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Otitis media (OM), a condition stemming from the proliferation of various bacteria within the tympanic cavity (TC), is commonly addressed through the administration of ofloxacin (OFL), a fluoroquinolone antibiotic. Nevertheless, the escalating issue of antibiotic resistance and the challenge of drug leakage underscore the exploration of an alternative, more effective treatment modality in clinical practice. Here, we introduce a simple and easily implementable fluid-regulated strategy aimed at delivering immunomodulatory hydrogels into the TC, ensuring conformal contact with the irregular anatomical surfaces of the middle ear cavity to more effectively eliminate bacteria and treat OM. This innovative strategy exhibits expedited therapeutic process of antibiotic-resistant, acute and chronic OM rats, and significant reductions in the severity of tympanic membrane (TM) inflammation, residual bacteria within the TC (0.12 *105 CFU), and the thickness of TM/TC mucosa (17.63/32.43 μm), as compared to conventional OFL treatment (3.6, 0.76 *105 CFU, 48.70/151.26 μm). The broad-spectrum antibacterial and antibiofilm properties of this strategy against a spectrum of OM pathogens are demonstrated. The strategy is validated to bolster the host's innate immune response through the stimulation of antibacterial protein synthesis, macrophage proliferation and activation, thereby accelerating bacterial eradication and inflammation resolution within the TC. This facile, cost-effective and in vivo degradable technology exhibits promising prospects for future clinical implementation. [ABSTRACT FROM AUTHOR]

Abstract Otitis media (OM), a condition stemming from the proliferation of various bacteria within the tympanic cavity (TC), is commonly addressed through the administration of ofloxacin (OFL), a fluoroquinolone antibiotic. Nevertheless, the escalating issue of antibiotic resistance and the challenge of drug leakage underscore the exploration of an alternative, more effective treatment modality in clinical practice. Here, we introduce a simple and easily implementable fluid-regulated strategy aimed at delivering immunomodulatory hydrogels into the TC, ensuring conformal contact with the irregular anatomical surfaces of the middle ear cavity to more effectively eliminate bacteria and treat OM. This innovative strategy exhibits expedited therapeutic process of antibiotic-resistant, acute and chronic OM rats, and significant reductions in the severity of tympanic membrane (TM) inflammation, residual bacteria within the TC (0.12 *105 CFU), and the thickness of TM/TC mucosa (17.63/32.43 μm), as compared to conventional OFL treatment (3.6, 0.76 *105 CFU, 48.70/151.26 μm). The broad-spectrum antibacterial and antibiofilm properties of this strategy against a spectrum of OM pathogens are demonstrated. The strategy is validated to bolster the host’s innate immune response through the stimulation of antibacterial protein synthesis, macrophage proliferation and activation, thereby accelerating bacterial eradication and inflammation resolution within the TC. This facile, cost-effective and in vivo degradable technology exhibits promising prospects for future clinical implementation.

Background: The high incidence of pediatric acute otitis media (AOM) makes the implications of overdiagnosis and overtreatment far-reaching. Quality indicators (QIs) for AOM are limited, drawing from generalized upper respiratory infection QIs, or locally developed benchmarks. Recognizing this, we sought to develop pediatric AOM QIs to build a foundation for future quality improvement efforts. Methods: Candidate indicators (CIs) were extracted from existing guidelines and position statements. The modified RAND Corporation/University of California, Los Angeles (RAND/UCLA) appropriateness methodology was used to select the final QIs by an 11-member expert panel consisting of otolaryngology—head and neck surgeons, a pediatrician and family physician. Results: Twenty-seven CIs were identified after literature review, with an additional CI developed by the expert panel. After the first round of evaluations, the panel agreed on 4 CIs as appropriate QIs. After an expert panel meeting and subsequent second round of evaluations, the panel agreed on 8 final QIs as appropriate measures of high-quality care. The 8 final QIs focus on topics of antimicrobial management, specialty referral, and tympanostomy tube counseling. Conclusions: Evidence of variable and substandard care persists in the diagnosis and management of pediatric AOM despite the existence of high-quality guidelines. This study proposes 8 QIs which compliment guideline recommendations and are meant to facilitate future quality improvement initiatives that can improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Otitis media (OM) refers to a common clinical ear disease. Noise seriously damages human hearing function. This study aimed to investigate the effects of various noise types on the hearing function of patients who have recovered from mild OM. Materials and Methods: A total of 160 patients with mild OM treated at our hospital from May 2020 to May 2023 were retrospectively selected for this study. Based on clinical data, the patients were divided into the non-noise group (n=80) and the noise (n=80) group. The hearing thresholds of the two groups were compared across various noise types at 500, 1000, and 2000 Hz. In addition, the hearing thresholds of the noise group were compared under the same conditions. Results: The noise group exhibited significantly higher hearing thresholds at 500, 1000, and 2000 Hz than the non-noise group (P<0.05). Under traffic, urban construction, and industrial noises, the auditory thresholds at 500, 1000, and 2000 Hz in the noise group were significantly higher than those observed under domestic and speech noises (P < 0.05). Conclusion: Noise shows a close relationship with the hearing function of patients with OM. Traffic, urban construction, and industrial noises greatly influence the hearing function of patients who have recovered from mild OM. [ABSTRACT FROM AUTHOR]

Inflammatory conditions such as chronic otitis media (COM) can cause irreversible impairments in the microarchitecture and functions of the incus, which subsequently leads to conductive hearing loss. To investigate bone mineral density (BMD) of the incus body (IB) and long process (ILP) on preoperative temporal CT in COM patients with and without incudo-stapedial joint discontinuity (ISJD), and also to determine the association between BMD values and the postoperative air-bone gap (ABG) in the ISJD group. The mean IB density (IBD)/occipital bone density (OBD) and ILP density (ILPD)/OBD values were compared between the patients with and without ISJD. The correlation between ABG gain and preoperative incus density values was assessed in the ISJD group. The mean IBD/OBD and ILPD/OBD values were significantly higher in patients with intact ISJ. There was a moderate positive correlation between postoperative ABG gain and ILPD/OBD values in the ISJD group. The decrease in BMD of the incus may involve ILP as well as IB in patients with ISJD caused by ILP lysis in COM. A higher preoperative ILPD/OBD was correlated with a higher postoperative ABG gain in COM patients with ISJD. [ABSTRACT FROM AUTHOR]

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Introduction: The whisper test is one of the several simple methods to detect hearing loss in children and adults. The electronic whisper sound test is a new tool for detecting hearing loss early, and research has yet to be conducted in Indonesia. This study aimed to determine the validity of the electronic whisper sound test as a screening method in school-aged children at the Outpatient Unit of Dr. Soetomo General Academic Hospital. Methods: This type of study used a retrospective research design by conducting an electronic whisper test as a hearing screening in school-aged children between the age group of 6 and 18 years who visited the Audiology Outpatient Unit of Dr. Soetomo General Academic Hospital for 6 months from October 2021 to March 2022. Results: Based on the patient visit data, 32 patients were randomly selected from the population who met the inclusion criteria. The critical electronic whisper sound test results were compared with the pure-tone audiometry as a gold standard hearing screening, with a sensitivity value of 92%, specificity of 78.8%, positive predictive value of 53.3%, and negative predictive value of 88.3%. Conclusion: Hearing screening is critical, especially for school-aged children, because it determines language and speech development. A simple procedure can be done through a whisper test, which in its development can be an electronic whisper test. Besides being easy and efficient, this tool does not require special skills. [ABSTRACT FROM AUTHOR]

