panel recommended the use of pneumatic otoscopy as the primary diagnostic method with tympanom- etry as a confirmatory diagnostic method. These rec- ommendations were based on limited scientific evi- dence and strong panel consensus and on limited scientific evidence and expert opinion, respectively. The OME guideline panel found no evidence linking the outcome of algorithms that combine the results of pneumatic otoscopy and tympanometry to the pres- ence of middleeareffusion. In addition, the panel believed that the evidence was insufficient to make any recommendation regarding the use of acoustic reflectometry in the diagnosis of OME. Finally, the panel decided not to make a recommendation on the use of tuning fork tests in the diagnosis of OME because of the lack of adequate studies. The OME guideline panel did not present any meta-analyses on diagnostic methods.
In the present study grade of adenoid hypertrophy has been assessed in all the 30 patients with chronic middleeareffusion and it has been found that all the patients had equal to or greater than grade 2 adenoid hypertrophy and majority of the patients (11 patients) had grade 3 adenoid hypertrophy, 10 patients had grade 3 adenoid hypertrophy and 9 patients had grade 4 adenoid hypertrophy. In the study group 13 out of 32 had grade 4 adenoid hypertrophy. This grade 4 adenoid hypertrophy was found to be statistically significant in children with otitis media with effusion (p<0.0002). In control group 15 out of 28 had grade 1 adenoid hypertrophy which was significant in the same group (p<0.002). Air-bone gap and thickness of fluid did not correlate with the increasing grade of adenoid hypertrophy. Conclusion of this study was like, Grade 4 adenoid hypertrophy was statistically found to be significant with otitis media with effusion but severity of hypertrophy were not reflected by hearing loss and thickness of fluid.
Chronic middleeareffusion, a term synonymous with otitis media with effusion, secretory otitis media, serous otitis media and glue ear is one of the chronic otological conditions of childhood. The pathology of condition is alteration of mucociliary system in the middleear cleft usually caused by malfunction of the Eustachian tube. Eustachian tube dysfunction leads to negative pressure inside middleear causing accumulation of serous or mucoid fluid within the tympanic cavity. 8
Middleeareffusion (MEE), an inflammation of the mid- dle ear accompanied by effusion or a collection of liquid in the middleear, is one of the most commonly diag- nosed illnesses among young children. Estimates of MEE incidence rates in the United States range from 49% to 97% during the first year of life . Incidence peaks be- tween 6 and 18 months with a steady decline until around 5 years, when there is a second smaller peak [1,2]. Al- most one-third of all children suffer with chronic MEE and it is estimated that some spend an average of 38% to 70% of their first 3 years with MEE . Most children with MEE have an average hearing loss of 20 to 30 dB  during an episode. The conductive hearing loss associ- ated with MEE causes sounds to be muffled and dis- torted.
Incidence and management of middle ear effusion in cleft palate patients Med J Malaysia Vol 47 No 1 March 1992 Incidence and management of middle ear effusion in cleft palate patients s Lokman, FRCS,[.]
ABSTRACT. Objective. To characterize the occur- rence of tube otorrhea after tympanostomy-tube place- ment (TTP) for persistent middle-eareffusion (MEE) in a group of otherwise healthy infants and young children. Methods. In a long-term, prospective study of child development in relation to early-life otitis media, we enrolled by 2 months of age healthy infants who pre- sented for primary care at 1 of 2 urban hospitals or 1 of 2 small-town/rural and 4 suburban private pediatric group practices. We monitored their middle-ear status closely. Children who developed persistent MEE of specified durations within the first 3 years of life became eligible for random assignment to undergo TTP either promptly or after an extended period if MEE persisted. The present report concerns 173 randomly assigned children who un- derwent bilateral TTP between ages 6 and 36 months and were followed for at least 6 months thereafter. Episodes of tube otorrhea were treated with oral antimicrobial drugs and, if persistent, with ototopical medication.
assessments were made independently of tympanomet- ric assessments and by validated otoscopists). A fourth limitation lies in the fact that currently available immit- tance instruments give values for peak height in whole tenths of a milliliter, with intermediate values rounded either up or down, thereby detracting somewhat from precision in generating algorithmic results. A fifth limi- tation lies in the fact that, in categorizing the tympano- metric data shown in Tables 5 and 6, the mathematical demarcations we used are arbitrary and, relatedly, that the estimates assigned to those categories are but esti- mates, not determinations. Finally, one must note that the present population-based findings in children ⬍ 3 years of age cannot properly be extrapolated to children in that age group who are at high risk for middle-ear abnormalities, such as those referred for specialty oto- laryngological or audiological services, nor is it certain how similar the findings would be in otherwise healthy older children.
presence of allergy, blood samples were collected before the insertion of ventilating tube for the Korean panel of the multiple allergosorbent test chemiluminescent assay (MAST-CLA) (MAST Immunosystems, Mountain View, CA, USA). This assay consists of 35 different specific IgE antibodies with associated allergens from food, mold, pollen, and inhalant allergens that are most frequently positive in Koreans. The MAST-CLA was performed ac- cording to the' manufacturer's instructions. The amount of the produced chemiluminescence, which is propor- tional to the amount of allergen-specific IgE in the test serum, was measured in a densitometer; the results were interpreted as classes 0, 0/1, 1, 2, 3, or 4 based on the amount of light emitted, with classes 2 to 4 considered positive results. At the time of tube placement surgery, the external auditory canal was irrigated with 70 % alco- hol and then the middleear fluid was collected using a suction collector (Storz®, Germany). The collected fluid was stored immediately at −70 °C for subsequent ana- lysis. The genomic DNA was extracted by mixing 50 μL of the stored middleeareffusion with 900 μL of cell lysis solution, followed by a 10 min centrifugation at 15,000 rpm at room temperature. DNA was extracted using PCR premix (Bioneer®, Daejeon, South Korea). For PCR, P6 protein was used as a primer for Haemophilus influenzae , PBP 2B for Streptococcus pneumoniae , and the M46 clone for Moraxella catarrhalis . Thirty-five cy- cles of 95 °C, 55 °C, and 70 °C were performed using a DNA thermal cycler. To detect the amplified product,
Tympanostomy tube placement (compared with watchful waiting) in children with chronic middleeareffusion, results in improved average hearing thresholds at 1 to 3 months after surgery (a period when the majority of tubes are functioning). Mean hearing thresholds after tube placement with or without adenoidectomy improved by ∼10 dB when assessed at 1 to 3 months. By 1 to 2 years after surgery, when most tubes have extruded, hearing thresholds are no longer different, likely reflecting the usually favorable natural history of spontaneous resolution of middleeareffusion in most children in both groups. There is limited evidence regarding quality of life outcomes, but neither of the 2
A century later, Antonio Maria Valsalva (1666-1723) was born in Imola, Italy. He became notable for his description of the aortic “sinus of Valsalva, ” but he is even more famous for his Treatise on the Human Ear. His description of the Eustachian tube is classic, in which he detailed the cartilaginous, membranous, and osseous parts of the tube. He discovered, and named the dilator tubae of the tensor veli palatini muscle and made note of the insertion of some fibers of the tensor tympani into the membranous portion of the tube. He recorded his thoughts on the acoustic functions of the Eustachian tube and supported concept of drainage of purulent material from the middleear. His observations on the function of the Eustachian tube resulted in Valsalva’s maneuver, which he used in clinical practice and which has persisted to this day. In addition to treatment of middle- eareffusion and negative pressure the maneuver is used as an inflation test for the patency of the Eustachian tube. Most likely, the maneuver was described much earlier, such as by Arab physicians of the eleventh century and some of the early Italian anatomists
Agreement may be more difficult on which signs and symptoms of acute local or systemic illness are sufficient to establish the diagnosis of AOM in con- junction with middleeareffusion. The diagnosis can be established by the presence of local signs such as otorrhea with evidence of middleear origin, a bulg- ing tympanic membrane that has cloudy or yellow fluid visible behind it or is distinctly red, or local symptoms such as ear pain. 15 Ear-pulling in the ab-
Tympanometry is an excellent method to assess the tympanic membrane and middleear system and thereby the functioning of Eustachian tube. This test detects middleeareffusion and negative middleear pressure accurately in an objective manner. But there may be high negative pressure in some children who are asymptomatic. Hence a restingpressure that is highly negative suggests Eustachian tube obstruction but presence of normal tympanogram does not necessarily exclude Eustachian tube dysfunction. In cases of Patulous Eustachian tube dysfunction, normal tympanogram can be obtained.