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.     

Influence of spontaneous otoacoustic emissions on distortion product otoacoustic emission amplitudes

Although the influence of the levels and ratios of the primary stimulus on the amplitude of distortion product otoacoustic emissions (DPOAEs) has been studied intensely, the influence of the presence of spontaneous otoacoustic emissions (SOAEs) has been investigated less thoroughly. The present investigation analysed whether the unilateral presence of 58 SOAEs in 43 normal-hearing adults was related to larger DPOAEs in the ear with SOAEs compared to the contralateral ear having no SOAEs. The study was designed such that the only factor that could influence the amplitude of DPOAEs was the presence of SOAEs. Input/output (I/O) functions were collected in response to primary tones that were presented in 5-dB steps from 70 to 40 dB SPL at the frequency of the unilaterally recorded SOAE of each subject. The primary outcome was the demonstration of statistically significant (P < 0.05) larger DPOAEs in ears exhibiting SOAEs than in ears without measurable SOAEs, except at the highest stimulus level of 70 dB SPL. These results suggest that SOAEs play an additive role in the measurement of DPOAEs. The enhancing effect of the unilateral presence of SOAEs on DPOAEs was statistically significant for 65 dB SPL and lower levels of primary tones. The authors speculate that passive cochlear properties begin to participate in the generation of DPOAEs at primary-stimulus levels greater than 65 dB SPL.     

Autologous tissue in initial type I and type III tympanoplasty operations in chronic suppurative otitis media

We reviewed 192 patients who had been treated for chronic otitis media. All operations were carried out at the Department of Otolaryngology, University of Tübingen. No patient had a previous ear operation and revision operations were excluded. The observation period varied from a minimum of 1 year to a maximum of 4 1/2 years. The ossicular chain was partially destroyed in 43 ears (22.4%). Ossiculoplasty was performed using autologous ossicles. An inens was used in 31 ears and a malleus in 12 cases. The overall failure rate was 20.8%. Most recurrent perforations were found in middle-aged patients. Children had only a 14% incidence of recurrent perforations. Fascia was the material associated with the highest failure rate (28.6%). After using perichondrium 6.8% of the cases had recurrent perforations, whereas the perichondrium-cartilage transplant was not successful in 4.8%. Overall, 62.7% of the patients were found to have an air-bone gap of 10 dB or less at 1.5 kHz 3-6 months after surgery. An air-bone gap of 20 dB or less was found in 91.2% of the patients. The main problem seen in the patients with chronic otitis media was not reconstruction of the ossicular chain but a lasting closure of the tympanic membrane. The perichondrium-cartilage transplant permitted the best results and is now recommended especially for patients with unfavorable middle ear conditions. A long-lasting closure of the tympanic membrane was also found in children (< or = 15 years of age). For this reason we also recommend an early operation in order to allow children to lead a normal life.     

Tympanometric detection of middle ear effusion in infants and young children

Tympanometry, a test of middle ear status new to clinical pediatrics, was carried out on 280 subjects, 10 days through 5 years of age. The tympanograms obtained were compared with otoscopic findings and, in 107 of the subjects, with findings at myringotomy. Seven distinct tympanometric curve types were identified and defined, based on their degree of correlation with the presence or absence of middle ear effusion. In subjects 7 months of age and older, curves suggesting normal (high) tympanic membrane compliance in combination with atmospheric or near-atmospheric middle ear air pressure were rarely associated with effusion. Conversely, curves suggesting low tympanic membrane compliance were highly correlated with the presence of effusion. Curves suggesting intermediate compliance or reduced middle ear air pressure were also correlated with effusion, but the degree of correlation was dependent on the shape of the curve. In infants less than 7 months of age, many of the ears with effusion had "normal" tympanograms, presumably because external auditory canal walls in such infants tend to be highly distensible. Tympanometry is a simple, rapid, atraumatic, valid, and objective test, easily administered by paraprofessional personnel. Its use can result in improved detection of middle ear effusion and other middle ear abnormalities, and also appears to promote improvement in diagnostic acumen.     

