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Objective: To assess the prevalence of otitis media with effusion (OME) among children who attended a tertiary level audiologic center 2 and 3 years after the COVID‐19 lockdown, and to determine the impact of temporary interruption of day care center attendance on chronic OME. Study Design: Retrospective study. Setting: Tertiary level referral audiologic center. Methods: We assessed the prevalence of OME among children aged 6 months to 12 years in 3 different periods (May‐June 2022, January‐February 2023, and May‐June 2023) and compared the results with those of the corresponding periods before the COVID‐19 lockdown. We also compared the disease resolution rates between a subgroup of children with chronic OME who interrupted day care center attendance for a 2‐month period (Subgroup A) and a similar subgroup who continued attending day care centers (Subgroup B). Results: The prevalence of OME was 38.5% (138/358) in May‐June 2022, 51.9% (193/372) in January‐February 2023, and 40.9% (149/364) in May‐June 2023. No significant prevalence differences were observed between the periods May‐June 2019, May‐June 2022, and May‐June 2023 (P =.78), and between the periods January‐February 2020 and January‐February 2023 (P =.93). At the May‐June 2023 assessment, the children belonging to Subgroup A presented a greater rate of disease resolution (85.7%, 18/21) than the children belonging to Subgroup B (32%, 8/25, P <.001). Conclusion: This study suggests that the prevalence of OME has returned to prelockdown levels, and that interrupting day care center attendance for a 2‐month period could be effective in resolving most cases of chronic OME. [ABSTRACT FROM AUTHOR]

Objective: To assess differences in otorrhea, tympanic membrane perforation, and time to extrusion in children receiving one of four commonly used, short‐term ventilation tubes for the first time. Methods: Retrospective chart review of 2 years of postoperative follow‐up to analyze patient outcomes after insertion of either a Paparella type‐I Activent, Armstrong Beveled, Modified Armstrong, or Armstrong Microgel ventilation tube. Incidence of complications was determined by reviewing provider notes. Adjusted multivariate logistic regression models were used to determine odds ratios of complications among the four tube types. Results: A total of 387 patients were reviewed. The mean age was 2.4 years and 35.9% were female. Armstrong beveled tubes had the highest odds of otorrhea. Paparella type‐I tube had the shortest time to extrusion of about 9 months, while Armstrong Beveled had the longest, at almost 19 months. When evaluating episodes of otorrhea each child experienced on average, per month, Armstrong beveled tubes had the highest monthly rate of otorrhea and Paparella type‐I the least. No significant differences were found regarding tympanic membrane perforation. Conclusions: This retrospective chart review showed that no tube was clinically superior across all complications. The findings from this study may give otolaryngologists an opportunity to consider choosing a specific type of tube according to the clinical situation. The large variations in extrusion times should be considered in terms of patient age, seasonality, and desired duration of tube placement. Level of Evidence: 4. Differences in otorrhea, tube blockage, tympanic membrane perforation, and time to extrusion were evaluated among children receiving one of four commonly used short‐term ventilation tubes: Paparella type‐I Activent, Armstrong Beveled, Modified Armstrong, and Armstrong Microgel. The major difference between tubes was time to extrusion and none was clinically superior in terms of complications. The large differences in extrusion times should be considered in terms of patient age, seasonality and desired duration of tube placement, and may give otolaryngologists an opportunity to consider choosing a specific tube according to the clinical situation. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate whether patient, tumour and radiation therapy factors are associated with development of middle ear effusion (MEE) in nasopharyngeal carcinoma (NPC) patients. Deign, Settings, and Participants: A retrospective review of NPC patients treated between January 2000 and June 2018 at Rabin Medical Center. Patient factors, tumour factors, radiation doses, and radiation fields were collected and outlined if needed (middle ear, eustachian tube [ET], tensor veli palatini [TVP], and levator palatini [LVP] muscles), then analysed and compared between patients with MEE and those without and between sides in patients with unilateral MEE. Main Outcome Measures and Results: Seventy‐three patients were enrolled. Most were males (71.2%) with advanced‐stage diseases (78%). At the time of diagnosis 14 patients (19.2%) presented with MEE. Following radiation, 18 patients, with no evidence of MEE at presentation, developed MEE. Tumour stage, histology, and laterality were not associated with development of MEE. Comparison of mean radiation field dosages including—gross target volume, clinical target volume, and patient target volume showed no association with post‐radiation MEE. In addition, no difference was found in the radiation doses to the middle ear, ET or the LVP nor the TVP between ears with and without MEE. Conclusions: Post‐irradiation MEE remains a common adverse effect in NPC patients. Surprisingly, tumour stage, tumour laterality, and histology were not associated with MEE. Similar findings were observed for total radiation doses and specific doses to the middle ear, ET, and ET muscles. [ABSTRACT FROM AUTHOR]

Background: Canine middle ear effusion (MEE) is usually asymptomatic, being an incidental finding when computed tomography or magnetic resonance imaging (MRI) of the head is performed for other reasons unrelated to otic disease. The clinical relevance of the presence of material in the tympanic bulla (TB) remains uncertain, and more detail about its prevalence and appearance in MRI are required. Objective: To assess the prevalence of presence of material within the TB of French bulldogs (FB) with no clinical signs suggestive of otitis (externa, media or interna) that underwent high‐field MRI for other medical reasons. Animals: Two hundred fifty‐two TB of 126 FB were included in this study. Materials and Methods: Nonexperimental retrospective study in which MRI images were evaluated by a board‐certified veterinary radiologist. Results: Fifty‐eight per cent of the dogs had material in the TB lumen (46% of the TB) and 59% were bilaterally affected. The signal intensity of this material related to the grey matter was variable on T1w and mainly hyperintense on T2w sequences. Conclusion and Clinical Relevance: FB are predisposed to MEE. This is important when assessing imaging studies of TB of FB with chronic otitis externa, as high percentage of cases may have concurrent MEE. MRI findings in FB with MEE are characterised by a hyperintense signal to the grey matter on T2w in most cases and variable on T1w sequences. [ABSTRACT FROM AUTHOR]

Background: Eustachian tube dysfunction (ETD) is the predominant cause of otitis media with effusion in children and adults. Balloon dilatation of the Eustachian tube (BDET) provides a new method for restoring the ventilatory function of Eustachian tube (ET). However, the differences in age-related morphological changes in the dimensions and positions of ET in children and adults are unclear. Purpose: This study aimed to examine age-related morphological changes in bony and cartilage segments of the ET in a three-dimensional space in normal population. Methods: A total of 71 randomly selected computed tomography (CT) images of the temporal bones of 46 people were retrospectively studied in four age groups: A (0-3 years old); B (4-8 years old), C (9-18 years old), and D (19-65 years old). Space analytic geometry was assessed to calculate the dimensions and positions of ET. Results: The bony segment of ET lengthened from infancy to adulthood with age in groups A, B and C (r = 0.562**/0.000). The cartilage segment of ET mostly extended with age from infancy to 8 years old in children (r = 0.633**/0.000), but with bending close to the sagittal plane and away from the horizontal plane with age in groups A, B and C (P < .05), and with a constant angle to the coronal plane among the four groups (P > .05). Conclusion: The bony and cartilaginous segments of ET exhibit distinct morphological changes in space with age. The bony segment of ET extends in a constant position from infancy to adulthood. In contrast, the cartilaginous segment of the ET indicates multidimensional positional changes until adulthood, in addition to the elongation from infancy to children. This may provide an accurate morphological basis for comparing the differences in ETD pathogenesis and surgical treatment between children and adults. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the influencing factors of otitis media with effusion (OME) in children with adenoid hypertrophy and to provide evidence for clinical treatment and care of children with adenoid hypertrophy. Design: A retrospective study. Methods: Preschool children with adenoid hypertrophy treated in our hospital from 1 January 2021 to 30 July 2022 were included. We analysed the characteristics of OME and non‐OME children with adenoid hypertrophy. Pearson correlation analysis and logistic regression analysis were performed to evaluate the risk factors for OME in children with adenoid hypertrophy. Conclusion: A total of 166 children with adenoid hypertrophy were included; the incidence of OME in children with adenoid hypertrophy was 34.94%. The incidence of OME decreased significantly with the increase in age (p = 0.014). Logistic regression analysis showed that age < 3 years (OR = 3.149, 95%CI: 2.812–3.807) and duration of adenoid hypertrophy ≥12 months (OR = 2.326, 95%CI: 2.066–2.612) were the risk factors of OME in children with adenoid hypertrophy (all p < 0.05). Patient Contribution: The incidence of adenoid hypertrophy with OME is high in preschool children, and it is related to the age and duration of adenoid hypertrophy. [ABSTRACT FROM AUTHOR]