Otitis media (OM) is an umbrella term for a number of conditions associated with middle ear inflammation. Chronic suppurative otitis media (CSOM), a type of OM, is characterized by long-term middle ear infection with perforated ear drum and otorrhea. The most common outcome associated with it is acquired hearing impairment in infected individuals which ultimately affects their cognitive and scholastic developments. Clinically, CSOM is thought to be a sequel of re-occurring episodes of Acute otitis media (AOM). Pseudomonas aeruginosa and Staphylococcus aureus are found to be the predominant pathogenic isolates in these patients. However, with the emergence of antibiotic resistance amongst these pathogens, the adequate evaluation and treatment of this condition has become more problematic. The disease has also been recognized as one of the neglected tropical clinical manifestations with high prevalence in school-age children, especially in poor or underprivileged countries. Moreover, untreated cases have further worsened the situation by contributing to various life-threatening complications. Thus, effective treatment and surgical strategies, as well as strengthening of hearing care algorithms along with the discovery of novel animal models for advanced clinical research, can jointly help to fight this disease. In this regard, mapping of the audiological analysis with microbiological findings in CSOM patients may help elucidate the frequency that favors growth of specific pathogens. Knowledge about this potential correlation can then support timely detection of the infection, which is perceived as one of the emerging approaches for its management. In addition to these strategies, creating a true sense of awareness among people can also help mitigate this pathological condition by facilitating early identification, prevention, and treatment. This review discusses the incidence, pathogenesis, investigations, complications, and available treatment modalities associated with CSOM. [ABSTRACT FROM AUTHOR]

Some nutraceuticals have been studied as supportive treatment for fighting upper respiratory tract infection and middle ear disease. Our study aims at evaluating the effect of a specific oral supplementation in the treatment of pediatric otits media. The subjects were randomly assigned by the physician (single-blinded study) to one of three groups: Control Group (CG), Treatment Group 1 (TG1), or Treatment Group 2 (TG2). Both TG were treated with Flogostop Duo (for 20 days—TG1 or 30 days—TG2) in combination with the standard treatment, while CG underwent standard treatment only. The standard treatment was nasal aerosol with Fluticasone and Mucolytic, and nasal washing with hypertonic solution. All patients were analyzed by otoscopy, impedance, fibroscopy, and pure auditory test at the baseline (T0), after 20 days (T1) and 35 days (T2). 120 children were included in the study, 40 in the CG, 40 in the TG1, and 40 in the TG2. Both TG1 and TG2 presented statistically significant differences with respect to controls in otoscopy, impedance, fibroscopy, and PTA at T2. The otoscopy improved at T2 with statistically significant value only in TG2. The impedance and fibroscopy improved at T1 both in TG1 and TG2 compared to CG. A statistically significant improvement was observed in TG2 at T2 in comparison to both CG and TG1. Statistically significant differences were observed in PTA at T2 only compared with controls. This study confirmed the efficacy of nutraceutical as supporting therapy in the upper respiratory tract infection in children. In particular, the supplement containing Boswellia serrata and Bromelain, which are molecules with strong anti-inflammatory and pain-control capacities, could add the benefit without the adverse effects which are related to NSAID use. [ABSTRACT FROM AUTHOR]

Objective: Microbial infection plays an important role in exacerbation of chronic otitis media. The aim of this study was to analyse the microbiota in chronic otitis media in the context of local treatment. Method: In this prospective study, samples for microbiological examination were taken from 119 patients who underwent operation because of chronic otitis media. Results: The results were compared between groups depending on the type of operation (none, tympanoplasty or radical), the presence of cholesteatoma or granulomatous tissue or discharge from the ear as a symptom of exacerbation. Antibiotic susceptibility of germs was analysed to define the strategy of treatment. A total of 209 samples were collected from 119 patients with chronic otitis media. Conclusion: Pseudomonas aeruginosa and Staphylococcus aureus were pathogens most frequently identified from the ear in the course of chronic otitis media. Pseudomonas aeruginosa was concerned with major pathology of the middle ear (radical surgery, cholesteatoma or granulomatous tissue, persisting discharge after treatment), whereas Staphylococcus aureus was obtained in dry perforations without other pathology in the middle-ear cavity. Ciprofloxacin was effective against Staphylococcus aureus, but Pseudomonas aeruginosa strains were ciprofloxacin resistant. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Acute otitis media (AOM) is the most-common indication for antibiotics in children. Delayed antibiotic prescribing for AOM can significantly reduce unnecessary antibiotic use and is recommended by the American Academy of Pediatrics for select children. We sought to improve delayed prescribing for AOM across 8 outpatient pediatric practices in Colorado. METHODS: Through a collaborative initiative with American Academy of Pediatrics and the Centers for Disease Control and Prevention, we implemented an economical 6-month antimicrobial stewardship intervention that included education, audit and feedback, online resources, and content expertise. Practices used The Model for Improvement and plan-do-study-act cycles to improve delayed antibiotic prescribing. Generalized estimating equations were used to generate relative risk ratios (RRRs) for outcomes at the intervention end and 3- and 6-months postintervention. Practice surveys were evaluated. RESULTS: In total, 69 clinicians at 8 practice sites implemented 27 plan-dostudy- act cycles. Practices varied by size (range: 6--37 providers), payer type, and geographic setting. The rate of delayed antibiotic prescribing increased from 2% at baseline to 21% at intervention end (RRR: 8.96; 95% confidence interval [CI]: 4.68--17.17). Five practices submitted postintervention data. The rate of delayed prescribing at 3 months and 6 months postintervention remained significantly higher than baseline (3 months postintervention, RRR: 8.46; 95% CI: 4.18--17.11; 6 months postintervention, RRR: 6.69; 95% CI: 3.53--12.65) and did not differ from intervention end (3 months postintervention, RRR: 1.12; 95% CI: 0.62--2.05; 6-months postintervention, RRR: 0.89; 95% CI: 0.53--1.49). CONCLUSIONS: Baseline rate of delayed prescribing was low. A low-cost intervention resulted in a significant and sustained increase in delayed antibiotic prescribing across a diversity of settings. [ABSTRACT FROM AUTHOR]

We report the in vivo biodistribution and ototoxicity of cationic liposomal-ceftriaxone (CFX) delivered via ear drop formulation in adult chinchilla. CFX was encapsulated in liposomes with size of ∼100 nm and surface charge of +20 mV. 100 μl liposomes or free drug was applied twice daily in both external ear canals of adult chinchillas for either 3 or 10 days. Study groups included free ceftriaxone (CFX, Day 3: n = 4, Day 10: n = 8), liposomal ceftriaxone (CFX-Lipo, Day 3: n = 4, Day 10: n = 8), and a systemic control group (Day 3: n = 4, Day 10: n = 4). Ceftriaxone delivery to the middle ear and systemic circulation was quantified by HPLC assays. Liposome transport was visualized via confocal microscopy. Auditory brainstem response (ABR) tests and cochlear histology were used to assess ototoxicity. Liposomal ceftriaxone (CFX-Lipo) displayed a ∼658-fold increase in drug delivery efficiency in the middle ear relative to the free CFX (8.548 ± 0.4638% vs. 0.013 ± 0.0009%, %Injected dose, Mean ± SEM). CFX measured in blood serum (48.2 ± 7.78 ng/ml) following CFX-Lipo treatment in ear was 41-fold lower compared to systemic free-CFX treatment (1990.7 ± 617.34 ng/ml). ABR tests and histological analysis indicated no ototoxicity due to the treatment. Cationic liposomal encapsulation results in potent drug delivery across the tympanic membrane to the middle ear with minimal systemic exposure and no ototoxicity. [ABSTRACT FROM AUTHOR]

