanostomy tubes in the
United States. More than 1 million children annually undergo tubomyringotomy,
constituting placement of more than 2 million tympanostomy tubes each year. The
organisms typically responsible for otorrhea are the same as those that cause
otitis media in very young children, including Streptococcus pneumonia,
Haemophilus influenzae and Moraxella catarrhalis. Drainage from tympanostomy
tubes in older children involves organisms that colonize the external auditory
canal, the most common being Pseudomonas aeruginosa and Staphylococcus aureus.
Ofloxacin (Floxin otic), a newer fluoroquinalone antibiotic, has several
advantages over other agents available for the treatment of otorrhea caused by
acute otitis media in patients with tympanostomy tubes. The twice daily dosing
regimen encourages better patient adherence to therapy, which is likely to
improve treatment efficacy. Ofloxacin has not been associated with ototoxicity in
animal models or in children participating in the clinical trials. It provides
coverages for a wide range of pathogens, including Pseudomonas sp., and is
indicated for use in children > or =1 year old and currently approved for
patients > or =12 years with chronic suppurative otitis media. Ofloxacin applied 
topically in children with tympanostomy tubes in place and purulent otorrhea is
as efficacious as oral amoxicillin/clavulanate (Augmentin) therapy. Other
currently available therapeutic options are discussed.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial

PMID: 11176590 [PubMed - indexed for MEDLINE]

2281: Pediatr Infect Dis J. 2001 Jan;20(1):111-5; discussion 120-2.

Efficacy of ofloxacin and other ototopical preparations for chronic suppurative
otitis media in children.

Bluestone CD.

University of Pittsburgh School of Medicine, and the Department of Pediatrics
Otolaryngology, Children's Hospital of Pittsburgh, PA 15213, USA.
Bluestc@chplink.chp.edu

The safety and efficacy of ototopical preparations, such as ofloxacin, in the
treatment of CSOM in infants and children do not currently have approval by the
FDA even though ofloxacin is FDA-approved for treatment of CSOM that occurs in
adults. However, treatment with ofloxacin is FDA-approved when AOM occurs in
children who have a tympanostomy tube in place, and effective treatment of this
acute infection should prevent the subsequent development of CSOM.

Publication Types: 
    Review

PMID: 11176589 [PubMed - indexed for MEDLINE]

2282: Pediatr Infect Dis J. 2001 Jan;20(1):108-10; discussion 120-2.

Efficacy of ofloxacin and other otic preparations for otitis externa.

Ruben RJ.

Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
10467-2401, USA. r.j.ruben@worldnet.att.net

Ofloxacin otic is as effective in curing otitis externa in children (<12 years of
age) as is the preparation combining polymyxin/neomycin plus hydrocortisone and
as ciprofloxacin otic. Furthermore ofloxacin otic, as it requires less frequent
dosing, is likely to encourage greater patient adherence and consequently to
achieve a better cure rate than both of these treatment options. Because a number
of cases of otitis externa are complicated by an undiagnosed tympanic membrane
perforation, the lack of ototoxicity associated with ofloxacin otic makes it a
particularly safe option for use in these patients.

Publication Types: 
    Review

PMID: 11176588 [PubMed - indexed for MEDLINE]

2283: Pediatr Infect Dis J. 2001 Jan;20(1):104-7; discussion 120-2.

Safety of ofloxacin otic and other ototopical treatments in animal models and in 
humans.

Gates GA.

Department of Otolaryngology-Head and Neck Surgery, University of Washington,
Seattle, USA.

To assess the safety of topical agents in the middle ear, animal studies were
reviewed. Compared with aminoglycoside-containing preparations, which caused
significant loss of hair cells in the basal turn of the cochlea, ofloxacin caused
no loss of hair cells, even at concentrations higher than used clinically.
Moreover auditory brainstem testing revealed no change in auditory thresholds in 
the ofloxacin-treated animals, whereas neomycin-treated animals showed
substantial threshold shifts. In human studies, use of topical ofloxacin 0.3% was
not associated with any change in hearing. Topical ofloxacin has no demonstrable 
adverse effects on middle ear or cochlear function.

Publication Types: 
    Review

PMID: 11176587 [PubMed - indexed for MEDLINE]

2284: Pediatr Infect Dis J. 2001 Jan;20(1):102-3; discussion 120-2.

In vitro and in vivo antimicrobial activity of topical ofloxacin and other
ototopical agents.

Klein JO.

Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, MA
02118, USA. jerome.klein@bmc.org

BACKGROUND: Ototopical agents are extensively used for otitis externa (OE), acute
otitis media identified by otorrhea in patients who have tympanostomy tubes
(AOM-TT) and chronic suppurative otitis media (CSOM). The quinolones have
particular value as ototopical agents because of the broad spectrum of
antibacterial activity of importance in otic diseases and the high concentrations
of antibacterial activity at the site of infection. METHODS: A survey of
literature on in vitro activity and microbiologic efficacy in clinical trials of 
quinolone otic products for OE, AOM-TT and CSOM. RESULTS: OE: Floxin otic and
Cortisporin TC otic suspension were equally effective in eradicating the three
major pathogens Pseudomonas aeruginosa, Proteus mirabilis and Staphylococcus
aureus. CSOM: Ofloxacin otic was effective in an open label trial in uniform
eradication of S. aureus, P. aeruginosa, Proteus mirabilis and Enterobacter spp. 
AOM-TT: Ofloxacin otic and amoxicillin/clavulanate (by mouth) were equivalent
clinically; rates of eradication of initial pathogens were similar for
Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, but
ofloxacin otic was superior in eradication of S. aureus and P. aeruginosa
CONCLUSIONS: In each of the studies of OE, CSOM and AOM-TT, ofloxacin otic
solution was effective in eradicating the bacterial pathogen from the site of
infection: equivalent to Cortisporin for children with OE; superior to
amoxicillin/clavulanate for patients with AOM-TT who had acute drainage; and
effective in eradicating bacterial pathogens from the external canal of patients 
with CSOM.

Publication Types: 
    Review

PMID: 11176586 [PubMed - indexed for MEDLINE]

2285: Pediatr Infect Dis J. 2001 Jan;20(1):98-101; discussion 120-2.

Historical perspective on the use of otic antimicrobial agents.

Myer CM 3rd.

Pediatric Otolaryngology Department, Children's Hospital Medical Center,
Cincinnati, OH 45229-3039, USA. myerc0@chmcc.org

Treatment of otorrhea has been described in the literature since 1500 BC. A
multitude of therapeutic options have been described, including the use of
astringents, antiseptics, alcohol, benzoin and various powders. Since the middle 
of the 20th century, antibiotic usage has been promoted as the most effective
means of therapy. Until recently none of the agents that were used was found to
be safe for middle ear use. Since 1990 there have been publications describing
the safety and efficacy of fluoroquinolone drops for acute and chronic otorrhea. 
This article details the transition from treatment of otorrhea with nonspecific
means to an era of antimicrobial therapy based on sound scientific evidence.

Publication Types: 
    Historical Article

PMID: 11176585 [PubMed - indexed for MEDLINE]

2286: Pediatr Infect Dis J. 2001 Jan;20(1):84-5.

Turicella otitidis mastoiditis in a healthy child.

Dana A, Fader R, Sterken D.

Wyeth-Ayerst Laboratories, St. Davids, PA, USA.

Turicella otitidis, a coryneform bacterium, has been associated with acute otitis
media. A 5-year-old girl developed acute mastoiditis. Turicella was isolated from
the right and left middle ear fluid.

Publication Types: 
    Case Reports

PMID: 11176577 [PubMed - indexed for MEDLINE]

2287: Pediatr Infect Dis J. 2001 Jan;20(1):34-9.

Acute otitis media caused by Streptococcus pneumoniae in children's hospitals
between 1994 and 1997.

Wald ER, Mason EO Jr, Bradley JS, Barson WJ, Kaplan SL; US Pediatric Multicenter 
Pneumococcal Surveillance Group.

University of Pittsburgh School of Medicine and Children's Hospital of
Pittsburgh, PA, USA.

OBJECTIVE: To determine patterns of resistance for isolates of Streptococcus
pneumoniae recovered from middle ear fluids of children from eight children's
hospitals between September, 1994, and August, 1997. METHODS: Data were extracted
retrospectively from the medical records of eight children's hospitals. A
standardized data form was completed for each episode of pneumococcal infection. 
Systemic isolates (blood and pleural, synovial and spinal fluids) of S.
pneumoniae were collected during the same period. All isolates of S. pneumoniae
from each center were sent to a central laboratory. Susceptibility to penicillin 
and ceftriaxone was determined by microbroth dilution. Organisms were considered 
nonsusceptible to penicillin if the minimum inhibitory concentration was > or =
0.1 microg/ml and nonsusceptible to ceftriaxone if the minimum inhibitory
concentration was > or = 1.0 microg/ml. RESULTS: S. pneumoniae was recovered from
the middle ear fluids of 707 children from all centers during the study period.
Thirty-nine (5.5%) were infections recorded at 4 centers which evaluated middle
ear fluid only sporadically and were not included in this analysis. The remaining
668 infections reported by the 4 remaining participating hospitals reflect the
experience of 608 children. There were 54% boys; 440 (73%) were Caucasian, 111
(18%) were African-American, 38 (6%) were Hispanic and for 19 (3%) the race was
not recorded. The children ranged in age from 16 days to 13.8 years with a mean
(+/-sD) of 26.0 (+/- 26.1) months. Children who received antibiotics in the 30
days before the middle ear isolate was recovered were more likely to harbor a
resistant strain of S. pneumoniae than children who had not recently received an 
antibiotic (P < 0.001). Isolates recovered from children with spontaneous
otorrhea were more likely to be susceptible to penicillin than isolates recovered
during myringotomy, with or without the insertion of tympanostomy tubes (P <
0.01). There was wide variation in the susceptibility of middle ear isolates to
penicillin and ceftriaxone according to geographic location; however, in every
locale the middle ear isolates were less likely to be susceptible to penicillin
and ceftriaxone than systemic isolates of S. pneumoniae. CONCLUSION: The
prevalence of penicillin-resistant and cephalosporin-resistant S. pneumoniae in
middle ear isolates derived from children cared for at four different children's 
hospitals was quite variable. In some locations the prevalence of resistance is
still increasing, whereas in other areas the rate of resistance was at a plateau 
during the period of surveillance. The prevalence of isolates of S. pneumoniae
susceptible to penicillin and ceftriaxone was always less common among middle ear
isolates than among systemic isolates. Previous antibiotic use remains the most
predictive factor for the recovery of isolates resistant to penicillin and
ceftriaxone.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 11176564 [PubMed - indexed for MEDLINE]

2288: Pediatr Infect Dis J. 2001 Jan;20(1):1-5.

Compliance issues related to the selection of antibiotic suspensions for
children.

Steele RW, Thomas MP, Bégué RE.

Department of Pediatrics, LSU School of Medicine, New Orleans, LA, USA.
RWSteele@aol.com

OBJECTIVE: To evaluate the palatability, cost and other compliance issues as
variables in the selection of antibiotic suspensions for children. METHODS:
Eighty-six physicians and health care personnel randomly sampled amoxicillin
(used as a standard for comparison) and 11 other antibiotics, evaluating them in 
categories of appearance, smell, texture, taste and aftertaste. Overall scoring
was then adjusted for cost, duration of therapy and dosing intervals. RESULTS:
Overall taste (palatability) ranking of antibiotics, highest to lowest, was as
follows: loracarbef, cefdinir, cefixime, azithromycin, ciprofloxacin,
trimethoprim-sulfamethoxazole, clarithromycin, trimethoprim,
amoxicillin/clavulanate, cefpodoxime and cefuroxime. Overall rating of
antibiotics was greatly influenced by other compliance variables, in order of
their impact: cost; duration of therapy (5 vs. 10 days); and dosing intervals.
Cost was not judged to be a major factor by most participants unless antibiotic
expense was >$50.00 for treatment of otitis media in our hypothetical 2-year-old,
13-kg child. Taking all variables into consideration, final ranking from highest 
to lowest was azithromycin, cefdinir, loracarbef, cefixime, amoxicillin,
trimethoprim-sulfamethoxazole, cefpodoxime, trimethoprim, clarithromycin,
ciprofloxacin, cefuroxime and amoxicillin/clavulanate. CONCLUSIONS: Variables
related to compliance for families filling antibiotic prescriptions and children 
taking these products are important in the selection of antimicrobial therapy.
Because final assessment is likely to vary considerably among health care
personnel, decisions must be made on an individual basis.

PMID: 11176558 [PubMed - indexed for MEDLINE]

2289: J Pediatr. 2001 Feb;138(2):266-8.

Surfactant protein-A gene locus associated with recurrent otitis media.

Rämet M, Löfgren J, Alho OP, Hallman M.

Department of Pediatrics, University Central Hospital, and Biocenter Oulu,
University of Oulu, Oulu, Finland.

Surfactant protein-A, which plays a role in innate host defense in the lung, is
also expressed in the Eustachian tube. We report that the frequency of specific
surfactant protein-A haplotypes and genotypes differs between children with
recurrent otitis media compared with a control population.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11174628 [PubMed - indexed for MEDLINE]

2290: ORL J Otorhinolaryngol Relat Spec. 2001 Jan-Feb;63(1):41-5.

Radical meatoplasty in the treatment of severe chronic external otitis.

Haapaniemi J, Laurikainen E, Suonpää J.

Department of Otorhinolaryngology, Head and Neck Surgery, Turku University
Central Hospital, Turku, Finland. jorma.haapaniemi@kaarina.fi

In the beginning, external otitis is an inflammation of the skin of the external 
ear canal. Partial or total obliteration of the meatus causes cleaning problems, 
which worsen the obliteration, and hence, the infection. Immunosuppressive
medication or illness, certain dermatological problems or frequent infections may
lead to irreversible changes and to the malignant form of external otitis with
life-threatening sequelae. Conservative treatments in the beginning are aimed at 
regaining the normal skin functions by helping the cleaning process and curing
the acute infection with repeated irrigation, proper antibacterial medication and
corticosteroids and anti-inflammatory analgesics. In rare prolonged cases,
surgical procedures are needed to help the cleaning process by removing the
irreversibly thickened skin and bone affections, and using grafts. On the basis
of our experience, even the removal of the diseased skin and enlarging of the
external ear canal are insufficient procedures in the most difficult cases. In
the present paper, we describe a new surgical method that we have performed to
treat chronic bilateral obliterative external otitis in 2 patients, with
favorable results. Copyright 2001 S. Karger AG, Basel

Publication Types: 
    Case Reports

PMID: 11174061 [PubMed - indexed for MEDLINE]

2291: N Engl J Med. 2001 Feb 8;344(6):403-9.

Comment in:
    Can Fam Physician. 2002 Nov;48:1777-9.    N Engl J Med. 2001 May 31;344(22):1719-20.    N Engl J Med. 2001 May 31;344(22):1719; author reply 1720.    N Engl J Med. 2001 May 31;344(22):1719; author reply 1720.    N Engl J Med. 2001 May 31;344(22):1719; author reply 1720.    N Engl J Med. 2001 May 31;344(22):1720.

Efficacy of a pneumococcal conjugate vaccine against acute otitis media.

Eskola J, Kilpi T, Palmu A, Jokinen J, Haapakoski J, Herva E, Takala A, Käyhty H,
Karma P, Kohberger R, Siber G, Mäkelä PH; Finnish Otitis Media Study Group.

National Public Health Institute, Helsinki, Finland.

BACKGROUND: Ear infections are a common cause of illness during the first two
years of life. New conjugate vaccines may be able to prevent a substantial
portion of cases of acute otitis media caused by Streptococcus pneumoniae.
METHODS: We enrolled 1662 infants in a randomized, double-blind efficacy trial of
a heptavalent pneumococcal polysaccharide conjugate vaccine in which the carrier 
protein is the nontoxic diphtheria-toxin analogue CRM197. The children received
either the study vaccine or a hepatitis B vaccine as a control at 2, 4, 6, and 12
months of age. The clinical diagnosis of acute otitis media was based on
predefined criteria, and the bacteriologic diagnosis was based on a culture of
middle-ear fluid obtained by myringotomy. RESULTS: Of the children who were
enrolled, 95.1 percent completed the trial. With the pneumococcal vaccine, there 
were more local reactions than with the hepatitis B vaccine but fewer than with
the combined whole-cell diphtheria-tetanus-pertussis and Haemophilus influenzae
type b vaccine that was administered simultaneously. There were 2596 episodes of 
acute otitis media during the follow-up period between 6.5 and 24 months of age. 
The vaccine reduced the number of episodes of acute otitis media from any cause
by 6 percent (95 percent confidence interval, -4 to 16 percent [the negative
number indicates a possible increase in the number of episodes]),
culture-confirmed pneumococcal episodes by 34 percent (95 percent confidence
interval, 21 to 45 percent), and the number of episodes due to the serotypes
contained in the vaccine by 57 percent (95 percent confidence interval, 44 to 67 
percent). The number of episodes attributed to serotypes that are cross-reactive 
with those in the vaccine was reduced by 51 percent, whereas the number of
episodes due to all other serotypes increased by 33 percent. CONCLUSIONS: The
heptavalent pneumococcal polysaccharide-CRM197 conjugate vaccine is safe and
efficacious in the prevention of acute otitis media caused by the serotypes
included in the vaccine.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11172176 [PubMed - indexed for MEDLINE]

2292: Clin Microbiol Infect. 2000 Feb;6(2):69-73.

Pneumococcal acute otitis media in children.

Kouppari G, Zaphiropoulou A, Stamos G, Deliyianni V, Apostolopoulos N, Legakis
NJ.

Microbiology Laboratory, Medical School, University of Athens, M. Asias 75,
Goudi, Athens 11527, Greece.

OBJECTIVES: To evaluate the clinical and laboratory findings of Streptococcus
pneumoniae acute otitis media in children during a 1 year period. METHODS: From
October 1995 to September 1996, 113 children aged 2 months to 14 years (median 18
months), with S. pneumoniae acute otitis media were studied. Susceptibility
testing was performed by the Kirby-Bauer method and the E-test, and serotyping by
the Quellung reaction. RESULTS: E-test assays detected five isolates (4.4%) to be
highly resistant to penicillin and 13 (11.5%) that had intermediate resistance.
All isolates were found to be susceptible to vancomycin, rifampicin and
cefotaxime. In total, 25 isolates (22.1%) were resistant to one or more drugs.
Fifty per cent of the penicillin-resistant or intermediately resistant S.
pneumoniae isolates were resistant to multiple drugs, whereas only 2.1% of the
penicillin-susceptible isolates were resistant to multiple drugs. The
predominating serogroups of the isolates with reduced susceptibility to
penicillin were the 19 (61.1%), 9 (16.7%), 23 (11.1%), 6 (5.5%) and 14 (5.5%)
whereas those of the susceptible isolates were the 19 (26.3%), 14 (13.7%), 3
(11.6%), 6 (11.6%), 9 (8.4%), 1 (5.3%) and 12 (5.3%). CONCLUSIONS: Streptococcus 
pneumoniae isolates from children with acute otitis media were
penicillin-insensitive in 15.9%. The multiresistant S. pneumoniae isolates
belonged to serogroups: 19 (45.4%), 9 (27.3%), 6 (18.2%) and 23 (9.1%).

PMID: 11168075 [PubMed - indexed for MEDLINE]

2293: Int J Pediatr Otorhinolaryngol. 2001 Feb;57(2):137-44.

Why are NICU infants at risk for chronic otitis media with effusion?

Engel J, Mahler E, Anteunis L, Marres E, Zielhuis G.

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital
Maastricht, Maastricht, The Netherlands. jamengel@wxs.nl

Newborns in a Neonatal Intensive Care Unit (NICU) and even later have a high
incidence of otitis media with effusion (OME). It is unclear which aspects play a
role in the incidence of chronic OME during infancy. In order to investigate the 
effect of nasally-placed tubes, cranial growth, immune system, and neuromotor
function on the occurrence of chronic OME, 83 NICU patients were observed
prospectively for middle ear status. Duration and type of treatment with nasal
tubes were obtained from the NICU notes. At the NICU, and 1 and 2 years of age
the cranial circumference and neuromotor function were assessed. As a proxy for
disturbed local immune system parental reports of snoring, mouth breathing and
common cold were used. Multivariate analysis revealed that infants treated with
nasotracheal and nasopharyngeal tubes showed a marginally significant increased
risk for chronic OME (OR=3.2 [95% CI 0.5--21.2]). Treatment with nasogastric
tubes appeared to have a lower risk for chronic OME (OR=1.5 [95% CI 0.1--25.1]). 
No significant effect was found for cranial circumference. Signs of disturbed
local immunity during the first 6 months of life (OR=1.4 [95% CI 0.4--4.7]), as
well as impaired neuromotor function (OR=1.9 [95% CI 0.5--6.8]), showed also a
marginally significant increased risk for chronic OME. The cohort of NICU
patients might be relatively too small in order to find significant effects.
Although the results of this study should be interpreted cautiously, it is
suggested that nasally-placed tubes for ventilatory assistance, disturbed local
immunity and impaired neuromotor function are associated with chronic OME.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11165651 [PubMed - indexed for MEDLINE]

2294: Int J Pediatr Otorhinolaryngol. 2001 Feb;57(2):115-21.

Detection and localization of interleukin-6 in the rat middle ear during
experimental acute otitis media, using mRNA in situ hybridization and
immunohistochemistry.

Forséni M, Melhus A, Ryan AF, Bagger-Sjöbäck D, Hultcrantz M.

Department of Otorhinolaryngology, Karolinska Hospital, Karolinska Institute, 171
76 Stockholm, Sweden. marie.forseni@ood.ki.se

OBJECTIVE: Otitis media is one of the most common diseases among children. A
well-known sequela of acute, chronic, and secretory otitis media is
tympanosclerosis. With the exception of surgery, there is no causal treatment
available for this condition, which may cause hearing disabilities. This study
aimed to describe the localization of interleukin (IL)-6 mRNA and its gene
product in the rat middle ear during pneumococcal otitis media. IL-6 is known to 
be involved in inflammatory and bone remodeling processes. METHODS: Using an
experimental model of pneumococcal acute otitis media, the expression of
interleukin IL-6, was analyzed. Sprague-Dawley rats were sacrificed at different 
time points varying from 1 h to 6 days intervals after inoculation. The middle
ears were analyzed by messenger RNA in situ hybridization, and by
immunohistochemistry with cell-type specific antibodies directed against IL-6.
RESULTS: Transcripts of IL-6 were observed only on day 1 post-inoculation,
whereas the final gene product was observed at all intervals after inoculation.
IL-6 was localized in the bony part of the bulla nearest to the mucosa, around
mucosal vessels, and in the ciliae of the mucosal epithelium. The results
demonstrated that IL-6 was synthesized locally as early as 1 h after bacterial
middle ear challenge, and that although transcription could not be detected after
24 h, the cytokine product persisted for at least 5 days after the infection was 
introduced. CONCLUSIONS: IL-6 was shown to be produced early in the inflammatory 
process during induced pneumococcal otitis media in the rat. No production was
seen after 24 h although the protein remained in the tissue for at least 5 days. 
IL-6 could initiate a differentiation of macrophages to osteoclasts and thereby
participate in a bone remodeling process leading to tympanosclerosis development.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11165648 [PubMed - indexed for MEDLINE]

2295: Int J Pediatr Otorhinolaryngol. 2001 Jan;57(1):79-83.

Comment in:
    Int J Pediatr Otorhinolaryngol. 2002 Jan 11;62(1):81-3.

Conservative management of Gradenigo syndrome in a child.

Marianowski R, Rocton S, Ait-Amer JL, Morisseau-Durand MP, Manach Y.

Department of Pediatric Otorhinolaryngology, Hôpital Necker-Enfants Malades, 11
avenue Franco-Russe, Paris 75007, France. remimarian@aol.com

Gradenigo syndrome consists of the association of otitis media, facial pain in
regions innervated by the first and second division of trigeminal nerve and
abducens nerve paralysis. It is caused by osteitis of the petrous apex (PA) and
is a very rare complication of otitis media. Its treatment usually consists in
mastoidectomy and antibiotics. We report a case of a 6-year-old child, which was 
managed medically with a positive outcome.

Publication Types: 
    Case Reports

PMID: 11165646 [PubMed - indexed for MEDLINE]

2296: Int J Pediatr Otorhinolaryngol. 2001 Jan;57(1):31-40.

Otitis media and academic achievements.

Augustsson I, Engstand I.

Department of Oto-Rhino-Laryngology, Orebro Medical Center Hospital, 70129
Orebro, Sweden.

OBJECTIVE: This is a study of whether there are any long-term differences in
academic achievements between children with and without observed or treated
middle ear disease in a population with a stable long-standing treatment policy. 
METHODS: A birth cohort of 2156 children was previously studied through a
questionnaire to the parents at 4 years of age, follow-up after audiometric
screening at 4, 7, 11 and 14 years of age, and study of records from all Ear,
Nose and Throats departments in the area; 2095 of these still lived in the area
and received academic grades on leaving the ninth year of the state school
system. We have compared these grades, and the choice of high school course for
children with different experiences of otitis media. RESULTS: A history of
treatment for bilateral secretory otitis media was correlated to minor group
difference in the mean of grades, but not to any significant difference in the
individual grades or in the choice of further studies. Having many episodes of
acute otitis before the age of four was uncorrelated to lower grades and to less 
tendency to continue with theoretical studies. CONCLUSIONS: No harmful effect of 
middle ear disease could be shown in a large sample, suggesting that Swedish
children do not suffer long-term effects on learning from otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11165640 [PubMed - indexed for MEDLINE]

2297: Int J Pediatr Otorhinolaryngol. 2001 Jan;57(1):1-9.

Acute mastoiditis--the antibiotic era: a multicenter study.

Luntz M, Brodsky A, Nusem S, Kronenberg J, Keren G, Migirov L, Cohen D, Zohar S, 
Shapira A, Ophir D, Fishman G, Rosen G, Kisilevsky V, Magamse I, Zaaroura S,
Joachims HZ, Goldenberg D.

Department of Otolaryngology, Head and Neck Surgery, Bnai Zion Medical Center, PO
Box 4940, 31048 Haifa, Israel. luntz@csts.co.il

OBJECTIVES: To evaluate the clinical course and identify the causative organisms 
of acute mastoiditis in a community where most of the patients who develop acute 
otitis media are treated with antibiotics. METHODS: A multicenter retrospective
review of a series of 223 consecutive cases of acute mastoiditis. SETTING: Nine
secondary or tertiary academic or non-academic referral centers. RESULTS: Prior
to the diagnosis of acute mastoiditis, 121 of the patients (54.3%) had been
receiving oral antibiotic treatment for acute otitis media for periods ranging
from 1 to 21 days (mean 5.3 days). Samples for bacterial culture were obtained
from 152 patients. Cultures were negative in 60 patients. The organisms isolated 
in the 92 positive cultures were: Streptococcus pneumoniae (15 patients),
Streptococcus pyogenes (14 patients), Staphylococcus aureus (13 patients),
Staphylococcus coagulase negative (three patients), Pseudomonas aeruginosa (eight
patients), Haemophilus influenzae (four patients), Proteus mirabilis (two
patients), Escherichia coli (two patients), Klebsiella pneumoniae (one patient), 
Enterobacter (one patient), Acinetobacter (one patient), anaerobic gram-negative 
bacilli (one patient), and fungi (two patients). Ten patients had mixed flora.
Sixteen patients presented with complications (cerebellar abscess, perisinus
empyema, subdural abscess or empyema, extradural abscess, cavernous sinus
thrombosis, lateral sinus thrombosis, bacterial meningitis, labyrinthitis,
petrositis, or facial nerve palsy). CONCLUSIONS: Antibiotic treatment cannot be
considered an absolute safeguard against the development of acute mastoiditis.
Early myringotomy for acute otitis media seems to decrease the incidence of
complications. The distribution of causative organisms in acute mastoiditis
differs from that in acute otitis media. Intracranial complications in acute
mastoiditis are not rare. Because of the diversity of causative organisms in
acute mastoiditis and the growing resistance of bacteria to the various
antibiotics, all means to obtain a sample for culture prior to antibiotic
treatment, including general anesthesia.

Publication Types: 
    Multicenter Study

PMID: 11165635 [PubMed - indexed for MEDLINE]

2298: Vaccine. 2000 Dec 8;19 Suppl 1:S144-7.

Xylitol in preventing acute otitis media.

Uhari M, Tapiainen T, Kontiokari T.

Department of Paediatrics, University of Oulu, FIN-90220 Oulu, Finland.
matti.uhari@oulu.fi

Xylitol is a polyol sugar alcohol and is referred to as birch sugar, because it
can be produced from birch. Natural sources of xylitol include plums,
strawberries, raspberries and rowan berries. Xylitol inhibits the growth of
Streptococcus pneumoniae and it inhibits the attachment of both pneumococci and
Haemophilus influenzae on the nasopharyngeal cells. In two clinical trials
xylitol was found efficient to prevent the development of acute otitis media with
a daily dose of 8.4-10 g of xylitol given in five divided doses. The efficacy in 
these 2-3 months follow-up trials was approximately 40% when chewing gum was used
and approximately 30% with xylitol syrup. The need to use antimicrobials reduced 
markedly when using xylitol. In a high-risk group of children with tympanostomy
tubes xylitol was ineffective in preventing otitis. Xylitol appears to be an
attractive alternative to prevent acute otitis media. A more practical frequency 
of doses should be found before its use can be widely recommended.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't
    Review

PMID: 11163479 [PubMed - indexed for MEDLINE]

2299: Vaccine. 2000 Dec 8;19 Suppl 1:S134-9.

Surgical prevention of otitis media.

Rosenfeld RM.

Department of Otolaryngology, SUNY Health Science Center at Brooklyn, 339 Hicks
Street, Brooklyn, NY 11201, USA. richrosenfeld@msn.com

Increasing concerns over drug-resistant bacteria mandate that alternative methods
of treatment and prevention, including surgery, be considered to reduce
antibiotic usage for acute otitis media (AOM). Meta-analysis of five randomized
trials of tubes versus no surgery showed a mean absolute decrease in AOM
incidence of 1.0 episode per child-year (95% CI, 0.4-1.6), with a relative
decrease of 56%. Similarly, the prevalence of middle-ear effusion decreased by
115 days per child-year (95% CI, 11-220). Within several weeks of tube placement 
79% of children had improved quality of life, 17% had trivial change, and 4% were
worse. Systematic review of 134 articles revealed transient post-operative
otorrhea in 16% of patients with tubes, and later in 26%; recurrent otorrhea
occurred in 7.4% of patients and chronic otorrhea in 3.8% Adenoidectomy reduced
AOM incidence by 0.32 episodes per child-year (95% CI, 0.03-0.61) for a 3-year
period in one study (26% relative decrease), but the effect was only significant 
for children with prior tubes. Surgical therapy of otitis media offers
significant benefits and is an effective prevention strategy in selected
children.

Publication Types: 
    Meta-Analysis

PMID: 11163477 [PubMed - indexed for MEDLINE]

2300: Vaccine. 2000 Dec 8;19 Suppl 1:S129-33.

Otitis media prevention: non-vaccine prophylaxis.

Giebink GS.

Department of Pediatrics and Otolaryngology, Otitis Media Research Center,
University of Minnesota School of Medicine, Minneapolis, MN 55455, USA.
giebi001@tc.umn.edu

Preventing recurrent acute otitis media (AOM) is a goal of child health care. The
objective is to reduce the frequency of pain and fever, shorten the duration of
hearing loss, reduce the costs of physician visits, surgery and drugs, reduce
parent anxiety, and prevent long term sequelae. Preventive approaches include
understanding individual and familial risk factors, avoidance of environmental
risk factors, antibiotic drug prophylaxis, polyvalent pneumococcal vaccination,
myringotomy with tympanostomy tubes, and adenoidectomy. Earlier and more
aggressive treatment can be provided to infants at increased risk. Antibiotic
prophylaxis is challenged by a relatively small benefit and emerging resistant
bacteria. Tympanostomy tubes are beneficial in chronic otitis media with effusion
(OME), but of less value in recurrent AOM absent chronic OME. Adenoidectomy after
tympanostomy tube failure is supported by at least one clinical trial.

Publication Types: 
    Review

PMID: 11163476 [PubMed - indexed for MEDLINE]

2301: Vaccine. 2000 Dec 8;19 Suppl 1:S116-21.

Passive immunization for the prevention of otitis media.

Englund JA, Glezen WP.

Department of Pediatrics, University of Chicago Hospitals, Chicago, IL 60637,
USA.

The safety and protective efficacy of exogenously-administered immunoglobulin for
the prevention of otitis media has been demonstrated in the clinical trials of
the human-derived polyclonal immune globulin used to prevent Haemophilus
influenzae type b disease and respiratory syncytial virus infection in high risk 
neonates and young children. However, this form of therapy is expensive,
difficult to administer due to the requirements of slow intravenous infusion or
relatively large volumes given intramuscularly, and associated with side effects 
related to the volume and nature of the immunoglobulin preparation. In contrast, 
RSV-specific monoclonal antibody has not been as successful as human-derived
immunoglobulin in preventing otitis media in high risk infants. The
administration of monoclonal-antibody for the prevention of otitis media will be 
difficult, potentially due to the need for antibody to multiple epitopes of the
viral and bacterial pathogens which could be targets. The use of maternal
antibody to provide passive immunity to young infants at a time when they are
most vulnerable to severe sequelae of infection can also be considered. We have
studied maternal immunization using either a 23-valent pneumococcal
polysaccharide vaccine or a conjugate H. influenzae type b (Hib) vaccine.
Significant levels of maternally-derived Hib or pneumococcal antibody were
transferred from the mother to the infant at the time of birth and persisting,
for some antigens, through 2 months of age. The use of maternal immunization to
prevent otitis media and other respiratory complications remains to be studied,
but results of these small clinical trials indicate further clinical
investigation is warranted.

PMID: 11163474 [PubMed - indexed for MEDLINE]

2302: Vaccine. 2000 Dec 8;19 Suppl 1:S101-7.

Vaccines for Moraxella catarrhalis.

McMichael JC.

Wyeth-Lederle Vaccines, 211 Bailey Road, West Henrietta, NY 14586-9728, USA.
mcmichj@war.wyeth.com

Vaccine development for Moraxella catarrhalis is in the antigen identification
stage. M. catarrhalis does not appear to synthesize secreted antigens such as
exotoxins, nor does it appear to possess a carbohydrate capsule. Modified forms
of these antigens are usually good vaccine components. There is some interest in 
whole bacterial cells and membrane fractions, but the search has largely focused 
on purified outer surface antigens. All of the present antigens have been
selected based on the response seen in animals, although the antibody response
seen in people exposed to the bacterium provides some guidance. The antibody
response provides information related to the cross-strain preservation of
epitopes and whether they are surface exposed. Antigens that elicit antibodies
that have complement dependent bactericidal capacity, opsonophagocytic activity
or interfere with one of the antigen's known functions such as adhesion or
nutrient acquisition are particularly valued. In addition to examining the
antibody response, some antigens have been evaluated in a murine pulmonary
clearance model. Using these assays and model, several vaccine candidates have
been identified. The antigens may be roughly classified by the function they
serve the bacterium. One set appears to promote adhesion to host tissues and
includes the hemagglutinins, ubiquitous surface protein A1 (UspA1), and possibly 
the CD protein. A second set is involved in nutrient acquisition. This set
includes the lactoferrin binding protein A (LbpA) and lactoferrin binding protein
B (LbpB), the transferrin binding protein A (TbpA) and transferrin binding
protein B (TbpB), the CD and E porins, and the Catarrhalis outer membrane protein
B (CopB). A third set is comprised of antigens involved in virulence and it
includes lipooligosaccharide (LOS) and the ubiquitous surface protein A2 (UspA2).
Antigens of unknown function, such as the 200K protein, may also be vaccine
candidates. The antigens that are most suitable will be determined in clinical
studies that are only beginning now.

Publication Types: 
    Review

PMID: 11163472 [PubMed - indexed for MEDLINE]

2303: Vaccine. 2000 Dec 8;19 Suppl 1:S96-9.

Acute otitis media in the era of effective pneumococcal conjugate vaccine: will
new pathogens emerge?

Pelton SI.

Section of Pediatric Infectious Diseases, Boston Medical Center, Boston
University School of Medicine, 774 Albany Street-Suite 512, Boston, MA 02118,
USA. spelton@bu.edu

The immunogenicity of pneumococcal conjugate vaccine (PCV) in young infants and
its serotype-specific efficacy in otitis media (OM) results in a modest reduction
in total episodes of OM and a more substantial reduction in disease due to the
most frequent pneumococcal serotypes. Since PCV will only prevent disease due to 
the most common serotypes, concerns about potential changes in the microbiology
of OM have emerged. Insight into potential changes can be obtained from reviewing
middle ear and nasopharyngeal isolates from studies of antimicrobial prophylaxis 
and bacterial polysaccharide immune globulin for prevention of OM and PCV for
prevention of invasive pneumococcal disease, respectively. In children receiving 
PCV, a shift in serotypes of SP colonizing the nasopharynx has been observed.
Since non-vaccine serotypes are already present in the community as the etiology 
of acute purulent OM, it is predictable that these non-vaccine serotypes will
become more common especially in children less than two years of age.

Publication Types: 
    Comparative Study
    Review

PMID: 11163471 [PubMed - indexed for MEDLINE]

2304: Vaccine. 2000 Dec 8;19 Suppl 1:S87-95.

The potential for using protein vaccines to protect against otitis media caused
by Streptococcus pneumoniae.

Briles DE, Hollingshead SK, Nabors GS, Paton JC, Brooks-Walter A.

Department of Microbiology, University of Alabama at Birmingham (UAB),
Birmingham, AL 35294-2170, USA. dbriles@uab.edu

Potential vaccine strategies against otitis media are to prevent (1) symptomatic 
infections in the middle ear and/or (2) carriage of pneumococci and thereby
subsequent middle ear infections. The possibility of using immunity to virulence 
proteins of pneumococci to elicit immunity against pneumococci has been examined.
PspA has been found to have efficacy against otitis media in animals. Vaccination
with a mixture of PsaA and PspA has been observed to offer better protection
against nasal carriage in mice, than vaccination with either protein alone. PspA 
and pneumolysin have been shown to elicit protection against invasive infections.
The inclusion of a few of these proteins into the polysaccharide-protein
conjugate vaccines may be able to enhance their efficacy against otitis media and
might be able to constitute a successful all-protein pneumococcal vaccine.

Publication Types: 
    Comparative Study
    Review

PMID: 11163470 [PubMed - indexed for MEDLINE]

2305: Vaccine. 2000 Dec 8;19 Suppl 1:S78-82.

Polysaccharide-based pneumococcal vaccines in the prevention of acute otitis
media.

Eskola J.

Aventis Pasteur, 60 avenue Leclerc, 69007, Lyon, France.
juhani.eskola@aventis.com

New pneumococcal vaccines, consisting of 7-11 capsular polysaccharides coupled to
protein carriers, are able to induce functionally active humoral and mucosal
antibody responses. They also reduce mucosal carriage of pneumococci in the
vaccinees. Preliminary results from efficacy trials suggest that about one-third 
of pneumococcal otitis could be prevented by using the seven-valent pneumococcal 
conjugate vaccine. If these efficacy estimates are true throughout childhood, up 
to 1.2 million episodes of acute otitis are preventable annually in the US. The
true impact of the vaccine on otitis burden is dependent not only on the efficacy
as demonstrated in the efficacy trials but also on the impact of the vaccine on
the mucosal carriage of bacteria and on the herd immunity induced by
vaccinations. Ongoing follow-up studies will reveal whether these factors
increase or decrease the efficiency of the proposed vaccination programme.

PMID: 11163468 [PubMed - indexed for MEDLINE]

2306: Vaccine. 2000 Dec 8;19 Suppl 1:S71-7.

Pneumococcal otitis media and pneumococcal vaccines, a historical perspective.

Austrian R.

Department of Molecular and Cellular Engineering, School of Medicine, The
University of Pennsylvania, Philadelphia, PA 19104-6088, USA.

Although pneumococcal otitis media was recognized in the 19th century, the
illness stimulated little interest in prophylaxis until recently. Whole cell
vaccines of killed pneumococci, developed to prevent pneumonia, were replaced by 
vaccines of capsular polysaccharides following demonstration of their
antigenicity in adults. Failure of the latter to stimulate antibodies in infants 
and young children and demonstration of the efficacy of capsular
polysaccharide-protein conjugate vaccines in preventing infection with Hemophilus
influenzae type b has led to the development of polyvalent pneumococcal
polysaccharide-protein conjugate vaccines. Preliminary studies have shown them to
be highly effective in preventing invasive pneumococcal disease in the first 2
years of life, and studies of their impact on otitis media are currently in
progress.

Publication Types: 
    Historical Article

PMID: 11163467 [PubMed - indexed for MEDLINE]

2307: Vaccine. 2000 Dec 8;19 Suppl 1:S66-70.

Influenza virus and rhinovirus-related otitis media: potential for antiviral
intervention.

Hayden FG.

Department of Internal Medicine, University of Virginia School of Medicine, Box
800473, Charlottesville, VA 22908, USA. fgh@virginia.edu

Adults frequently develop eustachian tube dysfunction and middle ear pressure
(MEP) abnormalities during natural and experimental influenza and human
rhinovirus (HRV) infections. Oral rimantadine treatment did not reduce the
otologic manifestations of experimental influenza in adults or natural influenza 
in children. However, intranasal zanamivir and oral oseltamivir significantly
reduced MEP abnormalities during experimental influenza in adults, and
oseltamivir treatment appears to reduce the likelihood of otitis media in
children with acute influenza. Investigational anti-HRV agents, including
intranasal tremacamra, intranasal AG7088, and oral pleconaril, warrant study in
this regard. Depending on the virus, early antiviral therapy has the potential to
impact the risk of otitis media following respiratory tract infections.

Publication Types: 
    Review

PMID: 11163466 [PubMed - indexed for MEDLINE]

2308: Vaccine. 2000 Dec 8;19 Suppl 1:S59-65.

Respiratory syncytial virus vaccines for otitis media.

Anderson LJ.

Division of Viral and Rickettsial Diseases, Centers for Disease Control and
Prevention, Mailstop A34, 1600 Clifton Road, Atlanta, GA 30333, USA. lja2@cdc.gov

RSV is a high priority for vaccine development because of its propensity to cause
pneumonia and bronchiolitis in the infant and young child. Since RSV infection is
likely to be a substantial contributor to otitis media, a vaccine could also
decrease rates of this disease. No vaccine has yet been developed but it is hoped
that the availability of an RSV infectious clone will make it possible to develop
a live virus vaccine for the infant and young child. Subunit RSV vaccines are
being developed for previously infected persons, i.e. in older children at high
risk for RSV disease and the elderly. An effective RSV vaccine for the infant and
young child could markedly decrease otitis media disease.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 11163465 [PubMed - indexed for MEDLINE]

2309: Vaccine. 2000 Dec 8;19 Suppl 1:S56-8.

Prevention of acute otitis media by prophylaxis and treatment of influenza virus 
infections.

Glezen WP.

Molecular Virology and Microbiology, Influenza Research Center at Baylor College 
of Medicine, One Baylor Plaza, Suite 221D, Houston, TX 77030, USA.
wglezen@bcm.tmc.edu

Human experimental challenge studies with influenza virus infection and
controlled intervention trials have demonstrated beyond doubt the role of
influenza virus infection in the pathogenesis of acute otitis media. Influenza
virus infections not only disrupt eustachian tube function, but also impair
recovery from infection and facilitate attachment of bacterial pathogens to
respiratory epithelial cells. Immunization of young children with either
inactivated or live, attenuated influenza vaccine will significantly reduce the
incidence of acute otitis media. Early treatment of influenza with antiviral
medication will reduce eustachian tube dysfunction that results from influenza
virus infection. Influenza produces high morbidity in children that could be
averted by universal immunization with attenuated nasal spray vaccine.

Publication Types: 
    Review

PMID: 11163464 [PubMed - indexed for MEDLINE]

2310: Vaccine. 2000 Dec 8;19 Suppl 1:S51-5.

The role of respiratory viruses in otitis media.

Heikkinen T.

Department of Pediatrics, Turku University Hospital, FIN-20520 Turku, Finland.
terho.heikkinen@utu.fi

Evidence derived from numerous studies ranging from animal experiments to
extensive clinical trials supports a crucial role for respiratory viruses in
acute otitis media. Viral infection of the upper respiratory tract initiates the 
whole cascade of events that ultimately leads to development of acute otitis
media, and viruses contribute to the pathogenesis of this disease by several
mechanisms. Recent data indicate that at least some types of viruses actively
invade the middle ear and may also interfere with the outcome of otitis media.
The availability of effective vaccines against the principal viruses predisposing
to acute otitis media could be expected to result in a substantial reduction in
the incidence of this disease.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 11163463 [PubMed - indexed for MEDLINE]

2311: Vaccine. 2000 Dec 8;19 Suppl 1:S41-50.

The pathogenesis of nontypable Haemophilus influenzae otitis media.

St Geme JW 3rd.

Edward Mallinckrodt Department of Pediatrics, Washington University School of
Medicine, 660 South Euclid Ave., Campus Box 8208, St Louis, MO 63110, USA.

Nontypable Haemophilus influenzae is a common cause of otitis media and initiates
infection by colonizing the upper respiratory tract. In this article, I review
our current understanding of the molecular determinants of H. influenzae
colonization and discuss the relationship between colonization and otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 11163462 [PubMed - indexed for MEDLINE]

2312: Vaccine. 2000 Dec 8;19 Suppl 1:S38-40.

Pathogenesis of pneumococcal inflammation: otitis media.

Tuomanen EI.

St Jude Children's Research Hospital, 332 N. Lauderdale Road, Memphis, TN 38139, 
USA. elaine.tuomanen@stjude.org

Pneumococci cause damage to the ear in otitis media and in association with
bacterial meningitis. The pathogenesis of injury involves host response to cell
wall and pneumolysin. Release of cell wall, particularly during
antibiotic-induced bacterial lysis, leads to an influx of leukocytes and
subsequent tissue injury. The signal transduction cascade for this response is
becoming defined and includes CD14, Toll-like receptor 2, NFkB, and cytokine
production. The second source of injury is the cytotoxicity of the pore forming
toxin, pneumolysin. Decreasing the sequelae of otitis can be achieved by an
increased understanding of the site-specific mechanisms of pneumococcal-induced
inflammation.

Publication Types: 
    Review

PMID: 11163461 [PubMed - indexed for MEDLINE]

2313: Vaccine. 2000 Dec 8;19 Suppl 1:S26-31.

The nasopharynx and the middle ear. Inflammatory reactions in middle ear disease.

Rynnel-Dagöö B, Agren K.

Department of Clinical Sciences, Division of Oto-Rhino-Laryngology, Karolinska
Institutet, Huddinge University Hospital, 17177, Stockholm, Sweden.
britta.rynnel@klinuet.ki.se

The host-parasite interactions in the nasopharynx with bacterial colonization and
antigen uptake in the lymphoid tissue, the adenoid, has an impact on the
maturation of local and systemic immunity. The adenoid is a part of mucosa
associated lymphoid tissue and is responsible for both effector and inductor
functions in the nasopharynx. Increasing evidence supports the role of serum
antibody in protecting the middle ear cavity from disease. There is evidence for 
a minor immunologic defect in a number of children with recurrent episodes of
AOM.

Publication Types: 
    Review

PMID: 11163459 [PubMed - indexed for MEDLINE]

2314: Vaccine. 2000 Dec 8;19 Suppl 1:S17-25.

Cell biology of tubotympanum in relation to pathogenesis of otitis media - a
review.

Lim DJ, Chun YM, Lee HY, Moon SK, Chang KH, Li JD, Andalibi A.

The Leslie and Susan Gonda Department of Cell and Molecular Biology, House Ear
Institute, 2100 West Third Street, Los Angeles, CA, USA. dlim@hei.org

The sterility of the eustachian tube and tympanic cavity of normal individuals is
maintained not only by the adaptive immune system, but also by the mucociliary
system and the antimicrobial molecules of innate immunity. Mucin production and
periciliary fluid homeostasis are essential for normal mucociliary function and
dysfunction of this system is an important risk factor for otitis media. The
secreted antimicrobial molecules of the tubotympanum include lysozyme,
lactoferrin, beta defensins, and the surfactant proteins A and D (SP-A, SP-D).
Defects in the expression or regulation of these molecules may also be the major 
risk factor for otitis media.

Publication Types: 
    Review

PMID: 11163458 [PubMed - indexed for MEDLINE]

2315: Vaccine. 2000 Dec 8;19 Suppl 1:S9-S16.

Treatment of acute otitis media - challenges in the era of antibiotic resistance.

Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, 
Israel. rdagan@bgumail.bgu.ac.il

The last decade is characterized by the increase in antibiotic resistance among
respiratory bacterial pathogens in the presence of only modest progress in the
development of new antibacterial agents to overcome this resistance. A series of 
recent studies show clearly that the increased resistance among the main AOM
pathogens (namely Streptococcus pneumoniae and Haemophilus influenzae) is
associated with a dramatic decrease in bacteriologic response to antibiotic
treatment, which in turn has an impact on clinical response. Thus, the individual
patient is affected by the increasing antibiotic resistance. Moreover, the
society as a whole is now also affected because the carriage and spread of
antibiotic resistant AOM pathogens is remarkably impacted by antibiotic
treatment. New studies show the remarkable ability of antibiotics to rapidly
promote nasopharyngeal carriage and spread of antibiotic-resistant AOM pathogens.
In these studies, the increase in carriage of antibiotic resistant S. pneumoniae 
is shown already after 3-4 days from initiation of antibiotic treatment and may
last for weeks to months after treatment. Children carrying antibiotic-resistant 
organisms transmit those organisms to their family and to their day care centers 
and thus a vicious cycle is created in which increased antibiotic resistance with
decreased response leads to increased antibiotic use, which in turn leads to
further increase in resistance. New antibiotics are not likely to improve this
situation. It is clear that the challenge in the next decade is to prevent AOM
rather than to treat it. Efforts to prevent AOM include improved environmental
factors, immunization with bacterial and viral vaccines and some creative
measures such as prevention of colonization and attachment to epithelium of AOM
pathogens. Whether these efforts will prove successful or, even if successful,
will only modify the clinical and bacteriologic picture presenting new
challenges, only time will tell.

Publication Types: 
    Review

PMID: 11163457 [PubMed - indexed for MEDLINE]

2316: Vaccine. 2000 Dec 8;19 Suppl 1:S2-8.

The burden of otitis media.

Klein JO.

Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, 774
Albany Street, Boston, MA 02118, USA. jerome.klein@bmc.org

Otitis media is the most frequent reason that children go to the doctor for
illness. In developing countries, where children have limited access to medical
care, suppurative complications of otitis media (OM) are frequent and permanent
hearing loss results. In developed countries, the most common morbidity of OM is 
conductive hearing loss due to middle ear effusion. Infants with severe and
recurrent OM and persistent middle ear effusion are at risk for problems in
behavior and development of speech, language and cognitive abilities. Parent
stress is frequent. The cost of otitis media is large (>$5 billion in the United 
States). Selection and spread of multi-drug resistant bacterial pathogens arising
from extensive use of antimicrobial agents for OM is a problem for management of 
all diseases due to the pathogens. The incidence and severity of OM may diminish 
with introduction of new bacterial and viral vaccines.

Publication Types: 
    Review

PMID: 11163456 [PubMed - indexed for MEDLINE]

2317: BMJ. 2001 Feb 10;322(7282):336-42.

Pragmatic randomised controlled trial of two prescribing strategies for childhood
acute otitis media.

Little P, Gould C, Williamson I, Moore M, Warner G, Dunleavey J.

Community Clinical Sciences (Primary Medical Care Group), University of
Southampton, Aldermoor Health Centre, Southampton SO15 6ST. psl3@soton.ac.uk

OBJECTIVE: To compare immediate with delayed prescribing of antibiotics for acute
otitis media. DESIGN: Open randomised controlled trial. Setting: General
practices in south west England. PARTICIPANTS: 315 children aged between 6 months
and 10 years presenting with acute otitis media. INTERVENTIONS: Two treatment
strategies, supported by standardised advice sheets-immediate antibiotics or
delayed antibiotics (antibiotic prescription to be collected at parents'
discretion after 72 hours if child still not improving). MAIN OUTCOME MEASURES:
Symptom resolution, absence from school or nursery, paracetamol consumption.
RESULTS: On average, symptoms resolved after 3 days. Children prescribed
antibiotics immediately had shorter illness (-1.1 days (95% confidence interval
-0.54 to -1.48)), fewer nights disturbed (-0.72 (-0.30 to -1.13)), and slightly
less paracetamol consumption (-0.52 spoons/day (-0.26 to -0.79)). There was no
difference in school absence or pain or distress scores since benefits of
antibiotics occurred mainly after the first 24 hours-when distress was less
severe. Parents of 36/150 of the children given delayed prescriptions used
antibiotics, and 77% were very satisfied. Fewer children in the delayed group had
diarrhoea (14/150 (9%) v 25/135 (19%), chi(2)=5.2, P=0.02). Fewer parents in the 
delayed group believed in the effectiveness of antibiotics and in the need to see
the doctor with future episodes. CONCLUSION: Immediate antibiotic prescription
provided symptomatic benefit mainly after first 24 hours, when symptoms were
already resolving. For children who are not very unwell systemically, a wait and 
see approach seems feasible and acceptable to parents and should substantially
reduce the use of antibiotics for acute otitis media.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11159657 [PubMed - indexed for MEDLINE]

2318: BMJ. 2001 Jan 27;322(7280):210-2.

Comment in:
    BMJ. 2001 Aug 18;323(7309):353-4.    BMJ. 2001 Jun 23;322(7301):1543; author reply 1543-4.    BMJ. 2001 Jun 23;322(7301):1543; author reply 1543-4.

Effect of recolonisation with "interfering" alpha streptococci on recurrences of 
acute and secretory otitis media in children: randomised placebo controlled
trial.

Roos K, Håkansson EG, Holm S.

Ear, Nose, and Throat Department, Lundby Hospital, 41717 Gothenburg, Sweden.
kristian.roos@lundbysjukhus.se

OBJECTIVE: To study the effect of recolonisation with alpha streptococci with the
ability to inhibit the growth of otopathogens ("interfering" activity) on the
recurrence of acute otitis media in susceptible children and the effect on the
frequency of secretory otitis media. DESIGN: Double blind, randomised, placebo
controlled study. SETTING: Ear, nose, and throat clinic with three doctors.
PARTICIPANTS: 130 children prone to otitis media aged between 6 months and 6
years, 108 of whom were eligible and followed for 3 months. MAIN OUTCOME
MEASURES: Recurrence of otitis media during follow up and a normal tympanic
membrane at the last valid visit. Interventions: Children with no recurrences
during the last month received phenoxymethylpenicillin (n=22), and those with a
recurrence within 1 month received amoxicillin clavulanic acid (n=86), both twice
daily for 10 days. These were followed by a streptococcal or placebo solution
sprayed into the nose for a further 10 days. At day 60 the same spray was started
for another 10 days. RESULTS: At 3 months 22 children (42%) given the
streptococcal spray were healthy and had a normal tympanic membrane compared with
12 (22%) of those given placebo. This difference was shown separately for
recurrences of both acute otitis media and secretory otitis media. CONCLUSIONS:
Selected bacteria with the ability to inhibit the growth of common otopathogens
can be used to protect against recurrent acute otitis media and secretory otitis 
media in children.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11159619 [PubMed - indexed for MEDLINE]

2319: Pediatrics. 2001 Feb;107(2):E15.

A randomized controlled trial of point-of-care evidence to improve the antibiotic
prescribing practices for otitis media in children.

Christakis DA, Zimmerman FJ, Wright JA, Garrison MM, Rivara FP, Davis RL.

Child Health Institute, University of Washington, Seattle, Washington, USA.
dachris@u.washington.edu

CONTEXT: Prescribing practices for otitis media are not consistent with current
evidence-based recommendations. OBJECTIVE: To determine whether point-of-care
evidence delivery regarding the use and duration of antibiotics for otitis media 
decreases the duration of therapy from 10 days and decreases the frequency of
prescriptions written. DESIGN: Randomized, controlled trial. SETTING: Primary
care pediatric clinic affiliated with university training program. Intervention. 
A point-of-care evidence-based message system presenting real time evidence to
providers based on their prescribing practice for otitis media. MAIN OUTCOME
MEASURES: Proportion of prescriptions for otitis media that were for <10 days and
frequency with which antibiotics were prescribed. RESULTS: Intervention providers
had a 34% greater reduction in the proportion of time they prescribed antibiotics
for <10 days. Intervention providers were less likely to prescribe antibiotics
than were control providers. CONCLUSIONS: A point-of-care information system
integrated into outpatient pediatric care can significantly influence provider
behavior for a common condition.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11158489 [PubMed - indexed for MEDLINE]

2320: J Antimicrob Chemother. 2001 Feb;47(2):211-4.

Individual use of antibiotics and prevalence of beta-lactamase production among
bacterial pathogens from middle ear fluid.

Thrane N, Olesen C, Sørensen HT, Schønheyder HC.

The Danish Epidemiology Science Centre, Department of Epidemiology and Social
Medicine, University of Aarhus, Aarhus C. Denmark. nthrane@dadlnet.dk

Prescription data and clinical laboratory data were analysed to assess the
influence of previous antibiotic therapy on the prevalence of beta-lactamase in
isolates of Haemophilus influenzae and Moraxella catarrhalis from primary
specimens of middle ear fluid from 2129 children aged 0-5 years. The prevalence
of beta-lactamase-positive H. influenzae was 6.6% [95% confidence interval (CI): 
3.5-9.8%] in children who received antibiotics 5-90 days before isolation of the 
organism compared with 7.0% (95% CI: 3.9-10.2%) in those who did not. The
prevalence of beta-lactamase-positive M. catarrhalis was 90.9% (95% CI:
84.0-97.8%) in children who received antibiotics compared with 86.7% (95% CI:
79.0-94.4%) in those who did not.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11157910 [PubMed - indexed for MEDLINE]

2321: J Laryngol Otol. 2000 Nov;114(11):874-7.

Otitic hydrocephalus of tubercular origin: a rare cause.

Grewal DS, Hathiram BT, Agarwal R, Dwivedi A, Walvekar R.

Department of Otolaryngology, T.N. Medical College, B.Y.L. Nair Hospital, Mumbai,
India.

Otitic hydrocephalus is characterized by increased intra-cranial pressure without
focal signs of neurological dysfunction. It usually occurs secondary to lateral
sinus thrombosis more commonly on the right side, but it can also occur without
lateral sinus thrombosis. With the advent of new antibiotics there has been a
spectacular decrease in the complications of otitis media. Otogenic intra-cranial
hypertension, always an uncommon condition, is seen only very rarely nowadays.
Tubercular otitis media still occurs in India, and due to delays in its diagnosis
it usually presents with complications. We present three patients with otitic
hydrocephalus of tubercular origin.

Publication Types: 
    Case Reports

PMID: 11144841 [PubMed - indexed for MEDLINE]

2322: J Laryngol Otol. 2000 Nov;114(11):832-6.

Protective role of superoxide dismutase in rat eustachian tubal mucosa against
acute otitis media induced by upper respiratory tract infection.

Lee ES, Woo JS, Hwang SJ, Lim HH, Suh HK.

Department of Otolaryngology Head and Neck Surgery, Korea University College of
Medicine, Seoul, Korea.

Superoxide dismutase has been known to play a role as an anti-oxidative system
against oxidative injury during acute inflammation. To investigate the role of
superoxide dismutase in eustachian tubal mucosa during acute otitis media (AOM), 
an animal model was made. Sprague-Dawley rats were inoculated with Streptococcus 
pneumoniae through the nasal cavity following development of virus-induced upper 
respiratory infection. The animals were divided into three groups according to
their tympanic cavity conditions following bacterial inoculation; inoculated
animals with no resultant AOM (no-AOM), animals with resultant AOM (AOM) and
animals with resolving otitis media (recovery). The changes of superoxide
dismutase in each tubal mucosa were compared with that of the normal control
using immunohistochemistry and immunoblotting methods. On Western blot, there
were little changes of optical density and surface area in no-AOM (213.5 +/-
22.4, 13.2 +/- 0.8 mm2) and recovery group (219.3 +/- 18.7, 14.8 +/- 0.7 mm2)
compared to the normal control (223.5 +/- 26.2, 16.7 +/- 0.4 mm2). However, a
marked decrease was found in the AOM model (167.6 +/- 19.3, 6.5 +/- 0.9 mm2).
These findings suggest that superoxide dismutase may play a role in protecting
tubal mucosa from free radical injury during AOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11144830 [PubMed - indexed for MEDLINE]

2323: J Laryngol Otol. 2000 Nov;114(11):830-1.

Determination of the lowest dilution of aluminium acetate solution able to
inhibit in vitro growth of organisms commonly found in chronic suppurative otitis
media.

Thorp MA, Oliver SP, Kruger J, Prescott CA.

Department of Otolaryngology, University of Cape Town, Cape Town, Republic of
South Africa.

Burow's solution has been found to inhibit the in vitro growth of most commonly
occurring bacteria found in the discharging ear. These organisms were inoculated 
onto appropriate agar plates that contained serial dilutions of aluminium
acetate. Results show that the lowest dilution able to inhibit the growth of
these organisms lies between a 1:80 and a 1:160 dilution of Burow's solution.

PMID: 11144829 [PubMed - indexed for MEDLINE]

2324: J Laryngol Otol. 2000 Nov;114(11):827-9.