Objective: Otitis media with effusion is common in children with cleft palates. This study aimed to investigate the link between palatal closure techniques and audiological outcomes. Methods: In this retrospective‐prospective cohort study, we examined the relationship between palate repair techniques and hearing outcomes in children with cleft palates. From 2017 to 2022, 190 ears of 95 cleft patients were studied at the Cleft Lip and Palate Department of Shiraz University of Medical Sciences. Variables assessed included the surgical technique, cleft severity, auditory brainstem response (ABR) threshold, and tympanometry configuration. Results: The mean ABR improved from a prepalatoplasty value of 39.51(11.62) decibels (dB) to a postpalatoplasty mean of 26.61(11.60) dB (Cohen's d: 1.12 [95% CI; 0.90–1.34]). Initially, 87.9% of the studied ears exhibited abnormal tympanometry, but this significantly decreased to 47% postsurgery (risk ratio: 4.43 [95% CI; 1.20–16.43]). When compared with Sommerlad intravelar veloplasty, the Nadjmi modified Furlow palatoplasty was associated with a notably lower mean ABR (β: −6.58 [95% CI: −10.43 to −2.73], p‐value =.001) and a reduced frequency of abnormal tympanometry (odds ratio [OR]: −1.10; 95% CI: −1.85 to −0.36, p‐value =.004). Factors like prepalatoplasty ABR, cleft palate severity, gender, and syndromic did not confound these findings. Conclusions: Although the Nadjmi modified Furlow palatoplasty showed better results, our findings indicate a significant improvement in ABR and tympanometry outcomes for both techniques. Future randomized controlled trials are suggested to confirm the influence of palatal closure techniques on audiological outcomes. Level of Evidence: 3b. This study evaluated the impact of palatal closure techniques on audiological outcomes in children with cleft palates, comparing Sommerlad intravelar veloplasty and the Nadjmi modified Furlow palatoplasty. The results indicated a significant improvement in auditory brainstem response and tympanometry outcomes with both techniques, with the Nadjmi modified Furlow showing notably better results, and future trials are suggested to confirm these findings. [ABSTRACT FROM AUTHOR]

Objective: To determine the carbon savings potential of incorporating virtual care into surgical care pathways for pediatric patients with obstructive sleep apnea or otitis media with effusion. Methods: Pediatric patients with obstructive sleep apnea or otitis media with effusion were not enrolled, instead, a modeling cohort study design was used. This study utilized the British Columbia healthcare system and geography to model emissions. Care pathways were developed for pediatric patients with obstructive sleep apnea or otitis media with effusion requiring care at a tertiary pediatric center. Home addresses were located at the geographical center of the two most populated municipalities within each of the 10 most populated regional districts in 2020. Virtual visits replaced up to three clinically equivalent in‐person visits. Emissions (kgCO2e) for transport and virtual visits were estimated. Population‐weighted means and descriptive statistics were calculated. Results: Utilizing 1, 2, or 3 virtual visits in the obstructive sleep apnea care pathway yielded potential emissions savings of 19.9%, 39.9%, and 59.8% respectively. Integrating 1, 2, or 3 virtual visits into the otitis media with effusion care pathway produced potential emissions savings of 16.6%, 33.2%, and 49.7%, respectively. Integrating 3 virtual visits can save up to 2156.8 kgCO2e per patient. Conclusions: Appropriately conducting up to 50% of clinical encounters virtually for children with obstructive sleep apnea or otitis media with effusion reduced theoretical carbon emissions. For a single child, emission savings could reach over 2150 kgCO2e. Level of Evidence: Level 5. [ABSTRACT FROM AUTHOR]

Ovarian hyperstimulation syndrome (OHSS) may be a severe complication of controlled ovarian hyperstimulation during assisted reproductive technology. During OHSS, fluid shifts from the intravascular space to the third‐space compartments as the result of an increase in capillary permeability. This can cause fluid accumulation in peritoneal as well as thoracic cavities. The patient presented with symptoms of severe OHSS (bilateral hydrothorax and pulmonary effusion), requiring bilateral ultrasound‐guided paracentesis and bilateral thoracentesis during her Emergency Room visits and hospitalization. Due to distant effects from the increased capillary permeability, the patient presented fluid in the middle ear, which led to the development of serous otitis media 12 days after egg retrieval. This was resolved 2–3 weeks later after being treated with antihistamines and antibiotics given by her Ear, Nose, and Throat doctor. OHSS risk may be reduced by continuous monitoring of patients undergoing ovulation induction, using an appropriate gonadotropin dosage, and using additional agents known to decrease its risk. If OHSS still occurs, symptomatic treatment and a multidisciplinary team of professionals may be needed to prevent fluid build‐up complications. In contrast to many published articles about OHSS and its complications, this is the first case report of a patient presenting serous otitis media as a complication of severe OHSS. Synopsis: Distant effects from the increased capillary permeability due to OHSS caused fluid in the middle ear and ear plugging, leading to serous otitis media. [ABSTRACT FROM AUTHOR]

Objectives: Otitis media with effusion (OME) is common, affecting up to 90% of children. Around 25% will have a persistent effusion with conductive hearing loss which can impact their development. Ventilation tubes (VTs) can improve their hearing in the short term. This study aims to analyse the trends in VT insertion rates across Scotland. Design: Retrospective observational study. Setting: All mainland Scottish health boards. Participants: All children aged 0–16 who underwent a VT insertion procedure from 2001 to 2018 were included. Main outcome measures: Data were provided by the Scottish Public Health Observatory, using Scottish Morbidity Records. Mid‐year population estimates were obtained from the National Records Office of Scotland. Socioeconomic deprivation was estimated based on area of residence using the Scottish Index of Multiple Deprivation. VT insertion rates were calculated and trends analysed. Results: A total of 35 878 VT procedures were performed in total with a mean rate of 2.02 per 1000 children per year. The highest insertion rates were observed in children aged 4–6. VT insertion rates reduced during the study period (R = −0.729, p =.001). Variability in VT insertion rates between health boards reduced. There was a significant association between socioeconomic deprivation and VT insertion rate, with the most deprived children having the highest rate (p <.001). Conclusions: VT insertion rates and the variability between Scottish health boards have reduced over the past two decades, suggesting a more equitable system. Our data intimates that the decision to perform VT insertion is based upon disease prevalence rather than clinician preference. [ABSTRACT FROM AUTHOR]

A large‐scale outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) occurred in Shanghai, China, in early December 2022. To study the incidence and characteristics of otitis media with effusion (OME) complicating SARS‐CoV‐2, we collected 267 middle ear effusion (MEE) samples and 172 nasopharyngeal (NP) swabs from patients. The SARS‐CoV‐2 virus was detected by RT‐PCR targeting. The SARS‐CoV‐2 virus, angiotensin‐converting enzyme 2 (ACE2), and transmembrane serine protease 2 (TMPRSS2) expression in human samples was examined via immunofluorescence. During the COVID‐19 epidemic in 2022, the incidence of OME (3%) significantly increased compared to the same period from 2020 to 2022. Ear symptoms in patients with SARS‐CoV‐2 complicated by OME generally appeared late, even after a negative NP swab, an average of 9.33 ± 6.272 days after COVID‐19 infection. The SARS‐CoV‐2 virus was detected in MEE, which had a higher viral load than NP swabs. The insertion rate of tympanostomy tubes was not significantly higher than in OME patients in 2019–2022. Virus migration led to high viral loads in MEE despite negative NP swabs, indicating that OME lagged behind respiratory infections but had a favorable prognosis. Furthermore, middle ear tissue from adult humans coexpressed the ACE2 receptor for the SARS‐CoV‐2 virus and the TMPRSS2 cofactors required for virus entry. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we propose a diagnostic model for automatic detection of otitis media based on combined input of otoscopy images and wideband tympanometry measurements. Methods: We present a neural network‐based model for the joint prediction of otitis media and diagnostic difficulty. We use the subclassifications acute otitis media and otitis media with effusion. The proposed approach is based on deep metric learning, and we compare this with the performance of a standard multi‐task network. Results: The proposed deep metric approach shows good performance on both tasks, and we show that the multi‐modal input increases the performance for both classification and difficulty estimation compared to the models trained on the modalities separately. An accuracy of 86.5% is achieved for the classification task, and a Kendall rank correlation coefficient of 0.45 is achieved for difficulty estimation, corresponding to a correct ranking of 72.6% of the cases. Conclusion: This study demonstrates the strengths of a multi‐modal diagnostic tool using both otoscopy images and wideband tympanometry measurements for the diagnosis of otitis media. Furthermore, we show that deep metric learning improves the performance of the models. [ABSTRACT FROM AUTHOR]