Methodical aspects of pneumatic segment plethysmography. III. Measuring tourniquet problems

A retrospective study was made of 200 chronic otitis media patients. Simple chronic otitis media was observed in 76 per cent of cases; the rest were associated with cholesteatoma. In about one third of the patients, the contralateral ear showed some inflammatory middle ear disease as well. The average time lapse between initial symptoms and hospitalization was about 10 years. The events leading to the tympanic perforation were difficult to ascertain, but included probably acute otitis media, possibly external otitis, trauma, and a rather large group (35-40 per cent) of insidious 'essential perforations'. The aetiology of the 'essential perforations' is so far not known, but might be non-inflammatory in nature but related to insufficient middle ear aeration and hypo-pneumatization as well as to what is termed atelectatic ears. The bacteria isolated from chronic otitis media ears (usually gram negative bacteria and staphylococcus aureus) are usually not the types of micro-organisms found in association with any primary or acute otitis media. It is proposed that the bacterial infection encountered in what is termed 'chronic otitis media' is often a secondary infection of a primary perforated tympanic membrane, the perforation originating or persisting in underventilated ears, and having arisen from various causes--some of them as yet unknown.     

Summating potential and action potential ratio in Meniere's disease before and after treatment

OBJECTIVE: This study aimed to compare the summating potential and action potential ratio (SP:AP) in patients with Meniere's disease before and after various surgical and medical treatments as an indication of change in endolymphatic hydrops to study the progression of Meniere's disease. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at an otology-neurotology referral center. PATIENTS: Eighty-eight ears of 84 patients with Meniere's disease received medical treatment in 18 ears and surgical treatments including endolymphatic shunt in 12 ears, streptomycin perfusion of the lateral semicircular canal in 9 ears, streptomycin perfusion of the middle ear in 33 ears, and dexamethasone perfusion of the middle ear in 16 ears. INTERVENTION: Transtympanic electrocochleography (ECoG) was performed in all patients before treatment and 1-57 months after treatment (mean, 13.5 months) with a 2-year interval in 28 patients. MAIN OUTCOME MEASURE: An enlarged SP:AP ratio (> or = 0.40) was used as the diagnostic criterion for endolymphatic hydrops. RESULTS: Overall, an enlarged SP:AP ratio was found in 75% of ears before treatment and 78% after treatment. The SP:AP ratio, when enlarged, remained enlarged in 91% of ears. A nonenlarged SP:AP ratio before treatment became enlarged after treatment in 41% of ears. In American Academy of Otolaryngology-Head and Neck Surgery stage 1 Meniere's disease (pure-tone threshold average < or = 25 dB), an enlarged SP:AP was found in 58% of ears before treatment and 79% after. Twenty-five (89%) of 28 patients followed for 2 years were free of vestibular symptoms after treatment, and in 22 patients (79%), the SP:AP remained enlarged. The distribution of an enlarged SP:AP ratio was associated with the duration of disease (chi-square = 33.5552, p < 0.01). CONCLUSIONS: The development of endolymphatic hydrops, as indicated by an enlarged SP:AP, is part of the progression of Meniere's disease. The longer the duration of the disease, the more likely the SP:AP ratio will be enlarged. These findings indicate that endolymphatic hydrops as detected by ECoG was not reversed in this study by the treatments used. Despite the absence of definitive spells of vertigo in most patients, endolymphatic hydrops as evidenced by an enlarged SP:AP ratio persisted.     

