Tympanometry and middle ear effusion: a cohort-study in three-year-old children

Myringotomy was done on 44 three to four-year-old children out of a total of 463 three-year-olds in a geographically defined area, because these 44 children persistently showed abnormal screening-tympanometry over 6 months. The findings were correlated to middle ear pressure, absolute compliance, absolute gradient and relative gradient parameters. As regards the state of effusion in the middle ear, all parameters showed a high predictive value. A reverse proportionality of compliance parameters and the content of fluid in the tympanic cavity, each related to the magnitude of associated hearing loss, was demonstrated. The significance of the findings in the tympanometric diagnosis of middle ear disease in young children is outlined, and a revised classification system of the tympanogram, predicting middle ear effusion with a sensitivity of 91% and a specificity of 84%, is recommended.     

Effects of middle ear effusion on the vestibular system in children

The use of washing machines was investigated in two remote Aboriginal communities in the Anangu Pitjantjatjara homelands. The aim was to look both at machine reliability and to investigate the health aspect of washing clothes. A total of 39 machines were inspected for wear and component reliability every three months over a one-year period. Of these, 10 machines were monitored in detail for water consumption, hours of use and cycles of operation. The machines monitored were Speed Queen model EA2011 (7 kg washing load) commercial units. The field survey results suggested a high rate of operation of the machines with an average of around 1,100 washing cycles per year (range 150 and 2,300 cycles per year). The results were compared with available figures for the average Australian household. A literature survey, to ascertain the health outcomes relating to washing clothes and bedding, confirmed that washing machines are efficient at removal of bacteria from clothes and bedding but suggested that recontamination of clothing after washing often negated the prior removal. High temperature washing (> 60 degrees C) appeared to be advantageous from a health perspective. With regards to larger organisms, while dust mites and body lice transmission between people would probably be decreased by washing clothes, scabies appeared to be mainly transmitted by body contact and thus transmission would be only marginally decreased by the use of washing machines.     

Determination of ciprofloxacin levels in chinchilla middle ear effusion and plasma by high-performance liquid chromatography with fluorescence detection

An isocratic high-performance liquid chromatographic method has been developed to determine ciprofloxacin levels in chinchilla plasma and middle ear fluid. Ciprofloxacin and the internal standard, difloxacin, were separated on a Keystone ODS column (100 x 2.1 mm I.D., 5 microns Hypersil) using a mobile phase of 30 mM phosphate buffer (pH 3), 20 mM triethylamine, 20 mM sodium dodecyl sulphate-acetonitrile (60:40, v/v). The retention times were 3.0 min for ciprofloxacin and 5.2 min for difloxacin. This fast, efficient protein precipitation procedure together with fluorescence detection allows a quantification limit of 25 ng/ml with a 50 microliters sample size. The detection limit is 5 ng/ml with a signal-to-noise ratio of 5:1. Recoveries (mean +/- S.D., n = 5) at 100 ng/ml in plasma and middle ear fluid were 89.4 +/- 1.2% and 91.4 +/- 1.6%, respectively. The method was evaluated with biological samples taken from chinchillas with middle ear infections after administering ciprofloxacin.     

Interleukin-8 concentration predicts the neutrophil count in middle ear effusion

Interleukin-8 (IL-8), a potent neutrophilic chemoattractant and inflammatory cytokine, is present in middle ear effusions (MEEs) of children with otitis media and is thought to be responsible for the accumulation of neutrophils in MEEs. We hypothesized that IL-8 concentration predicts the total number and proportion of neutrophils in MEEs. IL-8 concentration and total and differential cell counts were measured in MEEs of children undergoing tympanostomy tube placement for otitis media. IL-8 was present in 80 (98%) of 82 effusions. The mean +/- SEM value for IL-8 was 7342 +/- 847 pg/mL. The mean +/- SEM count and percentage of neutrophils were 1.34 x 10(6) +/- 3.44 x 10(5) and 70.6 +/- 3.1%, respectively. IL-8 concentrations correlated positively with the total number (r = +0.30; P = 0.02) and percentage of neutrophils (r = +0.32; P = 0.01) in the effusion. Additionally, purulent effusions had greater IL-8 concentrations (P = 0.003) and greater neutrophil count (P = 0.03) than mucoid or serous effusions. We conclude that IL-8 is consistently present in MEEs of children and IL-8 concentration predicts the total number and proportion of neutrophils. Furthermore, IL-8 concentration and the total number of neutrophils correlate positively with the type of effusion. These results support the hypothesis that IL-8 recruits neutrophils to the middle ear in MEEs.     