Duration of antibacterial effectiveness of gentamicin ear drops in external
otitis.

Rakover Y, Smuskovitz A, Colodner R, Keness Y, Rosen G.

Department of Otorhinolaryngology, Ha'Emek Medical Center, Afula, Israel.
rakover@clalit.org.il

The recommendation of Anderson and Steele, for the use of ear drops four times a 
day, has not been changed since 1948. In order to re-evaluate the frequency of
using ear drops, we examined the duration of the effectiveness of the
antibacterial activity of gentamicin ear drops in external otitis. Seventeen
patients (25 ears) with external otitis were studied. We took 18 samples from
each ear at 0, 1, 2, 3, 6, 8, 10, 12 and 14 hours and measured the concentration 
of gentamicin on the wick and in the ear canal. We found that the concentration
of gentamicin began to decrease only after 12 hours and a more significant
decrease was detected after 14 hours of treatment. We have shown that the
antibiotic used on the wick is effective for 12 hours. In conclusion, we
recommend using ear drops twice a day on a wick as routine therapy for external
otitis.

Publication Types: 
    Clinical Trial

PMID: 11144828 [PubMed - indexed for MEDLINE]

2325: Ann Pharmacother. 2000 Dec;34(12):1452-68.

treatment and prevention of otitis media.

Erramouspe J, Heyneman CA.

College of Pharmacy, Idaho State University, Pocatello 83209-8333, USA.
johnerra@otc.isu.edu

OBJECTIVE: To review and summarize recent advances in the treatment and
prevention of otitis media (OM). DATA SOURCES: A MEDLINE search (1996-March 2000)
was performed to identify relevant primary and review articles. References from
these articles were also reviewed if deemed important. STUDY SELECTION AND DATA
EXTRACTION: English-language primary and review articles focusing on the
treatment and prevention of acute otitis media (AOM) were included. Studies
focusing exclusively on OM with effusion or serous OM and chronic suppurative OM 
were excluded. Information regarding prevention and drug therapy was reviewed,
with an emphasis placed on advances made in the last two years. DATA SYNTHESIS:
Recently, an expert panel of the Centers for Disease Control and Prevention
recommended use of only three of 16 systemic antibiotics approved by the Food and
Drug Administration for treatment of AOM: amoxicillin, cefuroxime axetil, and
ceftriaxone. Controversy exists over the importance of key selection factors used
by the expert panel in determining which antibiotics to recommend in a two-step
treatment algorithm, that is, in vitro data, pharmacodynamic profiles, and
necessity for coverage of drug-resistant Streptococcus pneumoniae at all steps of
empiric treatment. Additional antibiotic and patient selection factors useful for
individualizing therapy include clinical efficacy, adverse effects, frequency and
duration of administration, taste, cost, comorbid infections, and ramifications
should bacterial resistance develop to the chosen antibiotic. Presumed or past
patient/caregiver adherence (especially when antibiotic failure has occurred) is 
also paramount in selecting antibiotic therapy. A three-step treatment algorithm 
for refractory AOM that employs amoxicillin, trimethoprim/sulfamethoxazole
(TMP/SMX), or high-dose amoxicillin/clavulanate (depending on the prior dose of
and adherence to amoxicillin therapy), and ceftriaxone or tympanocentesis at
steps 1, 2, and 3, respectively, appears rational and cost-effective. The recent 
upsurge in antimicrobial resistance is highlighted, and recommendations are
presented for the treatment of AOM and prevention of recurrent otitis media
(rAOM). CONCLUSIONS: Amoxicillin remains the antibiotic of choice for initial
empiric treatment of AOM, although the traditional dosage should be increased in 
patients at risk for drug-resistant S. pneumoniae. In cases refractory to
high-dose amoxicillin, TMP/SMX should be prescribed if adherence to prior therapy
seemed good or complete, or high-dose amoxicillin/clavulanate if adherence was
incomplete or questionable. Ceftriaxone should be reserved as third-line
treatment. The increasing prevalence of drug-resistant S. pneumoniae emphasizes
the importance of alternative medical approaches for the prevention of OM, as
well as judicious antibiotic use in established cases. Removal of modifiable risk
factors should be first-line therapy for prevention of rAOM. We support the use
of conjugate pneumococcal vaccine per guidelines for prevention of rAOM from the 
Advisory Committee on Immunization Practice of the Centers for Disease Control
and Prevention, with consideration given to influenza vaccine for cases of rAOM
that historically worsen during the flu season. Sulfisoxazole prophylaxis should 
be reserved for children who are immunocompromised, have concurrent disease
states exacerbated by AOM, or meet the criteria of rAOM despite conjugate
pneumococcal and influenza vaccination. Therapy should be intermittent, beginning
at the first sign of an upper respiratory infection, and should continue for 10
days. The invasive nature and risks of anesthesia relegate myringotomy,
tympanostomy tubes, and adenoidectomy to last-line therapies for rAOM.

Publication Types: 
    Review

PMID: 11144704 [PubMed - indexed for MEDLINE]

2326: Pediatr Infect Dis J. 2000 Dec;19(12 Suppl):S166-70.

Cefdinir vs. amoxicillin/clavulanic acid in the treatment of suppurative acute
otitis media in children.

Adler M, McDonald PJ, Trostmann U, Keyserling C, Tack K.

Belmont Health Centre, Harrow, Middlesex, UK.

An investigator-blinded, randomized, multicenter study was conducted to compare
the efficacy and safety of cefdinir and amoxicillin/ clavulanate (amoxicillin/CA)
in the treatment of pediatric patients with acute suppurative otitis media.
Patients 6 months to 12 years of age were randomized in a 1:1:1 ratio to receive 
cefdinir 14 mg/kg once-daily, cefdinir 7 mg/kg b.i.d., or amoxicillin/CA 13.3
mg/kg t.i.d. Test-of-cure was determined 11 to 16 days posttherapy. Of the 752
patients who entered the study, 665 (88%) completed treatment and 595 (79%) were 
evaluable. Response rates in the three treatment groups were similar. Overall
rates of adverse events were statistically lower in the cefdinir once-daily group
than in the amoxicillin/CA group. Diarrhea was the most common adverse event in
all treatment groups. Cefdinir given either once-daily or twice-daily is a safe
and effective treatment for pediatric patients with acute suppurative otitis
media.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11144399 [PubMed - indexed for MEDLINE]

2327: Pediatr Infect Dis J. 2000 Dec;19(12 Suppl):S159-65.

Comparative safety and efficacy of cefdinir vs amoxicillin/clavulanate for
treatment of suppurative acute otitis media in children.

Block SL, McCarty JM, Hedrick JA, Nemeth MA, Keyserling CH, Tack KJ; Cefdinir
Otitis Media Study Group.

Kentucky Pediatric Research, Bardstown, USA.

OBJECTIVE: Two dosage regimens of cefdinir were compared with
amoxicillin/clavulanate for the treatment of suppurative acute otitis media (AOM)
in children. METHODS: This was an investigator-blinded, randomized, comparative, 
multicenter trial, in which tympanocentesis was performed in 384 patients, ages 6
months to 12 years, who had nonrefractory AOM. Patients were randomized to
receive one of three 10-day treatment regimens: cefdinir 14 mg/kg daily (QD; n = 
128); cefdinir 7 mg/kg twice a day (BID; n = 128); or amoxicillin/clavulanate
40/10 mg/kg/day divided for use three times a day (TID; n = 128). RESULTS: Of the
384 enrolled patients 303 were evaluable for clinical efficacy. Clinical success 
rates were statistically equivalent for the 3 treatment groups at the end of
therapy: 85 of 102 (83.3%) for cefdinir QD; 81 of 101 (80.2%) for cefdinir BID;
86 of 100 (86%) for amoxicillin/clavulanate. Of the 197 evaluable patients from
whom a susceptible pathogen was recovered, presumptive eradication rates at end
of therapy were equivalent: 55 of 65 (84.6%), 54 of 66 (81.8%) and 55 of 66
(83.3%) for cefdinir QD-, cefdinir BID- and amoxicillin/clavulanate-treated
patients, respectively. However, presumptive eradication rates for Streptococcus 
pneumoniae were significantly lower for cefdinir BID (55.2%) than for
amoxicillin/clavulanate (89.5%; P = 0.0019) and marginally lower than for
cefdinir QD (80%; P = 0.054). Diarrhea was the most common treatment-associated
adverse reaction in all groups but was significantly more common in
amoxicillin/clavulanate-treated patients (35%) than in patients who had been
treated with cefdinir QD (10%, P<0.001) or cefdinir BID (13%, P<0.001).
CONCLUSIONS: A 10-day regimen of cefdinir 14 mg/kg QD or 7 mg/kg BID was as
clinically effective overall as a 10-day regimen of amoxicillin/ clavulanate
40/10 mg/kg/day divided TID in the treatment of tympanocentesis-confirmed,
nonrefractory AOM in children. These data suggest that cefdinir QD may be a
better alternative than cefdinir BID for refractory AOM. Both dosing regimens of 
cefdinir were associated with significantly fewer gastrointestinal adverse
reactions than was amoxicillin/clavulanate.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11144398 [PubMed - indexed for MEDLINE]

2328: Pediatr Infect Dis J. 2000 Dec;19(12 Suppl):S153-8.

Five-day twice daily cefdinir therapy for acute otitis media: microbiologic and
clinical efficacy.

Block SL, Hedrick JA, Kratzer J, Nemeth MA, Tack KJ.

Kentucky Pediatric Research, Bardstown, USA.

OBJECTIVE: To examine the microbiologic and clinical efficacy of a 5-day course
of cefdinir in the treatment of tympanocentesis-documented acute otitis media
(AOM). DESIGN: Open label noncomparative trial. SETTING: Primary care,
ambulatory. PATIENTS: Children ages 6 months through 12 years with signs of AOM
and middle ear effusion confirmed by tympanometry in at least one ear.
INTERVENTION: Patients underwent tympanocentesis at baseline and received
cefdinir 7 mg/kg twice a day for 5 days. MAIN OUTCOME MEASURES: Presumptive
eradication of middle ear pathogens determined by clinical cure of signs and
symptoms of AOM at end of therapy (Study Days 7 to 9) and Visit 3 (Study Days 16 
to 21). RESULTS: A total of 125 of 177 enrolled children had 134 pathogens
isolated by tympanocentesis: Streptococcus pneumoniae, 69 (51.5%); Haemophilus
influenzae 44 (32.8%; beta-lactamase-positive in 18 of 44 strains);
beta-lactamase-positive Moraxella catarrhalis, 15 (11.2%); and Streptococcus
pyogenes, 6 (4.5%). The clinical cure rates by patient in the microbiologically
and overall clinically evaluable groups, respectively, were 73% (84 of 115) and
77.4% (130 of 168) at the end of therapy visit and 57.4% (66 of 115) and 61.9%
(104 of 168) at Visit 3. Presumptive eradication rates at end of therapy were 8
of 11 (72.7%) and 4 of 8 (50%) for patients with penicillin-intermediate and
-resistant S. pneumoniae isolates, respectively. Adverse reactions occurred in
16% of patients, with diarrhea (11%) occurring most frequently. CONCLUSIONS: A
5-day regimen of cefdinir was effective in the eradication of the common
causative pathogens of nonrefractory AOM, including intermediate
penicillin-resistant S. pneumoniae and beta-lactamase-producing organisms.
Cefdinir should be considered a suitable second line antibiotic for AOM.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 11144397 [PubMed - indexed for MEDLINE]

2329: Pediatr Infect Dis J. 2000 Dec;19(12 Suppl):S147-52.

Five-day cefdinir course vs. ten-day cefprozil course for treatment of acute
otitis media.

Block SL, Kratzer J, Nemeth MA, Tack KJ.

Kentucky Pediatric Research, Bardstown, USA.

OBJECTIVE: To compare the clinical efficacy of a 5-day cefdinir course with a
10-day cefprozil course in the treatment of pediatric acute otitis media (AOM).
DESIGN: Comparative, investigator-blinded multicenter trial. SETTING: Primary
care, ambulatory. PATIENTS: Children ages 6 months through 12 years with clinical
symptoms and tympanic membrane signs of AOM, plus tympanometric-confirmed middle 
ear effusion in at least 1 ear. Of the 435 patients enrolled in the study, 373
were evaluable. INTERVENTION: Patients received cefdinir 14 mg/ kg/day divided
twice a day for 5 days or cefprozil 30 mg/kg/day divided twice a day for 10 days.
MAIN OUTCOME MEASURES: Clinical resolution of tympanic membrane signs and
symptoms of AOM determined at end of therapy on Study Days 9 to 11. RESULTS: The 
clinical cure rate at end of therapy was 80% (152 of 190) for cefdinir-treated
patients and 82.5% (151 of 183) for cefprozil-treated patients (95% confidence
interval, 10.43% to 5.4%). Diarrhea and overall adverse reactions, respectively, 
occurred in 7.8 and 13% of cefdinir-treated patients and in 4.2 and 12% of
cefprozil-treated patients. CONCLUSIONS: A short course 5-day regimen of cefdinir
was as clinically effective and well-tolerated as a 10-day regimen of cefprozil
in the treatment of nonrefractory AOM.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11144396 [PubMed - indexed for MEDLINE]

2330: Pediatr Infect Dis J. 2000 Dec;19(12 Suppl):S131-40.

Evaluating the need, timing and best choice of antibiotic therapy for acute
otitis media and tonsillopharyngitis infections in children.

Pichichero ME.

Elmwood Pediatric Group and University of Rochester Medical Center, NY, USA.

Deciding whether an antibiotic is necessary, when to begin therapy and selecting 
an optimal drug is an everyday challenge in clinical practice. In vitro
susceptibility testing which determines the minimum concentration necessary for a
particular antibiotic to inhibit or kill most strains of a bacterial species and 
pharmacodynamic modeling are useful but have limitations. The need for antibiotic
therapy for acute otitis media (AOM) has been recently questioned. However,
explanations for uniformly positive results with many antibiotic and placebo
comparative trials include overdiagnosis of AOM at study entry, inclusion of
patients with mild or uncomplicated AOM and broad criteria for the definition of 
clinical success. Recurrent and persistent AOM does not have as favorable a
natural history as uncomplicated AOM; children below 2 years of age benefit most 
from antibiotic therapy. Selecting the best choice among the many antibiotics
that can be used to treat AOM has become more complex over the last decade due to
escalating antibiotic resistance among the pathogens that cause this infection.
Broader spectrum antibiotics such as cefdinir, the newly introduced third
generation cephalosporin, have their most prominent use in the treatment of
persistent and recurrent AOM. In the early 1950s and 1960s penicillin clearly was
the best available agent for the treatment of group A streptococcal (GAS)
infections. In the 1970s the situation began to change as cephalosporin
antibiotics became available. Superior eradication rates with cephalosporins such
as cefdinir have now been well-documented. The leading hypothesis to explain the 
widening gap in efficacy between penicillin and cephalosporins relates to two
major concepts: the presence of copathogens and differential alteration of the
normal microbial ecology in the throat as a consequence of the selected therapy. 
There are positive and negative consequences to early initiation of antibiotic
therapy for GAS tonsillopharyngitis. Penicillin has persisting good efficacy in
patients older than the age of 12 years and in those who have been ill for >2
days. Shortening therapy for GAS tonsillopharyngitis offers a therapeutic
advantage. Cefpodoxime proxetil and cefdinir have a 5-day indication for the
treatment of GAS tonsillopharyngitis. Antibiotics with lower side effect profile,
infrequent dosing, good palatability in suspension formulation and efficacy with 
short duration of treatment may lead to better outcomes because noncompliance
often results in failed therapy, persistence of infection and morbidity.

Publication Types: 
    Review

PMID: 11144394 [PubMed - indexed for MEDLINE]

2331: Ann Otol Rhinol Laryngol Suppl. 2000 Dec;185:25-7.

Mastoiditis and acute otitis media in children with cochlear implants:
recommendations for medical management.

Kempf HG, Stöver T, Lenarz T.

Department of Otolaryngology, Medical University of Hannover, Germany.

Acute otitis media (OM) or mastoiditis is a very dangerous condition for the ear 
after cochlear implantation. However, acute OM is very common in childhood and
can occasionally occur in an implanted ear. Most cases of acute OM can be
successfully treated with intravenous high-dosage antibiotics. In cases of
mastoiditis and clinical signs of mastoid abscess, retroauricular drainage is
necessary to prevent infection of the implant bed. In a series of 366 children
given implants (1 to 14 years), acute OM occurred in 5.6% during a follow-up
period of 1 to 8 years. Seven ears had to be opened by means of myringotomy. Five
ears were opened by retroauricular incision with mastoid revision on the
implanted side. Adenoidectomy and use of ventilation tubes before cochlear
implantation, as well as careful subtotal mastoidectomy during the implantation, 
can reduce the incidence of acute OM in children after implantation. Early and
subsequent treatment with operative mastoid drainage can prevent implant loss and
should be performed at the implantation center.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11140991 [PubMed - indexed for MEDLINE]

2332: J Health Care Finance. 2000 Winter;27(2):51-65.

Emergency medicine versus primary care: a case study of three prevalent, costly, 
and non-emergent diagnoses at a community teaching hospital.

Martin BC.

Department of Public Health at East Tennessee State University, Johnson City,
USA.

The high cost of emergency department (ED) care is often viewed as an area for
achieving cost savings through reduced utilization for inappropriate conditions. 
The implementation of outpatient prospective payment for Medicare ED patients
heightens scrutiny of costs and utilization in the ED versus primary care
settings. Data from hospital clinical records, financial records, and a provider 
survey was used to develop a costing methodology and complete a comparative
analysis of the cost of care for three diagnoses by setting. Total costs were
significantly higher in the ED due primarily to differences in ancillary tests
and prescription drugs ordered.

Publication Types: 
    Comparative Study

PMID: 11140550 [PubMed - indexed for MEDLINE]

2333: Clin Exp Rheumatol. 2000 Nov-Dec;18(6):746-8.

Otitis externa sicca/fibrotising external otitis (FEO) as a complication of
Sjögren's syndrome.

Konttinen YT, Ramsay H, Hietanen J, Sorsa T, Nordstrom D.

Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. 
YRJO.KONTTINEN@helsinki.fi

Sjögren's syndrome (SS) is a condition characterized by sicca symptoms and by
autoimmune features. We describe two SS patients with otitis externa
fibroticans/sicca. One of these 2 patients developed a lesion of the tympanic
membrane making it necessary to perform a tympantomy and meatoplasty. Our
findings suggest firstly that the epithelial cell-mediated secretion of lamellar 
bodies and the production of the permeability barrier are defective in SS.
Secondly, local moisturing and/or topical corticosteroid treatment in SS patients
with sicca symptoms in the auditory canal could help to avoid reconstructive
surgical treatment.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 11138341 [PubMed - indexed for MEDLINE]

2334: Int J Pediatr Otorhinolaryngol. 2000 Dec 22;56(3):185-90.

Inhibition of OM pathogens by alpha-hemolytic streptococci from healthy children,
children with SOM and children with rAOM.

Tano K, Grahn-Håkansson E, Holm SE, Hellström S.

Department of Clinical Sciences, Otorhinolaryngology, Umeâ University and ENT
Department, Sunderby Hospital, S-971 80, Luleå, Sweden. krister.tano@nll.se

The present study was undertaken to elucidate the inhibitory activity of the
normal nasopharyngeal flora against the three most common otitis media (OM)
pathogens in healthy children, children with secretory otitis media (SOM) and
children with recurrent otitis media (rAOM). Isolates of alpha-hemolytic
streptococci (AHS) and OM pathogens were recovered from the tubal orifice in each
child. The samples were taken from 20 healthy children under general anesthesia, 
from 19 children with SOM and 20 children with rAOM. The method used to test the 
bacterial interference in vitro was a modified agar overlay method. The AHS
sampled from the tubal orifice of the healthy children were able to inhibit 92%
of the S. peumoniae isolates, 74% of the non-typable H. influenzae isolates and
89% of the M. catarrhalis isolates. The corresponding figures for children with
SOM and children with rAOM were: 73% of the S. pneumoniae isolates, 58 and 54% of
the non-typable H. influenzae isolates and 86 and 89% of the M. catarrhalis
isolates. The AHS from children with SOM and children with rAOM were
significantly less capable of inhibiting the S. peumoniae and the H. influenzae
isolates (P<0.001). There was no significant difference between the three groups 
of children regarding inhibitory activity against M. catarrhalis. The results
suggest that the inhibitory activity of the normal bacterial flora at the tubal
orifice against pneumococci and H. influenzae may be reduced in children with SOM
and rAOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11137592 [PubMed - indexed for MEDLINE]

2335: Int J Pediatr Otorhinolaryngol. 2000 Dec 22;56(3):175-84.

The variability and appropriateness of the antibiotic prescription of acute
otitis media in childhood. The Spanish Study Group for Antibiotic Treatments.

Solís G, Ochoa C, Pérez Méndez C.

Departament of Pediatrics, Hospital de Cabueñes, Gijón, Spain. gsolis@las.es

OBJECTIVE: To know the variability of treatment of acute otitis media in Spain
and the appropriateness of such with respect to consensus. MATERIAL AND METHODS: 
A descriptive, multicentre, prospective study was carried out in the services of 
11 Spanish hospitals. Children diagnosed with acute otitis media and treated on
30 days selected randomly between January and June 1997 were included. An
analysis of treatment variability was made. The results were compared with
consensus conference of a panel of experts. RESULTS: Out of the 29436 emergencies
studied on 30 days, 821 were diagnosed with acute otitis media. Fifteen point
seven percent of the cases were already receiving antibiotics (22% amoxicillin
clavulanate, 20% amoxicillin and 11% cefuroxime axetil). For the treatment, at
discharge, of the 93% an antibiotic was prescribed (amoxicillin clavulanate in
41%, amoxicillin in 15%, cefuroxime axetil in 11%, cefaclor 6% and azithromycin
5%). Two point eight percent of the children were admitted. According to the
guidelines of the panel of experts consulted, appropriateness was 61% for
antibiotics of first choice, 12% for drugs of alternate use and 25% for
inadequate treatment. The different hospitals presented significant variability
in the type of antibiotic used and the appropriateness of such. CONCLUSIONS:
Acute otitis media is treated with antibiotics in 93% of the cases diagnosed in
Spanish hospitals. The most commonly used antibiotics are amoxicillin clavulanate
and amoxicillin alone. The prescription and its appropriateness present
significant variability in the different hospitals studied.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 11137591 [PubMed - indexed for MEDLINE]

2336: Auris Nasus Larynx. 2001 Jan;28(1):3-7.

Serous or mucoid effusion in the course of secretory otitis media: influence of
ion transport modulation.

Portier F, Hsu WC, Herman P, Tran Ba Huy P.

Clinique d'ORL et de Chirurgie Cervico-Faciale. Hôpital Lariboisière, 2, rue
Ambroise Paré, 75010, Paris, France.

OBJECTIVE: Secretory otitis media is defined by a chronic effusion in the middle 
ear cavities, behind an intact tympanic membrane without acute infection. In the 
course of secretory otitis media, the effusion is sometimes thick (or mucoid) and
other times thin (or serous). For several authors, these differences might be
related to different inflammatory levels rather than to distinct
pathophysiological mechanisms. The purpose of this study was to determine whether
the modulation of ion transport by inflammation could account for the differences
observed in the aspect of ME effusion. METHODS: Hydrogen peroxide (H2O2), used as
an inflammation model was tested on a middle ear cell line (MESV) in culture.
RESULTS: Results show that low and high concentrations of H2O2 have opposite
effects on ion (and then water) absorption by the middle ear epithelium.
CONCLUSION: the modulation of ion and water absorption by inflammation could
modify the mucins concentration in the effusion, and explain observed viscosity
differences in the course of secretory otitis media.

PMID: 11137356 [PubMed - indexed for MEDLINE]

2337: Braz J Infect Dis. 2000 Dec;4(6):307-12.

Central venous sinus thrombosis following mastoiditis: report of 4 cases and
literature review.

Rocha JL, Kondo W, Gracia CM, Baptista MI, Büchele G, da Cunha CA, Martins LT.

Division of Infectious Disease, Nossa Senhora das Graças Hospital, Curitiba, PR, 
Brazil. jaimeluis@b.com.br

The frequency of mastoiditis and its complications have declined since the advent
of antibiotics. Among all complications, transverse sinus thrombosis is the least
frequent, although it may have the highest mortality rate. Before the
introduction of surgery and antibiotic treatment, mortality was close to 100%.
Previous administration of antibiotics may lead to changes in the clinical
presentation of venous sinus thrombosis that make diagnosis more difficult, in
spite of greatly improved imaging methods. This article reports 4 confirmed cases
of venous sinus thrombosis complicating mastoiditis that were diagnosed and
treated at Nossa Senhora das Graças Hospital, Curitiba--PR from June, 1999, to
February, 2000. All 4 cases were documented by magnetic resonance imaging. Each
patient recovered after treatment with antibiotics and anticoagulation. No
surgical intervention was necessary. Diagnosis of the complication requires a
high level of clinical suspicion and then evaluation by mastoid CT and cranial
MRI.

Publication Types: 
    Case Reports

PMID: 11136529 [PubMed - indexed for MEDLINE]

2338: Acta Otolaryngol. 2000 Oct;120(7):815-20.

Adaptive bone modeling and remodeling in acute otitis media caused by
non-typeable or type B Haemophilus influenzae or Moraxella catarrhalis.

Cayé-Thomasen P, Tos M.

The ENT Department, Gentofte University Hospital of Copenhagen, Hellerup,
Denmark. pcaye@dadlnet.dk

Experimental studies have shown that acute otitis media caused by Streptococcus
pneumoniae alters modeling dynamics in bone tissue structures surrounding the
middle ear cavity. Initial resorption of bone is followed by formative activity, 
seen as massive osteoneogenesis. However, neither resorptive nor formative
activity occurs in the otic capsule, supporting the existence of a perilymphatic 
zone of specialized bone. This study investigates adaptive bone modeling in acute
otitis media caused by other bacteria frequently encountered in this disease.
Seventy-five rats were inoculated with either non-typeable or type b Haemophilus 
influenzae, or Moraxella catarrhalis (25 rats in each group). Five rats from each
group were sacrificed on days 4, 8, 16, 60 and 180 post-inoculation. Qualitative 
as well as quantitative histopathology revealed increasing apposition of new bone
on both sides of the original bony wall of the middle ear bulla, i.e. at the
inner and outer periosteum. Remodeling activity was seen on later days of
sacrifice, as typical osteone (Haversian system) formation. Measured bone
thickness in four anatomically well-defined localities progressed to a peak 2
months post-inoculation, followed by some degree of normalization. However, bone 
thickness was still massively increased 6 months after the acute incident. Except
in the otic capsule, resorptive and formative activity was found in all bone
tissue structures surrounding the middle ear cavity. These findings were
irrespective of the type of inoculated bacteria. However, non-typeable or type b 
Haemophilus influenzae induces significantly more new bone formation than
Moraxella catarrhalis. We conclude that acute otitis media caused by either of
the bacteria is accompanied by massive and progressive net osteoneogenesis,
already evident on day 4 and peaking 2 months post-inoculation, followed by some 
degree of normalization. Non-typeable and type b Haemophilus influenzae induce
more new bone formation than Moraxella catarrhalis, whereas other features of
bone histomorphology were equivalent. The present findings further support the
existence of a perilymphatic zone of specialized bone.

PMID: 11132713 [PubMed - indexed for MEDLINE]

2339: Acta Otolaryngol. 2000 Oct;120(7):810-4.

Polyp and fibrous adhesion formation in acute otitis media caused by non-typeable
or type b Haemophilus influenzae or Moraxella catarrhalis.

Cayé-Thomasen P, Tos M.

The ENT Department, Gentofte University Hospital of Copenhagen, Hellerup,
Denmark. pcaye@dadlnet.dk

Among a variety of other histopathologic changes, polyps and fibrous adhesions
are readily formed in the middle ear mucosa during experimental acute otitis
media (AOM) caused by Streptococcus pneumoniae. Quantitative studies on
experimental AOM caused by other bacteria have shown that some of these
histopathologic changes, such as adaptive bone modeling and increase in goblet
cell density, differ according to the type of bacteria. This investigation
surveys polyp and fibrous adhesion formation in experimental AOM caused by either
non-typeable or type b Haemophilus influenzae, or Moraxella catarrhalis.
Seventy-five rats were inoculated with 1 of these 3 bacteria (25 rats in each of 
3 groups). Five rats from each group were sacrificed on days 4, 8, 16, 60 and 180
post-inoculation. The middle ear mucosae were dissected and histopathologic
changes in whole-mount and section preparations were studied using light
microscopy. Polyps were found in most ears and in the greatest numbers on the
early days; fewer polyps were found on the later days, regardless of the type of 
bacteria. However, non-typeable and type b H. influenzae induced formation of
significantly more polyps than M. catarrhalis. The polyps were primarily located 
in the epitympanum. Fibrous adhesions were primarily located in the hypotympanum 
and formed in almost all ears, on all days post-inoculation, regardless of the
type of bacteria. Numbers increased to a peak on day 16 and then decreased.
Non-typeable and type b H. influenzae induced formation of significantly more
adhesions than M. catarrhalis, and the middle ears displayed a higher number of
persisting adhesions in the animals inoculated with non-typeable H. influenzae.
We conclude that polyps and adhesions are formed in experimental AOM regardless
of bacterial type, confirming a pathogenesis based on inflammation. Both types of
H. influenzae induce formation of greater numbers of polyps/adhesions than M.
catarrhalis, and the non-typeable form causes more adhesive sequelae in the
mucosa than the encapsulated type b.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11132712 [PubMed - indexed for MEDLINE]

2340: J Vet Med Sci. 2000 Nov;62(11):1177-82.

Study of lipid in the ear canal in canine otitis externa with Malassezia
pachydermatis.

Masuda A, Sukegawa T, Mizumoto N, Tani H, Miyamoto T, Sasai K, Baba E.

Department of Veterinary Medicine, Graduate School of Agriculture and Biological 
Sciences, Osaka Prefecture University, Sakai, Japan.

An epidemiological investigation of 120 canine otitis externa cases in 1,370 dogs
was done on the incidence rate, ear pinna shapes, breeds and their relationships.
Eighty-five cases (12.6%) in 672 dogs with pendulous ears and 35 cases (5.0%) in 
698 dogs with erect ears had otitis externa, and the difference between them was 
significant (P<0.05). Ninety-five auditory cerumen specimens were cultured for
Malassezia pachydermatis (M. pachydermatis) and analyzed for concentrations of
major fatty acids. Although rates of cases positive for M. pachydermatis in both 
ear pinna shapes were almost the same, i.e. 55.2% in the pendulous group and
53.6% in the erect group, the average total fatty acid level of the pendulous ear
group was significantly (P<0.05) higher than that in the erect ear group after
dismissing extraordinary levels in the Siberian husky. Isolated M. pachydermatis 
strains were examined for the effects of fatty acid supplementation on their
growth. The majority of the strains utilized fatty acids and grew faster in fatty
acid supplemented broth. These results suggest that M. pachydermatis, the
predominant causative agent of canine otitis externa, prefers the auditory canal 
of dogs with lipid-rich earwax and grows fast, but growth strongly depends upon
the canine breed.

PMID: 11129861 [PubMed - indexed for MEDLINE]

2341: Arch Dis Child. 2001 Jan;84(1):45-49.

Comment in:
    ACP J Club. 2001 Jul-Aug;135(1):31.

Randomised controlled trial of the effect of ventilation tubes (grommets) on
quality of life at age 1-2 years.

Rovers MM, Krabbe PF, Straatman H, Ingels K, van der Wilt GJ, Zielhuis GA.

Department of Otorhinolaryngology, University Medical Centre Nijmegen, PO Box
9101, 6500 HB Nijmegen, Netherlands.

AIMS: To study the effect of treatment with ventilation tubes on quality of life 
in children aged 1-2 years with persistent otitis media with effusion (OME), as
compared to watchful waiting. METHODS: Multicentre randomised controlled trial (n
= 187) with two treatment arms: ventilation tubes and watchful waiting. Children 
were detected by auditory screening at the age of 9-12 months, and were
subsequently diagnosed as having persistent (4-6 months) bilateral OME. Quality
of life (TAIQOL and Erickson scales) was measured at 0, 6, and 12 months follow
up. RESULTS: There was improvement in quality of life, but the ventilation tube
group did not improve significantly more than the watchful waiting group.
Although an attempt has been made to identify possible subgroups that benefit
more, we were not able to find such subgroups, which might be a result of lack of
power in this study. CONCLUSION: Ventilation tubes do not have a substantial
incremental effect on the quality of life of infants aged 1-2 years with
uncomplicated persistent bilateral OME.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11124783 [PubMed - indexed for MEDLINE]

2342: Clin Otolaryngol Allied Sci. 2000 Dec;25(6):485-91.

The frequency of otitis media with effusion in British pre-school children: a
guide for treatment. ALSPAC Study Team.

Midgley EJ, Dewey C, Pryce K, Maw AR.

Bristol Children's Hospital, Unit of Paediatric and Perinatal Epidemiology and
Department of Otolaryngology/Head and Neck Surgery, University of Bristol,
Bristol, UK.

Data on the prevalence of otitis media with effusion (OME) as shown by serial
tympanometry is presented for young children during the first 5 years of life.
The children were participants in the Avon Longitudinal Study of Pregnancy and
Childhood (ALSPAC); a randomly selected 10% (n = 1400) of whom were selected for 
examination at ages 8, 12, 18, 25, 31, 37, 43, 49 and 61 months. Whilst sex had
no effect, there was a decrease in prevalence of OME with increasing age. There
was a marked seasonal effect on the prevalence of OME. Bilateral and unilateral
OME were significantly more prevalent in the winter than in the summer months
(36.6% in February in children aged 8 months compared with 16% at 61 months and
16.4% in August in children aged 8 months compared with 3.1% at 61 months). The
results form an important background against which to assess both the results of 
screening and also the indications for surgical treatment.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11122285 [PubMed - indexed for MEDLINE]

2343: Infect Immun. 2001 Jan;69(1):602-6.

Effect of influenza A virus infection on nasopharyngeal colonization and otitis
media induced by transparent or opaque phenotype variants of Streptococcus
pneumoniae in the chinchilla model.

Tong HH, Weiser JN, James MA, DeMaria TF.

Division of Otologic Research, College of Medicine and Public Health, The Ohio
State University, Columbus, Ohio 43210, USA.

Phase variation in the colonial opacity of Streptococcus pneumoniae has been
implicated as a factor in bacterial adherence, colonization, and invasion in the 
pathogenesis of pneumococcal disease. Additionally, the synergistic effects of
influenza A virus and S. pneumoniae in the development of otitis media (OM) have 
been reported. This study examined the ability of opaque or transparent S.
pneumoniae from the same strain in combination with an antecedent influenza A
virus infection to colonize the nasopharynx and invade the middle ear in the
chinchilla model. Our data indicated that there was no significant difference in 
the level of nasopharyngeal colonization and induction of OM between the opaque
and transparent variants unless there was a prior challenge with influenza A
virus. Subsequent to influenza A virus infection, there was a significant
difference between the variants in the ability to colonize and persist in the
nasopharynx and middle ear. The concentrations of the opaque variant in
nasopharyngeal-lavage samples and middle-ear fluid remained consistently higher
than those of the transparent variant for 10 days postinoculation. Data from this
study indicate that the effects of influenza A virus on the pathogenesis of
experimental S. pneumoniae-induced OM differ depending on the opacity phenotype
involved.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11119562 [PubMed - indexed for MEDLINE]

2344: Int J Pediatr Otorhinolaryngol. 2000 Dec 1;56(2):129-34.

Prevention of acute mastoiditis: fact or fiction?

Linder TE, Briner HR, Bischoff T.

Head and Neck Surgery, Department of Otorhinolaryngology, University Hospital of 
Zurich, Frauenklinikstr. 24, CH-8091, Zurich, Switzerland. linder@orl.usz.ch

Acute mastoiditis is the most common complication of acute otitis media (AOM). In
recent years routine antibiotic treatment for acute middle ear infections was
questioned and even abandoned in some countries. The goal of our study was to
investigate the influence of antibiotic treatment on the occurrence and clinical 
outcome of acute mastoiditis and to analyze the bacteriological findings. A
retrospective case record study of 48 patients with 50 episodes of acute
mastoiditis hospitalized at our tertiary-care center between 1992 and 1999 was
performed. Twenty-three patients (48%) received antibiotic treatment before
admission whereas 25 (52%) did not. The group of patients without antibiotic
pretreatment were younger (mean, 6 years) than patients with antibiotics (mean,
18 years) and their referral was delayed. The most common isolated single
pathogen was Streptococcus pneumoniae. All pneumococci were sensitive to
penicillin. Acute mastoiditis may be the first clinical sign of a middle ear
infection, especially in very young children. Adequate antibiotic pretreatment
cannot invariably prevent the development of acute mastoiditis even in the
absence of penicillin resistant pathogens.

PMID: 11115685 [PubMed - indexed for MEDLINE]

2345: Otolaryngol Head Neck Surg. 2000 Dec;123(6):775-8.

Improvement in bone conduction threshold after tympanoplasty.

Tüz M, Doğru H, Uygur K, Gedikli O.

Süleyman Demirel University, School of Medicine, ENT-Head & Neck Department,
Isparta, Turkey. mutuz@hotmail.com

OBJECTIVE: To investigate the causes of bone conduction threshold impairment
associated with middle ear pathoses and the factors influencing improvement in
bone conduction threshold after tympanoplasty. STUDY DESIGN AND SETTING: The
records of 98 consecutive patients with unilateral chronic otitis media who
underwent tympanoplasty were reviewed. Pre-operatively, 15 dB or more depression 
of bone conduction threshold at least in 2 frequencies between 500 and 6000 Hz
was considered to be significant. Similarly in the postoperative period, 15 dB or
more improvement of bone conduction threshold at least in 2 frequencies between
500 and 6000 Hz was regarded as significant. RESULTS: Twelve (12.5%) of 98 cases 
were found to have depressed bone conduction threshold; 6 of 12 cases had
improved bone conduction threshold after tympanoplasty. CONCLUSION: In cases with
cholesteatoma and extensive middle ear disease, successful results could be
achieved after tympanoplasty disregarding the air-bone gap and deteriorated bone 
conduction threshold. SIGNIFICANCE: Bone conduction threshold may improve after
tympanoplasty.

Publication Types: 
    Comparative Study

PMID: 11112978 [PubMed - indexed for MEDLINE]

2346: Otolaryngol Head Neck Surg. 2000 Dec;123(6):751-5.

Otogenic brain abscess: review of 41 cases.

Sennaroglu L, Sozeri B.

Department of Otolaryngology-Head and Neck Surgery, Hacettepe University Medical 
Faculty.

Forty-one patients in whom otogenic brain abscess was diagnosed and has been
treated since 1968 are presented. Sixty-five percent of the patients were between
5 and 15 years of age. All patients had chronic otitis media, and 95% had
cholesteatoma. Abscess was located in the temporal lobe in 54%, in the cerebellum
in 44%, and in both locations in 2% of the cases. Most patients had radical
mastoidectomy and evacuation of the abscess through the mastoidectomy (61%). In
addition to mastoidectomy, burr hole drainage was used in 20% and craniotomy in
15%. The most common micro-organism involved was Proteus. Overall mortality in
this series is 29%, but after 1976, when CT became available for the diagnosis
and follow-up, the mortality rate was reduced to 10%.

PMID: 11112974 [PubMed - indexed for MEDLINE]

2347: Otolaryngol Head Neck Surg. 2000 Dec;123(6):733-7.

Complications associated with labyrinthine fistula in surgery for chronic otitis 
media.

Manolidis S.

Bobby R. Alford Department of Otolaryngology and Communicative Sciences, Baylor
College of Medicine, Houston, TX 77030, USA. spirosm@bcm.tmc.edu

OBJECTIVE: Labyrinthine fistula (LF) is encountered during surgery for chronic
otitis media (COM) with an average frequency of 7.5%. This study was undertaken
to investigate the prevalence of coexisting complications with LF in surgery for 
COM. Study Design and Setting: A retrospective review of 111 consecutive cases of
COM surgery performed by the same surgeon in a large metropolitan teaching public
hospital in the United States serving the inner city population. RESULTS: There
were 23 (21%) LFs in 111 patients. The majority of cases were revision surgery
with an average of 2.6 operations per patient. Other complications were
encountered in 18 (78%) of the 23 patients with an LF: 5 (22%) encephaloceles, 9 
(39%) dehiscences of the tegmen, 12 (52%) patients with facial nerve involvement 
by cholesteatoma, and 2 (8.7%) patients with facial nerve paralysis. These
patients required extensive surgery for correction of their concurrent
complications. CONCLUSION: Compared with those cases in which a fistula was not
found, the ratio of the above complications were as follows: encephalocele, 1:9; 
facial nerve involvement by cholesteatoma, 1:11.3; facial nerve paralysis, 1:3.8.
SIGNIFICANCE: Patients with neglected COM have an incidence of an LF twice that
reported in the literature. The prevalence of associated complications with LF
requiring extensive surgery is significantly higher than that observed in
noncomplicated COM cases.

PMID: 11112967 [PubMed - indexed for MEDLINE]

2348: Ear Nose Throat J. 2000 Nov;79(11):884-8, 890-2.

Clinical experiences with acute mastoiditis--1988 through 1998.

Lee ES, Chae SW, Lim HH, Hwang SJ, Suh HK.

Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Korea
University, Seoul.

The incidence of acute mastoiditis has declined dramatically during the
postantibiotic era. Even so, antibiotic-resistant or unusual pathogens can still 
cause this disease entity. At our hospital, we documented an increase in
antibiotic-resistant and atypical pathogens such as Actinomyces spp. and
Mycobacterium tuberculosis. In this paper, we discuss the optimal diagnosis and
treatment strategy for acute mastoiditis, and we describe our retrospective
review of 13 patients with mastoiditis who were treated at our hospital from 1988
through 1998. Eight of these patients recovered following treatment with
intravenous antibiotics, with or without myringotomy, and five who had
complications of disease were managed surgically. Among these five, one developed
chronic otitis media and one developed cholesteatoma 3 years later. For patients 
with acute mastoiditis, we emphasize the need to be aware of any unusual
pathogens that do not respond to empiric antibiotic therapy.

Publication Types: 
    Case Reports

PMID: 11107691 [PubMed - indexed for MEDLINE]

2349: Acta Paediatr. 2000 Nov;89(11):1316-21.

A single intramuscular dose of ceftriaxone changes nasopharyngeal bacterial flora
in children with acute otitis media.

Heikkinen T, Saeed KA, McCormick DP, Baldwin C, Reisner BS, Chonmaitree T.

Department of Pediatrics, University of Texas Medical Branch, Galveston, USA.
terho.heikkinen@utu.fi

The increasing prevalence of drug-resistant bacteria is attributed to the
extensive use of antibiotics, which causes selective pressure on the
nasopharyngeal bacterial flora. Shortened courses of antibiotics have been
proposed to decrease the development of resistant strains. We determined the
effect of a single intramuscular dose of ceftriaxone (50 mg/kg) on the
nasopharyngeal bacterial flora in 167 children (median age 13 mo) with acute
otitis media. Nasopharyngeal samples for bacterial culture were obtained before
and 5 d after treatment with ceftriaxone. Before treatment, Moraxella catarrhalis
was isolated in 99 (59%) children, Streptococcus pneumoniae in 87 (52%), and
Haemophilus influenzae in 53 (32%). After treatment, M. catarrhalis was found in 
62 (37%) children, which constitutes a 37% decrease in the colonization rate by
this pathogen (p < 0.001). S. pneumoniae was isolated in 50 (30%; 43% decrease)
and H. influenzae in 17 (10%; 68% decrease) children after treatment (p < 0.001
for both). Before treatment, 60% of pneumococcal isolates were sensitive to
penicillin, 26% were of intermediate susceptibility, and 14% were
penicillin-resistant. Eradication of S. pneumoniae occurred mainly in children
with penicillin-sensitive isolates. As a consequence, only 24% of pneumococcal
isolates that remained after treatment were sensitive to penicillin, 59% were
penicillin-intermediate, and 16% were penicillin-resistant. A single dose of
ceftriaxone resulted in significant changes in the nasopharyngeal bacterial
flora, increasing the relative prevalence of pneumococcal strains with decreased 
susceptibility to penicillin.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

PMID: 11106042 [PubMed - indexed for MEDLINE]

2350: J Am Osteopath Assoc. 2000 Oct;100(10):635-9.

Galbreath technique: a manipulative treatment for otitis media revisited.

Pratt-Harrington D.

Ohio University College of Osteopathic Medicine, Athens, USA.

Otitis media is a common disorder that results in numerous visits to the
physician each year. Antimicrobials, antihistamines, steroids, and surgery have
all been used to treat otitis media; however, the literature makes little mention
of osteopathic manipulative treatment in this regard. This article describes a
technique that was first described in 1929 by William Otis Galbreath, DO. By
simple mandibular manipulation, the eustachian tube is made to open and close in 
a "pumping action" that allows the ear to drain accumulated fluid more
effectively. Physicians can easily teach this procedure to parents for use at
home.

Publication Types: 
    Case Reports
    Review

PMID: 11105452 [PubMed - indexed for MEDLINE]

2351: Acta Otolaryngol. 2000 Sep;120(6):716-23.

Eustachian tube function varies over time in children with secretory otitis
media.

Bunne M, Magnuson B, Falk B, Hellström S.

Department of Otorhinolaryngology, Sunderby Hospital, Luleå, Sweden.
Marie.Bunne@nll.se

Impaired opening and closing functions of the Eustachian tube are considered to
be pathogenic factors in secretory otitis media (SOM). As the clinical course of 
SOM is variable, the variability of tubal function is of interest. We aimed to
explore the short- and long-term variability of tubal opening and closing
functions in SOM. The study comprised 42 ears in 21 children (13 males and 8
females) with tympanostomy tubes due to SOM. The middle ear pressure was recorded
during repeated passive forced openings, equalization of + 100 daPa and - 100
daPa by swallowing, Valsalva inflation and forceful sniffing. Test sessions were 
performed twice (separated by 30 min) on each of 2 days, with a mean interval of 
3.7 months in between. In the forced opening test there was a considerable
intra-individual variability over time. Expressed as SD of the mean, the
variability of the forced opening and closing pressures in individual ears was on
average 15% and 23%, respectively, between sessions and 20% and 30% respectively,
between test days. In the equalization, Valsalva and sniff tests the rates of
responses that changed from positive to negative between sessions and test days
ranged from 12% to 33%. Female gender and retraction pockets were related to
poorer opening function in the forced opening test. Ears with serous effusion (in
contrast to mucoid) showed a similar trend and also a lower occurrence of
positive equalization, Valsalva and sniff tests. It was concluded that Eustachian
tube opening and closing functions are highly variable in ears with SOM.
Consequently, single tubal function tests have low value when used as a
prognostic tool in individual ears.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11099147 [PubMed - indexed for MEDLINE]

2352: Pediatr Infect Dis J. 2000 Nov;19(11):1040-5.

Bacteriologic and clinical efficacy of one day vs. three day intramuscular
ceftriaxone for treatment of nonresponsive acute otitis media in children.

Leibovitz E, Piglansky L, Raiz S, Press J, Leiberman A, Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center, and the
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,
Israel. eugenel@bgumail.bgu.ac.il

BACKGROUND: One dose of intramuscular ceftriaxone has been recently licensed in
the United States for the treatment of acute otitis media. However, data
regarding the bacteriologic and clinical efficacy of this regimen in the
treatment of nonresponsive acute otitis media are incomplete. OBJECTIVES: To
determine the bacteriologic and clinical efficacy of a 1-day 50-mg/kg vs. a 3-day
50-mg/kg/day intramuscular ceftriaxone regimen in the treatment of nonresponsive 
acute otitis media in children. PATIENTS AND METHODS: In an open, prospective
study 109 patients ages 3 to 36 months with culture-proved, nonresponsive acute
otitis media were randomized to receive 1 (n = 49) or 3 (n = 60) 50-mg/kg/day
intramuscular ceftriaxone doses, respectively. Middle ear fluid was aspirated for
culture by tympanocentesis on the day of enrollment (Day 1); a second
tympanocentesis with middle ear fluid culture was performed on Days 4 to 5.
Additional middle ear fluid cultures were obtained if clinical relapse occurred
after completion of therapy. Bacteriologic failure was defined by positive
cultures on Days 4 to 5. Patients were followed until Day 28 after completion of 
therapy. Susceptibility of the middle ear pathogens was measured by E-test.
RESULTS: Organisms recovered (n = 133) were Streptococcus pneumoniae (30 and 35
isolates for the 1-day and 3-day treatment group, respectively), Haemophilus
influenzae (26 and 38, respectively) and Moraxella catarrhalis (n = 4). Of the 30
S. pneumoniae isolated from the 1-day group, 27 (90%) and 6 (20%) were
nonsusceptible to penicillin and ceftriaxone, respectively; 9 of 27 (33%) were
fully resistant to penicillin. Thirty-four (97%) and 6 (17%) of the 35 S.
pneumoniae isolated from the 3-day group were nonsusceptible to penicillin and
ceftriaxone, respectively; 16 of 34 (47%) were fully resistant to penicillin.
Bacterial eradication of all H. influenzae and penicillin-susceptible S.
pneumoniae was achieved in both treatment groups. Bacterial eradication of 14 of 
27 (52%) and 33 of 34 (97%) penicillin-nonsusceptible S. pneumoniae was achieved 
in the 1-day and 3-day group, respectively. Seven (50%) of the 14 patients from
the 2 groups who did not achieve bacterial eradication did not improve clinically
on Days 4 to 5 and required additional ceftriaxone treatment. CONCLUSION: The
3-day intramuscular ceftriaxone regimen was significantly superior to the 1-day
intramuscular ceftriaxone regimen in the treatment of nonresponsive acute otitis 
media caused by penicillin-resistant S. pneumoniae.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 11099083 [PubMed - indexed for MEDLINE]

2353: J Int Med Res. 2000;28 Suppl 1:25A-36A.

Short courses of antibiotic in acute otitis media and sinusitis infections.

Pichicero M.

Elmwood Pediatric Group, University of Rochester Medical Center, Rochester, New
York 14642, USA.

Poor compliance with standard antibiotic regimens of 7 - 10 days' duration used
in the treatment of acute upper respiratory tract infections contributes
significantly to treatment failure. Patients fail to complete the recommended
course of treatment, stopping once symptoms have resolved, which is typically
within 2 - 5 days. Accumulating evidence from a large number of prospective
clinical studies suggests that shortened courses of treatment may be as, or more,
effective than conventional regimens of longer duration. As an example, a study
comparing 5 days of cefuroxime axetil therapy with either 10 days of cefuroxime
axetil or amoxycillin/clavulanate showed no differences in rates of clinical
cure, bacteriological eradication and recurrence in paediatric patients with
either acute otitis media or sinusitis. Shortened-course therapy with agents such
as cefuroxime axetil has the potential to improve patient compliance and so
reduce the rate of clinical failure and the emergence of resistant strains. Other
potential benefits include fewer side-effects, improved patient satisfaction and 
lower treatment costs.

Publication Types: 
    Review

PMID: 11092227 [PubMed - indexed for MEDLINE]

2354: J Int Med Res. 2000;28 Suppl 1:13A-24A.

Short-course antibiotic therapy for infections with a single causative pathogen.

Adam D.

Department of Antimicrobial Therapy and Infectious Diseases, Dr von Haunersches
Children's Hospital, Ludwig-Maximilians University, Munich, Germany.

Studies evaluating short-course therapy have focused on prevalent infections with
demonstrable aetiology. Metaanalyses of clinical trials demonstrate that
uncomplicated acute otitis media in children can be successfully treated with a
5-day course of cefuroxime axetil. In the treatment of tonsillopharyngitis, 4 -
5-day courses of oral cephalosporins compared favourably with the standard 10-day
penicillin V regimen. The clinical cure rate and the bacteriological eradication 
rate were both significantly higher for cephalosporins than for penicillin V.
Bacteriological failure rates for cephalosporins were about half those for
penicillin. In studies on acute bacterial exacerbations of chronic bronchitis, no
difference in the clinical cure rates or relapse rates was found between
short-course therapy using cephalosporins and standard courses. The short courses
had the advantage of improved gastrointestinal tolerance compared with longer
durations of treatment. The results suggest that new short-course dosing regimens
are viable and may be favourable in terms of increased tolerability, reduction in
healthcare costs, enhanced patient compliance and the control of the development 
of antibiotic resistance.

Publication Types: 
    Review

PMID: 11092226 [PubMed - indexed for MEDLINE]

2355: Ann Otol Rhinol Laryngol. 2000 Nov;109(11):1028-32.

Mastoid pneumatization of the patulous eustachian tube.

Tsuji T, Yamaguchi N, Aoki K, Mitani Y, Moriyama H.

Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo,
Japan.

The pathophysiology of the patulous eustachian tube (PET) remains unclear. The
degree of mastoid cell pneumatization is considered an indicator of chronic
inflammation of the middle ear. We used the mastoid cell area to investigate the 
relationship between past chronic inflammation of the middle ear cavity and a PET
in 84 patients (20 to 83 years old). The mastoid cell size was calculated from
radiographs and analyzed relative to the history of otitis media (OM). The
controls were 100 normal ears. The patients' mastoid cell size was significantly 
suppressed versus that of the controls, in both 31 PET cases with and 53 PET
cases without past OM. We surmise the possibility that the PET ears had
experienced inflammation even when the patients had no history of OM and the
tympanic membrane showed no OM sequelae. This study indicates the existence of
some relationship between a history of chronic inflammation of the middle ear
cavity and a PET.

PMID: 11089993 [PubMed - indexed for MEDLINE]

2356: Ann Otol Rhinol Laryngol. 2000 Nov;109(11):1021-7.

Effect of adenovirus type 1 and influenza A virus on Streptococcus pneumoniae
nasopharyngeal colonization and otitis media in the chinchilla.

Tong HH, Fisher LM, Kosunick GM, DeMaria TF.

Department of Otolaryngology, College of Medicine and Public Health, The Ohio
State University, Columbus 43210-1282, USA.

Considerable evidence has implicated respiratory tract virus potentiation of
bacterial adherence, colonization, and superinfection as a significant factor
contributing to the pathogenesis of otitis media (OM). Influenza A and B viruses,
adenovirus, and respiratory syncytial virus are the primary respiratory tract
viruses associated with this disease. Investigations have established a dramatic 
increase in the development of experimental OM in chinchillas co-inoculated with 
influenza A virus and Streptococcus pneumoniae (Spn). The mechanism underlying
this phenomenon was suggested to involve, in part, viral compromise of eustachian
tube mucosal integrity and function. This study was designed to assess and
compare the effect of adenovirus and influenza A virus infection on adherence,
the kinetics of colonization, and invasion of the middle ear by Spn in the
chinchilla model of OM. Cohorts were inoculated intranasally with adenovirus type
1 or influenza A virus, and then inoculated intranasally 7 days later with Spn
6A. All cohorts were observed over a 14-day period after challenge with Spn, and 
the incidence and severity of OM were assessed by several methods, including
culture of the nasopharynx and middle ear effusions. The data indicated that
influenza A virus promotes a significant increase in nasopharyngeal colonization 
by Spn, an increased incidence and severity of OM, and a sustained presence of
Spn in the effusions. Adenovirus infection, however, did not enhance colonization
by Spn or result in an increased incidence or severity of OM.

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 11089992 [PubMed - indexed for MEDLINE]

2357: Laryngoscope. 2000 Nov;110(11):1857-60.

Intranasal surfactant aerosol therapy for otitis media with effusion.

Venkatayan N, Troublefield YL, Connelly PE, Mautone AJ, Chandrasekhar SS.

Division of Otolaryngology--Head and Neck Surgery, University of Medicine and
Dentistry of New Jersey, New Jersey Medical School, Newark 07103-2714, USA.

OBJECTIVE: To determine the effect of surfactant alone and with other medications
delivered intranasally as a metered dose inhaler (MDI) aerosol on the resolution 
of experimentally induced otitis media with effusion (OME). BACKGROUND:
Eustachian tube dysfunction is a primary factor in the pathogenesis of OME.
Intranasal surfactant via MDI has been shown in this laboratory to reduce passive
opening pressure of the eustachian tube in normal gerbils and mice. STUDY DESIGN:
OME was developed in 35 gerbils by transtympanic injection of 10 microg
lipopolysaccharide from Klebsiella pneumoniae. Pretreatment otomicroscopy and
tympanometry were performed to exclude pre-existing middle ear disease, and
postinfection evaluations were performed on alternate days for a period of 30
days. Five animals received no treatment (control group); four were treated with 
propellant only (placebo); seven received surfactant alone; eight received
surfactant and betamethasone; and six received surfactant with phenylephrine. All
medications were sprayed intranasally as an aerosolized MDI and administered
daily from postinfection day 2 onward. RESULTS: OME resolved after 16.0 +/- 0.44 
days (mean + SD) in controls. There was no difference seen in the placebo or the 
surfactant with phenylephrine groups. Treatment with surfactant yielded
resolution in 10.57 +/- 0.37 days; this was reduced to 8.57 +/- 0.37 days with
surfactant plus betamethasone. These differences are statistically significant.
There was no recurrence of OME in any group. CONCLUSION: This study demonstrates 
that using an aerosolized MDI surfactant with and without betamethasone decreases
the duration of OME in this in vivo gerbil model.

PMID: 11081599 [PubMed - indexed for MEDLINE]

2358: Am J Otol. 2000 Nov;21(6):782-5.

Middle ear effusions after radiotherapy: correlation with pre-radiotherapy
nasopharyngeal tumor patterns.

Kew J, King AD, Leung SF, Tong MC, Ku PK, Wong KK, van Hasselt CA.

Department of Diagnostic Radiology and Organ Imaging, The Chinese University of
Hong Kong, Prince of Wales Hospital, Shatin, New Territories.

OBJECTIVE: The purpose of this study was to assess whether pretreatment tumor
patterns of nasopharyngeal carcinoma (NPC) can predict the status of the middle
ear after radiation treatment. MATERIALS AND METHODS: Pretreatment and follow-up 
magnetic resonance imaging (MRI) was performed in 32 patients (64 ears) who had
radiation therapy for NPC. For the purpose of analysis, the ears were placed into
their pre-radiation therapy tumor pattern groups and the presence of middle ear
effusion (MEE) with regard to eustachian tube (ET) invasion or displacement was
identified. RESULTS: MEEs were present in 31 (48.4%) ears after radiation
therapy. All of the MEEs that resolved were in the preradiation therapy groups
where tumor invasion of the eustachian tube was present irrespective of the
amount of ET displacement. There was, however, no significant difference for
resolved MEEs between ears with ET invasion or displacement (p = 0.32 and p =
0.71, respectively, Fisher's exact test). The MEEs occurred with significantly
greater frequency in ears with minor ET displacement than in those with major ET 
displacement (p = 0.013, Fisher's exact test) as well as in previously normal
ears compared with other groups (p = 0.008, Mann-Whitney U test). CONCLUSION: A
pre-radiation therapy NPC tumor pattern was not found that clearly predicted the 
outcome of MEE after radiation treatment. The findings, however, suggest that
approximately one third of MEEs in patients with invasion of ET or paratubal
structures, irrespective of the amount of ET displacement, resolve after therapy.
The MEEs that were present in ears with ET displacement and no invasion did not
resolve despite reversal of the displacement after treatment, which suggests that
ET position plays a less important role than invasion in the resolution of MEE.
It is, however, difficult to be certain, because ears with invasion were
invariably associated with ET displacement, and the contribution of radiation
therapy to the development of MEE further complicates the issue.

PMID: 11078063 [PubMed - indexed for MEDLINE]

2359: J R Coll Surg Edinb. 2000 Oct;45(5):321-5.

Management of childhood otitis media with effusion by Scottish otolaryngologists.

Mills RP, McKerrow WS.

Otolaryngology Unit, Royal Infirmary, Edinburgh, U.K.

A prospective audit of 5430 initial consultations and 1602 admissions to Scottish
hospitals for surgical treatment of otitis media with effusion in childhood in
ear, nose and throat departments throughout Scotland has been carried out. The
results suggest that Scottish children are assessed by clinicians of appropriate 
experience when initially seen in outpatients and only a minority (30%) are
listed for surgery following their first visit. Not all children have a hearing
test at their initial clinic visit. In those cases where surgical treatment is
not advised at the first visit, a policy of "watchful waiting" is preferred to
medical treatment by most clinicians. Bilateral dry tap rates varied between zero
in Forth Valley and 19% in Lanarkshire. Fifty one per cent of operations were
carried out by consultants and only 3% by SHOs. "Best practice" for the initial
management of childhood ear problems is widespread in Scotland but there is room 
for improvement. There is a need for review of the availability of paediatric
audiology services.

PMID: 11077781 [PubMed - indexed for MEDLINE]

2360: Otolaryngol Head Neck Surg. 2000 Nov;123(5):617-23.

Controlled multicenter study on chronic suppurative otitis media treated with
topical applications of ciprofloxacin 0.2% solution in single-dose containers or 
combination of polymyxin B, neomycin, and hydrocortisone suspension.

Miró N.

Servicio de Otorrinolaringología, Hospital Universitario Germans Trias i Pujol,
Badalona, Spain.