Background: Kabuki syndrome 1 (KS1; OMIM:147920), which is characterized by distinctive dysmorphic facial features (such as arched eyebrows, long palpebral fissures with eversion of the lower lid, and large protuberant ears), intellectual disability, short stature, and dermatoglyphic and skeletal abnormalities, is brought on by pathogenic variants in KMT2D (OMIM:602113). In this work, three individuals with novel pathogenic KMT2D gene variants had their longitudinal audiological manifestations and ear structural characteristics outlined. Methods: The longitudinal audiological data from neonatal hearing screening and a battery of several hearing tests were evaluated. The battery of hearing tests included tympanometry, distortion product otoacoustic emission (DPOAE), click‐evoked air‐conduction auditory brain‐stem response (AC‐ABR), click‐evoked bone‐conduction auditory brain‐stem response (BC‐ABR), narrow band CE‐chirp auditory steady‐state response (NB CE‐chirp ASSR), and pure‐tone audiometry (PTA). Phenotype identification and whole exome sequencing (WES) were performed on recruited individuals. Results: All three patients (two females and on male; last evaluations at 14 months, 11 months, and 5.7 years, respectively) failed the newborn hearing screening, and the audiological follow‐up data revealed mild to profound fluctuating hearing loss, which was directly influenced by the incidence and severity of otitis media with effusion (OME). When OME occurred, the AC‐ABR thresholds increased from 30–75 dBnHL to 45–90 dBnHL. The threshold for the BC‐ABR and BC‐PTA was between 25 and 50 dBnHL, indicating mild to moderate sensorineural hearing loss (SNHL). The high‐resolution computed tomography (HRCT) pictures indicated that all three patients had middle and inner ear abnormalities. Middle ear anomalies showed as diminished mastoid gasification and ossicle dysplasia. Cochlear dysplasia, a dilated vestibule, fusion of the vestibule with the horizontal semicircular canals, and a short and thick horizontal semicircular canal were visible on images of the inner ear. This study recruited three individuals with three novel pathogenic variants (c.5104C>T, c.10205delA, and c.12840delC) of KMT2D who were identified at ages 27 days, 2 months, and 5.5 years. Conclusions: Hearing characteristics of three individuals with three novel pathogenic variants of KMT2D range from mild to profound fluctuating hearing loss with mild to moderate SNHL. HRCT scans showed that all three individuals had anatomical middle and inner ear abnormalities. KS 1 patients must get clinical therapy for OME, frequent auditory monitoring, and prompt intervention. [ABSTRACT FROM AUTHOR]

A 3‐year‐old Maltese dog presented with vestibular signs that worsened after a grass seed was removed from the right external ear canal. Neurological examination was suggestive of a brainstem lesion. Magnetic resonance imaging of the head was performed, and findings were consistent with infectious meningoencephalitis and otogenic pneumocephalus secondary to intracranial extension of right otitis media. A culture of the right middle ear effusion yielded Staphylococcus epidermidis. The dog was euthanased under general anaesthesia due to worsening of the cardiovascular and respiratory parameters. Pneumocephalus in dogs has been described secondary to surgery, trauma, meningocele and meningoencephalocele. To the authors' knowledge, this is the first case report describing otogenic pneumocephalus in a dog. [ABSTRACT FROM AUTHOR]

This article discusses a study conducted at a hospital in Finland that examined the presence of respiratory viruses in children with acute otitis media (AOM), a common ear infection. The study found that AOM was most common in children with human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) infections. However, the highest number of AOM cases overall was found in children with rhinovirus infection. The study suggests that preventing these respiratory viral infections could help reduce the occurrence of AOM in children. The study was supported by various funding sources and the authors have no conflicts of interest. [Extracted from the article]

Objectives: Otitis media (OM) has a high prevalence worldwide and the treatment is crucial because hearing loss in children can lead to growth disorders such as language development disorders. The aim of this study is to analyse the changes in bacterial strains and the trends of antibiotic susceptibility in otitis media with effusion (OME), chronic otitis media (COM) and cholesteatomatous otitis media (Chole OM). Design: This retrospective study involved 2926 patients diagnosed with OME, COM, or Chole OM between January 2000 and December 2020. The clinical data were collected and analysed through chart review from May 2021 to July 2021. Setting: Two tertiary medical centres. Participants: The 2926 OM patients. Main Outcomes and Measures: An otorrhea sample was collected on the first day of their hospital visit. Middle ear fluid samples for bacterial culture and antibiotics susceptibility test were collected from patients during middle ear surgery, including ventilation tube insertion. In each type of OM, the distribution of bacterial strains in the 2000s and the 2010s was compared. In addition, changes in the detection rate of methicillin‐resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PA) and trends in their antibiotic susceptibility over the last 10 years were analysed. Results: The most frequently detected bacterial strains in OME, COM and Chole OM over the study period were coagulase‐negative Staphylococcus (CNS) (29.6%), MRSA (24.1%), and PA (20.1%). Compared to the 2000s, the proportion of non‐typable Haemophilus influenzae in OME and MRSA in COM increased in the 2010s (27.4%–31.6% and 1.5%–29.5%, respectively). In total three types of OM, although there was no significant trend of change in detection rates of MRSA, PA, and multidrug resistant‐P. aeruginosa (MDR‐PA) during the last 10 years, resistance to the Quinolone class of MRSA and PA tended to increase (P <.05). Conclusions: The composition of bacterial strains in each types of OM has changed over the past 20 years. Additionally, the antibiotic resistance of MRSA and PA has increased in the last decade. Therefore, when using empirical antibiotics in necessary situations, it is necessary to change to an appropriate antibiotic through a bacterial culture test and antimicrobial susceptibility test. [ABSTRACT FROM AUTHOR]

Objective: The frequency of tympanostomy tube (TT) placement among United States children with autism spectrum disorder (ASD) is not known. We explored the rate of TT placement in children with ASD in the United States and compared this to children without ASD. We further examined demographic and behavioral factors that might vary between the two groups. Methods: We utilized data from the National Health Interview Survey (NHIS) administered in 2014. This survey samples a representative population of patients across the United States and includes children under 18 years of age. The 2014 version of the NHIS survey was chosen as it identifies both autism and TT placement among sampled patients. Descriptive statistics and univariable and multivariable logistic regression analyses were performed. Results: In total, 11,730 children (239 [2.0%] with ASD) were included. Overall, 34 (14.2%) children with ASD underwent TT placement versus 987 (8.6%) in children without ASD (p = 0.002) ASD diagnosis was associated with increased odds of TT placement (1.52 OR, 95% CI 1.04–2.22). Male sex, white race, and non‐Hispanic ethnicity were also associated with increased odds of TT placement. Age at the time of TT surgery was not different between those with versus without ASD. Conclusion: Children with ASD have an increased rate of TT placement compared to children without ASD. The reason(s) for this increased rate might include the following: higher rates of infection in ASD, over‐diagnosis of ear infection or hearing disability in a difficult‐to‐examine population, and/or a predilection toward aggressive treatment in this at‐risk group. Level of Evidence: 3‐National database study Laryngoscope, 133:2407–2412, 2023 [ABSTRACT FROM AUTHOR]

Objective: To identify outcomes in hearing loss (HL) diagnosis and intervention in infants with a failed newborn hearing screen (NBHS) and otitis media with effusion (OME) compared to those with failed NBHS and without OME. Study Design: Retrospective review. Setting: Tertiary medical center. Methods: A chart review was performed on infants referred to Primary Children's Hospital for failed NBHS from 2012 to 2018. Eighty infants with failed NBHS and OME and 55 with failed NBHS and no OME were included. Incidence of permanent HL along with the age of HL confirmation and early intervention (EI) enrollment were compared. Results: The incidence of OME in infants with failed NBHS was 59.3%. Fifty‐six percent of infants with OME and 12.5% of those without OME did not receive definitive hearing confirmation in either ear due to loss to follow‐up or insufficient audiometric assessment. Permanent HL was identified in 11.3% (n = 9) of infants with OME and in 20.0% (n = 11) of those without OME. Infants with OME were significantly older at the time of HL confirmation (4.2 ± 2.1 months) and EI enrollment (5.4 ± 2.5 months) compared to those without OME at the time of HL confirmation (1.0 ± 1.0 months; p <.001) and EI enrollment (2.6 ± 1.8 months; p =.04). Conclusion: Infants with failed NBHS and OME are highly susceptible to a significant delay in HL confirmation or lack of confirmatory hearing tests. Timely OME resolution with earlier ventilation tube insertion by 3 months of age and follow‐up audiologic assessment is recommended. [ABSTRACT FROM AUTHOR]