Hypnotic susceptibility order effects in waking analgesia

OBJECTIVE: To develop a measuring apparatus that has the ability to sweep both frequency and external auditory meatus static pressure and can display measurement results in a three-dimensional expression. To measure the middle ear dynamic characteristics of normal-hearing subjects and of patients with this apparatus. DESIGN: Investigate 275 ears of 153 normal-hearing subjects and 72 ears with middle ear diseases. RESULTS: The measurement results show fairly distinctive patterns depending on the middle ear conditions, i.e., normal, ossicular chain separation, ossicular chain fixation, secretory otitis media, tympanic membrane perforation, and tympanic membrane atelectasis. The evaluation of patients with ossicular diseases revealed that the rate of correct diagnosis of ossicular chain separation is 84% and that of ossicular chain fixation is 74%. These diagnoses were confirmed by surgery. CONCLUSION: Displaying the measurement results in a three-dimensional expression is helpful to make correct diagnosis in clinical practice. It is especially easy to make a distinction between the ossicular chain separation and ossicular chain fixation. Therefore, it is concluded that this apparatus has a high degree of clinical applicability to the diagnosis of these diseases.     

Microsatellite instability is associated with the macroscopic configuration of neoplasms in patients with multiple colorectal adenomas

Endoluminal ultrasonography with small-caliber and high-frequency transducer is suitable for transcanal assessment of middle ear with effusion. An endoluminal ultrasound transducer (size 6 French, 20 MHz) with a side-viewing scanning plane was used to image 12 ears of six children suspected of having effusion in the middle ear. Sonographic findings were compatible with those of operation in 10 diseased ears. One false-negative result was obtained, and one trial was aborted owing to trauma to the canal wall. The present study proves utility in demonstrating fluid behind the tympanic membrane. A promising use of endoluminal ultrasonography for middle ear evaluation might be expected if some modification could be made to the transducer.     

The role of micro-noise trauma in the etiology of aging-related changes in the inner ear

Eleven chinchillas between 1 and 2.4 years of age had the malleus/incus complex removed from one middle ear and then lived in the Washington University animal facilities for 4 years post-surgery. Each animal had one ear (termed ambient-noise) in which the conductive apparatus was intact; the other ear (termed noise-protected) had a 50-60 dB conductive hearing loss. The background sound level in the animal facility was 59 dBA with periodic brief sounds up to 102 dBA. After the 4-year experimental period, both ears were fixed, embedded in plastic and dissected for microscopic examination as flat preparations. The quantitative and qualitative findings in the noise-protected ears were compared to those in the ambient-noise ears. Both groups of ears sustained losses of sensory and supporting cells throughout the organ of Corti. A variable amount of age pigment was found to have accumulated in the outer hair cells and all supporting cells. In the noise-protected ears, inner hair cell loss ranged from 1.0 to 3.1% and averaged 1.7 +/- 0.8%; outer hair cell loss ranged from 1.8 to 6.4% and averaged 3.6 +/- 1.2%. In the ambient-noise ears, inner hair cell loss ranged from 0.7 to 2.8% and averaged 1.6 +/- 0.7%; outer hair cell loss ranged from 1.3 to 5.4% and averaged 3.6 +/- 1.2%. Within-animal comparison of cell losses in the noise-protected and ambient-noise ears revealed no significant difference between the two groups. It is concluded that long-term exposure to micro-noise does not accelerate the spontaneous loss of sensory cells which occurs with aging. Although not quantified, there was no obvious difference in the amount or cellular distribution of age pigment in the two groups. Thus, it appears that the formation of age pigment in the ear is the result of the cells' basic metabolic processes rather than the wear and tear from sensory transduction.     

Early eradication of pathogens from middle ear fluid during antibiotic treatment of acute otitis media is associated with improved clinical outcome

