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.     

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.     

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.     

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.     

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.     

Plasti-pore implants in middle ear surgery

Plasti-pore, a high-density polyethylene sponge, was one of the earliest biocompatible materials developed specifically for implantation in the middle ear. It is one of the most nonreactive materials known when tested in simulated biochemical exposure to pseudoextracellular fluid. The two basic prosthetic designs are the total ossicular replacement prosthesis and the partial ossicular replacement prosthesis. Plasti-pore implants have now been used for 20 years and are widely accepted by otologic surgeons. The basic properties of the material, implant design, and surgical techniques involved using these prostheses are reviewed in this article.     

Middle ear gas composition and middle ear aeration

Partial pressures of the gases in the middle ears of 14 guinea pigs were measured continuously on-line with a specially designed mass spectrometer. The average values were carbon dioxide 67.55 mm Hg, oxygen 48.91 mm Hg, and nitrogen 596.54 mm Hg. These values confirm earlier measurements and show that the gas composition of the middle ear differs basically from that of air and resembles that of venous blood. These findings are indicative of bilateral diffusion between the middle ear cavity and the blood. We propose that under physiologic as well as under pathologic (ie, atelectatic) conditions, the gas content of the middle ear is also controlled by diffusion. This mechanism fits well with the fluctuating character of atelectatic ears. Thus, a negative middle ear pressure could be secondary to excessive loss of gases through increased and excessive diffusion, although additional mechanisms are probably also involved. A likely contributing factor is poor pneumatization of the mastoid, with consequent absence of a physiologic pressure regulation mechanism by its pneumatic system.     

Acute on-chronic middle ear disease

OBJECTIVE: To emphasise the value of computed tomography even in the absence of symptoms in a case of penetrating injury of the upper eyelid. METHODS: Case report. RESULTS: Although clinically asymptomatic, penetration of upper eyelid was associated with intracranial penetration that left a track in the brain parenchyma. CONCLUSIONS: Computed tomography of orbit and brain is an important investigation, even in seemingly trivial eyelid injury, to reveal the full extent of the damage.     

Prevalence of antimicrobial-resistant pathogens in middle ear fluid: multinational study of 917 children with acute otitis media

The management of acute otitis media is complicated by the emergence of resistance to beta-lactam and other antibiotics among common pathogens. We conducted a large, international study of infants and children with acute otitis media to identify pathogens and susceptibility patterns. During the winter of 1994 to 1995, middle ear fluid samples were collected from 917 patients with acute otitis media in Bulgaria, the Czech Republic, Hungary, Romania, Slovakia, Israel, and the United States. A single reference laboratory performed in vitro susceptibility testing. Pathogens were isolated from 62% of the patients. For Streptococcus pneumoniae (30% of the patients), untypeable Haemophilus influenzae (17%), and Moraxella catarrhalis (4%), there was significant variation among geographic regions (P < 0.001). The composite susceptibilities of these three organisms to amoxicillin ranged from 62% in the United States to 89% in Eastern and Central Europe; the corresponding susceptibilities to amoxicillin-clavulanate ranged from 90% in Israel to 95% in Eastern and Central Europe. beta-Lactamase was produced by 31 and 100% of the isolates of H. influenzae and M. catarrhalis, respectively. More isolates of S. pneumoniae were susceptible to amoxicillin (90%) or amoxicillin-clavulanate (90%) than to penicillin (70%; P = 0.002). The prevalence of resistant S. pneumoniae was highest in patients less than 12 months of age. S. pneumoniae, H. influenzae, and M. catarrhalis remain the most important bacterial pathogens in patients with acute otitis media; however, their prevalence is variable and resistance patterns are changing.     

Inverted papilloma of the middle ear

Inverted papilloma is a benign neoplasm confined almost exclusively to the sinonasal tract. We present the first known case report of an inverted papilloma arising from the middle ear. In this paper we discuss the pathophysiology and review the literature of this interesting clinical entity.     

Experiences with polyethylene ventilation tubes in children with recurrent middle ear inflammation (author's transl)

Middle-ear ventilation tubes (of the Sheehy modification) were placed in 401 ears of 209 children under 16 years of age as treatment for recurrent middle-ear infection. The same procedure was later required in 26% of the cases studied because of further recurrence of middle-ear infection. In four per cent of all patients studied, the ventilating tube failed to cure middle ear disease in spite of controlled concomitant antibacterial therapy. In these cases, an early extrusion of the tube was commonly found. Among all patients, the tube was spontaneously extruded in 76 per cent of the ears, whereas the intubation time was longer than half a year in 53 per cent of the cases. No complications from insertion of the ventilation tubes was seen in the present series of patients. The tympanic membrane was found to be normal in 71 per cent of all cases when follow-up examination was obtained three months after completion in intubation. However, a permanent tympanic membrane perforation was found in five ears (1% of patients). The present study has confirmed the usefulness of middle-ear ventilation tubes, particularly in patients with recurrent middle-ear infections.     