Objective: To assess the role and possible mechanism of surfactant protein A (SPA) in the pathogenesis of otitis media with effusion (OME). Methods: This was a multi‐part study with both an in vivo mouse model study as well as an in vitro study. The control and study groups (OME group) received phosphate‐buffered saline and inactivated Streptococcus pneumoniae, respectively, via external auditory meatus injections. Changes in the surface tension of secretions from the eustachian tube (ET) and SPA expression were measured in both groups. A transwell assay was performed to observe the effect of different concentrations of SPA on the migration ability of macrophages. We examined the differentially expressed genes related to SPA‐treated macrophages using RNA‐seq analysis. Results: On Day 3, the surface tension of the OME group was higher than that of the control group (p = 0.014). The variation intensity of SPA in the ET of the OME group was significantly lower than that of the control group (p < 0.001). Surface tension was correlated with SPA (r = −0.525, p = 0.037). The expression of SPA and macrophages in the ET was different between the two groups. In vitro experiments revealed that macrophages showed different migration abilities with SPA concentration changes (p < 0.05). RNA‐seq and western blotting were performed after macrophages were treated with SPA. The results showed that RhoA and Rac1/2/3 were differentially expressed. Conclusions: SPA can change the surface tension of secretions from the ET and affect macrophage migration to alter the function of the ET. Although research in this field of OME is nascent, initial work suggests that SPA likely plays an important role in OME progression. Level of Evidence: NA Laryngoscope, 133:1726–1733, 2023 [ABSTRACT FROM AUTHOR]

Aim: Australian Aboriginal and/or Torres Strait Islander children in rural/remote areas suffer high rates of persistent otitis media (OM) from early infancy. We aimed to determine the proportion of Aboriginal infants living in an urban area who have OM and investigate associated risk factors. Methods: Between 2017 and 2020, the Djaalinj Waakinj cohort study enrolled 125 Aboriginal infants at 0–12 weeks of age in the Perth South Metropolitan region, Western Australia. Proportion of children with OM based on tympanometry at ages 2, 6 and 12 months was evaluated, type B tympanogram indicating middle ear effusion. Potential risk factors were investigated by logistic regression with generalised estimating equations. Results: The proportion of children with OM was 35% (29/83) at 2 months, 49% (34/70) at 6 months and 49% (33/68) at 12 months of age. About 70% (16/23) of those with OM at ages 2 and/or 6 months had OM at 12 months compared with 20% (3/15) if no prior OM (relative risk = 3.48, 95% confidence interval (CI): 1.22–40.1). On multivariate analysis, infants living in houses with ≥1 person/room were at increased risk of OM (odds ratio = 1.78, 95% CI: 0.96–3.32). Conclusion: Approximately half of Aboriginal infants enrolled into the South Metropolitan Perth project have OM by the age of 6 months and early onset of disease strongly predicts subsequent OM. Early surveillance for OM in urban areas is needed for early detection and management to reduce the risk of long‐term hearing loss which can have serious developmental, social, behavioural, educational and economic consequences. [ABSTRACT FROM AUTHOR]

Otitis media (OM) in dogs can occur as a primary condition instead of as an extension of an otitis externa (OE), characterized by the presence of fluid in the middle ear (ME) referred to as OM with effusion (OME). OME has been reported in a brachycephalic breed (boxer), and the same condition is described as primary secretory OM in Cavalier King Charles Spaniels. These dogs can be asymptomatic or present with pain, facial nerve paralysis and reduced hearing. This report describes two cases of OME with associated neurologic signs in Boston terriers with no previous history of OE, normal external ear canals and tympanic membranes. Neurologic evaluation revealed right head tilt along with vestibular ataxia and frequent walking tight circles to the right in case 1, and a dull mentation with a right‐sided head tilt and torticollis, vestibular tetra‐ataxia, ambulatory tetraparesis and circling to the right in case 2. MRI imaging of the brain was performed. Results showed bilateral OM with right‐sided otitis interna and equivocal associated otogenic meningitis in case 1 and right‐sided OM in case 2. Myringotomy was performed, and both dogs' ME sampled for cytology that only revealed inflammatory cells; and bacterial cultures which revealed a light growth of Pseudomonas aeruginosa in case 1. ME were flushed with sterile saline. Oral glucocorticoids and antibiotics based on the susceptibility results, and a compound antibiotic and glucocorticoid ear solution were prescribed to case 1. Neurologic improvement was observed a few days after the appointment, but a mild right‐sided head tilt remained evident. Owner of case two elected humane euthanasia due to patient respiratory difficulties upon anaesthetic recovery and other concurrent healthy concerns. Current findings reinforce that brachycephalic dogs may be prone to develop OME, and advanced imaging tests are key to the diagnosis. [ABSTRACT FROM AUTHOR]

Summary: A biopsy of lymphoid tissue is currently required to diagnose Kaposi sarcoma‐associated herpesvirus (KSHV)‐associated multicentric Castleman disease (KSHV–MCD). Patients showing clinical manifestations of KSHV–MCD but no pathological changes of KSHV–MCD are diagnosed as KSHV inflammatory cytokine syndrome. However, a lymph node biopsy is not always feasible to make the distinction. A pathognomonic feature of lymph nodes in KSHV–MCD is the expansion of KSHV‐infected, lambda‐restricted but polyclonal plasmablasts. To investigate whether these cells also reside in extra‐nodal sites, effusion from 11 patients with KSHV–MCD and 19 with KSHV inflammatory cytokine syndrome was analysed by multiparametric flow cytometry. A distinct, lambda‐restricted plasmablastic population (LRP) with highly consistent immunophenotype was detected in effusions in 8/11 patients with KSHV–MCD. The same population was also observed in 7/19 patients with KSHV inflammatory cytokine syndrome. The detection of LRP stratified KSHV inflammatory cytokine syndrome into two clinically distinct subgroups; those with detectable LRP closely resembled KSHV–MCD, showing similar KSHV viral load, comparable severity of thrombocytopenia and hypoalbuminaemia, and similar incidences of hepatosplenomegaly. Collectively, the detection of LRP by flow cytometry can serve as a valuable tool in diagnosing KSHV–MCD. KSHV inflammatory cytokine syndrome with LRP in effusions may represent a liquid‐form of KSHV–MCD. [ABSTRACT FROM AUTHOR]

Background: Middle ear disease is common in children and, if untreated, can lead to long term complications. This study investigated whether ethnic or socioeconomic inequities existed among children referred to a tertiary regional paediatric ORL service. Methods: All middle ear pathology related referrals to Starship Children's Hospital ORL service during 2018 and 2019 were reviewed. Online clinical records were accessed to collect demographic data and appointment outcomes. The relationships between ethnicity, socioeconomic status, age at referral and clinic attendance were analysed. Results: A total of 1530 children were referred and 214 (14.0%) of these did not attend their scheduled appointments. Compared with the age of referral for European children, Māori children were referred on average 1.1 years older while Pasifika children were referred 2.4 years older. Compared to European children, Māori children were 4.3 times more likely to miss an appointment while Pasifika were 7.2 times more likely. Socioeconomic status had no significant effect on either age of referral or clinic attendance. Conclusions: Māori and Pasifika children with middle ear disease are referred later and are more likely to miss outpatient clinic appointments. Pasifika children are affected more than Māori. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the relationship between cleft width and otitis media (OM) and to determine whether a wide cleft palate (CP) is a risk factor of the incidence, type, amount of middle ear effusion, and prolonged morbidity in OM. Study Design: Retrospective cohort study. Methods: Children with CP who underwent palatoplasty between 2014 and 2018 were analyzed. Cleft width was measured at palatoplasty. The incidence of otitis media with effusion (OME) and acute otitis media (AOM), the type and amount of middle ear effusion, and OME duration and age at resolution were assessed in relation to cleft width. Results: One hundred eighteen children were included. The CP types were Veau I in 16, II in 35, III in 48, and IV in 19 patients. The incidence of OME and AOM before palatoplasty was 83.1% and 49.2%, respectively. Cleft width did not differ significantly between patients with or without OME but was significantly greater in those with, than in those without, AOM (p <.001), in those with mucoid, than in those with serous, effusion (p =.012), and in those with complete, than in those with partial, effusion (p =.01). Regardless of cleft width or type, OME persisted for a median duration of 50 months. Conclusions: Cleft width was significantly associated with the incidence of AOM and the type and amount of middle ear effusion before palatoplasty. However, it was not significantly related to the incidence, age at resolution, or duration of OME. Regardless of cleft width or type, OM in children with CP requires long‐term follow‐up. Level of Evidence: 2b. [ABSTRACT FROM AUTHOR]