Otitis media with effusion (OME) is a known side effect of radiation therapy in patients with head and neck cancer. To investigate the incidence rate and clinical course of radiation-induced OME, we have reported on the long-term characteristics of OME in patients with parotid gland malignancy. This cohort study assessed 200 patients who underwent post-parotidectomy radiation therapy from January 2010 to December 2019 in a tertiary referral center. Postoperative radiation therapy was performed at 6 weeks post-surgery. Serial magnetic resonance images were collected to detect otitis media. Two blinded otologists individually assessed data from radiation therapy initiation to 36 months of post-radiation therapy. A total of 121 patients were enrolled (male, 61 [50.4%]; mean age, 46.98 ± 15.69 years), of which 14 developed otitis media (11.6%) within 6 months after radiation therapy. Spontaneous remission occurred without intervention within 1 year, excluding one patient who sustained otitis media for 2 years. Radiation-induced OME occurred in 11.6% of patients and it remitted within 1 year without intervention. Therefore, cooperation between otolaryngologists and radiation oncologists is required and invasive intervention should be considered with careful risk-benefit evaluation [ABSTRACT FROM AUTHOR]

Objectives: To present the otologic findings of a patient with COVID-19 and complicated acute otitis media, evaluate for the presence of SARS-CoV-2 in middle ear fluid, and assess whether suctioning of middle ear fluid may be aerosol- generating. Methods: The case of a man with SARS-CoV-2 infection and complicated acute otitis media with facial paralysis is presented to illustrate unique clinical decisions made in context of the COVID-19 pandemic. A cadaveric temporal bone was used to simulate droplet spread during suctioning of fluorescein-labelled middle ear fluid and visualized with a blue-light filter. Results: A 23-year-old male who presented with complicated acute otitis media with facial paralysis was found to have an acute infection with SARS-CoV-2, with positive viral PCR of nasopharyngeal swab, and a negative PCR of the middle ear fluid. He was placed on isolation precautions and treated with myringotomy, topical and systemic antibiotics, and antivirals. Consistent with observations during endonasal suctioning, suctioning of middle ear fluid was not found to be aerosol or droplet generating. Conclusion: The case of a patient with active COVID-19 presenting with complicated acute otitis media in whom middle ear fluid was sampled to evaluate the etiology of the infection and the potential middle ear predilection of SARS-CoV-2 is described. This study has implications for the clinical management of patients with both known and unknown SARS-CoV-2 infection who present with ear disease. While middle ear suctioning may not be aerosol-generating, the risk of coughing or prolonged close contact requires heightened precautions during otologic procedures in patients with suspected or confirmed COVID-19. [ABSTRACT FROM AUTHOR]

Otitis media is an inflammatory disease of the ear, where its symptoms depend on the presence of effusion in the middle ear and swelling of the tympanic membrane. The aim of this study was to measure serum levels of IL-1â and IL-10 in patients with otitis media compared to the healthy group. The immune level was examined in 55 patients with otitis media who were clinically diagnosed in ENT consultations at Baquba Teaching Hospital. 35 healthy people as a healthy group. The study spanned from August 2019 to January 2020. The study showed a higher incidence of middle ear infection in males than females. The current study showed an increase in the total level. The level of cytokine IL-1â is higher in patients with otitis media of the health group (p≤0.05) serum levels of IL-10 decreased in patients with otitis media of the health group p≤0.05)) The study concluded a difference in serum levels IL-1â and IL-10 in patients with otitis media compared to the health group [ABSTRACT FROM AUTHOR]

Studying the impact of antibiotic treatment on otitis media (OM), the leading cause of primary care office visits during childhood, is critical to develop appropriate treatment strategies. Tracking dynamic middle ear conditions during antibiotic treatment is not readily applicable in patients, due to the limited diagnostic techniques available to detect the smaller amount and variation of middle ear effusion (MEE) and middle ear bacterial biofilm, responsible for chronic and recurrent OM. To overcome these challenges, a handheld optical coherence tomography (OCT) system has been developed to monitor in vivo response of biofilms and MEEs in the OM-induced chinchilla model, the standard model for human OM. As a result, the formation of MEE as well as biofilm adherent to the tympanic membrane (TM) was longitudinally assessed as OM developed. Various types of MEEs and biofilms in the chinchilla model were identified, which showed comparable features as those in humans. Furthermore, the effect of antibiotics on the biofilm as well as the amount and type of MEEs was investigated with low-dose and high-dose treatment (ceftriaxone). The capability of OCT to non-invasively track and examine middle ear conditions is highly beneficial for therapeutic OM studies and will lead to improved management of OM in patients. [ABSTRACT FROM AUTHOR]

Background: Acute otitis media (AOM)-inflammation of the middle ear-is the most common pediatric condition, affecting up to 75 % of children at some time before age 5 years. Despite the high incidence of AOM in children, it presents diverse challenges to parents who do not have accurate information on AOM and its management.Objective: To respond to this paucity of information we sought to synthesize the literature to provide a comprehensive understanding of parental information needs and experiences relating to AOMmanagement. This systematic review is an important first step in developing parent-informed knowledge translation tools for AOM to bridge the knowledge-practice gap.Patient Involvement: None.Method: Four electronic databases were searched and articles were screened according to pre- established inclusion criteria. Articles were included in the review if they (1) examined parental information needs and experiences with respect to AOM; (2) were written in English; and (3) were published from January 2000 onward.Results: Out of 1121 articles retrieved, 21 articles met the inclusion criteria. The findings from this review revealed that parents' knowledge about AOM is generally limited. Further, parents were often poorly informed about what AOM was, which resulted in uncertainty about how to help their child with AOM.Discussion: Our review findings illustrate that parents of children with AOM have pervasive unmet information needs and information deficits negatively impact AOM management, child and family well-being.Practical Value: Parental experiences and information needs identified through this review were used to develop innovative, evidence-based knowledge translation tools for parents of children with AOM. [ABSTRACT FROM AUTHOR]

Otitis Media (OM) is an important global issue that can have a long-lasting impact on a child's life. There is no easy fix! For a family who has a child with OM, the ramifications can be short term and have minimal consequences, or they can be very complex and involve medical, educational, behavioural and wellbeing issues, and may even be life-threatening. Navigating diagnosis and then the combinations of interventions in all areas is just the start of a very daunting journey. As a preventable disease, we have the opportunity to make a difference. This paper presents the development and implementation of the Hear our Heart Ear Bus Project (HoHEBP) within a regional city in western New South Wales (NSW), Australia. The HoHEBP supports families of Australian Indigenous and non-Indigenous children with OM through a transdisciplinary approach incorporating health and education, in partnership with families and communities to ensure the best possible outcomes for children and young people. We present how the HoHEBP provides a unique vehicle for change in the way we approach OM as a transdisciplinary team. Longitudinal data from 2014 to 2019 shows that numbers of children and young people being tested and diagnosed with OM, and referred to medical and educational specialists through the HoHEBP have increased, with over one third identifying as Indigenous (in this paper Indigenous is used respectfully to refer to Australian Aboriginal and Torres Strait Islander peoples). [ABSTRACT FROM AUTHOR]

