摘要:

ObjectiveTo review the progress that has been made in developing effective vaccines against the major bacterial pathogens responsible for acute otitis media.Data SourceReview of the literature with the aid of the MEDLINE database using the search termsotitis mediaandotitis media and vaccine.Data ExtractionData were collected from clinical trials and laboratory studies.FindingsThe heptavalent pneumococcal conjugated vaccine, Prevnar, reduced the incidence of acute otitis media from all causes by 7% in one study and by 6% in another study. For culture-positive pneumococcal otitis media, the point estimate of efficacy was 66.7% in one study, and the reduction in incidence was 34% in another study. A Phase I clinical trial has been completed successfully for a conjugated vaccine against nontypeableHaemophilus influenzae(NTHi), which has high immunogenicity for mice and rabbits, induces complement-mediated bactericidal activity against NTHi in rabbits, and is protective against NTHi otitis media in chinchillas. A conjugated vaccine againstMoraxella catarrhaliselicits strong immune responses in mice and rabbits and induces complement-mediated bactericidal activity in rabbits.ConclusionThe prevention of otitis media is likely to require multivalent pneumococcal, NTHi, andM. catarrhalisvaccines, and these vaccines likely can be developed within a decade.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

HypothesisIntranasal metered dose aerosolized inhaler surfactant will reduce opening pressure of the eustachian tube in gerbils and mice.BackgroundEustachian tube opening pressure necessary to allow ventilation of the middle ear must exceed the contractile force exerted by the tension on the curved surface of the eustachian tube. When the active function of opening the eustachian tube is inefficient, functional collapse of the tube persists, resulting in negative middle ear pressure. Such dysfunction is the primary cause of otitis media with effusion in children.MethodsSurfactant in a metered dose aerosolized intranasal delivery system was administered to 61 healthy Mongolian gerbils and 34 albino mice. In the first arm of the experiment, measurements of eustachian tube passive opening pressure were taken at baseline, after the delivery of propellant, and then at 5 and 10 minutes after surfactant administration. In the second arm of the experiment, the animals were divided into control, propellant, and experiment groups. At zero minutes, propellant was administered to the propellant group and intranasal surfactant was administered to the experiment group. Measurements of eustachian tube passive opening pressure were taken at 0, 5, and 10 minutes.ResultsSurfactant administration in the gerbil reduced eustachian tube passive opening pressure from a basal measurement of 40.5 mm Hg to 32.5 mm Hg after 5 minutes and to 30.1 mm Hg after 10 minutes. In mice, eustachian tube passive opening pressure reduced from a basal level of 41.8 mm Hg to 31.3 mm Hg after 5 minutes and to 31.2 mm Hg after 10 minutes in the surfactant group. Propellant placebo resulted in no change from basal level in both animal models and in both arms of the experiment.ConclusionIntranasal metered dose inhaler aerosolized surfactant is effective in reducing eustachian tube passive opening pressure.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundThe epitympanic approach to cholesteatoma provides excellent access to the anterior epitympanic space. When it is combined with reconstruction of the scutum, it is tempting to propose that the approach may offer the patient the advantage of both canal wall up and canal wall down techniques and the disadvantages of neither. In theory, then, the incidence of residual/recurrent cholesteatoma should be no greater than that for canal wall down surgery, and the need for a second look often associated with the canal wall up procedure should be less compelling. However, validation of this theory is lacking.ObjectiveTo test this theory, we sought to establish the incidence of recidivism in patients undergoing cholesteatoma removal via the epitympanic approach followed by canal wall reconstruction, to identify anatomic factors predisposing to persistent disease, and to identify technical features or problems associated with recurrent cholesteatoma.Study DesignA retrospective case series.SettingA tertiary referral center.PatientsFifty-four adults and 11 children with extensive cholesteatoma involving but not limited to the anterior epitympanic space.InterventionAll patents underwent removal of cholesteatoma via the epitympanic approach with canal wall reconstruction followed by reexploration 1 year later.ResultsRecurrent/residual disease was observed in 6 adults (11%) and 5 of 11 children (45%). The anterior epitympanic space harbored cholesteatoma in 100% of adults and 80% of children with recurrent disease.ConclusionThe epitympanic approach does not eliminate the need for reexploration in cases of extensive cholesteatoma involving the anterior epitympanic space. The anterior epitympanic space is highly likely to harbor residual disease. Features of the canal wall reconstruction can be identified that predispose to recurrence. Long-term follow-up and close surveillance are mandatory, especially in children.