Otic drops of either ciprofloxacin 0.2% solution (CIP) or a combination of
polymyxin B, neomycin, and hydrocortisone suspension (PNH) were administered for 
6 to 12 days to patients (14-71 years old) with chronic suppurative otitis media 
in a randomized, nonblinded, multicenter clinical trial. Two hundred thirty-two
enrolled patients were analyzed for efficacy on a "per protocol" basis. The most 
frequently identified causal agents were Staphylococcus aureus (28% of the
patients), Pseudomonas aeruginosa (19%), and Staphylococcus sp (9%). Clinical
success was observed in 91% and 87% of the CIP-and PNH-treated patients,
respectively. At 1-month follow-up, 4% of CIP and 6% of PNH patients showed a
relapse of otorrhea. Bacteriologic eradication was seen in 89% and 85% of
patients in the CIP and PNH groups, respectively. At 1-month follow-up,
reinfection or recurrence of infection appeared in 3 patients in the PNH group
and in 1 patient in the CIP group. Both treatments were well tolerated. The most 
frequently reported adverse events were pruritus, stinging, and earache.
Audiometric tests did not show changes attributable to study drugs in any but 1
patient in the PNH group. This clinical trial shows that topical 0.2%
ciprofloxacin solution in single-dose containers is effective and well tolerated 
in patients with chronic suppurative otitis media.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial

PMID: 11077352 [PubMed - indexed for MEDLINE]

2361: Otolaryngol Head Neck Surg. 2000 Nov;123(5):533-8.

Increased expression of major basic protein (MBP) and interleukin-5(IL-5) in
middle ear biopsy specimens from atopic patients with persistent otitis media
with effusion.

Wright ED, Hurst D, Miotto D, Giguere C, Hamid Q.

Meakins-Christie Laboratories, and the Department of Otolaryngology, McGill
University, Canada.

BACKGROUND: Molecular biologic evidence to support an etiologic role for allergy 
in the pathogenesis of persistent otitis media with effusion (OME) is lacking.
OBJECTIVE: The goal of this article was to document expression of
allergy-associated Th-2-type cytokines and inflammatory cells in the middle ear
mucosa of children with persistent OME. METHODS: With immunocytochemistry (CD3,
major basic protein) and in situ hybridization (interleukin-5 mRNA), middle ear
biopsy specimens from 7 children with persistent OME were stained. Nonatopic
stapedectomy patients with no history of otitis media served as controls (n = 7).
RESULTS: There was a statistically significant (P< 0.05) difference in expression
of CD3, major basic protein, and interleukin-5 between experimental and control
subjects. All 8 OME patients proved to be atopic by ELISA testing. CONCLUSIONS:
Type I allergy involving a Th-2-type cytokine and cellular profile may be a
contributing factor in the persistence of OME in atopic children. SIGNIFICANCE:
The middle ear may serve as a target organ for allergic inflammation, suggesting 
that appropriate allergy management may be a useful adjunct to the management of 
OME.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11077335 [PubMed - indexed for MEDLINE]

2362: Emerg Infect Dis. 2000 Nov-Dec;6(6):622-30.

Risk factors for otitis media and carriage of multiple strains of Haemophilus
influenzae and Streptococcus pneumoniae.

St Sauver J, Marrs CF, Foxman B, Somsel P, Madera R, Gilsdorf JR.

University of Michigan, Ann Arbor, Michigan, USA.

We studied genetic diversity in Streptococcus pneumoniae and Haemophilus
influenzae in throat culture isolates from 38 children attending two day-care
centers in Michigan. Culture specimens were collected weekly; 184 S. pneumoniae
and 418 H. influenzae were isolated from the cultures. Pulsed-field gel
electrophoresis identified 29 patterns among the S. pneumoniae isolates and 87
among the H. influenzae isolates. Of the cultures, 5% contained multiple genetic 
types of S. pneumoniae, and 43% contained multiple types of H. influenzae.
Carriage of multiple H. influenzae isolates, which was associated with exposure
to smoking, history of allergies, and age 36 to 47 months, may increase risk for 
otitis media in children.

PMID: 11076721 [PubMed - indexed for MEDLINE]

2363: J Vet Med B Infect Dis Vet Public Health. 2000 Oct;47(8):599-605.

Optimum incubation conditions for the isolation of yeasts from canine otitis
externa.

Blanco JL, Guedeja-Marrón J, Blanco I, García ME.

Departamento Patología Animal I, Facultad de Veterinaria, Universidad
Complutense, Madrid, Spain. jlblanco@eucmax.sim.ucm.es

Samples from otitis externa in the dog were cultured on a variety of media under 
different conditions of incubation in order to assess the most suitable
conditions, especially for the isolation of Malassezia pachydermatis. Columbia
blood and MacConkey agar at 37 degrees C for 24 h with air and Sabouraud glucose 
agar under microaerophilic conditions for 48 h at 37 degrees C were considered
the ideal combination.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11075548 [PubMed - indexed for MEDLINE]

2364: Arch Otolaryngol Head Neck Surg. 2000 Nov;126(11):1383-5.

Methicillin-resistant Staphylococcus aureus: pediatric otitis.

Santos F, Mankarious LA, Eavey RD.

Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114, USA.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a potentially
lethal organism in pediatric patients. MRSA is an uncommon otologic pathogen that
requires special diagnostic and therapeutic intervention. METHODS: Three
pediatric patients with community-acquired MRSA otologic infections were
identified during 1999. SETTING: Tertiary care ear institution. RESULTS: All
patients required intravenous antibiotic therapy to achieve resolution of the
infections. CONCLUSIONS: MRSA in children can be community acquired and can cause
otitis externa, otitis media with otorrhea, or acute mastoiditis; intravenous
therapy that includes vancomycin is necessary for resolution.

Publication Types: 
    Case Reports

PMID: 11074838 [PubMed - indexed for MEDLINE]

2365: Arch Otolaryngol Head Neck Surg. 2000 Nov;126(11):1345-8.

Outpatient tympanomastoidectomy: factors affecting hospital admission.

Megerian CA, Reily J, O'Connell FM, Heard SO.

Department of Otolaryngology-Head and Neck Surgery, University of Massachusetts
Medical School, 55 Lake Ave N, Worcester, MA 01655, USA. Megeriac@ummhc.org

BACKGROUND: Outpatient tympanomastoidectomy is common in many medical centers.
However, failure of same-day discharge is often the result of postoperative
nausea and vomiting (PONV). Many times this leads to hospital admission after
tympanomastoidectomy, and it is often difficult to predict before surgery whether
PONV will be an issue that impedes same-day discharge. OBJECTIVE: To determine
the clinical factors correlated with the incidence of PONV requiring hospital
admission after chronic ear surgery by hypothesizing that the complexity of a
particular case, as measured using a 10-point scale, is predictive of surgical
time or failure of same-day hospital discharge. STUDY DESIGN: Retrospective
medical chart review of 103 patients having mastoidectomy with tympanoplasty for 
chronic otitis media over a 2-year period. METHODS: We recorded patient age,
clinical data, surgical times, types of agents used for induction and maintenance
of anesthesia, use of prophylactic antiemetic drugs, types and doses of analgesic
agents, and PONV. Univariate and multivariate logistic regression analyses were
performed to determine which variables were associated with PONV that required
hospital admission. RESULTS: One third of patients studied were safely discharged
from the hospital the day of surgery, and 92% were discharged within 23 hours.
The most common cause for observation admission to the hospital was PONV. The
only variable in multivariate analysis that significantly correlated with PONV
mandating hospital admission after tympanomastoid surgery was a history of motion
sickness or PONV (odds ratio, 5.21; P =.02). Although severity of disease did not
correlate with length of hospital stay, it directly correlated with length of
surgery. CONCLUSIONS: A history of PONV or motion sickness is predictive of PONV 
and length of hospital stay. Routine planning for a 23-hour overnight observation
stay seems warranted for all patients undergoing tympanomastoidectomy, despite
severity of disease.

PMID: 11074831 [PubMed - indexed for MEDLINE]

2366: Int J Pediatr Otorhinolaryngol. 2000 Nov 30;56(1):41-4.

Comparison of the incidence of cholesteatoma surgery before and after using
ventilation tubes for secretory otitis media.

Rakover Y, Keywan K, Rosen G.

Department of Otorhinolaryngology, Ha'Emek Medical Center, Afula, Israel.
rakover@clalit.org.il

Inserting ventilation tubes has become, probably, the most common surgical
operation performed on children in the free world. In our study, we attempted to 
examine whether the widely used procedure of inserting ventilation tubes in
children with secretory otitis media is indeed justified in the long term. For
this purpose, we have studied the influence of the procedure on the formation of 
cholesteatoma by comparing the incidence of cholesteatoma surgery before and
after using ventilation tubes in our department. The data were divided into two
periods. The first period included the number of operations in the 10 years
(1961-1970) before ventilation tubes were used as a routine treatment for
secretory otitis media in our department. The second period included the number
of operations in the last 10 years (1989-1998) following the usage of ventilation
tubes over 30 years. We found that the number of cholesteatoma operations has
decreased, from 413 operations in the 10 years before ventilation tubes were used
to 228 operations over the last 10 years. The number of operations per 10000 of
the entire population has decreased from 20 operations to 6.6 operations after
using ventilation tubes (P=0.0000001). We have shown that the incidence of
surgery for cholesteatoma has been declining. Having analyzed the options that
might cause this decline, we believe that using ventilation tubes in secretory
otitis media might help to reduce the incidence of cholesteatoma surgery in the
long term.

Publication Types: 
    Comparative Study

PMID: 11074114 [PubMed - indexed for MEDLINE]

2367: Int J Pediatr Otorhinolaryngol. 2000 Nov 30;56(1):33-40.

Acute mastoiditis in children: review of the current status.

Spratley J, Silveira H, Alvarez I, Pais-Clemente M.

Division of Pediatric Otorhinolaryngology, Department of Otorhinolaryngology,
Hospital de S. João, University of Porto Medical School, 4202-451, Porto,
Portugal. j.spratley@mail.telepac.pt

BACKGROUND: acute mastoiditis is the most common intratemporal complication of
otitis media. Its management is still a challenge due to potentially serious
consequences. This study was designed to evaluate the recent experience with
pediatric acute mastoiditis at our institution and to determine if the incidence 
of this entity is changing over time. MATERIAL AND METHODS: retrospective review 
of records of children with acute mastoiditis treated at the hospital of the
Medical School at the University of Porto, Portugal, between July 1993 and June
1998. Criteria for the diagnosis of acute mastoiditis were postauricular swelling
and erythema, protrusion of the auricle, and evidence of co-existent or recent
otitis media. RESULTS: 43 patients fulfilled the entry criteria. Most were boys
(69%). Ages ranged from 8 months to 14 years and 4 months; infants represented
40% of the total. Acute mastoiditis was the first recognized sign of otitis media
in 48% of patients. More recent years of the study saw an increase in the number 
of children referred with acute mastoiditis. Upon admission, 56% were under
antibiotic treatment, with an average intake of 5.8 days. All patients were
hospitalized; 26 cases recovered after intravenous antibiotics plus myringotomy, 
and the rest required an additional surgical procedure. The most common organisms
recovered from cultures were Streptococcus pneumoniae and Streptococcus pyogenes.
In our series, associated complications occurred in 13.9%; facial paralysis in
one, and involvement of the central nervous system in five. CONCLUSIONS:
pediatric acute mastoiditis continues to be a potentially dangerous infection in 
the antibiotic era. The incidence of this complication may be increasing recently
in the community studied. Great care is required of clinicians to reach an early 
diagnosis in order to promote adequate management and prevent inherently severe
complications.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 11074113 [PubMed - indexed for MEDLINE]

2368: Int J Pediatr Otorhinolaryngol. 2000 Nov 30;56(1):23-31.

Acute otitis media: bacteriology and bacterial resistance in 205 pediatric
patients.

Commisso R, Romero-Orellano F, Montanaro PB, Romero-Moroni F, Romero-Diaz R.

Department of Otolaryngology, Head and Neck Surgery, Universidad Católica de
Córdoba, Oncativo 1290-4to Piso, 5000, Córdoba, Argentina.

Acute otitis media (AOM) is one of the most frequent diagnoses in children below 
the age of 2 years. Treatment is usually based on information included in the
literature concerning bacteriology. The purpose of this work was to define the
most frequent germs in the etiology of AOM within our community, in order to
optimize therapeutics for this pathology. Cultures in middle ear secretions
obtained through tympanocentesis were performed to this end, ensuring careful
sample taking and processing. The results obtained are similar to those published
in previous papers for which Streptococcus pneumoniae and Haemophilus influenzae 
proved to be the predominant germs. However, there are certain discrepancies
concerning the incidence of Moraxella catarrhalis and this has a direct impact on
the total percent of resistant strains, thus modifying therapeutic approaches for
treatment of AOM. The antibiotic sensitivity profiles of the most frequent
etiologic agents were studied in accordance with the principles established by
the 'National Committee for Clinical Laboratory Standards' (NCCLS).

Publication Types: 
    Comparative Study

PMID: 11074112 [PubMed - indexed for MEDLINE]

2369: Acta Paediatr. 2000 Sep;89(9):1068-71.

Middle ear effusion IL-6 concentration in bacterial and non-bacterial acute
otitis media.

Barzilaia A, Dekel B, Dagan R, Leibovitz E.

Department of Pediatrics, Chaim Sheba Medical Center, Tel Hashomer, Israel.
barzilaia@hotmail.com

BACKGROUND: The pathogenesis of acute otitis media is complex and multifactorial.
It is characterized by inflammation of the middle ear with an infiltration of
leukocytes, macrophages and mast cells. The resulting effusion contains a large
amount of inflammatory mediators, among which are cytokines. OBJECTIVES: To test 
the role of IL-6 in the inflammatory process associated with acute otitis media. 
METHODS: We analyzed 20 middle ear fluid (MEF) sample pairs, obtained by
aspiration before initiating antibiotic therapy (day 1) and during treatment
(days 4-5), for the presence of IL-6. IL-6 concentrations were assayed with an
ELISA kit (detection limit 5 pg/ml) and were correlated with bacterial etiology
and bacterial eradication from the middle ear. RESULTS: IL-6 was detected in all 
middle ear effusions analyzed. We found decreased IL-6 concentrations in culture 
negative MEF compared to culture positive MEF on both days I and 4-5 (day 1,
1752.20+/-1001.31 pg/ml vs 1216.20+/-1015.44 pg/ml, p = 0.19; days 4-5,
1049.36+/-472.40 pg/ml vs 800.33+/-676.00 pg/ml, p = 0.23); however, differences 
did not achieve statistical significance. Overall, a marked and significant
decrease in IL-6 concentration occurred following 72-96 h of antibiotic therapy
(1618.15+/-1004.88 pg/ml vs 936.85+/-581.05 pg/ml, p = 0.04). While MEF IL-6
concentrations decreased in ears where bacteria persisted (1468.20+/-858.48 pg/ml
vs 1044.80+/-514.16 pg/ml, p = 0.167) or were eradicated (2320.20+/-866.16 pg/ml 
vs 767.40+/-522.88 pg/ml, p = 0.029), a more prominent decline was demonstrated
in the latter. CONCLUSIONS: These results strongly suggest the involvement of
IL-6 in the ongoing inflammatory process in both bacterial and non-bacterial
acute otitis media. Resolution of inflammation in the middle ear, especially
where bacteria were eradicated, is reflected by low IL-6 levels.

PMID: 11071086 [PubMed - indexed for MEDLINE]

2370: Prescrire Int. 2000 Aug;9(48):99-102.

Ceftriaxone and otitis in children: new indication. Only in special
circumstances.

[No authors listed]

(1) Ceftriaxone, a third-generation cephalosporin antibiotic, is now licensed in 
France for (intramuscular) treatment of acute otitis media in children, both as
first-line therapy in children under 30 months, and after failure of a first
antibiotic regimen. (2) The clinical file on first-line ceftriaxone treatment is 
relatively bulky. In contrast, only two non comparative trials of ceftriaxone
after failure of initial treatment are available. (3) According to trials of
first-line treatment, the efficacy of a single intramuscular dose of ceftriaxone 
is equivalent to that of the sulfamethoxazole + trimethoprim combination and the 
amoxicillin + clavulanic acid combination, and similar to that of amoxicillin
(when all these reference antibiotics are given orally for 10 days). (4) Pain at 
the injection site is the main adverse effect of ceftriaxone, despite the local
anaesthetic (lidocaine) contained in the solvent.

Publication Types: 
    Comparative Study

PMID: 11067716 [PubMed - indexed for MEDLINE]

2371: Manag Care Interface. 2000 Apr;13(4):83-8.

The management of bacterial infections of the upper respiratory tract in
children: pharyngitis and otitis media.

Adam D.

Infectious Disease Unit of Children's Hospital of the University of Munich,
Munich, Germany.

Despite changes in the activities of infectious microorganisms, particularly
variations in their prevalences in different parts of the body, in clinically
defined diseases, and in their susceptibilities to antibiotics, the established
first-line agents for the empiric treatment of otitis media and pharyngitis are
still valid. Nevertheless, a number of the newer antimicrobials have become
valuable as second- and third-line medications when the first-choice drugs fail
or are contraindicated. In terms of fundamental principles, the question of
whether pharyngitis in children warrants routine antibiotic therapy remains
unresolved; in practical terms, antibiotic treatment should be considered
routinely.

Publication Types: 
    Meta-Analysis
    Research Support, Non-U.S. Gov't

PMID: 11066289 [PubMed - indexed for MEDLINE]

2372: Arch Environ Health. 2000 Sep-Oct;55(5):300-3.

Environmental risk factors for respiratory infections.

Rylander R, Mégevand Y.

Department of Environmental Medicine, University of Gothenburg, Sweden.

In this study, the authors investigated the possible relationship between
environmental-including dietary-factors and respiratory and ear infections in
children. A sample of 304 children, aged 4-5 y, in Geneva, Switzerland, was
studied. Mothers filled out a questionnaire that the authors provided. The
questionnaire included items on food frequency, infections, and background
factors (e.g., education, housing conditions, parents' smoking habits). Allergy
was a risk factor for all infections, and mother's age was a protective factor.
Humid conditions at home was a significant risk factor for cold, sore throat, and
otitis (odds ratios = 2.71, 3.03, and 2.77, respectively); mold in the home was a
significant risk factor for otitis (odds ratio = 2.80); and attending day-care
centers was a significant risk factor for cold and bronchitis (odds ratios = 1.36
and 1.89, respectively). Dietary factors were not related to disease risk nor
were environmental tobacco smoke or housing conditions generally related to an
increased risk.

PMID: 11063404 [PubMed - indexed for MEDLINE]

2373: Pediatr Emerg Care. 2000 Oct;16(5):343-5.

Facial paralysis secondary to acute otitis media.

White N, McCans KM.

Division of Pediatric Emergency Medicine, Cooper Hospital University Medical
Center, Camden, NJ, USA. verbal2@bellatlantic.net

We describe a case of facial paralysis in a 19-month-old male recently diagnosed 
with acute otitis media. Results of his physical examination was remarkable for
left-sided peripheral facial nerve palsy with an associated middle ear infection.
Physicians should understand the etiology, pathophysiology, treatment options,
and prognosis of facial palsy in association with otitis media.

Publication Types: 
    Case Reports

PMID: 11063365 [PubMed - indexed for MEDLINE]

2374: Med J Aust. 2000 Oct 2;173 Suppl:S48-50.

Conjugate pneumococcal vaccines: an overview.

Mulholland EK.

Department of Paediatrics, University of Melbourne, VIC.
mulhollk@cryptic.rch.unimelb.edu.au

A seven-valent conjugate pneumococcal vaccine has been shown to have dramatic
efficacy against invasive pneumococcal disease and lesser efficacy against otitis
media and pneumonia. This vaccine was licensed for use in infants in the United
States in February 2000 and is recommended there for routine use in infants and
catch-up vaccination in high-risk children. Specific regional pneumococcal
vaccines are not needed; nine to 11 serotypes cover most pneumococcal disease in 
most parts of the world; nine- and 11-valent conjugate vaccines are currently
being developed for the global market. There is evidence of serotype replacement 
in vaccine recipients (in both carriage and disease), which might reduce overall 
vaccine effectiveness. There is also evidence that vaccines may reduce rates of
antimicrobial resistance in pneumococci. Studies of the burden of pneumococcal
disease as well as program support are needed to assist developing countries to
introduce these expensive vaccines.

Publication Types: 
    Review

PMID: 11062808 [PubMed - indexed for MEDLINE]

2375: Lancet. 2000 Oct 21;356(9239):1398-402.

Comment in:
    Lancet. 2000 Oct 21;356(9239):1370-1.    Lancet. 2001 Jan 27;357(9252):311.

Treatment of acute otitis media with an antiadhesive oligosaccharide: a
randomised, double-blind, placebo-controlled trial.

Ukkonen P, Varis K, Jernfors M, Herva E, Jokinen J, Ruokokoski E, Zopf D, Kilpi
T.

National Public Health Institute, Helsinki, Finland. pentti.ukkonen@hus.fi

BACKGROUND: Antiadhesive compounds are promising candidates for prevention or
treatment of infections. We have investigated the efficacy of such an agent,
3'-sialyllacto-N-neotetraose (NE-1530), given intranasally for prophylaxis of
acute otitis media and for effect on nasopharyngeal carriage of bacteria.
METHODS: We did a randomised, double-blind placebo-controlled study at one study 
site. 507 healthy children were randomly assigned either NE-1530 (n=254) or
placebo (253) as intranasal sprays twice daily during 3 months. The children were
examined by the study physicians once a month and during illness. Treatment
efficacy was estimated from Cox proportional hazards model. A sample of
nasopharyngeal secretion was taken at every visit for culture of Streptococcus
pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Adverse events
were recorded in study diaries. FINDINGS: At least one event of acute otitis
media was diagnosed in 108 (43%) of 254 children in the NE-1530 group and in 86
(34%) of 253 children in the placebo group. The efficacy of treatment was
negative, -27% (95% CI -68 to 5; p=0.10). The nasopharyngeal carriage of S
pneumoniae, H. influenzae, and M. catarrhalis was not affected by treatment, and 
the adverse event profiles were almost identical for NE-1530 and placebo.
INTERPRETATION: NE-1530 did not have a beneficial effect on the occurrence of
acute otitis media or on the nasopharyngeal carriage of bacteria in children.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 11052582 [PubMed - indexed for MEDLINE]

2376: Vet Radiol Ultrasound. 2000 Sep-Oct;41(5):413-8.

Magnetic resonance imaging of the normal and diseased feline middle ear.

Allgoewer I, Lucas S, Schmitz SA.

Klinik und Poliklinik fuer kleine Haustiere an der Freien Universitaet Berlin,
Germany.

The magnetic resonance imaging appearance of the feline middle ear is described
in three healthy cats and in five cats with middle ear disease. Owing to the good
spatial resolution, multiplanar slice orientation as well as display high
contrast resolution of soft tissue, in particular fluids, MR imaging was helpful 
prior to surgery. It is superior to radiography which failed to allow
identification of the abnormality in two of our five cats. MR imaging for middle 
ear disease should include dorsal and transverse plane images using T1- and
T2-weighted sequences. In the presence of a mass within the bulla or the external
ear canal application of contrast medium is helpful.

PMID: 11052363 [PubMed - indexed for MEDLINE]

2377: Eur Arch Otorhinolaryngol. 2000;257(7):366-71.

Otoscopic findings in relation to tympanometry during infancy.

Engel J, Anteunis L, Chenault M, Marres E.

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital
Maastricht, The Netherlands. jamengel@wxs.nl

To determine the value of different otoscopic findings in diagnosing otitis media
with effusion, 3,780 otological examinations of 250 infants at ages 0-2 years
were compared with tympanometric findings. Otoscopy was performed by an
experienced otologist and research-audiologist prior to tympanometry. The
following success rates for these procedures were found: otoscopy, 85-91%,
tympanometry, 74-94%, either otoscopy or tympanometry, 89-99%. "Glue" was noted
as the most frequent abnormal otoscopic feature, i.e., depending on age, 6-32%.
Fluid line/ bubbles, bulging/hyperaemia or otorrhoea were rarely (0-5%) observed 
and contributed little to the diagnosis of otitis media with effusion. No
structural changes of the tympanic membrane were observed. Analysis of
tympanometric data revealed that the prevalence of tympanogram types B (21-44%), 
C1 (0.5-16%) and C2 (0-8%) was age-dependent. Comparison of otoscopic and
tympanometric findings indicated sufficient diagnostic agreement (Cohen's kappa
between 0.41 and 0.74) at age 6-24 months. In conclusion, otoscopy appears to be 
a valid instrument for diagnosing otitis media with effusion, at least from 6 to 
24 months of age. In addition, the results of our study suggest that
tuba-dysfunction and otitis media with effusion are age-dependent disorders
during infancy, without structural effects on the tympanic membrane.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11052246 [PubMed - indexed for MEDLINE]

2378: J Fam Pract. 2000 Oct;49(10):932-6.

Tympanometry interpretation by primary care physicians. A report from the
International Primary Care Network (IPCN) and the Ambulatory Sentinel Practice
Network (ASPN).

Green LA, Culpepper L, de Melker RA, Froom J, van Balen F, Grob P, Heeren T.

American Academy of Family Physicians Center for Policy Studies, Boston
University, MA, USA.

BACKGROUND: The accuracy of data gathered by primary care clinicians in
practice-based research networks (PBRNs) has been questioned. Tympanometry,
recently recommended as a means of improving accuracy of diagnosing acute otitis 
media, was included as an objective diagnostic measure in an international PBRN
study. We report the level of agreement of interpretations of tympanograms
between primary care physicians in PBRNs and experts. METHODS: Primary care
physicians in PBRNs in the Netherlands, United Kingdom, United States, and Canada
enrolled 1773 children aged 6 to 180 months who contributed 6358 tympanograms
during 3179 visits. The physicians were trained in the use and interpretation of 
tympanometry using the Modified Jerger Classification. We determined the level of
agreement between physicians and experts for interpretation of tympanograms. One 
comparison used the 6358 individual ear tracings. A second comparison used the
3179 office visits by children as the unit of analysis. RESULTS: The distribution
of expert interpretation of all tympanograms was: 35.8% A, 30% B, 15.5% C1, 12%
C2, and 6.8% uninterpretable; for visits, 37.8% were normal (A or C1), 55.6%
abnormal (B or C2), and 6.6% could not be classified. There was a high degree of 
agreement in the interpretation of tympanograms between experts and primary care 
physicians across networks (kappa=0.70-0.77), age groups of children
(kappa=0.69-0.73), and types of visits (kappa=0.66-0.77). This high degree of
agreement was also found when children were used as a unit of analysis.
CONCLUSIONS: Interpretations of tympanograms by primary care physicians using the
Modified Jerger Classification can be used with confidence. These results provide
further evidence that practicing primary care physicians can provide high-quality
data for research purposes.

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 11052167 [PubMed - indexed for MEDLINE]

2379: Ann Otol Rhinol Laryngol. 2000 Oct;109(10 Pt 1):958-64.

Erratum in:
    Ann Otol Rhinol Laryngol. 2005 Dec;114(12):967. Atshushi, H [corrected to
Harimaya, A].

Stimulation of adenoidal lymphocytes by Alloiococcus otitidis.

Tarkkanen J, Himi T, Harimaya A, Carlson P, Ylikoski J, Mattila PS.

Department of Pathology, Haartman Institute, Helsinki University Central
Hospital, Finland.

Otitis media with effusion (OME) is characterized by persistent effusion in the
middle ear cavity and by chronic inflammation in the middle ear mucosa.
Alloiococcus otitidis, a gram-positive aerobic bacterium, has been isolated in
middle ear effusion, and by means of sensitive polymerase chain reaction
detection assays it has been detected in as many as 20% of middle ear aspirates
of patients with OME. Because A otitidis may freely interact with leukocytes in
the middle ear effusion, it may potentially modulate the inflammatory reaction in
OME. To study the nature of these interactions, we applied an in vitro assay in
which killed A otitidis bacteria were incubated with peripheral blood and
adenoidal mononuclear cells. The expression of the proliferation-associated
surface marker CD69 was then measured in B lymphocytes and in CD4+ helper and
CD8+ cytotoxic-suppressor T lymphocytes by means of multicolor flow cytometry.
Alloiococcus otitidis induced the expression of CD69 in both peripheral blood and
adenoidal T and B cells. Among the T cells, the cytotoxic-suppressor T
lymphocytes were preferentially activated. It was also tested whether A otitidis 
would have an effect in another cytotoxic and immunoregulatory system, namely,
the induction of natural killer cell activity in peripheral blood mononuclear
cells. However, the effect was minimal compared with that of Salmonella minnesota
or Staphylococcus aureus. The results show that A otitidis has a unique
immunostimulatory capacity in vitro that is mainly confined to CD8+ T
lymphocytes.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11051437 [PubMed - indexed for MEDLINE]

2380: Clin Infect Dis. 2000 Oct;31(4):875-80. Epub 2000 Oct 25.

Effects of amoxicillin/clavulanate or azithromycin on nasopharyngeal carriage of 
Streptococcus pneumoniae and Haemophilus influenzae in children with acute otitis
media.

Ghaffar F, Muniz LS, Katz K, Reynolds J, Smith JL, Davis P, Friedland IR,
McCracken GH Jr.

Dept. of Pediatrics, Division of Infectious Disease, University of Texas
Southwestern Medical Center, Dallas, TX 75235-9063, USA. fghaff@mednet.swmed.edu

The effect of antibiotic therapy on nasopharyngeal colonization by Streptococcus 
pneumoniae and Haemophilus influenzae was evaluated in children diagnosed with
acute otitis media. Children were randomly assigned to receive either
amoxicillin/clavulanate or azithromycin therapy, and nasopharyngeal swabs were
obtained for culture before and after starting therapy. Amoxicillin/clavulanate
therapy eradicated or suppressed all strains of S. pneumoniae susceptible to
penicillin, 75% of strains with intermediate resistance, and 40% of strains
resistant to penicillin. Azithromycin therapy cleared two-thirds of
azithromycin-susceptible strains of S. pneumoniae but none of
azithromycin-nonsusceptible strains. Selection for antibiotic-resistant strains
in individual children was not observed in children who received
amoxicillin/clavulanate therapy but was observed in 2 children who received
azithromycin therapy. Carriage of H. influenzae was also reduced by antimicrobial
therapy but more so by amoxicillin/clavulanate. Antibiotic therapy does not
directly increase the number of resistant strains in the population but, by
eradicating susceptible strains, allows greater opportunity for carriage and
spread of resistant strains.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11049764 [PubMed - indexed for MEDLINE]

2381: J Microbiol Immunol Infect. 2000 Sep;33(3):187-90.

Clinical presentation of acute mastoiditis in children.

Jiang CB, Chiu NC, Hsu CH, Lee KS, Shu MT, Huang FY.

Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, ROC.

Nineteen children with 21 episodes of acute mastoiditis were treated in our
hospital from 1989 to 1998. The diagnosis was based on physical, radiologic, and 
surgical findings. The affected children were aged from 1 year old to 17 years
old, with the peak incidence at 4 years old (23.8%). Postauricular pain (90.5%)
and fever (81%) were the most common harbingers of incipient acute mastoiditis.
Streptococcus pneumoniae (38.1%) was the most common organism isolated followed
by Pseudomonas aeruginosa (23.8%). Underlying diseases such as leukemia and
myeloid metaplasia were found in 38.6% of patients. All of the patients were
initially treated with intravenous antibiotics during hospitalization. Six
patients were managed with an adjunctive drainage procedure such as myringotomy
or mastoidectomy. The most common complication of acute mastoiditis was hearing
loss (31.6%); the second was meningitis (21.1%). Subperiosteal abscess was found 
in two patients and brain abscess in one. Although acute mastoiditis is an
uncommon condition, early diagnosis and management are necessary to prevent more 
serious complications.

PMID: 11045383 [PubMed - indexed for MEDLINE]

2382: Laryngoscope. 2000 Oct;110(10 Pt 1):1745-9.

Complement C3 cleavage and cytokines interleukin-1beta and tumor necrosis
factor-alpha in otitis media with effusion.

Närkiö-Mäkelä M, Teppo AM, Meri S.

Department of Bacteriology and Immunology, Haartman Institute, University of
Helsinki, Finland.

OBJECTIVES: To analyze whether complement C3a anaphylatoxin, other C3 fragments, 
interleukin-1beta (IL-1beta), or tumor necrosis factor-alpha (TNF-alpha)
contributes to inflammation in chronic otitis media with effusion (OME). METHODS:
The amount of C3a was measured by enzyme-linked immunoassay. Further breakdown of
C3 was analyzed by Western blotting. IL-1beta and TNF-alpha concentrations were
measured by radioimmunoassay. Bacteria were analyzed by culture and polymerase
chain reaction. RESULTS: Highly elevated levels of C3a and other C3 cleavage
fragments were found in all middle ear effusion (MEE) samples. The mean values
(+/- SEM, n = 26) for C3a, IL-1beta, and TNF-alpha were 5,973 +/- 1,124 ng/mL,
1,043 +/- 490 pg/mL, and 79 +/- 14.3 pg/mL, respectively. Comparison to an
average C3 level of 555 (+/-108) microg/mL indicated that at least 40.5% +/- 6%
of total C3 had become activated within the MEE. C3a concentrations were higher
in the group in which the effusion had been present in the middle ear for a
prolonged period (> or =4 mo) (P = .04). Children with multiple tube insertions
had higher C3 (P = .006) and TNF-alpha (P = .04) concentrations in their MEE
samples than those receiving their first tubes. C3 and C3a concentrations in MEE 
correlated to each other (correlation coefficient [r] = 0.513, P = .0056), as did
concentrations of IL-1beta and TNF-alpha (r = 0.7016, P < .0001). No significant 
correlation was found between complement C3 or C3a levels and IL-1beta,
TNF-alpha, or bacterial growth. CONCLUSIONS: Highly elevated levels of C3a in MEE
indicate ongoing complement activation, which is stronger than in almost any
other disease demonstrated previously. Elevated C3a levels contribute to
chemotactic and inflammatory potential in the MEE and correlate with the
chronicity of the disease.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11037838 [PubMed - indexed for MEDLINE]

2383: Int J Pediatr Otorhinolaryngol. 2000 Oct 16;55(3):215-24.

The pathology of the temporal bones of a child with acquired cytomegalovirus
infection: studies by light microscopy, immunohistochemistry and polymerase-chain
reaction.

Bachor E, Sudhoff H, Litschel R, Karmody CS.

Department of Otorhinolaryngology, Universität Ulm, Prittwitzstrasse 43, D-89075,
Ulm, Germany. edgar.bachor@medizin.uni-ulm.de

STUDY DESIGN: The first case of an acquired cytomegalovirus (CMV) infection of
the inner ear is reported in a 3-year-old girl in remission from acute
lymphocytic leukemia. METHODS: Horizontal sections of the temporal bones were
studied by light microscopy and immunohistological staining by
avidin-biotin-complex-technique was performed on selected archival sections.
Three sections were processed for detection of the virus genome by the polymerase
chain reaction (PCR). RESULTS: By light microscopy the epithelium of the
endolymphatic sac, the utricle and the semicircular canals showed deeply stained 
acidophilic inclusions and the stria vascularis had a loose structure especially 
in the intermediate layer. The changes were limited to the non-sensory parts of
the labyrinth and no CMV type cells were observed in the organ of Corti. There
was a loss of inner and outer hair cells and loss of cochlear ganglion cells
caused by either the virus or treatment with gentamicin. Standard
immunohistochemistry failed to demonstrate staining with CMV antibodies, but PCR,
demonstrated CMV-DNA in one section. CONCLUSION: Molecular techniques may be able
to detect acquired CMV infections in archival pediatric bones temporal bones. The
histologic findings in the labyrinth were milder, however showed some similarity 
to children with congenital CMV labyrinthitis.

Publication Types: 
    Case Reports

PMID: 11035181 [PubMed - indexed for MEDLINE]

2384: Int J Pediatr Otorhinolaryngol. 2000 Oct 16;55(3):197-201.

Alteration of clinical picture and treatment of pediatric acute otitis media over
the past two decades.

Joki-Erkkilä VP, Pukander J, Laippala P.

Department of Otolaryngology, Medical School, University of Tampere, FIN-33101,
Tampere, Finland. vp.jokierkkila@nokianlaakariasema.inet.fi

The clinical picture of acute otitis media (AOM) has changed greatly over the
last few decades: serious complications have almost disappeared but more and more
children suffer from recurrent middle ear infections and prolonged silent
effusion. In this retrospective study we registered all AOM attacks among
children under 10 in two rural municipal areas of Finland during 12-month-periods
in 1978-79 and 1994-95. In addition to epidemiological data, the clinical picture
and given treatments were recorded. Between study periods the number of children 
with recurrent AOM attacks increased heavily. The percentage of spontaneous
otorrhea decreased from 6.0 to 3.3% (P=0.01) and the proportion of afebrile
patients increased from 64.0 to 73.4% (P=0.002). In 1978-79 there were
significantly more cases of diagnostic symptoms lasting over 24 h. Prescribing
penicillin-V as a primary treatment decreased from 80.2 to 10.5% in favor of
broad-spectrum antibiotics. The primary treatment with penicillin-V was
associated with a decreased risk of recurrences. Acute tympanocentesis was
performed less often and the incidence of surgical treatments (adenoidectomy
and/or tympanostomy tube insertion) doubled from 6.2 to 12.4% of the acute cases.
Although the clinical picture of AOM has become milder, children are treated with
wider spectrum antibiotics. Nevertheless, a large number of children suffer from 
sequelae and there is a greater need for surgical treatments than 20 years ago.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11035177 [PubMed - indexed for MEDLINE]

2385: Int J Pediatr Otorhinolaryngol. 2000 Oct 16;55(3):187-90.

Gastroesophageal reflux, allergy and chronic tubotympanal disorders in children.

Velepic M, Rozmanic V, Velepic M, Bonifacic M.

Clinic of Otorhinolaryngology, Rijeka University Medical School, Kresimirova 42, 
51000, Rijeka, Croatia.

The purpose of this study is to examine the relation between gastroesophageal
reflux and allergy as possible causes of chronic tubotympanal pathology. The 30
examined children (ages 2-13) were divided into two groups based on the
otological criteria. The 16 examined children suffered from a secretory otitis,
which lasted more than four months. Upon further examination with a microscope,
seven of these children exhibited symptoms of the adhesive process of the middle 
ear. Furthermore, 14 patients suffered from a recurrent otitis, i.e. more than
five cases of otitis per year, while five patients from this group suffered from 
a chronic otitis with a central defect of the tympanum. The method used for the
examination of the gastroesophageal reflux consisted of a continual 24 h
esophageal pH monitoring. The particular apparatus used for this included
antimony electrode (Synetics Medical, Sweden), while the analysis we performed
was processed through the PC software program Gastrosoft Inc. The reflux index
higher than five was considered pathological. At the time of the gastroesophageal
reflux examination, we also performed the allergological analysis. The presence
of allergy was confirmed by three methods: the positive allergological anamnesis,
the positive skin pick test and by the elevated quantities of specific IgEs
(Pharmacia CAP system). The examination resulted in the following: 18 of the
examined children suffered from the pathological gastroesophageal reflux (60%);
further seven of our patients tested positive on the allergological test (23%);
and the four who tested positive for allergy also suffered from the pathological 
gastroesophageal reflux (13%). In comparison with allergies, the pathological GER
was substantially more frequent in the patients who suffered from chronic
tubotympanal disorders.

Publication Types: 
    Comparative Study

PMID: 11035175 [PubMed - indexed for MEDLINE]

2386: Cochrane Database Syst Rev. 2000;(4):CD001935.

Update in:
    Cochrane Database Syst Rev. 2002;(4):CD001935.

Oral or topical nasal steroids for hearing loss associated with otitis media with
effusion in children.

Butler CC, van Der Voort JH.

Department of General Practice, University of Wales College of Medicine,
Llanedeyrn Health Centre, Llanedeyrn, Cardiff, South Galmorgan, UK, CF3 7PN.
butlercc@cf.ac.uk

BACKGROUND: OME is common and may cause hearing loss with associated
developmental delay. Treatment remains controversial. The effect of both systemic
and intra-nasal steroids on effusions has been assessed by randomised controlled 
trials. OBJECTIVES: To examine evidence for or against treating children with
hearing loss associated with OME with systemic or topical nasal steroids. SEARCH 
STRATEGY: Searches were conducted in February 2000. We searched the Cochrane
Controlled Trials Register using the terms 'otitis-media', 'otitis media with
effusion', 'glue ear', or 'OME', and 'steroids', 'glucocorticoids, synthetic',
'glucocorticoids, topical', 'anti-inflammatory agents, steroidal'. EMBASE and
MEDLINE were also searched for additional information. SELECTION CRITERIA:
Randomised controlled trials of oral and topical nasal steroids, either alone or 
in combination with another agent such as an antibiotic, were included.
Exclusions: publications in abstract form only since adequate appraisal was not
possible; uncontrolled, non-randomised or retrospective studies; studies
reporting outcomes with ears (rather than children) as the unit of analysis. DATA
COLLECTION AND ANALYSIS: Data were extracted from the published reports by the
two authors independently (CCB and JH van der V) using standardised data
extraction forms and methodology. The methodological quality of the included
studies were independently assessed by the two authors using the scheme described
in the Cochrane Handbook. Dichotomous results were expressed as an odds ratio
using a fixed effects model together with the 95% confidence intervals.
Continuous data were analysed using the weighted mean difference in a fixed
effects model. Tests for heterogeneity between studies were performed using a
Mantel-Haenszel approach. In trials with a cross over design, post-crossover
treatment data were not used. MAIN RESULTS: No study prospectively documented
hearing loss associated with OME prior to randomisation. Follow up was short
term. No serious or lasting side effects were reported in the four studies that
did mention side effects. Most comparisons involved small numbers of subjects.
The odds ratio for OME persisting after short term follow up for children treated
with oral steroids plus antibiotic compared to control plus antibiotic was 0.32
(95% CI 0.20 to 0.52). However there was significant heterogeneity between
studies (p<0.01). Trends favoured steroids for most other comparisons, but
confidence intervals included unity. There was no evidence of benefit for steroid
treatment in the longer term, and no study assessed effect of steroid treatment
on language development. REVIEWER'S CONCLUSIONS: There is evidence that steroids 
combined with an antibiotic lead to a quicker resolution of OME in the short
term. However, there is not evidence for long term benefit from treating hearing 
loss associated with OME with either oral or topical nasal steroids. These
treatments are therefore not recommended at the present time. Future studies
should document hearing loss associated with OME before the start of study
treatment. Follow up should be longer and ideally include symptom, audiometry and
developmental outcomes. Data should not be presented with ears as the unit of
analysis.

Publication Types: 
    Review

PMID: 11034736 [PubMed - indexed for MEDLINE]

2387: Cochrane Database Syst Rev. 2000;(4):CD000219.

Update in:
    Cochrane Database Syst Rev. 2004;(1):CD000219.

Update of:
    Cochrane Database Syst Rev. 2000;(2):CD000219.

Antibiotics for acute otitis media in children.

Glasziou PP, Del Mar CB, Hayem M, Sanders SL.

Associate Professior in Clinical Epidemiology, Dept of Social & Preventive
Medicine, Medical School, Herston QLD 4006, Australia, 4006.
P.Glasziou@spmed.uq.edu.au

BACKGROUND: Acute otitis media is one of the most common diseases in early
infancy and childhood. Antibiotic use for acute otitis media varies from 31% in
the Netherlands to 98% in the USA and Australia. OBJECTIVES: The objective of
this review was to assess the effects of antibiotics for children with acute
otitis media. SEARCH STRATEGY: We searched the Cochrane Controlled Trials
Register, MEDLINE, Index Medicus (pre 1965), Current Contents and reference lists
of articles from 1958 to January 2000. SELECTION CRITERIA: Randomised trials
comparing antimicrobial drugs with placebo in children with acute otitis media.
DATA COLLECTION AND ANALYSIS: Three reviewers independently assessed trial
quality and extracted data. MAIN RESULTS: Ten trials were eligible but only seven
trials, with a total of 2,202 children, included patient-relevant outcomes. The
methodological quality of the included trials was generally high. All trials were
from developed countries. The trials showed no reduction in pain at 24 hours, but
a 28% relative reduction (95% confidence interval 15% to 38%) in pain at two to
seven days. Since approximately 80% of patients will have settled spontaneously
in this time, this means an absolute reduction of 5% or that about 17 children
must be treated with antibiotics to prevent one child having some pain after two 
days. There was no effect of antibiotics on hearing problems of acute otitis
media, as measured by subsequent tympanometry. However, audiometry was done in
only two studies and incompletely reported. Nor did antibiotics influence other
complications or recurrence. There were few serious complications seen in these
trials: only one case of mastoiditis occurred in a penicillin treated group.
REVIEWER'S CONCLUSIONS: Antibiotics provide a small benefit for acute otitis
media in children. As most cases will resolve spontaneously, this benefit must be
weighed against the possible adverse reactions. Antibiotic treatment may play an 
important role in reducing the risk of mastoiditis in populations where it is
more common. [This abstract has been prepared centrally.]

Publication Types: 
    Review

PMID: 11034677 [PubMed - indexed for MEDLINE]

2388: J Laryngol Otol. 2000 Aug;114(8):618-20.

Cerebellopontine angle lymphoma presenting as chronic mastoiditis.

Hill N, Little B, Vasan N, Giles M.

Otolaryngology Department, Waikato Hospital, Hamilton, New Zealand.

Middle-ear tumours are not uncommonly mistaken for mastoiditis on presentation.
We report a case of cerebellopontine angle non-Hodgkin's B-cell lymphoma
originally presenting as a middle-ear inflammatory process. In mastoiditis not
resolving with conventional treatment it is important to look for an underlying
cause.

Publication Types: 
    Case Reports

PMID: 11027053 [PubMed - indexed for MEDLINE]

2389: J Laryngol Otol. 2000 Aug;114(8):581-3.

Telescopic myringotomy and tube application.

Abou-Elhamd KE.

Department of ENT, Sohag Faculty of Medicine, Sohag, Egypt.

Otoendoscopy is a new technique in otological surgery. The traditional surgery
for otitis media with effusion (OME) is myringotomy and tube insertion using an
operating microscope. In 45 children and five adults presenting to our department
with otitis media with effusion, rigid endoscopic myringotomy and grommet tube
insertion were performed using 2.7 mm diameter and 0 degree and 30 degrees angle 
telescopes under general anaesthesia for children and local anaesthesia for
adults. The use of rigid endoscopes provides a large field of view, that is of
excellent resolution and fidelity of colour as well as giving good side views. It
can be performed in the out-patient clinic with little inconvenience to the
patient and minimal risks.

PMID: 11027045 [PubMed - indexed for MEDLINE]

2390: FEMS Immunol Med Microbiol. 2000 Oct;29(2):101-6.

Effect of Alloiococcus otitidis and three pathogens of otitis media in production
of interleukin-12 by human monocyte cell line.

Himi T, Kita H, Mitsuzawa H, Harimaya A, Tarkkanen J, Hendolin P, Ylikoski J,
Fujii N.

Department of Otolaryngology, School of Medicine, Hokkaido, Japan.
himi@sapmed.ac.jp

Alloiococcus otitidis is detected in middle ear effusion of otitis media with
effusion (OME). Only a limited number of studies are available concerning the
immunological profile of A. otitidis. We have studied the ability of A. otitidis 
and three other representative pathogens of otitis media to stimulate the
production of interleukin-12 (IL-12) from a monocytic cell line THP-1. Viable A. 
otitidis induced the production of IL-12 in THP-1 cells but IL-12 production was 
reduced if glutaraldehyde-fixed bacteria were used as stimulants. When viable
bacteria were physically separated from THP-1 cells during the stimulation
period, remarkable reductions of IL-12 secretion were shown after challenge with 
gram-positive bacteria A. otitidis and S. pneumoniae. When stimulated with
soluble extracts of A. otitidis, THP-1 secreted IL-12 in a dose-dependent manner.
The subfraction with a molecular mass over 100 kDa showed a strong ability to
induce IL-12 production. Our results show that A. otitidis has immunostimulatory 
capacity with regard to IL-12 production. We also show that soluble antigen(s) of
A. otitidis can modulate the immune response in OME.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11024348 [PubMed - indexed for MEDLINE]

2391: J Small Anim Pract. 2000 Sep;41(9):398-401.

Middle ear disease associated with congenital palatine defects in seven dogs and 
one cat.

Gregory SP.

Department of Small Animal Medicine and Surgery, The Royal Veterinary College,
Hatfield, Hertfordshire.

Medical records of eight dogs and one cat with congenital palatine defects were
reviewed retrospectively. Five of the dogs had nasal discharge and seven had
radiographic signs of middle ear disease, but no clinical signs of ear disease
were identified in any of the dogs, nor were any reported by their owners during 
a one- to five-year follow-up period. One dog had an ipsilateral impairment of
hearing detected by brainstem auditory evoked responses. The cat had clinical and
radiographic signs of middle ear disease. These findings suggest that, as in
humans, congenital palatine defects in dogs and cats may predispose to middle ear
disease. Any associated deafness could cause problems for working dogs.

Publication Types: 
    Case Reports

PMID: 11023125 [PubMed - indexed for MEDLINE]

2392: Pediatrics. 2000 Oct;106(4):725-35.

Otitis media in childhood in relation to preschool language and school readiness 
skills among black children.

Roberts JE, Burchinal MR, Jackson SC, Hooper SR, Roush J, Mundy M, Neebe EC,
Zeisel SA.

Frank Porter Graham Child Development Center, Department of Allied Health
Sciences University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
27599-8180, USA. joanneroberts@unc.edu

OBJECTIVE: To examine whether otitis media with effusion (OME) and associated
hearing loss (HL) during the first 5 years of life were related to children's
language skills during the preschool years and to school readiness skills at
entry to kindergarten. METHODS: In a prospective study, the ears of 85 black
children primarily from low-income families and recruited from community-based
childcare programs were repeatedly examined from 6 months to 5 years of age for
the presence of OME and from 6 months to 4 years of age for HL when well and ill 
with OME. Assessments were made annually of the children's child-rearing
environments at home and in childcare, and children's language skills between 3
and 5 years of age and readiness skills in literacy and math were evaluated at
entry into kindergarten. RESULTS: Children had either bilateral or unilateral OME
approximately 30.4% and HL 19.6% of the observation time. OME and associated HL
were significantly positively correlated with some measures of expressive
language at 3 and 4 years of age; however, these direct relationships were no
longer significant when the child's gender, socioeconomic status, maternal
educational level, and the responsiveness and support of the home and childcare
environments were also considered. Further, both OME and HL were moderately
correlated with school readiness skills at entry to school, with children having 
more OME scoring lower in verbal math problems and with children with more HL
scoring lower in math and recognizing incomplete words. These associations
continued to remain significant even after partialing out the child and family
background factors. CONCLUSIONS: There was not a significant relationship between
children's early OME history or HL and language skills during the preschool
years. However, children with more frequent OME had lower scores on school
readiness measures. These associations were moderate in degree, however, and the 
home environment was more strongly related to academic outcomes than was OME or
HL. These results should be interpreted cautiously when generalizing to other
populations.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11015515 [PubMed - indexed for MEDLINE]

2393: Pediatrics. 2000 Oct;106(4):695-9.

Pneumococcal mastoiditis in children.

Kaplan SL, Mason EO Jr, Wald ER, Kim KS, Givner LB, Bradley JS, Barson WJ, Tan
TQ, Schutze GE, Yogev R.

Pediatric Infectious Disease Section of ¿Baylor College of Medicine, Houston,
Texas 77030-2399, USA. skaplan@bcm.tmc.edu

OBJECTIVE: To determine the impact of antibiotic resistance on the frequency,
clinical features, and management/outcome of mastoiditis attributable to
Streptococcus pneumoniae. DESIGN: Retrospective review of the medical records of 
children with mastoiditis caused by S pneumoniae from September 1993 through
December 1998. PATIENTS: Infants and children with pneumococcal mastoiditis cared
for at 8 children's hospitals in the United States. RESULTS: Thirty-four children
with pneumococcal mastoiditis were identified. The median age of the children was
12 months (range: 2 months-12.5 years); 28 (82%) were </=2 years old. Six
children had recurrent otitis media. A subperiosteal abscess was noted in 13
children (37%). The mastoids were abnormal in all 25 patients on whom computed
tomography was performed. There was no trend toward increasing numbers of cases
per year despite increasing proportions of pneumococcal isolates, which were
nonsusceptible to penicillin. Serogroup 19 accounted for 57% of isolates,
serogroup 23 for 14.3% of isolates, and serotype 3 for 10. 7% of isolates. Except
for receipt of less antibiotic therapy in the previous 30 days, children with
penicillin-susceptible isolates had similar demographic features and clinical
findings and surgical treatment as did children whose isolates were
nonsusceptible to penicillin. CONCLUSIONS: Pneumococcal mastoiditis occurs
primarily in children <2 years of age and usually is not associated with a
history of recurrent otitis media. The number of cases of mastoiditis caused by S
pneumoniae occurring among 8 children's hospitals has remained stable despite
increasing rates of antibiotic-resistant S pneumoniae. Serogroup 19 is the
leading serogroup associated with pneumococcal mastoiditis.Streptococcus
pneumoniae, mastoiditis, serotypes, resistance.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 11015510 [PubMed - indexed for MEDLINE]

2394: J Clin Microbiol. 2000 Oct;38(10):3872-5.

Evaluation of different preservation and storage methods for Malassezia spp.

Crespo MJ, Abarca ML, Cabañes FJ.

Departament de Sanitat i d'Anatomia Animals (Microbiologia), Facultat de
Veterinària, Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona),
Spain.

Freezing at -80 degrees C, lyophilization, preservation in distilled water, and
storage in different culture media were performed in order to find a suitable
method that allowed a prolonged storage of Malassezia spp. Freezing at -80
degrees C was the only method successful at maintaining all species.

Publication Types: 
    Comparative Study

PMID: 11015425 [PubMed - indexed for MEDLINE]

2395: Can Fam Physician. 2000 Sep;46:1780-2, 1785-8.

Referral of children with otitis media. Do family physicians and pediatricians
agree?

McIsaac WJ, Coyte P, Croxford R, Harji S, Feldman W.

Department of Family and Community Medicine, University of Toronto, Ontario.
wmcisaac@mtsinai.on.ca

OBJECTIVE: To determine factors influencing family physicians' and pediatricians'
decisions to refer children with recurrent acute otitis media (RAOM) and otitis
media with effusion (OME) to otolaryngologists for an opinion about tympanostomy 
tube insertion. DESIGN: Mailed survey. SETTING: Physicians' practices in Ontario.
PARTICIPANTS: Random sample of 1459 family physicians and all 775 pediatricians
in the province. MAIN OUTCOME MEASURES: Physicians' reports of the influence of
17 factors on decisions to refer (more likely, no influence, less likely to
refer) and number of episodes of otitis media, months with effusion, level of
hearing loss, or months of continuous antibiotics without improvement prompting
referral. RESULTS: Physicians agreed (> 80% concordance) on six out of 17 factors
as indications for referring children with RAOM or OME. Opinions about the
importance of other factors varied widely. Family physicians would refer children
with otitis media after fewer episodes of illness, fewer months of effusion,
lower levels of hearing loss, and fewer months of prophylactic antibiotic therapy
than pediatricians (all P < .001). Pediatricians would prescribe continuous
antibiotics longer (11.8 weeks) than family physicians (8.9 weeks, P < .0001),
which correlated with lower referral thresholds for family physicians.
CONCLUSION: Family physicians' and pediatricians' self-reported referral
practices for surgical opinions on children with otitis media varied
considerably. These observations raise questions about the consistency of care
for children with otitis media and whether revised clinical guidelines would be
helpful.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11013797 [PubMed - indexed for MEDLINE]

2396: Clin Otolaryngol Allied Sci. 2000 Oct;25(5):385-91.

Brain herniation and chronic otitis media: diagnosis and surgical management.

Mosnier I, Fiky LE, Shahidi A, Sterkers O.

Service ORL, Hôpital Beaujon, AP-HP, Faculté Xavier Bichat, Université Paris,
Clichy, France.

Herniation of the brain into the middle ear is a rare, but potentially
life-threatening complication of chronic otitis media. Fifty patients with a
tegmen defect associated with chronic otitis media were operated on between 1985 
and 1998. Among these 50, 15 patients presented brain herniation associated with 
the bony defect. Fourteen patients had undergone previous mastoid surgery for
chronic otitis media. Neurological symptoms were encountered in five patients. In
10, magnetic resonance imaging (MRI) was performed before surgery, and a
diagnosis of brain herniation could be made. The hernia was repaired in all
patients using a middle fossa craniotomy, combined with a transmastoid approach
in 11 cases where a large hernia, and/or inflammatory tissues were present in the
mastoid. The herniated brain tissue was resected in all, and the dural and bony
defects were closed with fascia and bone. No complication or recurrence occurred,
during a mean follow-up of 2 years. In conclusion, the occurrence of severe
neurological complications as a consequence of brain herniation emphasizes the
necessity for recognition and appropriate management of this disease.
Computerized tomography (CT) scanning allows the suspicion of brain herniation,
but a definitive diagnosis can best be established with an MRI study. The hernia 
should be repaired using a middle fossa craniotomy, combined with a transmastoid 
approach in one or two stages, when necessary.

PMID: 11012652 [PubMed - indexed for MEDLINE]

2397: Int J Pediatr Otorhinolaryngol. 2000 Sep 29;55(2):149-54.

Nasopharyngeal carcinoma in children.

Ong YK, Tan HK.

Department of Otolaryngology, National University Hospital, 5 Lower Kent Ridge
Road, Singapore, Singapore.

Nasopharyngeal carcinoma (NPC) is rare in children. We report two cases from KK
Women and Children's Hospital in Singapore, who presented with advanced
locoregional disease. The various aspects of NPC in children are discussed. It is
more common in males and black adolescents. The etiology is probably different
from that in adult. Undifferentiated NPC or lymphoepithelioma is the commonest
variety. Confusing symptoms like cervical lymphadenopathy and unilateral otitis
media with effusion (OME) are among the commonest presentations. When children
present with both conditions simultaneously, it is imperative to manage them like
adult patients and perform nasendoscopy to rule out NPC. The disease stage at
presentation is often more advanced compared with adults. These tumors are,
however, associated with a higher cure rate as they are most radiosensitive.
Radiotherapy with neo-adjuvant chemotherapy is currently the treatment of choice.
Both cases achieved satisfactory control of the disease and are presently under
close follow-up.

Publication Types: 
    Case Reports

PMID: 11006455 [PubMed - indexed for MEDLINE]

2398: Int J Pediatr Otorhinolaryngol. 2000 Sep 29;55(2):109-15.

Efficacy of ceftibuten in 5 versus 10 days treatment of recurrent acute otitis
media in children.

Roos K, Larsson P.

ENT Department, Lundby Hospital, S-417 17, Göteborg, Sweden.

OBJECTIVE: in recurrent acute otitis media (AOM) several alternative treatments
are suggested, e.g. cephalosporins. Information about the optimal duration of
treatment in recurrent AOM is sparse. The aim of the present study was to compare
the efficacy of ceftibuten in 5 versus 10 days treatment in recurrent AOM in
children. METHODS: this was a single-blind (doctor blinded), randomized,
multicentre study with two parallel groups. Eleven investigators at six centres
in the west of Sweden enrolled a total of 180 patients. Outpatients with a new
clinical AOM within 1 month were randomized to 5 or 10 days treatment with
ceftibuten, 9 mg/kg/day, as a single dose. RESULTS: the mean age of the patients 
was 1.2 years (range 6 months-8 years). The patients had on average had three
antibiotic treatments during the preceding 12 months. The recurrence rates in the
5- and 10-day groups were 21.4 and 4.5%, respectively, at first follow-up visit
day 12 (P=0.001). The total recurrence rates between the two groups during the
whole follow-up period of 40 days, 35 and 30%, respectively, did not differ
significantly. The rate of recurrence did not correlate to nasopharyngeal
findings of Streptococcus pneumoniae or Haemophilus influenzae. Pneumococci with 
decreased susceptibility to penicillin were found in 5% of all pneumococci, and
beta-lactamase producing H. influenzae in 8%. Adverse events were reported less
frequently in the 5- compared with the 10-day treatment group. CONCLUSION: this
study on young children with recurrent otitis media has shown no statistical
difference between ceftibuten given once daily for 5 and 10 days as determined on
day 40. The 10-day treatment was significantly better at early follow-up.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11006450 [PubMed - indexed for MEDLINE]

2399: J Otolaryngol. 2000 Aug;29(4):229-32.

Retrospective analysis of surgical outcome, symptom changes, and hearing
improvement following myringoplasty.

Bhat NA, De R.

Department of Otolaryngology, Walsgrave Hospital, Coventry, United Kingdom.

This study examines the surgical and audiologic results of myringoplasty and what
factors affect these outcomes. It also examines whether patients experience any
improvement in their main symptoms following surgery. This was a retrospective
analysis of case notes, patient questionnaires, and audiograms of all patients
undergoing myringoplasty between 1990 and 1995 at Walsgrave Hospital, Coventry,
UK. Overall success of myringoplasty for consultants was 81% and for trainees was
79%, with an overall success rate of 86% in children. Posterior and inferior
perforations had a 90% success rate for repair, compared to only 67% of anterior 
perforations. There was a statistically significant reduction in air-bone gaps
following myringoplasty, and the majority of patients felt that their ears were
drier and had improved hearing. Myringoplasty is a successful procedure in the
hands of consultants and trainees alike. The results are satisfactory enough to
justify surgery purely for deafness and also in symptomatic children. There is a 
strong correlation between surgical success and resolution of symptoms and
generally a satisfactory improvement in hearing.