Increases in middle ear pressure resulting from counter-diffusion of oxygen and carbon dioxide into the middle ear of monkeys

Bryodin 1 (BD1) is a potent ribosome-inactivating protein (RIP) isolated from the plant Bryonia dioica. It is relatively nontoxic in rodents (LD50 > 40 mg/kg) and represents a potential improvement over other RIPs and bacterial toxins that have been used in immunotoxins. Recombinant BD1, expressed in Escherichia coli, localizes to insoluble inclusion bodies necessitating denaturation and refolding steps to generate active protein. In this report, BD1 was expressed as a soluble recombinant protein in tobacco cell culture (ntBD1) and purified to near homogeneity with yields of up to 30 mg/(L of culture). The protein synthesis inhibition activity of ntBD1 was identical to that of both native BD1 isolated from the roots of B. dioica and recombinant BD1 expressed in E. coli. Toxicology analysis showed that ntBD1 was well tolerated in rats at doses that cannot be achieved with most other toxin components of immunotoxins. Additionally, a single-chain immunotoxin composed of BD1 fused to the single-chain Fv region of the anti-CD40 antibody G28-5 (ntBD1-G28-5 sFv) was expressed in tobacco tissue culture as a soluble protein and was specifically cytotoxic toward CD40 expressing non-Hodgkin's lymphoma cells in vitro. These data indicate that tobacco tissue culture is a viable system for soluble expression of BD1 and BD1-containing immunotoxins.     

Early-response cytokine expression in adult middle ear effusions

We determined the diseases associated with extremely high levels of alkaline phosphatase in hospitalized patients. Computerized laboratory records of the Hospital of Saint Raphael identified all inpatients who had elevations of alkaline phosphatase above 1,000 U/l from April 1994 to September 1995. Thirty-seven inpatients with alkaline phosphatase levels above 1,000 U/l were identified. Six had bone involvement from malignancy or Paget's disease and were eliminated from further analysis, and 31 patients were included in the study. Levels of alkaline phosphatase ranged from 1,014 to 3,360 U/l. Ten patients had sepsis as the cause of the elevated alkaline phosphatase. These included gram-negative organisms, gram-positive organisms, and two patients with fungal sepsis. Seven of 10 patients with sepsis had an extremely high alkaline phosphatase level and a normal bilirubin, 3 of 10 patients with sepsis also had acquired immunodeficiency syndrome (AIDS). Eight patients had biliary obstruction, 7 with malignant obstruction and 1 with a common bile duct stone. Nine patients had AIDS. The cause of the elevated alkaline phosphatase in these included three with sepsis, three with mycobacterium avium intracellulare (MAI) infection, two with cytomegalovirus infection, and one with Dilantin toxicity. Three patients had diffuse liver metastases. Finally, four patients had benign intrahepatic disease, including one patient with liver hemangiomas, one patient with sarcoid hepatitis, one patient with lead toxicity, and one patient with drug-induced cholestasis. Extremely high elevations of alkaline phosphatase are most frequently seen in patients with sepsis, malignant obstruction, and AIDS. Patients with sepsis can have an extremely high alkaline phosphatase level and a normal bilirubin. A variety of other causes were also noted.     

Penetration of ceftibuten into middle ear fluid

The penetration of ceftibuten, an extended-spectrum oral cephalosporin, into middle ear fluid (MEF) was evaluated in pediatric patients during a course of daily oral doses of 9 mg/kg of body weight for 10 days. Plasma and MEF collected at 2, 4, 6, or 12 h after at least 3 days of dosing were analyzed for ceftibuten by a high-pressure liquid chromatography method, and the data were used to calculate pharmacokinetic parameters. Plasma and MEF had almost identical maximum concentrations (Cmax) of ceftibuten (14 micrograms/ml). These Cmax values in MEF during acute otitis media were well in excess of the MIC for 90% of the isolates of each of four major pathogens in this disease. The time to Cmax was longer in MEF (4 h) than in plasma (2 h). Excellent penetration (71%) of ceftibuten into MEF was observed on the basis of the area under the curve ratio (MEF/plasma). These data clearly indicate that ceftibuten penetrated well into the MEF to yield clinically effective concentrations.