-
Ear, Nose, & Throat Journal Jun 2024To evaluate the effectiveness of ofloxacin ear drops versus no intervention in the repair of traumatic tympanic membrane (TM) perforations from randomized controlled... (Review)
Review
To evaluate the effectiveness of ofloxacin ear drops versus no intervention in the repair of traumatic tympanic membrane (TM) perforations from randomized controlled trials (RCTs). Medline/PubMed, CENTRAL, Clinical Trials.Gov, and Google Scholar. Inclusion criteria: (1) English language; (2) RCT studies; (3) reported the outcomes on the application of ofloxacin and outcomes of spontaneous healing. Exclusion criteria: (1) studies without a control group; (2) patient with severe otologic disease such as chronic suppurative otitis media or ossicular disruption or patients with craniocerebral injury; (3) studies with no pretreatment values or single-arm clinical studies. Country, year of publication, number of participants in each arm, patient characteristics such as age, sex, intervention details, laterality, cause of TM perforation, position of perforation, follow-up time, hearing gain, rate of TM closure, and closure time. A total of 6 RCTs studies were analyzed. A total of 502 participants were included; the relative risk for closure rate of ofloxacin treatment was 1.18 [95% confidence interval (CI), 1.08 to 1.28, < .001] and the mean difference (MD) for healing time was -18.4 (95% CI, -19.96 to -16.82, < .001), suggesting ofloxacin has a significant effect on closure of TM perforations. However, no clinically significant effect in hearing (SMD: 0.21, 95% CI, 0.02 to 0.40, = .03) was seen in ofloxacin group. Also, patients in the ofloxacin group were associated with a 13% reduction in the risk of infections compared to their observation-assigned counterparts, but this estimate was not statistically significant. Ofloxacin use in patients with traumatic TM perforation is effective in reducing healing time and increasing rate of TM perforation closure. No evidence of increased risk of hearing loss or infection rates are encountered when ofloxacin is prescribed to patients with traumatic TM perforation.
PubMed: 38907707
DOI: 10.1177/01455613241264479 -
Ear, Nose, & Throat Journal Jun 2024Myhre syndrome (MS) is a rare genetic condition that presents with multiple genetic anomalies including cleft lip and palate and Eustachian tube dysfunction. These...
Myhre syndrome (MS) is a rare genetic condition that presents with multiple genetic anomalies including cleft lip and palate and Eustachian tube dysfunction. These patients are at a high risk for airway scarring from intubation and mucosal inflammation. Hearing loss (conductive or mixed, of varying severity) is a common comorbidity in these patients, the exact etiology of which is still unclear. We present the cases of 2 unrelated children with MS who suffered progressive mixed hearing loss from fibrosis and obliteration of the middle ear spaces. Both patients had multiple sets of ear tubes that demonstrated early extrusion. The older patient underwent bone conduction implantation at age 11 which resulted in dramatic improvement of speech recognition and interactive skills. The other younger patient demonstrates a similar trajectory but has not yet undergone implantation. Otolaryngologists should take a cautious approach to surgery of the eardrum and middle ear to avoid unnecessary induction of fibrosis in this susceptible patient population. These cases highlight a newly described etiology for hearing loss and suggest a benefit to bone conduction implantation.
PubMed: 38907583
DOI: 10.1177/01455613241256474 -
Medicine Jun 2024Hemophagocytic lymphohistiocytosis (HLH) is a potentially life-threatening syndrome for which early recognition and treatment are essential for improving outcomes. HLH...
INTRODUCTION
Hemophagocytic lymphohistiocytosis (HLH) is a potentially life-threatening syndrome for which early recognition and treatment are essential for improving outcomes. HLH is characterized by uncontrolled immune activation leading to fever, cytopenias, hepatosplenomegaly, coagulation abnormalities, and elevated typical markers. This condition can be genetic or secondary, with the latter often triggered by infections. Here, we present a unique case of HLH secondary to acute otitis media (AOM), a common ear infection.
PATIENT CONCERNS
We describe a 4-year-old boy who initially presented with a high fever and otalgia, later diagnosed with bilateral AOM. Despite antibiotic treatment, his condition deteriorated.
DIAGNOSIS
The patient fulfilled diagnostic criteria for HLH.
