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http://www.ncbi.nlm.nih.gov/pubmed/23032917 Otolaryngol Head Neck Surg 2013 Jan;148(1):135-9 doi: 10.1177/0194599812462664 Epub 2012 Oct Adenoid ciliostimulation in children with chronic otitis media Andreoli SM, Schlosser RJ, Wang LF, Mulligan RM, Discolo CM, White DR Source Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29403, USA andreoli@musc.edu Abstract OBJECTIVE: Adenoid hypertrophy and chronic adenoiditis are associated with an increased incidence of chronic otitis media This study intends to determine the relationship between chronic otitis media and dynamic ciliary beat frequency in children undergoing adenoidectomy STUDY DESIGN: Prospective, controlled study SETTING: Pediatric tertiary care hospital SUBJECTS AND METHODS: Children undergoing adenoidectomy were enrolled Patients were stratified according to their indication for surgery, including adenotonsillar hypertrophy with obstructive sleep apnea, chronic otitis media with effusion, or recurrent episodes of acute otitis media Adenoids were harvested using the curette Tissue was sectioned and allowed to equilibrate in basal media for 24 hours Cilia-bearing tissue was then stimulated using isoproterenol or methacholine Ciliary beat frequency was serially reordered and analyzed using the SissonAmmons Video Analysis software program RESULTS: Baseline ciliary beat frequency was similar in all groups (N = 47, total) Using isoproterenol, children with chronic otitis media with effusion demonstrated a blunted dynamic ciliary response at and hours relative to control (P = 0176 and P = 0282) Methacholine-stimulated ciliary beat frequency was not different between each group CONCLUSION: At and hours following isoproterenol stimulation, there was a significant blunting of dynamic ciliary beat frequency in children with chronic otitis media with effusion This ciliary dysfunction may provide a physiological explanation related to chronic adenoiditis in children with chronic otitis media http://www.ncbi.nlm.nih.gov/pubmed/1728896 Adenoidectomy and otitis media Gates GA, Muntz HR, Gaylis B Source Department of Otolaryngology, Washington University School of Medicine, St Louis, Missouri 63110 Abstract Adenoid enlargement has traditionally been considered a factor in otitis media; adenoid size, however, does not appear to be correlated with otitis media occurrence Presence of pathogenic bacteria in the adenoids of children with otitis media has been shown, and adenoidectomy appears to affect the middle ear primarily by removal of the source of infection in the nasopharynx Three recent randomized, controlled studies showed the efficacy of adenoidectomy in the treatment of chronic secretory otitis media In one study comparing no treatment, adenoidectomy, and adenotonsillectomy, a significant benefit was seen with adenoidectomy that was not enhanced by tonsillectomy Another study that compared adenoidectomy, tympanostomy tubes, and a combination of the two showed a significant reduction in effusion time and less surgical retreatment over years in the two adenoidectomy groups The third study demonstrated the effect of adenoidectomy in children with recurrent chronic otitis media with effusion after failure of tympanostomy tube insertion All three studies showed that the effect of adenoidectomy was independent of adenoid size This review discusses current concepts of adenoid physiology and pathology, the major adenoidectomy studies, and indications for the procedure http://www.ncbi.nlm.nih.gov/pubmed/16089237 J Otolaryngol 2005 Jun;34 Suppl 1:S24-32 Otitis media and the new guidelines Kenna MA Source Department of Otolaryngology and Communication Disorders, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA margaret.kenna@childrens.haward.edu Abstract Otitis media, including recurrent acute otitis media (AOM) and otitis media with effusion (OME), is one of the most common reasons for an illness-related visit to the primary care clinician Until recently, antibacterial therapy was the standard treatment for most episodes of AOM and often for OME However, in 1994, a clinical practice guideline on OME was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality) and applied to normal children aged to years The recommendations in the 1994 guideline were evidence based, widely discussed, and somewhat controversial but also acted as a starting point for some ideas about standardization of management of this very common disease In 2004, revised clinical practice guidelines were published for OME that applied to children aged months to 12 years and included children with developmental disabilities and underlying conditions that predispose them to OME In addition, a new evidence-based clinical practice guideline for AOM was published in 2004 This guideline recognized that many episodes of AOM will resolve on their own without antimicrobial therapy, and on that basis, one of the recommendations for initial treatment