Objective: Eosinophilic otitis media (EOM) is an intractable disorder associated with bronchial asthma and chronic rhinosinusitis with nasal polyposis. Periostin is an extracellular matrix protein secreted by fibroblasts in response to interleukin (IL)-4 and/or IL-13 and is a known marker for eosinophilic disorders. We assessed serum periostin levels and expression of periostin in the middle ear mucosa according to three grade of EOM severity (grade1 to 3).Methods: 68 patients of blood and serum samples were corrected by whom diagnose bilateral EOM in Jichi Medical University Saitama Medical Center from January 2015 to June 2017.Immunohistochemical evaluation was performed to 18 EOM middle ears mucosa samples, which cauterized in tree groups and compared to that of chronic otitis media (COM).Results: Serum periostin levels was significantly higher in EOM patients than in COM patients (EOM, 125.0 ± 45.5 ng/mL; COM, 79.4 ± 38.3 ng/mL; P<0.0001). The expression of periostin immunopositivity in the EOM middle ear mucosa was significantly greater in severe cases (grade3 samples) than others (grade1 and grade2 samples) (P <0.001 and P = 0.011, respectively). Periostin was expressed at the lamina propria especially in severe EOM cases and the cases had little response to glucocorticoids treatment.Conclusion: This study showed that periostin in the middle ear mucosa was correlated with EOM severity, and EOM with highly expressed periostin had difficulty in glucocorticoids treatment. [ABSTRACT FROM AUTHOR]

Background/Aim: The outcomes of type 1 tympanoplasty in elderly patients remain controversial. Therefore, more studies are needed to clarify the prognosis of elderly patients after tympanoplasty. The purpose of this study was to evaluate the clinical outcomes of type 1 tympanoplasty in elderly patients. Patients and Methods: We retrospectively analyzed data from 116 patients who underwent type 1 tympanoplasty due to chronic otitis media. Seventy-one of the 116 patients were elderly individuals aged 65 years or older (study group). Forty-five patients were younger than 65 years (control group). Due to cochlear intolerance by aging in the study group, we used dexamethasone soaked gelfoam packing in the middle ear and intraoperative dexamethasone injection. To compare the outcomes between groups, we determined the mean hearing levels by averaging the hearing thresholds. The differences in the air-bone gaps before and after tympanoplasty were compared between groups. Results: In the study group, 54 patients had an underlying disease (76%). Hypertension was the most common underlying disease. The postoperative air conduction (AC) and bone conduction (BC) improved in both the study group and the control group. In the control group, postoperative air-bone gap (ABG) was significantly higher than preoperative ABG. Although the postoperative ABG improved in the study group, the improvement was insignificant. Conclusion: Although significant improvement of ABG was not achieved, postoperative AC and BC were improved. Intraoperative dexamethasone injection and dexamethasone soaked gelfoam packing in the middle ear was effective to prevent deterioration of BC after operation. [ABSTRACT FROM AUTHOR]

Objectives: Luc's abscess is a rare complication of acute otitis media, with a challenging diagnosis and a controversial surgical treatment. The aim of the present study was to review the published literature in order to clarify the clinical features and the surgical management of those patients.Methods: A systematic review of the literature was carried out for published reports or case series in English language, describing a temporo-zygomatic (or Luc's) abscess which complicated an acute or chronic otitis media and/or mastoiditis, confirmed through CT scan or MRI of the petrous bone. The collected clinical and radiological data were merged and critically appraised.Results: Eighteen reports of Luc's abscess were included. Adding our case report, a total of 21 cases were included in the analysis. Abscess drainage plus myringotomy alone vs. abscess drainage plus myringotomy and mastoidectomy were the two surgical management approaches described in the literature. Patients undergoing first line mastoidectomy were successfully treated in all cases, while among those undergoing a more conservative approach, one failure required subsequent mastoidectomy.Conclusions: The clinical features of Luc's abscess are rather constant and help in rising the suspicion before the radiological diagnosis. Although cases with associated intra-cranic complications have been reported, the limited existing data do not permit to advocate the mastoidectomy over a more conservative surgical approach. However, the decision to avoid mastoidectomy as the first line surgical treatment should be based on the clinical and radiologic assessment, after an accurate counseling, particularly in the case of a pediatric patient. [ABSTRACT FROM AUTHOR]

Objective: Recurrent acute otitis media is common in children. The preferred treatment measures for recurrent acute otitis media have a mixed evidence base. This study sought to assess baseline practice across ENT departments in England. Methods: A national telephone survey of healthcare staff was conducted. Every ENT centre in England was contacted. A telephone script was used to ask about antibiotic and grommet use and duration in recurrent acute otitis media cases. Results: Ninety-six centres (74 per cent) provided complete information. Recurrent acute otitis media treatment across England by ENT departments varied. The antibiotic first- and second-line prophylaxis offered varies, with trimethoprim used in 33 centres and 29 centres not offering any antibiotics. The timing or choice about when to use grommets also varies, but 87 centres (91 per cent) offer grommet surgery at one stage. Conclusion: The treatments received by children in England for recurrent acute otitis media vary by centre; collaborative research in this area is advised. [ABSTRACT FROM AUTHOR]

Objective: To report a case of petrous apicitis that manifested as chronic migraine without aura and to discuss the pathophysiological mechanisms behind this presentation. Background: Petrous apicitis is a rare complication of acute otitis media with varied clinical presentations that stem from the close proximity of the petrous apex to numerous neurovascular structures. Headache is among the common symptoms of petrous apicitis. Methods: A case of new onset headache in the setting of petrous apicitis with symptomatic response to antibiotic therapy was reported. We provided a brief review of peripheral pathophysiological mechanisms of migraine and correlated to mechanism of headache in petrous apicitis. Results: A 65‐year‐old man with chronic otitis externa/media presented with ongoing headache fulfilling International Classification of Headache Disorders 3rd edition (ICHD‐3) criteria for chronic migraine without aura that persisted despite undergoing right mastoidectomy and tympanoplasty with multiple courses of oral antibiotic therapy for his chronic otitis. MRI brain revealed petrous apicitis, otomastoiditis, and clival osteomyelitis. His imaging findings improved and his migraine‐like headache completely resolved after treatment with a prolonged course of antibiotics. Conclusions: Petrous apicitis can present as a headache with features of migraine, and in this case in particular, as chronic migraine without aura. The pathophysiological mechanisms that may underlie the generation of migraine‐like headache in petrous apicitis may include the activation of nociceptive fibers within the periosteum of the petrous apex and clivus whose cell bodies originate in the trigeminal ganglion and upper cervical dorsal root ganglia. By treating the peripheral pathology, resolution of the headache may be achieved. [ABSTRACT FROM AUTHOR]