INTERVENTIONS
Aggressive treatment by using combination therapy with immunoglobulins, intravenous steroids (dexamethasone), cyclosporine, and etoposide was performed.
OUTCOMES
After 1 month of treatment, improvement in the otologic symptoms was observed, and hematological findings gradually improved and normalized.
LESSIONS
The link between AOM and HLH may be associated with inflammatory responses and immunological mechanisms, highlighting the importance of considering HLH in severe infection cases. This case emphasizes the need for prompt diagnosis and management, especially in secondary HLH scenarios, to improve patient outcomes. It is imperative to be aware of the potential correlation between these 2 conditions, and healthcare professionals should consider the likelihood of HLH.
Topics: Humans; Lymphohistiocytosis, Hemophagocytic; Male; Child, Preschool; Otitis Media; Acute Disease; Dexamethasone; Cyclosporine; Etoposide; Immunoglobulins, Intravenous
PubMed: 38905364
DOI: 10.1097/MD.0000000000038616 -
Noise & HealthOtitis media (OM) refers to a common clinical ear disease. Noise seriously damages human hearing function. This study aimed to investigate the effects of various noise...
BACKGROUND
Otitis media (OM) refers to a common clinical ear disease. Noise seriously damages human hearing function. This study aimed to investigate the effects of various noise types on the hearing function of patients who have recovered from mild OM.
MATERIALS AND METHODS
A total of 160 patients with mild OM treated at our hospital from May 2020 to May 2023 were retrospectively selected for this study. Based on clinical data, the patients were divided into the non-noise group (n = 80) and the noise (n = 80) group. The hearing thresholds of the two groups were compared across various noise types at 500, 1000, and 2000 Hz. In addition, the hearing thresholds of the noise group were compared under the same conditions.
RESULTS
The noise group exhibited significantly higher hearing thresholds at 500, 1000, and 2000 Hz than the non-noise group (P < 0.05). Under traffic, urban construction, and industrial noises, the auditory thresholds at 500, 1000, and 2000 Hz in the noise group were significantly higher than those observed under domestic and speech noises (P < 0.05).
CONCLUSION
Noise shows a close relationship with the hearing function of patients with OM. Traffic, urban construction, and industrial noises greatly influence the hearing function of patients who have recovered from mild OM.
Topics: Humans; Otitis Media; Male; Female; Adult; Middle Aged; Retrospective Studies; Auditory Threshold; Noise; Hearing Loss, Noise-Induced; Aged
PubMed: 38904828
DOI: 10.4103/nah.nah_6_24 -
Cureus May 2024Acute suppurative otitis media can occasionally result in facial paralysis, which calls for prompt diagnosis and treatment. Facial paralysis, a synonym for Bell's palsy,...
Acute suppurative otitis media can occasionally result in facial paralysis, which calls for prompt diagnosis and treatment. Facial paralysis, a synonym for Bell's palsy, is a condition that causes rapid weakening of one side of the face muscles, leading to drooping of the face on that side. A major factor in determining the course of the condition is rehabilitation through physiotherapy. Here, we present a case of a 26-year-old female who felt discomfort in her left ear on February 21, 2024, but chose to ignore it then. She observed an abrupt deviation in her mouth and visited a rural hospital, where she was admitted. Facial asymmetry was observed during the examination, and she was found to have a grade V on the House-Brackmann scale. A near-normal muscle action was initiated by mime therapy, and proprioceptive stimulation was given by facial proprioceptive neuromuscular facilitation along with electrical stimulation. All these approaches benefited the patient in a significant manner.
PubMed: 38903317
DOI: 10.7759/cureus.60795 -
World Journal of Clinical Cases Jun 2024This case series investigated the clinical manifestations, diagnoses, and treatment of cerebral abscesses caused by . We retrospectively analyzed the clinical...
BACKGROUND
This case series investigated the clinical manifestations, diagnoses, and treatment of cerebral abscesses caused by . We retrospectively analyzed the clinical characteristics and outcomes of three cases of cerebral abscesses caused by and conducted a comprehensive review of relevant literature.