Otitis media with effusion (OME) is fluid accumulation in the middle ear without signs of systemic infection. OME can cause hearing loss, ear fullness, speech retardation, and a decrease in social relations and school success. In the treatment of OME, methods such as medical treatment and placing a tympanostomy tube in the eardrum are used. Correct evaluation of the eardrum is necessary to diagnose OME and follow‐up properly in the following period. In this study, we aimed to evaluate the otoendoscopic images of the eardrum in patients with otitis media with effusion using deep models. In the proposed model, Efficientnetb0, Darknet53, and Densenet201 architectures are used as the base. The feature maps obtained using these architectures are combined. In this way, different features of the otoendoscopic images of the eardrum in the data set were extracted and combined using different architectures. neighborhood component analysis optimization technique is used to select important features from the combined feature maps. By using this optimization method, the size of feature maps is reduced. In this way, the model is trained faster, and the testing process is carried out in a shorter time. When these features are classified in different classifiers, the model we propose has the most successful average accuracy value of 94.27% in the SVM classifier. [ABSTRACT FROM AUTHOR]

Objectives: To determine the effectiveness of ciprofloxacin.3% antibiotic eardrops in preventing clinically significant postoperative otorrhoea and tube obstruction following grommet insertion in children. Design: Three‐arm parallel assessor‐blinded randomised controlled trial. Randomisation in 1: 1: 1 ratio to single intraoperative application of ciprofloxacin drops, extended 5 day postoperative application and no drops. Patients were assessed by blinded assessors at 6 weeks postoperatively. Setting: The study was conducted in a large tertiary health network in Melbourne, Australia. Participants: All children, 17 years and under, undergoing bilateral middle ear ventilation tube surgery with or without concurrent upper airway surgery for recurrent acute otitis media and chronic otitis media with effusion were approached. Main outcome measures: Presence of postoperative otorrhoea and ventilation tube obstruction at 6 weeks postoperatively. Results: Two‐hundred and fifty‐six paediatric patients completed the study with a median age of 4.02 years. One‐hundred and fifty‐three participants were male. Ear analysis (n = 512) showed intraoperative antibiotics were more effective than no drops in preventing otorrhoea (RR =.341, 95% CI.158–.738, NNT =11.25, p =.006). Postoperative antibiotics were more effective than no drops in preventing ventilation tube obstruction (RR =.424, 95% CI.193 to.930, NNT =14.7, p =.032). Conclusion: Intraoperative topical ciprofloxacin was effective at preventing early postoperative otorrhoea, and a prolonged course was effective at preventing ventilation tube obstruction. Future studies on this topic should seek to clarify whether particular subgroups of patients benefit more from prophylactic topical antibiotics and model for cost‐effectiveness. [ABSTRACT FROM AUTHOR]

Background: Core outcome sets aim to reduce research heterogeneity and standardise reporting, allowing meaningful comparisons between studies. Objectives: To report on outcomes used in randomised controlled trials (RCTs) investigating uterine fibroid treatments, towards the development of a core outcome set for fibroid research. Selection strategy: Database search of MEDLINE, PubMed, EMBASE and CINAHL (inception to July 2021) for all English‐language RCTs involving surgical or radiological fibroid treatments. Data collection and analysis: A total of 1885 texts were screened for eligibility by two reviewers independently according to PRISMA methodology. JADAD and Management of Otitis Media with Effusion in Cleft Palate (MOMENT) scores were used to assess methodological and outcome reporting quality of studies, respectively. Outcomes were mapped to nine domains. Non‐parametric tests for correlation and to compare group medians were undertaken. Main results: There were 23 primary outcomes (23 outcome measures) and 173 secondary outcomes (95 outcome measures) reported in 60 RCTs (5699 participants). The domains with highest frequency of primary outcomes reported were bleeding and quality of life (QoL). The most frequent primary outcomes were postoperative pain, QoL and menstrual bleeding. No primary outcomes were mapped to fertility domains. Median MOMENT outcome score was 5 (interquartile range 3). There was correlation between MOMENT outcome score and JADAD scores (r = 0.491, P = 0.0001), publishing journal impact factor (r = 0.419, P = 0.008) and publication year (r = 0.332, P = 0.01). Conclusion: There is substantial variation in the outcomes reported in fibroid RCTs. There is a need for a core outcome set for fibroid research, to allow improved understanding regarding the effects of different treatments. There is substantial variation in outcomes reported in uterine fibroid randomised controlled trials. There is substantial variation in outcomes reported in uterine fibroid randomised controlled trials. [ABSTRACT FROM AUTHOR]

Objective: Pneumococcal conjugate vaccines (PCVs) have been reported to reduce the incidence of myringotomy with tympanostomy tube insertion (MTTI) in children. However, little information is available focusing specific ages. We examined the prophylactic efficacy of PCVs on the onset of complex otitis media (ComOM) that requires MTTI. Method: From 2011, the public support for PCV7 started with the usual four‐dose schedule and an emergency schedule for 2‐ to 4‐year‐old children in Japan. PCV7 was replaced with PCV13 in 2013. We reviewed the nationwide database obtained from the JMDC Claims Database (https://www.jmdc.co.jp/en/) to examine the MTTI incidence during the era before and after PCV introduction (from 2008 to 2010 and from 2011 to 2017, respectively). Subjects were analyzed by stratified age groups (from 0 to 8 years old) and in subdivided groups of 6 months (from 0 to 35 months old). We compared the MTTI incidence between the groups for each age as well as between those for each calendar year. Results: A significant reduction in the MTTI incidence was detected in the 1‐year‐old children of the PCV era compared to those of the pre‐PCV era. The reduction rates were more prominent in the 12–17 months group as compared to the 18–23 months group (PCV7 p =.005 and PCV13 p =.011, PCV7 p =.014 and PCV13 p =.153, respectively). The significant difference in the 1‐year‐old children continued in six of seven calendar years from 2011 to 2017, whereas no significant reduction was detected in children >3 years old. Conclusions: The introduction of both PCV7 and PCV13 reduced MTTI incidences in children around 1 year old, and the effects were more prominent during the early half‐periods. Our results support etiological evidence that pneumococcal infection in children aged 1 year and younger might play roles in the pathogenesis of ComOM that requires MTTI. [ABSTRACT FROM AUTHOR]

Non‐inflammatory joint effusion with characteristically increased synovial fluid viscosity is a rare but well‐recognised rheumatic manifestation of hypothyroidism in people and based on the literature search, this is the first report of the condition in dogs. A 2‐year‐old Pyrenean Mountain dog presented for lameness and multiple joint effusions. CT confirmed effusions affecting multiple limb joints along with delayed closure of multiple physes. Synovial fluid analysis from the effused joints showed no evidence of inflammation but the fluid viscosity was markedly increased. Serum total thyroxine concentration was decreased, thyroid‐stimulating hormone concentration was increased and antithyroglobulin autoantibody measurement returned a positive result. Oral levothyroxine supplementation resulted in relatively rapid and complete resolution of the clinical signs, in association with attaining a euthyroid state. Follow‐up examination and CT six months later confirmed resolution of the joint effusions and significant improvement or resolution of the other documented skeletal changes. [ABSTRACT FROM AUTHOR]

Design: The objective of this study was to establish whether autoinflation was an effective intervention in a paediatric audiology service. This was a pragmatic retrospective study with historical controls using a paired availability design. Setting: The study took place at a single paediatric audiology service in England. Participants: All children seen in the clinic over a two‐year period who were aged between 3 and 11 years and who had a type B tympanogram in at least one ear were included. The Otovent autoinflation device was available as a treatment option over the second year (Cohort B) but not the first (Cohort A). There were 976 children included in the study: Cohort A comprised 513 children, Cohort B comprised 463 children. Main outcome measures: The aims were to evaluate whether there was improvement in hearing thresholds following introduction of an autoinflation device, and whether there was a reduction in further audiology follow‐ups, and in referrals to an ear, nose and throat specialist for consideration of ventilation tube insertion. Results and conclusions: There was a statistically significant improvement in hearing thresholds in Cohort B compared to Cohort A, however the improvements were clinically minimal with small effect sizes. There was no significant difference in improvement of tympanometry results between the two cohorts. Significantly more children in Cohort B (autoinflation group) were referred to an ear, nose and throat specialist after their second appointment compared to Cohort A. It was feasible to introduce autoinflation into the care pathway, however there was no evidence of clinically meaningful improved outcomes for patients. [ABSTRACT FROM AUTHOR]

Objectives: Children with cleft palates often have comorbid eustachian tube dysfunction requiring pressure equalization tubes (PETs). PETs can relieve middle ear effusions that impede hearing. Ideal PET placement timing in this population is controversial. In this study, the audiologic exam passing rates of patients with cleft palate prior to and following PET insertion were assessed. Rates for patients receiving PETs at different ages were compared. It was hypothesized that earlier PET placement may benefit patients with additional months of improved hearing., Methods: A retrospective chart review was performed of patients with cleft palate between November 22, 2016 and November 22, 2021 at a tertiary center. Statistical analysis compared passing/normal audiologic exams in patients receiving PETs at different ages., Results: A total of 348 patients had cleft palate diagnoses, received PETs, and had adequate hearing data for inclusion. Those with PETs inserted at 3 months of age or less had an increase in percent of patients passing audiologic exams following versus prior to PET insertion of 13% (1.3 times improvement). Those receiving PETs between 7- and 12-months had the largest rate of improvement (42%) (2.4 times improvement); other groups had changes in passing rates between 31% and 40%. The rate of passing audiologic exams following PET insertion was high across all groups, ranging from 66% to 81%., Conclusion: This is one of the first studies exploring the timing of PET placement in this population and showed that patients receiving PETs at 3 months of age or younger passed subsequent audiologic exams at similar rates relative to those receiving PETs later in life., Level of Evidence: 3 Laryngoscope, 134:3391-3394, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