Granulomatosis with polyangiitis (GPA) is a rare rheumatologic disease characterized by small to medium vessel vasculitis and inflammation within multiple organ systems. Majority of cases involve both upper and lower respiratory tracts but other organs including brain, kidneys, joints and skin can also be involved. Patients who have recurrent otitis media and sinusitis often initially present to internists and then to ear nose and throat (ENT) physicians and may be treated with multiple courses of antibiotics without having proper workup for GPA. We present a middle-aged white male who exemplifies this unique presentation with new onset recurrent otitis media and mastoiditis, which did not respond to repeated courses of antibiotics requiring mastoidectomy and myringotomy tube placement. On chest x-ray, he was found to have multiple lung nodules that was followed by a computed tomography (CT) scan of his chest and CT guided biopsy which revealed granulomatous inflammation and necrosis, consistent with GPA. Autoimmune laboratory work-up was also suggestive of GPA. The patient had complete resolution of symptoms with steroid therapy. This case reinforces the concept of high index of suspicion of GPA for patients with recurrent and resistant otitis media or mastoiditis not responding to optimal duration and doses of antibiotics. Appropriate work-up for GPA may allow for earlier diagnosis of this devastating vasculitic disease which can help prevent multi-organ dysfunction. [ABSTRACT FROM AUTHOR]

Background: The main surgical techniques for the treatment of chronic otitis media so far, all have their characteristic advantages and disadvantages. Otolaryngologists have been trying to find an ideal surgical method for chronic otitis media. Objective: To study and evaluate the outcome of partial canal wall preserved tympanomastoidectomy (PCM) for the treatment of chronic otitis media. Methods: Thirty-nine patients were randomly divided into two groups. Twenty patients underwent PCM and 19 underwent canal wall down tympanomastoidectomy (CWD). All patients had a follow-up period of 5 years. Results: The mean time of healing was 6 weeks in the PCM group and 8 weeks in the CWD group. The cavities in the PCM group were normal or slightly larger than the normal external auditory canal. The patients required cavity cleaning less than once per year in the PCM group and 3–4 times per year in the CWD group. One patient in the PCM group developed a recurrent cholesteatoma located in the attic. Conclusion: The PCM technique showed a low-recurrence rate and good hearing outcomes. Patients had normal or slightly enlarged postoperative external auditory canal. Therefore, PCM is a useful technique for chronic otitis media. [ABSTRACT FROM AUTHOR]

Objective: Otitis media is one of the most common illnesses which may cause ossicles destruction and conductive hearing loss. However, nowadays the damaged middle ear bones may be replaced by a partial or total ossicular replacement prosthesis. The main aim of this article was to confirm the proper functioning of the new middle ear prosthesis. Methods: This work describes first clinical trials conducted on a group of three patients with the case of interrupted ossicles continuity and chronic otitis media. The clinical trials were performed according to permission No. 157/KBL/OIL2016. The patients were subjected to the bones chain reconstruction via implanting a bactericidal middle ear prosthesis called Otoimplant. The following preoperative and postoperative parameters have been evaluated: Air-Bone-Gap values, mean ABG values in different frequencies, bone and air conductivity, speech audiometry and microbiological assessment. The patients' recovery was observed according to the study protocol on the 7th day and 1, 3, 6 and 12 months after the surgery. Results: Audiological tests revealed that the mean Air-Bone-Gap was reduced by 36% in all the patients after 1 year. No bacteria or fungi were found in the middle ear spaces. Conclusions: Results confirm the bactericidal efficacy and hearing improvement of the Otoimplant. [ABSTRACT FROM AUTHOR]

Acute otitis media (AOM) is a leading cause of health encounters and antimicrobial prescriptions in children worldwide. We assessed (1) the rates of antimicrobial prescribing by pediatric emergency department clinicians using a smartphone otoscope device as compared with a conventional otoscope and (2) clinician acceptability of the smartphone device. We conducted a randomized control study in children's hospital emergency departments over 6 months. More than 1500 encounters were analyzed. The odds of prescribing antibiotics after being given a diagnosis of AOM by clinicians assigned to the smartphone group was 11% higher than the conventional group (18.8% vs 18.0%, odds ratio = 1.106, P = .600). Eight (73%) of the 11 physicians in the smartphone group preferred the smartphone device over the conventional otoscope. Use of a smartphone otoscope for detection of AOM in a pediatric emergency department setting did not lead to an increased likelihood of AOM diagnosis. [ABSTRACT FROM AUTHOR]

Objective: In the assessment of chronic otitis media (COM) and its treatment, patient-reported outcomes are becoming increasingly important. The aim of the present study was to translate and validate the Zurich chronic middle ear inventory (ZCMEI-21) in Japanese in order to provide the first Japanese-language instrument for measuring health-related quality of life (HRQoL) in COM.Methods: The ZCMEI-21 was translated into Japanese according to published guidelines. In order to assess validity, the ZCMEI-21-Jap total score was compared to a question directly addressing HRQoL as well as the five-level version of the EQ-5D questionnaire, a generic measure of HRQoL.Results: Demographic data and validity were assessed in a total of 91 COM patients. The ZCMEI-21-Jap total and subscale scores were well comparable to those of the original validation study. Cronbach's α of the ZCMEI-21-Jap was 0.85, indicating an excellent internal consistency. The ZCMEI-21-Jap total score showed a strong correlation (r=0.68, p<0.0001) to the question directly addressing HRQoL and, as expected, only a moderate correlation to the EQ-5D scores (r=0.49, p<0.0001 for descriptive system score and r=0.44, p<0.0001 for VAS score).Conclusion: We successfully translated the ZCMEI-21 into Japanese and were able to obtain sufficient information during the validation process for the use of the ZCMEI-21-Jap to quantify HRQoL in patients with COM. With the current study, we aim to take a step forward towards an international standardization of reporting HRQoL in COM. [ABSTRACT FROM AUTHOR]

Current guidelines recommend "watchful waiting" (WW) as an alternative to immediate antibiotic treatment. Continued high rates of antibiotic use suggest that WW may be underutilized. We conducted a retrospective chart review of 474 pediatric acute otitis media (AOM) cases at a clinic in central Pennsylvania. We assessed physical examination findings, diagnostic behavior, WW utilization, prescription writing, and filling in cases of pediatric AOM to evaluate the underutilization of WW. We evaluate diagnostic consistency with published guidelines and rates of antibiotic prescription resulting from misdiagnosis. We report WW instructions and compliance, and prescription filling behaviors. Fifty percent of AOM diagnoses in this sample were not supported by physical examination findings. The majority of these AOM diagnoses received antibiotic prescriptions, suggesting that unsupported diagnoses translated to injudicious prescribing. WW instructions corresponded to 57% fewer filled prescriptions and longer fill delay. We discuss the implications and recommendations to improve antibiotic stewardship. [ABSTRACT FROM AUTHOR]

Objective: The objective of this review is to summarize all aspects of middle ear diseases in children with cleft palate (CP).Methods: PubMed, Scopus, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and The Cochrane Library were searched for English-language randomized control trials (RCTs), meta-analyses, systematic reviews and observational studies published through 31st July 2017.Results: Epidemiology and pathogenesis of middle ear diseases in children with cleft palate have been discussed in this review. Methods of Evaluation, CP surgeries, complications and follow up have been detailed for the same.Conclusion: Evaluation of middle-ear disease in children with CP begins at birth by a newborn hearing screen. Tympanometry and otoscopy helps screen for middle-ear disease during follow-up visits. Ventilation tube may be placed when indicated based on the patient's clinical course and presentation. Long-term follow up should be provided to look for the development of cholesteatoma. [ABSTRACT FROM AUTHOR]