CASE SUMMARY
Case 1 presented with a history of left otitis media and exhibited high fever, confusion, and vomiting as primary symptoms. Postoperative pus culture indicated a brain abscess caused by infection. Case 2 experienced dizziness for two days as the primary symptom. Postoperative pus culture suggested an intermediate streptococcal brain abscess. Case 3: Enhanced head magnetic resonance imaging (MRI) and diffusion-weighted imaging revealed occupancy of the left temporal lobe, initially suspected to be a metastatic tumor. However, a postoperative pus culture confirmed the presence of a brain abscess caused by infection. The three cases presented in this case series were all patients with community-acquired brain abscesses resulting from angina caused by Streptococcus group infection. All three patients demonstrated sensitivity to penicillin, ceftriaxone, vancomycin, linezolid, chloramphenicol, and levofloxacin. Successful treatment was achieved through stereotaxic puncture, drainage, and ceftriaxone administration with a six -week course of antibiotics.
CONCLUSION
Preoperative enhanced head MRI plays a critical role in distinguishing brain tumors from abscesses. Selecting the correct early diagnostic methods for brain abscesses and providing timely intervention are very important. This case series was in accordance with the CARE guidelines.
PubMed: 38898852
DOI: 10.12998/wjcc.v12.i17.3243 -
Journal of Clinical Medicine Jun 2024Acute or chronic ear, nose and throat (ENT) conditions in people living with HIV can lead to hospitalization and affect their quality of life. The aim of our study was...
Acute or chronic ear, nose and throat (ENT) conditions in people living with HIV can lead to hospitalization and affect their quality of life. The aim of our study was to determine the frequency and characteristics of hospitalizations for acute sinusitis (AS) and acute otitis (AO) in people living with HIV. We performed a retrospective analysis over the course of six years (from January 2018 to December 2023), assessing all hospitalizations for AS and/or AO occurring in patients living with HIV, at the largest infectious diseases hospital in Romania. We identified a total of 179 cases, among which 149 cases (83.2%) were attributed to AS and 41 cases (22.9%) were due to AO. Among cases of AS, maxillary sinuses were most frequently involved ( = 140/149, 94.0%), and among cases of AO, acute congestive otitis media ( = 14, 34.1%) and acute purulent otitis media ( = 13, 31.7%) were the most common forms. The underlying HIV infection was classified as stage C3 in 57.5% of cases. In 19.6% of cases, it was possible to identify either the trigger or the etiological agent, and the most frequent bacterial pathogens were , , and . In conclusion, this study highlights that hospitalizations due to acute sinus and ear involvement are not isolated events in people living with HIV. A prospective follow-up is needed to gain a deeper and more dynamic understanding of how ENT health is affected in people with HIV infection. Furthermore, promoting prevention through vaccination may reduce to a certain extent the burden of ENT infections in this population.
PubMed: 38893057
DOI: 10.3390/jcm13113346 -
Journal of Otolaryngology - Head & Neck... 2024The high incidence of pediatric acute otitis media (AOM) makes the implications of overdiagnosis and overtreatment far-reaching. Quality indicators (QIs) for AOM are...
BACKGROUND
The high incidence of pediatric acute otitis media (AOM) makes the implications of overdiagnosis and overtreatment far-reaching. Quality indicators (QIs) for AOM are limited, drawing from generalized upper respiratory infection QIs, or locally developed benchmarks. Recognizing this, we sought to develop pediatric AOM QIs to build a foundation for future quality improvement efforts.
METHODS
Candidate indicators (CIs) were extracted from existing guidelines and position statements. The modified RAND Corporation/University of California, Los Angeles (RAND/UCLA) appropriateness methodology was used to select the final QIs by an 11-member expert panel consisting of otolaryngology-head and neck surgeons, a pediatrician and family physician.
RESULTS
Twenty-seven CIs were identified after literature review, with an additional CI developed by the expert panel. After the first round of evaluations, the panel agreed on 4 CIs as appropriate QIs. After an expert panel meeting and subsequent second round of evaluations, the panel agreed on 8 final QIs as appropriate measures of high-quality care. The 8 final QIs focus on topics of antimicrobial management, specialty referral, and tympanostomy tube counseling.
