phenylephrine-hydrochloride and Otitis-Media

Topics: Chronic Disease; Humans; Nose; Otitis Media; Rhinitis; Sinusitis

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

Topics: Adult; Asthma; Child; Humans; Nasal Polyps; Nose; Nose Diseases; Otitis Media; Respiratory Hypersensitivity; Rhinitis; Seasons; Sinusitis

To compare the clinical effectiveness of single-dose azithromycin treatment with 7 days of amoxycillin treatment among Aboriginal children with acute otitis media (AOM) in rural and remote communities in the Northern Territory.. Aboriginal children aged 6 months to 6 years living in 16 rural and remote communities were screened for AOM. Those diagnosed with AOM were randomly allocated to receive either azithromycin (30 mg/kg as a single dose) or amoxycillin (50mg/kg/day in two divided doses for a minimum of 7 days). We used a double-dummy method to ensure blinding. Our study was conducted from 24 March 2003 to 20 July 2005.. Failure to cure AOM by the end of therapy; nasal carriage of Streptococcus pneumoniae and non-capsular Haemophilus influenzae (NCHi).. We followed 306 of 320 children (96%) allocated to the treatment groups. Single-dose azithromycin did not reduce (or increase) the risk of clinical failure (50% failure rate [82/165]) compared with amoxycillin (54% failure rate [83/155]) (risk difference [RD], - 4% [95% CI, - 15% to 7%]; P = 0.504). Compared with amoxycillin, azithromycin significantly reduced the proportion of children with nasal carriage of S. pneumoniae (27% v 63%; RD, - 36% [95% CI, - 47% to - 26%]; P < 0.001) and NCHi (55% v 85%; RD, - 30% [95% CI, - 40% to - 21%]; P < 0.001). Nasal carriage of S. pneumoniae with intermediate or full resistance to penicillin was lower (but not significantly so) in the azithromycin group (10% v 16%), but this group had significantly increased carriage of azithromycin-resistant S. pneumoniae (10% v 3%; RD, 7% [95% CI, 0.1% to 12%]; P = 0.001). Carriage of beta-lactamase-producing NCHi was about 5% in both groups.. Although azithromycin reduced nasal carriage of S. pneumoniae and NCHi, clinical failure was high in both treatment groups. The possibility of weekly azithromycin treatment in children with persistent AOM should be evaluated.. Australian Clinical Trials Registry ACTRN 12609000691246.

Topics: Amoxicillin; Anti-Bacterial Agents; Australia; Azithromycin; Child; Child, Preschool; Confidence Intervals; Double-Blind Method; Female; Haemophilus influenzae; Humans; Infant; Male; Native Hawaiian or Other Pacific Islander; Nose; Odds Ratio; Otitis Media; Streptococcus pneumoniae; Tympanic Membrane Perforation

Topics: Adult; Aged; Antitubercular Agents; Dose-Response Relationship, Drug; Drug Administration Schedule; Ethmoid Sinusitis; Female; Fluoroquinolones; Follow-Up Studies; Furunculosis; Humans; Male; Middle Aged; Nose; Otitis Media; Treatment Outcome

To investigate the possible effect of a polyvalent pneumococcal vaccine on the nasopharyngeal and nasal carriage of Streptococcus pneumoniae, we studied 313 children under 8 years of age who had received either 14-valent pneumococcal capsular polysaccharide vaccine (Pn) or Haemophilus influenzae type b capsular polysaccharide vaccine (Hib) after having recovered from acute otitis media. Nasopharyngeal and nasal swabs were obtained during a symptomless phase, 6 to 12 months after the vaccination, and cultured by routine bacteriological methods. All S. pneumoniae strains were serotyped and among H. influenzae strains, type b was identified. In the group that had received the Pn vaccine, the carriage rate of S. pneumoniae types present in the vaccine (type 6 excluded) was 20%, somewhat but not significantly lower than the 30% carriage in the group having received the Hib vaccine. Conversely, the carriage rate of H. influenzae was slightly higher in the Pn (26%) than in the Hib (19%) vaccine group. 14% of the H. influenzae strains were of type b, and this proportion was the same in both vaccine groups. There were no differences between the two vaccination groups in the carriage rates of other S. pneumoniae types or of Staphylococcus aureus or of group A hemolytic streptococci. S. pneumoniae was more often cultured from nasopharyngeal than nasal swabs, especially in children over 6 years, whereas the total carriage rates of S. pneumoniae and H. influenzae were largely unaffected by age.

Topics: Bacterial Vaccines; Bacteriological Techniques; Carrier State; Child; Child, Preschool; Humans; Nasopharynx; Nose; Otitis Media; Pneumococcal Infections; Polysaccharides, Bacterial; Streptococcus pneumoniae

Topics: Clinical Trials as Topic; Humans; Infant, Newborn; Nose; Otitis Media; Pseudomonas aeruginosa; Pseudomonas Infections

Tuberculosis is a well-known communicable infectious disease and can involve almost any organ of the body. Upper respiratory tract involvement is seen in only 1.9% and involvement of the nasopharynx is even rarer, accounting for only 0.1%. The occurrence of nasopharyngeal tuberculosis (NPTB) is very rare even in endemic areas. Herein, we report two cases of NPTB in which patients had the previous history of chronic ear infection; and later were found to have NPTB. Initial symptoms of NPTB can be vague and easily be misdiagnosed. The literature is scarce on NPTB. To the best of our knowledge, no such cases have ever been reported from Pakistan. Although the incidence of NPTB is very low since we live in a country where tuberculosis incidence is really high, its possibility should be kept in mind as one of the differential diagnoses. Key Words: Nasopharyngeal, Tuberculosis, Otitis media, Fungal, Infection.

Topics: Diagnosis, Differential; Humans; Nasopharynx; Nose; Otitis Media; Tuberculosis

Otitis media (OM) or middle ear disease is a prevalent pediatric condition generally related to early growth of the cartilaginous Eustachian tube (CET). This study used a developmental series of dry crania to reconstruct CET and dilator tubae (DT, the muscle opening the CET) morphology. Timing and directionality of CET and upper respiratory tract (URT) growth were investigated. Traditional and 3D geometric morphometrics (GM) were used to assess bony landmarks on the crania. The series was divided using dental eruption into seven growth stages ranging from before eruption of deciduous dentition (approximately the first 6 postnatal months) to eruption of the first permanent maxillary molar (after approximately 6 years). Bony endpoints of the CET and DT were used to calculate their morphology. GM analysis showed substantial shape differences between newborns, early infants, and all later developmental stages. Univariate measures showed the largest growth change between birth and 6 months. Subsequently, CET morphology changed little in the latter half of year 1, instead maturing gradually until approximately 3 years whereas DT relative length and orientation finish growth by the end of year 1. Incongruence in slower CET growth and faster DT growth could impact CET function between 6 and 12 months and be a contributing factor of OM. Tubal aeration may improve after this time when both CET and DT morphology mature, coinciding with clinically reported drop-off in ear infections.

Topics: Ear Diseases; Eustachian Tube; Female; Humans; Infant, Newborn; Larynx; Nose; Otitis Media; Respiratory System

Human rhinoviruses (HRVs), human enteroviruses (HEVs) and human parechoviruses (HPeVs) have been linked to acute otitis media (AOM). We evaluated this association in a prospective birth cohort setting.. A total of 324 healthy infants were followed up from birth to age 3 years. Nasal swab samples were collected at age 3, 6, 12, 18, 24, and 36 months and screened for HRV and HEV using real-time reverse-transcription quantitative polymerase chain reaction. Stool samples were collected monthly and analyzed for HRV, HEV, and HPeV. AOM episodes diagnosed by physicians were reported by parents in a diary. The association of viruses with AOM was analyzed using generalized estimation equations, and their relative contributions using population-attributable risk percentages.. A clear association was found between AOM episodes and simultaneous detection of HEV (adjusted odds ratio for the detection of virus in stools, 2.04; 95% confidence interval, 1.06-3.91) and HRV (1.54; 1.04-2.30). HPeV showed a similar, yet nonsignificant trend (adjusted odds ratio, 1.44; 95% confidence interval, .81-2.56). HRV and HEV showed higher population-attributable risk percentages (25% and 20%) than HPeV (11%).. HEVs and HRVs may contribute to the development of AOM in a relatively large proportion of cases.

Topics: Acute Disease; Child, Preschool; Enterovirus; Enterovirus Infections; Feces; Female; Humans; Infant; Male; Nose; Otitis Media; Parechovirus; Picornaviridae Infections; Prospective Studies; Rhinovirus

Patients with mutations in the ectodysplasin receptor signalling pathway genes - the X-linked ligand ectodysplasin-A (

Topics: Animals; Antibodies; Disease Models, Animal; Ear, Middle; Ectodermal Dysplasia 1, Anhidrotic; Ectodysplasins; Female; Hyalin; Male; Mice; Nasopharyngitis; Nasopharynx; Nose; Otitis Media; Phenotype; Rats; Receptors, Ectodysplasin; Rhinitis; Signal Transduction

Nontypeable Haemophilus influenzae (NTHi) is a commensal in the human nasopharynx and the cause of pneumonia, meningitis, sinusitis, acute exacerbations of chronic obstructive pulmonary disease and acute otitis media (AOM). AOM is the most common ailment for which antibiotics are prescribed in the United States. With the emergence of new strains of antibiotic-resistant bacteria, finding an effective and broad coverage vaccine to protect against AOM-causing pathogens has become a priority. Mouse models are a cost-effective and efficient way to help determine vaccine efficacy. Here, we describe an NTHi AOM model in C57BL/6J mice, which also utilizes a mouse-adapted H1N1 influenza virus to mimic human coinfection.. We tested our coinfection model using a protein vaccine formulation containing protein D, a well-studied NTHi vaccine candidate that can be found in the 10-valent Streptococcus pneumoniae conjugate vaccine. We verified the usefulness of our mouse model by comparing bacterial loads in the nose and ear between protein D-vaccinated and control mice.. While there was no measurable difference in nasal bacterial loads, we did detect significant differences in the bacterial loads of ear washes and ear bullae between vaccinated and control mice.. The results from this study suggest that our NTHi AOM coinfection model is useful for assessing protein vaccines.

Topics: Administration, Intranasal; Animals; Antibodies, Bacterial; Bacterial Proteins; Carrier Proteins; Coinfection; Disease Models, Animal; Female; Haemophilus Infections; Haemophilus influenzae; Haemophilus Vaccines; Humans; Immunoglobulin D; Influenza A Virus, H1N1 Subtype; Lipoproteins; Male; Mice; Mice, Inbred C57BL; Nose; Otitis Media; Vaccines, Conjugate

Following Tx for facial blisters, our patient returned with what appeared to be viral conjunctivitis. Further evaluation revealed a missed tip-off to the proper Dx.

Topics: Anti-Bacterial Agents; Antiviral Agents; Conjunctivitis; Ear; Erythromycin; Female; Herpes Labialis; Humans; Keratitis, Herpetic; Lip; Middle Aged; Mouth; Nose; Otitis Media; Treatment Outcome; Trifluridine; Valacyclovir

To evaluate the nasal functions of patients with unilateral chronic otitis media using rhinomanometry, comparing chronic otitis media sides with healthy sides, chronic otitis media patients with cholesteatoma and without cholesteatoma, and patients with healthy individuals.. This prospective study included 102 patients with unilateral chronic otitis media (48 with and 54 without cholesteatoma). The control group comprised 40 individuals without any ear or nasal pathologies. All patients underwent active anterior rhinomanometry to measure nasal airway resistance and a saccharin test to measure mucociliary transport times.. There were no significant differences in nasal airway resistance and mucociliary transport time between the chronic otitis media sides and unaffected sides in the 102 patients (p = 0.72 and p = 0.28, respectively), between the non-suppurative chronic otitis media patients (without cholesteatoma) and chronic otitis media with cholesteatoma patients (p > 0.05), or between the study and control groups (p > 0.05).. The present study, with a larger sample size compared to previously published literature, supports the conclusion that unilateral nasal obstruction is unlikely to lead to chronic otitis media on the same side. The results also suggest that nasal functions do not contribute to the development of cholesteatoma.

Topics: Adult; Airway Resistance; Case-Control Studies; Cholesteatoma; Female; Humans; Male; Nasal Obstruction; Nose; Otitis Media; Prospective Studies; Rhinomanometry; Tertiary Care Centers; Young Adult

 Vaccines and antivirals against respiratory syncytial virus (RSV) are being developed, but there are scarce data on the full impact of RSV infection on outpatient children..  We analyzed the burden of RSV illness in a prospective cohort study of children aged ≤13 years during 2 consecutive respiratory seasons in Turku, Finland (2231 child-seasons of follow-up). We examined the children and obtained nasal swabs for the detection of RSV during each respiratory illness. The parents filled out daily symptom diaries throughout the study..  Of 6001 medically attended respiratory infections, 302 (5%) were caused by RSV. Per 1000 children, the average annual RSV infection incidence rates among children aged <3, 3-6, and 7-13 years were 275, 117, and 46 cases, respectively. In children aged <3 years, acute otitis media developed in 58%, and 66% of children in this age group received antibiotics. The mean duration of RSV illness was longest (13.0 days) and the rate of parental work absenteeism was highest (136 days per 100 children with RSV illness) in children aged <3 years..  The burden of RSV is particularly great among outpatient children aged <3 years. Young children are an important target group for the development of RSV vaccines and antivirals.

Topics: Acute Disease; Antiviral Agents; Child; Child, Preschool; Cost of Illness; Female; Finland; Hospitalization; Humans; Infant; Male; Nose; Otitis Media; Prospective Studies; Respiratory Syncytial Virus Infections; Respiratory Syncytial Virus Vaccines; Respiratory Syncytial Virus, Human; Risk Factors; Seasons; Socioeconomic Factors

Streptococcus pneumoniae (pneumococcus) is both a widespread nasal colonizer and a leading cause of otitis media, one of the most common diseases of childhood. Pneumococcal phase variation influences both colonization and disease and thus has been linked to the bacteria's transition from colonizer to otopathogen. Further contributing to this transition, coinfection with influenza A virus has been strongly associated epidemiologically with the dissemination of pneumococci from the nasopharynx to the middle ear. Using a mouse infection model, we demonstrated that coinfection with influenza virus and pneumococci enhanced both colonization and inflammatory responses within the nasopharynx and middle ear chamber. Coinfection studies were also performed using pneumococcal populations enriched for opaque or transparent phase variants. As shown previously, opaque variants were less able to colonize the nasopharynx. In vitro, this phase also demonstrated diminished biofilm viability and epithelial adherence. However, coinfection with influenza virus ameliorated this colonization defect in vivo. Further, viral coinfection ultimately induced a similar magnitude of middle ear infection by both phase variants. These data indicate that despite inherent differences in colonization, the influenza A virus exacerbation of experimental middle ear infection is independent of the pneumococcal phase. These findings provide new insights into the synergistic link between pneumococcus and influenza virus in the context of otitis media.

Topics: Animals; Carrier State; Coinfection; Influenza A virus; Mice; Nose; Orthomyxoviridae Infections; Otitis Media; Pneumococcal Infections; Streptococcus pneumoniae

Streptococcus pneumoniae asymptomatically colonizes the upper respiratory tract of children and is a frequent cause of otitis media. Patterns of microbial colonization likely influence S. pneumoniae colonization and otitis media susceptibility. This study compared microbial communities in children with and without otitis media. Nasal swabs and clinical and demographic data were collected in a cross-sectional study of Philadelphia, PA, children (6 to 78 months) (n=108) during the 2008-2009 winter respiratory virus season. Swabs were cultured for S. pneumoniae. DNA was extracted from the swabs; 16S rRNA gene hypervariable regions (V1 and V2) were PCR amplified and sequenced by Roche/454 Life Sciences pyrosequencing. Microbial communities were described using the Shannon diversity and evenness indices. Principal component analysis (PCA) was used to group microbial community taxa into four factors representing correlated taxa. Of 108 children, 47 (44%) were colonized by S. pneumoniae, and 25 (23%) were diagnosed with otitis media. Microbial communities with S. pneumoniae were significantly less diverse and less even. Two PCA factors were associated with a decreased risk of pneumococcal colonization and otitis media, as follows: one factor included potentially protective flora (Corynebacterium and Dolosigranulum), and the other factor included Propionibacterium, Lactococcus, and Staphylococcus. The remaining two PCA factors were associated with an increased risk of otitis media. One factor included Haemophilus, and the final factor included Actinomyces, Rothia, Neisseria, and Veillonella. Generally, these taxa are not considered otitis media pathogens but may be important in the causal pathway. Increased understanding of upper respiratory tract microbial communities will contribute to the development of otitis media treatment and prevention strategies.

Topics: Bacteria; Child; Child, Preschool; Cross-Sectional Studies; Female; Humans; Infant; Infant, Newborn; Male; Molecular Sequence Data; Nose; Otitis Media; Phylogeny; Streptococcus pneumoniae

Our goal was to estimate the local prevalence of Streptococcus pneumoniae nonsusceptible to penicillin and amoxicillin after widespread use of the heptavalent pneumococcal vaccine and to revise community-specific recommendations for first-line antibiotic treatment of acute otitis media.. We conducted serial prevalence surveys between 2000 and 2004 in the offices of community pediatricians in St Louis, Missouri. Study participants were children <7 years of age with acute upper respiratory infections. Children treated with an antibiotic in the past 4 weeks were excluded. S pneumoniae was isolated from nasopharyngeal swabs using standard techniques. Isolates with a penicillin minimum inhibitory concentration >2 microg/mL were considered to be S pneumoniae nonsusceptible to amoxicillin.. There were 327 patients enrolled in the study. Between 2000 and 2004, vaccine coverage with > or =3 doses of heptavalent pneumococcal vaccine increased from 0% to 54%, but nasopharyngeal carriage of S pneumoniae was stable at 39%. The prevalence of S pneumoniae nonsusceptible to penicillin fell from 25% to 12% among patients, did not vary if <2 years of age, was reduced in children with > or =3 doses of heptavalent pneumococcal vaccine, and increased in child care attendees but reduced in attendees who had > or =3 doses of heptavalent pneumococcal vaccine. The prevalence of S pneumoniae nonsusceptible to amoxicillin in patients remained <5%.. In our community, widespread use of heptavalent pneumococcal vaccine has reduced the prevalence of S pneumoniae nonsusceptible to penicillin, and the prevalence of S pneumoniae nonsusceptible to amoxicillin remains low (<5%). If antibiotic treatment is elected for children with uncomplicated acute otitis media, we recommend treatment with standard-dose amoxicillin (40-45 mg/kg per day) for children with > or =3 doses of heptavalent pneumococcal vaccine, regardless of age and child care status. High-dose amoxicillin should be used for children with <3 doses of heptavalent pneumococcal vaccine and those treated recently with an antibiotic.

Topics: Acute Disease; Amoxicillin; Anti-Bacterial Agents; Child, Preschool; Drug Resistance, Bacterial; Female; Heptavalent Pneumococcal Conjugate Vaccine; Humans; Male; Meningococcal Vaccines; Nose; Otitis Media; Penicillin Resistance; Pharynx; Pneumococcal Infections; Pneumococcal Vaccines; Streptococcus pneumoniae; Vaccines, Conjugate

Otitis media (OM), inflammation of the middle ear, remains the most common cause of hearing impairment in children. It is also the most common cause of surgery in children in the developed world. There is evidence from studies of the human population and mouse models that there is a significant genetic component predisposing to OM, yet nothing is known about the underlying genetic pathways involved in humans. We identified an N-ethyl-N-nitrosourea-induced dominant mouse mutant Junbo with hearing loss due to chronic suppurative OM and otorrhea. This develops from acute OM that arises spontaneously in the postnatal period, with the age of onset and early severity dependent on the microbiological status of the mice and their air quality. We have identified the causal mutation, a missense change in the C-terminal zinc finger region of the transcription factor Evi1. This protein is expressed in middle ear basal epithelial cells, fibroblasts, and neutrophil leukocytes at postnatal day 13 and 21 when inflammatory changes are underway. The identification and characterization of the Junbo mutant elaborates a novel role for Evi1 in mammalian disease and implicates a new pathway in genetic predisposition to OM.

Topics: Amino Acid Sequence; Animals; Chromosome Mapping; Cloning, Molecular; DNA Mutational Analysis; DNA-Binding Proteins; Ear, Middle; Flow Cytometry; Genetic Predisposition to Disease; Granulocytes; Lung; Male; MDS1 and EVI1 Complex Locus Protein; Mice; Mice, Inbred BALB C; Mice, Mutant Strains; Molecular Sequence Data; Mutation; Nose; Otitis Media; Phenotype; Proto-Oncogenes; Specific Pathogen-Free Organisms; Transcription Factors

We describe the way our multidisciplinary team manages cleft lips and palates at our centre at the Catholic University of Louvain. Since 1987, we have opted for the neonatal repair of the cleft lip and nose, and closure of the cleft palate at three months of age. Multidisciplinary follow-up then takes place to detect and correct the sequellae. The children are seen once a year by a plastic surgeon, an otorhinolaryngologist, a maxillofacial surgeon, a speech therapist, an audiologist, and an orthodontist. Secondary corrections are scheduled depending on functional, aesthetic, and psychological requirements.

Topics: Age Factors; Alveoloplasty; Cleft Lip; Cleft Palate; Deglutition Disorders; Follow-Up Studies; Humans; Infant; Infant, Newborn; Lip; Nose; Orthodontics, Corrective; Orthodontics, Interceptive; Otitis Media; Palate, Soft; Patient Care Team; Plastic Surgery Procedures; Speech Disorders; Velopharyngeal Insufficiency

A case of septic cavernous sinus thrombosis in 41 year old men is described. One week prior to hospitalisation he had an influenza infection. During influenza nose furunculus, labial herpes and viral left otitis media with facial nerve paresis occurred. Patient manipulated furunculus nasi. On admission to hospital he complained of severe hedeache, left ear pain and left visual loss. He had left orbital cellulitis with immobile eyeball, the left part of the face, neck and throat were swollen. Lumbar puncture showed cerebrospinal fluid containing protein 156 mg/dl, glucose 94 mg/dl, and 5888 polymorphonuclear cells. Cranial CT scan showed left exophatlmos with periorbital swelling, left ethmoid sinusitis, and probable thrombosis of cerebral vessels. Involvement of the right eye appeared after two days. He was treated with high dose of antibiotics, steroids and anticoagulants. After four days in the control cranial CT scan two focus of intracerebral hemorrhage were found in the frontal lobe. We excluded anticoagulants from the therapy. The patients improved slowly and he was discharged after 22 days of hospitalisation with the left abducent and facial nerve paresis.

Topics: Adult; Cavernous Sinus Thrombosis; Cerebral Hemorrhage; Facial Paralysis; Female; Furunculosis; Herpes Simplex; Humans; Lip; Nose; Otitis Media; Tomography, X-Ray Computed

Hearing impairment is the most prevalent sensory deficit in the human population. Otosclerosis and chronic otitis media are two of the most frequent causes of hearing loss of the Western world and both benefit from middle ear surgery. The success rate is high for both operations, in expert hands, but, in our clinic and in every ENT clinic, there remains a percentage of failure. Some of the most frequent post-operative complications can lead to tubal dysfunction. We believe that a correct and complete evaluation of the rhino-pharyngeal-tubal unit is very important before tympanoplasty and stapedioplasty in order to further reduce the incidence of some post-operative complications and to increase the success rate of middle ear surgery. What is well known in medicine, 'prevention is the best therapy', seems not oddly observed in ear surgery, where is usually operated the effect, while the evaluation and therapy of the causes seems to be underestimated.

Topics: Eustachian Tube; Hearing Disorders; Humans; Models, Biological; Nose; Otitis Media; Otosclerosis; Pharynx; Stapes Surgery; Tympanoplasty

Because many patients with velocardiofacial syndrome (VCFS) are first examined by otolaryngologists for ear or speech problems before being diagnosed with VCFS, we describe a series of patients with this genetic disorder, which is associated with multiple anomalies, including velopharyngeal insufficiency, cardiac defects, characteristic facial features, and learning disabilities.. We retrospectively analyzed the medical charts and available nasoendoscopic observations for 35 patients who were diagnosed with VCFS and who had a microscopic deletion in chromosome 22q11 as shown by DNA probe and fluorescence in situ hybridization.. For most patients, the medical chart documented cardiac anomalies, velopharyngeal insufficiency with hypernasal speech, and characteristic facial features including nasal, auricular, craniofacial, and ocular abnormalities. Incidence of middle ear infection with associated conductive hearing loss was also high and necessitated early placement of pressure equalization tubes. Some patients were treated with adenoidectomy for chronic otitis media; consequently, velopharyngeal insufficiency and hypernasal speech worsened. Nasoendoscopic examination as documented in the medical chart showed occult cleft palate, a small adenoid pad, and pulsation in the muscular wall.. Otolaryngologists have an important role in diagnosis and treatment of persons with VCFS and therefore should familiarize themselves with the typical history and most frequent head and neck manifestations of this syndrome.

Topics: Adolescent; Adult; Child; Child, Preschool; Chromosome Deletion; Chromosomes, Human, Pair 22; Cleft Palate; Craniofacial Abnormalities; DNA Probes; Ear, External; Endoscopy; Eye Abnormalities; Female; Hearing Loss, Conductive; Heart Defects, Congenital; Humans; In Situ Hybridization, Fluorescence; Infant; Learning Disabilities; Male; Nose; Otitis Media; Otorhinolaryngologic Diseases; Retrospective Studies; Speech Disorders; Syndrome; Velopharyngeal Insufficiency

Topics: Adult; Amyloidosis; Biopsy; Ear Canal; Epistaxis; Female; Humans; Larynx; Male; Middle Aged; Nasopharynx; Nose; Otitis Media; Otorhinolaryngologic Diseases; Tomography, X-Ray Computed

The incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections after middle ear surgery has recently increased at our hospital. Most of these infections were thought to be hospital-acquired when medical personnel in contact with an MRSA-infected patient may have inadvertently transmitted the pathogen to other patients. To prevent further transmission it is essential that such sources of MRSA infection and transmission routes be selected out and eradicated. Therefore, it is necessary to determine whether the strains of MRSA isolated from infected patients are identical to those obtained from medical personnel in order to prove a reciprocal transmission of organisms between medical personnel and patients. Surveillance bacterial cultures from the anterior nares and hands of medical personnel working in the Department of Otolaryngology, Korea University Guro Hospital, were performed at two different time points: 6 December 1994 and 17 June 1996. Ribotyping with Southern blot technique was used to compare 12 MRSA strains from medical carriers with 60 strains identified from the otorrhea of MRSA-infected patients undergoing middle ear surgery. As results, six different MRSA strains were identified (types I, II, III, IV, V and VI) from ribotyping with EcoR1. One distinct subtype, type I strain, was the most frequently identified strain in both medical carriers and patients. Results also showed that 6 MRSA isolates from 10 medical carriers and 20 from 30 patients contained type I ribotype at first culture. Two medical carriers' isolates and 13 isolates from 30 patients shared the same type I strain at the second surveillance culture. In all, 41 out of 72 MRSA strains (56.9%) shared an identical ribotype pattern. Postoperative MRSA infection rates after treatment of medical carriers and the application of rigorous preventive procedures decreased from 11.9 to 5.7% after first culture and 9.0 to 7.7% following second cultures. These findings confirm that MRSA transmission can occur between medical personnel and patients and that effective preventive measures can reduce the postoperative infection rate.

Topics: Blotting, Southern; Cross Infection; Ear, Middle; Follow-Up Studies; Hand; Humans; Incidence; Infection Control; Korea; Methicillin Resistance; Molecular Epidemiology; Nose; Otitis Media; RNA, Bacterial; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

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

Topics: Adenoids; Adenovirus Infections, Human; Child, Preschool; Female; Humans; Lymphatic Diseases; Nose; Otitis Media; Suppuration

Topics: Adenoids; Foreign Bodies; Humans; Nasal Obstruction; Nasal Polyps; Nasal Septum; Nose; Nose Neoplasms; Otitis Media; Patient Education as Topic; Rhinitis; Sleep Deprivation; Tooth Abnormalities

Febrile intensive care unit (ICU) patients were evaluated prospectively for sinusitis. Of 598 admissions, 26 patients with transnasal cannulas, ICU stays over 48 hours, and occult fevers were identified. These 26 underwent physical examinations and sinus computed tomographic (CT) scans. Maxillary centeses and cultures were done in patients with CT abnormalities. Patients with positive scans had nasal tubes removed and received decongestants. Scans were abnormal in 19 (73%). All patients with major CT changes had positive maxillary taps. Most infections were polymicrobial; enteric bacilli were common. Fever resolved with nonoperative care in 18 (95%) patients; in only 1 patient was fever primarily from sinusitis. Sinus CT scans are often abnormal in ICU patients with occult fevers and transnasal cannulas. Pneumatic otoscopy can serve as a screening tool. Most patients respond to nonoperative management. Remote infections are often present. Although radiographic nosocomial ICU sinusitis is common, it is seldom the sole source of fever or the proximate cause of significant morbidity.

Topics: Bacterial Infections; Endoscopy; Fever; Humans; Intensive Care Units; Intubation, Gastrointestinal; Intubation, Intratracheal; Maxillary Sinusitis; Nose; Otitis Media; Prospective Studies; Punctures; Sinusitis; Tomography, X-Ray Computed

During a 28-month period, 84 children with acute otitis media were studied by viral and bacterial cultures of middle ear fluid and viral cultures of nasal lavage fluid. Viruses were isolated from the middle ear fluid of 17 (20%) patients. Evidence of viral infection was demonstrated by positive viral cultures of middle ear fluid and/or nasal lavage fluid in 33 (39%) patients. Rhinovirus in one patient and influenza b virus in another were the only pathogens isolated. Influenza virus, enterovirus, and rhinovirus were the most common viruses found in middle ear fluids. Parainfluenza virus, adenovirus, and respiratory syncytial virus were found less often. In 82% of cases, the virus isolated from middle ear fluid was also isolated from nasal lavage fluid, but only 44% of viruses found in nasal lavage fluid were also found in middle ear fluid. Mixed bacterial and combined viral-bacterial infections were common. Only 15% of patients had no pathogen isolated from middle ear fluids. Using tissue culture techniques, we demonstrated that enterovirus and rhinovirus are also common middle ear pathogens. Our data reemphasize the significance of viruses as etiologic agents of acute otitis media and propose several questions regarding the viral-bacterial interactions and the types of viruses involved in the pathogenesis of the disease.

Topics: Acute Disease; Bacteria; Child; Child, Preschool; Ear, Middle; Exudates and Transudates; Female; Humans; Infant; Infant, Newborn; Male; Nose; Otitis Media; Rotavirus; Therapeutic Irrigation; Virus Cultivation; Viruses

Topics: Acute Disease; Adolescent; Adult; Bacteria; Child; Child, Preschool; Female; Humans; Infant; Male; Nose; Otitis Media; Pharynx

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

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

Middle ear fluid (MEF) aspirates and nasal swabs of children with acute otitis media (N = 255, age 2-6 yrs) were cultured by standard bacteriological methods. In addition, counterimmunoelectrophoresis and latex agglutination were applied to detect pneumococcal polysaccharide antigens (Pn-ag) in MEF. When the nasal culture grew Streptococcus pneumoniae (Pn), Pn was also present in 49% (73/148) and Pn-ag in 64% of the MEF cultures. If Haemophilus influenzae (Hi) appeared in the nasal culture. Hi was present in 41% (25/61) of the MEFs. There was a negative correlation between the growth of Pn or Hi in the nasal culture and the presence of other bacteria in the MEF. However, in spite of these correlations the nasal culture was concluded not to be useful in predicting the MEF bacteria.

Topics: Acute Disease; Antigens, Bacterial; Child; Child, Preschool; Counterimmunoelectrophoresis; Haemophilus influenzae; Humans; Nose; Otitis Media; Streptococcus pneumoniae

Chinchillas were colonized intranasally with type 7F Streptococcus pneumoniae, and pneumococcal otitis media developed in greater than 50% of the animals during the first week after negative middle ear pressure (-25 mm Hg) was briefly applied. Twenty-three chinchillas were vaccinated subcutaneously with the capsular polysaccharde of type 7F S. pneumoniae to determine whether vaccination could prevent the development of experimental otitis media. Following vaccination, 14 animals seroconverted with at least a twofold rise in serum antibody concentration; nine animals that were vaccinated did not seroconvert. All of 23 vaccinated animals and 42 of 42 unvaccinated control animals became colonized after intranasal inoculation with pneumococci. Only one (7%) of the vaccinated seroconverting animals developed pneumococcal otitis media, whereas 26 (62%) of the control animals developed middle ear infection with type 7F pneumococci. Four (44%) of nine vaccinated nonseroconverting animals developed pneumococcal otitis media. Protection was associated with high levels of serum antibody prior to intranasal inoculation. Higher antibody levels were found in sterile middle ear effusions than in S. pneumoniae-infected effusions. Vaccination with type 7F pneumococcal capsular polysaccharide significantly reduced the incidence of pneumococcal otitis media following intranasal inoculation of type 7F S. pneumoniae in chinchillas.

Topics: Animals; Antibodies, Bacterial; Bacterial Vaccines; Barotrauma; Chinchilla; Ear, Middle; Nose; Otitis Media; Polysaccharides, Bacterial; Streptococcus pneumoniae

Topics: Child; Dust; Humans; Hypersensitivity; Mouth Breathing; Nose; Occupational Diseases; Otitis Media; Snoring

Topics: Adolescent; Adult; Airway Obstruction; Child; Child, Preschool; Constriction, Pathologic; Down Syndrome; Eustachian Tube; Humans; Nose; Otitis Media; Respiratory Tract Infections

In the second article on pediatric otolaryngology, speed of diagnosis is stressed as vital to prevent permanent aftereffects such as deafness or facial paralysis. Aggressive education of parents in preventing emergencies is recommended.

Topics: Acids; Child; Ear; Emergencies; Esophagus; Facial Bones; Facial Injuries; Foreign Bodies; Fractures, Bone; Humans; Larynx; Lye; Nasopharynx; Nose; Otitis Media; Otorhinolaryngologic Diseases; Respiratory System; Temporal Bone

In an attempt to determine the effect of an upper respiratory tract infection on the ventilatory function of the Eustachian tube, 20 children who had recurrent acute or chronic middle ear effusions were studied. Baseline Eustachian tube function testing was obtained when there were no signs or symptoms of upper respiratory infection. These tests were repeated at six-week intervals and whenever an upper respiratory tract infection supervened.

Topics: Adolescent; Child; Deglutition; Eustachian Tube; Female; Humans; Male; Nose; Otitis Media; Pressure; Recurrence; Respiratory Tract Infections

Topics: Adolescent; Adult; Aged; Child; Eustachian Tube; Female; Humans; Male; Middle Aged; Nose; Otitis Media; Respiration; Ventilation-Perfusion Ratio

Topics: Female; Haemophilus influenzae; Humans; Male; Norway; Nose; Otitis Media; Pharynx; Respiratory Tract Infections; Sinusitis; Streptococcus; Streptococcus pyogenes; Students; Time Factors

Topics: Asthma; Cartilage; Child; Child, Preschool; Chronic Disease; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Male; Nasal Septum; Nose; Nose Deformities, Acquired; Otitis Media; Postoperative Complications; Pulmonary Ventilation; Respiratory Insufficiency; Rhinitis, Allergic, Seasonal; Rhinoplasty; Speech Disorders; Time Factors; Tonsillitis

Topics: Child; Ear; Ear Diseases; Humans; Lymphatic Diseases; Male; Nose; Nose Diseases; Otitis Media; Pharyngeal Diseases; Pharynx

Topics: Acute Disease; Adolescent; Antibodies; Audiometry; Bacteria; Bacterial Infections; Child; Child, Preschool; Drainage; Ear, Middle; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Methods; Nasal Decongestants; Nose; Otitis Media; Penicillins; Rupture, Spontaneous; Streptococcus pneumoniae; Tympanic Membrane

Topics: Animals; Eye; Nose; Otitis Media; Pasteurella; Pasteurella Infections; Rabbits; Time Factors

Topics: Adolescent; Adult; Aerobiosis; Anaerobiosis; Bacteria; Child; Cleft Palate; Humans; Mouth; Nose; Otitis Media; Pharynx; Respiratory Tract Infections; Speech

Topics: Abducens Nerve; Child, Preschool; Congenital Abnormalities; Female; Humans; Nasopharynx; Nose; Ophthalmoplegia; Otitis Media; Paralysis; Postoperative Complications

Topics: Adolescent; Adult; Delayed-Action Preparations; Female; Fracture Fixation; Humans; Male; Middle Aged; Nose; Otitis Media; Otorhinolaryngologic Diseases; Postoperative Complications; Rhinoplasty; Sinusitis; Sulfamoxole; Tonsillectomy; Tonsillitis

Topics: Adenoidectomy; Adenoids; Audiometry; British Columbia; Child; Deafness; Eosinophilia; Health Surveys; Humans; Hypertrophy; Nose; Otitis Media; Respiratory Hypersensitivity; Respiratory Tract Infections; Sampling Studies; Tonsillitis

Topics: Adaptation, Biological; Birth Injuries; Brain Injuries; Extraembryonic Membranes; Female; Fetal Death; Fetus; Hearing Disorders; Humans; Infant, Newborn; Infant, Premature, Diseases; Labor, Obstetric; Nose; Otitis Media; Pregnancy; Respiration; Respiratory Distress Syndrome, Newborn; Respiratory Tract Infections

Topics: Acrylates; Facial Muscles; Facial Nerve; Facial Paralysis; Fracture Fixation; Frontal Sinus; Humans; Mastoiditis; Maxillary Fractures; Methods; Nose; Otitis Media; Prostheses and Implants; Skull Fractures; Transplantation, Autologous

Topics: Abnormalities, Drug-Induced; Child; Cleft Palate; Congenital Abnormalities; Female; Goiter; Hearing Disorders; Hearing Tests; Humans; Hyperbilirubinemia, Hereditary; Infant; Infant, Newborn; Iris; Kernicterus; Lacrimal Apparatus; Mandibulofacial Dysostosis; Measles; Meningoencephalitis; Mumps; Nose; Nose Deformities, Acquired; Osteogenesis Imperfecta; Otitis Media; Pierre Robin Syndrome; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Rubella; School Health Services; Toxicology; Waardenburg Syndrome

Topics: Adult; Genetics, Medical; Humans; Male; Mastoid; Mucous Membrane; Nose; Otitis Media; Paranasal Sinuses; Periapical Granuloma; Radiography, Dental; Tympanoplasty

Topics: Ear Deformities, Acquired; Ear, External; Epistaxis; Granulomatosis with Polyangiitis; Hoarseness; Humans; Nose; Nose Deformities, Acquired; Otitis Media; Otolaryngology; Polyarteritis Nodosa

Topics: Cartilage; Cervical Vertebrae; Cornea; Dermatology; Ear, External; Embolism; Embolism, Air; Head; Hemorrhage; Humans; Lymphedema; Neck; Neck Dissection; Nose; Otitis Media; Paralysis; Parotid Gland; Postoperative Complications; Respiratory Insufficiency; Salivary Gland Fistula; Spinal Injuries; Surgical Procedures, Operative; Thoracic Duct; Tooth

Topics: Child; Congenital Abnormalities; Family Practice; Flatulence; General Practice; Humans; Infant; Infant Care; Infant, Newborn; Infant, Newborn, Diseases; Nose; Otitis Media; Pediatrics; Respiratory Insufficiency; Skull; Spasm; Stomatitis; Tongue; Tooth, Deciduous

Topics: Child; Chloramphenicol; Drug Therapy; Humans; Infant; Intestinal Obstruction; Intubation, Gastrointestinal; New York; Nose; Otitis Media; Penicillin G; Penicillin G Procaine; Procaine; Statistics as Topic

Topics: Emergencies; Epistaxis; Humans; Labyrinth Diseases; Mastoiditis; Nose; Otitis Media; Otolaryngology; Respiratory Tract Diseases; Surgical Procedures, Operative; Vitamins

Topics: Child; Humans; Infant; Nose; Otitis Media; Sympathomimetics

Topics: Bacteria; Ear; Humans; Nose; Otitis Media; Respiratory System

Topics: Child; Humans; Infant; Nose; Otitis Media; Rhinitis

Topics: Chronic Disease; Humans; Nose; Otitis Media; Sinusitis

Topics: Child; Disease; Ear, Middle; Humans; Infant; Malnutrition; Nasal Cavity; Nose; Nose Diseases; Otitis Media; Paranasal Sinus Diseases

Topics: Adenoids; Disease; Humans; Nose; Otitis Media; Pharyngeal Diseases; Pharynx; Sinusitis

Topics: Humans; Nose; Otitis Media; Penicillins; Scarlet Fever; Sinusitis

Topics: Eustachian Tube; Nose; Otitis Media; Radium