Does the type of middle ear aspirate have any prognostic significance in otitis media with effusion in children?

Two hundred and twenty-two children with chronic, bilateral middle ear effusions were assessed during a 2 year follow-up period. At initial myringotomy the middle ear aspirate was found to be serous in 44 children and mucoid in 178 children. Evaluation at 1 and 2 years post-operatively showed no difference in otoscopic fluid clearance or mean hearing threshold at either follow-up time in relation to either type of fluid. There was no greater need for ventilation tube reinsertion in either group during the overall follow-up period. There was found to be no significant difference between the children with serous or mucoid effusions in relation to a range of pre-operative and operative variables. The study suggests that outcome in terms of fluid clearance and hearing thresholds is independent of the fluid type and there appears no greater need for revision ventilation tube insertion in relation to the findings at myringotomy. The type of effusion found on aspiration prior to ventilation tube insertion has no prognostic value. Children with serous fluid should be managed in an identical manner to those in which the fluid is thicker and mucoid in character.     

Psychomotor development in infants and young children

The functional relationship between brain catecholamines and serotoninergic function was studied in stress-naive and chronically immobilized rats after blockade of catecholamine synthesis with alpha-methyl-p-tyrosine (alpha MpT). The levels of noradrenaline (NA), serotonin, and 5-hydroxyindole acetic acid (5-HIAA) in pons plus medulla, brainstem, hypothalamus, hippocampus, and frontal cortex, and those of 3-methoxy, 4-hydroxyphenile-tileneglicol sulphate (MHPG-SO4) in the hypothalamus were measured by HPLC. Chronic immobilization (IMO) resulted in higher NA levels in pons plus medulla and hypothalamus, the latter area (the only one in which the NA metabolite was determined) also showing slightly elevated MHPG-SO4 levels as compared to stress-naive rats. Chronic IMO did not alter either serotonin or 5-HIAA levels, but acute stress consistently increased 5-HIAA levels in all areas, independently of previous chronic stress. Administration of alpha-MpT drastically reduced NA and increased 5-HIAA levels in all brain regions excepting the frontal cortex. The effect of the drug on serotoninergic function was not altered by previous chronic exposure to IMO. These data suggest that the noradrenergic system appears to exert a tonic inhibitory effect on serotoninergic activity in the brain, with the intensity of the effect depending on the brain area studied. In addition, chronic stress does not appear to alter the functional relationship between noradrenergic and serotoninergic activities, although interactions might exist in more restricted brain areas; this deserves further study.     

Phimosis of infants and young children in Japan

Bacterial and viral infections may be associated with the onset of a number of autoimmune diseases and relapses of these conditions. We describe a patient in whom there was a close temporal relationship between a suppurative wound infection and the onset of microscopic polyarteritis. The clinical features of this disease responded to treatment with high dose prednisolone and cyclophosphamide. The patient had several further infective episodes while being treated, but there were no disease exacerbations or relapses related to these. Anti-neutrophil cytoplasmic antibodies (ANCA) were never demonstrated in this patient. Thus while it is likely that the infection precipitated the onset of the systemic vasculitic illness, this occurred independently of ANCA.     

Gas exchange function of the middle ear in patients with otitis media with effusion

Gas exchange function through the middle ear mucosa was assessed using nitrous oxide (N2O) in patients with otitis media with effusion (OME), as well as in normal ears during elective surgery for unrelated disorders. In all normal ears except one (n = 43), an increase in pressure was observed after N2O inhalation. In 42 of 84 ears with OME, a pressure increase was observed, but not in the remaining 42 ears (50%), indicating that the gas exchange function in these latter ears was impaired. In 21 of the 42 ears showing no middle ear pressure increase following N2O inhalation, the middle ear pressure was again monitored after myringotomy and aspiration of the effusion A pressure increase was found in 16 ears, indicating that the impairment in gas exchange function in ears with OME may be reversible in most cases. Computed tomography of the mastoid was examined preoperatively in 66 ears, with the presence or absence of a middle ear pressure change well correlated in 57 ears with the presence or absence of mastoid aeration.     