We commend Varghese et al. for "mandating a different outlook" in their recent article on eosinophilic otitis media (EOM). Their statements are supported by medical literature dating back to 1931, reported by Proetz, Shambaugh, Zhang, Draper, Doyle, Pelikan, Ojala, McMahan, Tomonaga, Nsouli, Lasisi, Nguyen, Tian, Sobol, Smirnova, Shim, Smirnova, Luong, and ourselves. Allergy causes EOM and it responds to immunotherapy. [ABSTRACT FROM AUTHOR]

Abstract Objectives The high incidence of Acute Otitis Media (AOM) along with low antibiotic efficacy in the treatment of AOM is particularly favorable for the emergence of antimicrobial resistance. The promotion of more conservative antibiotic prescription habits has become an important focus of governments and academic societies. Little is known about the awareness and use of AOM practice guidelines by physicians in the Middle East. Our aim is to characterize AOM management in Lebanon by using an anonymous survey instrument to uncover potential disparities in treatment trends and evaluate differences in clinical guideline adherence patterns. Methods A total of 75 practicing physicians were anonymously surveyed in Beirut, Saida, Nabatieh, Bekaa and Tripoli, Lebanon. The survey tool used was previously used in Amman, Jordan by our colleagues at the University of Michigan. The survey we used assessed awareness of and adherence to practice guidelines by prompting responses to hypothetical AOM cases. Differences in performance between various physician groups were noted. Results Overall, physician participants answered 67% of the survey questions correctly. Trainees did better overall in terms of AOM management (62% correct responses as compared to 48% in attending physicians, p = 0.0175). Trainees also performed better in terms of their ability to manage cases of potential AOM in two-year old children and their ability to choose the appropriate medications (79% correct response rate compared to 71% in attending physicians, p = 0.0278). Participants who reported guideline adherence most or all of the time had a 67% correct response rate in regards to their ability to diagnosis AOM, compared to a 57% correct response rate in those who reported adhering sometimes or rarely to the guidelines (p = 0.0489). In the cases requiring antibiotic treatment for body temp of over 39C with/without otalgia, only 47–57% of participants identified the appropriate antibiotic regimen. Conclusion There are areas of potential improvement in adherence to clinical guidelines in the management, diagnosis, and treatment of AOM by Lebanese physicians. Conducting interventions among physicians to improve awareness of clinical guidelines and current treatment recommendations in Lebanon will likely improve adherence to guidelines, enhance clinical outcomes, and may help advance the fight against antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Objective: To find out the efficacy of topical application of 3% Fosfomycin in cases of Chronic Suppurative Otitis Media (CSOM). Methods: This prospective study was conducted from January 2016 to December 2017 in the Department of ENT, Head & Neck Surgery, Dow University of Health Sciences & Dr. Ruth K.M. Pfau Civil Hospital Karachi, Pakistan. All patients had clinical diagnosis of CSOM. Fosfomycin 3% was given topical treatment in ear drop three times daily for one week. Amount given in each dose was 2 drops or 0.1 ml. A complete audiological assessment was conducted by an audiologist at day 7 and outcome of the treatment was noted as resolved (complete dry ear), Improved, Not-changed or Worsened. Results: Out of 172 patients, 65 (37.8%) had pseudomonas Aeroginosa, 49 (28.5%) had Staphylococcus Aureus, 37 (21.5%) had Proteus Mirabilis, 6 (3.5%) had E Coli, 6 (3.5%) had Klebsiella Pneumoniae, 4 (2.3%) had Enterobacter species whereas 5 (2.9%) patients had miscellaneous organisms on culture of ear swab. The mean duration of discharge was 7.23 ±5.78 years. The outcome showed that majority of the patients 144 (83.7%) had completely dry ear after one week of treatment with 3% fosfomycin. Other 17 patients (9.9%) had improvement with decrease in amount of ear discharge. Nine patients (5.2%) had no change in ear discharge and in 2 cases (1.2%) amount of ear discharge increased. Conclusion: The finding of this study depicted that topical application of 3% fosfomycin can be very beneficial in cases of CSOM. Overall response to treatment was good and no otoxicity was noted. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the eustachian tube (ET) function (ETF) in adults with ventilation tube (VT) inserted for the treatment of chronic otitis media with effusion (COME). MATERIALS and METHODS: A total of 17 subjects with at least one VT were enrolled. A detailed history was obtained, and risk factors were assessed with questionnaires. Examination including nasopharyngeal video endoscopy and ETF tests, the forced response test (FRT), inflation- deflation test (IDT), and nasal/nasopharyngeal maneuvers (such as sniffing and Valsalva, Toynbee, and the diver's maneuvers) were performed. RESULTS: Averages for FRT were 580±333 daPa, 382±251 daPa, and 138±192 daPa for opening pressure, steady-state pressure, and closing pressure, respectively. Most subjects demonstrated minimal or weak active function during the FRT and IDT. While nasopharyngeal maneuvers changed the nasal/nasopharyngeal pressures, they did not significantly change the middle-ear pressures. These results indicated that most subjects had severe obstructive ET dysfunction (ETD) with an ET lumen that required high pressure differences to open and poor active muscular function inadequate for luminal dilation. These results imply that while any treatment to widen the ET, such as balloon dilation of the ET, is not expected to change the voluntary active muscular function, it may reduce the tissue pressures and resistance, thus facilitating luminal opening both passively and actively. CONCLUSION: Most patients with VT inserted for the treatment of COME appear to have an abnormal ETF with difficulty in passively opening the ET and weak active muscular function. Management of such patients addressing only passive properties may not be sufficient for the resolution of ETD. [ABSTRACT FROM AUTHOR]

Objectives: Chronic suppurative otitis media (CSOM) is a serious disease with the presence of bacterial infection in the middle ear. Worldwide, 1% to 46% of the population living in developed and developing countries have CSOM, about 65-330 million people, 60% of whom have significant hearing loss. The study of the wound healing efficacy and tolerability of the drug MEKRITEN (garlic extract liquid) was performed to identify the possibility of issuing recommendations for the drug for clinical use in the Republic of Uzbekistan. Materials and Methods: The main group of patients, who received the study drug, consisted of 30 patients; the group of patients who received the comparison drug comprised 20 patients. Patients of the main group (30 persons) were given 'garlic extract liquid,' which was developed by the Tashkent Pharmaceutical Institute, given as 2 drops twice per day for 10 days in the external auditory canal. Patients in the comparison group (20 people) took other drugs (0.25% solution of levomycetin) in a similar way. Patients were examined and observed carefully to determine the severity of symptoms such as pain, secretion (in points), and clinical analyses were performed including general blood analysis, and urine. In addition, the researchers performed biochemical (ALT, AST, bilirubin), instrumental (ultrasound of the liver), and special (biopsy of fibrous tissue of echinococcal capsules) analyses. Results: The average rating of the tolerability and effectiveness in the points for MEKRITEN made portability of 4.97 points, and the effectiveness was 4.77 points, and for 0.25% levomycetin solution, they were 4.8 and 3.35 points, respectively. While receiving MEKRITEN, no adverse effects and allergic reactions were observed. No criteria for treatment cessation were observed (adverse effects, ineffective treatment, poor adherence to protocol, and refusal to continue) thus the study was not stopped in any patients. Conclusion: Local therapy with the drug MEKRITEN in patients with CSOM is more effective than local application of 0.25% levomycetin solution. Local therapy with MEKRITEN in the treatment of CSOM leads to faster termination of otorrhoea and is accompanied by fewer adverse drug reactions. [ABSTRACT FROM AUTHOR]

The article discusses a study focusing on the use of type 2 tympanoplasty along with incus interposition ossiculoplasty for treating chronic otitis media (COM). Topics discussed include the damage to ossicular chain assembly by COM, which can lead to hearing loss; the tympanic membrane (TM) perforation in COM; and the transcanal approach through ear speculum in the surgery.