OBJECTIVE: To determine the relation between early bacteriologic eradication and clinical outcome of acute otitis media (AOM) in infants and young children treated with various antibiotics. STUDY DESIGN: The study group consisted of patients ages 3 to 24 months seen at the Pediatric Emergency Room with: (1) symptoms and physical findings consistent with AOM of < or = 7 days duration; (2) no spontaneous perforation or tympanostomy tubes; (3) positive initial middle ear fluid culture; and (4) a follow-up to at least Day 10+/-2 of the study with a second culture performed 72 to 96 h after initiation of antibiotic treatment. Any patient with a positive middle ear fluid culture 72 to 96 h after initiation of antibiotic treatment was considered to have bacteriologic failure. Otologic evaluation was done by an otolaryngologist unaware of the culture results and of the study drug allocation. A clinical score based on body temperature, report of irritability and ear tugging observed by the parents and the appearance and redness of the ear drum as observed by the otolaryngologist was also used for clinical evaluation. RESULTS: The study group consisted of 123 patients, of whom 57 (46%) had positive middle ear fluid 72 to 96 h after initiation of antibiotic treatment. Clinical failure was observed in 21 of 57 (37%) patients in whom bacteriologic eradication did not occur vs. only 2 of 66 (3%) patients with bacteriologic eradication after 3 to 4 days of treatment (P < 0.001). Clinical score for both moderate and severe disease decreased significantly faster in those with bacteriologic eradication than in those in whom middle ear fluid was still culture-positive 72 to 96 h after initiation of treatment. CONCLUSION: Clinical failures in our population were associated with inability to eradicate the causative organisms of AOM from the middle ear fluid within 3 to 4 days after initiation of antibiotic therapy. Most patients (including those without bacteriologic eradication) improved after 3 to 4 days of treatment, but patients with sterile middle ear fluid felt better after 3 to 4 days of treatment than patients in whom middle ear fluid was still culture-positive.     

Influence of the gas exchange function through the middle ear mucosa on the development of sniff-induced middle ear diseases

To investigate the influence of gas exchange function through the middle ear mucosa on the development of sniff-induced middle ear diseases, the authors examined the mastoid pneumatization among patients with sniffing habit using computed tomography, and also examined the change of negative middle ear pressure induced by sniffing using tympanogram. In 20 ears with cholesteatoma or adhesive otitis media, the areas of mastoid cavity measured at the level of the lateral semicircular canal were significantly smaller than those in 26 ears with otitis media with effusion (OME) or attic retraction and in eight normal ears with sniffing habit (P < .01 and P < .0001, respectively). In 26 ears with OME or attic retraction, the areas of mastoid cavity were significantly smaller than those in eight normal ears with sniffing habit (P < .0001). By contrast, in the four ears with sniff-induced middle ear disease, the recovery of negative middle ear pressure in 5 minutes without swallowing was less than 10 mm H2O, whereas in all seven ears with normal eardrum, negative middle ear pressure recovered by more than 20 mm H2O in 5 minutes. These findings suggested that impairment of gas exchange function through the middle ear mucosa, as well as eustachian tube dysfunction, might be closely related to the development of sniff-induced middle ear diseases.     

