Otitis

The prevalence of hearing loss among schoolchildren with chronic suppurative otitis media in Nigeria, and its effect on academic performance

December 1, 2008     Fatai Olatoke, MBBS, Foluwasayo Emmanuel Ologe, MBBS, Clement C. Nwawolo, MBBS, and Mohammed Jimoh Saka, MBBS
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Abstract

We conducted a cross-sectional study to determine the prevalence of hearing loss among 1,500 Nigerian schoolchildren aged 9 to 15 years who had chronic suppurative otitis media (CSOM). We also attempted to ascertain the effect that this hearing loss had on their academic performance. The study population was drawn from three schools in different socioeconomic tiers—low (n = 300), medium (n = 400), and high (n = 800). Overall, CSOM was present in 35 of these children (2.3%)—12 from the low-status school (4.0%), 11 from the middle-status school (2.8%), and 12 from the high-status school (1.5%); the overall difference in prevalence among the three schools was statistically significant (χ2 = 6.40; degrees of freedom [df] = 2; p = 0.04). In all, 52 ears were affected by CSOM; of these, 18 (34.6%) had a pure-tone average (PTA) within normal limits, 20 (38.5%) had a mild conductive hearing loss, and 14 (26.9%) had a moderate loss. All but 2 of 160 control ears (1.2%) had hearing thresholds within normal limits. The difference in PTAs across groups was statistically significant (χ2 = 114.89; df = 2; p< 0.001). As for academic performance, cumulative average test scores were significantly lower in the CSOM patients than in the controls—χ2 = 14.57; df = 3; p = 0.002. At the higher end of the academic scale, scores of 66% and higher were obtained by 40.0% of patients and 51.3% of controls, and scores of 50 to 65% were achieved by 20.0% of patients and 37.5% of controls. At the lower end, scores of 40 to 49% were obtained by 31.4% of patients and 6.3% of controls, and scores of 39% and lower were obtained by 8.6% and 5.0%, respectively. We conclude that hearing loss was a significant sequela of CSOM in our study population and that it had an adverse effect on their academic performance. Children in the low socioeconomic group appeared to be more vulnerable.

Multiple simultaneous complications of acute otitis media in a child diagnosed with chronic granulomatous disease: A case report

April 30, 2008     Robert Wilson, MD, Tarika Bhuta, MD, and Richard Haydon, MD
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Abstract

While the prevalence of acute otitis media complications in pediatric patients has decreased over the past 30 years because of effective antibiotic therapy, the incidence has begun to rise again recently, possibly because of increased antibiotic resistance. Patients who simultaneously manifest multiple complications may require a more thorough evaluation, including an immunologic work-up. The presented case should encourage physicians to investigate the possibility of an underlying immunodeficiency when treating patients with multiple simultaneous complications of acute otitis media.

Acute suppurative otitis media

April 30, 2008     Eric P. Wilkinson, MD and Rick A. Friedman, MD, PhD
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An estimate of the number of mastoidectomy procedures performed annually in the United States

April 30, 2008     Lesley C. French, MD, Mary S. Dietrich, PhD, and Robert F. Labadie, MD, PhD
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Abstract

We conducted a study to estimate the number of mastoidectomy procedures performed annually in the United States. Our results are based on state-specific healthcare utilization data and Medicare-funded procedural data from 2002. The utilization data were obtained from the State Ambulatory Surgery Database, which is made available through the Healthcare Cost and Utilization Project. Statistical Package for the Social Sciences (SPSS) statistical software was used to quantify the number of mastoidectomy procedures performed during 2002 in Maryland, New Jersey, New York, and Florida. Information was also obtained from the Federated Ambulatory Surgery Association on the number of Medicare-funded mastoidectomy procedures performed in 2002. State and U.S. population statistics were obtained from the U.S. Census Bureau. These data were extrapolated to obtain a nationwide estimate of the number of mastoidectomies performed annually in the U.S. With 99% confidence, we determined that 0.73 to 0.94 mastoidectomy procedures were performed per 10,000 population in Maryland and 2.55 to 2.74/10,000 in New York. Estimates for both New Jersey and Florida fell in between. Medicare patients underwent between 1.68 and 1.79 procedures per 10,000 population. Based on these data, we estimate that between 30,000 and 60,000 mastoidectomies are performed each year in the U.S., although we suspect that our range may be an underestimation of the actual number because of some limitations inherent in the data collection process. Although mastoidectomy is a common outpatient procedure, to the best of our knowledge, no report on the annual frequency of mastoidectomy procedures in the U.S. has ever been published in the English-language literature. We hope that our report will serve to motivate further research into technological and surgical advancements surrounding this procedure.

Clinical evaluation of piezoelectric ear surgery

March 31, 2008     Massimo Dellepiane, MD, Renzo Mora, MD, Francesco A. Salzano, MD, and Angelo Salami, MD
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Abstract

We evaluated the use of piezoelectric surgery (Piezosurgery; Mectron Medical Technology; Carasco, Genoa, Italy) as a means of avoiding some complications of osteotomy and osteoplasty in otologic surgery, particularly in classic canal-wall-up mastoidectomy. Piezoelectric surgery is a recently developed system for cutting bone with microvibrations created by the piezoelectric effect. This effect occurs when an electric current is passed through certain ceramics and crystals, causing them to oscillate at ultrasonic frequencies. Our study population was made up of 20 adults with unilateral chronic otitis media. In all patients, piezoelectric surgery allowed for effective, precise, safe, easy, and rapid intraoperative management. In particular, the instrument's precision allowed surgeons to make exact, clean, and smooth cuts without causing any injury to adjacent soft tissue. No complications were noted. We conclude that the piezoelectric device is superior to conventionally rotating instruments for performing classic canal-wall-up mastoidectomy.

Correlation between otitis media and craniofacial morphology in adults

December 1, 2007     Renata C. Di Francesco, MD, PhD, Perboyre Lacerda Sampaio, MD, PhD, and Ricardo Ferreira Bento, MD, PhD
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Abstract

We conducted a comparison study to determine if the development of otitis media in adults is correlated with craniofacial morphology. Our study population was made up of 66 adults, aged 18 to 40 years; 32 of these patients had otitis media and 34 did not. All subjects underwent a complete otolaryngologic examination, video-otoscopy, fiberoptic nasal endoscopy, and lateral cephalometry. Statistical analysis of the cephalometric measurements in the otitis media group and the control group revealed significant differences in the angle between the anterior skull base and medial skull base, upper facial height, and anterior facial height. Also, some significant differences were seen between the measurements in the otitis media group and the normal dimensions of the harmonic face as reported in the literature; these differences were seen in the length of the anterior skull base, the angle of cranial deflection, the depth of the maxilla, the angle of the mandibular plane, the angle of facial depth, the angle of the facial cone, and lower facial height. Not all of these significant differences, however, were predictive of the evolution of otitis media. Based on our analysis, we conclude that four cephalometric measurements are predictive of the evolution of otitis media: (1) the length of the anterior skull base, (2) the angle between the anterior skull base and medial skull base, (3) maxillary depth, and (4) upper facial height. No correlations were found between otitis media and nasal blockage or between otitis media and facial type.

Is IV access necessary for myringotomy with tubes?

October 31, 2007     Arthur H. Allen, DO
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Abstract

A retrospective chart review was conducted at a community-based hospital to determine whether intravenous access is necessary during the performance of myringotomy with tube insertion. The study included 50 pediatric patients divided equally into 2 groups: group 1, who did not have intravenous access established before the procedure, and group 2, who did have intravenous access established. To be enrolled, patients in both groups had to be ≤12 years of age, have an American Society of Anesthesiologists physical status classification of P1 or P2, and had to have undergone no adjunctive procedure with the myringotomy. Induction time was significantly shorter in group 1 (average: 6.96 ± 2.72 minutes) than in group 2 (average: 9.80 ± 3.82 minutes; p = 0.004). Operating time and total operating room time were not significantly different between the two groups. Additionally, 24 of 25 patients in group 1 had their pain managed with acetaminophen or no medication at all, while 9 of 25 group 2 patients received acetaminophen and 13 received intravenous pain medication. Interestingly, no patients in group 1 required antiemetics, whereas 4 patients in group 2, who were given intravenous or intramuscular narcotics, received antiemetic medications. These findings indicate that myringotomy with tube insertion can be safely accomplished without establishing intravenous access. Induction times and time under general anesthesia were significantly increased when intravenous access was obtained. The findings also suggest that acetaminophen provides adequate postoperative pain control in this patient population and that the use of intravenous or intramuscular narcotics increases the risk of postoperative nausea.

Relative value of different fluoroquinolones

October 31, 2007    
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Systemic effects of ototopical dexamethasone

October 31, 2007    
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