The study examined the effectiveness of asynchronous video-otoscopy by a telehealth facilitator, for diagnosing ear disease in an underserved community at a primary health care clinic. Study I explored whether video-otoscopy images by a facilitator provided accurate asynchronous diagnosis. Onsite otoscopy was performed by an otolaryngologist on 61 adults. Video-otoscopy images were taken by the facilitator with no formal health care training, and by the otolaryngologist. Images were uploaded to secure server from which the otolaryngologist rated and made a diagnosis six weeks later. More otolaryngologist acquired images (83.6%) were graded as acceptable or better than facilitator images (75.4%). Moderate concordance was measured between asynchronous diagnosis from video-otoscopy images acquired by the otolaryngologist and facilitator (κ = 0.596). Lack of depth perception was considered a limitation of video-otoscopy images. Study II investigated asynchronous video-otoscopy recordings made by a facilitator in children at primary health care. Onsite otomicroscopy of 140 children (2-16 years) by an otologist was the gold standard. Video-otoscopy recordings were completed by a facilitator. Four and eight weeks later, an otologist and general practitioner asynchronously graded and made a diagnosis from online recordings. Video-otoscopy recording quality was acceptable or better in 87% of cases. Asynchronous diagnosis from recordings was not possible for 18% of ears. There was substantial agreement between asynchronous video-otoscopy and onsite diagnoses (κ = 0.679-0.745). Variability of asynchronous diagnosis accuracy was similar to inter- and intra-rater diagnostic variability. Study III examined the point prevalence of otitis media in the children from study II. Onsite otomicroscopy was completed by an otologist. Prevalence of otitis media was 24.8%, with OME the most prevalent (16.5%). Despite AOM prevalence of 1.7%, caregivers reported otalgia for 7.4% of children within two weeks of assessment. Caregivers did therefore not typically seek medical opinion for otalgia. Lack of medical opinion is problematic as the sample demonstrated high CSOM prevalence (6.6%). A telehealth facilitator with limited training was capable of acquiring good quality video-otoscopy measures in children and adults. Asynchronous video-otoscopy recordings may be used within a telehealth clinic in a primary health care clinic to reduce morbidity and mortality associated with CSOM. / Thesis (DPhil)--University of Pretoria, 2015. / Speech-Language Pathology and Audiology / DPhil / Unrestricted

No description available.

Otitis media (OM), one of the commonest of childhood diseases, causes much suffering. OM exists in a variety of forms, two of which are acute otitis media (AOM) and otitis media with effusion (OME). The clinical courses of these conditions differ, AOM usually presenting with earache, fever and/or aural discharge, and the OME usually with hearing impairment. The tympanic membrane (TM) mirrors the events in the middle ear cavity, and pars flaccida (PF) is the initial site of inflammatory changes in the TM. PF is rich in mast cells (MCs), which by releasing various mediators, may trigger TM inflammation. The aims of the present studies were to investigate early inflammatory changes in the TM in rat models of OM; after mast cell degranulation, in response to AOM, and OME, after myringotomy in AOM and in normal ears. Furthermore, we developed a new rat AOM model, that excludes surgical trauma and resembles the natural route of infection in man. AOM and OME elicited the first inflammatory response in PF of the TM. The response to OME was discrete, but a slight increase in macrophages was found. During the first 48 hours of AOM, the inflammatory response was intense, following a bimodal pattern. This reaction is similar to that found after MC degranulation. In AOM, macrophages were the predominant cell in PF, while in pars tensa (PT), polymorphonuclear cells (mainly neutrophils) predominated. When myringotomy was performed in AOM ears, the healing time was shorter than that of myringotomy in normal ears. The highly inflamed lamina propria seemed to promote healing. During early AOM, as well as following myringotomy, fibrin extravasates into PF and PT. This fibrin deposition may be involved in regulating the inflammatory response. Repeated nasal challenge with the otitis media pathogen Streptococcus pneumoniae provoked AOM and concomitant TM stimulation reduced the number of AOM cases. This new rat AOM model has the advantage of avoiding trauma in the middle ear cavity, while eliciting an intense inflammatory response in the middle ear cavity (MEC).