PMID: 11003075 [PubMed - indexed for MEDLINE]

2400: J Otolaryngol. 2000 Aug;29(4):221-3.

Otitis media with effusion in children with congenital or early-onset hearing
impairment.

Vartiainen E.

Department of Otolaryngology, University of Kuopio, Finland.

OBJECTIVE: The purpose of this study was to examine the incidence of otitis media
with effusion (OME) among children with bilateral congenital or early-onset
hearing impairment (CEHI) and to assess whether the diagnosis of OME had any
effect on the detection of CEHI. METHODS: The study population consisted of all
patients diagnosed in a Finnish university hospital between 1976 and 1995 as
having CEHI (> 25 dB, 0.5-4 kHz, in the better hearing ear). Early-onset hearing 
impairments were defined as losses attributed to perinatal or neonatal
complications. Otitis media with effusion was assigned when asymptomatic middle
ear effusion had lasted at least 2 months and tympanocentesis had yielded mucous 
effusion. RESULTS: A total of 184 child patients with CEHI were identified. Of
these, OME was diagnosed and treated in 28 (15%) patients. Of the patients with
OME, diagnosis of CEHI was made before the occurrence of OME in 7 (25%) and at
the same time in 10 (36%) but was delayed at least 6 months after the treatment
of OME in 11 (39%) patients. CONCLUSION: It is suggested that all children
undergoing ventilation tube placement should have age-appropriate hearing
examination to exclude coexisting sensorineural hearing loss.

PMID: 11003073 [PubMed - indexed for MEDLINE]

2401: Pediatr Infect Dis J. 2000 Sep;19(9):938-43.

Judicious use of antibiotics for common pediatric respiratory infections.

Jacobs RF.

Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little
Rock, USA. jacobsrichardf@exchange.uams.edu

BACKGROUND: Antibiotic resistance among common respiratory infection-producing
bacteria such as Streptococcus pneumoniae, Haemophilus influenzae and Moraxella
catarrhalis has become a major global public health problem. The use of
antibiotics, whether or not medically justified for a particular illness,
contributes to the development of resistant bacteria. To help to contain the
proliferation of drug-resistant bacteria, members of the CDC and the American
Academy of Pediatrics (AAP) recently published principles for the judicious use
of antibiotics in common pediatric respiratory infections including the common
cold, otitis media, sinusitis and tonsillopharyngitis. This article reviews the
CDC/AAP principles for management of these illnesses and describes results of
clinical practice studies in which efforts to improve the judicious use of
antibiotics were undertaken. CONCLUSIONS: The success of the CDC/AAP principles
in containing the increase in antimicrobial resistance depends upon their being
practiced. Results of clinical practice studies indicate that judicious use of
antimicrobial therapy in pediatric respiratory infections can be realized through
education and persistence. More widespread educational and behavior modification 
efforts are necessary to reduce unnecessary prescription of antibiotics and to
curtail the still burgeoning problem of bacterial resistance.

Publication Types: 
    Review

PMID: 11001130 [PubMed - indexed for MEDLINE]

2402: Pediatr Infect Dis J. 2000 Sep;19(9):929-37.

Short course antibiotic therapy for respiratory infections: a review of the
evidence.

Pichichero ME.

Elmwood Pediatric Group, University of Rochester, NY 14642, USA.
mepo@uhura.cc.rochester.edu

BACKGROUND: The judicious use of antibiotics entails achieving the appropriate
balance between prescribing them with sufficient frequency and duration to effect
a clinical cure for bacterial infections and overprescribing them, a practice
that increases prescription drug costs as well as the risks of bacterial
resistance, noncompliance with therapy and side effects. The recognition that the
traditional 10-day or greater duration of therapy for acute otitis media,
tonsillopharyngitis and sinusitis does not derive from a strong scientific or
medical rationale (with the exception of penicillin therapy for
tonsillopharyngitis) and the increasing awareness of the adverse sequelae of
long-duration antibiotic therapy have led some clinicians to call for shortening 
the duration of antibiotic therapy in these infections. The soundness of this
recommendation hinges on the demonstration that shortened courses of antibiotic
therapy are at least as effective as traditional courses of therapy. SYNOPSIS:
Data relevant to determining the optimum duration of therapy in acute otitis
media, tonsillopharyngitis and sinusitis are reviewed in this article. The review
demonstrates particularly strong justification for shortening the duration of
therapy from the standard 10 days to 5 days in acute otitis media, in which
numerous open label and controlled studies have shown equivalent efficacy of the 
two durations of regimen. A growing body of evidence indicates that
tonsillopharyngitis, too, can be effectively treated with non-penicillin
antibiotics given for fewer than 10 days. Although sinusitis data are less
plentiful than those for acute otitis media and tonsillopharyngitis, the results 
available to date are encouraging in suggesting that shortened courses of therapy
may also be appropriate for acute maxillary sinusitis.

Publication Types: 
    Review

PMID: 11001129 [PubMed - indexed for MEDLINE]

2403: Pediatr Infect Dis J. 2000 Sep;19(9):911-6.

Recurrent and persistent otitis media.

Pichichero ME.

Elmwood Pediatric Group, University of Rochester, NY 14642, USA.
mepo@uhura.cc.rochester.edu

Recurrent acute otitis media occurs during the first several years of life in
approximately 20 to 30% of the pediatric population. A clinical challenge closely
related to recurrent otitis media is persistent otitis media, manifested by
persistence during antimicrobial therapy of symptoms and signs of middle ear
infection (treatment failure) and/or relapse of acute otitis media within 1 month
of completion of antibiotic therapy. Recurrent and persistent otitis media
infections are early childhood problems with identifiable risk factors.
Differentiation of these infections from otitis media with effusion is important 
in avoiding misdiagnosis and overtreatment with antibiotics. The predominant
pathogens of recurrent and persistent acute otitis media are antibiotic-resistant
Streptococcus pneumoniae and beta-lactamase-producing Haemophilus influenzae. A
working group convened by the Centers for Disease Control recommended three
antibiotics for the treatment of recurrent and persistent acute otitis media: (1)
amoxicillin/clavulanate in combination with amoxicillin (high dose amoxicillin
regimen, 80 to 90 mg/kg/day); (2) cefuroxime axetil (standard dose, 30
mg/kg/day); and (3) ceftriaxone (possibly requiring up to three injections to
optimize clinical success). Other antibiotics were considered suboptimal or had
accumulated insufficient data upon which to base a judgment. Conclusions. Optimal
management of recurrent and persistent acute otitis media is a clinical
challenge. Accurate diagnosis of acute otitis media is the first step in optimal 
management. Selection of appropriate antibiotic therapy should take into account 
the major pathogens (S. pneumoniae, H. influenzae and Moraxella catarrhalis) and 
the occurrence of antibiotic resistance.

Publication Types: 
    Review

PMID: 11001126 [PubMed - indexed for MEDLINE]

2404: Arch Dis Child. 2000 Oct;83(4):317-9.

The clinical course of bronchiolitis associated with acute otitis media.

Shazberg G, Revel-Vilk S, Shoseyov D, Ben-Ami A, Klar A, Hurvitz H.

Department of Pediatrics, Bikur Cholim Hospital, Hadassah Medical School, Hebrew 
University, 5 Strauss St, Jerusalem 91004, Israel. shazberg@md2.huji.ac.il

BACKGROUND: Acute otitis media (AOM) is the most common bacterial co-infection of
viral bronchiolitis. AIMS: To evaluate the influence of AOM on the clinical
course of bronchiolitis. SUBJECTS: 150 children younger than 24 months old,
diagnosed with bronchiolitis, hospitalised between December 1997 and May 1999.
METHODS: Body temperature, respiratory rate, oxygen saturation, and the need for 
oxygen supplementation were recorded on admission and daily throughout
hospitalisation. Complete blood count, erythrocyte sedimentation rate, and assay 
for respiratory syncytial virus were performed on admission. All children were
examined daily for the appearance of AOM. The clinical course of children with
bronchiolitis and AOM was compared to those without AOM. RESULTS: AOM was
diagnosed in 79/150 (53%) children with bronchiolitis. Most were diagnosed within
the first two days of hospitalisation. No significant difference was found in the
clinical and laboratory findings on admission and on daily follow up between
children with and without AOM. CONCLUSIONS: This 2.5 year prospective study
showed no difference in the course of bronchiolitis, whether an ear infection was
present or not.

PMID: 10999866 [PubMed - indexed for MEDLINE]

2405: Br J Audiol. 2000 Aug;34(4):231-40.

Influence of age, type of audiometry and child's concentration on hearing
thresholds. MRC Multi-centre Otitis Media Study Group.

[No authors listed]

MRC Institute of Hearing Research, Notthingham, UK.

Surprisingly little evidence is available in children between the ages of 3 and 7
years on the effect on hearing thresholds of the method of audiometry and of the 
developmental ability to concentrate and to respond. The Trial of Alternative
Regimens in Glue Ear Treatment (TARGET) is a large, national, multi-centre trial 
of surgical intervention in children with otitis media with effusion (OME) that
offers an opportunity to study these effects. Of 1517 children, aged between 3.25
and 6.75 years, reaching the selection stage, 4.5% were unable to give reliable
air-conduction thresholds. A further 3% (i.e. 7.5% in all) could not give
reliable bone-conduction thresholds. This inability was greatest in the youngest 
children. During air-conduction testing, a significantly greater proportion (p
<0.005) of children were recorded as having only 'fair' or 'poor' concentration
on conventional audiometry than with play audiometry. On the other hand, the
magnitude of the effect of poor concentration, as rated 'fair/poor' versus
'good', was slightly greater on play as opposed to conventional audiometry (+5 dB
versus +3 dB). Although statistically significant, the age of the child had only 
a very small effect on the air- or bone-conduction thresholds, once the type of
audiometry, concentration and the presence of OME had been controlled for. It is 
concluded that adequately informative thresholds are usually obtainable by
conventional audiometry in this age group, even if the concentration is recorded 
as 'fair' or 'poor'. However, when conventional audiometry is not feasible, play 
audiometry should be attempted in the 3-5-year-old age group.

PMID: 10997452 [PubMed - indexed for MEDLINE]

2406: Int J Pediatr Otorhinolaryngol. 2000 Sep 15;55(1):33-45.

The relationship between otitis media with effusion and contact with other
children in a british cohort studied from 8 months to 3 1/2 years. The ALSPAC
Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

Dewey C, Midgeley E, Maw R.

Unit of Paediatric and Perinatal Epidemiology, University of Bristol, Bristol,
UK. cdewey@AMGEN.COM

OBJECTIVE: It is generally acknowledged that otitis media with effusion is more
prevalent among children attending grouped day care. This study aimed to refine
this by determining the relationships with the numbers of children at the place
of day care, the age of the child and the number of siblings he/she had. METHODS:
ALSPAC (the Avon Longitudinal Study of Pregnancy and Childhood) is a population
based longitudinal study starting early in pregnancy and following the children
throughout their lives. Nested within this study, a randomly selected group of
1590 children, the Children in Focus, were invited to attend a clinic for hands
on examinations. Tympanometry was carried out at ages 8, 12, 18, 25, 31, 37 and
43 months of age. Bilateral otitis media with effusion (OME) was identified if
both ears showed a flat trace. Multi-level modelling with logistic regression
adjusted for a number of social and environmental influences. RESULTS: Of the
1590 children invited to the 8-month clinic, 300 (19%) were excluded from the
analysis because of failure to attend or because of missing data. The analyses
were based on 1290 children. The prevalence of bilateral OME decreased with age, 
from 24.6% at 8 months to 11.9% at 43 months. Children with older siblings and
those attending day care with four or more other children were at an increased
risk of OME. The adjusted odds ratios (AOR) were 1.52 (95% confidence interval
[CI] = 1.23, 1.88) and 1.36 (95% CI = 1.02, 1.82), respectively. The risk
associated with older siblings declined with age and by 3 years these children
were no longer more likely to have OME than children with no older siblings. No
such interaction with age was found for children in group day care and these
children continued to be at an increased risk over the entire age period of the
study. There was no increased risk associated with day care when no other
children attended (AOR = 1.18, 95% CI = 0.88, 1.58) or when one to three others
were present (AOR = 1.10, 95% CI = 0.85, 1.42). Although there was no
relationship with the number of hours spent in day care, children who had started
attending group care with four or more other children before 9 months of age did 
have an increased risk compared with children starting later AOR = 1.88, 95% CI =
1.12, 3.14. CONCLUSIONS: These results provide evidence that early contact with
other children increases the risk of OME and that children attending day care
with four or more other children remain at an increased risk of OME at least
until 31/2 years.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 10996234 [PubMed - indexed for MEDLINE]

2407: Int J Pediatr Otorhinolaryngol. 2000 Sep 15;55(1):21-7.

Tympanometry and acoustic reflectometry in ears with chronic retraction without
effusion.

Kemaloğlu YK, Beder L, Sener T, Göksu N.

Gazi University Faculty of Medicine Department of ENT-HNS, Yalim sokak 2/13
Küçükesat, 06660 Ankara, Turkey. ykkemal@med.gazi.edu.tr

OBJECTIVE: Purpose of this study was to find out test accuracy and predictivity
of tympanometry (TYMP) and parameters (reflectivity and curve angle) of acoustic 
reflectometry (AR) in the ears with prior clinic and otoscopic evidences of
effusion in which no effusion was detected by myringotomy, by comparing with the 
data found in normal ears and in those with effusion. METHODS: While study group 
included 31 ears with chronic retraction in which no effusion was detected by
myringotomy, control group included 150 fully normal ears and 150 ears with
effusion confirmed by myringotomy. B tracings in TYMP, and values of reflectivity
higher than 5 and curve angle lower than 75 degrees in AR were accepted as
indicators of effusion; in the combined test, the ears with non-B tracings in
which curve angle higher than 75 degrees were accepted as those without effusion.
RESULTS: False positivity values of TYMP, reflectivity and curve angle and the
combined test found in the ears with chronic retraction without effusion (29, 23,
19 and 35% respectively; chi(2)-test, P > 0.1) were significantly higher than
normal ears (chi(2)-test, P < 0.001), but lowe than those of effusion
(chi(2)-test, P<0.0001). Further, although negative predictivity values of TYMP, 
reflectivity and curve angle were found to be lower in these ear, compared to
normal ears (chi(2)-test, P < 0.01), the combined test reached to a perfect
negative predictivity, as much as in normal ears. On the other hand, positive
predictivity values were decreased in the ears with chronic retraction without
effusion by only reflectivity. CONCLUSIONS: By both TYMP and AR alone, it is more
difficult to find out the ears without effusion among the ears clinically and
otoscopically diagnosed as otitis media than to find out normal ears. Therefore, 
in clinical work, false positivity of these devices were higher, and their
specificity and negative predictivity were lower; although the combined test
solved problem of low negative predictivity, high number of false positive ears
in clinical work, that is lower specificity, continues to be an unsolved problem 
by either TYMP or AR alone, or both together.

Publication Types: 
    Clinical Trial
    Comparative Study
    Controlled Clinical Trial

PMID: 10996232 [PubMed - indexed for MEDLINE]

2408: Int J Pediatr Otorhinolaryngol. 2000 Sep 15;55(1):1-9.

Experimental study of the virulence of Streptococcus pneumoniae with reduced
susceptibility to penicillin.

Magnúsdóttir AB, Hermansson A, Melhus A.

Department of Oto-Rhino-Laryngology, Lund University Hospital, S-221 85 Lund,
Sweden.

Streptococcus pneumoniae is a major cause of morbidity and mortality in all age
groups. In a few years, penicillin non-susceptible pneumococci (PNSP) have
emerged worldwide as a new threat. In order to better understand the mechanisms
behind the rapid expansion of these strains, the virulence of 10 clinical and two
transformed PNSP strains were compared with the virulence of three fully
susceptible strains in a mouse model of bacteremia and a rat model of acute
otitis media. Serotype, antibiotic susceptibility, and to some extent also
genetic profile and growth rate of the strains were investigated before
inoculation. The animals were monitored for up to 7 days after challenge by
clinical examinations/otomicroscopy and cultures from middle ears and blood. The 
results of the study demonstrated that the PNSP strains had a significantly
reduced ability to persist at the infectious site, and to some extent also to
induce infections, compared with fully susceptible strains. The reduction was
most evident for strains isolated from sources other than blood. It is therefore 
possible that other factors than virulence factors are of importance for the
ability of PNSP strains to expand.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 10996229 [PubMed - indexed for MEDLINE]

2409: Eur Arch Otorhinolaryngol. 2000;257(6):323-6.

Cytokines in children with otitis media with effusion.

Skotnicka B, Hassmann E.

Department of Pediatric Otorhinolaryngology, University Children's Hospital,
Bialystok, Poland.

We assayed 38 middle ear effusions from 23 children aged 4-13 years (mean 7)
undergoing tympanostomy tube placements. All fluid was assayed for tumor necrosis
factor (TNF) alpha, interleukin (IL) 1beta, IL-8, and IL-10. Cytokine
concentrations were measured by means of an enzyme-linked immunosorbent assay.
Detectable levels of IL-1beta, IL-8, and IL-10 were found in all of the
effusions. TNF-alpha was detected in 18 of the middle ear effusions (47.4%). The 
mean concentration of TNF-alpha, IL-1beta , IL-8, and IL-10 was, respectively,
0.423 +/- 1.39, 30.58 +/- 68.7, 7001.9 +/- 6743, and 56 +/- 58.7 pg/ml. There was
a strong, statistically significant correlation between the concentrations of
TNF-alpha and IL-1beta (r = 0.87, P = 0.001) and between IL-1beta and IL-8 (r =
0.53, P = 0.001). There was no correlation between the concentrations of IL-10
and other cytokines examined or between tympanic membrane pathology and the
concentrations of TNF-alpha, IL-1beta , IL-8, or IL-10. The presence of IL-10 in 
middle ear effusions may be one of the causes of a lack of clinical features of
acute inflammation and may lead to a chronic inflammatory state.

PMID: 10993552 [PubMed - indexed for MEDLINE]

2410: Eur Arch Otorhinolaryngol. 2000;257(6):300-3.

The pathology and clinical features of "glue ear": a review.

Rinaldo A, Ferlito A.

Department of Otolaryngology-Head and Neck Surgery, University of Udine,
Policlinico Città di Udine, Italy.

The clinical entity known as "glue ear" is synonymous with mucoid otitis media
and represents the most common cause of hearing loss in children. This review
considers the current state of our knowledge of mucoid otitis media, discussing
definition and terminology, pathology, etiology and microbiology, clinical
features, differential diagnosis and treatment.

Publication Types: 
    Review

PMID: 10993548 [PubMed - indexed for MEDLINE]

2411: Eur Arch Otorhinolaryngol. 2000;257(6):295-9.

A planimetric study of therapy-dependent development of temporal bone
pneumatization in secretory otitis media.

Hug JE.

hug.orl@bluewin.ch

The present study is based on the results of a planimetric investigation of
temporal bone pneumatization in 43 children. Radiological and clinical follow-up 
studies 10 years after therapy for secretory otitis media indicate an adaptation 
in the size of pneumatization to an almost normal area. The increase shows that a
myringotomy is sufficient in cases of serous effusion, whereas a mucous fluid
requires long-term middle ear ventilation.

PMID: 10993547 [PubMed - indexed for MEDLINE]

2412: J Allergy Clin Immunol. 2000 Sep;106(3):467-71.

Intranasal fluticasone propionate does not prevent acute otitis media during
viral upper respiratory infection in children.

Ruohola A, Heikkinen T, Waris M, Puhakka T, Ruuskanen O.

Department of Pediatrics, Turku University Hospital, Finland.

BACKGROUND: Acute otitis media (AOM) is the most common complication of a viral
upper respiratory infection (URI) in children. The virus-induced host
inflammatory response in the nasopharynx plays a key role in the pathogenesis of 
AOM. Suppression of this inflammatory process might prevent the development of
AOM as a complication. OBJECTIVE: We sought to assess the effect of intranasally 
administered fluticasone propionate on prevention of AOM during a viral
respiratory infection. METHODS: A total of 210 children (mean age, 2.1 years;
range, 0.7-3.9 years) with normal middle ear status and URI of 48 hours' duration
or less were randomly allocated to receive either fluticasone (100 microg twice
daily) or placebo for 7 days. The specific viral cause of the infection was
determined from nasopharyngeal aspirates obtained at the first visit. The
children were re-examined at the end of the 7-day medication period. RESULTS: In 
the fluticasone group AOM developed in 40 (38.1%) of 105 children compared with
29 (28.2%) of 103 children receiving placebo (P =.13). The viral cause of the
respiratory infection was determined in 167 (86.1%) of 194 children from whom a
nasopharyngeal aspirate was obtained. In children with rhinovirus infection, AOM 
developed significantly more often in the fluticasone group (45.7%) than in the
placebo group (14.7%, P =.005). CONCLUSION: Intranasally administered fluticasone
does not prevent the development of AOM during URI but may increase the incidence
of AOM during rhinovirus infection.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 10984365 [PubMed - indexed for MEDLINE]

2413: Laryngoscope. 2000 Sep;110(9):1511-5.

An animal model for the study of genetic predisposition in the pathogenesis of
middle ear inflammation.

Clark JM, Brinson G, Newman MK, Jewett BS, Sartor BR, Prazma J, Pillsbury HC 3rd.

Department of Surgery, The University of North Carolina School of Medicine,
Chapel Hill 27599-7070, USA.

OBJECTIVES: Chronic otitis media with effusion (COME) is the most prevalent
inflammatory disease in children and is associated with numerous adverse
long-term sequelae. Many factors have been associated with an increased risk of
developing COME, one of which may be a genetic predisposition to the disease. To 
study the role that genetics play in the pathogenesis of COME, we used an animal 
model to compare the middle ear inflammatory responses in two different strains
of rats (Lewis and Fisher). METHODS: In earlier studies, we demonstrated that
exposure of the middle ear to endotoxin caused early extensive exudation and,
later, goblet cell hyperplasia and mucin hypersecretion. In the present study,
the animals were divided into six groups. In each group the animals were given
transtympanic injection with gram-positive bacterial cell wall product
(peptidoglycan-polysaccharide [PG-PS]). The middle ear bullae were studied at 1
week and 3 weeks after infection, and after systemic reinfection. Comparisons
were made of the quantity of mucin exudate by enzyme-linked immunosorbent assay
and by histological evaluation of the middle ear epithelial thickness. RESULTS:
Our data demonstrate a statistically significant difference in middle ear
inflammation and effusion formation between the two genetically different strains
of rats. CONCLUSIONS: These data support the hypothesis that the middle ear
response to PG-PS may be genetically determined and therefore suggest that
genetic predisposition may play a role in the pathogenesis of COME.

PMID: 10983952 [PubMed - indexed for MEDLINE]

2414: Laryngoscope. 2000 Sep;110(9):1457-61.

Interleukin-1 receptor antagonist as an adjunct in the treatment of Haemophilus
influenzae otitis media in the chinchilla.

Kerschner JE, Beste DJ, Lynch JB, Fox MC, Kehl KS.

Department of Otolaryngology and Communication Sciences, Medical College of
Wisconsin, Milwaukee, USA.

OBJECTIVES: This purpose of this study was to investigate the effect of blockade 
of the inflammatory cytokine pathway on experimentally induced otitis media in
the chinchilla model. STUDY DESIGN: Pilot, randomized placebo-controlled trial.
METHODS: Ampicillin-sensitive Haemophilus influenzae otitis media was induced in 
45 adult chinchillas. The animals were randomly assigned to the following
treatment groups: 1) transbullar injections (TBI) of interleukin-1 receptor
antagonist (IL-1ra) and intramuscular ampicillin, 2) TBI of saline and
intramuscular ampicillin, 3) TBI of IL-1ra and intramuscular sa-1 line or 4) TBI 
of saline and intramuscular saline. Blinded investigators measured resolution of 
otitis media by otomicroscopy, tympanogram, and culture results. RESULTS:
Comparisons were made between the treatment groups to assess the ability of
IL-1ra to assist with resolution of otitis media using exact two-group binomial
tests with the StatXact statistical program. The group with TBI of IL-1ra and
intramuscular ampicillin as a treatment demonstrated trends suggesting more rapid
resolution of positive cultures and more rapid and complete return to normal
results on tympanograms and otomicroscopic findings compared with the group
treated with TBI of saline and intramuscular ampicillin. These trends did not
achieve statistical significance with the relatively small sample sizes used in
this pilot study. CONCLUSIONS: This investigation provides further evidence that 
the inflammatory cytokine cascade plays a significant role in the pathophysiology
of otitis media and that modulation of this inflammatory pathway may provide
novel and efficacious treatments for otitis media Further studies with larger
groups of animals are warranted to determine whether the trends identified in
this pilot study are reproducible and achieve statistical significance.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10983942 [PubMed - indexed for MEDLINE]

2415: Am J Ind Med. 2000 Oct;38(4):441-6.

A mortality follow-up study of WW II submariners who received nasopharyngeal
radium irradiation treatment.

Kang HK, Bullman TA, Mahan CM.

Environmental Epidemiology Service, Veterans Health Administration, Department of
Veterans Affairs, Washington, DC 20036, USA.

BACKGROUND: During World War II, large numbers of submarine trainees received
nasopharyngeal radium irradiation therapy to treat aerotitis media or middle ear 
barotrauma. METHODS: Using a life table and the Cox proportional hazards model,
mortality risk of 1, 214 submariners believed to have received treatment for
aerotitis media was compared to 3,176 "untreated" submariners. RESULTS: "Treated"
submariners had a significant increased mortality risk for all causes (odds ratio
(OR) = 1.32; 95% confidence interval (CI) = 1. 14-1.53) and circulatory diseases 
(OR = 1.51; 95% CI = 1.20-1.90), and a non-significant increased mortality risk
of head and neck cancer (OR = 1.40; 95% CI = 0.54-3.58). CONCLUSIONS: While the
excess risk was not statistically significant by conventional standards, the
finding does suggest that those who received NP radium irradiation therapy may be
at increased risk of death due to head and neck cancers. Due to the lack of data 
the role of risk factors other than radium exposure cannot be assessed.

PMID: 10982985 [PubMed - indexed for MEDLINE]

2416: J Infect Dis. 2000 Oct;182(4):1146-52. Epub 2000 Sep 5.

Natural development of antibodies to pneumococcal surface protein A, pneumococcal
surface adhesin A, and pneumolysin in relation to pneumococcal carriage and acute
otitis media.

Rapola S, Jäntti V, Haikala R, Syrjänen R, Carlone GM, Sampson JS, Briles DE,
Paton JC, Takala AK, Kilpi TM, Käyhty H.

National Public Health Institute, Dept. of Vaccines, 00300 Helsinki, Finland.
satu.rapola@ktl.fi

Pneumococcal surface protein A (PspA), pneumococcal surface adhesin A (PsaA), and
pneumolysin (Ply) are common to virtually all Streptococcus pneumoniae isolates. 
They are immunogenic and protective against pneumococcal challenge in animals and
are the major candidates for a protein-based pneumococcal vaccine for humans.
However, little is known of the natural development of antibodies to these
proteins in humans. The objective of this study was to evaluate the natural
development of antibodies to PspA, PsaA, and Ply in relation to pneumococcal
infection and carriage in young children. Serum antibodies to these proteins were
measured by EIA in children at ages 6, 12, 18, and 24 months and in their
mothers. All age groups were capable of producing antibodies to the 3 proteins.
The antibody concentrations increased with age and were strongly associated with 
pneumococcal exposure, whether by carriage or infection (acute otitis media).

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 10979911 [PubMed - indexed for MEDLINE]

2417: Arch Otolaryngol Head Neck Surg. 2000 Sep;126(9):1105-10.

Viral RNA in middle ear mucosa and exudates in patients with chronic otitis media
with effusion.

Moyse E, Lyon M, Cordier G, Mornex JF, Collet L, Froehlich P.

Département d'ORL et de Chirurgie Cervico-Faciale, Hôpital E. Herriot, 69003
Lyon, France.

OBJECTIVE: To evaluate viral and cytokine signaling correlates of the persistent 
inflammation associated with chronic otitis media with effusion (OME). DESIGN:
Prospective study. METHOD: Reverse transcriptase-polymerase chain reaction
targeting RNA viruses frequently associated with OME (respiratory syncytial virus
and parainfluenza virus type 3, the proinflammatory cytokines interleukin 8 and
interleukin 1beta, and RANTES [regulated upon activation, normal T cell expressed
and secreted]) was performed on mucosal biopsy samples and on samples of the
liquid and cellular compartments of inflammatory exudates obtained from 26
children (49 ears) with infected middle ears. Ribonucleic acid extracted from
rapidly frozen samples was reverse transcribed by Moloney murine leukemia virus
reverse transcriptase and amplified for 35 cycles using previously validated
primers. Amplicons were evaluated by molecular size after agarose gel
electrophoresis with ethidium bromide. RESULTS: Most children had evidence of the
presence of an RNA virus in at least one specimen. Respiratory syncytial virus
was present in 40% and parainfluenza virus type 3 in 8% of effusions. Interleukin
8 messenger RNA was present in 21% of inflammatory exudates but never in cells
from the mucosal biopsy samples. CONCLUSIONS: Our data support a viral
contribution to the cause of OME and suggest that the inflammatory cytokines
observed derive more from cells in the inflammatory exudate than from those in
the middle ear mucosa.

PMID: 10979124 [PubMed - indexed for MEDLINE]

2418: Dev Med Child Neurol. 2000 Jul;42(7):481-6.

Lasting auditory attention impairment after persistent middle ear infections: a
dichotic listening study.

Asbjørnsen A, Holmefjord A, Reisaeter S, Møller P, Klausen O, Prytz B, Boliek C, 
Obrzut JE.

Department of Psychosocial Sciences, University of Bergen, Norway.
asbjornsen@psych.uib.no

Dichotic listening performance was studied in children who at an early age had
undergone a myringotomy with insertion of ventilating tubes for persistent middle
ear infections (otitis media with effusion; OME) and compared with age-equivalent
children who had no history of otitis media or hearing problems. The OME group
consisted of 19 children with a median age of 9 years; 15 of whom were
right-handed, and 14 were boys. The comparison sample comprised 18 children with 
a median age was 9 years 4 months. Hand preference and sex were matched with the 
OME group. Both groups were tested with dichotic listening to consonant-vowel
syllables and additional forced-attention tasks. The comparison sample showed a
weak right-ear advantage, and age-adequate attentional modulations. The children 
in the OME group showed a strong right-ear advantage, but were not able to
modulate the ear advantage during directed-attention tasks. Models for
interpreting the result are discussed.

PMID: 10972421 [PubMed - indexed for MEDLINE]

2419: Clin Otolaryngol Allied Sci. 2000 Aug;25(4):315-20.

The effects of chronic otitis media with effusion on the measurement of
distortion products of otoacoustic emissions: presurgical and postsurgical
examination.

Topolska MM, Hassman E, Baczek M.

Department of Paediatric Otolaryngology, Medical University of Bialystok,
Bialystok, Poland.

This study aims to determine the influence of middle ear effusion and inserted
tympanostomy tubes on the feasibility of recording and of the amplitude of
distortion product otoacoustic emissions (DPOAE). Effusion in the middle ear
reduces the number of measurable responses and their amplitude in the whole range
of frequencies from 0.5 to 8 kHz. These changes were more distinct in mucous than
in serous effusion. There was an increase in the number of measurable responses
and amplitude of DPOAE after surgery. Inserted tympanostomy tubes have no
influence on the feasibility of DPOAE recording but reduce their amplitude in
comparison to the control group.

PMID: 10971540 [PubMed - indexed for MEDLINE]

2420: Clin Otolaryngol Allied Sci. 2000 Aug;25(4):274-9.

The role of Mucodyne in reducing the need for surgery in patients with persistent
otitis media with effusion.

Commins DJ, Koay BC, Bates GJ, Moore RA, Sleeman K, Mitchell B, Bates S.

Departments of Otolaryngology/Head and Neck Surgery, Pain Relief and Paediatrics,
Oxford Radcliffe Hospitals (Radcliffe Infirmary, Churchill Hospital and John
Radcliffe Hospital) Oxford, UK.

A recent meta-analysis suggested a possible beneficial effect of
carboxymethylcysteine (Mucodyne) in resolving otitis media with effusion (OME),
but the methodology in several of the included trials was flawed. A double-blind 
randomised controlled trial (RCT) involving 163 patients (78 randomised to
Mucodyne and 85 to placebo) was therefore performed. Main outcome measure:
operative intervention or not. Of the 28 patients with resolved OME, 17 were in
the Mucodyne group and 11 in the placebo group. Although it appeared that
patients treated with Mucodyne were 1.68 times more likely to undergo resolution 
of OME than patients receiving placebo, this did not reach statistical
significance. [Risk ratio of 1.68 (95% C.I., 0.74-3.37)]. chi2 test (df = 162) = 
2.24 (P = 0.134). The absolute risk difference in the study was 8.5% (95% C.I.,
-3-20). We cannot exclude the possibility that Mucodyne is as beneficial as a 20%
additional resolution of OME, or as harmful as a 3% decrease in the resolution of
OME.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 10971533 [PubMed - indexed for MEDLINE]

2421: Ear Nose Throat J. 2000 Aug;79(8):650-2, 654-7.

Laser-assisted myringotomy for otitis media: a feasibility study with short-term 
followup.

Reilly JS, Deutsch ES, Cook S.

Division of Pediatric Otolaryngology, Alfred I. duPont Hospital for Children,
Wilmington, Del 19899, USA.

Intermediate-duration middle ear ventilation appears to be a good treatment
option for selected children with otitis media. Laser-assisted myringotomy is one
way to provide such ventilation. It can provide prompt pain relief and resolution
of middle ear effusion and effusion-related hearing loss, and it can provide an
opportunity for surveillance of antibiotic-resistant organisms. We performed
laser-assisted myringotomy on 97 ears of 54 children over a 5-month period. All
children had acute or recurrent otitis media or persistent middle ear effusions. 
Our experience suggests that laser-assisted myringotomy is a feasible treatment
option for selected patients. Practitioner experience and patient and family
considerations will contribute to the decision whether to use general or topical 
anesthesia.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10969476 [PubMed - indexed for MEDLINE]

2422: Ear Nose Throat J. 2000 Aug;79(8):626-30.

Screening for otitis media with effusion to measure its prevalence in Chinese
children in Hong Kong.

Tong MC, Yue V, Ku PK, Lo PS, van Hasselt CA.

Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong.

In an attempt to gain a better understanding of the prevalence of otitis media
with effusion (OME) in the Hong Kong community, and to compare the
characteristics of the disease here with OME as it is described in the Western
literature, we screened more than 6,000 6- and 7-year-old children with both
clinical and audiologic examinations. The initial positive screening rate was
5.3%. Upon further evaluation, we determined that the overall prevalence of
persistent OME was 2.2%. We found that the disease pattern and natural history of
persistent OME in Hong Kong children are similar to those reported in the Western
literature.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10969473 [PubMed - indexed for MEDLINE]

2423: Pediatrics. 2000 Sep;106(3):E42.

The effect of ventilation tubes on language development in infants with otitis
media with effusion: A randomized trial.

Rovers MM, Straatman H, Ingels K, van der Wilt GJ, van den Broek P, Zielhuis GA.

Department of Otorhinolaryngology, University Medical Center Saint Radboud,
Nijmegen, The Netherlands. m.rovers@mie.kun.nl

OBJECTIVE: To study the effectiveness of ventilation tubes on the language
development in infants with persistent otitis media with effusion (OME). All
existing studies addressed children 3 years of age or older. Currently, OME is
detected and treated with ventilation tubes at a younger age. Because of the
critical relationship between age, hearing, and language development, we
conducted a study of the effects of ventilation tubes on language development in 
infants 1 to 2 years old with persistent OME. DESIGN: A multicenter, randomized, 
controlled trial (embedded in a cohort) with 2 treatment arms: 1) treatment with 
ventilation tubes (VT group; n = 93); or 2) with a period of watchful waiting (WW
group; n = 94). Hearing loss and expressive and comprehensive language were
assessed every 6 months, while tympanometry and otoscopy were performed every 3
months. Other factors with potential influence on language development were also 
included: adenoidectomy, hospital, attending day care, sex, age at randomization,
educational level of the mother, upper respiratory infections, and the native
country of the parents and older siblings. The trial was designed to allow for
the detection of a mean difference in language development of 3 months or more
between children allocated to the VT and WW groups. RESULTS: No relevant
differences were found in expressive or comprehensive language between the 2
groups after adjustment for educational level of the mother, IQ of the child, and
differences at baseline. A principal component analysis showed that in the VT
group, the children with frequent complaints improved 1.6 months more in
comprehensive language than those with no or some complaints. The children with
favorable language stimulation, however, did not improve more than the children
with less favorable stimulation. No differences were found for expressive
language among the various clusters. The probability to improve >3 months in
comprehensive language was.48 (95% confidence interval [CI]:.29-.68) for children
with highly educated mothers versus.09 (95% CI:.02-.30) for children whose
mothers had a low educational level. In the WW group, these changes were.30 (95% 
CI:.14-.53) and.14 (95% CI:.04-.35), respectively. The probability to improve >4 
months in expressive language was.52 (95% CI:.32-.71) for children with highly
educated mothers versus.06 (95% CI:.01-.31) for children whose mothers had a low 
educational level. In the WW group these changes were.42 (95% CI:.23-.64) and.11 
(95% CI:.03-.35), respectively. In addition, there were delays in expressive
language in both groups compared with their age expected values. The
comprehensive language of the children who were effusion-free during the
follow-up (n = 54) improved 1.5 months (95% CI: -.2-3.2) more than that of the
children who had persistent effusion during the entire follow-up (n = 28). No
differences were found for expressive language development. Disregarding the
intervention contrast, improvements in hearing seemed to be related to
improvements in language development, especially in verbal comprehension.
DISCUSSION: In this study, we used the Reynell, Schlichting, and Lexi tests to
study the relation between early persistent OME and language development. These
tests are directly related to normal language, widely accepted, and validated. It
cannot be ruled out that more specific measures such as auditory perception tests
would have produced more differences between groups, but the focus was on general
language development. A total of 10 children in the WW group received treatment
with ventilation tubes during follow-up. A further 11 children dropped out during
the trial. A sensitivity analysis with the 10 children who received ventilation
tubes did not change the results, and baseline differences were not found between
the 11 children who dropped out and those who completed the trial. CONCLUSIONS:
In the total group of infants with persistent OME, ventilation tubes did not h

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 10969126 [PubMed - indexed for MEDLINE]

2424: Pediatrics. 2000 Sep;106(3):483-8.

Comment in:
    Pediatrics. 2002 Feb;109(2):351-2; author reply 353.    Pediatrics. 2002 Feb;109(2):351-2; author reply 353.    Pediatrics. 2002 Feb;109(2):351-2; author reply 353.    Pediatrics. 2002 Feb;109(2):351-2; author reply 353.

Pacifier as a risk factor for acute otitis media: A randomized, controlled trial 
of parental counseling.

Niemelä M, Pihakari O, Pokka T, Uhari M.

Department of Pediatrics, Division of Phoniatrics, University of Oulu, Oulu,
Finland. marjon@cc.oulu.fi

OBJECTIVES: To evaluate the association between pacifier use and the increased
occurrence of acute otitis media (AOM) in an intervention trial. METHODS:
Fourteen well-baby clinics were selected to participate in an open, controlled
cohort study. These clinics were paired according to the number of children and
the social classes of the parents they served. One clinic in each pair was
randomly allocated for an intervention, while the other served as a control. The 
nurses at the intervention clinics were trained to instruct the parents of
children <18 months old to limit pacifier use during their prescheduled visits to
the clinic. The intervention consisted of a leaflet explaining the harmful
effects of pacifier use and instructions to restrict its use. Two hundred
seventy-two children were successfully recruited from the intervention clinics
and 212 from the control clinics. The data about pacifier use and the occurrence 
of respiratory infections and AOM were collected similarly in both groups.
RESULTS: After the intervention, a 21% decrease was achieved in continuous
pacifier use at the age of 7 to 18 months (P =.0001), and the occurrence of AOM
per person-months at risk was 29% lower among children at the intervention
clinics. The children who did not use a pacifier continuously in either of the
clinics had 33% fewer AOM episodes than the children who did. CONCLUSION:
Pacifier use appeared to be a preventable risk factor for AOM in children. Its
restriction to the moments when the child was falling asleep effectively
prevented episodes of AOM.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 10969091 [PubMed - indexed for MEDLINE]

2425: Int J Pediatr Otorhinolaryngol. 2000 Aug 31;54(2-3):143-8.

Rate of persistent perforation after elective tympanostomy tube removal in
pediatric patients.

Lentsch EJ, Goudy S, Ganzel TM, Goldman JL, Nissen AJ.

Department of Surgery, Division of Otolaryngology, University of Louisville
School of Medicine, 40292, Louisville, KY, USA.

This study was performed to determine the rate of persistent perforations
according to age, tube type and duration of intubation in children who underwent 
elective tympanostomy tube removal. Our retrospective analysis of hospital and
clinic charts included all patients who underwent elective tube removal from July
1995 to December 1997 at our institution. Information from the chart review
included patient age at time of tube removal, type of tube removed, duration of
intubation, presence of granulation tissue/polyps, and concomitant paper patch
placement. The outcome of each surgical removal was determined by examining
follow-up clinic charts. A patient was deemed to have a persistent perforation if
the eardrum had not adequately healed within 3 months after surgery. Data on 201 
patients were gathered. These patients had 273 tube removals. Eleven percent of
ears (29/273) had persistent perforations. According to tube type, no
perforations (0/48) occurred with Collar Bobbin tubes, 6% (3/50) with Tytan
tubes, 7% (3/44) with Duravent tubes, and 22% (16/74) with Paparella II tubes.
Three percent (3/101) of tubes in place for <3 years and 15% (26/172) of tubes in
place for >3 years showed persistent perforations after removal. Ears with
granulation polyps had a 9% (18/203) rate of perforations, whereas those without 
granulation polyps had a 16% (11/70) rate of perforations. Forty percent (4/10)
of ears were treated with paper patches at the time of tube removal showed
persistent perforations. Our data indicate that the rate of persistent
perforation (11%) after elective tympanostomy tube removal is high. The factors
associated with higher rates of persistent perforation (P<0.05) include duration 
of intubation >3 years prior to removal and the use of long-term Paparella II
tubes.

Publication Types: 
    Evaluation Studies

PMID: 10967385 [PubMed - indexed for MEDLINE]

2426: Int J Pediatr Otorhinolaryngol. 2000 Aug 31;54(2-3):93-6.

Topical use of mitomycin C in laser myringotomy: an experimental study in rats.

Yucel OT.

ENT Department, Medical Faculty, Hacettepe University, Ankara, Turkey.
tyucel@tr-net.net.tr

OBJECTIVE: Ventilation tubes are used to a large extent for the treatment of
otitis media with effusion. As this has some drawbacks, laser myringotomy was
suggested as a treatment alternative. The use of laser has some advantages but
its use is limited in prolonging the patency rate of myringotomy. Mitomycin C
(MMC) is being used in some surgical applications to reduce stenosis as it has
the property to inhibite activity of fibroblasts. We explored the use of
mitomycin C as an adjunct in prolonging the patency rate in laser myringotomy on 
rats. METHODS: We performed laser myringotomy on both ears of 20 rats. We, then
applied MMC with a concentration of 2 mg/ml on 10 rats to one of their ears
(Group 1). In group 2 we used MMC with a concentration of 1 mg/ml. After a
follow-up of 8 weeks we calculated the patency rate for the two groups and the
total ears with MMC and without MMC. RESULTS: The mean patency rate observed for 
group 1 was found to be 6 weeks whereas for group 2, it was 5.8 weeks. The
overall patency rate for the ears with and without MMC is 5.9 and 1.5 weeks,
respectively. While there was a statistical difference between ears with and
without MMC (P<0.01), there was no difference between the two groups according to
concentrations. CONCLUSION: Mitomycin C has an adjunct effect in laser
myringotomy in prolonging the patency rate of myringotomy on rats. Low
concentrations of mitomycin C have the same effect in this issue.

Publication Types: 
    Comparative Study

PMID: 10967377 [PubMed - indexed for MEDLINE]

2427: Int Immunol. 2000 Sep;12(9):1235-43.

Adenoids provide a microenvironment for the generation of CD4(+), CD45RO(+),
L-selectin(-), CXCR4(+), CCR5(+) T lymphocytes, a lymphocyte phenotype found in
the middle ear effusion.

Mattila PS, Nykänen A, Eloranta M, Tarkkanen J.

Department of Otorhinolaryngology, Helsinki University Central Hospital,
Haartmaninkatu 4 E, 00290 Helsinki, Finland.

Adenoidectomy in children with otitis media with effusion reduces inflammation in
the middle ear by an unknown mechanism. Potentially, the adenoids of these
children may serve as a site for the differentiation of lymphocytes, which after 
entering blood circulation eventually extravasate in the middle ear mucosa and
thereby contribute to excessive inflammation. During lymphocyte extravasation
various adhesion molecules and chemokines play a crucial role. To evaluate
possible connections between the adenoids and middle ear inflammation, the
expression of the chemokine receptors CXCR4 and CCR5 and the lymphocyte homing
receptor L-selectin were analyzed in adenoidal and middle ear lymphocytes. It was
found that most CD4(+) T lymphocytes in the middle ear effusion express the
memory phenotype marker CD45RO and the chemokine receptors CXCR4 and CCR5, but
are negative for the lymphocyte homing receptor L-selectin. This cell phenotype
was rare in peripheral blood but was found much more frequently in the adenoids. 
The results suggest that the adenoids provide a microenvironment for the
generation for CD4(+), CD45RO(+), L-selectin(-), CXCR4(+) and CCR5(+) T
lymphocytes. Further, these cells may include cells that have the capacity to
home to the middle ear mucosa. As the adenoidal CD4(+) memory phenotype CD45RO(+)
T cells expressed the activation antigen CD69 and included cells expressing the
HIV co-receptors CXCR4 and CCR5 at a high level, they may be permissive for HIV
infection.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 10967018 [PubMed - indexed for MEDLINE]

2428: Otolaryngol Head Neck Surg. 2000 Sep;123(3):258-62.

Tympanic membrane and middle ear pathologic correlates in mucoid otitis media.

Tekin M, Mutlu C, Paparella MM, Schachern PA, Jaisinghani VJ, Le CT.

Otitis Media Research Center, Department of Otolaryngology, University of
Minnesota Medical School, Minneapolis, USA.

OBJECTIVE: The goal of this study was to correlate tympanic membrane (TM) and
middle ear (ME) pathologies in mucoid otitis media (MOM). Methods and Material:
Forty ears with MOM and 56 control ears were retrospectively evaluated for TM and
ME pathologies. Comparisons of TM thicknesses in MOM versus control ears were
correlated with the Student t test; chi(2) analysis was used to correlate
pathologic findings of the TM and ME. RESULTS: Thicknesses in all quadrants
except the umbo were increased in MOM because of infiltration of inflammatory
cells and fibrosis. The most common ME pathologies were granulation tissue and
fibrosis. Significant correlations included (1) TM retraction and ME granulation 
tissue and fibrosis and (2) pars flaccida, posterosuperior, and anteroinferior
thickness and ME granulation tissue and fibrosis. CONCLUSION: TM changes are
likely to occur in patients with otitis media with effusion (MOM), and their
presence is a strong indication of underlying ME pathology.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 10964301 [PubMed - indexed for MEDLINE]

2429: Postgrad Med J. 2000 Sep;76(899):559-60.

Gradenigo's syndrome.

Motamed M, Kalan A.

Department of Otolaryngology, Head and Neck Surgery, Whipps Cross Hospital,
London, UK.

Gradenigo's syndrome, which is characterised by the triad of suppurative otitis
media, pain in the distribution of the trigeminal nerve, and abducens nerve palsy
may give rise to potentially fatal complications. Knowledge of the aetiology and 
appropriate investigations can lead to early diagnosis. A case is reported which 
illustrates this.

Publication Types: 
    Case Reports
    Review

PMID: 10964120 [PubMed - indexed for MEDLINE]

2430: Ann Otol Rhinol Laryngol Suppl. 2000 Aug;183:1-12.

Controversies in the medical management of persistent and recurrent acute otitis 
media. Recommendations of a clinical advisory committee.

Pichichero ME, Reiner SA, Brook I, Gooch WM 3rd, Yamauchi T, Jenkins SG, Sher L.

University of Rochester Medical Center, Microbiology/Immunology, NY 14642, USA.

Streptococcus pneumoniae is the predominant bacterial pathogen associated with
acute otitis media (AOM), causing an estimated 7 million cases annually in the
United States. Bacterial resistance should be considered when selecting an
antimicrobial agent for otitis media. Significant increases in drug-resistant S
pneumoniae are documented worldwide, and less than 50% of S pneumoniae strains
are fully susceptible to penicillin in some regions of the United States.
Although amoxicillin is recommended for uncomplicated AOM, treatment guidelines
should be flexible and adaptable, taking into consideration local and regional
susceptibility patterns, the age of the patient, the frequency of prior
infections, and the response to prior therapy. Resistant organisms are more
prevalent in children younger than 2 years of age and in those who have recurrent
or persistent AOM. Overdiagnosing AOM, selecting inappropriate empiric therapy,
or both, leads to overuse and misuse of antibiotics and causes increased drug
resistance. This article reviews persistent and recurrent AOM and discusses the
pitfalls of diagnosis and the practical limitations of current treatment
recommendations.

Publication Types: 
    Guideline
    Practice Guideline
    Research Support, Non-U.S. Gov't

PMID: 10963616 [PubMed - indexed for MEDLINE]

2431: J Laryngol Otol. 2000 Jun;114(6):448-9.

Medial displacement of grommets: an unwanted sequel of grommet insertion.

Kumar M, Khan AM, Davis S.

Department of Otolaryngology, Royal Gwent Hospital, Newport, South Wales, UK.
manoj.kumar@talk21.com

Grommet insertion is one of the commonest surgical procedures performed in the
UK. We have come across three cases in which grommets have displaced medially in 
the middle ear after establishing a satisfactory post-insertion position. We
suggest that an abnormally long myringotomy incision and improper placement of
the grommet are responsible for this unwanted outcome.

Publication Types: 
    Case Reports

PMID: 10962678 [PubMed - indexed for MEDLINE]

2432: J Laryngol Otol. 2000 Jun;114(6):432-6.

Burow's solution in the treatment of active mucosal chronic suppurative otitis
media: determining an effective dilution.

Thorp MA, Gardiner IB, Prescott CA.

Department of Otolaryngology, University of Cape Town, Republic of South Africa.

Burow's solution (13 per cent aluminium acetate) has been found to inhibit in
vitro the growth of most commonly occurring bacteria found in the discharging
ear. An in vitro study has shown that the minimum inhibitory concentration of
Burow's solution for these organisms lies between a 1:80 and a 1:160 dilution.
This paper reports on a clinical trial that incorporated 67 discharging ears to
establish the most effective strength of aluminium acetate solution. There was no
statistical difference in the effectiveness of full strength Burow's solution
compared to 3.25 per cent aluminium acetate solution (a quarter strength Burow's 
solution). Response rates of 80.8 per cent and 75 per cent respectively following
a two-week treatment period were achieved using these two solutions. A 1.3 per
cent aluminium acetate solution (1/10 strength Burow's solution) was found to be 
markedly inferior. Bacteriological and audiological profiles were recorded for
each patient.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 10962675 [PubMed - indexed for MEDLINE]

2433: Int J Pediatr Otorhinolaryngol. 2000 Aug 11;54(1):13-20.

On the physics of the infant feeding bottle and middle ear sequela: ear disease
in infants can be associated with bottle feeding.

Brown CE, Magnuson B.

Mt. Zion Family Care Center, Southern Illinois University School of Medicine,
1200 North State Highway 121, Mt. Zion, IL 62549 USA. ceb@fgi.net

BACKGROUND: When using conventional feeding bottles, negative pressure is
generated in the oral cavity, as well as, in the bottle when fluid is removed by 
sucking. The negative pressure inside the bottle causes the infant to suck
excessively and the intraoral negative pressure may subsequently be transmitted
to the middle ear via the eustachian tube. METHODS: in seven infants,
simultaneous pressure recordings were performed in the feeding vessel and the
middle ear using three types of feeding bottles. RESULTS: with conventional
non-ventilated and under-ventilated bottles a negative pressure formed while the 
infant sucked and negative intratympanic pressure was frequently generated.
CONCLUSIONS: it is suggested that this sequence of events may lead to secretory
otitis and it's accompanying consequences. In contrast, a fully ventilated bottle
showed positive pressure throughout the feeding procedure, which is similar to
normal breast-feeding, and negative pressure changes were not recorded in the
middle ear.

PMID: 10960691 [PubMed - indexed for MEDLINE]

2434: Int J Pediatr Otorhinolaryngol. 2000 Aug 11;54(1):7-12.

Turnover of Haemophilus influenzae isolates in otitis-prone children.

Dhooge I, Vaneechoutte M, Claeys G, Verschraegen G, Van Cauwenberge P.

Department of Otolaryngology, University Hospital Ghent, De Pintelaan 185,
B-9000, Ghent, Belgium. ingeborg.dhooge@rug.ac.be

INTRODUCTION: Previous studies have suggested a direct relationship between the
nasopharyngeal carriage of potential middle ear pathogens and the development of 
middle ear disease. It has been shown that otitis-prone (OP) children tend to be 
colonized more often than non-OP children. To study the turnover of nontypeable
Haemophilus influenzae (NTHI) in the nasopharynx of OP children, arbitrarily
primed PCR was applied to NTHI strains isolated nasopharyngeal swabs collected
prospectively during a 2-year study period from 35 OP children under 4 years of
age at fixed intervals. METHODOLOGY/MATERIALS: In 20 patients, H. influenzae
could be isolated from different sites (left and/or right ear and/or nasopharynx)
or at different occasions during follow-up. Forty-eight H. influenzae isolates of
different sites (left and/or right ear and/or nasopharynx) of the same patient as
well as from siblings were typed using arbitrarily primed PCR with primer ERIC2
and RAPD Ready-to-Go beads (Pharmacia Biotech, Uppsala, Sweden). RESULTS: Typing 
with arbitrarily primed PCR enabled to differentiate 29 genotypes among the 48 H.
influenzae isolates. Sixteen of these fingerprints were observed only once.
Thirteen of these fingerprints appeared on two or more occasions. In the three
pairs of siblings the same strain was identified at one moment. Genetically
identical NTHI strains from unrelated individuals were never identified. In 11 of
14 cases for which isolates were obtained simultaneously from different sites
(throat and/or left ear and/or right ear) or from three pairs of siblings,
identical fingerprints were observed. In nine cases whereby isolation was
separated by a period of more than 4 weeks (maximum 28 weeks) the fingerprints of
the isolates were different from the original isolate. CONCLUSION: Typing with
arbitrarily primed PCR indicated substantial genetic diversity among the H.
influenzae isolates studied, since for a total of 48 isolates of 20 different
patients, 29 different genotypes were observed. Since simultaneous isolation for 
different sampling sites (ear or nasopharynx) as well as for both of siblings,
resulted mostly in identical fingerprints, and since sampling of the same site of
the same patient, separated by an interval of more than 1 month, almost always
resulted in different genotypes, one could conclude that both cross colonization 
(between sampling sites within the same patient and between siblings) and
turnover are high. The relation between acquisition and development of disease
needs further attention.

PMID: 10960690 [PubMed - indexed for MEDLINE]

2435: Scand J Infect Dis. 2000;32(4):436-8.

Drug-resistant tuberculous mastoiditis in 2 children.

Pavlopoulou ID, Theodoridou M, Daikos GL, Lazopoulou DK, Koudoumnakis E,
Papadopoulos L, Syriopoulou VP.

First Department of Pediatrics, Aghia Sophia Children's Hospital, Athens, Greece.

Tuberculosis of the middle ear and mastoid is uncommon nowadays. Two cases of
drug-resistant tuberculous mastoiditis in immunocompetent Greek native children
are reported and the diagnostic and therapeutic difficulties of this rare
condition are discussed.

Publication Types: 
    Case Reports

PMID: 10959661 [PubMed - indexed for MEDLINE]

2436: J Infect Dis. 2000 Sep;182(3):882-7. Epub 2000 Aug 17.

Induction of mucin gene expression in middle ear of rats by tumor necrosis
factor-alpha: potential cause for mucoid otitis media.

Lin J, Haruta A, Kawano H, Ho SB, Adams GL, Juhn SK, Kim Y.

Otitis Media Research Center, Department of Otolaryngology, University of
Minnesota School of Medicine, Minneapolis, MN 55455, USA. linxx004@tc.umn.edu

Mucoid otitis media (MOM) is characterized by viscous fluid, high in mucin
concentration, which accumulates in the middle ear cavity. Recent studies suggest
that initial infection in the middle ear cleft may be key to the development of
MOM. However, factors of the initial infection attributed to the stimulation of
mucin production are not clearly understood. This study demonstrated that tumor
necrosis factor (TNF)-alpha, a proinflammatory cytokine in mucoid effusion,
markedly increased Muc2 mucin mRNA expression in middle ear epithelium, in a
time- and dose-dependent manner. Parallel to this was a marked increase in mucin 
glycoprotein in middle ear fluid. Also, TNF-alpha demonstrated an autocrine
and/or paracrine effect on the expression of endogenous TNF-alpha gene in the
middle ear, which may contribute to the production of mucin in this study. These 
findings suggest that TNF-alpha plays an important role in the development of MOM
by stimulating mucin metabolism.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 10950784 [PubMed - indexed for MEDLINE]

2437: Lifetime Data Anal. 2000 Sep;6(3):187-205.

Predictive inference, causal reasoning, and model assessment in nonparametric
Bayesian analysis: a case study.

Arjas E, Andreev A.

Rolf Nevanlinna Institute, University of Helsinki, Finland.
elja.arjas@rni.helsinki.fi

This paper continues our earlier analysis of a data set on acute ear infections
in small children, presented in Andreev and Arjas (1998). The main goal here is
to provide a method, based on the use of predictive distributions, for assessing 
the possible causal influence which the type of day care will have on the
incidence of ear infections. A closely related technique is used for the
assessment of the nonparametric Bayesian intensity model applied in the paper.
Two graphical methods, supported by formal tests, are suggested for this purpose.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10949858 [PubMed - indexed for MEDLINE]

2438: Paediatr Perinat Epidemiol. 2000 Jul;14(3):268-74.

Seasonal variation in the prevalence of persistent otitis media with effusion in 
one-year-old infants.

Rovers MM, Straatman H, Zielhuis GA, Ingels K, van der Wilt GJ.

Department of Otorhinolaryngology, University Medical Centre, St Radboud,
Nijmegen, The Netherlands. M.Rovers@mie.kun.nl

The objective of this population-based cohort study was to evaluate the
prevalence of persistent otitis media with effusion (OME) and its seasonal
variation in 12-month-old infants. All 30099 infants born in the eastern part of 
The Netherlands between 1 January 1996 and 1 April 1997 were invited for hearing 
screening, comprising a protocol of three possible tests. Those who failed all
three screening tests were referred to an ENT clinic for examination. Prevalences
(i.e. the probability that a child would fail all the screening tests) were
calculated by searching for the best logistic model for the first, second and
third screening test as well as for the visit to an ENT department. By
multiplying the prevalences found by the different models with each other, a
prevalence was calculated that accounted for increasing age and the timing of the
successive hearing tests. Furthermore, 95% confidence intervals were calculated
for this age-season-corrected prevalence. When all the children attended the
hearing tests at 9, 10, 11 and 12 months of age and when the number of births was
the same in all months, the overall prevalence was 4.8% [95% CI 4.3, 5.2]. The
highest prevalence (8.0%) was found in April, and the lowest (1.5%) in October.
Rates of bilateral OME during the late winter months were twice as high as those 
during the late summer.

PMID: 10949220 [PubMed - indexed for MEDLINE]

2439: J R Soc Health. 2000 Jun;120(2):90-3.

'Glue ear' in perspective.

Chopra R.

Department of Otolaryngology, Crawley Hospital, West Sussex.

Contrary to common perception 'glue ear' is a vast and complex subject. It is the
most common cause of hearing loss in children; its treatment is often questioned 
and involves utilisation of substantial health service resources. This article is
aimed not only at placing the condition in perspective but also at establishing a
short yet comprehensive understanding of its many aspects including aetiology and
management. There is no intention, however, to dwell here excessively upon its
intricacies and abstrusities.

PMID: 10944881 [PubMed - indexed for MEDLINE]

2440: East Afr Med J. 2000 Jan;77(1):20-2.

Bacteriology of chronic otitis media in Dar es Salaam, Tanzania.

Moshi NH, Minja BM, Ole-Lengine L, Mwakagile DS.

Department of Otorhinolaryngology, Muhimbili University College of Health
Sciences, Dar es Salaam, Tanzania.

