phenylephrine-hydrochloride and Otitis-Media-with-Effusion

We describe a patient with symptomatic os odontoideum and a previous history of C1-2 wiring who underwent successful treatment with a staged endonasal odontoidectomy and C1-2 revision of instrumentation. Access to the odontoid process was gained through the endonasal corridor using an inverted U-shaped nasopharyngeal flap (IUNF). Post-operatively, the patient experienced resolution of her presenting neurologic symptoms but developed conductive hearing loss secondary to bilateral middle ear effusion, requiring bilateral myringotomy and tube placement 3 months post-operatively. We hypothesize this dysfunction may have resulted from surgical edema, packing buttressing the IUNF, or some combination thereof. In this manuscript, we review the evolution of the nasopharyngeal exposure for odontoidectomy and whether an IUNF may predispose to this complication.

Topics: Female; Humans; Nose; Odontoid Process; Otitis Media with Effusion; Retrospective Studies; Treatment Outcome

Mucociliary clearance (MCC), which exists in many systems, is the first defensive mechanism of the human body. Nasal MCC has an important role in transporting the secretions of the nasal cavity and paranasal sinuses along with the trapped inhaled pathogens to the nasopharynx. Physiologic or pathologic situations that effect nasal MCC, such as temperature, humidity, nasal obstruction, allergic rhinitis, chronic infections, etc., lead to impaired MCC and related local or circumjacent system disorders. With this perspective, when a unified airway with a multiple disease principle is considered, investigating the relationship between adenoid hypertrophy (AH), otitis media with effusion (OME) and nasal MCC is logical. In this review, histological and physiologic properties of nasal MCC and its possible role involving pathologic situations such as AH and OME is discussed together with recent literature findings.

Topics: Adenoids; Animals; Humans; Hypertrophy; Mucociliary Clearance; Nose; Otitis Media; Otitis Media with Effusion

Two types of Eustachian tube dysfunction can result in otitis media: obstruction and abnormal patency. Obstruction may be either functional or mechanical. Functional obstruction can result from persistent collapse of the Eustachian tube due to increased tubal compliance, an inadequate active opening mechanism, or both. Mechanical obstruction may be the result of either intrinsic or extrinsic factors. Otitis media can result from inadequate ventilation of the middle ear or entry of unwanted nasopharyngeal secretions into the middle ear (by aspiration, insufflation, or reflux), or both. An understanding of these concepts of Eustachian tube function and otitis media can then be related to the rationale for nonsurgical and surgical management and prevention of middle-ear disease.

Topics: Adult; Airway Obstruction; Child; Eustachian Tube; Humans; Infant; Nose; Otitis Media with Effusion; Pressure

Otitis media with effusion (OME) is a very common problem in primary care, but one that lacks an evidence-based non-surgical treatment.. To determine the clinical effectiveness of nasal balloon autoinflation for the treatment of OME in children.. A pragmatic, two-arm, open randomised controlled trial.. Forty-three general practices from 17 UK primary care trusts recruited between January 2012 and February 2013.. School children aged 4-11 years with a history of OME symptoms or related concerns in the previous 3 months, and a type B tympanogram, diagnostic of a middle ear effusion, in one or both ears.. Three hundred and twenty children were randomised, 160 to each group, using independent web-based computer-generated randomisation (with minimisation based on age, sex and baseline severity of OME) to either nasal balloon autoinflation performed three times per day for 1-3 months plus usual care, or usual care alone.. The proportion of children demonstrating clearance of middle ear fluid in at least one ear (with normal tympanograms) at 1 and 3 months, assessed blind to treatment. An ear-related measure of quality of life (QoL) [a 14-point questionnaire on the impact of OME (OMQ-14)], weekly diary recorded symptoms, compliance and adverse events were all secondary outcomes.. At 1 month, the proportion of children with normal tympanograms was 47.3% (62/131) in those allocated to autoinflation and 35.6% (47/132) in those receiving usual care [adjusted relative risk (RR) 1.36, 95% confidence interval (CI) 0.99 to 1.88]. At 3 months, the proportions were 49.6% (62/125) and 38.3% (46/120), respectively (adjusted RR 1.37, 95% CI 1.03 to 1.83; number needed to treat = 9). The change in OMQ-14 also favoured the intervention arm (adjusted global score difference -0.42; p = 0.001). Reported compliance was good: 89% in the first month and 80% in months 2 and 3. Adverse events included otalgia in 4% of treated children compared with 1% in the control group. Minor nosebleeds (14% vs. 15%) and respiratory tract infections (18% vs. 13%) were noted.. We found the use of autoinflation in young children with OME to be feasible in primary care and effective in both clearing effusions and improving child and parent ear-related QoL and symptoms. This method has scope to be used more widely. Further research is needed for very young children, and to inform prudent use in different health settings.