Durch die höhere Verfügbarkeit von Schnittbildverfahren in der Kleintiermedizin treten Flüssigkeitsansammlungen in der Bulla tympanica immer häufiger als Zufallsbefund bei Hunden, insbesondere bei brachyzephalen Rassen, auf. Aufgrund der fehlenden klinischen Symptome der Patienten ist eine akute Entzündung unwahrscheinlich. Daher bezeichnen neuere Studien diese Flüssigkeitsansammlung als primär sekretorische Otitis media (PSOM). In der vorliegenden Studie wurde untersucht, ob Hunde der Rassen Mops und Französische Bulldogge mit einer primär sekretorischen Otitis media einen konduktiven Hörverlust für das betroffene Ohr im Vergleich zu „Ohr gesunden“ Hunden ihrer Rasse zeigen. Des Weiteren wurde untersucht, ob Französische Bulldoggen signifikant häufiger eine primär sekretorische Otitis media als Hunde der Rasse Mops zeigen. Es wurden bei jeweils 41 Hunde der Rasse Mops und Französische Bulldogge, die zur chirurgischen Versorgung des Brachyzephalen Syndroms vorgestellt wurden, die frühen akustisch evozierten Potentiale (FAEP) abgeleitet. Des Weiteren erfolgte bei allen Patienten eine Computertomographie des Kopfes, eine Otoskopie und ggf. eine Punktion der Bulla tympanica inklusive einer Zytologie und bakteriologischen Untersuchung des Sekrets. In der vorliegenden Studie konnte kein konduktiver Hörverlust für die Hunde mit einer PSOM nachgewiesen werden. Es zeigte sich nur eine Verlängerung der Latenz der Welle I bei Vorliegen einer PSOM, jedoch ohne dass eine signifikant erhöhte Hörschwelle für diese Patienten festgestellt werden konnte. Als Ursache für die Verlängerung der Latenz der Welle I kommt sowohl die beschriebene Füllung der Bulla als auch ein stenotischer Gehörgang in Frage. Die Hörschwelle ist zwar bei den Hunden mit einer PSOM tendenziell höher als bei den Patienten ohne Füllung der Bullae, allerdings konnte hierfür kein signifikanter Unterschied nachgewiesen werden. Bei 40 % der untersuchten Patienten mit einseitiger PSOM konnte für beide Ohren dieselbe Hörschwelle bestimmt werden, so dass eine Füllung der Bulla tympanica nicht immer zu einer vorhersagbaren Veränderung der Hörschwelle führen muss. Eine mögliche Erklärung für diesen Umstand ist ein sensorineuraler Hörverlust, der durch eine chronische Entzündung des Mittelohres zustande kommt. Dies ist bisher nur in der Humanmedizin beschrieben und die Pathogenese ist noch unklar. Die Ergebnisse zeigen zusätzlich, dass Französische Bulldoggen signifikant häufiger von einer PSOM betroffen sind. Die Ursache für diese Häufung könnte ein dickerer weicher Gaumen der Französischen Bulldoggen im Vergleich zu Hunden der Rasse Mops sein, durch den es zu einer Funktionsstörung der Tuba auditiva kommen könnte. Beim Vergleich der Hunde ohne Vorliegen einer Füllung konnte festgestellt werden, dass Französische Bulldoggen eine höhere Hörschwelle und eine längere Latenz der Welle I als Hunde der Rasse Mops aufweisen. Bei beiden Rassen ist zusätzlich auffällig, dass die Hörschwelle um 30 dB höher liegt als bei Hunden anderer Rassen (SHIU et al. 1997). Alle brachyzephalen Hunde dieser Studie zeigen somit ein im Vergleich zu anderen Rassen vermindertes Hörvermögen, das aber durch eine PSOM nicht weiter verschlechtert wird. Der Symptomenkomplex Brachyzephalen Syndrom muss nach der vorliegenden Studie durch die Symptome vermindertes Hörvermögen und das Vorliegen einer PSOM ergänzt werden. Die klinischen Auswirkungen des Hörverlusts, wie etwa eine starke Anhänglichkeit, könnten bei Hunden dieser Rassen übersehen werden, da dies als gewünschter Charakterzug der Rassen interpretiert wird und nicht als mögliches Symptom einer Erkrankung wahrgenommen wird. / Because of the increased availability of cross-sectional imaging modalities in small animal medicine the incidental finding of material in the middle ear is more common, especially in brachycephalic dogs. Because the animals show no clinical signs, an acute inflammation is unlikely. Therefore recent studies term it as primary secretory otitis media (PSOM). The aim of the current study was to determine whether brachycephalic dogs with PSOM show a conductive hearing loss compared to brachycephalic dogs without changes in the middle ear. Additionally it was evaluated whether French bulldogs suffer from PSOM more frequent than pugs. BAER was recorded in 41 pugs and 41 French bulldogs, which were under general anesthesia because of the surgical correction of the brachycephalic syndrome. In all patients a computed tomography of the head, an otoscopy and if possible a myringotomy with aspiration of the fluid in the middle ear was performed. If fluid was available a cytological examination and a bacterial culture of the fluid was initiated. In the current study no conductive hearing loss was detected in brachycephalic dogs with PSOM. The latencies of wave I were increased in patients with PSOM, although the thresholds of hearing were not increased. The increased latencies of wave I can be explained by the fluid in the middle ear as well as the stenotic external ear canal. The thresholds of hearing in dogs with PSOM were tendentially higher than in dogs without fluid in the middle ear, but the correlation was not significant. In 40 % of the patients with PSOM in one ear the threshold of hearing in both ears is at the same level. Therefore there is no strict correlation between fluid in the middle ear and an increased threshold of hearing on the affected side. This could be explained by a sensorineural hearing loss caused by chronic inflammation of the middle ear. Until now a chronic inflammation as a cause of sensorineural hearing loss has only been described in human medicine, not in veterinary medicine. The pathogenesis is still unknown. The results show that French bulldogs suffer more frequently from the PSOM than pugs. French bulldogs usually show a bigger soft palate than pugs which could result in a dysfunction of the tuba auditiva. Hence the bigger soft palate could be causing the increased prevalence of PSOM in French bulldogs. Compared to pugs without PSOM, French bulldogs without PSOM show an increased latency of wave I as well as an increased threshold of hearing. Additionally for both breeds an increase in the threshold of hearing by 30 dB compared to normocephalic breeds could be detected (SHIU et al. 1997). It is remarkable that French bulldogs as well as pugs show a hearing loss without correlation to the PSOM. In conclusion hearing loss has to be added to the characteristic triad of symptoms of the brachycephalic syndrome. Clinical signs of hearing loss like loyalty to the owner could be misinterpreted especially in these breeds, since this is a favored behavior of these dogs.