OBJECTIVES: To determine the aetiology of chronic otitis media (COM) in Dar es
Salaam and to find out the shelf life of boric acid in spirit ear drops (BAISED).
DESIGN: Cross-sectional study. SETTING: Muhimbili Medical Centre and selected
primary schools within Dar es Salaam. MAIN OUTCOME MEASURES: Bacterial isolates
and their sensitivity patterns and shelf life of BAISED. SUBJECTS AND METHODS:
One hundred and seventy six pus swab specimens obtained from 150 patients with
COM for more than three months were submitted for culture and antimicrobial
sensitivity testing in 1997. RESULTS: The isolates included Pseudomonas
aeruginosa (51.7%), Staphylococcus aureus (17.2%), Proteus mirabilis (13.2%),
Klebsiella spp. (8.0%), Escherichia coli (5.8%) and unidentified coliforms in
4.0%. All isolates were sensitive to gentamicin. Sensitivity of Pseudomonas
aeruginosa and Proteus mirabilis to kanamycin was 98.5% and 100%, respectively.
P. aeruginosa was sensitive to chloramphenicol, ampicillin and tetracycline by
58.1%, 10.1% and 8.3%, respectively. Three per cent BAISED inhibited the growth
of all Pseudomonas aeruginosa even after it has been stored at room temperature
for six weeks. CONCLUSION: Based on these results, the drug of choice for
management of COM in Dar es Salaam is gentamicin. However, given its ototoxicity 
effects and the fact that BAISED is effective and affordable, the later should be
the treatment of choice.

PMID: 10944833 [PubMed - indexed for MEDLINE]

2441: Clin Otolaryngol Allied Sci. 2000 Jun;25(3):209-14.

Randomised controlled trial of early surgery versus watchful waiting for glue
ear: the effect on behavioural problems in pre-school children.

Wilks J, Maw R, Peters TJ, Harvey I, Golding J.

Department of Otolaryngology, University of Bristol, UK.

This trial was designed to compare early surgery with watchful waiting for
persistent bilateral otitis media with effusion (OME) in terms of hearing loss
and behavioural problems in pre-school children. A randomised controlled trial
compared the effects of early treatment with ventilation tubes versus watchful
waiting for 9 months. Results were analysed by intention-to-treat. One hundred
and eighty-two pre-school children (date of birth between 1 April 1991 and 31
December 1992), mean age of 2.9 years (SD 0.85) with at least a 3-month history
of bilateral OME and hearing loss of greater than 25 dB were treated in Bristol
Children's Hospital between November 1993 and January 1996. Bilateral ventilation
tubes were inserted within 6 weeks of randomisation or within 6 weeks of
reassessment after 9 months of watchful waiting, with a final assessment at 18
months. The main outcome measures were behavioural problems, measured by the
Richman Behaviour Checklist, and hearing loss at 4000 Hz in the better hearing
ear. Early surgical intervention significantly reduced behavioural problems by
17% (95% CI, 2% - 33%). This difference was largely mediated by concurrent
hearing loss. After 18 months, there was no longer a significant difference (95% 
Cl, -19% to +10%). However, the majority (85%) of the Watchful Waiting group had 
required surgery and 22% of all children still had behavioural problems.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 10944051 [PubMed - indexed for MEDLINE]

2442: Clin Otolaryngol Allied Sci. 2000 Jun;25(3):181-94.

The aetiology of otitis media with effusion: a review.

Kubba H, Pearson JP, Birchall JP.

Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
haytham@kubba.netlineuk.net

Otitis media with effusion (OME) is the most common cause of deafness in children
in the developed world. In this article we aim to present an overview of current 
research developments on the aetiology of OME and the resulting implications for 
treatment. In the model we describe, the primary event is inflammation of the
middle ear mucosa, usually due to the presence of bacteria. This leads to the
release of inflammatory mediators, which cause secretion of a mucin-rich effusion
by up-regulating mucin genes. Prolonged stimulation of the inflammatory response 
and poor mucociliary clearance lead to persistence of the middle ear fluid,
giving rise to the clinical presentation of OME. We describe OME in the following
sequence: the initial production of the effusion, the composition of the effusion
produced, and factors impairing clearance of the effusion.

Publication Types: 
    Review

PMID: 10944048 [PubMed - indexed for MEDLINE]

2443: Clin Allergy Immunol. 2000;15:247-62.

Diagnostic assessment of otitis media.

Kaleida PH, Fireman P.

University of Pittsburgh School of Medicine, Pennsylvania, USA.

Accurate diagnosis of OM is important but often difficult. To enhance the
likelihood of accurate diagnosis, pneumatic otoscopy is the preferred method of
examination generally available to clinicians. Findings by pneumatic otoscopy
should be coupled with the presence or absence of symptoms and signs to delineate
a diagnosis of AOM or OME. Tympanometry can be a useful adjunct in the clinical
assessment of middle ear effusion. Audiometry is particularly important for
patients with recurrent or chronic middle ear disease.

Publication Types: 
    Review

PMID: 10943297 [PubMed - indexed for MEDLINE]

2444: Ear Nose Throat J. 2000 Jul;79(7):524-6.

Fascioperiosteal flap and neo-osteogenesis in radical mastoidectomy: long-term
results.

Kahramanyol M, Ozünlü A, Pabusçu Y.

Department of Otorhinolaryngology-Head and Neck Surgery, Gülhane Military Medical
Academy, Ankara, Turkey.

We performed an analysis of long-term outcomes data on 60 patients with chronic
otitis media with cholesteatoma who had undergone a surgical procedure based on
an improved radical mastoidectomy and an inferiorly based fascioperiosteal flap. 
We found that at the 2-, 7-, 10-, and 13-year postoperative followup visits, all 
mastoid cavities were healthy and reduced in volume. At the final examination,
the mean cavity volume was found to be decreased by 39% of the mean volume
measured 1 month postoperatively. This reduction in volume is attributable to the
neo-osteogenic activity of the flap, which was confirmed by histopathologic and
radiologic findings. No recurrences took place.

PMID: 10935305 [PubMed - indexed for MEDLINE]

2445: Fam Pract. 2000 Aug;17(4):317-22.

Tympanometry for diagnosis and treatment of otitis media in general practice.

Johansen EC, Lildholdt T, Damsbo N, Eriksen EW.

Department of Otology, Vejle Hospital, Vejle, Institute of Public Health, General
Practice, University of Southern Denmark and General Practice, Vejle, Denmark.

OBJECTIVE: The aim of this study was to evaluate the role of tympanometry for
diagnosis, treatment and follow-up of otitis media in general practice. METHODS: 
The results from otoscopy performed by 40 physicians in general practice in Vejle
County, Denmark were combined with the clinical condition and this was recorded
as the preliminary decision about diagnosis, treatment and follow-up.
Subsequently, tympanometry was performed in 3176 children aged between 1 month
and 16 years; a total of 6352 tympanometries. With this added knowledge, a final 
decision about diagnosis, treatment and follow-up was recorded. The practitioners
were trained in performing tympanometry including the interpretation of the
results. Simultaneously, they were involved in the establishment of guidelines
for diagnosis, treatment and follow-up of otitis media in general practice. The
main outcome measures were changes between preliminary and final decisions about 
diagnoses, treatments and follow-up regimens. RESULTS: Tympanometry was performed
successfully in 87.7% of the children, and in 26.4% changes in diagnoses were
found. However, tympanometry did not influence the distributions of the main
outcome measures in the sample as a whole. Uncomplicated cases were checked in
general practice and referrals to specialists were not increased. CONCLUSION:
Tympanometry can be performed successfully in general practice after appropriate 
instruction. In 26.4% of children, the diagnoses were changed, which may result
in more appropriate treatment and follow-up. Tympanometry is a clinically
relevant supplement to the examination of a child in general practice.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10934180 [PubMed - indexed for MEDLINE]

2446: Int J Pediatr Otorhinolaryngol. 2000 Jul 14;53(3):195-205.

Associations between the eustachian tube and craniofacial skeleton.

Kemaloğlu YK, Kobayashi T, Nakajima T.

Department of ENT-HNS, Faculty of Medicine, Gazi University, Ankara, Turkey.
ykkemal@med.gazi.edu.tr

OBJECTIVE: Growth and development of the anatomic region where the Eustachian
tube (ET) is located are associated with the parameters related to other parts of
the craniofacial skeleton (CFS). It has been suggested that ET dysfunction is as 
an important factor in pathogenesis of otitis media in childhood which is
associated with its postnatal growth and development process. The purpose of this
study was to evaluate associations of length of the ET with various craniofacial 
parameters. METHODS: On lateral cephalometric radiographs of 50 Japanese adult
(25 male and 25 female), the dimension of the region where the ET is located
('length of the ET') and 22 (15 linear and seven angular) craniofacial parameters
were measured by using a digitiser and computer. Correlation and regression
analyses were performed between this dimension and other craniofacial parameters.
RESULTS: It was found that the dimension of the region in which the ET is located
('length of the ET') was associated with many craniofacial parameters belonging
to different subunits of the CFS. However, the stepwise regression analysis
showed that total cranial base length, posterior upper face height and maxillary 
depth had determinative effects on this dimension. CONCLUSION: Development of the
ET was associated with development of the cranial base and nasomaxillary complex.
Therefore, it could be hypothesised that any cessation or aberration in these
parts of the CFS cause corresponding imbalances in the ET, which may predispose
to otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10930635 [PubMed - indexed for MEDLINE]

2447: Int J Antimicrob Agents. 2000 Aug;15(3):169-77.

Antibiotic treatment for acute otitis media.

Leibovitz E, Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center and the
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,
Israel. eugenel@bgumail.bgu.ac.il

The major problems encountered in the antibiotic therapy of acute otitis media
(AOM) are the tremendous increase in the resistance to antibiotics of its main
pathogens and the lack of tight criteria (taking into consideration, as a major
determinant, the eradication of the pathogens from the middle ear fluid) in the
selection of the appropriate antibiotic drugs for the treatment of this disease. 
Future drugs for the treatment of AOM will have to be approved only after their
in vivo microbiological efficacy for each major pathogen is documented. This
documentation will be provided by more antibiotic studies with bacteriological
outcome using the double-tympanocentesis method and stratifying the AOM patients 
by age and initial clinical severity. Judicious use of antibiotics for the
treatment of AOM will have a major impact on society, leading to a less frequent 
but more skilled administration of the most effective drugs.

Publication Types: 
    Review

PMID: 10926438 [PubMed - indexed for MEDLINE]

2448: J Fam Pract. 2000 Jul;49(7):605-11.

Comment in:
    J Fam Pract. 2000 Jul;49(7):612-3.

Persistent otitis media with effusion: can it be predicted? A family practice
follow-up study in children aged 6 months to 6 years.

van Balen FA, de Melker RA.

Department of Family Practice, University of Utrecht, The Netherlands.
F.A.M.VanBalen@med.uu.nl

BACKGROUND: Otitis media with effusion (OME) has a high rate of spontaneous
resolution, and a policy of waiting and watching for 3 months is justified. The
decision about further treatment should be individualized, depending on duration 
and symptoms. Knowledge of the determinants for persistent OME would be helpful
for identifying patients with a need for active treatment or increased monitoring
for complications. METHODS: A total of 433 children aged 6 months to 6 years were
monitored for 3 months in the offices of 57 family physicians. A questionnaire
pertaining to determinants was completed. The outcome measures were: presence of 
unilateral or bilateral OME or bilateral OME after 3 months. The outcome was
determined on the basis of tympanometry results. We performed bivariate and
multivariate analyses. RESULTS: The presence of an upper respiratory tract
infection (URTI) at the follow-up visit was associated with finding OME at that
visit. When a URTI was present, no other determinants for persistent OME were
found. When absent, the determinants for persistent bilateral OME were: no
history of adenoidectomy, an episode of acute otitis media (AOM) in the first
year of life, and month of entry into the study (June-November). For persistent
unilateral or bilateral OME, the only significant determinant was an episode of
AOM in the first year of life. CONCLUSIONS: Childrenwith 1 or more of the
following factors need special attention for prevention of the sequelae of
persistent OME: no history of adenoidectomy, AOM in the first year of life, and
the presence of bilateral OME in the period between June and November.

PMID: 10923569 [PubMed - indexed for MEDLINE]

2449: Arch Otolaryngol Head Neck Surg. 2000 Aug;126(8):1011-3.

In vitro bacterial interference in the nasopharynx of otitis media-prone and
non-otitis media-prone children.

Brook I, Gober AE.

Department of Pediatrics, Georgetown University School of Medicine, Chevy Chase, 
MD, USA.

OBJECTIVE: To compare the frequency of recovery of potential pathogens and
aerobic- and anaerobic-interfering bacteria in the nasopharynx of otitis
media-prone (OMP) with that in non-OMP (N-OMP) children. PATIENTS AND METHODS:
Nasopharyngeal cultures were obtained from 20 OMP and 20 N-OMP children.
Potential pathogens and aerobic and anaerobic bacteria with interfering
capabilities against these organisms were identified. RESULTS: Eighteen potential
pathogens were isolated from 12 of the 20 OMP children, and 9 were recovered from
5 of the 20 N-OMP children (P<.05). Fifty-eight aerobic and anaerobic isolates
with interfering capability against 4 potential pathogens were recovered from 5
of the OMP group, and 139 from 17 of the N-OMP group (P<.05). These interfering
organisms included alphahemolytic streptococci, nonhemolytic streptococci,
Prevotella species, and Peptostreptococcus species. CONCLUSION: The
nasopharyngeal flora of N-OMP children contains more aerobic and anaerobic
organisms with interfering capability and less potential pathogens than that of
OMP children.

Publication Types: 
    In Vitro

PMID: 10922236 [PubMed - indexed for MEDLINE]

2450: Cleft Palate Craniofac J. 2000 Jul;37(4):416-20.

A possible otological complication due to maxillary expansion in a cleft lip and 
palate patient.

Aizenbud D, Hefer T, Rachmiel A, Figueroa AA, Joachims HZ, Laufer D.

Orthodontics and Cleft Palate Centre, Maxillofacial Depatment, Rambam Medical
Centre and Technion Faculty of Medicine, Haifa, Israel.
d_aizenbud@rambam.health.gov.il

OBJECTIVE: We present a possible negative side effect of a sudden onset of
secretory otitis media in a 12-year-old boy with unilateral cleft lip and palate 
who underwent maxillary expansion. The secretory otitis media caused a temporary 
hearing loss developed during the activation of the expander appliance. The
possible causes for this complication are discussed. CONCLUSIONS: Clinicians
should be aware of the possible association between maxillary expansion and
secretory otitis media.

Publication Types: 
    Case Reports

PMID: 10912722 [PubMed - indexed for MEDLINE]

2451: Am J Otol. 2000 Jul;21(4):499-504.

Intratympanic immunosuppressives for prevention of immune-mediated sensorineural 
hearing loss.

Yang GS, Song HT, Keithley EM, Harris JP.

Division of Otolaryngology, University of California, San Diego, School of
Medicine, La Jolla 92093-0666, USA.

HYPOTHESIS: Round window membrane application of immunosuppressives reduces
cochlear inflammation and hearing loss in a guinea pig model of sterile
labyrinthitis. BACKGROUND: Systemic immunosuppressives are used to treat
sensorineural hearing loss due to inflammation (autoimmune, bacterial, viral),
which in animal models causes hearing loss. Transtympanic application of drugs is
an attractive and possibly efficacious method of treatment that avoids systemic
toxicities. METHODS: Sterile labyrinthitis was created using keyhole limpet
hemocyanin (KLH). Dexamethasone (0.048 mg/day and 0.288 mg/day), cyclosporine
(0.5%), prednisolone acetate (1%), fluorouracil, (5%), and FK506 (0.01%) were
delivered to the round window membrane with one injection (filling middle ear
space) or osmotic minipumps. Efficacy was evaluated by auditory brainstem
response and histology. RESULTS: No drug was effective at reducing hearing loss
or inflammation. CONCLUSION: Local application of immunosuppressives did not
suppress inner ear inflammatory infiltrates and hearing loss in KLH-induced
labyrinthitis in a guinea pig model.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 10912694 [PubMed - indexed for MEDLINE]

2452: Am J Otol. 2000 Jul;21(4):485-93.

Attic aeration in temporal bones from children with recurring otitis media:
tympanostomy tubes did not cure disease in Prussak's space.

Palva T, Johnsson LG, Ramsay H.

Department of Otolaryngology, University of Helsinki, Finland.

HYPOTHESIS: Blockage of the aeration pathways to the attic may cause
circumscribed or widespread alterations that are difficult to diagnose
clinically. The narrow route via the posterior pouch to Prussak's space is
especially vulnerable to obstruction in recurring otitis media. BACKGROUND:
Recent studies of the epitympanic diaphragm and compartments have clarified the
anatomy of the attic aeration and drainage pathways and emphasized the role of
their patency in the healing process of middle ear infections. In neonatal otitis
media, the amniotic fluid cellular content (AFCC) has proved to be a good
indicator in outlining the areas where inflammation products concentrate,
possibly causing early blockage of ventilation. METHODS: Twenty-eight temporal
bones from 14 children were studied; 4 of these children had experienced
bilateral recurring otitis media. In the latter group, 1 ear was studied by
microdissection and the other by serial sectioning. RESULTS: Prussak's space was 
involved in all 4 pairs of bones and either contained thick mucus, contained
secretion in the process of organization, or was obliterated. The tympanic
isthmus was fully obstructed in 1, partially blocked in 2, and open in 5
specimens. CONCLUSIONS: If a thick mature connective tissue mass develops under
the epidermal layer of Shrapnell's membrane during an obliteration process of
Prussak's space, the condition may stay stable and benign. Severe retraction of
Shrapnell's membrane represents a likely forerunner of a retraction pocket
cholesteatoma. Systematic otomicroscopy allows early detection, and cure can be
achieved by minor surgery. In some children, despite the treatment of recurring
otitis media with ventilation tubes, the attic and mastoid can be extensively
involved, necessitating atticomastoidectomy and the creation of new pathways for 
attic aeration.

Publication Types: 
    Case Reports

PMID: 10912692 [PubMed - indexed for MEDLINE]

2453: Am J Otol. 2000 Jul;21(4):468-73.

Use of a hyaluronan-based biomembrane in the treatment of chronic
cholesteatomatous otitis media.

Martini A, Morra B, Aimoni C, Radice M.

ENT Department, Faculty of Medicine, University of Ferrara, Italy.

OBJECTIVE: To test the efficacy and safety of a hyaluronan-based biomembrane in
stimulating the healing process in patients undergoing tympanomastoid surgery.
STUDY DESIGN: The trial was an open, two-arm, controlled, randomized,
prospective, multicenter study conducted at two different hospitals. PATIENTS:
Sixty subjects (18-65 years of age, both sexes) with chronic cholesteatomatous
otitis media were enrolled and treated by the "one-stage open technique."
Efficacy and safety parameters were assessed at 3, 5, 7, 9, 11, 13, 17, 21, and
25 weeks after surgery. Three sets of composite criteria were considered:
patient's assessment of quality of healing, otomicroscopy, and audiometry.
RESULTS: Of the 60 patients, 50 completed the study. Subjects treated with the
biomembrane had statistically significant better scores than controls (no
treatment) for all variables considered, excluding audiometry (no significant
differences). No adverse events occurred in treated patients. CONCLUSION: Data
demonstrate that the application of a hyaluronan-based biomembrane improves the
healing of the mastoid cavity following "open" tympanoplasty. In particular,
re-epithelialization was significantly faster after the application of the
biomembrane. Moreover, the device neither caused any adverse events nor showed
signs of ototoxicity. Re-epithelialization of open cavities and tympanic grafts
still represents for surgeons an unpredictable step in the healing process.
Hyaluronian-derivates may effectively contribute to the reduction of such
variability.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial

PMID: 10912689 [PubMed - indexed for MEDLINE]

2454: Am J Otol. 2000 Jul;21(4):462-7.

Granular myringitis: is it a surgical problem?

El-Seifi A, Fouad B.

Department of Microsurgery, The Military Medical Academy, Cairo, Egypt.

OBJECTIVE: An attempt to settle the controversies associated with granular
myringitis (GM) including incidence, etiology, pathology, presentation, relation 
to chronic otitis media, and treatment. STUDY DESIGN: Retrospective. SETTING:
Tertiary referral center and private otology practice. PATIENTS: 94 patients
presenting with GM over 28 years. INTERVENTION: Diagnosis by otoscopy,
audiometry, radiology, and bacteriology; long-term follow-up (6 months to 12
years); assessment of treatment results. MAIN OUTCOME MEASURES: The pathologic
states of the affected tympanic membranes were studied in both active and
quiescent stages. The results of conservative versus surgical management were
evaluated. RESULTS: The disease presents with chronic painless otorrhea, normal
hearing and mastoid pneumatization, and granular areas, which may be patchy,
diffuse, or segmental. The latter is the most frequent and is most commonly
posterosuperior. The infecting organism is Pseudomonas aeruginosa. The pathologic
process affects all drum layers and can cause a perforation. The most important
predisposing factor is disturbed epithelial migration, which may be exaggerated
by eustachian tube dysfunction. Of 26 cases treated conservatively, none healed
without recurrence. Of 48 cases treated surgically, there were 2 recurrences.
CONCLUSIONS: Pathologically, the disease affects all drum layers. It presents
with an active stage, which may be misdiagnosed as chronic otitis media or
cholesteatoma, and a quiescent stage when it may be overlooked. Although distinct
from chronic otitis media, it can cause a perforation. The disease responds
readily to medical treatment, but recurrence is common. Radical surgery offers a 
curative measure in refractory cases.

PMID: 10912688 [PubMed - indexed for MEDLINE]

2455: J Laryngol Otol. 2000 May;114(5):376-7.

When a mastoid swelling is not mastoiditis.

Hung T, Huchzermeyer P.

Department of Otolaryngology, St George's Hospital, London, UK.

A case is reported of swelling over the mastoid process due to subgaleal abscess 
possibly secondary to trivial cutaneous trauma. The diagnosis was difficult as
subgaleal abscess is an extremely rare condition especially after the advent of
the antibiotic era. The route of entry of the infection to the subgaleal space
was unclear as there was no skin puncture. The absence of substantial trauma
excluded subgaleal haematoma as a precondition. We would like to discuss the
possible aetiologies and the management of this rare case in the light of the
limited information available in the world literature.

Publication Types: 
    Case Reports

PMID: 10912270 [PubMed - indexed for MEDLINE]

2456: J Laryngol Otol. 2000 May;114(5):373-5.

Abscess formation in the temporomandibular joint as a complication of otitis
media.

Takes RP, Langeveld AP, Baatenburg de Jong RJ.

Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University
Medical Center, The Netherlands.

A case of an eight-month-old girl with an abscess in the temporomandibular joint 
as a complication of acute otitis media is described. The complications of acute 
otitis media in general and the probable explanation for the development of this 
complication are discussed.

Publication Types: 
    Case Reports

PMID: 10912269 [PubMed - indexed for MEDLINE]

2457: J Laryngol Otol. 2000 May;114(5):366-9.

Non-pseudomonal malignant otitis externa and jugular foramen syndrome secondary
to cyclosporin-induced hypertrichosis in a diabetic renal transplant patient.

Lancaster J, Alderson DJ, McCormick M.

Department of Otorhinolaryngology, Royal Liverpool University Hospital, UK.

We present the case of a 58-year-old diabetic renal transplant patient who
developed a left jugular foramen syndrome, secondary to an ipsilateral
staphylococcal malignant (necrotizing) otitis externa. This followed a protracted
episode of uncomplicated otitis externa with no evidence of bone involvement on
computed tomography (CT) scanning. Cyclosporin-induced hypertrichosis (excess
hair growth) in his external auditory canal contributed greatly to the initial
difficulty in managing his otitis externa. Following an initial successful
treatment with prolonged intravenous antibiotics the patient relapsed with a
secondary infection in the same anatomical site due to Candida parapsilosis.
Despite further intensive treatment including antimicrobials, a subtotal
petrosectomy and hyperbaric oxygen therapy he eventually succumbed to his
disease.

Publication Types: 
    Case Reports

PMID: 10912267 [PubMed - indexed for MEDLINE]

2458: J Laryngol Otol. 2000 May;114(5):336-8.

Effect of anaesthetic agents on tympanometry and middle-ear effusions.

Fish BM, Banerjee AR, Jennings CR, Frain I, Narula AA.

Department of Otorhinolaryngology/Head and Neck Surgery, Leicester Royal
Infirmary, UK.

Following informed parental consent 93 children underwent bilateral grommet
insertion. Tympanometry was performed pre-operatively, and immediately prior to
myringotomy. A standardized anaesthetic was used. At myringotomy the presence or 
absence of fluid was recorded, as well as the time since induction of the general
anaesthetic. A pre-operative type B tympanogram predicted a middle-ear effusion
at myringotomy in 92 per cent of patients. A pre-operative type C2 tympanogram
predicted a middle-ear effusion at myringotomy in 39 per cent of patients. Sixty 
tympanograms (30 per cent) changed following a general anaesthetic. Fourteen type
B tympanograms changed to type A and eight of these had effusions. The duration
of the general anaesthetic did not influence the probability of a middle-ear
effusion being present at myringotomy. A pre-operative type B tympanogram is a
good predictor of middle-ear fluid. The duration of the general anaesthetic is
not significant in predicting the presence of a middle-ear effusion.

PMID: 10912260 [PubMed - indexed for MEDLINE]

2459: Acta Otolaryngol Suppl. 2000;543:196-200.

Paediatric otolaryngology--disease profile and characteristics of children in
outpatient surgery.

Kvaerner KJ, Moen MC, Haugeto O, Mair IW.

Department of Otorhinolaryngology, Ullevål University Hospital, Oslo, Norway.
K.j.kvarner@ioks.uio.no

Data were collected from 178 consecutively operated children during a 6-week
period at an Oslo hospital in order to study disease profile and routines for
referral and treatment in outpatient otorhinolaryngologic surgery. Median time
from referral to surgery was less than 4 months. The majority of the children
subjected to operation for recurrent acute otitis media, tonsillitis or upper
respiratory infections had suffered from the disease for 12 months or less.
Obstructive symptoms were registered in 18% of the children. Hospital referrals
and controls came mainly from ENT (ear, nose and throat) specialists or
paediatricians. Significantly more boys were subjected to surgery. Median age at 
the time of surgery was 4.2 years, and there was an equal distribution of
pharyngeal and middle ear surgery. The numerous combinations of middle ear
surgery reflect the non-specific treatment guidelines for otitis media.

PMID: 10909019 [PubMed - indexed for MEDLINE]

2460: Acta Otolaryngol Suppl. 2000;543:130-1.

Tympanoplasty with ionomeric cement.

Kjeldsen AD, Grøntved AM.

Department of Otorhinolaryngology, Odense University Hospital, Denmark.

Patients with isolated erosion of the long incus process suffer from severe
hearing loss caused by lack of continuity of the ossicular chain. This study is a
retrospective evaluation of the hearing results using two different surgical
procedures. Since January 1993, 12 consecutive patients with isolated erosion of 
the long incus process have been treated with a new surgical technique in which
the ossicular chain was rebuilt with ionomeric cement. The results in hearing
performance (mean pure-tone average (PTA) 0.5, 1 and 2 kHz) were evaluated pre-
and post-surgery, and compared to those in a group of 20 historical controls who 
underwent surgery in 1991 and 1992 using incus autograft interposition. Among the
12 index patients, 7 (58%) achieved improvement in PTA of > 10 dB, in 3 there was
no difference and in 2 a slight decline. Among the 20 controls, 14 (70%) achieved
improvement in PTA of > 10 dB, in 4 there was a slight improvement and in 2 a
decline. The difference was not statistically significant. Hearing improvement
using ionomeric cement in type II tympanoplasty was satisfactory. Reconstruction 
of the ossicular chain with ionomeric cement is recommended, as the procedure is 
easy to perform, presents less risk of damage to the stapes and cochlea, requires
less extensive surgery and does not exclude other surgical methods in cases of
reoperation.

PMID: 10909000 [PubMed - indexed for MEDLINE]

2461: Acta Otolaryngol Suppl. 2000;543:122-6.

Acute mastoidectomy in a Danish county from 1977 to 1997--operative findings and 
long-term results.

Petersen CG, Ovesen T, Pedersen CB.

Ear, Nose and Throat Department, Aarhus University Hospital, Denmark.

Data from patients undergoing acute mastoidectomy were examined retrospectively
to evaluate if the nature of acute mastoiditis (AM) treated surgically has
changed during the last 20 years (1977-97). Moreover, a prevalence study was
conducted to clarify the otological and audiological course following acute
mastoidectomy. Patients with cholesteatoma and intracranial complications were
excluded. Thus, 79 patients with a median age of 16 months were included.
Thirty-seven percent had a history of middle ear disease, and the mean duration
from onset of symptoms to admission was 9 days. Well-being was affected in 46%,
and 82% had fever. The clinical picture was dominated by auricular protrusion
(77%) and pathological tympanic membrane (94%). Postauricular oedema, hyperaemia 
and tenderness were demonstrated in 89%, 78% and 49% of cases, respectively.
Peroperatively, purulent middle ear effusion was recognized in 92%, subperiosteal
abscess in 66% and pus in the mastoid in 90%. Specimens revealed growth of
pathogens in 58%, predominantly Gram-positive bacteria. The observation period
was 1-20 years. The findings in operated ears were not significantly different
from the contralateral non-operated ears concerning incidence of otitis media,
hearing and ear canal volume. Conclusively, acute mastoidectomy is a safe and
effective treatment to eliminate infection. The operation can be done with
negligible risk and does not leave long-term sequelae.

PMID: 10908998 [PubMed - indexed for MEDLINE]

2462: Acta Otolaryngol Suppl. 2000;543:89-91.

Middle ear epithelium has inflammatory capacity.

Schousboe LP, Ovesen T, Pedersen CB.

Department of Otorhinolaryngology, Aarhus University Hospital, Denmark.

Endotoxin, tumour necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1
beta) and intercellular adhesion molecule-1 (ICAM-1) were detected in 88%, 51%,
58% and 66% of 152 middle ears from patients suffering from otitis media with
effusion. In this study the hypothesis that bacterial endotoxin, TNF-alpha, IL-1 
beta and ICAM-1 induce the inflammatory process characteristic of otitis media
with effusion was tested. Cultures of rabbit middle ear epithelium were exposed
to endotoxin, TNF-alpha or IL-1 beta. The expression of ICAM-1 on the cell
surfaces was measured with a direct enzyme-linked immunosorbent assay on the cell
layer. For TNF-alpha, 5 ng/ml significantly increased ICAM-1 expression, whereas 
100 ng/ml had a toxic effect. For IL-1 beta, as little as 1 ng/ml produced a
significant increase in ICAM-1 expression. Endotoxin stimulated ICAM-1 expression
less strongly in concentrations from 100 ng/ml to 100 micrograms/ml. The findings
indicate that stimulation of ICAM-1 by endotoxin is mediated, at least in part,
by TNF-alpha and IL-1 beta. It is concluded that endotoxin induces sustained
inflammation in OME, and that this inflammation is mediated, at least in part, by
the primary cytokines TNF-alpha and IL-1 beta.

PMID: 10908988 [PubMed - indexed for MEDLINE]

2463: Acta Otolaryngol Suppl. 2000;543:86-8.

Concentrations of the Pseudomonas aeruginosa toxin pyocyanin in human ear
secretions.

Reimer A, Edvaller B, Johansson B.

Department of Otorhinolaryngology, University Hospital of Malmö, Sweden.
ake.reimer@vellinge.mail.telia.com

Pseudomonas aeruginosa is the most common bacterium in chronic otitis media.
Several extracellular factors have been described. Pyocyanin (Pyo) is the blue
pigment that gives the bacterium its name "the pyocyanous bacteria". Pyo is known
to have an inhibitory effect on the activity of cilia. It is a zwitterion that
might easily penetrate biological membranes. Samples of ear secretions for
culture and analysis of the concentration of Pyo were collected from 17 patients 
with different ear infections. Concentrations varied from 3 to 2714 nmol/g, with 
a mean of 905 nmol/g. For comparison, concentrations were also measured in
bacteriological filtrates of P. aeruginosa obtained from wounds and urine
specimens. Concentrations in filtrates varied from 13 to 8114 nmol/g, mean 1968
nmol/g. The results indicate that pyocyanin might act as virulence factor that
compromises ciliary function and enables the microorganism to establish itself
within the ear.

PMID: 10908987 [PubMed - indexed for MEDLINE]

2464: Acta Otolaryngol Suppl. 2000;543:79-81.

Effect of N-acetylcysteine on the incidence of recurrence of otitis media with
effusion and re-insertion of ventilation tubes.

Ovesen T, Felding JU, Tommerup B, Schousboe LP, Petersen CG.

ENT Department, Aarhus University Hospital, Denmark.

Previous studies have demonstrated the anti-inflammatory, anti-oxidant, and
mucolytic nature of N-acetylcysteine (NAC). Theoretically, these properties make 
the substance ideal for therapeutic use against otitis media with effusion (OME).
The disease is characterized as a sustained non-specific inflammation of the
middle ear mucosa with secretory transformation of the epithelium resulting in
accumulation of fluid in the middle ear space. To investigate the effects of
instillation of NAC in the middle ear, a double-blind, placebo-controlled,
randomized trial was carried out. A total of 75 children who were undergoing
their first bilateral insertion of ventilation tubes (VT) due to OME were
randomized to Mucomyst (NAC) or placebo (the vehicle) on one ear in relation to
the VT insertion. The contralateral ear underwent VT insertion exclusively.
Instillation of Mucomyst or placebo was repeated 3 and 7 days afterwards. The
children were followed regularly for 11-39 months. Episodes of otorrhea,
recurrence of OME after VT extrusion and re-insertion of VTs were registered as
primary outcome parameters. The results demonstrated that Mucomyst significantly 
reduced the recurrence of OME and re-insertion of VTs (p < 0.025) and
significantly increased the time until VT extrusion (p < 0.0167). In addition,
the number of episodes of ear problems and visits at the ENT clinic were reduced 
significantly by NAC (p < 0.0383).

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 10908985 [PubMed - indexed for MEDLINE]

2465: Acta Otolaryngol Suppl. 2000;543:73-6.

Lasting effects of otitis media with effusion on language skills and listening
performance.

Klausen O, Møller P, Holmefjord A, Reisaeter S, Asbjørnsen A.

Department of Otolaryngology, Head & Neck Surgery, Haukeland University Hospital,
Norway.

Otitis media with effusion (OME) and its related hearing loss has been associated
with delayed language development, particularly if the disease is recurrent or of
long duration. To find out more about the long-term effects of OME on language
skills and listening performance we performed a retrospective study. A group of
19 otherwise healthy 9-year-old children with an earlier history of long lasting 
bilateral OME were compared with an age-matched control group of 19 children with
no history of OME or hearing impairment and normal otoscopy, tympanometry and
audiometry. The children in the OME group had an average of 1.4 treatments with
ventilation tubes. Mean hearing levels for 500, 1,000 and 2,000 Hz in the OME
group were 13 dB in the right ear and 11.3 dB in the left ear. All children were 
examined with the Illinois test of psycholinguistic abilities (ITPA), test for
articulation, Boston naming test, dichotic listening tests with additional tasks 
of directed attention and tests for word and sound discrimination. In the OME
group we found significant lower scores in the articulation test and small, but
significant, lower scores in the test regarding sound discrimination. No
significant differences on other language skills were detected in the ITPA test
or Boston naming test. We found a significantly higher degree of right ear
advantage and lower attentional effectiveness in the OME-group.

PMID: 10908983 [PubMed - indexed for MEDLINE]

2466: Acta Otolaryngol Suppl. 2000;543:67-9.

Factors associated with the development of recurrent acute otitis media--the
significance of choosing the right and accurate dependent and independent
variables in the multivariate analysis.

Jero J, Kentala E, Karma P.

Department of Otolaryngology, Helsinki University Central Hospital, Finland.

The results of univariate and multivariate statistical analysis were compared in 
identifying predictive factors of the development of recurrent acuta otitis media
(RAOM) after an initial episode of acute otitis media (AOM) in 121 children.
Univariate correlations between the development of RAOM and potential risk
factors were analysed, and variables at p < 0.10 were incorporated into the
stepwise multiple logistic regression analysis. The comparisons between the
univariate and multivariate analysis in identifying the predictive factors were
made and the importance of changing the dependent variables in the multivariate
analysis was analysed. It seems that univariate analysis is over-sensitive, but
multivariate analysis is over-conservative in finding possible predictors of
RAOM. Choosing the right and accurate dependent and independent variables in the 
multivariate analysis is extremely important, when this method is used.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10908981 [PubMed - indexed for MEDLINE]

2467: Acta Otolaryngol Suppl. 2000;543:63-6.

Clinical outcome of acute pneumococcal otitis media and serum antibody responses 
to pneumococcal pneumolysin and polysaccharides in children.

Jero J, Virolainen A, Karma P.

Department of Otolaryngology, University of Helsinki, Finland.

Serum antibody responses to pneumococcal antigens and their relationship to the
clinical outcome were determined in a prospective study of 121 children with
acute otitis media (AOM). Pneumococcus positive children with a pneumolysin
response more often had a recurrence and middle ear effusion (MEE) after 1 month 
than did the non-responders (p = 0.005 and p = 0.04, respectively). All the
children who responded to pneumolysin also had clinically strong symptoms and
signs of AOM. Children who responded to pneumococcal polysaccharides developed
otitis media with effusion within a 6-month follow-up period more often than did 
the non-responders (p = 0.005). The results of this study suggest that children
with pneumococcal AOM and an antibody response to the intracellular pneumococcal 
protein pneumolysin behave clinically differently from children with an antibody 
response to polysaccharides.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10908980 [PubMed - indexed for MEDLINE]

2468: Acta Otolaryngol Suppl. 2000;543:58-60.

Tympanometric hysteresis effect and errors in middle ear pressure
determination--a preliminary study in children with secretory otitis media.

Gaihede M, Lambertsen K, Bramstoft M, Kamarauskas A, Fogh A.

Department of Otolaryngology, Head and Neck Surgery, Aalborg Hospital, Denmark.
mgaihede@dadlnet.dk

Previous tympanometric studies on middle ear pressure (MEP) have revealed the
hysteresis effect, which is illustrated in bidirectional tympanometries by the
different peak pressures for either direction. This leads to an error in
determination of MEP, which has been reported to be 10-25 daPa in normal ears,
but experimental data have suggested that this error may be increased in ears
with secretory otitis media (SOM). This was investigated in a group of 18
children with SOM by bidirectional tympanometries. The peak pressure difference
(PPD) was calculated and found to be 75 daPa in the group of SOM, which was
significantly larger than in normal ears (mean = 3 daPa) (p < 0.001). The maximum
PPD in the SOM group was 205 daPa, indicating an error in MEP determination of
more than 100 daPa. Hysteresis is related to the viscous properties of the middle
ear system, and the increased hysteresis in SOM ears can be explained by the
additional viscosity of the middle ear effusion. In order to improve the accuracy
of MEP estimation it is suggested that in ears with SOM, the mean pressure of
bidirectional tympanometries should be applied.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10908978 [PubMed - indexed for MEDLINE]

2469: Acta Otolaryngol Suppl. 2000;543:56-7.

Effect of penicillin on experimental acute otitis media. A histopathological
study of goblet cell density, bone modelling dynamics, polyp and adhesion
formation.

Cayé-Thomasen P, Hermansson A, Tos M, Prellner K.

Department of Oto-rhino-laryngology, Gentofte University Hospital of Copenhagen, 
Denmark. pcaye@dadlnet.dk

Clinical studies have shown that the effect of antibiotic treatment on acute
otitis media is modest. Experimental acute otitis media induces a number of
histopathological changes in the middle ear mucosa. Among these are increased
goblet cell density, polyp and adhesion formation, as well as massive
osteoneogenesis. To investigate the effect of penicillin administration on these 
histopathological features, we employed a rat model of acute pneumococcal otitis 
media. Five of 25 rats were sacrificed on days 4, 8, 16, 90 and 180
post-inoculation, preceded by oral administration of penicillin V 100 mg/kg/day, 
initiated on day 2 and lasting 5 days. Using a light microscope, qualitative and 
quantitative histopathology of middle ear goblet cell density, bone-modelling
dynamics, polyp and adhesion formation was registered and compared with previous 
studies of untreated animals. Increase in goblet cell density and new bone
formation was reduced significantly by treatment, whereas polyp and adhesion
formation was unaffected by penicillin administration. It is concluded that
penicillin reduces middle ear secretory capacity and new bone formation during
and following acute otitis media, conceivably preventing subsequent development
of secretory otitis media, leaving polyp and adhesion formation unchanged.

PMID: 10908977 [PubMed - indexed for MEDLINE]

2470: Acta Otolaryngol Suppl. 2000;543:54-5.

Middle ear secretory capacity after acute otitis media caused by Streptococcus
pneumoniae, Moraxella catarrhalis, non-typeable or type B Haemophilus influenzae.
A comparative analysis based on goblet cell density.

Cayé-Thomasen P, Hermansson A, Tos M, Prellner K.

Department of Oto-rhino-laryngology, Gentofte University Hospital of Copenhagen, 
Denmark. pcaye@dadlnet.dk

To investigate whether the type of bacteria is correlated with an increase in
goblet cell density during and after acute otitis media, we inoculated the middle
ear of 25 rats with either Streptococcus pneumoniae, Moraxella catarrhalis,
non-typeable or type b Haemophilus influenzae. Mucosal goblet cell density was
determined by a whole-mount method on days 4, 8, 16, 60 and 180 post-inoculation.
The goblet cell density was increased on all days of sacrifice, employing either 
bacteria, except M. catarrhalis 6 months after the acute incident. Type b H.
influenzae induced the highest increase, followed by non-typeable H. influenzae, 
S. pneumoniae and M. catarrhalis. The mucosal area containing goblet cells was
enlarged on all examination days, employing either bacteria. We conclude, that
mucosal secretory capacity is highly increased during and up to 6 months after
acute middle ear infection caused by either bacteria, conceivably predisposing a 
subsequent development of secretory otitis media. The results indicate that type 
b H. influenzae seems to be the bacteria most likely to induce a subsequent
secretory condition.

PMID: 10908976 [PubMed - indexed for MEDLINE]

2471: Acta Otolaryngol Suppl. 2000;543:51-3.

Prevalence of chronic otitis media in a randomly selected population from two
communes in southern Vietnam.

Balle VH, Tos M, Dang HS, Nhan TS, Le T, Tran KP, Tran TT, Vu MT.

ENT Department, Gentofte University Hospital, Hellerup, Denmark.

The prevalence of chronic otitis media was studied in an urban and a rural
community in southern Vietnam in 1995. A total of 3,300 children, aged from 6
months to 10 years, were selected randomly by taking every third child on the
vaccination list. In this cross-sectional study, 453 ears were found to have
chronic otitis media or sequelae otitidis, giving an overall prevalence of 6.86%.
A total of 140 ears had perforations. Various attic changes were found in 73 ears
and other chronic tympanic membrane changes, such as atrophy, tympanosclerosis
and adhesions, in 219 ears. Cholesteatoma was seen in two ears.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10908975 [PubMed - indexed for MEDLINE]

2472: Acta Otolaryngol Suppl. 2000;543:48-50.

Otitis media as a sign of Wegener's granulomatosis in childhood.

Atula T, Honkanen V, Tarkkanen J, Jero J.

Department of Otorhinolaryngology, Helsinki University Central Hospital, Finland.
timo.atula@hus.fi

Wegener's granulomatosis (WG) is a rare disease among paediatric patients.
Chronic otitis media with or without facial nerve dysfunction is a known
manifestation of the disease among adults. A case of a 15-year-old boy with WG,
whose initial symptoms were acute otitis media and facial nerve paralysis, is
presented. The otorhinolaryngological manifestations, as well as diagnostic and
current treatment modalities in paediatric patients with WG, are discussed.

Publication Types: 
    Case Reports
    Review

PMID: 10908974 [PubMed - indexed for MEDLINE]

2473: Int J Pediatr Otorhinolaryngol. 2000 Jun 30;53(2):121-4.

Treatment of otitis media with effusion in children with mucopolysaccharidoses.

Motamed M, Thorne S, Narula A.

Department of Otolaryngology Head and Neck Surgery, Leicester Royal Infirmary,
UK.

Otitis media with effusion (OME) is a constant finding in children with
mucopolysaccharidoses (MPS). Affected children may also present the anaesthetist 
with a difficult airway. A 7-year retrospective review of the management of OME
in individuals with MPS was carried out. Nine patients were identified. All had a
number of short-term ventilation tube insertions (one to four, mean two) before a
diagnosis of MPS was made. Following diagnosis three required repeated short-term
ventilation tubes insertions (two to four, mean three), four had long-term
ventilation tube insertions once only. Five children who had residual hearing
loss were provided with hearing aids but compliance was poor in two. Once a
diagnosis of MPS has been made, a hearing aid, if compliant, or a long-term
ventilation tube would be a better option than a short term one in order to
minimise the anaesthetic risk. A 'watch and wait' policy is not recommended.

PMID: 10906517 [PubMed - indexed for MEDLINE]

2474: Int J Pediatr Otorhinolaryngol. 2000 Jun 30;53(2):111-20.

Office-based laser assisted tympanic membrane fenestration in adults and
children: pilot data to support an alternative to traditional approaches to
otitis media.

Siegel G, Brodsky L, Waner M, Shaha S.

Department of Otolaryngology, Northwestern School of Medicine, Chicago, IL, USA.

OBJECTIVES: To determine the role of intermediate duration ( approximately 3
weeks) middle ear ventilation using office-based laser assisted tympanic membrane
fenestration in resolving an episode of otitis media with effusion in adults and 
children who otherwise would have been treated with insertion of pressure
equalization tubes. METHODS: A retrospective chart review of 92 patients (162
ears) was conducted to identify the utility and technical challenges associated
with laser assisted tympanic membrane fenestration in an office setting. Clinical
characteristics reviewed included: age, gender, duration of effusion, season
performed, and hearing and health status of middle ear upon healing of the
fenestration. RESULTS: 69% of all patients were effusion free upon closure of the
fenestration; 68% of those <3 years; 70% of those 3-7 years; and 70% of those
25-80 years. Some episodes recurred and at final follow-up 64% had normal middle 
ear structure and function (range of follow-up =1-18 months, mean 2.5 months,
median 2.0). Shorter duration of effusion pre-fenestration was more often
associated with return to normal middle ear structure and function (P<0.01).
Season performed, number of previous episodes of otitis media and pre-treatment
tympanometry were not predictive of result. No significant complications were
observed. CONCLUSIONS: The use of office-based laser assisted tympanic membrane
fenestration is a reasonably safe and effective procedure for the treatment of
otitis media in most adults and children. As a minimally invasive otologic
procedure, laser assisted tympanic membrane fenestration has great potential to
decrease the rates of both antibiotic usage and insertion of ear tubes.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10906516 [PubMed - indexed for MEDLINE]

2475: Br J Ophthalmol. 2000 Aug;84(8):917-8.

Otolaryngological findings in congenital nasolacrimal duct obstruction and
implications for prognosis.

Uğurbaş SH, Zilelioğlu G, Saatçi M.

Oculoplastic Lacrimal Service, Department of Ophthalmology, Ankara University,
Ankara, Turkey. shugurbas@usa.net

AIM: To investigate otolaryngological abnormalities associated with congenital
nasolacrimal duct obstruction (CNLDO) and their effect on the prognosis. METHODS:
65 consecutive cases of CNLDO were followed up with routine
otorhinolaryngological examination with tympanometry. RESULTS: Otitis media with 
effusion (OME) and uvula bifida were detected in 44.6% and 9.2% of the children, 
respectively. Medical treatment and probing were less effective in patients with 
OME (p<0. 05). CONCLUSIONS: OME and uvula bifida are significant anomalies
associated with CNLDO and the former has a marked effect on the prognosis. This
finding may help to determine the patients who will need further treatment after 
massage and probing.

PMID: 10906104 [PubMed - indexed for MEDLINE]

2476: J Clin Pharm Ther. 2000 Jun;25(3):161-4.

Treatment of acute otitis media in patients with a reported penicillin allergy.

Falconer CL, Gardner DM.

College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, Nova
Scotia, Canada B3H 3J5.

Otitis media occurs commonly in children, and is usually treated with an
antibiotic. In this case report, amoxicillin was prescribed for a 6-year-old boy 
suffering from acute otitis media. As he had previously experienced a rash after 
the administration of a penicillin, the medication order was switched from
amoxicillin to trimethoprim/sulfamethoxazole (TMP/SMX). In an effort to determine
whether or not this intervention was appropriate, references were found using
Medline, International Pharmaceutical Abstracts and the Cochrane Library. Issues 
to be addressed included the need for antibiotics in acute otitis media, the
comparative efficacy and tolerability of antimicrobial agents and the reliability
of reported penicillin allergies. Amoxicillin and TMP/SMX were found to be
first-line agents in the treatment of acute otitis media owing to their efficacy,
safety and cost, with neither drug being significantly better than the other. The
need to treat otitis media with antibiotics remains controversial. Reported
penicillin allergies were found to be an unreliable indicator of a potentially
serious reaction. In conclusion, it was found that treatment with TMP/SMX was an 
appropriate intervention.

Publication Types: 
    Case Reports

PMID: 10886460 [PubMed - indexed for MEDLINE]

2477: Ann Otol Rhinol Laryngol. 2000 Jul;109(7):623-7.

Surgical management of uncomplicated otitis media in a pediatric Medicaid
population.

Berman S, Bondy J, Byrns PJ, Lezotte D.

Department of Pediatrics, University of Colorado Health Sciences Center, Denver, 
USA.

The objective of this study was to document the frequency and timing of otitis
media-related visits, audiological consultations, and surgical interventions
following a new episode of otitis media. A retrospective descriptive study was
performed on a Medicaid administrative database that follows individual patients 
over time. The study included 14,453 children enrolled in Medicaid during 1991
and 1992 who were 30 months of age or younger and had a "new" episode of otitis
media. Among 14,321 patients with an uncomplicated episode of otitis media, there
were 10,443 with additional otitis media visits. Audiological testing was
performed in 1,134 (10.9%). The testing occurred within 2 months of the onset of 
otitis media in 52.2% of the children and within 3 months in 66.6%. Physicians
referred 400 children (3.8%) to an otolaryngologist; 299 (75%) underwent 1 or
more surgical procedures. These surgical interventions included placement of
ventilating tubes in 296 children, adenoidectomy in 34 children (all of whom also
had placement of ventilating tubes), mastoidectomy in 2 children, and
tympanoplasty in 1 child. The proportion of children who underwent surgical
placement of ventilating tubes who had prior audiological testing was 174 of 296 
(58.8%). The overall surgical rate for ventilating tubes was 2.9%. Among children
who underwent surgery, the procedure occurred within 2 months of the onset of
otitis media in 21.4% of children. Attempts to rationalize the management of
otitis media in early childhood must deal with the difficulties in distinguishing
among the otitis media conditions. The findings of this study suggest a need to
know whether insertions of ventilating tubes within 3 months after a new episode 
of otitis media are related to unresponsive or recurrent infections.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10903041 [PubMed - indexed for MEDLINE]

2478: Infect Immun. 2000 Aug;68(8):4593-7.

Evaluation of phase variation of nontypeable Haemophilus influenzae
lipooligosaccharide during nasopharyngeal colonization and development of otitis 
media in the chinchilla model.

Tong HH, Blue LE, James MA, Chen YP, DeMaria TF.

Division of Otologic Research, College of Medicine and Public Health, The Ohio
State University, Columbus, Ohio 43210, USA.

Nontypeable Haemophilus influenzae (NTHI) has four loci, lic-1 to lic-3 and lgtC,
that generate phase-variable lipooligosaccharide (LOS) structures. lic-1, which
is required for the expression of phosphorylcholine (ChoP), is the best
characterized and is associated with an enhanced ability of H. influenzae to
persist within the nasopharynges of infant rats. Recent data indicate that LOS
impacts various aspects of NTHI virulence in the chinchilla model of
nasopharyngeal colonization and otitis media (OM). In this study the effects of
ChoP expression and the sequences of lic-1 to lic-3 and lgtC of NTHI strain 2019 
were evaluated in the chinchilla OM model. Nasopharyngeal colonization data
showed that a switch from the ChoP(-) to the ChoP(+) phenotype was observed as
early as day 3 after intranasal inoculation. Chinchillas colonized by strains
with the ChoP(+) phenotype demonstrated a significantly higher level of NTHI 2019
per milliliter of nasal lavage fluid than chinchillas colonized with
predominantly the ChoP(-) variant (P < 0.05). The concentration of cells with the
ChoP(+) phenotype in the middle ear was 3 log units higher than that of cells
with the ChoP(-) variant (P < 0.01). There was a statistically significant
association between ChoP(+) expression in the nasal lavage and the development of
OM with culture-positive middle ear fluids in this model. These data suggest that
expression of the ChoP(+) phenotype promotes enhanced nasopharyngeal colonization
and development of OM.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10899860 [PubMed - indexed for MEDLINE]

2479: Infect Immun. 2000 Aug;68(8):4505-17.

Variability of outer membrane protein P1 and its evaluation as a vaccine
candidate against experimental otitis media due to nontypeable Haemophilus
influenzae: an unambiguous, multifaceted approach.

Bolduc GR, Bouchet V, Jiang RZ, Geisselsoder J, Truong-Bolduc QC, Rice PA, Pelton
SI, Goldstein R.

The Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center,
Boston University School of Medicine, Boston, Massachusetts 02118, USA.

Candidate vaccine antigens for preventing otitis media caused by nontypeable
Haemophilus influenzae (NTHI) should possess one or more conserved epitopes. We
sought to evaluate the candidacy of P1, a surface-expressed outer membrane
protein knowing that this antigen is subject to diversifying selection.
Therefore, we selected NTHI strains from among >500 phylogenically variant
isolates representative of the diversity found in natural populations of H.
influenzae. Twenty-three variants of P1 (</=95% similarity) were identified among
42 strains. When chinchillas were immunized with recombinant P1 (rP1) obtained
from one of these isolates (BCH-3), all animals developed antibodies specific for
rP1. Immunized animals were protected against disease when challenged with BCH-3,
but not with an ompP1 mutant of BCH-3 or a strain (BCH-2) possessing a
heterologous P1 (91% identity). We conclude that (i) while P1 induces protection 
against NTHI-mediated otitis media, development of a polyvalent vaccine
reflecting the variability of P1 would be necessary to construct an efficacious
vaccine and (ii) use of a phylogenically characterized collection of
representative isolates in concert with gene sequencing, cloning, gene
inactivation, and animal testing offers an efficient, rational, and rigorous
strategy for evaluating the potential problems associated with variability of
vaccine targets and specificity of related immune responses.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 10899849 [PubMed - indexed for MEDLINE]

2480: Audiol Neurootol. 2000 Sep-Oct;5(5):292-9.

Passive transfer of experimental autoimmune labyrinthitis.

Ikezono T, Tomiyama S, Pawankar R, Jinnouchi K, Suzuki Y, Yagi T.

Department of Otorhinolaryngology, Nippon Medical School, Tokyo, Japan.
tikezono@nms.ac.jp

The aim of the present study was to establish an animal model of autoimmune
labyrinthitis using heterologous inner ear antigen (IEAg) and to elucidate
whether the experimentally induced labyrinthitis could be passively transferred. 
Cochlear and vestibular membranous labyrinthine tissues from bovine temporal
bones were used as IEAg. Donor mice were inoculated intracutaneously at multiple 
sites with an emulsion consisting of equal parts of IEAg and complete Freund's
adjuvant. After 10 days, mononuclear cells were collected from lymph nodes,
spleen and blood of the donor mice and injected intravenously into naive
recipient mice. Cellular infiltration was observed in the perilymphatic space of 
the cochlea of all donor and recipient mice. Endolymphatic hydrops was also
observed in 63% of donor and 42% of recipient mice. These findings suggest that
the experimentally induced labyrinthitis observed in this animal model was
probably due to an autoimmune reaction to the IEAg and was passively transferred 
by a cell-mediated immune reaction. Copyright 2000 S. Karger AG, Basel

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10899699 [PubMed - indexed for MEDLINE]

2481: Laryngoscope. 2000 Jul;110(7):1119-23.

Noninvasive fluorescent identification of bacteria causing acute otitis media in 
a chinchilla model.

Spector BC, Reinisch L, Smith D, Werkhaven JA.

Department of Otolaryngology, Vanderbilt University Medical Center, Nashville,
Tennessee 37232-2559, USA.

OBJECTIVES: To evaluate a noninvasive method of bacterial identification via
fluorescence spectroscopy in the setting of acute otitis media in a chinchilla
model. STUDY DESIGN: Prospective. METHODS: For each chinchilla, transbullar
inoculation with Streptococcus pneumoniae, Haemophilus influenzae, or
Staphylococcus aureus was performed bilaterally and clinical infection was
determined by otoscopy. An optical fiber coupled to a spectrofluorometer allowed 
for the delivery of an excitation wavelength to the inflamed tympanic membrane
and the acquisition of the resulting emission signal. Sequential emission spectra
obtained over a range of excitation wavelengths were assembled by a computer
algorithm, and a single, three-dimensional plot was created for each test ear.
Similarly, plots from the healthy external auditory canal (EAC) were also
recorded. Twelve animals were used to establish a library of four reference plots
representing the three bacteria and the EAC. Of the 24 ears available for study, 
10 were excluded from analysis because of lack of clinical infection or presence 
of tympanic membrane perforation with purulent drainage. From four additional
animals, four samples from ears infected with the above bacteria and three
samples of the EAC served as unknowns. The unknown plots were analyzed by an
investigator blinded to their identity. RESULTS: Using a multiple correlation of 
the unknown to the reference plots, seven of seven samples were correctly
identified. CONCLUSIONS: We were able to establish a prototype method for the
noninvasive identification of a limited library of pathogens in a chinchilla
model of acute otitis media.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10892680 [PubMed - indexed for MEDLINE]

2482: Laryngoscope. 2000 Jul;110(7):1112-8.

An animal model for external ear canal inflammation.

Wright CG, Pawlowski KS, Roland PS, Meyerhoff WL.

Department of Otolaryngology--Head and Neck Surgery, University of Texas
Southwestern Medical Center, Dallas 75235-9035, USA.

OBJECTIVE: To develop an animal model for testing efficacy of anti-inflammatory
drugs designed to treat external ear canal (EAC) disease. METHODS: Histological
and morphometric methods were used to characterize EAC inflammation produced by
topical application of tetradecanoylphorbol acetate (TPA) in mice. The effects of
both single and repeated TPA applications were studied. A treatment trial was
performed to evaluate the effects of a ciprofloxacin/hydrocortisone suspension on
TPA-induced EAC inflammation. In 10 animals, two bilateral applications of TPA
were made, spaced 24 hours apart. Immediately after the second TPA application,
otic suspension was applied unilaterally four times over a 48-hour period. The
contralateral EACs were left untreated to provide TPA-only controls. RESULTS:
Twenty-four hours after a single TPA application, EAC skin showed
polymorphonuclear (PMN) leukocyte infiltration, vascular dilation, and thickening
of the dermis and epidermis. Dermal and epidermal thickening were more pronounced
after two TPA applications and PMN leukocyte infiltration remained high 48 hours 
after a second TPA placement. After treatment with the otic suspension, PMN
leukocyte counts were reduced by an average of 76% relative to EACs that received
TPA only. There was also statistically significant reduction of dermal swelling
and a trend toward reduced epidermal thickness. Vascular dilation was clearly
reduced as well EACs that received four applications of the suspension alone
showed no adverse effects compared with those that received saline. CONCLUSION:
TPA-induced inflammation of the mouse EAC provides a suitable model for testing
the therapeutic efficacy of anti-inflammatory agents being considered for
clinical use.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10892679 [PubMed - indexed for MEDLINE]

2483: Ear Hear. 2000 Jun;21(3):212-7.

Otoacoustic emissions and tympanometry in children with otitis media.

Koivunen P, Uhari M, Laitakari K, Alho OP, Luotonen J.

Department of Otolaryngology, University of Oulu, Finland.

OBJECTIVE: To examine otoacoustic emission and tympanometric findings in children
with surgically confirmed middle ear effusion (MEE). DESIGN: A total of 102
children aged 0.7 to 11.4 yr undergoing surgery because of otitis media were
included in the study. A tympanometric examination and transient evoked
otoacoustic emission (TEOAE) measurement were performed on each ear before
myringotomy. MEE was aspirated, weighed and classified as mucoid or nonmucoid.
TEOAE measurements were compared with the quantity and quality of MEE and to the 
tympanometric findings. RESULTS: Fifty (72%) ears out of the 65 ears containing
effusion showed reduced TEOAE. The quantity of effusion was associated
significantly (p < 0.001) with the TEOAE responses, and mucoid effusion reduced
the emissions more than nonmucoid. The sensitivity of tympanometry in identifying
the ears without recordable TEOAE was 73% and the specificity 81%. CONCLUSION:
MEE results in a significant reduction in TEOAEs even when the effusion is
nonmucoid. This suggests that transmission of acoustic energy to and from the
middle ear is altered in children experiencing any form of otitis media with
effusion.

Publication Types: 
    Comparative Study

PMID: 10890729 [PubMed - indexed for MEDLINE]

2484: Ear Hear. 2000 Jun;21(3):206-11.

High-frequency hearing loss and wideband middle ear impedance in children with
otitis media histories.

Margolis RH, Saly GL, Hunter LL.

Otitis Media Research Center, Department of Otolaryngology, University of
Minnesota, Minneapolis 55455, USA.