Topics: Child; Child, Preschool; Female; Humans; Insufflation; Male; Nose; Otitis Media with Effusion; Primary Health Care; Quality of Life; Treatment Outcome; United Kingdom

We conducted a randomized, controlled clinical trial to investigate the efficacy of treatment of persistent middle ear effusion (MEE) and associated hearing loss with a modified Politzer device used in the home setting over a 7-week period. Efficacy was determined by comparing pre-and posttherapy air-conduction thresholds, tympanometric peak pressures, and otoscopic findings. The study group was made up of 94 children (174 ears), aged 4 to 11 years, who had at least a 2-month history of MEE and associated hearing loss. At study's end, patients in the treatment group experienced statistically significant improvements in all measured outcomes; no significant improvements were seen in the control group in all measured outcomes. At study's end, the hearing sensitivity of 73.9% of the treated ears was within normal limits, compared with only 26.7% of the control ears. These findings demonstrate that home treatment of children with persistent MEE and associated hearing loss with the modified Politzer device is highly efficacious.

Topics: Acoustic Impedance Tests; Air Pressure; Audiometry, Pure-Tone; Auditory Threshold; Child; Child, Preschool; Eustachian Tube; Hearing Loss, Conductive; Humans; Insufflation; Nose; Otitis Media with Effusion; Otolaryngology; Single-Blind Method; Treatment Outcome

The use of autoinflation in the treatment of glue ear has been widely recommended. In order to assess its efficacy, 40 children were studied. 21 children practised nasal autoinflation of a toy balloon 3 times daily for 3 weeks and 19 children had no treatment. In the autoinflation group only 4 glue ears improved, while in the untreated group 10 glue ears improved. This study suggests that autoinflation has no part to play in the treatment of glue ear in children.

Topics: Airway Resistance; Child; Child, Preschool; Ear, Middle; Eustachian Tube; Humans; Nose; Otitis Media with Effusion; Pressure

Topics: Adult; Child; Dilatation; Equipment Design; Eustachian Tube; Exercise; Humans; Musculoskeletal Diseases; Nose; Occupational Diseases; Otitis Media with Effusion; Otolaryngology; Sleep Apnea Syndromes

Physiologic and developmental role of mastoid pneumatisation in children with otitis media with effusion (OME) is still controversial. For measuring mastoid pneumatisation and examine developmental characteristics, we used children with orofacial malformation of high risk for long term negative pressure in the middle ear and are expected to have lower rate of size and growth of pneumatisation. Mastoid were measured on Schuller's mastoid X-ray pictures planimetrically in study group of 146 children with bilateral (BCLP), unilateral (UCLP) and isolated (ICP) cleft palate, and control group of non-cleft 52 children, both groups with confirmed otitis media with effusion and no previous otological surgery. The lowest pneumatisation found in BCLE, BCLP and UCLP showed no growth of mastoid with age and lower mastoid size than OME controls. ICP is the only cleft type with growth of mastoid with aging. OME patients has the highest size of mastoid and growth rate with aging.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Mastoid; Nose; Otitis Media with Effusion; Radiography; Retrospective Studies

To examine the long-term effect of ventilation tube insertion in treating patients with non-tumor adult-onset otitis media with effusion (OME).. During the period from 1999 to 2001, a total of 153 adult patients received ventilation tube insertion for OME and were followed up for 12-18 months postoperatively. A retrospective analysis of these cases was conducted.. Out of the 153 patients, 81 had received at least one previous operation of ventilation tube insertion. During 12-18 months following the operation, the ventilation tubes were extruded in 89 patients, among whom 55 had OME recurrence. The recurrence of OME following ventilation tube extrusion was significantly correlated to the pathological changes in the nose or nasopharynx of the patients.. The underlying pathological changes may lead to recurrence of adult-onset OME following extrusion of the ventilation tube, therefore, better long-term outcome may be expected only after identifying the underlying pathological changes and giving them appropriate treatment in addition to ventilation tube insertion.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Middle Ear Ventilation; Nasopharynx; Nose; Otitis Media with Effusion; Retrospective Studies