In this report of otologic characteristics of XLH patients, we found that one in every four patients with XLH presented with hearing loss. Hearing loss and associated variables Patients with hearing loss had a higher prevalence of tinnitus (5 of 6 patients (83%) vs. 5 of 20 patients (25%), I P i = .018) and a phosphate Z-score significantly lower than patients without hearing loss (-4.59 (SD 1.27) vs. -3.55 (SD 0.83), I P i = .025). Patients with hearing loss had higher prevalence of tinnitus and lower serum phosphate compared to patients without hearing loss. Keywords: FGF23; hearing loss; hereditary hypophosphatemic rickets; otorhinolaryngology; X-linked hypophosphatemia EN FGF23 hearing loss hereditary hypophosphatemic rickets otorhinolaryngology X-linked hypophosphatemia 1251 1256 6 10/14/21 20211101 NES 211101 Key points In this report of otological involvement in XLH patients, 23% of them presented hearing loss. [Extracted from the article]

To investigate the presence of respiratory viruses in the middle ear cavity of the individuals with a healthy middle ear and the children with otitis media with effusion (OME). A total of 72 middle ear samples were collected from 25 children with OME (Group 1) and 47 individuals with no middle ear disease (Group 2). Multiplex real‐time polymerase chain reaction was used to investigate the presence of 20 different respiratory viruses. Virus results were compared with bacteriomes of the same populations. At least one respiratory virus was detected in 56% of the patients in Group 1 and 12.8% of the individuals in Group 2. The viral co‐infection rate for Group 1 and 2 was 8% and 2.1%, respectively. In Group 1, adenovirus was the most frequently detected virus with a rate of 24%, either alone (16%) or concurrent with other viruses (8%), followed by influenza B (12%), rhinovirus, and bocavirus (8%) each. Parainfluenza 4, coronavirus OC43, and RSV A/B were detected in 4% of the sample each. In Group 2, rhinovirus was detected in two samples (4.3%) followed by adenovirus, coronavirus OC43, coronavirus E299, and coronavirus NL63 with a rate of 2.1% each. The detection rate of respiratory viruses was significantly higher in children aged 6 to 11 years. There was no positive association between virus and bacteria found in the middle ear cavity. The current study has provided comprehensive data indicating the presence of diverse respiratory viruses in the healthy middle ear cavity. Our results also suggest that respiratory viruses might have a contribution to OME pathogenesis. [ABSTRACT FROM AUTHOR]

Objectives: Otitis media (OM) is the most common pediatric diagnosis in the United States. However, our understanding of the molecular pathogenesis of OM remains relatively poor. Investigation of molecular pathways involved in OM may improve the understanding of this disease process and elucidate novel therapeutic targets. In this study, RNA sequencing (RNA‐Seq) was used to discern cellular changes associated with OME compared to healthy middle ear epithelium (MEE). Study Design: Ex vivo case‐control translational. Methods: Middle ear epithelia was collected from five pediatric patients diagnosed with OME undergoing tympanostomy tube placement and five otherwise healthy pediatric patients undergoing cochlear implantation. Specimens underwent RNA‐Seq and pathways analyses. Results: A total of 1,292 genes exhibited differential expression in MEE from OME patients compared to controls including genes involved in inflammation, immune response to bacterial OM pathogens, mucociliary clearance, regulation of proliferation and transformation, and auditory cell differentiation. Top networks identified in OME were organismal injury and abnormalities, cell morphology, and auditory disease. Top Ingenuity canonical pathways identified were axonal guidance signaling, which contains genes associated with auditory development and disease and nicotine degradation II and III pathways. Associated upstream regulators included β‐estradiol, dexamethasone, and G‐protein‐coupled estrogen receptor‐1 (GPER1), which are associated with otoprotection or inflammation during insult. Conclusions: RNA‐Seq demonstrates differential gene expression in MEE from patients with OME compared to healthy controls with important implications for infection susceptibility, hearing loss, and a role for tobacco exposure in the development and/or severity of OME in pediatric patients. Level of Evidence: 4 Laryngoscope, 131:2590–2597, 2021 [ABSTRACT FROM AUTHOR]

Objective: To evaluate the role of social isolation during the lockdown due to the SARS-CoV-2 outbreak (severe acute respiratory syndrome coronavirus 2) in modifying the prevalence of otitis media with effusion (OME) and the natural history of chronic OME. Study Design: Retrospective study. Setting: Tertiary level referral audiologic center. Methods: We assessed the prevalence of OME among children aged 6 months to 12 years who attended the outpatient clinic for hearing or vestibular disorders during 2 periods before the lockdown, May-June 2019 (n = 350) and January-February 2020 (n = 366), and the period immediately after the lockdown, May-June 2020 (n = 216). We also compared the disease resolution rates between a subgroup of children with chronic OME (n = 30) who were diagnosed in summer 2019 and reevaluated in May-June 2020 and a similar subgroup (n = 29) assessed in 2018-2019. Results: The prevalence of OME in this clinic population was 40.6% in May-June 2019, 52.2% in January-February 2020, and 2.3% in May-June 2020. Children with chronic OME had a higher rate of disease resolution in May-June 2020 (93.3%) than those examined in May-June 2019 (20.7%, P <.001). Conclusion: Closure of schools and the physical distancing rules were correlated with a reduction in the prevalence of OME and favored the resolution of its chronic forms among children who attended the outpatient clinic. These data could suggest that in the presence of chronic OME, keeping young children out of group care settings for a period might be beneficial to allow for OME resolution. [ABSTRACT FROM AUTHOR]

Aim: Unnecessary antibiotic prescriptions to treat otitis media (OM) contribute to adverse drug reactions, increased cost and antibiotic resistance. Clinical care guidelines can help promote consistent treatment of conditions such as OM. This study evaluates adherence before and after implementation of an institutional guideline for the diagnosis and treatment of paediatric OM. Methods: A retrospective chart review was performed to collect encounter information for paediatric patients seen within a primary care clinic network and diagnosed with OM before and after full implementation of a clinical care guideline. Patient cohorts from 2013 and 2016 were compared to determine which factors, including age, symptoms and diagnosis, were associated with treatment guideline adherence. Results: Comparison of encounters from 2013 (n = 418) to 2016 (n = 635) revealed a significant difference in adherence to the 2013 Michigan Medicine Otitis Media Guideline. Overall adherence increased from 61.2% in 2013 to 70.6% in 2016 (χ2 = 9.85, P < 0.0017). Antibiotic use for acute OM decreased from 99.7% in 2013 to 96.7% in 2016 (χ2 = 10.04, P = 0.0015). Antibiotic prescriptions for OM with effusion decreased significantly from 42.9% in 2013 to 17.4% in 2016 (χ2 = 11.93, P < 0.0006). Conclusion: Implementation of an institutional OM clinical practice guideline contributed to a significant increase in overall treatment adherence of OM for paediatric patients between the 2013 and 2016 cohorts. The number of antibiotic prescriptions for paediatric patients diagnosed with acute OM or OM with effusion significantly decreased from 2013 to 2016. [ABSTRACT FROM AUTHOR]

Introduction: Long‐term follow‐up (≥4 years) demonstrated a low incidence of cardiac and vascular treatment‐emergent adverse events (TEAEs) with bosutinib treatment. We evaluated cardiac, vascular, hypertension, and effusion TEAEs after ≥ 7 years of follow‐up in patients with Philadelphia chromosome–positive (Ph+) leukemia. Methods: This retrospective analysis of a phase I/II study and its ongoing extension study included data from patients with chronic phase chronic myeloid leukemia (CML) treated with bosutinib after resistance/intolerance to imatinib (CP2L) or to imatinib plus dasatinib and/or nilotinib (CP3L), and those with accelerated/blast phase CML or acute lymphoblastic leukemia after treatment with, at a minimum, imatinib (ADV). Results: In all, 570 patients were treated with bosutinib; median treatment duration was 11.1 months (range: 0.03‐133.1). The incidence of cardiac, vascular, hypertension, and effusion‐related TEAEs was 10.9%, 8.8%, 9.1%, and 13.3%, respectively. Few patients had maximum grade 3‐4 TEAEs (cardiac, 3.9%; vascular, 4.0%; hypertension, 3.0%; effusion, 4.6%). Grade 5 TEAEs occurred in the cardiac (0.7%) and vascular (1.8%) clusters only. In years 5‐7, fewer than 5% of patients each year had newly occurring cardiac, vascular, hypertension, or effusion TEAEs. The exposure‐adjusted TEAE rates (patients with TEAEs/total patient‐year) pooled across CP2L, CP3L, and ADV cohorts were as follows: cardiac, 0.044; vascular, 0.035; hypertension, 0.038; and effusion, 0.056, of which, correspondingly, 0.9%, 1.2%, 0%, and 2.1% required treatment discontinuation. Conclusions: The incidence of cardiac, hypertension, vascular, and effusion events was low in patients with Ph+ CML resistant or intolerant to prior therapy who were treated with bosutinib. [ABSTRACT FROM AUTHOR]