Background. Chronic suppurative otitis media causes serious lifelong consequences when treatment is delayed. Early detection and effective treatment result in a good outcome and possible complications are thus avoided. The aim of this study was to determine the factors resulting in delayed care seeking for treatment of CSOM. Method and Patient. The study was a cross-sectional survey conducted at a tertiary teaching hospital in Rwanda. A questionnaire was used to collect data of patients diagnosed with CSOM who attended ENT Department during the study period. We defined delayed care seeking as seeking treatment 6 months after onset of symptoms. Data was entered and analysed using SPSS 16.0. Result. This study enrolled 109 patients, 97 (88.9%) of whom had delays in care seeking. Majority were young adults ranging between 21 and 30 years (39.2%) while 58.8% were rural residents. Fifty-eight patients (56.9%) of those with delayed presentation used traditional medicine. The main reason for delayed care seeking was low knowledge of CSOM reported by 88 (90.7%) patients. Conclusion. This study shows that majority of patients with delayed care seeking are young adult patients. There is low knowledge concerning this disease and this significantly contributes to delayed care seeking. [ABSTRACT FROM AUTHOR]

Background: To compare the outcome of myringotomy alone with myringotomy and tympanostomy tube (grommet) in otitis media with effusion (OME) in terms of improvement in hearing and tympanogram pattern. Methods: In this comparative study 60 patients diagnosed of otitis media with effusion (OME) not responding to medical treatment were included. They were divided in two groups, each of 30 patients. In first group only myringotomy was done. In second group myringotomy with tympanostomy tube insertion was done. The parameters compared were improvement of hearing and improvement in tympanogram pattern. Hearing was assessed by voice test and tuning fork tests (Rinnie's, Webers). Patients were assessed before surgery, after two weeks, after one month and after three months. Results:Out of 60 patients 39 were males and 21 were females. Age range was from 5 to 15 years with mean age 8 years. In first group there was 48% improvement in hearing and tympanogram pattern after two weeks, 55% improvement after one month and 62% improvement after three months. In second group there was 67% improvement after two weeks, 84% after one month and 95% after three months. One patient (3%) developed post op otorrhoea which was treated by conservative management. Conclusion:Myringotomy with tympanostomy tube insertion has a better outcome in terms of hearing improvement in OME patients as compared to myringotomy alone. [ABSTRACT FROM AUTHOR]

Background Health care systems and physicians need to conform to budgets and streamline resources to provide cost-effective quality care. Although endoscopic tympanoplasty (ET) has been performed for decades, no studies on the cost-effectiveness of ET and microscopic tympanoplasty (MT) for treating chronic otitis media have been published. The present study aimed to compare the cost-effectiveness of ET and MT for treating chronic otitis media. Methods This study was performed using a Cohort-style Markov decision-tree economic model with a 30-year time horizon. The economic perspective was that of a third-party payer (Taiwan National Health Insurance System). Two treatment strategies were compared, namely ET and MT. The primary outcome was the incremental cost per quality-adjusted life year (QALY). Probabilities were obtained from meta-analyses. Costs were obtained from the published literature and Taiwan National Health Insurance System database. Multiple sensitivity analyses were performed to account for data uncertainty. Results The reference case revealed that the total cost of ET was $NT 20,901 for 17.08 QALY per patient. By contrast, the total cost of MT was $NT 21,171 for 17.15 QALY per patient. The incremental cost effectiveness ratio for ET versus that of MT was $NT 3703 per QALY. The cost-effectiveness acceptability curve indicated that ET was comparable to MT at a willingness-to-pay threshold of larger than $NT 35,000 per QALY. Conclusion This cost-effectiveness analysis indicates that ET is comparable to MT for treating chronic otitis media in Taiwan. This result provides the latest information for physicians, the government, and third-party payers to select proper clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: The goal of this study was to evaluate the effects of middle ear packing agents (MEPA) on post-operative hearing improvement and complications after tympanoplasty in patients with adhesive otitis media (OM). Materials and methods: Patients with adhesive OM who underwent tympanoplasty surgery were enrolled in the study between January 2012 and January 2015. A total of 205 patients who received canal wall-down tympanoplasty with ossicular chain reconstruction were randomized into one of the three groups with different MEPA. Group 1 (n=72) received MeroGel as the MEPA, Group 2 (n=64) cartilage, and Group 3 (n=69) both. Air conduction (AC) and bone conduction (BC) thresholds at 0.5, 1, 2, and 4 kHz were measured, and air-bone gaps (ABG) were analyzed before and after the surgery for each patient. Results: Mean pre- and post-operative ABG was 30.9 dB and 17.6 dB in Group 1, 31.4 dB and 21.9 dB in Group 2, and 32.2 dB and 19.1 dB in Group 3. The ABG closure was 13.3 ± 7.5 in Group 1, 9.5 ± 5.9 in Group 2, and 13.1 ± 9.3 in Group 3. The improvement of ABG after surgery was statistically significant in all three groups (p<.05). The ABG closure was statistically significantly smaller in Group 2 than in other two groups (p<.05). Conclusions: Tympanoplasty using esterified hyaluronic acid (i.e. MeroGel) or cartilage as the MEPA resulted in improved hearing for patients with conductive hearing loss due to adhesive OM. Using MeroGel as the MEPA appeared to achieve a better post-operative outcome than using cartilage. [ABSTRACT FROM AUTHOR]

Background: otitis media with effusion is common in children and the treatment is still controversial issue. Objective: this study aimed to evaluate the role of topical nasal steroid in treatment of otitis media with effusion in children. Patients and Method: this was a systematic review of the literature to collect data through searching the Medoline data base (www.pubmed .com) until March 2017 concerning the effectiveness of topical nasal steroids in treatment of otitis media with effusion in children using the different keywords in different combination. Results: meta analysis by relative risk for persistence of OME of 0.551 with 95% CI of 0.314 to 0.966 , meta analysis by risk difference for persistence of OME of -0.229 with a 95% CI of -0.569 to -0.030 and meta analysis by odds ratio for persistence of OME of 0.214 with a 95% CI of 0.049 to 0.936, which was statistically significant favoring topical steroid over control . Conclusion : topical nasal steroid is an effective treatment for otitis media with effusion without the complications of oral steroid , nasal steroid spray can be used for longer period, with much greater safety. It can also be helpful in controlling nasal allergy and the adenoid size, which are contributing factors in developing and recurring otitis media with effusion. [ABSTRACT FROM AUTHOR]