Oropharyngeal tumors of dogs--a clinical study of 79 cases

Secretory otitis media is defined as a fluid in the middle ear without signs or symptoms of infection. As the aetiology and pathogenesis of the disease are unknown, and as it affects children aged from 3 to 12 years, treatment procedures proposed for management of secretory otitis media, are not uniform. Some authors [1, 4, 6] consider that functional or mechanical obstructions of the Eustachian tube could provoke secretory otitis. The purpose of the treatment is to remove exudate from the middle ear and appropriately ventilate it for a longer period. That could instantly normalize the hearing and exclude the appearance of late complications of secretory otitis. Although the disease could heal spontaneously, the treatment should be performed immediately for preventing sequelae of secretory otitis. The aim of the study was to evaluate possible aetiologic factors of secretory otitis in our population, and to evaluate results of lympanometry in children with exudate in the middle ear. There were 65 children, aged from 3 to 12 years (Table 1), who complained of deafness and were examined at the ORL Department in Banja Luka. The clinical examination revealed the integrity and color of tympanic membrane, scars, adhesions and atrophic areas. Audiometry and tympanometry had been performed in addition. Patients who proved to have exudate in the middle ear received nasal decongestants and mucolitics during three months, and were evaluated every three weeks by audiometry and tympanometry. Pathologic findings in the nose and epipharynx were the most common findings: enlarged adenoids in 38 (58%) patients, hypetrophic rhinitis in 15 (23%) and allergic rhinitis in 5 (8%) patients. Frequent relapses of middle ear infection in the first three years of life were found in 26 (40%) patients and early first attacks in the first year of life in 15 (23%) patients (Table 2). Premature onset (15%) and allergy (21%) had also been frequently found. Results of tympanometry and audiometry are shown in Table 3. Exudate in the middle ear and type B tympanogram were found in 86 ears, while in other patients dysfunction of the Eustachian tube and type C1 and C2 tympanograms were found. After 6 weeks the exudate disappeared in 16 ears and tympanogram converted in type A and type C2, while the initially found C1 tympanogram was transformed in type A in 5 of 13 ears. After 12 weeks the tympanogram type B was found in 46 ears, while in 40 ears (47%) the tympanogram was changed in type A and type C2. After 6 and 12 weeks of therapy tympanometric types were statistically examined by chi 2 test. We have found a significant difference in tympanometric types and prevalence of type A and C1 tympanograms. Paracentesis and insertion of ventilating tubes were done in 46 ears with the remaining exudate. We have found mucous exudate in 35 (76%) ears associated with retraction and scars of tympanic membrane (Table 4), what indicated that the longer duration of mucous exudate caused degenerative changes in the middle ear. Serous exudate, found in 9 ears (24%), did not affect the color and integrity of the tympanic membrane. Sensitivity of tympanometry in detection of exudate in the middle ear was 96%. Secretory otitis media is a frequent disease in childhood, that could cause functional and morphological sequelae in the middle ear. As for now, there is no unique concept of diagnosis and treatment of the disease, and it is still a current problem. We suggest a three-month evaluation of tympanometric and audiometric patterns, repeated every three weeks, in children suspected of having exudate in the middle ear. There is a large trend of spontaneous disappearance of exudate in the middle ear and changing of tympanogram type. Such children should be evaluated over the period of one year, and if there is no relapse additional treatment should not be carried out. If exudate in the middle ear persists for three months and type of the tympanogram is unchanged, myringotomy and insert     

Effects of nasal packing on eustachian tube function

Eustachian tube function was assessed by tympanometry in 47 patients (94 ears) with anterior nasal packing placed after nasal surgery and in 12 patients (24 ears) requiring anterior and posterior packing for epistaxis. Twenty-four of the 94 ears (25.5%) in patients with anterior packing exhibited reductions in middle ear pressure (greater than or equal to --100 mm H2O), whereas 12 of 13 ears (92.3%) ipsilateral to and six of 11 ears (45.4%) contralateral to the posterior pack demonstrated comparable reductions in middle ear pressure. The observation that posterior packing is associated with a greater incidence of eustachian tube dysfunction than anterior packing suggests that the mechanism of this dysfunction may be related to stasis in the peritubal lymphatic plexus rather than to nasal obstruction per se.     

Brainstem auditory evoked potentials in young children before and after tympanostomy tube placement

To evaluate the effect of tympanostomy tube placement upon the hearing function of infants and young children, brainstem auditory evoked potentials (BAEP) were recorded in a group of young children (mean age 22 mos) receiving this treatment for otitis media with effusion (OME). For comparison, a group of healthy infants with normal behavioral audiometry were also tested with BAEP. Hearing loss was estimated for each ear using peak V latency-intensity curves. To evaluate the immediate effect of tube placement, 98 ears in 52 children were tested immediately before and after tube insertion. The 63 ears with effusion had prolonged peak latencies that decreased significantly (P < 0.001) immediately after tube placement and a mean hearing loss estimate of 22 dB that improved significantly (P < 0.0001) to 11 dB immediately after tube insertion. The 35 ears without effusion at myringotomy had a mean hearing loss estimate of 8 dB that did not change significantly after tube insertion. To evaluate the short-term effect of tube presence, 39 ears in 25 children were tested 3 weeks to 18 months after tube insertion. The 28 ears with dry tubes had a mean hearing loss estimate of 3 dB, and the 11 ears with otorrhea had a mean hearing loss estimate of 31 dB. The magnitude of mean hearing loss estimates in these young children with OME and the improvement in hearing function with tube placement is similar to that reported in older children studied with BAEP and audiometry. The study groups with a history of otitis media that had resolved by the time of testing had isolated prolongation of mean III-V interpeak latencies compared to normals (P < 0.01). These studies show that BAEP techniques are useful in estimating hearing loss in children with OME who are difficult to test by behavioral audiometry and show changes in rostral brainstem transmission in very young children with a history of OME.     