CONCLUSIONS
Evidence of variable and substandard care persists in the diagnosis and management of pediatric AOM despite the existence of high-quality guidelines. This study proposes 8 QIs which compliment guideline recommendations and are meant to facilitate future quality improvement initiatives that can improve patient outcomes.
Topics: Humans; Otitis Media; Quality Indicators, Health Care; Acute Disease; Child; Quality Improvement
PubMed: 38888942
DOI: 10.1177/19160216241248538 -
PloS One 2024Most US children with acute otitis media [AOM] receive prompt antibiotic treatment, though guidelines encourage watchful waiting. Previous systematic reviews of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Most US children with acute otitis media [AOM] receive prompt antibiotic treatment, though guidelines encourage watchful waiting. Previous systematic reviews of antibiotics versus watchful waiting have focused on symptom resolution and RCTs, limiting the assessment of serious, rare complications. We sought to evaluate these complications by including observational studies.
METHODS
RCTs and observational studies that compared antibiotics to placebo or watchful waiting for pediatric clinician diagnosed AOM were identified [PubMed/MEDLINE, Embase, Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, and Web of Science] and reviewed for meta-analysis. Two reviewers independently extracted study characteristics, patient characteristics, and outcomes. We assessed publication bias, study bias with ROBINS-1 and RoB-2 and used random-effects models to assess treatment effects.
RESULTS
24 studies were included. Antibiotics decreased the risk of acute mastoiditis [incidence 0.02%, RR 0.48, 95% CI 0.40-0.59; NNT 5,368]. This protective effect may be underestimated because of misclassification of non-suppurative conditions as AOM. Intracranial complications remained too rare to assess. Antibiotics markedly increased the risk of adverse effects [incidence 10.5%, RR 1.49, 1.27-1.73; NNH 23]. Studies used non-specific criteria for acute mastoiditis, potentially underestimating treatment effects.
CONCLUSIONS
Prompt antibiotic therapy reduces the risk for some AOM complications. The NNT to prevent serious, rare complications is high, while the NNH is relatively low. Large-scale population-based observational studies using real-world datasets with validated measures of severe complications are needed to improve understanding of risk factors for serious AOM complications, facilitate more selective antibiotic therapy, and optimize individual outcomes and public health.
Topics: Humans; Anti-Bacterial Agents; Otitis Media; Child; Acute Disease; Child, Preschool; Mastoiditis; Randomized Controlled Trials as Topic
PubMed: 38885271
DOI: 10.1371/journal.pone.0304742 -
Cureus May 2024Chronic suppurative otitis media (CSOM) is a chronic inflammation of the mucoperiosteal lining of the middle ear cleft, presenting with recurrent ear discharge through a...
BACKGROUND AND OBJECTIVES
Chronic suppurative otitis media (CSOM) is a chronic inflammation of the mucoperiosteal lining of the middle ear cleft, presenting with recurrent ear discharge through a tympanic membrane perforation. The present study aims to assess the spectrum of bacterial infection among CSOM cases and detect the isolated organism's antibiotic sensitivity pattern.
METHODS
The prospective hospital-based observational study was conducted from June 2021 to June 2022 and included 94 CSOM cases. An aural swab of the ear discharge was collected from each patient under aseptic precautions. The swab was utilized for Gram's staining and the aerobic bacterial pathogen culture. The organisms isolated were tested for antibiotic sensitivity using the Kirby-Bauer disc diffusion method.
RESULTS
The most affected age group was the second decade of life (27.7%, n=26), with a male-to-female ratio of 1.35:1. The mean duration of ear discharge was 24.0±14.7 months, mostly mucoid ear discharge (39.4%, n=37). Among gram-positive bacteria, methicillin-resistant was isolated in 16 (17.0%) cases. was the most isolated gram-negative bacteria strain in 26 (27.7%) cases. Cotrimoxazole (67.7%, n=21) had the highest sensitivity towards gram-positive bacteria isolates. Amongst gram-negative bacteria, amikacin and ciprofloxacin were the most sensitive, with 78.0% (n=39) susceptibility.
CONCLUSION
Evaluating the spectrum of infecting organisms of CSOM and their antibiotic sensitivity may help initiate prompt treatment with the appropriate antibiotic regimen, thereby preventing future complications.
PubMed: 38883034
DOI: 10.7759/cureus.60371