OBJECTIVE: This study was undertaken to determine the relationship between
extended-high-frequency (EHF) hearing losses and wideband middle ear impedance in
children with chronic otitis media (OM) histories. DESIGN: Children with OM
histories were selected from a prospective study cohort if they had normal
tympanograms, no air-bone gaps, and no otoscopic evidence of active OM at the
time of testing. OM subjects were divided into two groups, those with Better
Hearing in the EHF range and those with Worse Hearing in the EHF range. The OM
groups were compared with an age-matched, healthy Control group that had no more 
than five documented episodes of OM and no more than two in any 1 yr. All
children were 9 to 16 yr of age. Subjects were tested by standard audiometric
methods in the conventional audiometric range (0.25 to 8.0 kHz) and the EHF range
(8 to 20 kHz). Middle ear impedance and reflectance were measured with an
experimental system over the frequency range 0.25 to 10.08 kHz. RESULTS: The
Worse Hearing OM group had slightly poorer hearing in the conventional
audiometric frequency range compared with the other two groups. The Better
Hearing OM group and the Control group had nearly identical EHF hearing. The
Worse Hearing OM group had significantly poorer EHF hearing compared with the
other two groups, the difference increasing exponentially with frequency. Middle 
ear impedance differences among groups were confined to low frequencies (<2 kHz).
The Control group had significantly higher negative reactance than the two OM
groups. There were no significant group differences in impedance or reflectance
in the high frequencies (2 to 10 kHz). CONCLUSIONS: The results of this study
confirm those of previous reports that children who have recovered from chronic
OM have significantly poorer hearing in the EHF range compared with children
without significant OM histories. The EHF hearing losses that occur in children
with OM histories are strongly frequency dependent, suggesting a preferential
effect on the base of the cochlea. Middle ear impedance and reflectance
differences do not account for the EHF hearing losses observed in children with
OM histories. The results support the hypothesis that OM-related EHF hearing
losses are cochlear in origin.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10890728 [PubMed - indexed for MEDLINE]

2485: Lett Appl Microbiol. 2000 Jul;31(1):42-5.

Antimicrobial susceptibility of staphylococci isolated from otitis externa in
dogs.

Lilenbaum W, Veras M, Blum E, Souza GN.

Laboratorio de Bacteriologia, Instituto Biomédico, Universidade Federal
Fluminense, Niteroi, RJ, Brazil. mipwalt@vm.uff.br

Samples were obtained from 65 unmedicated adult dogs, processed for isolation of 
Staphylococcus species and tested for susceptibility to penicillin G, gentamicin,
oxacillin, tetracycline, trimethoprim-sulphamethoxazole, streptomycin, ampicillin
and rifampin. Forty-four isolates were obtained, which represents 67.7% of
samples. Coagulase-negative species were most commonly found, and the most
frequently isolated staphylococcus species were Staph. epidermidis and Staph.
aureus. Other species, such as Staph. simulans, Staph. haemolyticus, Staph.
saprophyticus and Staph. intermedius were also isolated. Resistance to
antibiotics was frequently observed, with 90.9% of the isolates showing
resistance to at least one drug. The most active antimicrobial agents against
staphylococci isolated from otitis externa of dogs were rifampin and oxacillin.
Multidrug resistance was a common finding, and one strain of Staph. haemolyticus 
species, was resistant to all tested antimicrobial agents. Resistance to three or
more different drugs was a common finding, observed in 16 strains (36.4%) of both
coagulase-positive and coagulase-negative staphylococci. This study highlights
the emergence of cases of otitis externa determined by coagulase-negative
staphylococcus strains and once more emphasizes the need for bacterial culture
with species identification and susceptibility testing of swab specimens from the
ear canal in order to choose appropriate antimicrobial agents.

PMID: 10886613 [PubMed - indexed for MEDLINE]

2486: J Otolaryngol. 2000 Jun;29(3):148-53.

Clinicomicrobiologic evaluation of active tubotympanic type chronic suppurative
otitis media.

Khanna V, Chander J, Nagarkar NM, Dass A.

Department of Ear, Nose and Throat, Government Medical College Hospital,
Chandigarh, India.

OBJECTIVES: This prospective study was conducted to determine the spectrum of
micro-organisms encountered in patients with active-stage chronic suppurative
otitis media (CSOM) (tubotympanic type) and to see whether prescribing an
antibiotic after culture sensitivity was more beneficial as compared to initial
treatment without cultures. DESIGN: Prospective randomized study of 110 patients 
of active CSOM (tubotympanic type) divided into two groups of 55 cases each.
SETTING: Departments of Ear, Nose and Throat and Microbiology of a tertiary care 
hospital. METHODS: The patients in group A were prescribed an antibiotic
according to the culture and sensitivity, whereas in group B, culture was not
done at the first visit, and a broad-spectrum antimicrobial, namely,
co-trimoxazole, was prescribed blindly for a maximum period of 2 weeks. The cases
that still had ear discharge were then subjected to culture and sensitivity and
the antibiotic was prescribed accordingly. MAIN OUTCOME MEASURES: All patients in
group A were subjected to bacterial culture and sensitivity and fungal culture.
Only failed cases in group B were subjected to the same. RESULTS: In group A, 47 
patients (85.50%) had positive bacterial culture and 20 patients had positive
fungal culture. Pseudomonas aeruginosa was the most common bacterial isolate. All
of these 47 patients had a dry ear with a maximum 2 weeks of antibiotic therapy. 
Among the remaining 8 patients who had negative bacterial culture, 5 patients
(9.0%) showed fungal isolates on culture and responded to topical antifungal
treatment. The remaining 3 failed cases (5.5%) responded to daily dry mopping
alone. In group B, 41 patients (74.54%) attained a dry ear. Bacterial culture and
sensitivity were done in the remaining 14 (25.46%) failed cases. The culture was 
positive in 11 patients (20.0%) and sterile in 3 patients (5.5%). In the latter
group, only 1 patient had fungus on culture and the remaining 2 patients
responded to daily dry mopping alone, which was done at a maximum for a week
only. The most common fungal pathogen isolated was Aspergillus flavus.
CONCLUSIONS: Pseudomonas aeruginosa was the most common bacteria and Aspergillus 
flavus the most common fungus isolated in this study. In group A patients, the
failed cases were less as compared to the control group B, but the p value was
.2. Hence, there is no definite role of culture and sensitivity in the initial
management plan of all cases of CSOM. Ideally, every such case should be
prescribed a broad-spectrum antibiotic and only in failed cases should culture
and sensitivity be done.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 10883827 [PubMed - indexed for MEDLINE]

2487: Scand J Infect Dis. 2000;32(3):322-3.

Streptococcus salivarius acute meningitis with latent petromastoiditis.

Megarbane B, Casetta A, Esvant H, Marchal P, Axler O, Brivet FG.

Department of Medical Emergency, Antoine Béclère Hospital, Clamart, France.

A 48-y-old woman, with a previous history of neurosurgical intervention for a
trigeminal neurinoma, presented with acute meningitis due to Streptococcus
salivarius. There were significant changes in the petrous region, as revealed by 
MRI, leading to the diagnosis of associated latent subacute mastoiditis.

Publication Types: 
    Case Reports

PMID: 10879608 [PubMed - indexed for MEDLINE]

2488: J Speech Lang Hear Res. 2000 Jun;43(3):631-44.

Effects of otitis media with effusion on hearing in the first 3 years of life.

Gravel JS, Wallace IF.

Albert Einstein College of Medicine, Bronx, NY 10461, USA. gravel@aecom.yu.edu

Hearing sensitivity was examined prospectively in young children as a function of
otitis media with effusion (OME) status in Years 1, 2, and 3. Hearing and OME
status were sampled bimonthly from 5 to 36 months of age. Behavioral thresholds
were obtained at 4 test frequencies (500, 1000, 2000, and 4000 Hz) using visual
reinforcement audiometry and conditioned play audiometry techniques. The majority
of children's audiograms were obtained using a computer-controlled test
procedure. Thresholds for the test frequencies were averaged for each visit and
then averaged across all visits in each year. Reference values were developed for
infants and children in Years 1, 2, and 3 who were OME free. Results reveal that 
children who were classified as bilaterally OME positive in Years 1, 2, and 3 had
significantly poorer hearing than children classified as bilaterally OME free in 
each of these time periods. There was no difference in hearing as a function of
gender, socioeconomic status, or birth-risk status.

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 10877434 [PubMed - indexed for MEDLINE]

2489: Arch Otolaryngol Head Neck Surg. 2000 Jun;126(6):790-1.

An unusual source of Vibrio alginolyticus-associated otitis: prolonged
colonization or freshwater exposure?

Mukherji A, Schroeder S, Deyling C, Procop GW.

Department of Infectious Diseases, Cleveland Clinic Foundation, Ohio, USA.

Otitis externa and otitis media are commonly encountered in clinical practice. We
report an unusual case of otitis externa, which was caused by Vibrio
alginolyticus, several months after saltwater exposure. Clinicians need to be
aware of this unusual pathogen, especially in refractory cases of ear infections.

Publication Types: 
    Case Reports

PMID: 10864119 [PubMed - indexed for MEDLINE]

2490: Int J Pediatr Otorhinolaryngol. 2000 Jun 9;53(1):17-24.

Organic change of effusion in the mastoid in otitis media with effusion and its
relation to attic retraction.

Hasebe S, Takahashi H, Honjo I, Sudo M.

Department of Hearing and Speech Science, Kyoto University Graduate School of
Medicine, Sakyo-ku, 606-8507, Kyoto, Japan.

To try to solve the pathogenesis of severe attic retraction viewed from mastoid
condition, we examined the residual soft tissue density (RSTD) in the mastoid by 
computed tomography (CT) in 85 patients (107 ears) with otitis media with
effusion (OME) 3 months after tympanostomy tube insertion or later. The incidence
of RSTD in the mastoid was significantly higher in OME of adults (52.6%) than in 
children (24.1%). Ears with severe attic retraction had RSTD significantly more
frequently (80%) than those with no or mild attic retraction, and many of the
mastoids with severe attic retraction were occupied totally by RSTD. The area of 
the mastoid (mastoid pneumatization) was significantly smaller, and CT density of
the mastoid (sclerotic tendency) was significantly higher in ears with RSTD than 
in those without. RSTD after tympanostomy tube insertion in the mastoid
indicating organic change of effusion was considered one of the important factors
relating to the pathogenesis of severe attic retraction.

Publication Types: 
    Case Reports
    Clinical Trial

PMID: 10862920 [PubMed - indexed for MEDLINE]

2491: Infect Immun. 2000 Jul;68(7):4024-31.

Expression of cytokine genes during pneumococcal and nontypeable Haemophilus
influenzae acute otitis media in the rat.

Melhus A, Ryan AF.

Department of Surgery/Otolaryngology, University of California at San Diego
School of Medicine and Veterans Affairs Medical Center, La Jolla, California,
USA. asa.melhus@mikrobiol.mas.lu.se

Acute otitis media (AOM) elicits potent inflammatory responses from the cells of 
the middle ear mucosa as well as from infiltrating leukocytes. To explore host
responses during experimental AOM induced by Streptococcus pneumoniae type 3 and 
nontypeable Haemophilus influenzae (NTHi), otomicroscopy findings and expression 
of cytokine genes in the middle ear were monitored up to 1 month postinoculation.
The mucosa and infiltrating cells responded rapidly to the bacterial challenge.
Otomicroscopically, AOM appeared 1 day after NTHi inoculation and 3 days after
pneumococcus inoculation. Pneumococcal AOM was more severe than NTHi otitis, but 
in general, lower transcript levels were detected in pneumococcus-infected than
in NTHi-infected animals. Interleukin-6 (IL-6) mRNA levels peaked at 3 to 6 h for
both pneumococcus-infected and NTHi-infected animals. IL-1alpha, tumor necrosis
factor alpha, and IL-10 mRNA levels peaked at 6 h for NTHi otitis and 1 to 3 days
for pneumococcal otitis. Comparing otomicroscopy with expression profiles, it
would appear that the majority of cytokine mRNAs had passed their peak before the
AOM diagnosis could be made clinically. Only transforming growth factor beta mRNA
followed a slower time course, peaking very late and continuing expression even
after the AOM was otomicroscopically resolved. IL-2 and IL-4 mRNAs were not
detected in any animal at any time. Most of the investigated cytokines are very
early markers for AOM and may be involved in initiation of inflammation, but they
would be poor targets for pharmacological manipulation since their levels decline
before clinical signs appear.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 10858218 [PubMed - indexed for MEDLINE]

2492: Ann Otol Rhinol Laryngol. 2000 Jun;109(6):549-53.

Effect of WEB 2170 BS, platelet activating factor receptor inhibitor, in the
guinea pig model of middle ear inflammation.

Karasen RM, Sutbeyaz Y, Aktan B, Ozdemir H, Gundogdu C.

Department of Otolaryngology, School of Medicine, Ataturk University, Erzurum,
Turkey.

Platelet activating factor (PAF), a potent inflammatory mediator, is a
biologically active phospholipid. Recent studies have shown that PAF may play an 
important role in the pathogenesis of otitis media (OM). WEB 2170 BS has been
shown to be a PAF antagonist both in vitro and in vivo. In this study, the
anti-inflammatory effects of WEB 2170 BS were investigated in a guinea pig model 
of OM induced by middle ear (ME) inoculation of killed Staphylococcus aureus. The
outcome of treatment was determined by measurement of myeloperoxidase activity in
the samples of ME mucosa, evaluation of temporal bone histopathology, and the
presence of ME fluid. The myeloperoxidase activity in the WEB 2170 BS-treated
group was found to be significantly lower than that in the control group.
Histopathology of the temporal bones indicated decreased inflammation in the
treated group as compared to the controls. In addition, ME fluid was absent in 16
of the 20 ears of the 10 treated animals. These results demonstrate that WEB 2170
BS can produce significant anti-inflammatory effects in this model of OM.

PMID: 10855565 [PubMed - indexed for MEDLINE]

2493: Vet Radiol Ultrasound. 2000 May-Jun;41(3):231-4.

Canalographic evaluation of the external ear canal in dogs.

Eom K, Lee H, Yoon J.

Department of Veterinary Radiology, College of Veterinary Medicine, Seoul
National University, Korea.

Canalography was performed to measure the diameter of the horizontal ear canal
and to assess the clinical relevance of the measurements in identifying
abnormalities of the ear canal. The diameter of the proximal and distal end of
the annular cartilage in the horizontal ear canal was measured using canalography
in 222 ears. The tympanic membrane could not be visualized with otoscopic
examination in 70 ears even after ear cleansing. These canals were classified as 
being stenotic. The diameter of the proximal annular cartilage in the stenotic
canals ranged from 0.8 to 3.1 mm (mean = 2.6 +/- 0.8 mm). The proximal annular
cartilage was consistently smaller in diameter than the distal annular cartilage.
The ratio between the diameter of the proximal and distal annular cartilage
varied between dogs. In stenotic ear canals (70 ears) the ratio was less than
0.65. Total ear canal ablations and histopathological analysis were performed in 
70 ear canals classified as stenotic after canalography. Hyperplasia of the
epidermal layer was found in 56 stenotic canals. Stenosis of the canal due to
otitis externa was found in the other 14 canals. Three canals with severe otitis 
externa were also diagnosed with canalography as having a ruptured tympanic
membrane. The results suggest that canalography can be used to measure the
diameter of the horizontal ear canal and to assess whether or not the tympanic
membrane is ruptured prior to conservative or surgical therapy.

PMID: 10850873 [PubMed - indexed for MEDLINE]

2494: Kaohsiung J Med Sci. 2000 Mar;16(3):162-5.

Otogenic brain abscess--a case report.

Chen PT, Ho KY, Tai CF, Su KJ, Lin IF, Kuo WR.

Department of Otorhinolaryngology, Kaohsiung Medical University Hospital, Taiwan.

Brain abscess is one of the life-threatening complications of otitis media.
Mortality and morbidity have decreased with the advent of antibiotic therapy.
More frequently encountered in cases of acute otitis media in the preantibiotic
era, in recent years otogenic brain abscess was noticed almost only in patients
of chronic otitis media with cholesteatoma. A case of brain abscess in a
49-year-old female was initially diagnosed as a headache. A high resolution
computed tomography (HRCT) scan of the temporal bones later revealed that there
were two abscesses over the right side temporal lobe. A modified radical
mastoidectomy was performed. Cultures of the middle ear cholesteatoma later grew 
Pseudomonas aeruginosa and Strenotrophomonas maltophilia. Antibiotic therapy was 
carried on for three months postoperatively. The patient improved but retained a 
conductive hearing loss.

Publication Types: 
    Case Reports

PMID: 10846353 [PubMed - indexed for MEDLINE]

2495: Allergy. 2000 May;55(5):435-41.

Evidence of eosinophil, neutrophil, and mast-cell mediators in the effusion of
OME patients with and without atopy.

Hurst DS, Venge P.

Department of Medical Sciences, University Hospital, Uppsala, Sweden.

BACKGROUND: This study was designed to measure the involvement of eosinophils,
neutrophils, and mast cells in the middle ear of patients with OME and to see
whether that inflammatory response differed depending on whether or not the
patient was atopic. METHODS: Levels of ECP, MPO, and tryptase were measured in
effusion from 97 patients whose atopic status was determined by in vitro testing 
with 12 inhalants and five foods. RESULTS: Seventy-nine of 97 OME patients (81%) 
were atopic, among whom 86% (68/79) had elevated levels of effusion ECP, and 64% 
(23/36) had elevated tryptase. Mean ECP was 166 microg/l vs 3.38 microg/l, mean
MPO was 6231 microg/l vs 116 microg/l, and mean tryptase was 4.8 microg/l vs 1.34
microg/l in atopic vs nonatopic ears. Total serum IgE did not differ between
atopics and nonatopics (P=0.28). CONCLUSIONS: The inflammatory response by
eosinophils, neutrophils, and mast cells in the middle ear was distinctly
different between atopic and nonatopic patients (P < 0.001). This study provides 
evidence that eosinophils and mast cells, both essential to a Th-2 driven immune 
response, are present in the majority of ears with chronic OME, and supports the 
hypothesis that middle-ear mucosa, like that of the rest of the upper respiratory
tract, is capable of an allergic response.

Publication Types: 
    Comparative Study

PMID: 10843423 [PubMed - indexed for MEDLINE]

2496: J Infect Dis. 2000 Jun;181(6):1979-82. Epub 2000 May 31.

Low cord blood type 14 pneumococcal IgG1 but not IgG2 antibody predicts early
infant otitis media.

Lockhart NJ, Daly KA, Lindgren BR, Meland M, Le CT, Giebink GS.

Otitis Media Research Center and Department of Pediatrics, School of Medicine,
University of Minnesota, Minneapolis, Minnesota, USA.

Type-specific IgG1 and IgG2 antibodies to Streptococcus pneumoniae capsular
polysaccharides 14 and 19F were measured in cord blood samples from 425 neonates,
to determine which antibody subclass was most strongly associated with otitis
media (OM) during the first 6 months of life (early OM). Early OM was
significantly associated with type 14 IgG1 antibody in the lowest antibody
quartile (P=.055) but not with type 19F IgG1 antibody or with either IgG2
antibody. IgG1 and IgG2 antibodies were significantly intercorrelated for type 14
(r=.52, P<.001) and type 19F (r=.38, P<.001). Multivariate analysis revealed that
having type 14 IgG1 antibody in the lowest quartile, child care attendance, and
sibling and maternal OM history were independent risk factors for early OM.
Although type-specific pneumococcal IgG2 antibody concentrations were
significantly higher than IgG1 concentrations, IgG2 antibodies apparently are not
protective against OM during early infancy.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10837178 [PubMed - indexed for MEDLINE]

2497: J Clin Microbiol. 2000 Jun;38(6):2383-5.

Atypical lipid-dependent Malassezia species isolated from dogs with otitis
externa.

Crespo MJ, Abarca ML, Cabañes FJ.

Departament de Patologia i Producció Animals (Microbiologia), Facultat de
Veterinària, Universitat Autònoma de Barcelona, 08193 Bellaterra (Barcelona),
Spain.

During a survey of the occurrence of Malassezia species in the external ear
canals of dogs with chronic otitis externa, lipid-dependent Malassezia species
were isolated in three dogs. These species were identified as Malassezia furfur
and M. obtusa but showed atypical assimilation patterns. To our knowledge, this
is the first report of the isolation of lipid-dependent species of the genus
Malassezia in association with canine otitis.

PMID: 10835009 [PubMed - indexed for MEDLINE]

2498: Pediatrics. 2000 Jun;105(6):E72.

Direct expenditures related to otitis media diagnoses: extrapolations from a
pediatric medicaid cohort.

Bondy J, Berman S, Glazner J, Lezotte D.

Department of Preventive Medicine and Biometrics, University of Colorado Health
Sciences Center, Denver, Colorado 80262, USA. jessica.bondy@uchsc.edu

BACKGROUND: Treatment of otitis media in children is associated with substantial 
expenditures because of its high frequency during childhood. Vaccines against
respiratory pathogens causing otitis media are now being developed. Information
about otitis media-related medical expenditures will be needed to determine the
cost-effectiveness of these preventive interventions. METHODS: This study used
utilization data from claims to impute otitis media-related expenditures for
medical visits, pharmaceuticals, and surgical procedures for 87 057 children 13
years of age and younger who were continuously enrolled in Colorado's
fee-for-service Medicaid program during 1992. International Classification of
Disease, Ninth Revision diagnostic codes were used to identify visits for otitis 
media. An antibiotic was considered to have been prescribed to treat otitis media
if it was dispensed up to 24 hours before or within 48 hours after a physician
encounter showing a diagnosis of otitis media. All tympanostomies,
mastoidectomies, and adenoidectomies were assumed to be related to otitis media. 
Expenditures were imputed from utilization using a Medicaid fee schedule.National
expenditures for 1992 to treat otitis media were extrapolated from Colorado's
Medicaid data. We adjusted for differences between Colorado and the United States
as a whole in terms of price, number, and intensity of services; for differences 
in reimbursement rates by service between Medicaid and private insurance; and for
differences in utilization between Medicaid enrollees and the uninsured. To
provide a more current expression of medical expenditures for otitis media, we
inflated the 1992 expenditure estimates to 1998 dollars using the Consumer Price 
Index published by the US Bureau of Labor Statistics. RESULTS: Twenty-eight
percent of children experienced at least 1 episode of diagnosed otitis media. The
proportion of children with a diagnosis of otitis media was highest (42%-60%) in 
the 7-month to 36-month age range. The proportion was also higher among white
(34.5%) and Hispanic (25.3%) children than among black children (18.5%), as well 
as among rural (34.5%) compared with urban children (27.2%).Children 19 to 24
months of age incurred the highest total annual expenditures per child with
otitis media ($239.68). Expenditures for drugs, visits, and procedures were all
highest for this group. The per-patient cost to Medicaid was greater for visits
than for drugs or procedures across all age groups. Total per-patient
expenditures were higher for males ($174.67) than for females ($154.47) and
higher for white children ($176.59) than for Hispanic ($154.12) or black children
($134.44). The differences among the ethnic groups can be attributed almost
entirely to differences in expenditures for procedures and drugs. Although mean
expenditures per patient varied substantially by some patient characteristics
(eg, race), these differences accounted for only a small fraction of the enormous
variation in costs per patient. Including children with and without otitis media,
age-specific estimated expenditures per child peaked among children 1 ($132.94)
and 2 years of age ($88.72). Children 3 to 6 years of age incurred expenditures
only one third as great as those incurred by children 1 year of age.Total
national expenditures were estimated to have been approximately $4.1 billion in
1992 dollars and $5.3 billion in 1998 dollars. Over 40% of national expenditures 
to treat otitis media in children younger than 14 years of age were incurred for 
children between 1 and 3 years of age ($453 per capita in 1992 dollars over these
2 years vs $1027 for all years of age from 2 to 13). Nationally, expenditures for
visits remained the largest component of expenditures. LIMITATIONS: This study
assessed expenditures from the point of view of the health care system; that is, 
no social costs, such as lost work time, or expenditures not normally covered by 
insurance, such as those for transportation, we

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10835085 [PubMed - indexed for MEDLINE]

2499: J Vet Med B Infect Dis Vet Public Health. 2000 Apr;47(3):191-6.

Antibacterial susceptibility patterns of Pseudomonas strains isolated from
chronic canine otitis externa.

Martín Barrasa JL, Lupiola Gómez P, González Lama Z, Tejedor Junco MT.

Departamento de Microbiología, Universidad de Las Palmas de Gran Canaria, Spain.

Development of antibiotic resistance in bacteria is a problem of great concern.
It is important to establish the convenience of antimicrobial susceptibility
tests in animal infections. The aim of this study was to test the susceptibility 
to antibiotics of Pseudomonas strains isolated from chronic canine otitis
externa. We tested 23 strains of Pseudomonas: 19 Ps. aeruginosa, three Ps.
fluorescens and one Pseudomonas spp. The most effective antibiotics were
tobramycin (100% susceptible), marbofloxacin (91.3%) and ceftazidime (91.3%).
Ticarcillin and gentamicin, commonly used for the treatment of otitis externa
also showed good results (susceptibility of strains was 86 and 65.2%
respectively). Lower susceptibility was found using enrofloxacin (52.1%) probably
due to its indiscriminate use. We emphasize the need for a rational policy of
antibiotic prescribing in order to prevent the selection of resistant strains.

PMID: 10829573 [PubMed - indexed for MEDLINE]

2500: Otolaryngol Head Neck Surg. 2000 Jun;122(6):934-40.

Use of ototopical antibiotics in treating 3 common ear diseases.

Hannley MT, Denneny JC 3rd, Holzer SS.

American Academy of Otolaryngology-Head and Neck Surgery Foundationm Alexandria, 
VA 22314, USA.

Prompted by rising rates of antibiotic resistance, lack of standardized treatment
regimens, and new treatment alternatives, the American Academy of
Otolaryngology-Head and Neck Surgery convened an expert consensus panel to
consider recommendations for the responsible use of antibiotics in chronic
suppurative otitis media, tympanostomy tube otorrhea, and otitis externa. The
Panel concluded that in the absence of systemic infection or serious underlying
disease, topical antibiotics alone constitute first-line treatment for most
patients with these conditions, finding no evidence that systemic antibiotics
alone or in combination with topical preparations improve treatment outcomes
compared with topical antibiotics alone. Topical preparations should be selected 
on the basis of expected bacteriology and informed knowledge of the risk-benefit 
of each available preparation. The use of nonototoxic preparations in treating
acute otitis externa (when the tympanic membrane is perforated or its status is
unknown), chronic suppurative otitis media, and tympanostomy tube otorrhea should
be considered.

Publication Types: 
    Consensus Development Conference
    Review

PMID: 10828818 [PubMed - indexed for MEDLINE]

2501: Scand J Infect Dis. 2000;32(2):197-9.

Ceftazidime versus aztreonam in the treatment of pseudomonal chronic suppurative 
otitis media in children.

Somekh E, Cordova Z.

Pediatric Infectious Diseases Unit, Edith Wolfson Medical Center, Holon, Israel.

In a prospective, open, randomized trial, ceftazidime was given to 15 children
and aztreonam to another 15 children with chronic suppurative otitis media
without cholesteatoma (CSOM). Patients enrolled to the study had a pure culture
of Pseudomonas aeruginosa growing in middle ear discharge. The subjects' mean age
was 56 months in the ceftazidime group and 48 months in the aztreonam group.
Success rate, defined as complete disappearance of discharge, was 84.6% in the
ceftazidime treated patients and 67% in the aztreonam group (p value not
significant). The number of days required for complete dryness of the ear was 7.9
and 8.4 respectively. Two patients in each group had recurrence of suppurative
discharge within 90 d from discontinuation of antibiotic treatment. These results
suggest that aztreonam is an optional alternative systemic treatment for
paediatric patients with pseudomonal CSOM, especially in subjects allergic to
penicillin.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 10826908 [PubMed - indexed for MEDLINE]

2502: J Pediatr Psychol. 2000 Jan-Feb;25(1):15-8.

Comment in:
    J Pediatr Psychol. 2000 Jan-Feb;25(1):19-21.

Otitis media: precursor of delayed reading.

Kindig JS, Richards HC.

University of Virginia, USA. jsk7n@virginia.edu

OBJECTIVE: To investigate the connection between otitis media in the language
acquisition years and the occurrence of delayed reading between the ages of 8 and
10. METHOD: Participants were 40 children, half of whom had a history of otitis
media between the ages of birth and three years and half who were free of the
disease. These children, now ages 8-10, were tested with the WISC-R and a variety
of reading measures. RESULTS: Children with a history of otitis media scored over
a year below grade level in reading and significantly below controls on a variety
of literacy measures as well as on the Verbal Comprehension factor on the WISC-R.
CONCLUSIONS: Children with early onset otitis media (birth to three years) tend
to be at greater risk for delayed reading than age-matched controls.

PMID: 10826239 [PubMed - indexed for MEDLINE]

2503: J Pediatr Psychol. 2000 Jan-Feb;25(1):5-13.

Comment in:
    J Pediatr Psychol. 2000 Jan-Feb;25(1):19-21.

Effects of early middle ear effusion on child intelligence at three, five, and
seven years of age.

Johnson DL, Swank PR, Owen MJ, Baldwin CD, Howie VM, McCormick DP.

Department of Psychology, University of Houston, Texas 77204-5341, USA.
dljohnson@uh.edu

OBJECTIVE: This study tested the hypothesis that children with prolonged middle
ear effusion (MEE) during the first 3 years of life are at risk for cognitive
delays or deficits. METHOD: A prospective study enrolled 698 children from
diverse backgrounds and controlled for eight demographic and environmental
factors. Participants were recruited at birth and monitored for ear status
frequently in the home; 379 children were assessed for cognition with the
Stanford-Binet, 4th ed., at 3 years of age, 294 at 5 years, and 198 at 7 years.
RESULTS: Using the SAS General Linear Models (GLM) procedure, we found a
significant direct relation between duration of bilateral MEE and Stanford-Binet 
Composite and Nonverbal Reasoning/Visualization Factor scores at age 3, but not
at age 5 or age 7. Statistical clustering analysis revealed four groups with
different temporal patterns of MEE: Low MEE, Early MEE (peaking at 0-6 months),
Later MEE (peaking at 6-12 months), and High MEE. GLM analyses revealed no direct
effects, but several moderated effects, of MEE cluster on cognitive development
at 3 years, but none at 5 or 7 years. In general, children in the Later MEE and
High MEE groups appeared to be more adversely affected by bilateral MEE at 3
years, but effects were moderated in complex ways by socioeconomic status or home
stimulation. Growth curve modeling across the three assessment periods showed no 
effects of total duration of MEE but did indicate that children in the Later MEE 
cluster had low scores at age 3 but caught up at ages 5 and 7. CONCLUSIONS:
Prolonged MEE, especially between 6 and 12 months, may put children at risk for
cognitive delays at 3 years, but the risk effect is not strong and effects are no
longer detectable at 5 or 7 years.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10826238 [PubMed - indexed for MEDLINE]

2504: J Am Anim Hosp Assoc. 2000 May-Jun;36(3):239-43.

Meningoencephalitis secondary to bacterial otitis media/interna in a dog.

Spangler EA, Dewey CW.

Texas Veterinary Medical Center, Texas A&M University, College Station
77843-4474, USA.

Central nervous system (CNS) complications of bacterial otitis media/interna are 
an infrequent occurrence in human patients and have rarely been reported in the
veterinary literature. Early recognition of CNS involvement and the use of
appropriate diagnostic tests to characterize the nature of the lesion(s) are
crucial in determining the best course of treatment. In this paper, the authors
describe a dog with bacterial meningoencephalitis secondary to otitis
media/interna.

Publication Types: 
    Case Reports

PMID: 10825096 [PubMed - indexed for MEDLINE]

2505: J Infect Dis. 2000 May;181(5):1842-5. Epub 2000 May 15.

Immune response to surface protein A of Streptococcus pneumoniae and to
high-molecular-weight outer membrane protein A of Moraxella catarrhalis in
children with acute otitis media.

Samukawa T, Yamanaka N, Hollingshead S, Murphy TF, Faden H.

Wakayama Medical College, Wakayama, Japan.

The immune response was evaluated in 11 children with Streptococcus pneumoniae
and in 9 children with Moraxella catarrhalis otitis media. The age of the
children had a range of 4-32 months. The mean IgG, IgM, and IgA antibody
responses to surface protein A (PspA) of S. pneumoniae in sera from children at
the acute and convalescent stages were 4864 versus 5831 ng/mL, P<.05, 1075 versus
3752 ng/mL, P<.05, and 67 versus 93 ng/mL, nonsignificant (NS), respectively. The
mean IgG, IgM, and IgA antibody responses to the high-molecular-weight outer
membrane protein (UspA) of M. catarrhalis in sera from children at acute and
convalescent stages were 710 versus 935 mg/mL, NS; 1895 versus 2646 ng/mL, NS;
and 121 versus 204 ng/mL, P<.05, respectively. These data show that PspA and UspA
are immunogenic in children after otitis media.

PMID: 10823798 [PubMed - indexed for MEDLINE]

2506: Ann Otol Rhinol Laryngol. 2000 May;109(5):467-72.

Cellular distribution of mucosa-associated lymphoid tissue with otitis media in
children.

Kamimura M, Balaban CD, Sando I, Ganbo T, Suzuki C.

Department of Otolaryngology, University of Pittsburgh School of Medicine,
Pennsylvania 15213, USA.

This study examined mucosa-associated lymphoid tissue (MALT) in the eustachian
tube (ET), middle ear (ME), and mastoid antrum (MA) in 163 celloidin-embedded
temporal bones from children with or without otitis media. Otitis media was
defined by the presence of histopathologically identified inflammatory cell
infiltration in the mucosa or cavity of the ME. We found MALT in the ET in 30
cases (46.2%), in the ME in 19 cases (29.2%), and in the MA in 4 cases (6.2%) out
of 65 cases of otitis media, and in the ET in 7 (7.1%), in the ME in 0, and in
the MA in 0 out of 98 specimens without otitis media. No MALT appeared in any
children under the age of 1 month. Immunohistochemical methods were used to
investigate MALT in 12 horizontally cut temporal bones with OM. The follicular
area contained OPD4-positive (helper-inducer T) cells and a few CD8-positive
(cytotoxic and suppressor T) cells, whereas the parafollicular area contained
OPD4-positive and CD8-positive T cells. CD57-positive (natural killer) cells were
confined to the germinal center. CD30-positive (activated T and B) cells were
observed throughout the follicles. A few CD15-positive (granulocyte, monocyte)
cells were found in the follicles. Histopathologic and immunohistochemical
findings were indistinguishable for MALT in the ET, ME, and MA. Our results
suggest that MALT may be a mechanism for producing a rapid and massive local
immune reaction to repeated bacterial infections via the ET.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10823475 [PubMed - indexed for MEDLINE]

2507: Pediatr Infect Dis J. 2000 May;19(5 Suppl):S17-22; discussion S22-3.

Role of viruses in the pathogenesis of acute otitis media.

Heikkinen T.

Department of Pediatrics, Turku University Hospital, Finland.
terho.heikkinen@utu.fi

To date there is ample evidence suggesting a crucial role for respiratory viruses
in the pathogenesis of AOM. Respiratory viral infection appears to initiate the
cascade of events that finally leads to development of AOM (Fig. 1). The
pathogenesis of AOM is complicated, involving a network of factors, some probably
not yet identified, which affect each other in a time-dependent manner. Increased
knowledge of the detailed mechanisms of viral infection, the host inflammatory
response during URI and the interaction between viruses and bacteria could lead
to major advances in the prevention of AOM.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 10821468 [PubMed - indexed for MEDLINE]

2508: Pediatr Infect Dis J. 2000 May;19(5 Suppl):S9-15; discussion S15-6.

Bacterial otitis media: pathogenetic considerations.

Murphy TF.

Department of Medicine, State University of New York at Buffalo, Department of
Veterans Affairs Western New York Healthcare System, 14215, USA.
murphyt@acsu.buffalo.edu

A variety of exciting and important new observations regarding the pathogenesis
of nontypable H. influenzae infection have been made in the past decade. The
interactions between mucin and OMPs show a high degree of specificity. Multiple
adhesins have been identified on the bacterial surface. Colonization of the upper
respiratory tract is a dynamic process. Immunodominant, antigenically
heterogeneous OMPs are the targets of strain-specific immune responses,
accounting in part for the recurrent nature of OM in otitis-prone children. The
LOS of nontypable H. influenzae displays a remarkable degree of antigenic and
phase variation and may be involved in molecular mimicry of host antigens.
Finally nontypable H. influenzae not only lives on the mucosal surface but also
clearly has been demonstrated to enter epithelial cells and remain viable in
intracellular and intercellular locations in the human upper respiratory tract.
These areas of investigation have important implications in understanding the
pathogenesis of OM. Elucidating mechanisms of pathogenesis will be important in
guiding development of novel ways to prevent OM.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 10821467 [PubMed - indexed for MEDLINE]

2509: Ann Med. 2000 Apr;32(3):157-63.

Increasing importance of viruses in acute otitis media.

Heikkinen T, Chonmaitree T.

Department of Pediatrics, Turku University Hospital, Finland.
terho.heikkinen@utu.fi

Acute otitis media is generally considered a simple bacterial infection that can 
be effectively treated with antibiotics. However, despite the extensive use of
broad-spectrum antibiotics, poor clinical response to treatment of acute otitis
media is common in children. Numerous studies ranging from animal experiments to 
extensive clinical studies have clearly demonstrated that respiratory viruses
play a crucial role in the aetiology and pathogenesis of acute otitis media.
Viral infection of the upper respiratory tract initiates the whole cascade of
events that finally leads to the development of acute otitis media as a
complication. Respiratory viruses induce a release of inflammatory mediators in
the nasopharynx, increase bacterial colonization and adherence, and have a
suppressive effect on the host's immune defense. Recent data indicate that at
least some types of viruses actively invade the middle ear. Viruses also seem to 
enhance the inflammatory process in the middle ear and impair the outcome of the 
disease. Vaccines against the major viruses predisposing to acute otitis media
hold a great promise for the prevention of this disease. Major advances in the
management of acute otitis media will require further research into the
mechanisms of viral infection, viral-bacterial interaction and the host
inflammatory response during viral infection.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 10821322 [PubMed - indexed for MEDLINE]

2510: Pediatr Infect Dis J. 2000 May;19(5):458-63.

Comment in:
    Pediatr Infect Dis J. 2000 May;19(5):471-3.

Five vs. ten days of antibiotic therapy for acute otitis media in young children.

Cohen R, Levy C, Boucherat M, Langue J, Autret E, Gehanno P, de La Rocque F.

Department of Microbiology and Pediatrics, Intercommunal Hospital of Créteil,
France. robert.cohen@wanadoo.fr

BACKGROUND: Many publications in recent years have argued in favor of shortened
therapy for acute otitis media. However, doubt persists regarding children
younger than 2 years, and some authors therefore restrict short course therapy to
children older than 2 years. METHODS: In a prospective, comparative, double
blind, randomized, multicenter trial we compared cefpodoxime-proxetil, 8
mg/kg/day in two divided doses for 10 days, with an identical 5-day regimen
followed by a 5-day placebo period. RESULTS: Between October, 1996, and April,
1997, 450 children (mean age, 14.3 months) were enrolled, 227 in the 5-day group 
and 223 in the 10-day group. In the per protocol analysis clinical success was
obtained on Days 12 to 14 after the beginning of treatment (main analysis) in 175
(84.1%) of the 208 children receiving the 5-day regimen and 194 (92.4%) of the
210 children receiving the 10-day regimen (P = 0.009). The superiority of the
standard regimen was more marked among children cared for outside their homes
(92.5% vs. 81.5%). Clinical success persisted on Days 28 to 42 among 134 (85.4%) 
of the 157 assessable patients in the 5-day group and 144 (83.7%) of the 172
assessable patients in the 10-day group (P = 0.68). CONCLUSIONS: The 10-day
regimen resulted in a higher success rate at the conclusion of therapy, but there
were no differences between the two study groups 4 to 6 weeks after enrollment in
the study protocol.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 10819344 [PubMed - indexed for MEDLINE]

2511: Pediatr Infect Dis J. 2000 May;19(5):432-7.

Nonsusceptible Streptococcus pneumoniae in children with chronic otitis media
with effusion and recurrent otitis media undergoing ventilating tube placement.

Haddad J Jr, Saiman L, San Gabriel P, Chin NX, Whittier S, Deeter RG, Takoudes
TG, Keller JL, Della-Latta P.

Division of Pediatric Otolaryngology/Head and Neck Surgery, Columbia University
College of Physicians and Surgeons, New York, NY 10032, USA.
haddadj@cpmc3.cpmc.columbia.edu

CONTEXT: Children with chronic otitis media are at risk for nonsusceptible
Streptococcus pneumoniae (NSP) infection. If these children undergo ventilating
tube placement, there is an opportunity to culture middle ear fluid and the
nasopharynx to determine carriage of NSP. OBJECTIVE: To determine the incidence
of NSP carriage, NSP antibiotic susceptibility and risk factors for NSP carriage 
in children with chronic otitis media undergoing tube placement. DESIGN AND
SETTING: Prospective cohort study in an academic medical center with recruitment 
of patients from an otolaryngology private practice and clinic. PATIENTS:
Children < 18 years of age undergoing tube placement for chronic otitis media.
INTERVENTIONS: Myringotomy and tube placement, with culture of middle ear fluid
and nasopharynx. MAIN OUTCOME MEASURES: The incidence of NSP cultured from the
middle ears and nasopharynx of recruited subjects with the use of the minimum
inhibitory concentration break points for penicillin susceptibility recommended
by the National Committee for Clinical Laboratory Standards. RESULTS: S.
pneumoniae was identified in at least 1 site from 23 of 300 study subjects
(7.6%); of these 23, 12 case subjects (52.2%) harbored NSP. Of the risk factors
assessed by preoperative questionnaire, only younger age was associated with NSP 
colonization (P < 0.0001). Of the six oral cephalosporins studied, cefpodoxime
and cefuroxime showed good in vitro activity against S. pneumoniae isolates with 
intermediate penicillin resistance. CONCLUSIONS: Children with chronic otitis
media undergoing tube placement may carry NSP and provide a means of monitoring
the incidence of NSP and antibiotic susceptibilities for children with ear
infections in their communities. Younger age is a risk factor for NSP carriage in
this population.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 10819339 [PubMed - indexed for MEDLINE]

2512: Clin Otolaryngol Allied Sci. 2000 Apr;25(2):161-8.

Children with recurrent episodes of acute otitis media: the effect of local
administration of immunoglobulin G on acute otitis media, colonization and
turnover of non-encapsulated Haemophilus influenzae in the nasopharynx.

Lindberg K, Hammarström L, Samuelson A, Rynnel-Dagöö B.

Department of Otorhinolaryngology, Karolinska Institute, Huddinge Hospital,
Sweden.

In most children with recurrent episodes of acute otitis media (AOM), tube
treatment is successful, but there are those who nevertheless suffer from middle 
ear infections. The aim of the present study was to ascertain whether local
administration of immunoglobulin could reduce the number of episodes of otorrhoea
in otitis-prone infants <2 years old who were treated with tubes, or whether it
could affect the nasopharyngeal colonization and turnover of bacterial pathogens 
in the nasopharynx. IgG or placebo were also administered intranasally daily for 
6 months to 50 infants, randomized in a double-blind study. An arbitrarily primed
polymerase chain reaction (AP-PCR) was used to characterize the different
isolates of NTHI (non-encapsulated, non-typable Haemophilus influenzae). Three
infants in the IgG group and six infants in the control group suffered from > or 
=3 episodes of acute otitis media. No effect on the nasopharyngeal colonization
or the turnover of non-encapsulated H. influenzae in the nasopharynx could be
detected in either group.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 10816223 [PubMed - indexed for MEDLINE]

2513: Int J Technol Assess Health Care. 2000 Winter;16(1):276-81.

Using a balancing procedure in multicenter clinical trials. Simulation of patient
allocation based on a trial of ventilation tubes for otitis media with effusion
in infants.

Rovers MM, Straatman H, Zielhuis GA, Ingels K, van der Wilt GJ.

University Hospital Nijmegen.

OBJECTIVE: A basic issue in randomized controlled trials (RCTs) is whether we can
safely assume comparability between groups at baseline with respect to all
potentially important prognostic factors. In other words, did randomization work 
sufficiently well? In small trials balanced allocation procedures are employed,
whereas in large-scale trials simple randomization will do. The question is: When
should balancing be considered? METHODS: We performed a simulation study in which
we varied the number of categories in the prognostic factors and the number of
patients. RESULTS: Simulation showed that, in all instances, a balancing
procedure almost always led to perfect or almost perfect balance, while the
imbalance with simple randomization was larger. To study the effect of balanced
and random allocation on subgroup analyses in our OME trial, we compared the
quotient of the width of the confidence intervals (CI). The widest CI in random
allocation over the 13 hospitals was on average 13% wider than in balanced
allocation. CONCLUSION: Investigators should always consider balanced allocation,
especially in categories with a low number of patients and when subgroup analysis
over many categories is requested.

PMID: 10815372 [PubMed - indexed for MEDLINE]

2514: Stat Med. 2000 May 30;19(10):1295-302.

Improving interpretability: gamma as an alternative to R(2) as a measure of
effect size.

Reidpath DD, Diamond MR, Hartel G, Glasziou P.

School of Health Sciences, Deakin University, 221 Burwood Hwy, Burwood VIC 3125, 
Australia. reidpath@deakin.edu.au

A traditional measure of effect size associated with tests for difference between
two groups is the variance explained by group membership (R(2)). If exposure to a
disease causes a small but long term deficit in performance, however, R(2) does
not capture that cumulating effect. We propose an alternative statistic, gamma,
based on the probability of an unexposed person outperforming an exposed person. 
Although gamma is also a point estimate, it more easily conveys what the
cumulating effect of a deficit would be. We discuss some of the advantages of
this measure. Copyright 2000 John Wiley & Sons, Ltd.

Publication Types: 
    Comparative Study

PMID: 10814978 [PubMed - indexed for MEDLINE]

2515: CMAJ. 2000 May 2;162(9):1285-8.

Otolaryngologists' perceptions of the indications for tympanostomy tube insertion
in children.

McIsaac WJ, Coyte PC, Croxford R, Asche CV, Friedberg J, Feldman W.

Department of Family and Community Medicine, University of Toronto, Ont.
wmcisaac@mtsinai.on.ca

BACKGROUND: Bilateral myringotomy with insertion of tympanostomy tubes is the
most common operation that children in Canada undergo. Area variations in
surgical rates for this procedure have raised questions about indications used to
decide about surgery. The objective of this study was to describe the factors
that influence otolaryngologists to recommend tympanostomy tube insertion in
children with otitis media and their level of agreement about indications for
surgery. METHODS: A survey was sent to all 227 otolaryngologists in Ontario in
the fall of 1996. The influence of 17 clinical and social factors on
recommendations to insert tympanostomy tubes were assessed. Case vignettes were
used to determine the effect of multiple factors in decisions about the need for 
surgical management. RESULTS: Surveys were returned by 138 (68.3%) of the 202
eligible otolaryngologists. There was agreement (more than 90% of respondents)
about 6 indications for surgery: persistent effusion, a lack of improvement after
3 months of antibiotic therapy, a history of persistent effusion for 3 or more
months per episode of otitis media, more than 7 episodes of otitis media in 6
months, a bilateral conductive hearing loss of 20 dB or more and a persistently
abnormal tympanic membrane. Some respondents were more likely to recommend tube
insertion if there were parental concerns about hearing problems or the frequency
or severity of episodes of otitis media. Otolaryngologists agreed about the role 
of tympanostomy tubes in 1 of 4 case vignettes but disagreed about whether
adenoidectomy should also be performed in that instance. Most viewed tympanostomy
tube insertion as beneficial, with few adverse effects. INTERPRETATION: There is 
a lack of consensus among practising otolaryngologists in Ontario as to which
children with recurrent otitis media or persistent effusion should undergo
bilateral myringotomy with tympanostomy tube insertion. These findings suggest
the need to revisit clinical guidelines for this procedure.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10813009 [PubMed - indexed for MEDLINE]

2516: Scand J Prim Health Care. 2000 Mar;18(1):25-9.

Predictive value of parent-reported symptoms in the assessment of otitis media
with effusion during infancy.

Engel J, Anteunis L, Volovics A, Hendriks J, Marres E.

Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital
Maastricht, The Netherlands.

OBJECTIVE: To determine the predictive value of parent-reported symptoms in the
assessment of otitis media with effusion (OME) during infancy. DESIGN:
Prospective longitudinal study that compared the results of questionnaire-based
parental reports with the state of the middle ear assessed by otoscopy and
tympanometry at 3-month intervals from birth to the age of 2 years. SETTING:
Outpatient Department, University Hospital Maastricht, The Netherlands. SUBJECTS:
One hundred and fifth healthy-born infants. MAIN OUTCOME MEASURES: Sensitivity,
specificity, positive and negative predictive values of parent-reported ear
infection, hearing loss, mouth breathing, snoring and common cold. RESULTS:
Prevalence rates showed the following ranges: OME, 39%-53%, parent-reported ear
infection, 2%-20%, hearing loss 2%-7%, mouth breathing, 30%-41%, snoring, 31%-41%
and common cold, 65%-81%. Common cold demonstrated the highest sensitivity (83%) 
with a low specificity of 36%. Hearing loss gave the highest positive predictive 
value (PPV) (70%) with a moderate negative predictive value (NPV) (54%). PPV
increased with the number of anamnese questions answered positively. CONCLUSIONS:
The diagnostic value of parent-reported ear infection, hearing loss and common
cold was found to be limited. Combinations of positively-reported symptoms gives 
increased diagnostic validity while the absence of parent-reported symptoms does 
not necessarily indicate the absence of OME.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 10811039 [PubMed - indexed for MEDLINE]

2517: Auris Nasus Larynx. 2000 Jul;27(3):231-9.

Middle ear volume and pressure effects on tympanometric middle ear pressure
determination: model experiments with special reference to secretory otitis
media.

Gaihede M.

Department of Otolaryngology, Holstebro Central Hospital, DK-7500, Holstebro,
Denmark. mgaihede@dadlnet.dk

Objective: Middle ear pressure (P(m)) measured by tympanometry has revealed high 
negative values in patients with secretory otitis media (SOM) in contrast to
direct measurement. This may be explained by errors in tympanometry caused by
volume displacement of the tympanic membrane (TM) affecting the volume of the
middle ear (V(m)) and the P(m) according to Boyle's Law. Such errors are
susceptible to the size of V(m). Methods: A realistic middle ear model based on
previous clinical studies of normal pressure-volume relations of the middle ear
system (MES) was constructed. In this model non-linear behaviour and hysteresis
of the MES was imitated and P(m) as well as V(m) could be controlled. Results:
Tympanometrically estimated P(m) decreased on average 38 daPa, when V(m) was
changed from 21 to 1 cm(3). The decrease was most pronounced, when V(m) became
smaller than 5 cm(3). Moreover, tympanometry showed a linear numerical
overestimation of P(m) by a factor 2.31 compared with model P(m). Conclusion: A
curve fit was derived describing the tympanometric P(m) as a function of V(m).
This demonstrated that tympanometric P(m) approached -infinity daPa, when middle 
ear volume approached 0 cm(3), which indicates that negative tympanometric
recordings and B curves can be found in ears with normal P(m) entirely due to
very small V(m)'s. This explains the discrepancy between direct and tympanometric
measurements of P(m) in SOM, since the effusion replaces the air filled
expandable volume resulting in a very small 'functional' V(m). Numerical
overestimation of P(m) by tympanometry was explained by hysteresis, which
reflected the viscoelastic properties of the MES. These results question the
significance of negative P(m)'s as a pathogenetic factor in SOM.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10808111 [PubMed - indexed for MEDLINE]

2518: Auris Nasus Larynx. 2000 Jul;27(3):213-7.

Soluble L-selectin and interleukin-8 in otitis media with effusion.

Pospiech L, Jaworska M, Kubacka M.

Department of Otolaryngology, Medical University, ul. Chalubinskiego 2, 50-368,
Wroclaw, Poland.

Objective: adhesion of leukocytes to vascular endothelium and their invasion into
local tissues are important steps in inflammation. L-selectin plays a crucial
role in leukocyte rolling and adhesion on endothelial cell surface. Interleukin-8
(IL-8) is a potent chemotactic substance toward neutrophils and lymphocytes-T and
mediate their migration to local inflammation. The levels of soluble L-selectin
(sL-selectin) and IL-8 were measured in middle ear effusions (MEE) from children 
with otitis media (OM) to estimate their role in pathogenesis of inflammation in 
middle ear. Methods: MEE were collected from 113 ears of 62 children during
routine myringotomy. The entire specimen was diluted with phosphate-buffered
saline (PBS) to 2 ml and centrifugated at 1500 rpm for 15 min to separate
cellular components. Supernatants of MEE were stored frozen at -20 degrees C for 
sL-selectin and at -80 degrees C for IL-8 assessment. The concentration of
sL-selectin and IL-8 were estimated with ELISA and compared with total protein
concentration measured by Bradford assay. Results: MEEs from children with
chronic mucous otitis media contained significantly higher mean concentrations of
IL-8 559.4 pg/mg total protein (TP) (+/-535.6) in comparison with normal serum
17.79 pg/mg TP (+/-10.9), serous OM 40.3 pg/mg TP (+/-28.1) and purulent OM 104.4
pg/mg TP (+/-128.6). High concentration of IL-8 was found in MEE from the
children with early recurrence of OMS. The levels of sL-selectin were higher in
purulent effusions 77.2 ng/mg TP (+/-67.4) than those of chronic mucoid 27.6
ng/mg TP (+/-36.7) and serous OM 26.3 ng/mg TP (+/-27.1). Conclusion: the results
support a hypothesis that IL-8 can be responsible for prolongation of
inflammatory process in middle ear, therefore long-term treatment and observation
of children with the high levels of IL-8 in MEE may be necessary. Elevated level 
of sL-selectin in acute OM suggests the involvement of L-selectin in the acute
phase of OM.

PMID: 10808107 [PubMed - indexed for MEDLINE]

2519: Laryngoscope. 2000 May;110(5 Pt 1):779-86.

Hearing preservation with labyrinthine ablation in otitis media.

Antonelli PJ, Briggs RD, Gerhardt KJ.

Department of Otolaryngology, University of Florida, Gainesville 32610-0264, USA.
antonpj@ent.ufl.edu

OBJECTIVES: Iatrogenic fenestration of the inner ear in the presence of otitis
media is commonly associated with permanent hearing loss. Hearing can generally
be preserved when the vestibular labyrinth is ablated in a controlled manner in
noninflamed ears. The purpose of this study was to examine the feasibility of
hearing preservation with violation of the inner ear in the presence of middle
ear inflammation. STUDY DESIGN: Prospective and controlled animal model. METHODS:
Otitis media was induced bilaterally in pigmented guinea pigs with transtympanic 
injection of Streptococcus pneumoniae, nontypeable Haemophilus influenzae, or
formalin-killed nontypeable H influenzae. Two to 4 days after injection, the
horizontal canal of one ear was transected and sealed. Hearing was tested before 
and after labyrinthine ablation. RESULTS: Otitis media was induced in all ears.
Bacterial cultures were positive in 19 of 20 S pneumoniae-injected ears, and in
10 of 16 nontypeable H influenzae-injected ears. One week after surgery,
elevation of click thresholds (> 15 dB) was encountered in none of the
fenestrated or unfenestrated S pneumoniae-infected ears, in two of six
unfenestrated and three of six fenestrated nontypeable H influenzae-infected
ears, and in one of five killed-nontypeable H influenzae-injected ears both with 
and without fenestration. CONCLUSIONS: These data suggest that ablation of a
semicircular canal in the presence of middle ear inflammation or infection does
not necessarily lead to profound sensorineural hearing loss. Hearing loss
associated with iatrogenic violation of the semicircular canals may be more
dependent on factors other than the presence of nonspecific middle ear
inflammation.

PMID: 10807357 [PubMed - indexed for MEDLINE]

2520: Laryngoscope. 2000 May;110(5 Pt 1):773-8.

Past history of otitis media and balance in four-year-old children.

Casselbrant ML, Furman JM, Mandel EM, Fall PA, Kurs-Lasky M, Rockette HE.

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, PA
15213, USA.

OBJECTIVES/HYPOTHESIS: To obtain normative data for a population of children 4
years of age with respect to standard vestibular and balance test protocols and
to determine, in the absence of concurrent middle ear effusion (MEE), the
possible changes caused by a history of recurrent or persistent MEE. STUDY
DESIGN: Comparative studies of the results of vestibular and balance tests in a
cohort of young children with and without a history of MEE. METHODS: Seventy-one 
children, 4 years of age, with a well-documented history since early infancy
regarding the presence or absence of MEE were evaluated using pneumatic otoscopy,
tympanometry, audiometry, and vestibular and balance (rotational and moving
platform posturography) tests. For the results of the vestibular and balance
tests, comparisons were made between the group of 31 children (43.7%) without and
the group of 40 children (56.3%) with a history of recurrent or persistent MEE,
when a positive disease history was defined as at least a 10% cumulative
percentage of time with MEE between early infancy and time of testing. RESULTS:
When compared with children with a negative history of significant MEE, children 
with a positive history had a lower average gain to a rotational stimulus of 0.1 
Hz, 150 degrees/s (0.57 vs. 0.44; P = .007). There were no significant
differences between groups with respect to other measures. CONCLUSIONS: These
results suggest that a history of recurrent or persistent MEE affects the
vestibular and/or balance function of 4-year-old children when tested in the
absence of a concurrent episode of MEE. The possible sequelae of the disease
should be weighed in future considerations of early intervention for MEE.

PMID: 10807356 [PubMed - indexed for MEDLINE]

2521: Arch Otolaryngol Head Neck Surg. 2000 May;126(5):609-14.

Prevention of otitis media with effusion by repeated air inflation in a monkey
model.

Alper CM, Swarts JD, Doyle WJ.

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, PA
15213, USA.

OBJECTIVES: To test the following hypotheses that (1) middle ear (ME) air
inflation prevents the development of otitis media with effusion in a monkey
model of functional eustachian tube obstruction, and (2) ME inflation treatment
of otitis media with effusion can cause artifactual clinical improvements due to 
fluid displacement from the tympanum to the adjacent airspaces. DESIGN:
Randomized controlled trial. SUBJECTS: Twelve cynomolgus monkeys. INTERVENTIONS: 
Eustachian tube dysfunction was induced by botulinum paralysis of the right
tensor veli palatini muscle in all monkeys. Before and on study days 9, 15, and
21 after paralysis, the presence or absence, and distribution of ME effusion were
documented using magnetic resonance imaging (MRI). Right and left ears were
examined twice daily for 21 days using tympanometry, and right ME air inflation
(n = 6 ears) or sham inflation (n = 6 ears) was done immediately after those
examinations if the ME pressure was -100 mm H2O or less. On 10 of the scheduled
MRI evaluations, the MRI was repeated immediately after an inflation to document 
the possible redistribution of fluid within the ME caused by the maneuver.
RESULTS: Middle ear pressure remained within normal limits for the follow-up
period in 11 of the 12 nonparalyzed left ears, in none of the 6 sham-inflated
right ears, and in 3 of the 6 air-inflated right ears. Three air-inflated right
ears developed flat tympanograms (ie, days 14 through 16). Magnetic resonance
imaging documented inflammation and fluid in 1 of the 11 nonparalyzed left ears
and in all sham-inflated right ears. Lesser degrees of inflammation and effusion 
based on MRI evaluations were noted for the 3 air-inflated right ears that
retained near-ambient pressures when compared with the right 3 ears that
developed a flat tympanogram. The MRI measure of effusion quantity within the
tympanum was decreased acutely after inflation, but was simultaneously increased 
in the adjacent airspaces of the temporal bone. CONCLUSIONS: Repeated air
inflation prevented the development of otitis media with effusion in 50% of the
ears with functional eustachian tube obstruction. Postinflation MRI documented
the displacement of fluid by inflation from the tympanum to the mastoid and
petrous air cells. Using standard clinical evaluations such as tympanometry and
otoscopy, this fluid redistribution can cause a false diagnosis of improvement.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10807328 [PubMed - indexed for MEDLINE]

2522: Arch Otolaryngol Head Neck Surg. 2000 May;126(5):585-92.

Impact of tympanostomy tubes on child quality of life.

Rosenfeld RM, Bhaya MH, Bower CM, Brookhouser PE, Casselbrant ML, Chan KH,
Cunningham MJ, Derkay CS, Gray SD, Manning SC, Messner AH, Smith RJ.

Department of Otolaryngology, SUNY Health Science Center at Brooklyn, NY, USA.
richrosenfeld@msn.com

BACKGROUND: The objective benefits of tympanostomy tubes for otitis media are
well established, but the subjective impact of surgery on child quality of life
(QOL) has not been systematically studied. OBJECTIVES: To determine the
subjective impact of tympanostomy tubes on child QOL, and to compare the
variability in QOL before surgery with that observed after surgery. DESIGN:
Prospective, observational, before-and-after trial. SETTING: Fourteen
referral-based pediatric otolaryngology practices in the United States. PATIENTS:
Consecutive (64%) and convenience (36%) sample of 248 children (median age, 1.4
years) with otitis media scheduled for bilateral tympanostomy tube placement as
an isolated surgical procedure. INTERVENTION: Tympanostomy tubes were inserted as
part of routine clinical care. Validated measures of QOL (OM-6 survey),
satisfaction with health care decision (Satisfaction With Decision Scale), and
satisfaction with office visit; surveys were completed at baseline (visit 1), at 
surgery (visit 2), and after surgery (visit 3). MAIN OUTCOME MEASURES: Short-term
changes in QOL before surgery (visit 1 to visit 2) and after surgery (visit 2 to 
visit 3). RESULTS: Changes in QOL before surgery were mostly trivial, and were
smaller than changes observed after surgery (P<.001). Large, moderate, and small 
improvements in QOL occurred after surgery in 56%, 15%, and 8% of children,
respectively. Physical symptoms, caregiver concerns, emotional distress, and
hearing loss were most improved, but significant changes were also seen for
activity limitations and speech impairment. Trivial changes occurred in 17% of
children, and 4% had poorer QOL. Predictors of poorer QOL were otorrhea 3 or more
days (10% of variance) and decreased satisfaction with surgical decision (3% of
variance). Hearing status, child age, type of otitis media (recurrent vs
chronic), and office visit satisfaction were unrelated to outcome. CONCLUSIONS:
Tympanostomy tubes produce large short-term improvements in QOL for most
children. The best outcomes occur when postoperative otorrhea is absent or
minimal, and when parents are satisfied with their initial decision to have
surgery. Further research is needed to document the long-term impact of tubes on 
child QOL.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10807325 [PubMed - indexed for MEDLINE]

2523: Cochrane Database Syst Rev. 2000;(2):CD000473.