No description available.

Effectiveness of impedance audiometry in diagnosing serous otitis media in children was examined in this study. The impedance test battery was performed on seventy-six ears of pre-myringotomy children (Mean age: 4.6 years). The status of the middle ear was assessed by the operating physician during surgery, and impedance results were correlated with the operative findings. Middle ear effusion was the variable that most influenced impedance results. Acoustic reflex threshold and tympanometry were the most sensitive tests in predicting effusion. Multiple correlations between these tests and the presence of significant effusion indicated that both measures together are diagnostically more sensitive than either test alone. Also, reflex measurement at one test frequency is as accurate a predictor of effusion as reflex measurement at all frequencies.

OBJECTIVES: Bacterial infections in the normally sterile environment of the middle ear cavity usually trigger host immune response, whereby the innate immune system plays a dominant role as the host’s first line of defense. In this study we evaluated the expression levels of Toll-like receptors (TLRs) -2, -4, -5, -9, and nucleotidebinding oligomerization domain-containing proteins (NODs) -1 and -2, all of which are related to bacterial infection in pediatric patients with otitis media with effusion (OME). METHODS: The study sample consisted of 46 pediatric patients with OME, all of whom had ventilation tubes inserted. The expression levels of TLR-2, -4, -5, -9, NOD-1 and -2 mRNA in middle ear effusion were assessed by polymerase chain reaction. RESULTS: All effusion fluid samples collected from patients with OME showed expression of TLR-2, -4, -5, -9, NOD-1, and -2 mRNA. However, we found no correlations among expression levels of pattern recognition receptors (PRRs) in relation to characteristics of exudates, presence of bacteria, or frequencies of ventilation tube insertion (p>0.05). CONCLUSION: Our findings suggest that exudates of OME patients show PRR expressions that are related to the innate immune response regardless of the characteristics of effusion fluid, presence of bacteria in exudates, or frequency of ventilation tube insertion.