of AOM in specified situations was watchful waiting without antibacterial therapy This article briefly discusses the current knowledge about AOM and OME and then addresses the new AOM and OME guidelines point by point It is important to remember that although important, these clinical practice guidelines are just guidelines and that actual management of the patient with otitis media depends on clinical judgement, the severity of the illness, other underlying medical conditions, ready access to adequate follow-up care, and other features, such as cultural differences Surgical recommendations were not included in the AOM guidelines but were addressed in the OME guidelines Further information about the efficacy and effectiveness of both sets of guidelines will likely include the results of prospective studies using the guidelines in both normal children and those with underlying medical conditions http://www.ncbi.nlm.nih.gov/pubmed/21865719 Adv Otorhinolaryngol 2011;72:160-3 doi: 10.1159/000324781 Epub 2011 Aug 18 Otitis media and tonsils role of adenoidectomy in the treatment of chronic otitis media with effusion Park K Source Department of Otolaryngology, Ajou University School of Medicine, Suwon, South Korea parkkh@ajou.ac.kr Abstract Innate immunity involves the first line of the mucosal defense system Homeostatic defense of the middle ear and Eustachian tube is maintained in part by molecules related to the innate immunity The middle ear and tonsils are the organs related to the innate immunity Recent attention has focused on the possibility that chronic otitis media and adenotonsillitis may represent a chronic infective state such as evidenced in conditions secondary to biofilms or small colony variants The role of biofilms in the persistence of chronic mucosalbased ENT-related infections was first recognized in otitis media and adenotonsillitis The efficacy of adenotonsillectomy on otitis media with effusion (OME) has been demonstrated by several randomized and controlled studies It was speculated that tonsil and adenoid may play a role as an infectious focus to OME In summary, patients suffering from recurrent or chronic OME may benefit from adenoidectomy due to the removal of an infectious source in the nasopharynx rather than the removal of a large adenoidal mass http://www.ncbi.nlm.nih.gov/pubmed/22032778 Int J Immunopathol Pharmacol 2011 Oct;24(4 Suppl):1-5 Adenoids during childhood: the facts Marseglia GL, Caimmi D, Pagella F, Matti E, Labó E, Licari A, Salpietro A, Pelizzo G, Castellazzi AM Source Department of Pediatrics, University of Pavia - Foundation IRCCS Policlinico San Matteo, Italy gl marseglia@smatteo.pv.it Abstract Adenoids are constantly exposed to viral and bacterial agents as well as to allergens They play a major role in the upper airways immunity, being effector organs in both mucosal-type and systemic-type adaptive immunity Because of both their immunological function and their specific location, adenoids are considered to be as reservoirs of viruses and bacteria Reiterative infections may therefore contribute both to Eustachian tube dysfunction and to tissue hypertrophy Nasal endoscopy is a key diagnostic tool to detect both adenoid hypertrophy and adenoiditis Moreover, such a procedure may be very helpful in detecting bacterial biofilms that could justify the concomitant presence of recurrent episodes of otitis media, chronic and occult sinusitis in children Even though the connection between allergies and adenoidal diseases is not completely clear, allergic diseases cause an inflammatory state that influences adenoidal tissue as well, configuring the picture of allergic adenoiditis, a condition in which adenoid tissue exhibit numerous IgE positive mast cells Several studies are still needed to better understand the relationship between allergies and infections and the influence they play on adenoids during childhood http://www.ncbi.nlm.nih.gov/pubmed/7665305 Int J Pediatr Otorhinolaryngol 1995 Jun;32 Suppl:S71-80 The adenoid as a key factor in upper airway infections van Cauwenberge PB, Bellussi L, Maw AR, Paradise JL, Solow B Source Department of Otorhinolaryngology, University Hospital, Ghent, Belgium Abstract The adenoids (and the nasopharynx) play a key role in the normal functioning and in various pathologies of the upper respiratory tract In this paper the role of adenoidal pathology and the beneficial effect of adenoidectomy in some upper respiratory tract and facial anomalies and diseases are discussed; otitis media with effusion, recurrent acute otitis media, sinusitis, snoring and sleep apnea and abnormal patterns in the midface growth and development http://www.ncbi.nlm.nih.gov/pubmed/16240917 Acta Otorrinolaringol Esp 2005 Aug-Sep;56(7):290-4 [Otitis medias with effusion: association with the Eustachian tube dysfunction and adenoiditis The case of the Central Hospital of Maputo] [Article in Spanish] da Costa JL, Navarro A, Branco Neves J, Martin M Source Instituto Superior de Ciờncias e Tecnologia de Moỗambique (ISCTEM) Abstract INTRODUCTION: Although the aetiology of otitis media is known to be multifactorial, adenoids infections and Eustachian tube dysfunction, have been frequently associated with the incidence of middle-ear effusion Middle-ear effusion cases are frequent in Maputo, Mozambique, and very often insertion of tympanostomy tubes and adenoidectomy alone or with amigdalectomy have been used to treat these cases and to prevent further episodes The objective of this study is to describe the association of these factors with otitis medias with effusion in patients that visit the Otorrinolaringology department (ENT) at the Central Hospital of Maputo (HCM), as well as to describe the clinical and epidemiological profile of these patients PATIENTS AND METHODS: A cross sectional study was conducted 4157 clinical files of all patients who made their first visit to the ENT department at the HCM, with otitis media during a period of years (1995 to 1998) RESULTS: 23.3% of patients who visited the ORL service of Maputo with otitis media, are children under years; the major proportion of otitis media with effusion was observed in children aged from to years old (49.2%) In boys under, otitis media with effusion is strongly associated with the history of adenoiditis and/or Eustachian tube dysfunction (OR=9.53) and in older patients (OR=12.26) CONCLUSION: The proportion of otitis media with effusion increases more evidently in patients with disfuntion tube syndrome Other factor that can be important in patients under seven, is the presence of adenoiditis http://www.ncbi.nlm.nih.gov/pubmed/9042072 J Allergy Clin Immunol 1997 Feb;99(2):S787-97 Otitis media and eustachian tube dysfunction: connection to allergic rhinitis Fireman P Source Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, PA 15213, USA Abstract Otitis media and otitis media with effusion are among the most common childhood illnesses and contribute a great deal to health care costs The cause of otitis media is multifactorial Eustachian tube dysfunction, bacterial or viral infection of the middle ear, and nasal inflammation resulting from allergic rhinitis or upper respiratory infection are acknowledged contributing factors Data from epidemiology studies indicate that 25% to 40% of upper respiratory infections in children younger than years are accompanied by an episode of otitis media, 40% to 50% of children older than years with chronic otitis media have confirmed allergic rhinitis Studies of the pathogenesis of otitis media have identified interactions among infection, allergic reactions, and eustachian tube dysfunction Nasal inflammation due to allergen challenge results in classic signs and symptoms of allergic rhinitis and eustachian tube dysfunction Eustachian tube dysfunction leads to increased negative pressure in the middle ear and improper ventilation Both viral upper respiratory infection and nasal allergic reaction provoke nasal inflammation, eustachian tube dysfunction, and enhanced nasal protein transudation and secretion, which is likely to be sustained and modulated by inflammatory mediators and cytokines In a study of experimental infection with influenza A virus, histamine release increased from peripheral blood basophils of patients with allergic rhinitis These data support an interaction between viral infection and nasal allergy in enhancing certain pathophysiologic responses Viral upper respiratory infections may promote secondary bacterial infections by altering bacterial adherence, modulating host immune and inflammatory responses, and impairing eustachian tube function In acute otitis media, bacteria are cultured front approximately 70% of middle ear effusions with Streptococcus pneumoniae being the most common organism Initial management of otitis media consists of appropriate antimicrobial therapy In the presence of allergic rhinitis, antiallergic therapies may be used to augment symptom resolution and therapeutic response Surgical insertion of tympanostomy or ventilation tubes to promote drainage of unresolved effusions has become common Further delineation of the pathogenesis of otitis media and otitis media with effusion will guide appropriate medical management and may decrease the need and frequency of surgical procedures ... recurrent or chronic OME may benefit from adenoidectomy due to the removal of an infectious source in the nasopharynx rather than the removal of a large adenoidal mass http://www.ncbi.nlm.nih.gov/pubmed/22032778... a chronic infective state such as evidenced in conditions secondary to biofilms or small colony variants The role of biofilms in the persistence of chronic mucosalbased ENT-related infections... otitis media has been shown, and adenoidectomy appears to affect the middle ear primarily by removal of the source of infection in the nasopharynx Three recent randomized, controlled studies showed
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