Update in:
    Cochrane Database Syst Rev. 1998;(4):CD000473.

Interventions for chronic suppurative otitis media.

Acuin J, Smith A, Mackenzie I.

Clinical Epidemiology Unit, De La Salle University, College of Medicine,
Dasmarinas, Cavite, Philippines. jmacuin@pworld.net.ph

BACKGROUND: Chronic suppurative otitis media (CSOM) is a serious bacterial
infection of the middle ear that can follow untreated acute otitis media.
OBJECTIVES: To assess the effects of different treatments for CSOM. SEARCH
STRATEGY: We searched Medline from 1966 to 1996 and a bibliographic collection of
the Hearing Impairment Research Group in Liverpool, UK. We handsearched two
otolaryngology journals and contacted members of an international hearing
network. SELECTION CRITERIA: Randomized trials of any method of management for
patients with eardrum perforation and persistent otorrhea. DATA COLLECTION AND
ANALYSIS: Three reviewers independently assessed eligibility and trial quality.
One reviewer extracted data. We contacted investigators for clarifications. MAIN 
RESULTS: Twenty-four trials involving 1660 people were included. Clinical
definitions and severity of CSOM varied, methodological quality was generally low
and follow-up was short. Treatment with antibiotics or antiseptics accompanied by
aural toilet was more effective in resolving otorrhea than no treatment (two
trials, odds ratio 0.37, 95% confidence interval 0.24 to 0. 57) or aural toilet
alone (six trials, odds ratio 0.31, 95% confidence interval 0.23 to 0.43).
Topical treatment with antibiotics or antiseptics was more effective than
systemic antibiotics (six trials, odds ratio 0.46, 95% confidence interval 0.30
to 0.69). Combining topical and systemic antibiotics was not more effective than 
topical antibiotics. Topical quinolones were more effective than non-quinolones
(five trials, odds ratio 0.26, 95% confidence interval 0.16 to 0.41). No
difference in the effectiveness of topical antibiotics and topical antiseptics
was found (three studies, odds ratio 1.34, 95% confidence interval 0.64 to 2.81).
Some topical antibiotic combinations may be more effective than others in
resolving otorrhea. Rates of adverse drug events were low and equal between
groups. REVIEWER'S CONCLUSIONS: Treatment of CSOM with aural toilet and topical
antibiotics, particularly quinolones, is effective in resolving otorrhea and
eradicating bacteria from the middle ear. Longterm outcomes such as preventing
recurrences, closure of tympanic perforation and hearing improvement need to be
further evaluated.

Publication Types: 
    Review

PMID: 10796720 [PubMed - indexed for MEDLINE]

2524: Cochrane Database Syst Rev. 2000;(2):CD001095.

Short course antibiotics for acute otitis media.

Kozyrskyj AL, Hildes-Ripstein GE, Longstaffe SE, Wincott JL, Sitar DS, Klassen
TP, Moffatt ME.

Community Health Sciences, Faculty of Medicine, University of Manitoba, 750
Bannatyne Avenue, Winnipeg, Manitoba, Canada, R3E 0W3.
moffatt@bldghsc.1an1.umanitoba.ca

BACKGROUND: Otitis media is a common pediatric problem, for which antibiotics are
frequently prescribed. OBJECTIVES: To determine the effectiveness of a short
course of antibiotics (less than seven days) in comparison to a longer course
(seven days or greater) for the treatment of acute otitis media in children.
SEARCH STRATEGY: The medical literature was searched for randomized controlled
studies of the treatment of ear infections in children with antibiotics published
from January 1966 to July 1997. Search last updated March 1998. SELECTION
CRITERIA: Studies were included if they met the following criteria: subjects one 
month to 18 years of age, clinical diagnosis of ear infection, no previous
antimicrobial therapy and randomization to treatment with less than seven days
versus seven days or more of antibiotics. DATA COLLECTION AND ANALYSIS: Data on
treatment outcomes were extracted from individual studies, and combined in the
form of a summary odds ratio. A summary odds ratio (OR) equivalent to one
indicated that the treatment failure rate following less than seven days of
antibiotic treatment was similar to the failure rate following seven days or more
of antibiotic. MAIN RESULTS: The summary OR for treatment outcomes at eight to 19
days in 1,524 children treated with short-acting antibiotics for five days versus
eight to 10 days was 1.52, 95% CI: 1.17-1.98, but by 20 to 30 days outcomes
between treatment groups (n=2,115) were comparable (OR=1.22, 95% CI:0.98-1.54).
The absolute difference in treatment failure (Random effects model RD=2.9%,
95%CI:-0.3% to 6.1%) at 20 to 30 days suggests that at minimum 17 children would 
need to be treated with the long course of short-acting antibiotics to avoid one 
treatment failure. Similarity in outcomes was observed for up to three months
following therapy (OR=1.16,95% CI=0.9-1.5). Comparable outcomes were shown
between treatment with ceftriaxone or azithromycin, and more than seven days of
other antibiotics. REVIEWER'S CONCLUSIONS: This review suggests that five days of
short-acting antibiotic is effective treatment for uncomplicated ear infections
in children.

Publication Types: 
    Review

PMID: 10796591 [PubMed - indexed for MEDLINE]

2525: Cochrane Database Syst Rev. 2000;(2):CD000219.

Update in:
    Cochrane Database Syst Rev. 2000;(4):CD000219.

Antibiotics for acute otitis media in children.

Glasziou PP, Hayem M, Del Mar CB.

Associate Professior in Clinical Epidemiology, Dept of Social & Preventive
Medicine, Medical School, Herston QLD 4006, Australia, 4006.
P.Glasziou@spmed.uq.edu.au

BACKGROUND: Acute otitis media is one of the most common diseases in early
infancy and childhood. Antibiotic use for acute otitis media varies from 31% in
the Netherlands to 98% in the USA and Australia. OBJECTIVES: The objective of
this review was to assess the effects of antibiotics for children with acute
otitis media. SEARCH STRATEGY: We searched the Cochrane Controlled Trials
Register, MEDLINE, Index Medicus, Current Contents and reference lists of
articles from 1958 to January 1999. SELECTION CRITERIA: Randomised trials
comparing antimicrobial drugs with placebo in children with acute otitis media.
DATA COLLECTION AND ANALYSIS: Three reviewers independently assessed trial
quality and extracted data. MAIN RESULTS: Nine trials were eligible but only six 
trials, with a total of 1,962 children, included patient-relevant outcomes. The
methodological quality of the included trials was generally high. All trials were
from developed countries. The trials showed no reduction in pain at 24 hours, but
a 34% relative reduction (95% confidence interval 16% to 48%) in pain at two to
seven days. Since approximately 85% of patients will have settled spontaneously
in this time, this means an absolute reduction of about 5% or that about 20
children must be treated with antibiotics to prevent one child having some pain
after two days. There was no effect of antibiotics on deafness, as measured by
subsequent tympanometry, other complications, or recurrence. However, audiometry 
was done in only two studies and incompletely reported, and there were few
serious complications seen in these trials: only one case of mastoiditis occurred
(in a penicillin treated group). One semi-randomised trial in Sweden in 1954
reported a rate of 17% in the untreated group versus none in the penicillin
treated groups. REVIEWER'S CONCLUSIONS: Antibiotics provide a small benefit for
acute otitis media in children. As most cases will resolve spontaneously, this
benefit must be weighed against the possible adverse reactions. Antibiotic
treatment may play an important role in reducing the risk of mastoiditis in
populations where it is more common.

Publication Types: 
    Review

PMID: 10796513 [PubMed - indexed for MEDLINE]

2526: Am Fam Physician. 2000 Apr 15;61(8):2410-6.

Acute otitis media: part II. Treatment in an era of increasing antibiotic
resistance.

Pichichero ME.

University of Rochester Medical Center, New York, USA.

Antibiotic resistance is increasing among the pathogens that commonly cause acute
otitis media. This development may merit changes in the traditional antibiotic
treatment of acute otitis media. Risk factors for resistant pathogens include
recent antibiotic treatment of acute otitis media, children in day care
facilities, wintertime infections and acute otitis media in children less than
two years of age. Amoxicillin remains the antibiotic of first choice, although a 
higher dosage (80 mg per kg per day) may be indicated to ensure eradication of
resistant Streptococcus pneumoniae. Oral cefuroxime or amoxicillin-clavulanate
and intramuscular ceftriaxone are suggested second-line choices for treatment
failure. Compliance with antibiotic regimens is enhanced by selecting agents that
require less frequent dosing (such as one or two times a day) and by prescribing 
shorter (five days or less) treatment courses. Selective use of tympanocentesis
if the patient does not respond to empiric therapy can help confirm the diagnosis
and guide effective therapy.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 10794582 [PubMed - indexed for MEDLINE]

2527: Top Magn Reson Imaging. 2000 Apr;11(2):76-86.

Otogenic intracranial inflammations: role of magnetic resonance imaging.

Dobben GD, Raofi B, Mafee MF, Kamel A, Mercurio S.

Department of Radiology and Neurosurgery, University of Illinois at Chicago,
60612, USA.

The clinical course of acute otitis media is usually short, and the process
terminates because of the host's immune system, the infection-resistant
properties of the mucosal linings, and the susceptibility of the major organisms 
(beta-hemolytic streptococcus or pneumococcus) to penicillin. However, a small
proportion (1% to 5%) of untreated or inadequately treated patients may
experience complications. Prior to the development of an intracranial
complication of otomastoiditis, warning symptoms or signs may be evident; these
include severe earache, severe headache, vertigo, chills and fever, and meningeal
symptoms and signs. Increasing headache, particularly temporoparietal headache
near the affected ear, often indicates an impending intracranial complication.
This symptom, often the only indication of an epidural abscess, demands prompt
investigation and medical and surgical intervention. In our experience, computed 
tomography (CT) permits accurate diagnosis of acute coalescent or latent (masked)
mastoiditis and its associated complications. However, magnetic resonance imaging
(MRI) remains the study of choice to evaluate otogenic intracranial
complications. This article demonstrates the important role of MRI in diagnosing 
various stages of acute otomastoiditis and its associated complications.

Publication Types: 
    Review

PMID: 10794197 [PubMed - indexed for MEDLINE]

2528: Pediatrics. 2000 May;105(5):1119-30.

Language, speech sound production, and cognition in three-year-old children in
relation to otitis media in their first three years of life.

Paradise JL, Dollaghan CA, Campbell TF, Feldman HM, Bernard BS, Colborn DK,
Rockette HE, Janosky JE, Pitcairn DL, Sabo DL, Kurs-Lasky M, Smith CG.

Department of Pediatrics, University of Pittsburgh School of Medicine,
Pittsburgh, PA, USA. jpar+@pitt.edu

OBJECTIVE: As part of a prospective study of possible effects of early-life
otitis media on speech, language, cognitive, and psychosocial development, we
tested relationships between children's cumulative duration of middle ear
effusion (MEE) in their first 3 years of life and their scores on measures of
language, speech sound production, and cognition at 3 years of age. METHODS: We
enrolled 6350 healthy infants by 2 months of age who presented for primary care
at 1 of 2 urban hospitals or 1 of 2 small town/rural and 4 suburban private
pediatric practices. We intensively monitored the children's middle ear status by
pneumatic otoscopy, supplemented by tympanometry, throughout their first 3 years 
of life; we monitored the validity of the otoscopic observations on an ongoing
basis; and we treated children for otitis media according to specified
guidelines. Children who met specified minimum criteria regarding the persistence
of MEE became eligible for a clinical trial in which they were assigned randomly 
to undergo tympanostomy tube placement either promptly or after a defined
extended period if MEE remained present. From among those remaining, we selected 
randomly, within sociodemographic strata, a sample of 241 children who
represented a spectrum of MEE experience from having no MEE to having MEE whose
cumulative duration fell just short of meeting randomization criteria. In
subjects so selected, the estimated duration of MEE ranged from none to 65.6% of 
the first year of life and 44.8% of the first 3 years of life. In these 241
children we assessed language development, speech sound production, and cognition
at 3 years of age, using both formal tests and conversational samples. RESULTS:
We found weak to moderate, statistically significant negative correlations
between children's cumulative durations of MEE in their first year of life or in 
age periods that included their first year of life, and their scores on formal
tests of receptive vocabulary and verbal aspects of cognition at 3 years of age. 
However, the percent of variance in these scores explained by time with MEE in
the first year of life beyond that explained by sociodemographic variables ranged
only from 1.2% to 2.9%, and the negative correlations were concentrated in the
subgroup of children whose families had private health insurance (rather than
Medicaid). We found no significant correlations in the study population as a
whole or in any subgroup between time with MEE during antecedent periods and
children's scores on measures of spontaneous expressive language, speech sound
production, or other measured aspects of cognition. In contrast, by wide margins,
scores on all measures were consistently highest among the most socioeconomically
advantaged children and lowest among the most socioeconomically disadvantaged
children. CONCLUSIONS: Our findings suggest either that persistent early-life MEE
actually causes later small, circumscribed impairments of receptive language and 
verbal aspects of cognition in certain groups of children or that unidentified,
confounding factors predispose children both to early-life otitis media and to
certain types of developmental impairment. Findings in the randomized clinical
trial component of the larger study should help distinguish between causality and
confounding as explanations for our findings.language, speech, cognition,
development, otitis media, middle ear effusion.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 10790473 [PubMed - indexed for MEDLINE]

2529: J Laryngol Otol. 2000 Jan;114(1):47-9.

Labyrinthine involvement and multiple perforations of the tympanic membrane in
acute otitis media due to group A streptococci.

Kanazawa T, Hagiwara H, Kitamura K.

Department of Otolaryngology-Head and Neck Surgery, Jichi Medical School,
Tochigi, Japan. kanatake@jichi.ac.jp

We present here three cases of acute otitis media caused by a virulent group A
streptococcal infection that rapidly led to deterioration in hearing. Two of the 
three cases presented with severe sensorineural and mixed hearing loss with
multiple tympanic membrane perforations, and the third presented with severe
bilateral sensorineural hearing loss following acute otitis media involving group
A streptococci. All patients were treated with systemic (piperacillin) and
topical antibiotics (ofloxacin ear drops): one patient also received a systemic
steroid (betamethasone). Deafness persisted in one patient but in the other two, 
hearing gradually recovered. Severe cytotoxicity was considered to have occurred 
in all patients, resulting in multiple perforations of the tympanic membrane and 
necrosis in the middle ear.

Publication Types: 
    Case Reports

PMID: 10789411 [PubMed - indexed for MEDLINE]

2530: J Laryngol Otol. 2000 Jan;114(1):26-32.

Middle-ear disease in remote Aboriginal Australia: a field assessment of surgical
outcomes.

Mak D, MacKendrick A, Weeks S, Plant AJ.

Kimberley Public Health Unit, Derby, Australia. donna.mak@health.wa.gov.au

Chronic middle-ear disease is highly prevalent among Australian Aboriginal
people, and many undergo surgical treatment. However, the outcomes of surgery in 
this group have not been fully evaluated. This is a descriptive study of
operations for middle-ear disease (excluding grommets) on Aboriginal patients in 
Kimberley hospitals between 1 October 1986 and 31 December 1995. Logistic
regression was used to model predictors of surgical outcome. Success was defined 
by an intact tympanic membrane and air-bone gap of < or = 25 dB at review at, or 
later than, six months post-operation. A success rate of 53 per cent was
observed; increasing age was the only variable predictive of success. Successful 
outcomes were more likely in adults and children aged > 10 years, however, this
does not take into account the necessity of hearing for language acquisition and 
learning. Dedicated resources must be allocated for post-operative follow-up of
Aboriginal patients so that much-needed, rigorous evaluations of ENT surgery can 
be conducted.

PMID: 10789407 [PubMed - indexed for MEDLINE]

2531: J Laryngol Otol. 2000 Jan;114(1):24-5.

Accuracy of patient self-medication with topical eardrops.

England RJ, Homer JJ, Jasser P, Wilde AD.

Department of Otolaryngology, Hull Royal Infirmary, UK.

Topical eardrops are commonly prescribed by otolaryngologists and general
practitioners and many believe that patient compliance is poor, although this has
not been studied in a properly controlled manner. Thirty-nine patients with
otitis externa were reviewed four times during a two-week course of topical
eardrops and their treatment compliance studied. The patients tended to
undermedicate themselves, and this tendency increased over the two-week period.
Patients were administering significantly fewer drops by the end of day 11 than
by the end of day 3 (p = 0.2). Compliance patterns were extremely poor, in that
only 40 per cent of patients were managing to self-medicate within a 25 per cent 
error margin by the end of day 3. These findings may have future implications in 
the ongoing debate on eardrop use.

PMID: 10789406 [PubMed - indexed for MEDLINE]

2532: Ear Nose Throat J. 2000 Apr;79(4):300, 303-5.

Superior adenoidectomy in children with palatal abnormalities.

Kakani RS, Callan ND, April MM.

Department of Surgery, State University of New York at Stony Brook, USA.

When treating a child with a palatal abnormality for otitis media or a nasal
obstruction, otolaryngologists often face the question of whether the benefits of
adenoidectomy are worth the risk of the development of velopharyngeal
insufficiency. Treatment options for these patients include a complete
adenoidectomy, a partial adenoidectomy, or no surgical intervention. In this
retrospective study, we describe the outcomes of 22 such patients who were
treated with a superior adenoidectomy performed with a St. Clair adenoidforceps
under indirect vision with a laryngeal mirror. All patients experienced a
complete or near-complete resolution of their nasal obstruction, and none
developed permanent velopharyngeal insufficiency. Only three patients experienced
a recurrence of otitis media. Our experience suggests that superior adenoidectomy
is a safe and effective procedure.

PMID: 10786394 [PubMed - indexed for MEDLINE]

2533: Ear Nose Throat J. 2000 Apr;79(4):290-2, 294, 296 passim.

Treatment of otitis media with effusion based on politzerization with an
automated device.

Arick DS, Silman S.

New York Eye and Ear Infirmary, New York City, USA.

This study evaluated the efficacy of politzerization with an automated, hand-held
device that controls volume velocity (airflow) in the treatment of 20 children
with otitis media with effusion. These patients underwent politzerization twice a
week for up to 6 weeks. Another 20 children with otitis media with effusion who
were not treated with politzerization served as controls. Following treatment,
resolution of the average air-bone gap to within normal limits was achieved in
70% of the treated group and 20% of the controls, which eliminated the need for
grommet insertion in these patients. Improvement in tympanometric peak pressure
was also significantly greater in the treated group. Politzerization was
efficiently and successfully performed in all patients. The automated device's
ease of administration and its ability to control airflow suggests that it has
the potential to be an effective home treatment that can be administered by the
parents or guardians of children who have otitis media with effusion.

PMID: 10786393 [PubMed - indexed for MEDLINE]

2534: Pediatr Infect Dis J. 2000 Apr;19(4):383-7.

Management of otitis media: 2000 and beyond.

Klein JO.

Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, MA
02118, USA. jerome.klein@bmc.org

BACKGROUND: In the next few years what will alter our modes of diagnosis, choice 
of therapies and strategies for prevention of acute otitis media (AOM)? These
issues, as well as whether antibiotic resistance will continue to threaten the
efficacy of currently available antimicrobial agents, whether industry and
academia will be able to respond to bacterial resistance with effective new
antimicrobial drugs and whether the pneumococcal conjugate vaccine will
substantially reduce the incidence of AOM provide a basis for discussing the
problems and possible solutions related to AOM. ANTIMICROBIAL DRUGS: Bacteria and
viruses will continue to find ways to survive the activity of currently available
antimicrobial drugs. Among the new antibacterial drugs under consideration are
ketolides, oxazolodinones and quinolones. Guidelines stress limiting usage of
antimicrobial agents to diseases that are likely caused by bacterial pathogens.
Antiviral drugs are now available against influenza virus and respiratory
syncytial virus infections. DIAGNOSIS: Tympanometry and/or acoustic reflectometry
are adjunctive techniques for assisting in the diagnosis of middle ear effusion
in children whose otoscopic examination is ambiguous. Laser myringotomy has been 
used in several hundred children; however, there are no published studies of
randomized trials. NEW VACCINES: Investigators have evaluated the safety and
efficacy of a heptavalent pneumococcal polysaccharide vaccine conjugated with
CRM197 (a diphtheria toxin mutant). The results showed a reduction in the overall
burden of severe and recurrent AOM. Respiratory syncytial virus is the viral
pathogen most frequently associated with AOM. For this reason safe and effective 
viral vaccines are needed to complement the efficacy of bacterial vaccines for
prevention of AOM. CONCLUSIONS: Parents influence decisions by pediatricians to
use antimicrobial agents and should be informed about the appropriate usage of
antibiotics. Educators and public health officials must find techniques to
distinguish WebSites that provide information of value from those that are not
credible. Of paramount importance is the development of techniques to increase
the accuracy of clinical and microbiologic diagnosis. Finally there is a need for
studies of appropriate scientific design that can assess the efficacy and safety 
of alternative therapies.

PMID: 10783040 [PubMed - indexed for MEDLINE]

2535: Pediatr Infect Dis J. 2000 Apr;19(4):378-82.

Clinical significance of resistant organisms in otitis media.

Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center, Ben-Gurion
University, Beer-Sheva, Israel. rdagan@bgumail.bgu.ac.il

BACKGROUND: Otitis media is an important health care problem of childhood. The
bacteriology of otitis media comprises three main pathogens: Streptococcus
pneumoniae, nontypable Haemophilus influenzae and Moraxella catarrhalis. Although
the prevalence of resistant strains varies geographically and temporally,
antimicrobial resistance is widespread and increasing. RESISTANCE TO ANTIBIOTIC
DRUGS: Among the risk factors for development of resistance in otitis media are
antimicrobial use, young age, day-care attendance and prior hospitalization. The 
increasing rate of resistance to antibiotic drugs is associated with a decreased 
rate of successful eradication of pathogens from middle ear fluid, which is
associated with clinical failure. A bacteriologic cure rate of 80 to 85% is
observed for S. pneumoniae and nontypable H. influenzae when serum concentrations
exceed the MIC for 40 to 50% of dosing interval. Comparative trials indicate that
some of the beta-lactams can achieve bacteriologic eradication in acute otitis
media, although major differences in outcome exist among agents based on
pathogen, beta-lactamase status and MIC values. ANTIBIOTIC CHOICE: Overall the
choice of antibiotics for treatment of otitis media should take into
consideration their in vitro activity against the locally prevalent organisms,
especially resistant organisms, and results obtained from studies in which
bacteriologic outcome was used as the endpoint.

Publication Types: 
    Review

PMID: 10783039 [PubMed - indexed for MEDLINE]

2536: Pediatr Infect Dis J. 2000 Apr;19(4):298-303.

Predictive value of pneumococcal nasopharyngeal cultures for the assessment of
nonresponsive acute otitis media in children.

Eldan M, Leibovitz E, Piglansky L, Raiz S, Press J, Yagupsky P, Leiberman A,
Dagan R.

Pediatric Infectious Disease Unit, Soroka University Medical Center and the
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,
Israel.

BACKGROUND: Nonresponsive acute otitis media (NR-AOM) is reported in > 10% of
children with AOM treated with antibiotics. Drug-resistant Streptococcus
pneumoniae is currently considered the leading cause of antibiotic failures in
AOM. Nasopharyngeal colonization with S. pneumoniae was found to increase
significantly during episodes of AOM. OBJECTIVES: To investigate the
nasopharyngeal colonization with S. pneumoniae during NR-AOM and compare it with 
that found in AOM not recently treated with antibiotics (NT-AOM); to assess the
predictive value of nasopharyngeal pneumococcal cultures results for the
bacteriologic assessment of NR-AOM. MATERIALS AND METHODS: Patients age 3 to 48
months with NT-AOM and NR-AOM were prospectively studied. Simultaneous
nasopharyngeal cultures for S. pneumoniae and middle ear fluid cultures were
obtained at enrollment. Antibiotic susceptibility testing was performed in all S.
pneumoniae isolates. Penicillin and ceftriaxone MICs for S. pneumoniae were
determined by E-test. The sensitivity, specificity and positive and negative
predictive values of positive or negative nasopharyngeal cultures for the
presence of S. pneumoniae in middle ear fluid were calculated. RESULTS: We
studied 362 and 217 children with NT-AOM and NR-AOM, respectively. Of the
children with NT-AOM and NR-AOM, 95 and 97%, respectively, were younger than 2
years of age. S. pneumoniae was isolated in the nasopharynx of 66 and 58% of
children with NT-AOM and NR-AOM, respectively. Penicillin-nonsusceptible S.
pneumoniae was isolated more frequently from the nasopharynx of patients with
NR-AOM than from those with NT-AOM (84% vs. 47%; P < 0.01). Antibiotic
susceptibility patterns were similar for S. pneumoniae isolates recovered from
the nasopharynx and those from the middle ear fluid in both NT-AOM and NR-AOM. A 
positive nasopharyngeal culture had only little predictive value for the presence
of S. pneumoniae in middle ear fluid (41 and 51% for NT-AOM and NR-AOM,
respectively). However, the negative predictive value of nasopharyngeal cultures 
for recovery of S. pneumoniae in NR-AOM was high and significantly higher in
NR-AOM than in NT-AOM (91% vs. 78%, respectively; P = 0.009). The negative
predictive value of nasopharyngeal cultures for recovery of antibiotic-resistant 
S. pneumoniae was 95 and 93% in NT-AOM and NR-AOM, respectively. Conclusions. A
significantly higher nasopharyngeal colonization rate with antibiotic-resistant
S. pneumoniae was found in patients with NR-AOM than in those with NT-AOM.
Negative nasopharyngeal culture for antibiotic-resistant S. pneumoniae
practically rules out its presence in middle ear fluid.

Publication Types: 
    Clinical Trial
    Comparative Study
    Controlled Clinical Trial

PMID: 10783018 [PubMed - indexed for MEDLINE]

2537: Am Fam Physician. 2000 Apr 1;61(7):2051-6.

Comment in:
    Am Fam Physician. 2000 Apr 1;61(7):1987, 1990-2.

Acute otitis media: Part I. Improving diagnostic accuracy.

Pichichero ME.

Department of Microbiology and Immunology, University of Rochester Medical
Center, New York 14642, USA.

Acute otitis media is overdiagnosed. Symptoms are neither sensitive nor specific 
for the diagnosis of otitis media; fever and ear pain are present in only one
half of patients. Undue reliance on one feature--redness of the tympanic
membrane--and failure to assess tympanic membrane mobility with pneumatic
otoscopy contribute to inaccurate diagnoses. Adequate visualization of the
tympanic membrane is often impaired by low light output from old otoscope bulbs
and blockage of the ear canal by cerumen. Distinguishing acute otitis media from 
otitis media with effusion is clinically important because antibiotics are seldom
indicated for the latter condition. A key differentiating feature is the position
of the tympanic membrane: it is usually bulging in acute otitis media and in a
neutral position or a retracted position in otitis media with effusion.
Tympanometry and acoustic reflectometry can be useful adjunctive tools to confirm
the presence of fluid in the middle ear. Selective use of tympanocentesis in
cases of refractory or recurrent middle ear disease can help guide appropriate
therapy and avoid unnecessary medical or surgical interventions.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 10779248 [PubMed - indexed for MEDLINE]

2538: Ann Otol Rhinol Laryngol. 2000 Apr;109(4):381-4.

Correlation of pure tone audiogram results and hearing benefit of tympanoplasty
for chronic suppurative otitis media.

Yuen AP, Ho WK, Hui Y, Wei WI, Au DK.

Department of Surgery, The University of Hong Kong, Queen Mary Hospital, People's
Republic of China.

The aim of this study was to evaluate the correlation between pure tone audiogram
results and the subjective sensation of hearing benefit of patients who had
tympanoplasty for chronic suppurative otitis media. This is a prospective study
of 115 patients who had tympanoplasty between 1992 and 1994. The outcome,
including a pure tone audiogram and the subjective sensation of hearing benefit, 
was evaluated at 1 year after operation. There were 63 (55%) patients with
subjective hearing benefit after the tympanoplasty. The subjective sensation of
hearing benefit correlated with the magnitude of the air conduction (AC)
threshold reduction, and increased from 39% for an AC reduction of less than or
equal to 10 dB to 100% for an AC reduction of more than 30 dB. The effect of the 
interaural AC threshold difference on the subjective sensation of hearing was not
significant; improvement was felt by 92% of patients when the operated ear became
the better hearing ear, and by 73% of patients when the operated ear remained the
worse hearing ear. There was considerable discrepancy between the subjective
hearing benefit and the pure tone audiogram results. A combination of parameters,
including the air-bone gap, the AC threshold, and the subjective hearing change, 
is recommended in reporting the results of tympanoplasty.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10778893 [PubMed - indexed for MEDLINE]

2539: Med J Aust. 2000 Feb 21;172(4):153-6.

Comment in:
    Med J Aust. 2000 Feb 21;172(4):149.

Applying the results of a systematic review in general practice.

Doust JA, Silagy CA.

Department of General Practice, Flinders University of South Australia, Adelaide.
jenny.doust@flinders.edu.au

OBJECTIVE: To assess how general practitioners might interpret and apply the
results of a systematic review relevant to general practice. DESIGN:
Cross-sectional postal survey of general practitioners in August 1997.
PARTICIPANTS: 51 general practitioners in the Southern Division of General
Practice in Adelaide and 11 professors or heads of departments of general
practice. MAIN OUTCOME MEASURES: Extent to which comments on the implications for
practice and implications for research coincided with the evidence presented in a
systematic review of antibiotics for the treatment of acute otitis media in
children; and reported probability that respondents would prescribe antibiotics
in three brief case scenarios. RESULTS: There was considerable variation in the
comments made by general practitioners on the implications of the review for
clinical practice. After reading the review, respondents with training in
critical appraisal were more likely to state that children with acute otitis
media would usually recover spontaneously and reported a lower probability of
prescribing antibiotics in two of the three case scenarios. CONCLUSIONS:
Providing systematic reviews is not sufficient for the results of such evidence
to be translated into clinical practice. There is an association between critical
appraisal skills and the application of evidence-based practice.

PMID: 10772584 [PubMed - indexed for MEDLINE]

2540: Infect Immun. 2000 May;68(5):2992-4.

Bactericidal/permeability-increasing protein prevents mucosal damage in an
experimental rat model of chronic otitis media with effusion.

Nell MJ, Koerten HK, Grote JJ.

Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The 
Netherlands. M.J.Nell@lumc.nl

In this study, the efficacy of bactericidal/permeability-increasing protein (BPI)
was assessed in a rat model of chronic otitis media with effusion. BPI injection 
prevented disturbance of the mucociliary clearance system of the middle ear.
Hence, it is postulated that BPI can be a new therapy for chronic otitis media
with effusion.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10769000 [PubMed - indexed for MEDLINE]

2541: Infect Immun. 2000 May;68(5):2756-65.

Passive transfer of antiserum specific for immunogens derived from a nontypeable 
Haemophilus influenzae adhesin and lipoprotein D prevents otitis media after
heterologous challenge.

Kennedy BJ, Novotny LA, Jurcisek JA, Lobet Y, Bakaletz LO.

The Ohio State University College of Medicine and Public Health, Department of
Pediatrics, Division of Molecular Medicine, Columbus, Ohio 43205-2696, USA.

We recently determined that passive transfer of serum directed against a
synthetic peptide called LB1 or a recombinant fusion protein immunogen
[LPD-LB1(f)(2,1,3)] could prevent otitis media after challenge with a homologous 
nontypeable Haemophilus influenzae (NTHI) isolate. NTHI residing in the
nasopharynx was rapidly cleared from this site, thus preventing it from ascending
the eustachian tube and inducing otitis media in chinchillas compromised by an
ongoing viral upper respiratory tract infection. While LB1 is based solely on one
NTHI adhesin, the latter immunogen, LPD-LB1(f)(2,1,3), was designed to
incorporate two NTHI antigens shown to play a role in the pathogenesis of otitis 
media; lipoprotein D (LPD) and the P5-homologous fimbrin adhesin. The design of
LPD-LB1(f)(2,1,3) also accommodated for the recently demonstrated existence of
three major groupings, based on amino acid sequence diversity, in the third
surface-exposed region of P5-fimbrin. LPD-LB1(f)(2,1,3) was thus designed to
potentially confer broader protection against challenge by diverse strains of
NTHI. Chinchillas were passively immunized here with serum specific for either
LB1 or for LPD-LB1(f)(2,1,3) prior to challenge with a member of all three groups
of NTHI relative to diversity in region 3. The transferred serum pools were also 
analyzed for titer, specificity, and several functional activities. We found that
both serum pools had equivalent ability to mediate C'-dependent killing and to
inhibit adherence of NTHI strains to human oropharyngeal cells. When passively
transferred, both serum pools significantly inhibited the signs and incidence of 
otitis media (P </= 0.01) induced by any of the three challenge isolates. Despite
providing protection against disease, the ability of these antisera to induce
total eradication of NTHI from the nasopharynx was not equivalent among NTHI
groups. These data thus suggested that while early, complete eradication of NTHI 
from the nasopharynx was highly protective, reduction of the bacterial load to
below a critical threshold level appeared to be similarly effective.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 10768970 [PubMed - indexed for MEDLINE]

2542: J Chemother. 2000 Feb;12(1):88-93.

Ceftazidime for outpatient parenteral antibiotic therapy (OPAT) of chronic
suppurative otitis media due to Pseudomonas aeruginosa.

Esposito S, Noviello S, Ianniello F, D'Errico G.

Clinica Malattie Infettive, Seconda Università degli Studi di Napoli, Naples,
Italy. silvanoesposito@mail.dex-net.com

The number of patients receiving parenteral antibiotic therapy outside the
hospital (OPAT) is growing rapidly, not only because of financial considerations,
but also to limit the risk of nosocomial infections, hospitalization trauma, and 
to improve the quality of life. The same benefits of OPAT have recently been
extended to pediatric patients. In the present study, the efficacy and safety of 
OPAT was evaluated in 52 children (age range 6-12 years) affected by chronic
suppurative otitis media (CSOM) whose parents were deemed compliant.
Otorhinolaryngologists and infectious disease specialists (IDS) cooperated in
diagnosing, managing patients and being available 24 hours a day for family
consultation. Bacteriological examination of ear exudate was carried out before
antibiotic treatment. For all 52 children the infection was caused by Pseudomonas
aeruginosa in vitro sensitive to ceftazidime. Ceftazidime was administered at the
dosage of 500 mg b.i.d. i.m. at the patient's home according to a self
administration model for 7-10 days. All patients returned every other day during 
the treatment course for clinical observation and cleansing of the ear, and 30
days after the end of the treatment (follow-up). Complete clinical cure and
bacteriological eradication were observed in 35 patients (67%), clinical
improvement in 12 (23%). No side-effects or hearing impairment were reported at
clinical and audiometric check-ups; compliance was absolute. Our data suggest
that children affected by CSOM can be managed as outpatients by a cooperative
team of otorhinolaryngologists and IDS.

PMID: 10768520 [PubMed - indexed for MEDLINE]

2543: J Chemother. 2000 Feb;12(1):79-87.

Efficacy and safety of amoxycillin/clavulanate (Augmentin) twice daily versus
three times daily in the treatment of acute otitis media in children. The
Augmentin 454 Study Group.

Damrikarnlert L, Jauregui AC, Kzadri M.

Children's Hospital, Bangkok, Thailand.

This multicenter, randomized, single-blind study compared the efficacy and safety
of a new, twice-daily formulation of amoxycillin/clavulanate (Augmenting) with
the standard three-times-daily formulation. Children with a clinical diagnosis of
acute otitis media, aged between 2 months and 12 years, received either
amoxycillin/clavulanate 45/6.4 mg/kg/day twice-daily (b.d.) (range
38.3/5.5-76.2/10.9 mg/kg/day) or amoxycillin/clavulanate 40/10 mg/kg/day
three-times-daily (t.d.s.) (range 25/6.25-56/14 mg/kg/day) for 7 or 10 days.
Patients were evaluated during therapy (Days 3-5), at the end of therapy (Days
7-12) and at follow-up (Days 38-42). At the end of therapy, for the
intent-to-treat and per-protocol populations, respectively, clinical success
(cure) was achieved by approximately 94% of patients in both treatment groups. A 
successful bacteriological response at the end of therapy (Visit 3) was
documented in 7/9 patients (77.8%) in the twice-daily group and in 11/13 patients
(84.6%) in the three-times-daily group. At follow-up (Visit 4), 93.3% of patients
in the twice-daily group and 87.9% in the three-times-daily group continued to
have a clinically successful response. Both treatment regimens were well
tolerated, with most adverse events being of a mild-moderate and transient
nature. The most common treatment-related adverse event was diarrhea, occurring
in 7.2% of patients in the twice-daily group and in 10.7% of the
three-times-daily group. In total, 173 patients (82.8%) in the twice-daily group 
and 151 patients (73.3%) in the three-times-daily group were compliant with
medication. In conclusion, this study confirms that b.d. amoxycillin/clavulanate 
is an effective treatment for pediatric acute otitis media and demonstrates that 
the b.d. and t.d.s. formulations of amoxycillin/clavulanate produce equivalent
efficacy. Furthermore, there was a trend towards a higher level of compliance and
a lower incidence of drug-related adverse events in the twice-daily compared with
the three-times-daily treatment group.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 10768519 [PubMed - indexed for MEDLINE]

2544: Int J Pediatr Otorhinolaryngol. 2000 Apr 15;52(2):163-7.

Pseudoaneurysm of a lateral internal carotid artery in the middle ear.

Henriksen SD, Kindt MW, Pedersen CB, Nepper-Rasmussen HJ.

Ear, Nose and Throat Department, Aarhus University Hospital, Norrebrogade 44,
DK-8000, Aarhus, Denmark.

We report a case where a 7-year-old girl suffered significant aural bleeding
following myringotomy of the tympanic membrane. Investigations by computed
tomography scan, carotid angiography, and magnetic resonance angiography showed a
lateral aberrant internal carotid artery (LACI) with a little pseudoaneurysm in
the middle ear. The anomaly of the internal carotid artery was supposed to be
congenital, and the pseudoaneurysm was supposed to be traumatic, formed after
incision into the wall of the artery. Considerations about diagnosis, symptoms,
and treatment are discussed. The patient was treated by balloon embolization in
the internal carotid artery without sequelae.

Publication Types: 
    Case Reports

PMID: 10767464 [PubMed - indexed for MEDLINE]

2545: Int J Pediatr Otorhinolaryngol. 2000 Apr 15;52(2):149-55.

Acute mastoiditis: predictors for surgery.

Kvestad E, Kvaerner KJ, Mair IW.

Department of Otorhinolaryngology, Ullevål University Hospital, N-0407, Oslo,
Norway.

To estimate the incidence of acute mastoiditis and identify predictors for
mastoid surgery, a retrospective case record study of 38 children hospitalised
for acute mastoiditis in Oslo from 1989 to 1998 was performed. Median age at
diagnosis was 18 months and 13 (34%) of the children received mastoidectomy.
Compared to the period 1970-1979, the incidence of mastoidectomy was
significantly reduced. Only seven children (18%) had experienced acute otitis
media prior to the current episode. Symptom duration of 6 days or more prior to
hospitalisation and elevated white blood cell counts and C-reactive Protein were 
predictive for mastoidectomy ((OR = 5.0 (1.0-22.8), (OR = 24.5 (2.5-240) and OR =
10.5 (1-108.8)). Furthermore, total time from symptom onset to hospital discharge
was significantly higher in children who received mastoidectomy. We suggest early
referral to an otolaryngologic department in children suspected of acute
mastoiditis.

Publication Types: 
    Comparative Study

PMID: 10767462 [PubMed - indexed for MEDLINE]

2546: Int J Pediatr Otorhinolaryngol. 2000 Apr 15;52(2):143-8.

Intracranial complications of acute mastoiditis.

Go C, Bernstein JM, de Jong AL, Sulek M, Friedman EM.

The Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences,
Baylor College of Medicine, One Baylor Plaza, SM 1727, Houston, TX, USA.
cgo@bcm.tmc.edu

OBJECTIVE: Oral antibiotic use may have changed the incidence and microbiology of
otitic intracranial complications. We reviewed cases of acute mastoiditis to
document: (1) incidence of intracranial complications; (2) risk factors; and (3) 
identify pathologic organisms. METHODS: A retrospective study of children at a
tertiary care children's hospital with acute mastoiditis from July, 1986 through 
June, 1998. RESULTS: 118 children with acute mastoiditis were identified. Eight
patients (6.8%), ages 20 months to 14 years, had intracranial complications
related to acute mastoiditis. Three children had a sigmoid sinus thrombosis, two 
children had an epidural abscess, and two children had both complications of
sigmoid sinus thrombosis and epidural abscess, and a sigmoid sinus thrombosis and
meningitis was present in one child. Pre-admission oral antibiotics were
administered for an average of 10 days in seven of the eight patients. Persistent
otorrhea and/or otalgia were present in all patients. Intraoperative cultures
were negative in four cases (50%). Organisms isolated included: Streptococcus
pneumoniae (2); Proteus mirabilis (1); Pseudomonas aeruginosa (1); and coagulase 
negative Staphylococcus (1). Multi-drug resistant organisms were documented in
only one case. All patients underwent a contrast enhanced CT of the temporal
bones and brain. Surgical management included complete mastoidectomy in all
patients and a pressure equalization tube in seven of the eight cases.
CONCLUSIONS: Our review did not document an increase in the incidence of otitic
intracranial complications. Persistent otalgia or otorrhea while on oral
antibiotics with associated neurologic symptoms are ominous signs suggestive of a
complication. Multi-drug resistant organisms are uncommon whereas negative
intraoperative cultures are common.

PMID: 10767461 [PubMed - indexed for MEDLINE]

2547: Int J Pediatr Otorhinolaryngol. 2000 Apr 15;52(2):131-41.

Variability of Eustachian tube function in children with secretory otitis media. 
Evaluations at tube insertion and at follow-up.

Bunne M, Falk B, Hellström S, Magnuson B.

Department of Otorhinolaryngology, Sunderby Hospital, S-971 80, Luleå, Sweden.
marie.bunne@nll.se

OBJECTIVE: Despite the variable clinical course of diseases related to Eustachian
tube function, the variability of tubal function has been less focused than
outcomes of single tests. This study aimed to compare the passive and active
tubal function and its variability in children with secretory otitis media (SOM) 
at tube insertion and at follow-up. METHOD: Thirty-eight ears in 19 children aged
4-10 years (mean 7.0 years) with long-standing SOM were examined 4-6 h after tube
insertion, at 4 months and at 9 months. The pressure in the middle ear and the
nasopharynx were recorded while performing (1) forced opening test, (2)
equalization of +100 and -100 daPa, (3) Valsalva test, and (4) sniff test. The
procedure was repeated after 30 min. Relationships were analyzed by uni- and
multi-variate analysis of variance. RESULTS: From tube insertion to 4 months, the
mean forced opening pressure increased from 282+/-128 to 355+/-153 daPa (P<0.01),
and the mean closing pressure from 91+/-51 to 126+/-82 daPa (P<0.01). There was
no further change at 9 months. Female gender, serous effusion (in contrast to
mucoid), and more than three previous episodes of acute otitis media were related
to higher opening and closing pressures. At tube insertion, 60% and 16% equalized
+100 and -100 daPa, respectively, and 28% succeeded in performing Valsalva
inflation. The sniff test was positive in 32%, indicating a closing failure.
These rates did not change significantly over time. For individual ears, outcomes
of all tests varied considerably when retested after 30 min; P(o) changed by
+/-12% and P(c) by +/-26%, and 9-29% of the ears changed from a positive to
negative response, or vice versa, in the equalization, Valsalva, and sniff tests.
CONCLUSIONS: The unexpected finding of weaker closing forces at the day of tube
insertion and increased tubal resistance at follow-up might be ascribed to
changes in the muco-adhesive forces related to the disease and tube treatment.
The pronounced intra-individual variability of test outcomes indicates that tubal
function is dynamic and variable in ears prone to SOM, which emphasizes that
results of single tubal function tests have very low prognostic value.

Publication Types: 
    Clinical Trial
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 10767460 [PubMed - indexed for MEDLINE]

2548: Laryngoscope. 2000 Apr;110(4):668-73.

Identification of MUC5B mucin gene in human middle ear with chronic otitis media.

Kawano H, Paparella MM, Ho SB, Schachern PA, Morizono N, Le CT, Lin J.

University of Minnesota Otitis Media Research Center, Department of
Otolaryngology, Minneapolis, USA.

OBJECTIVES: To identify the mucin gene and its expressing cells in the middle ear
mucosa with chronic otitis media (COM), and to study the correlation between
infiltration of inflammatory cells in the submucosa and expression of the mucin
gene in the mucosal epithelium with COM. STUDY DESIGN: Middle ear mucosal
specimens removed from the inferior promontory area of 19 patients undergoing
middle ear surgery for COM were studied. METHODS: Sections were stained with H&E,
Alcian blue-periodic acid Schiff (AB-PAS), polyclonal MUC5B antibody, and
specific MUC5B riboprobe for histological, histochemical, immunohistochemical,
and mucin mRNA analyses. RESULTS: H&E staining revealed pseudostratified
epithelia in 18 of the middle ear specimens with COM and cuboidal secretory
epithelia in one. AB-PAS staining of epithelia revealed abundant secretory cells 
and their products (glycoconjugates). In situ hybridization and
immunohistochemistry studies demonstrated that the secretory cells of the middle 
ear mucosa with COM expressed MUC5B mucin mRNA and its product MUC5B mucin.
CONCLUSIONS: The MUC5B mucin gene and its product were identified in the middle
ear secretory cells of patients with COM. Its expression was extensive in
pseudostratified mucosal epithelia and related to infiltration of inflammatory
cells in the submucosa of the middle ear cleft with COM, suggestive that
inflammatory cell products are involved in the production of MUC5B.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 10764016 [PubMed - indexed for MEDLINE]

2549: Laryngoscope. 2000 Apr;110(4):536-44.

Hearing results in pediatric patients with chronic otitis media after ossicular
reconstruction with partial ossicular replacement prostheses and total ossicular 
replacement prostheses.

Murphy TP.

OBJECTIVE: To examine hearing results in pediatric patients after ossicular
reconstruction with partial ossicular replacement prostheses (PORPs) and total
ossicular replacement prostheses (TORPs) in children with chronic otitis media.
METHODS: A retrospective chart review was performed on 55 pediatric patients with
chronic otitis media who underwent ossicular reconstruction from 1991 to 1998.
Patients' audiograms were evaluated preoperatively and postoperatively for
pure-tone average (PTA), air-bone gap (ABG), speech reception threshold (SRT),
method of ossicular reconstruction, and management of the mastoid. RESULTS:
Twenty-seven patients underwent ossicular reconstruction with TORPs. The average 
preoperative ABG was 40.1 dB, and the average postoperative ABG was 31.6 dB.
Forty-one percent of the children improved their PTA greater than 10 dB
postoperatively, and 52% of children did not change their ABG by more than 10 dB 
postoperatively. Nineteen percent of children with TORPs had a postoperative ABG 
less than 20 dB, and 44% of children with TORPs had a postoperative ABG less than
30 dB. Twenty-eight patients underwent ossicular reconstruction with PORPs. The
average preoperative ABG was 29.7 dB, and the average postoperative ABG was 22.5 
dB. Thirty-two percent of patients improved their PTA by greater than 10 dB,
while 57% of children with PORPs did not change their ABG by more than 10 dB
postoperatively. Forty-three percent of children with PORPs had an ABG of less
than 20 dB postoperatively, and 71% of children with PORPs had a postoperative
ABG less than or equal to 30 dB. CONCLUSIONS: Children who underwent ossicular
reconstruction with PORPs had slightly better postoperative hearing than did
children with TORPs. Postoperative hearing was essentially unchanged in
approximately 55% of both groups. Preoperative hearing levels may be the most
important factor determining postoperative hearing in nonstaged surgery for
children with chronic otitis media Long-term hearing results in children with
single-stage surgery were not as good as those reported in the literature for
staged surgery. Severe mucosal disease and eustachian tube dysfunction may
contribute to poorer hearing results in children.

Publication Types: 
    Comparative Study
    Review

PMID: 10763997 [PubMed - indexed for MEDLINE]

2550: J Infect Dis. 2000 Apr;181(4):1322-9. Epub 2000 Apr 7.

Acute otitis media caused by antibiotic-resistant Streptococcus pneumoniae in
southern Israel: implication for immunizing with conjugate vaccines.

Dagan R, Givon-Lavi N, Shkolnik L, Yagupsky P, Fraser D.

Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva
84101, Israel. rdagan@bgumail.bgu.ac.il

The potential coverage of antibiotic-resistant pneumococci causing acute otitis
media (AOM) by 7-, 9-, and 11-valent conjugate pneumococcal vaccines was studied 
in southern Israel. A total of 876 cases of pneumococcal AOM were studied in the 
context of various clinical conditions. Of the isolates, 68% were resistant to
>/=1 drug, 61% were resistant to penicillin, and 13% were resistant to >/=3
antibiotic classes. Antibiotic resistance and coverage by the various candidates 
were age and population dependent and were higher among those with a complicated 
clinical course, as indicated by recent antibiotic use and recurrence of AOM. The
results suggest that, if efficacious, the conjugate pneumococcal vaccines can
substantially reduce the occurrence of pneumococcal AOM in general and
complicated pneumococcal AOM in particular.

Publication Types: 
    Clinical Trial

PMID: 10753730 [PubMed - indexed for MEDLINE]

2551: Pediatr Infect Dis J. 2000 Mar;19(3):212-5.

Acute mastoiditis in children: an increase in frequency in Northern Virginia.

Bahadori RS, Schwartz RH, Ziai M.

Department of Otolaryngology, Inova Hospital for Children, Falls Church, VA, USA.

BACKGROUND: Acute mastoiditis is reported to occur 2 or 3 times annually in the
largest children's hospitals. We encountered an average of 1 case annually at our
hospital from 1986 to 1991. During an 8-year period ending October 31, 1999, 22
patients were diagnosed and treated at our hospital. Of these, 17 presented
during the last 34 months. METHODS: Retrospective chart review from office and
hospital records of children from infancy to age 12 years with a discharge
diagnosis of acute mastoiditis who were treated from 1992 through 1999. RESULTS: 
All children were referred to one of the two pediatric otolaryngologists in our
community because of forward protrusion of the auricle and retroauricular
cellulitis. Eleven (50%) were <14 months old. Ninety-five percent had a
concomitant ipsilateral, inflamed, bulging, immobile eardrum. Computerized
tomographic imaging, performed on all patients, revealed universal cortical
destruction, subperiosteal abscess or bone destruction in four and dural venous
thrombosis in two. Mastoidectomy was necessary for eight children (36%) because
of complications of mastoiditis (n = 4) or for failure to improve with
antibiotics and myringotomy drainage (n = 4). Streptococcus pneumoniae or
Streptococcus pyogenes was recovered from 10 of 17 children (59%) from whom
cultures were obtained. CONCLUSION: Cases of acute mastoiditis have markedly
increased in our suburban children's hospital. The disease was most common during
infancy. Serious complications of mastoiditis occurred in four (18%) of the
children in this series.

PMID: 10749461 [PubMed - indexed for MEDLINE]

2552: Pediatr Infect Dis J. 2000 Mar;19(3):187-95.

Comment in:
    Pediatr Infect Dis J. 2000 Mar;19(3):181-2.    Pediatr Infect Dis J. 2000 Mar;19(3):183-6.

Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine
in children. Northern California Kaiser Permanente Vaccine Study Center Group.

Black S, Shinefield H, Fireman B, Lewis E, Ray P, Hansen JR, Elvin L, Ensor KM,
Hackell J, Siber G, Malinoski F, Madore D, Chang I, Kohberger R, Watson W,
Austrian R, Edwards K.

Kaiser Permanente Vaccine Study Center, Oakland, CA 94612, USA.
Steve.Black@kp.org

OBJECTIVE: To determine the efficacy, safety and immunogenicity of the
heptavalent CRM197 pneumococcal conjugate vaccine against invasive disease caused
by vaccine serotypes and to determine the effectiveness of this vaccine against
clinical episodes of otitis media. METHODS: The Wyeth Lederle Heptavalent CRM197 
(PCV) was given to infants at 2, 4, 6 and 12 to 15 months of age in a double
blind trial; 37,868 children were randomly assigned 1:1 to receive either the
pneumococcal conjugate vaccine or meningococcus type C CRM197 conjugate. The
primary study outcome was invasive disease caused by vaccine serotype. Other
outcomes included overall impact on invasive disease regardless of serotype,
effectiveness against clinical otitis media visits and episodes, impact against
frequent and severe otitis media and ventilatory tube placement. In addition the 
serotype-specific efficacy against otitis media was estimated in an analysis of
spontaneously draining ears. RESULTS: In the interim analysis in August, 1998, 17
of the 17 cases of invasive disease caused by vaccine serotype in fully
vaccinated children and 5 of 5 of partially vaccinated cases occurred in the
control group for a vaccine efficacy of 100%. Blinded case ascertainment was
continued until April, 1999. As of that time 40 fully vaccinated cases of
invasive disease caused by vaccine serotype had been identified, all but 1 in
controls for an efficacy of 97.4% (95% confidence interval, 82.7 to 99.9%), and
52 cases, all but 3 in controls in the intent-to-treat analysis for an efficacy
of 93.9% (95% confidence interval, 79.6 to 98.5%). There was no evidence of any
increase of disease caused by nonvaccine serotypes. Efficacy for otitis media
against visits, episodes, frequent otitis and ventilatory tube placement was 8.9,
7.0, 9.3 and 20.1% with P < 0.04 for all. In the analysis of spontaneously
draining ears, serotype-specific effectiveness was 66.7%. CONCLUSION: This
heptavalent pneumococcal conjugate appears to be highly effective in preventing
invasive disease in young children and to have a significant impact on otitis
media.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 10749457 [PubMed - indexed for MEDLINE]

2553: J Laryngol Otol. 2000 Feb;114(2):97-100.

The complications of chronic otitis media: report of 93 cases.

Osma U, Cureoglu S, Hosoglu S.

Department of Otorhinolaryngology and Clinical Microbiology, Dicle University,
School of Medicine, Diyarbakir, Turkey. uosma@hotmail.com

The aim of this study was to investigate the incidence, mortality and morbidity
of complications due to chronic otitis media (COM). During the nine-year period
1990-1999, 2890 cases of COM were reviewed, 93 (3.22 per cent) having 57 (1.97
per cent) intracranial complications (IC) and 39 (1.35 per cent) extracranial
complications (EC). In three patients more than one complication was observed.
Meningitis and brain abscess were common in the IC group. Subperiosteal abscess
(mastoid and Bezold's abscess) was a common complication in the EC group.
Cholesteatoma and granulation/polyp in the middle ear/mastoid were the major
findings in both groups. Fifteen patients died from IC. Overall, the mortality
rate was 16.1 per cent in all patients having complications, and in patients with
IC it was 26.3 per cent. In all of the patients with complications, the morbidity
rate was 11.8 per cent. Our study supports the finding that meningitis and brain 
abscess are the common complications of COM and the main reason for mortality.

PMID: 10748823 [PubMed - indexed for MEDLINE]

2554: J Clin Microbiol. 2000 Apr;38(4):1628-31.

Molecular phylogenetic evidence for noninvasive zoonotic transmission of
Staphylococcus intermedius from a canine pet to a human.

Tanner MA, Everett CL, Youvan DC.

Kairos Scientific Inc., Santa Clara, California 95054, USA.
mtanner@kairos-scientific.com

rRNA-based molecular phylogenetic techniques were used to identify the bacterial 
species present in the ear fluid from a female patient with otitis externa. We
report the identification of Staphylococcus intermedius from the patient and a
possible route of transmission. Analysis of 16S ribosomal DNA restriction
fragment length polymorphisms indicated that the dominant species present was S. 
intermedius. A pet dog owned by the patient also was tested and found to harbor
S. intermedius. In humans, the disease is rare and considered a zoonosis.
Previously, S. intermedius has been associated with dog bite wounds,
catheter-related injuries, and surgery. This study represents the first reported 
case of a noninvasive infection with S. intermedius.

Publication Types: 
    Case Reports
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 10747154 [PubMed - indexed for MEDLINE]

2555: Med Mycol. 2000 Feb;38(1):73-6.

Proteinase, phospholipase, hyaluronidase and chondroitin-sulphatase production by
Malassezia pachydermatis.

Coutinho SD, Paula CR.

Microbiology Department, University of São Paulo, Brazil. selene@uol.com.br

The production of four functional enzyme categories was investigated in 30
strains of Malassezia pachydermatis isolated from dogs with otitis or dermatitis.
The most appropriate reading intervals for these assays were determined with the 
aid of statistical comparisons. All strains produced proteinase and
chondroitin-sulphatase; hyaluronidase and phospholipase were produced by all skin
isolates (15/15) and 14 out of 15 ear canal isolates. Strains from ear canals did
not differ significantly as a group from skin strains in quantitative production 
of any of the four enzymes; production of proteinase and chondroitin-sulphatase
in particular was markedly uniform.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10746230 [PubMed - indexed for MEDLINE]

2556: Ear Nose Throat J. 2000 Mar;79(3):176-7.

Description of an office technique for laser ventilation of the ears.

Siegel GJ.

Northwestern University Medical School, Chicago, IL, USA. gsiege@pol.net

The author presents a description of a technique he developed called laser office
ventilation of ears (LOVE). LOVE, an office-based procedure performed under local
anesthesia, can provide intermediate-term ventilation for middle ear disease.
This procedure has potential to change the standard of care for otitis media.
Such changes might include a decrease in the need for antibiotics (and thus
antibiotic resistance), a decrease in hearing loss associated with otitis media, 
and a decrease in the overall cost of treatment.

PMID: 10743763 [PubMed - indexed for MEDLINE]

2557: Otolaryngol Head Neck Surg. 2000 Apr;122(4):514-20.

Bacteria-mucin interaction in the upper aerodigestive tract shows striking
heterogeneity: implications in otitis media, rhinosinusitis, and pneumonia.

Bernstein JM, Reddy M.

Departments of Otolaryngology and Pediatrics, School of Medicine and Biomedical
Sciences, State University of New York at Buffalo, Buffalo, NY, USA.

The mucociliary system of the upper and lower respiratory tracts is a critical
nonspecific pathway for the elimination of bacteria and other particulate matter.
The interaction between bacteria and purified mucin of the upper and lower
respiratory tracts has been a major focus of our laboratory for the past decade. 
We have previously demonstrated that nontypable Haemophilus influenzae and
Moraxella catarrhalis adhere to human purified nasopharyngeal mucin and human
middle ear mucin by a very limited number of specific outer membrane proteins.
There have been no previous studies on the interaction of Streptococcus
pneumoniae and purified mucin. Such information would be of extreme importance in
identifying specific mechanisms of preventing colonization of this important
pathogen to nasopharyngeal mucin. Using an overlay technique of purified
radiolabeled mucins of the upper and lower respiratory tracts in a solid phase
assay with 4 predominant pathogens of the upper and lower respiratory tracts, we 
found a striking heterogeneity of bacteria-mucin interaction. The implications of
these interactions in the development of otitis media, rhinosinusitis, and lower 
respiratory infections are briefly discussed.

PMID: 10740170 [PubMed - indexed for MEDLINE]

2558: Otolaryngol Head Neck Surg. 2000 Apr;122(4):477-81.

External and middle ear effects on infant hearing screening test results.

Doyle KJ, Rodgers P, Fujikawa S, Newman E.

University of California Irvine Medical Center, CA, USA.

This study investigated the relationship between external and middle ear factors 
and hearing screening results by automated auditory brain stem response (ABR) and
transient-evoked otoacoustic emissions (EOAEs). The ears of 200 healthy newborns 
aged 5 to 48 hours underwent screening by ABR and EOAE, followed by otoscopic
examination. The pass rates for ABR and EOAE were 91% and 58.5%, respectively. On
otoscopic examination, 28% (112/400) ears had occluding vernix obscuring the view
of the tympanic membrane. Cleaning of vernix was successfully performed in all
but 2 ears that had occluding vernix. Cleaning of vernix significantly increased 
the pass rates of all 400 ears for ABR and EOAE to 96% and 69%. Decreased
tympanic membrane mobility was found in 22.7% (90/396) of ears that were
evaluated otoscopically. Decreased tympanic membrane mobility had a significant
effect on EOAE screening; only 33.4% of ears passed EOAE testing. Decreased
tympanic membrane mobility did not significantly affect pass rates for ABR
screening; 95% of these ears passed the automated ABR screen. Implications for
newborn hearing screening are discussed.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10740164 [PubMed - indexed for MEDLINE]

2559: Ann Otol Rhinol Laryngol. 2000 Mar;109(3):249-54.