Determination of complements in serum and middle ear effusion of the patients with secretory otitis media

Complements in serum and middle ear effusion were determined in 20 patients with secretory otitis media, and compared with those in the normal controls. The C5 and C1-INH in serum of the patients were significantly higher. On the contrary, C9 and B factor (Bf) were significantly lower, and the circulatory immunocomplex was also higher. In patients with secretory otitis media, the middle ear effusion levels of C3, C4 and C5 were significantly lower, and Bf and immunocomplex were significantly higher than those in serum. The results suggest that the ability of complements in clearing immunocomplex is low. Therefore, the immunocomplex may deposit in the mucosa of the middle ear. Thus the permeability of capillary will be increased, and the middle ear effusion occurs.     

Significance of epidermoid formations in the middle ear in fetuses and children

OBJECTIVE: To determine the incidence, size, and location of epidermoid formations (EFs), which have been suggested to be precursors of congenital cholesteatomas, in temporal bones from fetuses and children. DESIGN: We examined temporal bones from 226 fetuses and children up to the age of 10 years for the incidence, size, and location of EFs. RESULTS: Twenty-five EFs were identified in middle ears of 3 fetuses, 7 neonates, 9 infants, and 2 children aged 2 and 3 years. There was a male-female preponderance of 5:4. Generally, we saw EFs between the anterosuperior edge of the eardrum and the anterior limb of the tympanic ring, but 4 were below the level of the handle of the malleus. Their widths ranged from 25 to 300 microns. Keratinization was not observed in any EF. Contrary to previous reports, we found EFs not only in ears of fetuses, but also in ears of infants and children. CONCLUSION: Although EFs may persist in some ears, possibly developing into congenital cholesteatomas, our findings do not provide direct support for this concept.     

Evoked otoacoustic emissions in children in relation to middle ear impedance

The influence of changes in middle ear impedance with and without serotympanon on the measurement of evoked otoacoustic emissions (EOAE) was investigated in 108 children between 3 and 12 years of age. Children with proven serotympanon never showed good EOAE. In those who only had changes in middle ear impedance without a serotympanon, the decrease in EOAE amplitude was more related to the magnitude of conductive hearing loss than to the change in impedance itself. These results are compared with those of a neonatal screening project in which some of the 532 healthy fullterm newborns showed poor emissions in the first days of life. It seems reasonable to assume that this is due to incomplete pneumatization of the middle ears of these children, especially as a control audiogram later in their lives showed normal hearing thresholds.     

Gammadelta T cell receptor repertoire in middle ear effusions in children

In order to elucidate the immune response in otitis media with effusion, polymerase chain reaction was employed to examine gammadelta T cell receptor repertoire in the middle ear effusions of patients with otitis media with effusion. RNAs were extracted from 13 middle ear effusions of 10 children with otitis media with effusion. Vgamma2 was the most frequently used Vgamma gene. As for Vdelta gene usage, Vdelta2 amplification gave the strongest signal in 10 out of 13 samples. The results suggest that gammadelta T cells bearing Vgamma2/Vdelta2 T cell receptors accumulate in the middle ear effusions in children, and that these T cells may respond to certain bacteria or bacterial products in the middle ear.     

General anesthesia with and without nitrous oxide (N2O) and the weight of middle ear effusion in children undergoing adenoidectomy and tympanostomy

This study was designed to explore the effect of nitrous oxide (N2O) on the amount of middle ear effusion. Seventy-six children referred for adenoidectomy or tympanostomy tube placement were divided into two groups in the basis of the method of anesthesia. One group of 39 children was ventilated with a mixture of 30% oxygen and 70% nitrous oxide, while the other group of 37 patients was ventilated with a mixture of oxygen and air. The amounts of middle ear effusion obtained in myringotomy were weighed and compared between these groups. Preoperative and perioperative tympanograms were performed. Ventilation with nitrous oxide caused a distinct rise in middle ear pressure. The amount of the middle ear effusion, however, remained the same in the two groups. It is concluded that the operating surgeon can rely on the myringotomy finding even when nitrous oxide anesthesia is used.     

Hypocomplementemic ear effusion in relapsing polychondritis

In a case of relapsing polychondritis it was possible to aspirate a collection of subcutaneous fluid from the patient's involved ear. A determination of total hemolytic complement activity of this fluid was low, suggesting that activation of the complement system may have occurred in the course of the patient's disease and might be related to the pathogenesis of this disorder.