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo assess the efficacy of a surgical technique, the temporary attic and posterior canal wall osteoplasty, in preventing cholesteatoma recurrence.Design/Participants: The records of 94 patients submitted to tympanoplasty for cholesteatoma in the ear, nose, and throat department of a main city hospital between 1989 and 1997 were retrospectively reviewed.InterventionsIntact canal wall procedure with attic and posterior canal wall temporary removal was performed in 47 cases. A canal wall down operation was performed in the 47 remaining cases. The follow-up ranged from 22 to 84 months.Methods and Main Outcome MeasuresThe patients from one group could be exactly matched for the main prognostic factors (type of cholesteatoma, ossicular status, and preoperative auditory status) with the patients from the other group. Auditory results were defined according to the Committee on Hearing and Equilibrium Guidelines. A 1-way analysis of variance was used to determine group differences. A probability value of p < 0.05 was the level of significance selected.ResultsAll of the patients in the 2 groups were cholesteatoma free at the last follow-up, and significantly better hearing results were observed in the osteoplasty group.ConclusionsThe osteoplasty with temporary removal of the posterior and attic canal wall is a useful adjunct to tympanoplasty in cholesteatoma cases as far as the hearing results and recurrence rates are concerned. This method combines the functional advantages of canal wall up operations with the safety yielded by canal wall down procedures.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo establish the efficacy of immediate preoperative ototopical ofloxacin eardrops in eradicating middle ear pathogens and improving operative outcome.Study DesignSingle-blind, randomized control study.SettingTertiary referral center, ambulatory clinic, and hospital setting.PatientsConsecutive patients with chronic suppurative otitis media for Type I tympanoplasty (myringoplasty).InterventionsThe patients were randomly assigned to 3 groups: Group A underwent 10-minute daily treatments with eardrops for 2 weeks before surgery, Group B underwent 3-minute daily treatments for 2 weeks before surgery, and Group C underwent no treatment.Main Outcome MeasuresPreoperative and perioperative bacteriology and success of the surgery as defined by an intact tympanic membrane in the eighth week postsurgery.ResultsThere were 101 patients entered in the study. The preoperative, perioperative, and postoperative observation of discharge and quantity of the discharge were compared, and no differences were found among the groups (Kruskal-Wallis test). The perioperative culture results were analyzed and 18/21 (86%) became culture negative in Group A, 23/27 (85%) became culture negative in Group B, and 3/21 (14%) became culture negative in the control group (Group C versus Group A or Group B, &khgr;2tests p < 0.001). The success rates of surgery as defined by an intact tympanic membrane showed no difference: 28/33 (85%), 27/33 (82%), and 31/35 (89%) in Groups A, B, and C, respectively. The preoperative positive bacteriology rate in the surgical failures was 10/15 (67%), compared with 16/76 (21%) for the successful procedures (p < 0.001).ConclusionOur study has shown that ofloxacin successfully eradicates most bacterial flora preoperatively. We cannot, however, confirm the benefits of its preoperative usage in improving the graft success rate.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe purpose of this study was to present early and late bone-conduction hearing thresholds and data about cochlear and vestibular disturbances in patients after erbium:yttrium-aluminum-garnet (Er:YAG) laser stapedotomy in otosclerosis.Study DesignThe study design was a retrospective study.SettingThe study was conducted at an academic tertiary referral center.PatientsIn this study, audiologic data of 117 patients undergoing Er:YAG laser-assisted stapedotomy for otosclerosis between 1993 and 1999 were included.Main Outcome MeasuresThe preoperative minus 2 postoperative (early, 1–3 days; late, at least 6 weeks) average pure-tone bone-conduction thresholds at 1, 2, and 4 kHz and 0.5, 1, 2, and 3 kHz were calculated. The postoperative appearance of nystagmus, vertigo, and tinnitus was analyzed.ResultsA total of 91 of 117 patients showed unchanged preoperative minus postoperative pure-tone bone-conduction averages at 1, 2, and 4 kHz in the late postoperative measurement. A slight deterioration was observed in 8 of 117 patients. Regarding the frequencies 0.5, 1, 2, and 3 kHz, 97 of 117 patients showed unchanged preoperative minus postoperative pure-tone bone-conduction averages. A new transient tinnitus appeared in 37 of 117 patients, and a new persistent tinnitus was found in 3 of 117 patients. Most of the patients had no postoperative dizziness (63/117 patients) and no postoperative nystagmus (109/117 patients).ConclusionThe study did not show significant sensorineural hearing loss at or below 3 kHz. Vestibular and cochlear function has no clinically relevant suppression after Er:YAG laser stapedotomy.