The eyes absent (EYA) -like genes are essential for the formation of sensory organs among fly ( Drosophila melanogaster ) and mammals. EYA4 , one of the vertebrate genes of Eya family, is reported to be causative for late-onset mid-frequency sensorineural hearing loss in humans, while Eya4 -deficient mice exhibited congenital profound deafness and otitis media with effusion due to the eustachian tube dysmorphology. Because of the species difference in the phenotype, the pathophysiology of EYA4 in the human cochlea has yet to be elucidated. Here, we examine the expression pattern of EYA4 in the cochlea of common marmoset ( Callithrix jacchus ), a non-human primate. The results indicated a distinct expression pattern of EYA4 in the adult marmoset cochleae, especially strong in all supporting cells, while in mouse their expressions were diminished. Interestingly, EYA4 expression in the hair cells, supporting cells and neurons was co-localized with sine oculis homeobox–SIX1, a transcription factor essential for the transcriptional activity of EYA4. The results revealed inter-species differences in the expression pattern of EYA4 gene in supporting cells between primates and rodents. The results also indicated a fundamental role of EYA4 in the primate auditory cells. Experiments with primate models such as marmosets or with human cochlear cells may provide cues about the unknown pathogenesis of EYA4 -related hearing loss. [ABSTRACT FROM AUTHOR]

The purpose of this study is to investigate what characteristics of tinnitus in patients with chronic otitis media was reduced after tympanoplasty and to assess the relationship between post-operative tinnitus reduction and pre-operative tinnitus tone, tinnitus duration, post-operative hearing recovery, and tympanogram. Medical records were prospective between March 2013 and May 2016. Audiologic evaluation by pure tone audiometry and acoustic impedance and tinnitus assessment using scores on the Tinnitus Handicap Inventory (THI) was conducted preoperatively and 6 months post-operatively. The data were analyzed using the Wilcoxon test, Student's and paired t test, and ANOVA. The pre-operative incidence of tinnitus in patients with COM was 47%. There was a very significant difference between pre-operative and post-operative mean THI scores ( p < 0.05). Tinnitus was reduced or alleviated in 83% of tinnitus patients. Pre-operative low-tone tinnitus was significantly reduced 6 months after surgery. After surgery, air-conducted hearing improvement at 250, 500, and 1000 Hz in the tinnitus significant recovery group was greater than the tinnitus non-significant recovery group ( p < 0.05). Tinnitus reduction in tympanogram A was significantly greater than in tympanograms B or C ( p < 0.05). There was no statistically significant correlation between tinnitus duration and tinnitus reduction ( p > 0.05). There was no significant effect of presence cholesteatoma and dry period on the gain THI ( p > 0.05). The types of tympanoplasty had no effect on tinnitus improvement ( p > 0.05). No patients experienced new tinnitus after surgery. Following tympanoplasty, most patients experienced a reduction in tinnitus. Pre-operative low-tone tinnitus is easier to reduce after tympanoplasty. Post-operative normal tympanogram and improved low-frequency AC hearing were important to tinnitus reduction. [ABSTRACT FROM AUTHOR]

Introduction: Temporalis fascia graft is the most commonly used graft material for reconstruction of the tympanic membrane in chronic suppurative otitis media. However, the success rate is low in case of subtotal and total perforations. We have used both cartilage and the temporalis fascia for the repair with greater success. Aims and Objectives: The aim and objective of the study was to compare the result of temporalis fascia graft and composite graft (temporalis fascia and cartilage) in the repair of subtotal and total perforation of tympanic membrane with respect to graft take-up rate and hearing improvement. Materials and Methods: A total of 300 patients were selected for the study. One hundred and fifty cases we used only temporalis fascia (tympanoplasty with temporalis fascia graft [TTG] group) and another 150 cases both temporalis fascia and cartilage (Composite graft, tympanoplasty with composite graft [TCG] group) were used. The result was assessed after 6 months of surgery. Results: Graft take-up rate in TTG group is 82.67% and in TCG group is 95.34%. More remnant and re-perforations were found in TTG group. It was found that, in TTG group out of 124 patients, hearings improved in 104 patients (83.87%), remain same in 15 patients (12.09%), and deteriorated in 5 patients (4.032%). In TCG group out of 143 patients, hearings improved in 116 patients (81.118%), remain same in 19 patients (15.322%), and deteriorated in 8 patients (6.451%). Discussion and Conclusion: Composite graft is a better graft in comparison to temporalis fascia graft for the repair of the subtotal and total perforation. [ABSTRACT FROM AUTHOR]

Context and Aims: Since unilateral chronic suppurative otitis media (CSOM) does not look to be an isolated entity, but rather a series of constitutional events that affecting both ears, so this study aimed to evaluate the otoscopic, radiological, and audiological status of the contralateral ears (CLEs) in patients with unilateral CSOM. Patients and Methods: A prospective, observational study recruited 96 consecutive patients with unilateral CSOM with or without cholesteatoma, in whom their CLEs revealed an intact tympanic membrane (TM) were categorized as “Group 1” and “Group 2” respectively, they were evaluated with otomicroscopy, computed tomography (CT) scanning of temporal bones, pure tone audiometry and tympanometry. All above-mentioned observations were recorded and analyzed. Results: The incidence of otoscopic CLEs structural abnormalities was 47.91% in both groups; being 45.83% in “Group 1” mostly 25% of TM retraction, and 50% in “Group 2” mainly (20.84%) of thinning TM. Mastoid CT scan showed (35.41%) air cell abnormalities in both groups; being 37.5% in “Group 1” and 33.33% in “Group 2,” while tympanic cavity mucosal thickening was 33.33% “in Group 1” and 25% in “Group 2.” Conductive hearing loss was found (39.58%) in both groups; being 45.83% in “Group 1” and 33.33% in “Group 2,” while C-curve tympanometry curve was 63.63% and 36.36% in both groups, respectively. Conclusions: The incidence of otoscopic structural abnormalities of CLEs was mainly in the form of TM retraction in squamous type and thinning TM in mucosal type; also, the radiological and audiological abnormalities of the CLEs were shown more event in squamous than in mucosal type of CSOM. [ABSTRACT FROM AUTHOR]

Otitis media (OM) is a relatively common infectious disease, and its chronic form may lead to complications such as hearing impairment. This study aims to determine the prevalence, etiology, antibiotic susceptibility, and complications of OM in Iran through meta-analysis. English language databases, including Science Direct, PubMed, Scopus, Web of Science, and Persian language databases, including SID, Magiran, Iranmedex, Medlib, as well as the Google Scholar search engine, were searched from 1994 to 2017, using the Mesh keywords: Otitis media, Middle ear, Causality, Etiology, and Iran. The heterogeneity assessment of the studies was done using Q-Cochran test and I2 index. Considering the high heterogeneity of the studies, the random effects model was used to estimate the point prevalence with 95% confidence interval. Data were analyzed using STATA version 11.1 software. Fifty-one articles with a sample size of 10,675 were reviewed in this study, the most common types of OM involvement were right otitis (51% [95% confidence interval (CI): 33–68]), left otitis (44% [95% CI: 36–52]), and bilateral otitis (33% [95% CI: 7–59]). The most common bacterial etiologies involved in OM were Pseudomonas aeruginosa (26% [CI 95%: 17–35]), Proteus (21% [95% CI: 0%–45%]), and Staphylococcus (20% [95% CI: 0–42]). The fungal etiology of OM was estimated to be 22% (95% CI: 4–40). The most common OM pathologies were ossicular changes (56%[95% CI, 27–85]), granulation (49% [95% CI: 18–80]), cholesteatoma (32% [95% CI: 13–51]), tympanosclerosis (17% [95% CI: 10–23]), and cholesterol granuloma (11% [95% CI: 0–26]). The results of this meta-analysis provide useful information on the epidemiology of OM in Iran to otorhinologists and health policymakers. [ABSTRACT FROM AUTHOR]