Responses of neurons in the inferior colliculus to binaural masking level difference stimuli measured by rate-versus-level functions

The psychophysical detection threshold of a low-frequency tone masked by broadband noise is reduced by < or = 15 dB by inversion of the tone in one ear (called the binaural masking level difference: BMLD). The contribution of 120 low-frequency neurons (best frequencies 168-2,090 Hz) in the inferior colliculus (ICC) of the guinea pig to binaural unmasking of 500-Hz tones masked by broadband noise was examined. We measured rate-level functions of the responses to identical signals (So) and noise (No) at the two ears (NoSo) and to identical noise but with the signal inverted at one ear (NoS pi): the noise was 7-15 dB suprathreshold. The masked threshold was estimated by the standard separation, "D". The neural BMLD was estimated as the difference between the masked thresholds for NoSo and NoS pi. The presence of So and S pi tones was indicated by discharge rate increases in 55.3% of neurons. In 36.4% of neurons, the presence of So tones was indicated by an increase in discharge rate and S pi tones by a decrease. In 6.8% of neurons, both So and S pi tones caused a decrease in discharge rate. In only 1.5% of neurons was So indicated by a decrease and S pi by an increase in discharge rate. Responses to the binaural configurations were consistent with the neuron's interaural delay sensitivities; 34.4% of neurons showing increases in discharge rate to both So and S pi tones gave positive BMLDs > or = 3 dB (S pi tones were detected at lower levels than So), whereas 37.3% gave negative BMLDs > or = 3 dB. For neurons in which So signals caused an increase in the discharge rate and S pi a decrease, 72.7% gave positive BMLDs > or = 3 dB and only 4.5% gave negative BMLDs > or = 3 dB. The results suggest that the responses of single ICC neurons are consistent with the psychophysical BMLDs for NoSo versus NoS pi at 500 Hz, and with current binaural interaction models based on coincidence detection. The neurons likely to contribute to the psychophysical BMLD are those with BFs near 500 Hz, but detection of So and S pi tones may depend on different populations of neurons.     

Effect of contralateral noise exposure on otoacoustic distortion product emissions in man

The influence of contralateral white noise with levels of 50 and 60 dBnHL on the amplitude of distortion-product otoacoustic emissions (DPOAE) was measured. Thirty ears of normally hearing adults (17 women, 13 men, mean age 26.5 +/- 5.3 years) were examined. Two representative DPOAE frequencies 2f1-f2 = 1342 Hz and 6341 Hz were compared. The lower DPOAE frequency was placed in the frequency region where middle-ear pressure has a strong influence on DPOAE amplitudes, the higher DPOAE frequency respectively in the region where lesser influence is exerted by middle-ear pressure. During the application of contralateral white noise a statistically significant total of 85% of DPOAE amplitudes was reduced, although there was some variation in the individual behaviour of DPOAE amplitudes. In general the higher DPOAE frequency (6341 Hz) was reduced distinctly less than the lower DPOAE frequency (1342 Hz). The reaction of DPOAE amplitude depended closely on the time course of the contralateral stimulus and amplitude reductions were present over 10 minutes without adaptation or fatigue. It is not possible to differentiate between middle-ear or inner-ear mediate effects but the middle ear is at least involved. Based on the presence of those DPOAE amplitude reductions over ten minutes without adaptation or fatigue and the fact that lower frequencies are influenced much more than higher frequencies a synergistic effect--middle-ear and efferent mediated--is suggested.     