Purpose: To characterize the classification, incidence, diagnosis and prognosis of traumatic choroidal injuries. Methods: Subjects were selected from the database of the Eye Injury Vitrectomy Study (EIVS) and were examined for occurrences of different categories of choroidal injuries. Standard photographs were collected. Anatomical and visual outcomes were assessed in patients with greater than 1 year of follow‐up. Eyes that had no light perception (NLP) and/or phthisis bulbi were defined as having had unfavourable outcomes. The percentage of eyes with an unfavourable outcome was analysed for different types of choroidal injuries. Results: Nine categories of choroidal injuries with distinctive features were identified in the EIVS database. The incidence and the percentage of eyes with an unfavourable outcome in each injury category were as follows: suprachoroidal effusion, 21.2% (7.2%); suprachoroidal haemorrhage, 12.8% (11.2%); massive suprachoroidal haemorrhage, 4.0% (64.9%); choroidal avulsion, 4.2% (92.2%); traumatic chorioretinal rupture, 1.8% (13.3%); choroidal rupture, 4.8% (6.8%); choroidal loss, 1.6% (79.3%); choroidal hole, 1.1% (5.3%); and choroidal damage at the wound site, 39.2% (17.7%). Conclusions: Ocular trauma can cause a variety of choroidal injuries that have distinctive features, some of which are associated with a high frequency of unfavourable prognoses. [ABSTRACT FROM AUTHOR]

Background: Allergic rhinitis is a common childhood disease responsible for a major impact on quality of life and healthcare resources. Many hypotheses have been proposed to explain the link between allergy and otitis media, although a definitive mechanism has not been identified yet. One of the major critical points is that authors failed in distinguishing among different phenotypes of middle ear inflammation. This review pointed out literature evidence from the laboratory and clinical experience linking allergy to different phenotypes of otitis media in children. Methods: We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Review and Meta‐Analysis (PRISMA) process. Our search yielded 3010 articles that were finally screened. This resulted in 20 manuscripts of which the full texts were included in a qualitative analysis. We paid particular attention in distinguishing among phenotypes of otitis media. Results: Clinical evidence and analyses of biomarkers suggested that allergy may be linked to some phenotypes of otitis media and, in particular, to otitis media with effusion (OME) and acute re‐exacerbations in children with middle ear effusion. It was not possible to perform the analysis for allergy and acute and chronic otitis media because of paucity and heterogeneity of data. Conclusion: Allergy should be considered in the diagnostic workup of children with OME as well as OME should be excluded in children with persistent moderate to severe AR. In these cases, clinicians should evaluate prompt and accurate treatment of allergy in improving outcomes, although futures studies are required to increase evidence supporting that anti‐allergy treatment may be effective in the recovery and outcome of otitis media with effusion. [ABSTRACT FROM AUTHOR]

Same clinical entity can have different biology and can behave differently. This must be kept in mind while making therapeutic decisions. Primary effusion lymphoma is a rare and devastating disease with high fatality. Chemotherapy provides limited benefit. We describe a unique case of a good outcome with steroid alone treatment. [ABSTRACT FROM AUTHOR]

Introduction: The 2001 Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Islander populations were revised in 2010. This 2020 update by the Centre of Research Excellence in Ear and Hearing Health of Aboriginal and Torres Strait Islander Children used for the first time the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Main recommendations: We performed systematic reviews of evidence across prevention, diagnosis, prognosis and management. We report ten algorithms to guide diagnosis and clinical management of all forms of otitis media. The guidelines include 14 prevention and 37 treatment strategies addressing 191 questions. Changes in management as a result of the guidelines: A GRADE approach is used.Targeted recommendations for both high and low risk children.New tympanostomy tube otorrhoea section.New Priority 5 for health services: annual and catch‐up ear health checks for at‐risk children.Antibiotics are strongly recommended for persistent otitis media with effusion in high risk children.Azithromycin is strongly recommended for acute otitis media where adherence is difficult or there is no access to refrigeration.Concurrent audiology and surgical referrals are recommended where delays are likely.Surgical referral is recommended for chronic suppurative otitis media at the time of diagnosis.The use of autoinflation devices is recommended for some children with persistent otitis media with effusion.Definitions for mild (21–30 dB) and moderate (> 30 dB) hearing impairment have been updated.New "OMapp" enables free fast access to the guidelines, plus images, animations, and multiple Aboriginal and Torres Strait Islander language audio translations to aid communication with families. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Cell culture models are valuable tools for investigation of the molecular pathogenesis of diseases including otitis media (OM). Previous study indicates that age-, sex-, and race-associated differences in molecular signaling may impact disease pathophysiology. Currently, a singular immortalized middle ear epithelial (MEE) cell line exists, HMEEC-1, derived from an adult without known middle ear disease. In this study, HMEEC-1 and primary MEE cultures from pediatric patients with and without OM were stimulated with inflammatory cytokines or OM-pathogenic bacterial lysates to examine differences in the response of molecules associated with OM pathogenesis.Study Design: Case-control series.Methods: MEE cultures were established from patients aged <6 years: two with recurrent OM (ROM), two with OM with effusion (OME), and one patient without OM who was undergoing cochlear implant surgery control undergoing cochlear implantation (Peds CI). Primary MEE cultures and HMEEC-1 cells were stimulated with tumor necrosis factor-α, interleukin (IL)-1β, or nontypeable Haemophilus influenzae lysate. TNFA, IL1B, IL6, IL8, IL10, and MUC5B were assayed via quantitative polymerase chain reaction. IL-8 was assayed by enzyme-linked immunosorbent assay.Results: Gene/protein target expressions were frequently higher in pediatric OM lines than in HMEEC-1 and Peds CI. HMEEC-1 cells were frequently less responsive to stimuli than all pediatric lines. OME lines were often more responsive than ROM lines.Conclusions: OM may be associated with specific molecular phenotypes that are retained in primary cell culture. Adult-derived HMEEC-1 cells differ significantly in baseline expression and response of OM-associated molecules relative to pediatric MEE cells. Work is underway to immortalize pediatric OM MEE cultures as improved tools for the OM research community.Level Of Evidence: 4 Laryngoscope, 131:410-416, 2021. [ABSTRACT FROM AUTHOR]