Validation of outcomes survey for adults with chronic suppurative otitis media.

Wang PC, Nadol JB Jr, Merchant S, Austin E, Gliklich RE.

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston 02114, 
USA.

Currently, there is no valid, disease-specific outcomes measure to evaluate
health impact and treatment effectiveness for patients with chronic suppurative
otitis media (CSOM). The Chronic Ear Survey (CES) is a new, disease-specific
outcomes measure for CSOM that was administered in a prospective manner to 91
patients with CSOM. It was then validated according to established criteria for
reliability, validity, and sensitivity to clinical change by correlation with
objective data and self-assessment questionnaires such as the Hearing Handicap
Inventory for Adults (HHIA) and the generic 36-Item Short-Form Health Survey
(SF-36). Significant correlations between subscale scores of the CES and
audiometric data and between subscale scores of the HHIA and SF-36 were found.
The standardized response mean for the CES total score was 0.42, indicating
moderate sensitivity to clinical change. Overall, results demonstrated that the
CES is a reliable and valid instrument for investigation of health status and
health-related quality-of-life outcomes.

PMID: 10737305 [PubMed - indexed for MEDLINE]

2560: Auris Nasus Larynx. 2000 Apr;27(2):117-20.

Long-term observation on hearing change in patients with chronic otitis media.

Sakagami M, Maeda A, Node M, Sone M, Mishiro Y.

Department of Otolaryngology, Hyogo College of Medicine, Nishinomiya City, Japan.
msakaga@hyo-med.ac.jp

OBJECTIVE: Very few reports are available in the literature to clarify the
natural long course of hearing change in an individual patient with chronic
otitis media (COM). We reviewed hearing change in patients suffering from
perforated COM without an operation. METHODS: Eighty-seven ears of 70 patients
had COM with tympanic perforation and were observed without an operation. The
mean follow-up period was 10.7 years (5-22 years) and the mean age at the first
examination was 51.3 years. To minimize the effect of aging, 23 patients with
normal ear drums on the other side were further analyzed. RESULTS: All 87 ears
tended to show deterioration of hearing gradually under long observation. In 23
patients, hearing deterioration was 0.13 dB/year in the control side and 0.61
dB/year in the COM side (P < 0.02). Although elevation of bone conduction hearing
level tended to be larger at high frequencies than at low and middle frequencies,
there was no significant difference between COM and normal ears. CONCLUSIONS: Air
conduction hearing levels deteriorated with the passage of time and surgery is
recommended at the early stage of COM to prevent progress of hearing loss.

PMID: 10733138 [PubMed - indexed for MEDLINE]

2561: Audiol Neurootol. 2000 Mar-Apr;5(2):64-8.

A study of tea tree oil ototoxicity.

Zhang SY, Robertson D.

Auditory Laboratory, Department of Physiology, University of Western Australia,
Nedlands, Australia.

Tea tree oil shows promise as an effective treatment for a number of
micro-organisms commonly associated with otitis externa and otitis media, but its
possible ototoxicity has not been previously assessed. The ototoxicity of tea
tree oil was examined in the guinea pig by measuring the thresholds of the
compound auditory nerve action potential (CAP) to tone bursts before and after
instillation of the oil into the middle ear. After 30 min of instillation, 100%
tea tree oil caused a partial CAP threshold elevation at 20 kHz. A lower
concentration of oil [2% tea tree oil dissolved in saline using 0.5% detergent
(Tween-80)] did not cause any significant lasting threshold change after middle
ear instillation for the same period of time. The latter concentration of oil is 
greater than the minimum inhibitory concentration reported for most
micro-organisms in the effective spectrum of the oil and this suggests that this 
concentration may be safe and effective provided only short exposures (about 30
min) are used. The results suggest that high concentrations of tea tree oil
applied to the round window for a relatively short time are to some extent
ototoxic to the high-frequency region of the cochlea. Hence further study is
needed to establish whether tea tree oil can be used with safety in the treatment
of external and middle ear infections. Copyright 2000 S. Karger AG, Basel.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10720822 [PubMed - indexed for MEDLINE]

2562: Laryngoscope. 2000 Mar;110(3 Pt 1):342-5.

Adenoidectomy with laser or incisional myringotomy for otitis media with
effusion.

Szeremeta W, Parameswaran MS, Isaacson G.

Department of Otorhinolaryngology and Bronchoesophagology, Temple University
School of Medicine, and the Temple University Children's Medical Center,
Philadelphia, Pennsylvania 19140, USA.

OBJECTIVE: To compare the effectiveness of CO2 laser myringotomy to incisional
myringotomy at the time of adenoidectomy for refractory otitis media with
effusion (OME). STUDY DESIGN: Controlled retrospective consecutive case series.
METHODS: All children undergoing myringotomy and adenoidectomy for OME in the
spring of 1999 had 1.7-mm-diameter perforations created in their tympanic
membranes using a CO2 laser and conventional microslad. Their ears were evaluated
at first postoperative visit (mean, 16.65 days after surgery) by a validated
otoscopist to determine the presence or absence of perforations and middle ear
effusions. These patients were compared with historical controls comprising all
children undergoing incisional myringotomy and adenoidectomy in 1998. A chi2
analysis was performed to compare the results of these two myringotomy
techniques. RESULTS: Twenty-three children (39 ears) underwent laser myringotomy 
and adenoidectomy in 1999, compared with 26 children (48 ears) who underwent
incisional myringotomy and adenoidectomy in 1998. In the laser myringotomy group,
8 of the 39 ears had a persistent opening at first follow-up; 4 of the 39 ears
showed evidence of effusion. In the incisional myringotomy group, all 48 ears had
healed; 7 of these ears showed evidence of effusion. CONCLUSION: Myringotomies
created using the CO2 laser are more likely to be patent at first postoperative
visit than those made with incisional technique (P < .01). However, this
prolonged middle ear ventilation does not significantly decrease the prevalence
of effusion (P > .1).

Publication Types: 
    Comparative Study

PMID: 10718416 [PubMed - indexed for MEDLINE]

2563: Laryngoscope. 2000 Mar;110(3 Pt 3):32-5.

Outcomes assessment for chronic otitis media: the Chronic Ear Survey.

Nadol JB Jr, Staecker H, Gliklich RE.

Department of Otology and Laryngology, Harvard Medical School, and Massachusetts 
Eye and Ear Infirmary, Boston 02114, USA.

Analysis of outcomes in chronic otitis media has in the past been limited to
audiological measurement or physical examination. The Chronic Ear Survey (CES) is
an instrument to measure the impact of chronic otitis media and its treatment.
The survey provides information regarding total ear-specific health, as well as
subscore information regarding activity restriction, symptoms, and medical
resource usage attributable to chronic otitis media Application of the CES to a
prospective, nonrandomized series of 147 patients revealed that patients with
chronic otitis media have significantly decreased CES scores compared with
unaffected controls and that surgical intervention provides a significant
improvement in ear-specific outcomes.

Publication Types: 
    Comparative Study

PMID: 10718413 [PubMed - indexed for MEDLINE]

2564: J Med Assoc Thai. 2000 Jan;83(1):61-8.

Comparison of ofloxacin otic solution with oral amoxycillin plus chloramphenicol 
ear drop in treatment of chronic suppurative otitis media with acute
exacerbation.

Supiyaphun P, Kerekhanjanarong V, Koranasophonepun J, Sastarasadhit V.

Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand.

The efficacy and safety of 0.3 per cent Ofloxacin otic solution (OFLX) 6 drops
twice daily was compared with those of oral Amoxycillin 500 mg three times daily 
plus 1 per cent Chloramphenicol ear drop at 3 drops three times daily (AMOX +
CRP) in a two-week treatment of chronic suppurative otitis media (CSOM) with
acute exacerbation. 80 adult patients were enrolled in a prospective, randomized,
investigator-blind study at the outpatient ENT service of Chulalongkorn
University Hospital. The most common pathogens isolated at the pretreatment visit
were Staphylococcus aureus (30.3%) and Pseudomonas aeruginosa (24.7%). The
susceptibility of all the pathogenic isolates to ofloxacin, amoxycillin and
chloramphenicol were 96.4, 57.1 and 51.8 per cent respectively. The overall
response expressed as an improvement or cure of otalgia, otorrhea and middle ear 
mucosal inflammation was recorded. It revealed that the improvement rate of the
OFLX-treated patients was better than that of AMOX + CRP-treated, but was not
statistically significant. However, the cure rate was significantly better in
OFLX-treated than in AMOX + CRP-treated groups in terms of painless (p = 0.05)
and dry (p < 0.001) ears. Ototoxicity was assessed by an elevation in bone
conduction threshold (BC) and/or speech reception threshold (SRT) of greater than
5 dB or a presence of high tone hearing loss resulting from treatments. A
significant decrease in BC and SRT was revealed in OFLX-treated ears (p < 0.0001;
p = 0.002 respectively) but a significant elevation of BC was found in AMOX +
CRP-treated ears (p = 0.007). The ototoxic rate was significantly higher in AMOX 
+ CRP-treated than in OFLX-treated ears whether assessed by BC (p < 0.001) or SRT
(p = 0.03). In conclusion, OFLX was more effective and safer than AMOX + CRP in
the treatment of CSOM with acute exacerbation.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 10710871 [PubMed - indexed for MEDLINE]

2565: Environ Health Perspect. 2000 Mar;108(3):205-11.

Susceptibility to infections and immune status in Inuit infants exposed to
organochlorines.

Dewailly E, Ayotte P, Bruneau S, Gingras S, Belles-Isles M, Roy R.

Unité de Recherche en Santé Publique, Centre Hospitalier Universitaire de Québec,
Pavillon CHUL, Beauport, Québec, Canada. edewailly@cspq.qc.ca

We investigated whether organochlorine exposure is associated with the incidence 
of infectious diseases in Inuit infants from Nunavik (Arctic Quebec, Canada). We 
compiled the number of infectious disease episodes during the first year of life 
for 98 breast-fed and 73 bottle-fed infants. Concentrations of organochlorines
were measured in early breast milk samples and used as surrogates to prenatal
exposure levels. Immune system parameters were determined in venous blood samples
collected from infants at 3, 7, and 12 months of age. Otitis media was the most
frequent disease, with 80. 0% of breast-fed and 81.3% of bottle-fed infants
experiencing at least one episode during the first year of life. During the
second follow-up period, the risk of otitis media increased with prenatal
exposure to p,p'-DDE, hexachlorobenzene, and dieldrin. The relative risk (RR) for
4- to 7-month-old infants in the highest tertile of p, p'-DDE exposure as
compared to infants in the lowest tertile was 1. 87 [95% confidence interval
(CI), 1.07-3.26]. The RR of otitis media over the entire first year of life also 
increased with prenatal exposure to p,p'-DDE (RR, 1.52; CI, 1.05-2.22) and
hexachlorobenzene (RR, 1.49; CI, 1.10-2.03). Furthermore, the RR of recurrent
otitis media ( [Greater/equal to] 3 episodes) increased with prenatal exposure to
these compounds. No clinically relevant differences were noted between breast-fed
and bottle-fed infants with regard to immunologic parameters, and prenatal
organochlorine exposure was not associated with immunologic parameters. We
conclude that prenatal organochlorine exposure could be a risk factor for acute
otitis media in Inuit infants.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10706525 [PubMed - indexed for MEDLINE]

2566: J Antimicrob Chemother. 2000 Mar;45(3):311-4.

Therapeutic effects of parenteral beta-lactam antibiotics on experimental otitis 
media caused by penicillin-resistant Streptococcus pneumoniae in guinea-pigs.

Hori R, Araki H, Yonezawa M, Minami S, Watanabe Y.

Research Laboratories, Toyama Chemical Co. Ltd, 2-4-1 Shimookui, Toyama City,
Toyama 930-8508, Japan.

The therapeutic effects of parenteral beta-lactam antibiotics were evaluated in
experimental acute otitis media caused by penicillin-resistant Streptococcus
pneumoniae (PRSP) in guinea-pigs. Cefotaxime, ceftriaxone and piperacillin
significantly reduced viable cell counts of PRSP in the middle ear at a dose of
50 mg/kg bd for 3 days (P < 0.01 compared with control). The therapeutic effects 
of cefotaxime, ceftriaxone and piperacillin were superior to those of cefotiam
and ceftazidime. These therapeutic effects reflected both in vitro activity and
pharmacokinetic properties of the drugs.

PMID: 10702549 [PubMed - indexed for MEDLINE]

2567: Otolaryngol Head Neck Surg. 2000 Mar;122(3):349-51.

Conductive hearing loss associated with pressure equalization tubes.

Estrem SA, Batra PS.

Division of Otolaryngology, Department of Surgery, University of Missouri School 
of Medicine, Columbia, MO 65212, USA.

Pressure equalization (PE) tube placement traditionally has been used to lessen
conductive hearing loss with chronic middle ear effusion. It is assumed that the 
small diameter of the tube should not interfere with the conduction of sound. In 
this article we present 5 patients in whom placement of a PE tube resulted in
significantly worse conductive hearing. Occlusion of the PE tube with cigarette
paper or Gelfoam improved hearing, as documented with audiometry. The average
conductive hearing losses attributable to the ventilation tube for this series of
patients were 22, 17, 15, 13, 4, and 10 dB at the frequencies of 250, 500, 1000, 
2000, 4000, and 8000 Hz, respectively. This amount of change attributable to PE
tubes in this small selection of patients is much greater than would be commonly 
appreciated. We conclude that the opening in the tympanic membrane provided by PE
tubes can potentially result in a significant conductive hearing loss. Discussion
includes those conditions in which reduced hearing may be more likely to occur.

PMID: 10699808 [PubMed - indexed for MEDLINE]

2568: Otolaryngol Head Neck Surg. 2000 Mar;122(3):330-3.

Tympanostomy tubes and otic suspensions: do they reach the middle ear space?

Hebert RL 2nd, Vick ML, King GE, Bent JP 3rd.

Division of Otolaryngology, Medical College of Georgia, USA.

The treatment of patients with tympanostomy tubes (TTs) and otorrhea with
medicated otic suspensions is well known, but confirmation of penetration into
the middle ear is difficult. To address this question, we created an in vitro
model of the human head and ear and then tested it with 5 different types of
liquid exposure: tap water, soapy water, polymyxin B sulfate (Cortisporin),
tobramycin and dexamethasone (TobraDex), and ciprofloxacin (Cipro) suspensions. A
positive test result corresponded to liquids entering the middle ear through the 
TT. No positive test result was elicited with tap water (0/20), but soapy water
did enter the middle ear (10/40) and was statistically significant (P = 0.0112). 
Without the use of slight tragal pressure, Cortisporin, TobraDex, and Cipro drops
did not consistently pass through the TT (0/20, 1/25, 1/25). By placing the drops
with the addition of tragal pressure, a statistically significant difference was 
obtained for each solution (20/20, 20/20, and 20/20, respectively [P < 0.0001]). 
We conclude that with a clean external auditory canal, patent TT, and no middle
ear fluid, medicated otic suspensions enter the middle ear only when combined
with slight tragal pressure.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10699804 [PubMed - indexed for MEDLINE]

2569: J Clin Microbiol. 2000 Mar;38(3):1263-6.

Otitis externa associated with Malassezia sympodialis in two cats.

Crespo MJ, Abarca ML, Cabañes FJ.

Departament de Patologia i Producció Animals (Microbiologia), Facultat de
Veterinària, Universitat Autònoma de Barcelona, 08193-Bellaterra (Barcelona),
Spain.

The lipid-dependent species Malassezia sympodialis was isolated from two cats
with otitis externa. To our knowledge, this is the first report of the isolation 
of lipid-dependent species of the genus Malassezia associated with skin disease
in domestic animals.

Publication Types: 
    Case Reports

PMID: 10699037 [PubMed - indexed for MEDLINE]

2570: Vet Radiol Ultrasound. 2000 Jan-Feb;41(1):46-9.

Magnetic resonance imaging of otitis media in a dog.

Dvir E, Kirberger RM, Terblanche AG.

Department of Medicine, Onderstepoort Veterinary Academic Hospital, University of
Pretoria, Republic of South Africa.

Otitis media/interna was diagnosed in a 20-month-old German shepherd with the
assistance of magnetic resonance (MR) imaging. The MR images were acquired
primarily to exclude a brain lesion responsible for vestibular signs. No brain
lesion was detected, but obvious signs of chronic changes in the left bulla and
external ear canal were confirmed. Thickening of the epithelium and soft tissue
surrounding the external ear canal and a laminated appearance of high and low T2 
intensities in the tympanic bulla's mucosa were present. The hypointense lines
were suspected to be fibrous tissue, indicating chronic changes. This report
suggests that MR imaging may serve as a useful imaging tool for otitis media and 
that it supplies information not obtained with radiography or computed
tomography.

Publication Types: 
    Case Reports

PMID: 10695880 [PubMed - indexed for MEDLINE]

2571: Pediatr Infect Dis J. 2000 Feb;19(2):95-104.

Erratum in:
    Pediatr Infect Dis J 2000 Apr;19(4):275.

Bacteriologic and clinical efficacy of amoxicillin/clavulanate vs. azithromycin
in acute otitis media.

Dagan R, Johnson CE, McLinn S, Abughali N, Feris J, Leibovitz E, Burch DJ, Jacobs
MR.

Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion
University of the Negev, Beer-Sheva, Israel. rdagan@bgumail.bgu.ac.il

OBJECTIVES: To compare the bacteriologic and clinical efficacy of
amoxicillin/clavulanate and azithromycin in patients with acute otitis media
(AOM), particularly the ability to eradicate the predominant AOM pathogens from
middle ear fluid as assessed by mandatory second tympanocentesis. METHODS: In
this single blind study 238 infants and children with AOM were randomized to
receive amoxicillin/clavulanate (45/6.4 mg/kg/day in two divided doses for 10
days) or azithromycin (10 mg/kg on Day 1, then 5 mg/kg daily on Days 2 through
5). Tympanocentesis was performed before the first dose and repeated on Day 4, 5 
or 6. Clinical response was assessed at end of therapy between Days 12 and 14 and
at follow-up between Days 22 and 28. RESULTS: Amoxicillin/clavulanate was
significantly more likely to eradicate all bacterial pathogens [83% (54 of 65)
vs. 49% (35 of 71), P = 0.001] and Haemophilus influenzae [87% (26 of 30) vs. 39%
(13 of 33), P = 0.0001] from middle ear fluid than was azithromycin.
Amoxicillin/clavulanate was also more likely to eradicate Streptococcus
pneumoniae, but the difference was not statistically significant [90% (18 of 20) 
vs. 68% (13 of 19) [corrected], P = 0.095]. On Days 12 to 14, signs and symptoms 
were more likely to resolve completely or improve in all culture-positive
patients [86% (60 of 70) vs. 70% (51 of 73), P = 0.023] and in those with H.
influenzae infections [91% (30 of 33) vs. 65% (22 of 34), P = 0.010] who received
amoxicillin/clavulanate compared with those who received azithromycin. Otherwise 
there were no significant differences between groups in clinical outcomes on Days
12 to 14 or at follow-up. CONCLUSIONS: Our findings indicate that
amoxicillin/clavulanate has superior bacteriologic and clinical efficacy compared
with azithromycin in children with AOM.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 10693993 [PubMed - indexed for MEDLINE]

2572: Clin Ther. 2000 Jan;22(1):29-39.

Antimicrobial therapy of acute otitis media: review of treatment recommendations.

Aronovitz GH.

Emory University Medical School, Atlanta, Georgia, USA.

OBJECTIVE: This paper reviews 3 previously published articles that provided
recommendations for antimicrobial therapy of acute otitis media (AOM) and
combines them to provide revised recommendations. BACKGROUND: AOM is one of the
most common pediatric infections requiring a prescription for an antimicrobial
agent. The optimal approach to treatment of AOM requires early, efficacious, and 
practical therapy. Several experts and organizations have developed
recommendations for the management of AOM, but the number of these may overwhelm 
the busy primary care practitioner. A MEDLINE search of the pediatric and
infectious disease literature on AOM treatment recommendations was used to select
3 representative, previously published articles for this review. When selecting
an agent, physicians should consider in vitro activity, particularly against
drug-resistant Streptococcus pneumoniae; pharmacokinetics; adverse events;
palatability of the suspension; and cost. In addition, physicians' clinical
experience is an important determinant. CONCLUSIONS: Amoxicillin is recommended
as the first-line agent to treat uncomplicated AOM. For clinical treatment
failures after 3 days of amoxicillin, recommended antimicrobial agents include
oral amoxicillin/clavulanate, cefuroxime axetil, cefprozil, cefpodoxime proxetil,
and intramuscular (i.m.) ceftriaxone. I.m. ceftriaxone should be reserved for
severe cases or patients in whom noncompliance is expected. Tympanocentesis for
identification of pathogens and susceptibility to antimicrobial agents is
recommended for selection of third-line agents.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 10688388 [PubMed - indexed for MEDLINE]

2573: Arch Otolaryngol Head Neck Surg. 2000 Feb;126(2):174-6.

Aerobic and anaerobic bacteriology of concurrent chronic otitis media with
effusion and chronic sinusitis in children.

Brook I, Yocum P, Shah K.

Department of Pediatrics, Georgetown University School of Medicine, Washington,
DC, USA. dribrook@yahoo.com

OBJECTIVE: To correlate the aerobic and anaerobic microbiologic findings of
concurrent chronic otitis media with effusion and chronic maxillary sinusitis.
METHODS: Cultures were obtained from 32 children with concurrent chronic otitis
media with effusion and maxillary sinusitis who underwent tympanostomy tube
placement. RESULTS: A total of 42 isolates, 24 aerobic and 18 anaerobic, were
recovered from 30 patients; 27 were isolated from both sites, 4 from the ear
only, and 11 from the sinus only. The most common isolates were Haemophilus
influenzae (9 isolates), Streptococcus pneumoniae (n = 7), Prevotella species (n 
= 8), and Peptostreptococcus species (n = 6). Microbiological concordance between
the ear and sinus was found in 22 (69%) of culture-positive patients. CONCLUSION:
The concordance in recovery of organisms in more than two thirds of the patients 
illustrates the common bacterial etiology between chronic otitis media with
effusion and chronic sinusitis in children.

PMID: 10680868 [PubMed - indexed for MEDLINE]

2574: Arch Otolaryngol Head Neck Surg. 2000 Feb;126(2):165-73.

Treatment of chronic suppurative otitis media with topical tobramycin and
dexamethasone.

Alper CM, Dohar JE, Gulhan M, Ozunlu A, Bagger-Sjobak D, Hebda PA, Swarts JD.

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh,
University of Pittsburgh, PA 15213, USA. alperc@pitt.edu

OBJECTIVES: To investigate the safety and efficacy of a topical combination of
tobramycin and dexamethasone in a primate model of chronic suppurative otitis
media (CSOM) and to explore the contribution of the added topical steroid for the
treatment of CSOM. DESIGN: Blinded, randomized, placebo-controlled trial.
SUBJECTS: Sixty juvenile cynomolgus monkeys randomized into the following 6
treatment groups of 10 monkeys each: 0.3% tobramycin (group 1), combined 0.3%
tobramycin-0.1% dexamethasone (group 2), combined 1.0% tobramycin-0.33%
dexamethasone (group 3), 0.1% dexamethasone (group 4), vehicle (group 5), and
phosphate-buffered saline solution (group 6). INTERVENTIONS: Chronic suppurative 
otitis media was established by inoculating the right ear with Pseudomonas
aeruginosa. After 4 weeks of drainage, animals were treated according to the
group assignment with 3 drops twice daily for 7 weeks. Hearing thresholds were
monitored with repeated auditory brainstem response testing (ABR), and clinical
response was monitored with repeated otoscopic examinations and cultures
throughout the study. Cytocochleograms were evaluated for quantification of outer
hair cell loss. RESULTS: Rapid resolution of otorrhea and eradication of P
aeruginosa occurred in all groups receiving tobramycin. The inclusion of
dexamethasone accelerated the resolution of otorrhea and negative yields of
cultures compared with tobramycin alone. Otorrhea and positive culture findings
persisted in the groups not treated with topical antibiotic. Results of ABRs at 4
and 8 weeks and cytocochleograms for outer cell hair loss were not affected by
drug administration. Perilymph samples collected at the end of the study showed
no detectable tobramycin. CONCLUSIONS: Combined tobramycin-dexamethasone ear
drops were safe and effective in the monkey CSOM model. Dexamethasone enhanced
the efficacy of tobramycin.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10680867 [PubMed - indexed for MEDLINE]

2575: Antimicrob Agents Chemother. 2000 Mar;44(3):654-7.

Efficacy of linezolid in experimental otitis media.

Pelton SI, Figueira M, Albut R, Stalker D.

Section of Pediatric Infectious Diseases, Maxwell Finland Laboratory for
Infectious Diseases, Boston, Massachusetts, USA. spelton@bu.edu

Therapy for otitis media (OM) due to resistant Streptococcus pneumoniae (MIC of
penicillin, >/=2.0 microgram/ml) is challenging. Linezolid, an oxazolidinone,
represent a new class of antimicrobial agents with excellent in vitro activity
against penicillin-resistant S. pneumoniae; however, in vitro activity against
nontypeable Haemophilus influenzae (NTHI) is limited. We evaluated its efficacy
against experimental acute OM due to a multidrug-resistant S. pneumoniae isolate 
and two isolates of NTHI. The chinchilla model was utilized to evaluate the
efficacy of linezolid against experimental infection due to S. pneumoniae or
NTHI. Serum and middle ear antibiotic concentrations were determined, and
sterilization of experimental OM was evaluated. Chinchillas were inoculated
directly with S. pneumoniae into the superior bulla. Twenty-four hours after
inoculation, all animals had positive middle ear and nasopharyngeal cultures.
Animals were given linezolid at 25 mg/kg/dose twice a day (b.i.d.) by orogastric 
feeding tube or amoxicillin at 40 mg/kg/dose b.i.d. intramuscularly for 5 days.
By day 5, all animals in the linezolid group had sterile middle ear cultures and 
eradication of S. pneumoniae from the nasopharynx. In the amoxicillin group, all 
nine animals remained middle ear and nasopharynx positive (P < 0.01). In animals 
inoculated with NTHI, 25 and 37.5 mg/kg b.i.d. failed to sterilize middle ear
infection or eradicate colonization. Mean levels in middle ear fluid measured
during experimental infection were 12.8 microgram/ml at 2 to 6 h and 4. 1
mirogram/ml at 16 to 17 h after orogastric dosing at 25 mg/kg. Linezolid achieved
a high concentration in the middle ear during experimental OM. Linezolid
eradicated multidrug-resistant S. pneumoniae from the middle ear and nasopharynx.
Experimental infection and nasopharyngeal colonization due to NTHI persisted
despite achievement of concentrations in the middle ear that were above the MIC
(for NTHI).

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10681334 [PubMed - indexed for MEDLINE]

2576: Nurs Clin North Am. 2000 Mar;35(1):87-94.

The judicious use of antibiotic agents in common childhood respiratory illness.

Manning ML, Bell LM.

Departments of Infection Control and Occupational Health, Children's Hospital of 
Philadelphia, Pennsylvania 19104, USA.

Increased bacterial resistance is caused most frequently by the widespread use of
antimicrobial agents. Antimicrobial agents are often used inappropriately to
treat common respiratory illnesses in children. This article discusses the
judicious use of antimicrobials in the common cold, otitis media, acute
sinusitis, pharyngitis, and bronchitis.

Publication Types: 
    Review

PMID: 10673566 [PubMed - indexed for MEDLINE]

2577: J Infect Dis. 2000 Feb;181(2):646-52.

Role of Streptococcus pneumoniae and Haemophilus influenzae in the development of
acute otitis media and otitis media with effusion in a gerbil model.

Soriano F, Parra A, Cenjor C, Nieto E, García-Calvo G, Giménez MJ, Aguilar L,
Ponte C.

Department of Medical Microbiology, Fundación Jiménez Díaz, 28040 Madrid, Spain. 
fsoriano@microb.net

The efficacy of amoxicillin/clavulanate and cefuroxime was determined in a gerbil
model of otitis media with a mixed Streptococcus pneumoniae plus Haemophilus
influenzae middle ear (ME) infection. Results were compared with those obtained
in a previous single H. influenzae model. All untreated animals inoculated with
the mixed inoculum developed acute otitis media (AOM), whereas 86.7% of those
inoculated with H. influenzae developed otitis media with effusion (OME).
Antibiotics eradicated H. influenzae from the ME more efficiently in AOM than in 
OME, and this difference was highly significant (P</=.001) after administration
of 5 mg/kg of either drug (amoxicillin/clavulanate, 100% vs. 10%; cefuroxime,
73.3% vs. 10%). Efficacy was predicted by the relation of in vitro susceptibility
and ME antibiotic concentration, which was 2.7 times higher in AOM than in OME.
In the mixed otitis model, the most efficacious antibiotic was able to prevent
AOM, but >80% of animals developed culture-negative OME.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10669350 [PubMed - indexed for MEDLINE]

2578: J Speech Lang Hear Res. 2000 Feb;43(1):100-20.

Otitis media, fluctuant hearing loss, and speech-language outcomes: a preliminary
structural equation model.

Shriberg LD, Friel-Patti S, Flipsen P Jr, Brown RL.

The Phonology Project, Waisman Center on Mental Retardation and Human
Development, University of Wisconsin-Madison, 53705, USA.
shriberg@waisman.wisc.edu

The goals of this study were to estimate the risk for lowered speech-language
outcomes associated with early recurrent otitis media with effusion (OME) with
and without hearing loss and to develop a preliminary descriptive-explanatory
model for the findings. Three statistical approaches were used to assess
associations among OME, hearing loss, and speech-language outcomes. Participants 
were a subsample of 70 children followed prospectively in the Dallas Cooperative 
Project on Early Hearing and Language Development (Friel-Patti & Finitzo, 1990). 
Findings indicated that hearing levels at 12-18 months were significantly
associated with speech delay and low language outcomes at 3 years of age. The
risk for subclinical or clinical speech delay at 3 years of age was 2% for
children with less than 20 dB average hearing levels at 12-18 months and 33% for 
children with greater than 20 dB average hearing levels at 12-18 months. A
structural equation model (Jöreskog & Sörbom, 1993) indicated that the
significant and substantial effects of hearing levels at 12-18 months on speech
status at 3 years were significantly mediated by language status at 3 years.
Discussion includes implications of these findings for alternative speech
perception models linking early OME and hearing loss to later speech-language
disorder.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10668655 [PubMed - indexed for MEDLINE]

2579: J Speech Lang Hear Res. 2000 Feb;43(1):79-99.

Risk for speech disorder associated with early recurrent otitis media with
effusion: two retrospective studies.

Shriberg LD, Flipsen P Jr, Thielke H, Kwiatkowski J, Kertoy MK, Katcher ML,
Nellis RA, Block MG.

The Phonology Project, Waisman Center on Mental Retardation and Human
Development, University of Wisconsin-Madison, 53705, USA.
shriberg@waisman.wisc.edu

The goals of this two-part series on children with histories of early recurrent
otitis media with effusion (OME) were to assess the risk for speech disorder with
and without hearing loss and to develop a preliminary descriptive-explanatory
model for the findings. Recently available speech analysis programs, lifespan
reference data, and statistical techniques were implemented with three cohorts of
children with OME and their controls originally assessed in the 1980s: 35
typically developing 3-year-old children followed since infancy in a
university-affiliated pediatrics clinic, 50 typically developing children of
Native American background followed since infancy in a tribal health clinic, and 
(in the second paper) 70 children followed prospectively from 2 months of age to 
3 years of age and older. Dependent variables included information from a suite
of 10 metrics of speech production (Shriberg, Austin, Lewis, McSweeny, & Wilson, 
1997a, 1 997b). Constraints on available sociodemographic and hearing status
information limit generalizations from the comparative findings for each
database, particularly data from the two retrospective studies. The present paper
reports findings from risk analysis of conversational speech data from the first 
two cohorts, each of which included retrospective study of children for whom data
on hearing loss were not available. Early recurrent OME was not associated with
increased risk for speech disorder in the pediatrics sample but was associated
with approximately 4.6 (CI = 1.10-20.20) increased risk for subclinical or
clinical speech disorder in the children of Native American background.
Discussion underscores the appropriateness of multifactorial risk models for this
subtype of child speech disorder.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 10668654 [PubMed - indexed for MEDLINE]

2580: Am J Public Health. 2000 Feb;90(2):245-50.

Factors associated with tympanostomy tube insertion among preschool-aged children
in the United States.

Kogan MD, Overpeck MD, Hoffman HJ, Casselbrant ML.

Centers for Disease Control and Prevention, National Center for Health
Statistics, Hyattsville, Md., USA. mkogan@hrsa.gov

OBJECTIVES: Recurrent and persistent otitis media is often treated by
tympanostomy tube insertion to ventilate the middle ear and restore hearing. This
study examined the factors that predict which children are most likely to receive
tympanostomy tubes through 3 years of age. METHODS: Multiple logistic regression 
was conducted on data from a nationally representative sample of children (N =
8285). RESULTS: By 3 years of age, 6.8% of US children had tubes inserted.
Logistic regression indicated that after control for number of ear infections,
children without any gaps in health insurance, who attended a day-care center,
who were White, whose birth-weight was less than 1500 g, and who lived in the
Midwest or South were significantly more likely to have tympanostomy tubes.
CONCLUSIONS: These data suggest that differences exist as to who receives tubes. 
Of particular concern are differences by race/ethnicity and continuity of health 
insurance coverage. With expansions in health care coverage to larger proportions
of uninsured children, it will be important to monitor these programs to ensure
that all children who may need tympanostomy tubes have access to them.

PMID: 10667186 [PubMed - indexed for MEDLINE]

2581: Acta Radiol. 2000 Jan;41(1):49-51.

CT findings in tuberculous otomastoiditis. A case report.

Cavallin L, Muren C.

Department of Radiology, Södersjukhuset, Stockholm, Sweden.

PURPOSE: Otomastoiditis is a rare but important manifestation of tuberculosis and
is well recognizable when information on its clinical course is considered in
connection with the radiographic changes. MATERIAL AND METHOD: A patient with a
clinical history of chronic otorrhea, resistant to conventional therapy but
without dramatic symptoms, was referred for CT examination. RESULTS: CT revealed 
widespread soft tissue densities in the tympanic cavity and in the mastoid
process, with bone erosions in the latter. Surgery and bacteriology confirmed the
diagnosis of Mycobacterium tuberculosis infection. CONCLUSION: CT evidence of
widespread bone destruction without clinical signs of aggressive infection should
suggest the diagnosis of a mycobacterial process. Early treatment is essential in
order to avoid propagation of the disease and lasting loss of function.

Publication Types: 
    Case Reports

PMID: 10665870 [PubMed - indexed for MEDLINE]

2582: Nurse Pract. 2000 Jan;25(1):69, 73-80, 85; quiz 86-7.

Acute otitis media and pneumococcal resistance: making judicious management
decisions.

Tigges BB.

Family Nurse Practitioner Program, University of New Mexico College of Nursing,
USA.

The emergence of drug-resistant Streptococcus pneumoniae (DRSP) has implications 
for the primary care provider who treats acute otitis media (AOM) in children.
AOM must be carefully distinguished from otitis media with effusion (OME).
Antibiotic treatment for AOM is recommended because of the low rate of
spontaneous resolution of S. pneumoniae infection and the risk of suppurative
complications, particularly in young children. Amoxicillin continues to be the
first drug of choice. Children for whom the first course of antibiotics fails
should be treated with amoxicillin-clavulanate, cefuroxime axetil, or
ceftriaxone. Trimethoprim-sulfamethoxazole, the macrolides, and most of the
cephalosporins have limited effectiveness against DRSP and should no longer have 
a major role in AOM treatment. OME need not be treated with antibiotics unless
the effusion has been present for 3 to 4 months. Tympanostomy tubes are an
effective treatment for both chronic OME and recurrent AOM. Given the significant
increase of DRSP during the past decade, clinicians must minimize antibiotic use 
and, when antibiotics are required, make judicious clinical decisions.

Publication Types: 
    Review

PMID: 10665001 [PubMed - indexed for MEDLINE]

2583: Eur Arch Otorhinolaryngol. 2000;257(1):1-5.

Lateral sinus thrombosis after untreated otitis media. A clinical problem--again?

Spandow O, Gothefors L, Fagerlund M, Kristensen B, Holm S.

Department of Otorhinolaryngology, Norrlands University Hospital, Umeå, Sweden.

Antimicrobial agents have greatly reduced the incidence of intracranial
complications of infections of the middle ear and mastoid. Too many prescriptions
and overconsumption of antibiotics when otitis media is suspected has caused
resistance to many antibiotics, leading to a pronounced and justifiable desire to
reduce the widespread excessive use of antibiotics. The possible untoward
consequences of a too restricted antibiotic policy, however, is illustrated by
the following case of a 14-year-old boy who, after non-treatment of an ear
infection, fell ill with one-sided headache and vomiting caused by a lateral
sinus thrombosis. After intravenous treatment with antibiotics, anticoagulants
and ventilation of the middle ear, the infection was cured without complications.
This case calls attention to the symptoms of otitic complications arising outside
the temporal bone. The physician must always bear in mind the possibility of an
unusual event. The general treatment of endocranial complications is outlined,
giving details of the treatment given in this special case. We stress that one
should not be too cautious in prescribing antibiotics in otitis media.

Publication Types: 
    Case Reports

PMID: 10664036 [PubMed - indexed for MEDLINE]

2584: BMJ. 2000 Feb 5;320(7231):350-4.

Comment in:
    ACP J Club. 2000 Sep-Oct;133(2):62.    BMJ. 2000 Sep 23;321(7263):765-6.    BMJ. 2000 Sep 23;321(7263):765; author reply 766.    BMJ. 2000 Sep 23;321(7263):765; author reply 766.    BMJ. 2000 Sep 23;321(7263):766.    BMJ. 2000 Sep 23;321(7263):766.

Primary care based randomised, double blind trial of amoxicillin versus placebo
for acute otitis media in children aged under 2 years.

Damoiseaux RA, van Balen FA, Hoes AW, Verheij TJ, de Melker RA.

Department of General Practice, University Medical Centre, Universiteitsweg 100, 
3584 CG Utrecht, Netherlands. Damoiseaux@med.uu.nl

OBJECTIVE: To determine the effect of antibiotic treatment for acute otitis media
in children between 6 months and 2 years of age. DESIGN: Practice based, double
blind, randomised, placebo controlled trial. SETTING: 53 general practices in the
Netherlands. SUBJECTS: 240 children aged 6 months to 2 years with the diagnosis
of acute otitis media. INTERVENTION: Amoxicillin 40 mg/kg/day in three doses.
MAIN OUTCOME MEASURES: Persistent symptoms at day four and duration of fever and 
pain or crying, or both. Otoscopy at days four and 11, tympanometry at six weeks,
and use of analgesic. RESULTS: Persistent symptoms at day four were less common
in the amoxicillin group (risk difference 13%; 95% confidence interval 1% to
25%). The median duration of fever was two days in the amoxicillin group versus
three in the placebo group (P=0.004). No significant difference was observed in
duration of pain or crying, but analgesic consumption was higher in the placebo
group during the first 10 days (4.1 v 2.3 doses, P=0.004). In addition, no
otoscopic differences were observed at days four and 11, and tympanometric
findings at six weeks were similar in both groups. CONCLUSIONS: Seven to eight
children aged 6 to 24 months with acute otitis media needed to be treated with
antibiotics to improve symptomatic outcome at day four in one child. This modest 
effect does not justify prescription of antibiotics at the first visit, provided 
close surveillance can be guaranteed.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 10657332 [PubMed - indexed for MEDLINE]

2585: Am J Otol. 2000 Jan;21(1):36-41.

Labeling of the glucocorticoid receptor and Na,K-ATPase in a rat otitis media
model.

Hultcrantz M, Erichsen S, Rylander R, Stierna P, Bagger-Sjöbäck D.

Department of Otorhinolaryngology, Karolinska Hospital, Stockholm, Sweden.

HYPOTHESIS: Glucocorticoid hormones exert an influence on the inflammatory
response of the middle ear during acute otitis media. Rats with experimentally
induced purulent otitis media were given either glucocorticoid hormones in excess
or a glucocorticoid hormone blocker that deprived the animals of the hormone.
BACKGROUND: Acute otitis media is a common inflammatory disease among children.
Streptococcus pneumoniae is the most usual causative agent. The standard
treatment today is phenoxymethylpenicillin. The role of glucocorticoid hormones
in inflammatory reactions in the middle ear has been widely debated. METHODS: In 
an otitis media model, a suspension of pneumococci was inoculated into the bulla 
of the rat, after the animals were pretreated with either a dose of
corticosteroid hormones or the glucocorticoid receptor blocking agent RU 486.
Rats with induction of otitis media only, but no pretreatment, were used as
control subjects, as were the left control-operated ears of all rats. The
inflammatory response in the inner ear and in the middle ear was evaluated. The
presence of glucocorticoid receptors and the enzyme Na,K-ATPase was investigated 
with immunohistochemistry. RESULTS: The inflammatory response in the animals with
untreated otitis media and in the group with otitis media in rats pretreated with
the receptor blocker was much more extensive than in the group of animals
pretreated with corticosteroids. In the corticosteroid-treated group, the
tympanic membrane and the mucous membrane of the middle ear were less edematous, 
but the middle ear cavity contained more pus. Only a few lymphocytes were found
in the inner ears of these rats. When the inner ear was labeled with antibodies
against glucocorticoid receptors, there seemed to be no difference between the
labeling patterns in the three groups. This was also the case for antibody
labeling against Na,K-ATPase. CONCLUSION: The present results indicate that the
reaction in the middle ear mucous membrane is more pronounced in rats that had
been pretreated with the hormone receptor blocking drug. An increase of
corticosteroid hormone levels during the inflammatory process seem to diminish
the reaction in the tympanic membrane and the middle ear mucosa. Neither the
hormone receptor blocking drug nor the steroid hormones change the content of
glucocorticoid receptors and Na,K-ATPase in the inner ear in the otitis media rat
model.

PMID: 10651433 [PubMed - indexed for MEDLINE]

2586: Am J Otol. 2000 Jan;21(1):32-5.

Labyrinthine fistula after cholesteatomatous chronic otitis media.

Gersdorff MC, Nouwen J, Decat M, Degols JC, Bosch P.

ENT Department, Université Catholique de Louvain, University Hospital St-Luc,
Brussels, Belgium.

OBJECTIVES: To report on cases of labyrinthine fistula diagnosed in an ear, nose,
and throat department and to study the incidence, location, pre- and
postoperative symptoms (hearing loss, tinnitus, vertigo, facial palsy),
preoperative diagnostic imaging, and surgical treatment of two types of
cholesteatomatous labyrinthine fistulae-the extensive fistula that erodes both
the bony and membranous labyrinths and the bone fistula that affects only the
bony labyrinth. STUDY DESIGN: Retrospective case review. PATIENTS: Fifty-four
patients with cholesteatomatous chronic otitis media with labyrinthine fistulae. 
SETTING: Tertiary referral center. INTERVENTIONS: Diagnosis and treatment. MAIN
OUTCOME MEASURES: Clinical, imaging, and surgical correlation of extensive
fistulae and bone fistulae. RESULTS: The incidence of labyrinthine fistulae was
7% in all patients who underwent surgery for chronic otitis media. The bone type 
(66%) is more common than the extensive type (33%). Compared with bone fistulae, 
the outcome for extensive fistulae is more severe in terms of hearing loss,
vertigo, and facial palsy. In terms of preoperative diagnosis, computed
tomography imaging ensured early diagnosis in 89% of extensive cases and in 28%
of bone cases. For extensive fistulae, the surgical technique was more radical,
requiring an open technique in 66% of cases versus 22% of the bone fistulae
cases. The most common location is the lateral semicircular canal (61%).
CONCLUSIONS: The breach in the membranous labyrinth is consistent with a more
aggressive pathology, causing more severe pre- and postoperative symptoms.
Preoperative computed tomography is more sensitive for diagnosing extensive
fistulae, which also require a more radical treatment.

PMID: 10651432 [PubMed - indexed for MEDLINE]

2587: Ann Otol Rhinol Laryngol. 2000 Jan;109(1):24-9.

Resistant bacteria in middle ear fluid at the time of tympanotomy tube surgery.

Sutton DV, Derkay CS, Darrow DH, Strasnick B.

Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical
School, Norfolk, USA.

This study was performed to determine the prevalence of resistant Streptococcus
pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis isolated from
middle ear fluid of children undergoing placement of ventilation tubes. The
extent of resistance to commonly prescribed antibiotics and the risk factors
associated with this resistance were also examined. Children who had fluid
present in their middle ears at the time of ventilation tube placement from May
1996 to May 1997 were included in the study. Middle ear fluid was plated onto
culture media in the operating room, and antimicrobial resistance of cultured
organisms was ascertained. Risk factors for this resistance were determined from 
the medical history and analyzed. Cultures of 244 patients (355 ears) were
positive for organisms in 29.6%. Penicillin resistance was found in 38.2% of S
pneumoniae cultures. Beta-lactamase production was found in 65.1% and 100% of H
influenzae and M catarrhalis specimens, respectively. Risk factor analysis
revealed young age, day care attendance, and number of antibiotic courses to most
reliably predict the presence of resistant microorganisms.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10651407 [PubMed - indexed for MEDLINE]

2588: Ann Otol Rhinol Laryngol. 2000 Jan;109(1):17-23.

Results of tympanoplasty in children after 15 to 27 years.

Tos M, Orntoft S, Stangerup SE.

Department of Otolaryngology, Gentofte University Hospital, Hellerup, Denmark.

Results of tympanoplasty in children with noncholesteatomatous chronic otitis
media are presented in a 16- to 27-year follow-up. During the 13-year period from
1968 to 1980, 116 children (124 ears) were operated on, and they were submitted
to several follow-ups with audiometry and otomicroscopy. The attendance at the
last follow-up was 70%, and the minimum time since surgery for these patients was
15 years. All dry ears were operated on transcanally with a fixed ear speculum,
without any lateral incision of the ear canal skin. Cumulatively, in total, 14
ears (11%) had reperforation: 7 ears early and 7 ears late. At 6 months, there
were 6% early reperforations; some were surgically closed and some reappeared
later, even after several years, as late perforations. At 2 to 15 years of
follow-up, there were 4% reperforations, and at 16 to 27 years, 6%. Hearing was
good and stable. The results were the same in ears operated on at the ages of 2.5
to 7 years and 8 to 14 years, as well as with preoperatively positive and
negative Valsalva maneuvers. In total, 14% of ears were revised during the entire
observation period. It is concluded that transcanal tympanoplasty, even in young 
children, has good long-term stability and can definitively and permanently solve
the problem of noncholesteatomatous chronic otitis in children.

PMID: 10651406 [PubMed - indexed for MEDLINE]

2589: Vaccine. 2000 Jan 18;18(13):1264-72.

Biological activities of antibodies elicited by lipooligosaccharide
based-conjugate vaccines of nontypeable Haemophilus influenzae in an otitis media
model.

Sun J, Chen J, Cheng Z, Robbins JB, Battey JF, Gu XX.

Laboratory of Immunology, National Institute on Deafness and Other Communication 
Disorders, Rockville, MD 20850, USA.

Vaccination of chinchillas with nontypeable Haemophilus influenzae (NTHi)
lipooligosaccharide (LOS) conjugates protected against otitis media. Correlations
between the levels of conjugate-induced LOS antibodies (Abs) in sera and middle
ear fluids (MEFs) and Ab-mediated biological functions and protection were
examined. Following parenteral vaccination and middle ear challenge, all
vaccinated animals, but none of the controls, had high titers of anti-LOS in
their sera and MEFs. There was a correlation between the levels of anti-LOS IgG +
M, IgG or IgA in the sera and in the MEFs (P < 0.001). An inverse correlation was
found between the level of serum IgG + M and bacterial counts and between the
levels of MEF Abs and bacterial counts at the early postchallenge stage (P <
0.05). Of the 39 vaccinated animals, 44% showed complete protection against
otitis media, 46% (18/39) of their sera inhibited adherence of NTHi to human
epithelial cells, 49% (19/39) demonstrated bactericidal activity and 49% (19/39) 
showed opsonophagocytic activity. In contrast, none of the controls (19) were
protected, none of their sera inhibited bacterial adherence or had bactericidal
activity and only 21% showed opsonophagocytosis. Our interpretation is that
vaccine-induced LOS Abs transuded into the middle ear and conferred immunity to
NTHi by binding to LOS of NTHi, inhibition of NTHi adherence to epithelial cells 
and complement-mediated bacteriolysis (or opsonophagocytosis).

Publication Types: 
    Comparative Study

PMID: 10649628 [PubMed - indexed for MEDLINE]

2590: Arch Dis Child. 2000 Feb;82(2):165-8.

Interleukin 8 in middle ear fluid during acute otitis media: correlation with
aetiology and bacterial eradication.

Leibovitz E, Dagan R, Laver JH, Piglansky L, Raiz S, Abboud MR, Fliss DM,
Leiberman A, Barzilai A.

The Pediatric Infectious Disease Unit, Soroka University Medical Center and
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva,
84101, Israel.

OBJECTIVES: To study the concentration of interleukin 8 (IL-8) in the middle ear 
fluid of children with acute otitis media and the association between IL-8
concentrations, aetiology of acute otitis media, and bacteriological
sterilisation. STUDY DESIGN: Middle ear fluid was obtained by tympanocentesis at 
enrollment (day 1) and on day 4-5 in 81 children aged 3-36 months with acute
otitis media who received antibiotic treatment. IL-8 concentrations were measured
by enzyme linked immunosorbent assay. RESULTS: 101 samples were obtained on day 1
and 47 samples on day 4-5. 94 pathogens were isolated in 79 of 101 samples
obtained on day 1: 56 Haemophilus influenzae, 35 Streptococcus pneumoniae, 2
Moraxella catarrhalis, and 1 Streptococcus pyogenes. Among 40 paired, initially
culture positive samples, sterilisation was achieved on day 4-5 in 22 but not in 
18 (13 H influenzae, 2 S pneumoniae, and 3 H influenzae and S pneumoniae
concomitantly). IL-8 was detected in 96 of 101 and 46 of 47 samples obtained on
days 1 and 4-5, respectively. Mean (SD) IL-8 concentration on day 1 was
significantly higher in culture positive than in negative samples (12,636
(23,317) v 5,920 (7,080) pg/ml). In paired samples, IL-8 concentration fell in 12
of 22 ears in which sterilisation was achieved and in 9 of 21 ears with
persistent or new infection. Mean (SD) IL-8 concentrations on day 4-5 were
significantly higher in culture positive than in negative samples (15,420
(15,418) v 6,695 (5,092) pg/ml). CONCLUSIONS: Higher IL-8 concentrations are
found in culture positive middle ear fluid in acute otitis media. Bacterial
eradication is associated with a fall in these concentrations.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 10648376 [PubMed - indexed for MEDLINE]

2591: Auris Nasus Larynx. 2000 Jan;27(1):39-43.

A guinea pig model of adhesive otitis media and the effect of tympanostomy.

Hashimoto S.

Department of Otolaryngology, Niigata University School of Medicine, Japan.

OBJECTIVE: The pathophysiology and prevention strategies of adhesive otitis media
were investigated using two animal otitis media models induced by the inoculation
of a corrosive agent into the tympanic clefts of guinea pigs. METHODS: In the
first experiment, KANSUI (consisting of potassium carbonate and sodium carbonate)
solution was injected into the left tympanic cleft of the guinea pigs. Five
groups of five animals were sacrificed at 2 weeks, and at 1, 3, 6, and 12 months 
after inoculation to observe the pathological changes with time. In the second
experiment, a similar otitis media model was induced in 18 guinea pigs.
Tympanostomy was performed at 1 and 2 weeks after induction of the otitis media
to eliminate inflammatory exudate from the tympanic cleft. Three groups of six
animals were sacrificed at 1, 3, and 6 months after the tympanostomy to compare
the differences in pathological changes between the groups with and without
tympanostomy. RESULTS: In the first experiment, severe mucosal injury to the
middle ear mucosa was observed at 2 weeks, and at 1 and 3 months after
inoculation, and the tympanic membrane (TM) had adhered to the promontorium at 3,
6 and 12 months after inoculation. In the second experiment, TM adhesion
decreased following the tympanostomy. CONCLUSION: It is suggested that severe
injury to the middle ear mucosa caused TM adhesion during the process of wound
healing, and that tympanostomy is effective in preventing adhesive otitis media.

PMID: 10648067 [PubMed - indexed for MEDLINE]

2592: Auris Nasus Larynx. 2000 Jan;27(1):35-8.

Bilateral same day surgery for bilateral perforated chronic otitis media.

Sakagami M, Mishiro Y, Tsuzuki K, Seo T, Sone M.

Department of Otolaryngology, Hyogo College of Medicine, Nishinomiya City, Japan.
msakaga@hyo-med.ac.jp

OBJECTIVE: Bilateral same day surgery has been performed rarely because of the
risk of postoperative sensorineural hearing loss following conventional
myringoplasty or tympanoplasty (CMT). Simple underlay myringoplasty (SUM) through
the ear canal has been developed by Yuasa R, Saijo S, Tomioka Y, et al. Office
closure of eardrum perforation with fibrin glue (in Japanese), Otolaryngol Head
Neck Surg (Tokyo) 1989;61:1117-1122, which has little risk of sensorineural
hearing loss. We tried bilateral same day surgery using this technique and
evaluated its outcome. METHODS: Of 86 cases with bilateral perforated chronic
otitis media that we treated between 1995-1997, 25 cases underwent bilateral same
day surgery. Bilateral SUMs was performed on seven patients, SUM and CMT on 16
patients, and bilateral CMTs on two patients. RESULTS: Closure of perforation was
successful in 18 patients (72%) on both sides and in seven patients (28%) on one 
side. Postoperative air-bone gap of less than 20 dB was achieved in 15 cases
(60%) on both sides and in 23 cases (92%) on one side. CONCLUSION: Bilateral same
day surgery for bilateral perforated chronic otitis media is possible if the
operative indications are considered.

Publication Types: 
    Comparative Study

PMID: 10648066 [PubMed - indexed for MEDLINE]

2593: Curr Opin Rheumatol. 2000 Jan;12(1):32-40.

Immune-mediated inner ear disease.

Stone JH, Francis HW.

Division of Rheumatology, Johns Hopkins Vasculitis Center, Johns Hopkins Medical 
Institutions, Baltimore, MD, USA. jstone@welch.jhu.edu

Immune-mediated inner ear disease (IMIED) is a syndrome that includes the
subacute onset of sensorineural hearing loss, often accompanied by vertigo and
tinnitus. This constellation of symptoms may occur as a primary disorder in which
no other organ involvement is evident, or it may complicate certain systemic
conditions, including Wegener's granulomatosis, Cogan's syndrome, polyarteritis
nodosa, and systemic lupus erythematosus. The precise disease mechanisms remain
undefined, largely because of the difficulty obtaining relevant tissue specimens 
in untreated patients. However, if treated promptly with aggressive
immunosuppression, the devastating sequelae of IMIED may be avoided. In this
article, we review the pathophysiology, clinical evaluation, diagnostic testing, 
and therapy of IMIED.

Publication Types: 
    Review

PMID: 10647952 [PubMed - indexed for MEDLINE]

2594: Infect Immun. 2000 Feb;68(2):921-4.

Evaluation of the virulence of a Streptococcus pneumoniae neuraminidase-deficient
mutant in nasopharyngeal colonization and development of otitis media in the
chinchilla model.

Tong HH, Blue LE, James MA, DeMaria TF.

Division of Otologic Research, College of Medicine and Public Health, The Ohio
State University, Columbus, Ohio 43210, USA.

Considerable evidence has implicated Streptococcus pneumoniae neuraminidase in
the pathogenesis of otitis media (OM); however, its exact role has not been
conclusively established. Recently, an S. pneumoniae neuraminidase-deficient
mutant, DeltaNA1, has been constructed by insertion-duplication mutagenesis of
the nanA gene of S. pneumoniae strain D39. The relative ability of DeltaNA1 and
the D39 parent strain to colonize the nasopharynx and to induce OM subsequent to 
intranasal inoculation and to survive in the middle ear cleft after direct
challenge of the middle ear were evaluated in the chinchilla model.
Nasopharyngeal colonization data indicate a significant difference in the ability
of the DeltaNA1 mutant to colonize as well as to persist in the nasopharynx. The 
neuraminidase-deficient mutant was eliminated from the nasopharynx 2 weeks
earlier than the D39 parent strain. Both the parent and the mutant exhibited
similar virulence levels and kinetics during the first week after direct
inoculation of the middle ear. The DeltaNA1 neuraminidase-deficient mutant,
however, was then completely eliminated from the middle ear by day 10
postchallenge, 11 days before the D39 parent strain. Data from this study
indicate that products of the nanA gene have an impact on the ability of S.
pneumoniae to colonize and persist in the nasopharynx as well as the middle ear.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10639464 [PubMed - indexed for MEDLINE]

2595: J Clin Microbiol. 2000 Jan;38(1):125-32.

Clinically applicable multiplex PCR for four middle ear pathogens.

Hendolin PH, Paulin L, Ylikoski J.

Institute of Biotechnology, University of Helsinki, 00014 Helsinki, Finland.
Panu.Hendolin@Helsinki.fi

The multiplex PCR method for the detection of Alloiococcus otitidis, Haemophilus 
influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae (P. H. Hendolin, 
A. Markkanen, J. Ylikoski, and J. J. Wahlfors, J. Clin. Microbiol. 35:2854-2858, 
1997) in middle ear effusions (MEEs) was modified to be better suited for
clinical use. To detect false-negative results, an internal amplification was
added to the reaction, and to prevent carryover contamination, the
dUTP-uracil-N-glycosidase system was incorporated into the procedure. Labor was
minimized by using the heat-activatable AmpliTaq Gold polymerase in order to
circumvent manual hot start and by detecting the amplification products on an
automated sequencer. The performance of the improved protocol was verified with
MEEs from patients with otitis media with effusion. In addition, a ligase
detection reaction (LDR) was developed for confirmation of the PCR products. The 
modifications increased the reliability of the protocol and the hands-off time
significantly. However, when two DNA extraction protocols were compared,
gram-negative bacteria were detected more often in phenol-treated MEEs (94 versus
46%; P < 0.001), and gram-positive bacteria were detected more often in MEEs
dissolved in sodium dodecyl sulfate-NaOH-chaotropic salt (83 versus 27%; P <
0.001). The LDR was found to be 100% specific. In all, the results demonstrate
the feasibility of the rapid (7-h) multiplex PCR method for routine laboratory
use.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10618075 [PubMed - indexed for MEDLINE]

2596: Antimicrob Agents Chemother. 2000 Jan;44(1):43-50.

Comment in:
    Antimicrob Agents Chemother. 2000 Sep;44(9):2590-2.

Bacteriologic efficacies of oral azithromycin and oral cefaclor in treatment of
acute otitis media in infants and young children.

Dagan R, Leibovitz E, Fliss DM, Leiberman A, Jacobs MR, Craig W, Yagupsky P.

Pediatric Infectious Disease Unit, Soroka University Medical Center, and Faculty 
of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
rdagan@bgumail.bgu.ac.il

A prospective, open-label, randomized study was conducted in order to determine
the bacteriologic efficacies of cefaclor and azithromycin in acute otitis media
(AOM). Tympanocentesis was performed on entry into the study and 3 to 4 days
after initiation of treatment. Bacteriologic failure after 3 to 4 days of
treatment with both drugs occurred in a high proportion of culture-positive
patients, especially in those in whom AOM was caused by Haemophilus influenzae
(16 of 33 [53%] of those treated with azithromycin and 13 of 34 [52%] of those
treated with cefaclor). Although a clear correlation of the persistence of the
pathogen with increased MICs of the respective drugs could be demonstrated for
Streptococcus pneumoniae, no such correlation was found for H. influenzae. It is 
proposed that susceptibility breakpoints for H. influenzae should be considerably
lower than the current ones for both cefaclor and azithromycin for AOM caused by 
H. influenzae.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 10602721 [PubMed - indexed for MEDLINE]

2597: Head Neck. 2000 Jan;22(1):87-9.

Malignant otitis externa caused by Malassezia sympodialis.

Chai FC, Auret K, Christiansen K, Yuen PW, Gardam D.

Department of Otolaryngology, Head and Neck Surgery, Royal Perth Hospital,
Wellington St, Perth WA 6000, Australia.

BACKGROUND: Malignant otitis externa caused by fungal infections is rare. A
review of the literature showed only 9 cases, and the causative fungus in all
cases was Aspergillus. This article reports an unusual case caused by Malassezia 
sympodialis. METHODS: A 53-year-old man with non-insulin dependent diabetes
presented with malignant otitis externa. He deteriorated despite treatment with
intravenous antipseudomonal therapy and surgical debridement. Microbiologic tests
revealed M. sympodialis. He responded rapidly to intravenous amphotericin.
RESULTS: Systemic human infections caused by M. sympodialis have not been
reported. M. furfur systemic infection is rare and has been associated lipid
hyperalimentation by means of a central catheter. Only 1 other case of M.
fungemia without these associated risk factors has been reported. CONCLUSIONS:
The first case of malignant otitis externa caused by M. sympodialis is presented.
It highlights the difficulty of initial biologic diagnosis and the need for
lipid-enriched media to grow this fastidious organism. Copyright 2000 John Wiley 
& Sons, Inc. Head Neck 22: 87-89, 2000.

Publication Types: 
    Case Reports

PMID: 10585610 [PubMed - indexed for MEDLINE]