Topics: Child; Humans; Insufflation; Middle Ear Ventilation; Nose; Otitis Media with Effusion; Treatment Outcome

132 patients with diagnosis acute or subacute exudative otitis media were treated conservatively (n = 79) or surgically (n = 53). Conservative treatment was effective in 41% of the cases, surgical treatment produced positive results in 62.3%. The operative treatment combined elements of endoscopic nasal surgery and methods used in tympanoplasty, plastic treatment of the auditory tube, surgery of the internal ear.

Topics: Acute Disease; Adult; Audiometry, Pure-Tone; Decision Making; Ear, Middle; Endoscopy; Eustachian Tube; Follow-Up Studies; Humans; Middle Aged; Nose; Otitis Media with Effusion; Plastic Surgery Procedures; Sympathectomy; Treatment Outcome; Tympanoplasty

Adenoidal hypertrophy is the commonest cause of nasal obstruction in the pediatric population. It may cause marked morbidity as regards respiratory physiology, facial growth and middle ear function. Determination of adenoidal presence and size is not easy. Nasal endoscopy and radiology are the most accepted modes of diagnosis and each has its disadvantages. We have used acoustic rhinometry to determine the size of adenoids. Changes in nasal volume and resistance were recorded and an easy formula was devised to determined adenoid size. This technique is easy, non-invasive and reproducible with a 93.5% predictive value.

Topics: Acoustics; Adenoidectomy; Adenoids; Airway Resistance; Cephalometry; Child; Child, Preschool; Ear, Middle; Endoscopy; Female; Humans; Hypertrophy; Male; Manometry; Maxillofacial Development; Mouth Breathing; Nasal Obstruction; Nose; Otitis Media with Effusion; Otitis Media, Suppurative; Predictive Value of Tests; Radiography; Reproducibility of Results; Respiration; Sleep Apnea Syndromes; Snoring

The present study was performed to estimate changes of middle ear pressure (ME-P) during actions of daily life such as nose blowing and sniffing. ME-P was measured in 18 patients with perforation of the eardrum. They were asked to perform actions which included nose blowing and sniffing. Eustachian catheterization and politzerization were also applied. Change of ME-P before and after these actions was recorded using a pressure monitor. Results showed that changes of ME-P after nose blowing with both nostrils closed were large and rapid. The mean value of ME-P after nose blowing was 252 mmH2O. In our previous study, the mean value of cerebrospinal fluid pressure (CSF-P) after nose blowing was 388 mmH2O. Therefore, the pressure gradient across the cochlear windows is about 130 mmH2O during nose blowing. The cochlear windows may have been pressed toward the middle ear side. After sniffing, ME-P was unchanged. These results suggest that nose blowing may be an important cause of perilymphatic fistula (PLF) via the "explosive route", while sniffing is not likely to cause PLF.

Topics: Activities of Daily Living; Adolescent; Adult; Aged; Catheterization; Cerebrospinal Fluid Pressure; Chronic Disease; Cochlea; Ear Diseases; Ear, Middle; Eustachian Tube; Female; Fistula; Humans; Male; Middle Aged; Nose; Otitis Media; Otitis Media with Effusion; Perilymph; Pressure; Transducers, Pressure; Tympanic Membrane

Numerous workers have studied the relationship between nasal mucociliary clearance and adenoid removal in terms of nasal function. This study was performed to investigate the role of preoperative saccharin clearance time and velocity determination in selecting children with established otitis media with effusion (OME) for adenoidectomy. Testing was not found to be particularly reproducible and there was no statistically significant relationship between mucociliary parameters and the otoscopic resolution of effusion.