Objectives: To identify predictors of acceptable hearing at 5 weeks, 6 and 12 months in children with bilateral otitis media with effusion (OME). Design and setting: Secondary analysis of OSTRICH data, conducted in hospital ear, nose and throat (ENT) and paediatric audiology and audiovestibular medicine departments across Wales and England. Participants: The OSTRICH study included 389 children aged 2‐8 years with bilateral hearing loss attributable toOME for at least 3 months. Main outcome measures: Baseline, 5‐week, 6‐ and 12‐month audiology measurements were collected and logistic regression models used to identify pre‐randomisation baseline variables that predicted return of acceptable hearing, which was defined as less than or equal to 20 dB hearing loss averaged within the frequencies of 0.5, 1, 2 and 4 kHz in at least one ear in children assessed by pure tone audiometry, ear‐specific insert visual reinforcement audiometry or ear‐specific play audiometry less than or equal to 25 dB hearing loss averaged within the frequencies of 0.5, 1, 2 and 4 kHz in children assessed by sound‐field visual reinforcement audiometry or sound‐field performance/play audiometry, based on national guidelines. Results: Less severe baseline hearing loss across both ears most consistently predicted acceptable hearing at 5 weeks (adjusted odds ratio [aOR] 0.91, 95% CI 0.87‐0.95), 6 months (0.94 [0.90‐0.98]) and 12 months (0.93 [0.89‐0.97]). Negative history of atopy (2.05 [1.16‐3.61]), never using hearing aids (aOR 2.16 [1.04‐4.48]), and being male (1.75 [1.02‐2.99]) were significant at 6 months, but not at 12 months. Symptom duration was a predictor at 5 weeks, but not at 6 or 12 months. Conclusions: Milder baseline hearing loss most consistently predicts acceptable hearing at 5 weeks, 6 and 12 months in children with chronic OME. Negative history of atopy, never using hearing aids, and male gender are associated with better prognosis. These predictors can be used to identify children that may not require treatment. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the overall and subgroup prevalence of otitis media with effusion (OME) in Africa, and identify setting‐specific predictors in children and adults. Methods: PubMed, African Journals Online, African Index Medicus, Afrolib, SciELO, Embase, Scopus, Web of Science, The Cochrane Library, GreyLit and OpenGray were searched to identify relevant articles on OME in Africa, from inception to December 31st 2019. A random‐effects model was used to pool outcome estimates. Results: Overall, 38 studies were included, with 27 in meta‐analysis (40 331 participants). The overall prevalence of OME in Africa was 6% (95% CI: 5%‐7%; I2 = 97.5%, P <.001). The prevalence was 8% (95% CI: 7%‐9%) in children and 2% (95% CI: 0.1%‐3%) in adolescents/adults. North Africa had the highest prevalence (10%; 95% CI: 9%‐13%), followed by West and Southern Africa (9%; 95% CI: 7%‐10% and 9%; 95% CI: 6%‐12% respectively), Central Africa (7%; 95% CI: 5%‐10%) and East Africa (2%; 95% CI: 1%‐3%). There was no major variability in prevalence over the last four decades. Cleft palate was the strongest predictor (OR: 5.2; 95% CI: 1.4‐18.6, P =.02). Other significant associated factors were age, adenoid hypertrophy, allergic rhinitis in children, and type 2 diabetes mellitus, low CD4 count in adults. Conclusion: OME prevalence was similar to that reported in other settings, notably high‐income temperate countries. Health care providers should consider age, presence of cleft palate, adenoid hypertrophy and allergic rhinitis when assessing OME in children and deciding on a management plan. More research is required to confirm risk factors and evaluate treatment options. Level of Evidence: 3a [ABSTRACT FROM AUTHOR]

Background: Traditionally, patients are seen by an ear, nose and throat (ENT) surgeon prior to allied health referral for treatment of swallowing, voice, hearing and dizziness. Wait‐times for ENT consultations often exceed those clinically recommended. We evaluated the service impact of five allied health primary contact clinics (AHPC‐ENT) on wait‐times and access to treatment. Setting: A metropolitan Australian University Hospital Outpatient ENT Department. Participants: We created five AHPC‐ENT pathways (dysphonia, dysphagia, vestibular, adult and paediatric audiology) for low‐acuity patients referred to ENT with symptoms of dysphonia, dysphagia, dizziness and hearing loss. Main outcome measures: Using multiple regression analysis, we compared waiting times in the 24‐month pre‐ and 12‐month post‐implementation of the AHPC‐ENT service. In addition, we measured the number of patients requiring specialist ENT intervention after assessment in the AHPC‐ENT, adverse events and evaluation of service delivery costs. Results: Seven hundred and thirty‐eight patients were seen in the AHPC‐ENT over the first 12 months of implementation (dysphagia, 66; dysphonia, 153; vestibular, 151; retro‐cochlear, 60; and paediatric glue ear, 308). All pathways significantly reduced the waiting times for patients by an average of 277 days, compared with usual care. The majority of patients were able to be discharged without ongoing ENT intervention (72% dysphagia; 81% dysphonia; 74% vestibular; 53% retro‐cochlear; and 32% paediatric glue ear). No adverse events were recorded. Conclusions: The AHPC‐ENT improved waiting times for assessment and access to treatment. Future research on cost‐effectiveness and diagnostic agreement between AHPs and ENT clinicians would provide further confidence in the model. [ABSTRACT FROM AUTHOR]

Objective: Eustachian tube dysfunction (ETD) is a common diagnosis among adults presenting for outpatient care. We sought to determine national utilization and the associated cost of invasive procedures for adult ETD. Study Design: Cross-sectional study. Setting: National health care database. Subjects and Methods: The Truven Health MarketScan Databases (2010-2014) analytic cohort included health care encounters of patients ≥18 years of age with a diagnosis of ETD or related conditions of otitis media with effusion (OME) or tympanic membrane retraction (TMR). Visits associated with recent diagnoses of acute upper respiratory infection, head and neck cancer, or radiation therapy were excluded. Invasive procedure usage was subdivided into nasal and otologic procedures. Results: ETD, OME, or TMR was diagnosed in 1,298,987 patients, 11.1% of which were chronic. The most common procedure was diagnostic endoscopy (including nasal endoscopy and laryngopharyngoscopy), which was used most frequently in the first 3 months after diagnosis, during which it was performed in 120,971 (9.3%) patients. The most frequent therapeutic nasal procedure was eustachian tube inflation without catheterization, performed in 11,412 patients over 5 years at a total cost of $1,210,939 ($106 per person annually). The most common therapeutic otologic procedure was myringotomy with tympanostomy, performed on 56,137 patients over 5 years at a total cost of $47,713,708 ($810 per person annually). Conclusion: Several nasal and otologic procedures are associated with a diagnosis of adult ETD at substantial cost. Development of therapeutic alternatives should be sought to mitigate the need for invasive procedures to treat this condition. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the feasibility of a two‐stage screening strategy for otitis media with effusion (OME) in pre‐school and school children. The risk factors of OME were also studied. Methods: One hundred and eighty‐nine children aged 4–8 years were recruited. The two‐stage screening consisted of an on‐site screening with a portable otoscopy along with a questionnaire to both diagnose children with OME and identify children at risk, and a standard screening performed at a regional hospital for final diagnosis. The prevalence detected from the two‐stage screening approach was compared to the actual prevalence. Results: The detection rate of OME through the two‐stage screening approach was not significantly different from the actual prevalence rate (12.7% vs. 13.4%, P = 0.847). Children from the urban area had a lower risk for OME than that from the rural area (P = 0.007, odds ratio (OR) = 0.28, 95% confidence interval (CI): 0.11–0.74). Compared to childcare dining, family dining helped to reduce the chance of OME (P < 0.001, OR = 0.15, 95% CI: 0.06–0.38). Conclusions: The two‐stage screening strategy was effective for screening for OME among pre‐school and school children. It can be used in rural areas that have a high prevalence of OME and limited medical resources. [ABSTRACT FROM AUTHOR]

Aim: To determine the prevalence and risk factors of ear disease in Turner syndrome (TS), propose an algorithm for future surveillance and recommend preventative strategies. Methods: Review of TS patients seen in the West of Scotland between 1989 and 2015, with questionnaire follow‐up in 2015. Results: Of 168 girls, median age 27.3 (3.8‐47.2) years, ear problems occurred more frequently with 45,X and 45,X/46,XiXq than other karyotypes: 71/103 (69%) versus 23/65 (35%). Recurrent acute otitis media (AOM) first developed at 0‐5 years in 23 (40%) girls, persisting in 16 (10%) at 5‐10 years; and first developing at 5‐10 years in 11 (7%). Persistent otitis media with effusion (OME) first developed at 0‐5 and 5‐10 years in 23 (40%) and 14 (8%) girls. Recurrent AOM was significantly linked with cholesteatoma in 8 (4.9%) girls (7 aged >10 years). Permanent hearing loss was documented in 28 girls (16.7%), with 16 (9.5%) receiving hearing aids (bone‐anchored in 3). Conclusion: Acute otitis media and OME occur commonly in preschool TS girls and may persist or newly develop in later childhood. Recurrent AOM predisposes to cholesteatoma. Strategies to reduce otological morbidity include: intensive patient education, annual audiology, vaccinations and a randomised trial of antibiotic prophylaxis in high‐risk groups. [ABSTRACT FROM AUTHOR]

Objectives: To provide a state of the art review on accruing studies focused on defining the middle ear microbiome, highlighting the relationship of the microbiome to disease pathophysiology. Data sources Pubmed indexed peer‐reviewed articles and published textbooks. Review methods: Comprehensive review of the literature using the following search terms: "microbiome" "bacterial pathogens" with the term "otitis media," and "middle ear." Results: A multitude of microbiome studies have been published in the recent past. In general findings from these studies underscore distinct profiles based on disease category. The adenoidal reservoir theory may not explain all etiologies of middle ear effusion production. The host immune system appears to be associated to the bacterial population identified in the middle ear space. Atopic respiratory diseases correlate to the middle ear microbiome. Some novel middle ear bacterial genera may be protective in terms of disease. Conclusion: The understanding of otitis media disease progression pathophysiology is evolving, informed by accruing middle ear microbiomic data. The functional implications of middle ear microbiome findings need to be studied further. This may help counterbalance probiotic vs antibiotic approaches to disease mitigation. [ABSTRACT FROM AUTHOR]