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe objective of this study was to evaluate postoperative meatal stenosis after surgery for congenital aural atresia using anteriorly and inferiorly based periosteal flaps (AIPFs). These were compared with the groups that did not use these flaps.Study DesignThis was a retrospective clinical study.SettingThe study was conducted at the tertiary referral hospital.PatientsThere were 133 patients (151 ears) who had undergone surgical correction for congenital aural atresia from November 1987 to March 1999.InterventionThe anterior approach surgical method was used to correct the congenital aural atresia.Main Outcome MeasureA comparison between the 2 groups, 1 using the AIPFs and the other that did not use the AIPFs, was performed to evaluate both the incidence and the interval of postoperative meatal stenosis. The correlation between the age of the first operation to correct congenital aural atresia and the incidence of postoperative meatal stenosis was also investigated.ResultsMeatal stenosis was the most common postoperative complication (23.8%) found. The incidence of meatal stenosis was much lower in the group using AIPFs (n = 105) than in the group that did not (n = 46) (19.0% versus 35.0%). The interval for the development of postoperative meatal stenosis showed similar distribution in both groups. In age distribution, the younger the age of the first operation, the more frequent the occurrence of postoperative meatal stenosis.ConclusionAIPF is an effective surgical method for reducing the incidence of postoperative meatal stenosis.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

HypothesisTo determine the time needed for clearance of amniotic fluid from the middle ear after birth, an animal model study was performed.BackgroundBefore birth, the middle ear is full of amniotic fluid, and there is controversy about the time it takes for it to clear postnatally. This is of importance because it is suspected that amniotic fluid in the middle ear of the newborn may affect results of screening of hearing when using otoacoustic emissions.MethodsAdult and neonatal guinea pigs underwent a right-side cochleotomy followed by baseline otoscopy, tympanometry, and auditory nerve– and brainstem-evoked response (ABR) measurements of the left ear. Subsequently, the animals' left middle ears were filled with saline through a hole drilled in the bulla. Over the next few days, assessment of saline clearance was conducted by repeated left-side otoscopy, tympanometry, and measurement of ABR.ResultsAfter filling the middle ear with saline, the tympanic membrane was opaque, a type B tympanogram was obtained, and the ABR threshold was elevated. After an average of 6.3 ± 3.0 days, air bubbles were seen in otoscopy, a type C tympanogram was obtained, and the ABR threshold improved. Finally, after an average of 9.5 ± 2.7 days, all 3 parameters returned to their baseline values.ConclusionTaking into consideration that this is an animal study, the results suggest that clearance of amniotic fluid from the newborn middle ear takes longer than has been generally thought. In addition, an animal model for assessing the clearance of fluid from the middle ear has been developed.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThis study describes the histopathologic findings of a patient with severe bilateral sensorineural hearing loss after perinatal and postnatal hypoxia and asphyxia.Study DesignHistopathologic examination on the temporal bones.SettingThe study was performed at the Elizabeth McCullough Knowles Otopathology Laboratory, Division of Otopathology, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, U.S.A.ResultsHistopathologic examination on the left temporal bone revealed severe atrophy of the organ of Corti throughout the entire cochlea, decrease in the number of the spiral ganglion cells especially in the basal turn, and mild atrophy of saccular macula. In the right temporal bone, similar abnormalities were observed in the inner ear, but the changes were milder than those in the left temporal bone. No other distinct pathologic finding was observed in either ear.ConclusionThese findings suggest that the presence of severe hypoxic ischemia causes cochleosaccular atrophy. To our knowledge, this is the first histopathologic case report describing the long-term effect of perinatal and postnatal hypoxia and asphyxia that produced cochleosaccular abnormalities in the human inner ear.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo present an anteroposterior approach with split ear canal technique in severe malformed ears in which cochlear implantation is not possible through the standard facial recess approach.SettingThe operation was performed at Hacettepe University Medical Faculty, which is a tertiary care center.Study DesignCase report.PatientA 4-year-old female patient with severe Mondini malformation whose facial nerve was completely dehiscent and overlying the stapes and round window.InterventionThe anteroposterior approach was used, and the middle ear was entered after the tympanomeatal flap was elevated. The posterior wall of the ear canal was split longitudinally with a diamond drill. The electrode was inserted easily through the ear canal and then transferred into the mastoid.ConclusionThe anteroposterior approach with split ear canal method may be used if, during facial recess, the landmarks in the middle ear (stapes, stapedius tendon, round window, and promontory) cannot be identified clearly because of an abnormal facial nerve (coursing anteriorly, preventing the use of a drill). It is an alternative for the canal wall down procedure.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID