http://www.ncbi.nlm.nih.gov/pubmed/9863390 Srp Arh Celok Lek 1998 Jul-Aug;126(7-8):242-7 Clinical importance of tympanometry in the diagnosis of chronic secretory otitis [Article in Serbian] Spremo S, Markić Z, Kurbalija Source: Department of Otorhinolaryngology, Clinical Centre, Banja Luka Abstract Secretory kích thích, tiết otitis media is defined as a fluid in the middle ear without signs or symptoms of infection As the aetiology and pathogenesis of the disease are unknown, and as it affects children aged from to 12 years, treatment procedures proposed đề nghị, đề xuất, đưa for management of secretory otitis media, are not uniform Some authors [1, 4, 6] consider that functional or mechanical obstructions of the Eustachian tube could provoke - khích, xúi giục, kích động - khiêu khích, trêu chọc, chọc tức- kích thích, khêu gợi, gây secretory otitis The purpose of the treatment is to remove exudate from the middle ear and appropriately ventilate it for a longer period That could instantly normalize the hearing and exclude the appearance of late complications of secretory otitis Although the disease could heal spontaneously, the treatment should be performed immediately for preventing sequelae - (y học) di chứng, di tật of secretory otitis The aim of the study was to evaluate possible aetiologic factors of secretory otitis in our population, and to evaluate results of tympanometry in children with exudate in the middle ear There were 65 children, aged from to 12 years (Table 1), who complained of deafness and were examined at the ORL Department in Banja Luka The clinical examination revealed the integrity - tính trực, tính liêm - tính tồn bộ, tính tồn vẹn, tính ngun; tình trạng khơng bị sứt mẻ, tình trạng tồn vẹn, tình trạng ngun vẹn and color of tympanic membrane, scars, adhesions - dính chặt vào, bám chặt vào - tham gia, gia nhập (một đảng phái) - trung thành với; giữ vững (ý kiến lập trường ) - tán đồng, đồng ý and atrophic areas Audiometry and tympanometry had been performed in addition Patients who proved to have exudate in the middle ear received nasal decongestants and mucolitics during three months, and were evaluated every three weeks by audiometry and tympanometry Pathologic findings in the nose and epipharynx were the most common findings: enlarged adenoids in 38 (58%) patients, hypetrophic rhinitis in 15 (23%) and allergic rhinitis in (8%) patients Frequent relapses - trở lại, lại rơi vào (một tình trạng đó)- phạm lại- (y học) phát lại; phải lại (bệnh gì) of middle ear infection in the first three years of life were found in 26 (40%) patients and early first attacks in the first year of life in 15 (23%) patients (Table 2) Premature onset (15%) and allergy (21%) had also been frequently found Results of tympanometry and audiometry are shown in Table Exudate in the middle ear and type B tympanogram were found in 86 ears, while in other patients dysfunction of the Eustachian tube and type C1 and C2 tympanograms were found After weeks the exudate disappeared in 16 ears and tympanogram converted in type A and type C2, while the initially found C1 tympanogram was transformed in type A in of 13 ears After 12 weeks the tympanogram type B was found in 46 ears, while in 40 ears (47%) the tympanogram was changed in type A and type C2 After and 12 weeks of therapy tympanometric types were statistically examined by chi test We have found a significant difference in tympanometric types and prevalence of type A and C1 tympanograms Paracentesis and insertion of ventilating tubes were done in 46 ears with the remaining exudate We have found mucous exudate in 35 (76%) ears associated with retraction and scars of tympanic membrane (Table 4), what indicated that the longer duration of mucous exudate caused degenerative changes in the middle ear Serous exudate, found in ears (24%), did not affect the color and integrity of the tympanic membrane Sensitivity of tympanometry in detection of exudate in the middle ear was 96% Secretory otitis media is a frequent disease in childhood, that could cause functional and morphological sequelae in the middle ear As for now, there is no unique concept khái niệm, quan niệm of diagnosis and treatment of the disease, and it is still a current problem We suggest a three-month evaluation of tympanometric and audiometric patterns, repeated every three weeks, in children suspected of having exudate in the middle ear There is a large trend - phương hướng-khuynh hướng, xu hướng, chiều hướng of spontaneous disappearance of exudate in the middle ear and changing of tympanogram type Such children should be evaluated over the period of one year, and if there is no relapse additional treatment should not be carried out If exudate in the middle ear persists for three months and type of the tympanogram is unchanged, myringotomy and insert PMID:9863390[PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/8179272 Ann Otol Rhinol Laryngol Suppl 1994 May;163:54-8 Adenoidectomy for otitis media with effusion Gates GA.SourceVirginia Merrill Bloedel Hearing Research Center, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle 98195 Abstract The efficacy of adenoidectomy in the surgical treatment of children with otitis media with effusion (OME) persisting after adequate medical therapy has been established in three independent randomized clinical trials Although each of these studies used a different experimental design, all showed significant reductions in morbidity from OME after adenoidectomy as compared to the control groups Subsequent application of these findings in formulating clinical guidelines for the use of adenoidectomy has yet to be realized, and recommendations to parents for or against the procedure appear to vary more with the surgeon's philosophy than with the condition of the child This discussion examines the effectiveness and cost of adenoidectomy for the treatment of children with chronic OME and addresses the question of whether adenoidectomy should be used as a primary or a secondary surgical therapy The argument lý lẽ tranh cãi, tranh luận is made to use adenoidectomy as a primary therapy in selected cases on the basis of patient age, type of OME, and patient preference, and to base the decision not on the size of the adenoid, but on its known pathophysiology PMID:8179272[PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/20091650 Cochrane Database Syst Rev 2010 Jan 20;(1):CD007810 doi: 10.1002/14651858.CD007810.pub2 Adenoidectomy for otitis media in children van den Aardweg MT, Schilder AG, Herkert E, Boonacker CW, Rovers MM Source Department of Otorhinolaryngology, University Medical Center Utrecht, Wilhelmina Children's Hospital, HP: KE.04.140.5, PO Box 85090, Utrecht, Netherlands, 3508 AB Abstract BACKGROUND: Adenoidectomy, surgical removal of the adenoids, is a common ENT operation worldwide in children with otitis media A systematic review on the effectiveness of adenoidectomy in this specific group has not previously been performed OBJECTIVES: To assess the effectiveness of adenoidectomy versus non-surgical management or tympanostomy tubes in children with otitis media SEARCH STRATEGY: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials The date of the most recent search was 30 March 2009 SELECTION CRITERIA: Randomised controlled trials comparing adenoidectomy, with or without tympanostomy tubes, versus non-surgical management or tympanostomy tubes only in children with otitis media The primary outcome studied was the proportion of time with otitis media with effusion (OME) Secondary outcomes were mean number of episodes, mean number of days per episode and per year, and proportion of children with either acute otitis media (AOM) or otitis media with effusion (OME), as well as mean hearing level Tertiary outcome measures included atrophy of the tympanic membrane, tympanosclerosis, retraction of the pars tensa and pars flaccid and cholesteatoma DATA COLLECTION AND ANALYSIS: Two authors assessed trial quality and extracted data independently MAIN RESULTS: Fourteen randomised controlled trials (2712 children) studying the effectiveness of adenoidectomy in children with otitis media were evaluated Most of these trials were too heterogeneous hỗn tạp, khác thể, không đồng to pool in a meta-analysis Loss to follow up varied from 0% to 63% after two years.Adenoidectomy in combination with a unilateral tympanostomy tube has a beneficial effect on the resolution of OME (risk difference (RD) 22% (95% CI 12% to 32%) and 29% (95% CI 19% to 39%) for the non-operated ear at six and 12 months, respectively (n = trials)) and a very small (< dB) effect on hearing, compared to a unilateral tympanostomy tube only The results of studies of adenoidectomy with or without myringotomy versus chống, chống lại, đấu với non-surgical treatment or myringotomy only, and those of adenoidectomy in combination with bilateral tympanostomy tubes versus bilateral tympanostomy tubes only, also showed a small beneficial effect of adenoidectomy on the resolution of the effusion The latter results could not be pooled due to large heterogeneity of the trials.Regarding AOM, the results of none of the trials including this outcome indicate (y học) cần phải, đòi hỏi phải chỉ, cho biết, dấu tỏ ra, ý, ngụ ý, biểu lộ, biểu thị a significant beneficial effect of adenoidectomy The trials were too heterogeneous to pool in a metaanalysis.The effects of adenoidectomy on changes of the tympanic membrane or cholesteatoma have not been studied AUTHORS' CONCLUSIONS: Our review shows a significant benefit of adenoidectomy as far as the resolution - (y học) tiêu độc, tiêu tan of middle ear effusion in children with OME is concerned có liên quan; có dính líu However, the benefit to hearing is small and the effects on changes in the tympanic membrane are unknown The risks of operating should be weighed against these potential benefits.The absence of a significant benefit of adenoidectomy on AOM suggests that routine - lề thói ngày; cơng việc thường làm ngày - thủ tục; lệ thường surgery for this indication is not warranted đảm bảo, chứng thực http://www.labome.org/grant/r01/dc/adenoidectomy/for/adenoidectomy-for-otitis-media-in-2-3-yearold-children-6350559.html Summary Principal Investigator: Margaretha Casselbrant Affiliation: Children's Hospital of Pittsburgh Country: USA Abstract: DESCRIPTION: Efficacy of adenoidectomy for the treatment and prevention of otitis media with effusion has been shown for children four years and older In their "Clinical Practice Guidelines, Otitis Media with Effusion in Young Children", the Agency for Health Care Policy and Research of the U.S Department of Health and Human Services concluded that "Adenoidectomy is not recommended for treatment of OME in a child age through years in the absence of specific adenoid pathology" This conclusion was based on the Panel's finding no clinical trials to support any judgement as to the efficacy of adenoidectomy in the primary management of otitis media with effusion in very young children, coupled with the risk of postoperative bleeding By means of a well designed large-scale randomized controlled trial, the efficacy of adenoidectomy and myringotomy with and without tympanotomy tube insertion will be compared with that of myringotomy and tympanotomy alone in reducing the morbidity of bilateral otitis media with effusion of at least months's duration associated with hearing loss (>20 dB) in children ages and years The primary outcome measure will be percentage of time with middle ear effusion Rates of episodes of acute otitis media, otorrhea, and otitis media with effusion, time to first recurrence, number of surgical procedures, treatment failures, hearing status, and other sequelae and complications will be recorded and compared among the three treatment groups We estimate that 63 evaluable subjects need to be entered in each treatment arm to have a 90 percent power of detecting a benefit of at least 0.30 in percentage of time with middle ear effusion The outcome of this trial should resolve the question of efficacy of adenoidectomy for otitis media with effusion in this age group http://www.labome.org/grant/r01/dc/pathogenesis/of/pathogenesis-of-otitis-media-with-effusion7796813.html Summary Principal Investigator: PATRICIA HEBDA Affiliation: University of Pittsburgh Country: USA Abstract: Otitis media (OM) is a common disease of the pediatric age group considered to be multifactorial in etiology While most cases of symptomatic OM with acute onset resolve within one month of presentation, a significant percentage persists for months to years as OM with effusion (OME), and many children present with OME evidenced by middle ear (ME) mucosal inflammation and effusion without recent signs and symptoms OME is a persistent inflammation that most often fails to respond to conventional quy ước - theo tập quán, theo tục lệ- thường medical therapies Recent studies conducted by us show that hydrops ex vacuo is a valid explanation for the development and persistence of OME under certain conditions Disrupting - đập gãy, đập vỗ, phá vỡ Eustachian tube (ET) function in animals causes middle ear (ME) pressure dysregulation reflected as underpressures, which in turn causes increased permeability of the mucosal vasculature and results in ME effusion However, the mechanism(s) responsible for transducing truyền chất, tính trạng the biological signals associated with the underpressure that result in ME mucosal inflammation are not known We hypothesize that transduction of the signal associated with middle ear underpressure initiates and sustains an inflammatory process that contributes to persistence of OME and to adverse changes in ME physiology Three Specific Aims are proposed - đề nghị, đề xuất, đưa lấy làm mục đích; đặt ra, đề (làm mục đích) - tiến cử, đề cử to test this hypothesis: 1) To determine the role of inflammatory signaling in the production and persistence of ME effusion after ET obstruction, 2) To utilize tissue culture model systems for the elucidation of specific cellular mechanisms involved in disease pathogenesis, and 3) To use biochemical, pharmacologic and genetic manipulation to assess the role of key inflammatory mediators and pathways in provoking or sustaining the mucosal changes induced in the animal OME model systems To achieve these aims, experiments are proposed using rodent models of OME and tissue cultures of ME epithelial cells and fibroblasts already established by the investigators With these studies the investigators hope to elucidate the role of specific inflammatory signals and pathways in promoting disease persistence, and thus to identify potential targets for future therapeutic interventions http://www.ncbi.nlm.nih.gov/pubmed/20152070 Int J Immunopathol Pharmacol 2010 Jan-Mar;23(1 Suppl):4-7 Functional anatomy of the Eustachian tube Cunsolo E, Marchioni D, Leo G, Incorvaia C, Presutti L Source: Otolaryngology Department, University Hospital, Modena, Italy elio.cunsolo@gmail.com Abstract The Eustachian tube (ET) is divided in portions: a bony portion, a cartilaginous portion, and a junctional portion From an anatomical-functional point of view, the bony portion of ET is the region of ventilation and clearance of secretions, and is lined by pseudostratified, ciliated, columnar epithelium, with an anti-gravitational hút, hấp dẫn direction of the drainage The ET in the bony portion is in a state of forced opening The cartilaginous portion is instead để thay vào, để cho; the heart of this dynamic system tube, because the mechanism of opening and closing of the tube is at this level ET is normally closed, and it opens only during swallowing, being essential for good functioning of the middle ear, because it provides ventilation from the nasopharynx to the middle ear, and, at the same time, clearance of secretions from the middle ear-mastoid unit to the nasopharynx Moreover, the ET protects the middle ear against nasopharyngeal pressure variations , ascending secretions, and microorganisms The ability to develop all these functions makes the tube a complex organ ... now, there is no unique concept khái niệm, quan niệm of diagnosis and treatment of the disease, and it is still a current problem We suggest a three-month evaluation of tympanometric and audiometric... children with otitis media were evaluated Most of these trials were too heterogeneous hỗn tạp, khác thể, không đồng to pool in a meta-analysis Loss to follow up varied from 0% to 63% after two... resolution - (y học) tiêu độc, tiêu tan of middle ear effusion in children with OME is concerned có liên quan; có dính líu However, the benefit to hearing is small and the effects on changes in the