Topics: Adenoidectomy; Child; Child, Preschool; Female; Humans; Male; Mucociliary Clearance; Nose; Otitis Media with Effusion; Reproducibility of Results

Topics: Adenoidectomy; Adenoids; Adolescent; Adult; Child; Endoscopy; Eustachian Tube; Humans; Hypertrophy; Middle Aged; Middle Ear Ventilation; Nasopharynx; Nose; Otitis Media with Effusion; Prospective Studies; Recurrence; Treatment Outcome; Tympanic Membrane

Topics: Eustachian Tube; Hearing Disorders; Humans; Nose; Otitis Media with Effusion; Pressure

In an animal experiment involving Rhesus monkeys the relationship between the rhinomanometrical findings and the results of Eustachian tube tests was investigated. Nasal challenges were performed with histamine and Substance P in order to create an edema of the nasal mucosa. We studied the nasal resistance and tubal function parameters with the help of computer-assisted techniques of pressure and flow measurement. It was the aim of the study to investigate if an edema of the Eustachian tube, demonstrated by an increase of the nasal resistance, has an influence on the tubal function. It was noted that an increase of the nasal resistance influenced some parameters of Eustachian tube function. Especially the steady state pressure and the closing pressure increased with increasing nasal resistance. These experiments illustrate the correlation between edema of the nasal mucosa and the function of the Eustachian tube.

Topics: Airway Resistance; Animals; Edema; Eustachian Tube; Histamine; Macaca mulatta; Manometry; Nose; Otitis Media with Effusion; Substance P

Topics: Australia; Child; Child, Preschool; Chlamydia trachomatis; Ear, Middle; Europe; Female; Humans; Infant; Male; Nose; Otitis Media; Otitis Media with Effusion; Pharynx

Middle ear effusions and swabs from the external auditory meatus, nasopharynx and anterior nares have been collected from 100 children with chronic secretory otitis media. Isolates of Haemophilus influenzae and Streptococcus pneumoniae were typed and in vitro sensitivities to commonly used antibiotics were determined for these species and Staphylococcus aureus. Positive middle ear cultures were obtained from 21 children (27 effusions). Haemophilus influenzae and S. pneumoniae were the commonest organisms isolated, both from the middle ear and upper respiratory tract. When one or other of these species was isolated from the middle ear, the same organism was generally found in the upper respiratory tract, but not in the ear canal. The serotypes isolated from the different sites were also the same. Type 19 was the commonest Pneumococcal serotype isolated, while type e was the commonest capsulated strain of H. influenzae. Thirty-six per cent of strains of H. influenzae were resistant to penicillin and 25% of those of S. pneumoniae were resistant to trimethaprim. Eighty-one per cent of isolates of S. aureus were penicillin resistant. There was no difference in the incidence of either S. pneumoniae or H. influenzae in the post nasal spaces of children who had had their adenoids removed and those who had not.

Topics: Adenoidectomy; Ampicillin; Child; Child, Preschool; Ear, External; Ear, Middle; Female; Haemophilus influenzae; Humans; Infant; Male; Microbial Sensitivity Tests; Nasopharynx; Nose; Otitis Media with Effusion; Penicillins; Staphylococcus aureus; Staphylococcus epidermidis; Streptococcus pneumoniae; Trimethoprim

Fifty children aged between five and eight years of age who have had proven otitis media with effusion have been retrospectively assessed. Twenty-five children who had attended the Casualty Department with head injuries, who have had X-radiography of their skulls as part of their investigation, acted as controls. All the children in this group were selected because they had no otological history. The 50 children comprising the retrospective survey were split into two groups: Group 1, with recurrent secretory otitis media requiring surgical intervention on more than three occasions; Group 2, comprising 25 children who had had up to three surgical interventions. All the children had PA X-radiography of their skulls in order to demonstrate the bony nasal septum. In Group 1, a septal deformity was found to be sited at the middle third of the bony septum at the vomero-ethmoid suture. In Group 2, the deformity was found to involve the whole of the middle third of the bony septum, plus portions of the upper and lower thirds of the bony septum. In the control group, in whom there was no history of otological disease, there was no deformity sited at the middle third of the bony septum.

Topics: Child; Child, Preschool; Cilia; Cranial Sutures; Ethmoid Bone; Eustachian Tube; Humans; Nasal Septum; Nasopharynx; Nose; Otitis Media; Otitis Media with Effusion; Pulmonary Ventilation; Radiography; Retrospective Studies