Sudden sensorineural hearing loss associated with anticardiolipin antibody

We experienced three female patients with sudden sensorineural hearing loss. All the patients showed elevation of anticardiolipin antibody in the serum. Immunoglobulin (Ig) M anticardiolipin antibody was present in case 1 (a 34-year old woman). IgG anticardiolipin antibodies were present in cases 2 (a 50-year-old woman) and 3 (a 9 year old girl). The patient in case 1 showed hearing disturbance of low tone in the left ear and normal vestibular function in both ears. The case 2 patient had an average hearing level of 81.7dB at 0.5. 1, and 2kHz and severe canal paresis in the right ear. In case 3 the patient showed an average hearing level of 53.3dB in the right ear and normal vestibular function in both ears. It was suggested that thrombosis which might have been induced by anticardiolipin antibody could have caused the sudden sensorineural hearing loss in these patients. Steroid therapy cured the hearing disturbance completely in case 1. Steroid and prostaglandin E1 therapy did not improve the hearing disturbance in case 2. Steroid, prostaglandin E1, and ticlopidine hydrochloride therapy improved the hearing disturbance in case 3. It appears that not only steroids but also prostaglandin E1 and ticlopidine hydrochloride therapy may be effective in patients with sensorineural hearing loss associated with anticardiolipin antibody.     

Penicillium marneffei fungemia in an AIDS patient: the first case report in Taiwan

The microbiology of in 55 ear aspirates obtained from 34 children with chronic otorrhea was studied. Aspiration of the middle ear exudate was done immediately following removal of tympanostomy tube (TT). The middle ear aspirates and swab specimens of the external auditory canals were cultured for aerobic and anaerobic bacteria. Sixty-five isolates were recovered only from the middle ears, 73 only from the external ear canals, and 73 were present at both sites. Analysis of the 138 middle ear isolates demonstrated the recovery of aerobic bacteria only in 28 patients (50%), anaerobes only in seven (13%), and both aerobes and anaerobes in 20 (36%). There were 77 aerobic and 61 anaerobic isolates. Commonly recovered aerobes were Pseudomonas aeruginosa (17 isolates), Staphylococcus aureus (11), Proteus sp. (7), Moraxella catarrhalis (6), Klebsiella pneumoniae (5) and non-typable Haemophilus influenzae (5). Commonly isolated anaerobes were Peptostreptococcus sp. (25 isolates), Prevotella sp. (10), Bacteroides sp. (8) and Fusobacterium sp. (6). Pseudomonas aeruginosa and S. aureus were more often isolated in children older then 6 years. These findings demonstrate the polymicrobial bacteriology of TT-related otorrhea in children. Specimens collected from the external auditory canals can be misleading. Reliable information can be obtained from the ear exudes when collected through the TT or through the open perforation after their removal.     

Middle ear gas composition in pathologic conditions: mass spectrometry in otitis media with effusion and atelectasis

It is generally assumed that the gas enclosed in the middle ear and mastoid air cell system is subject to continuous absorption, and that partial pressures for oxygen and carbon dioxide equal those of "mixed venous blood." We previously determined the concentrations in 10 adults with healthy ears by means of mass spectrometry. The results showed that the value for oxygen was in the expected range, but that the value for carbon dioxide was higher than in "mixed venous blood." The aim of the present investigation was to measure the gas concentrations with the same technique in diseased ears, to see if there are any differences in middle ear gases between healthy and diseased ears. In terms of group means, the present measurements in 13 ears of children with otitis media with effusion or atelectasis did not differ from the values previously obtained for healthy ears of adults for any of the gases.