Este estudo teve como objetivo verificar a liberação de xilitol em saliva artificial ao longo do tempo após aplicação de verniz contendo 10% e 20% do açúcar. Para tal, 15 blocos de dentes bovinos foram divididos em três grupos (Grupo 1- recebeu verniz a 10%; Grupo 2 - recebeu verniz a 20% e Grupo 3 - recebeu verniz sem xilitol). Na seqüência, cada bloco foi imerso em tubo de microcentrífuga contendo 500 µL de saliva artificial. Foram coletadas e analisadas as amostras salivares em diferentes tempos após a aplicação do verniz (1h, 8h, 12h, 16h, 24h, 48h e 72h). Comparando-se os valores de concentração de xilitol em mg/L nos grupos G1 e G2, pode-se observar que houve diferença estatisticamente significante entre os grupos (ANOVA, F=32,68, p=0,0004) e tempos (ANOVA, F=2465,53, p=0,0000). Foi observada interação entre as variáveis grupo e tempo (ANOVA, F=1486,25, p=0,0000). Notou-se uma liberação significativamente maior no Grupo G2 nos tempos de 1 h (168,96 mg/L) e 8 h (164,22 mg/L), quando comparados com o Grupo G1 (1 h=63,42 mg/L e 8 h=69,52 mg/L), conforme detectado pelo teste de Tukey (p=0,0002). No entanto, nos tempos de 12 h, 16 h, 24 h, 48 h e 72 h, a liberação do açúcar foi significativamente maior no Grupo 1 (56,92 mg/L; 49,70 mg/L; 49,40 mg/L; 55,52 mg/L; 32,66 mg/L, respectivamente) em relação ao Grupo 2 (29,90 mg/L; 18,52 mg/L; 19,76 mg/L; 24,20 mg/L; 12,72 mg/L, respectivamente), conforme detectado pelo teste de Tukey (p=0,0002). Portanto, o verniz contendo 10% de xilitol liberou maiores concentrações do açúcar em períodos de tempo mais longos, denotando-se em uma liberação mais lenta e homogênea deste verniz. / The aim of this study was to test xylitol release in artificial saliva along time after application of varnishes containing 10% and 20% xylitol. For this purpose, 15 block of bovine teeth were divided into three groups (Group 1-varnish 10%; Group 2-varnish 20%; Group 3-control). In sequence, each block was immersed in a microcentrifuge tube containing 500 µL of artificial saliva. Saliva samples were collected and analyzed for xylitol in different times after varnishes application (1h, 8h, 12h, 16h, 24h, 48h e 72h). Data were analyzed by 2-way ANOVA and Tukey?s test (p<0.05). An interaction between group and time was observed (ANOVA, F=1,486.25, p=0.0000). Xylitol release was significantly higher for Group G2 in times 1 h (168.96 mg/l) and 8 h (164.22 mg/l) when compared with Group G1 (1h=63.42 mg/l e 8h=69.52 mg/l). However, for the other periods, the sugar release was significantly higher in Group 1(56.92 mg/l; 49.70 mg/l; 49.40 mg/l; 55.52mg/l and 32.66 mg/l, respectively, for 12 h, 16 h, 24 h, 48 h and 72 h) when compared to Group G2 (29.90 mg/l; 18.52 mg/l; 19.76 mg/l; 24.20 mg/l and 12.72 mg/l, respectively). In conclusion, the varnish containing 10% xylitol released sugar more slowly and for longer periods, characterizing a more homogeneous release.

'A face de cada um de nós apresenta características únicas. Resultado da combinação de tipos variados de mandíbulas, maxilas, órbitas, é o que nos faz reconhecer cada indivíduo. As crianças apresentam proporções faciais distintas dos adultos. O processo de crescimento e desenvolvimento craniofacial é influenciado por diversos fatores: tanto sistêmicos (genéticos, metabólicos, etc.) quanto locais (respiração nasal, dentição, hábitos orais). Sabe-se que a incidência de otites na infância é maior que em adultos e o que se atribui `a posição mais horizontal da tuba auditiva, em relação `a base do crânio nas crianças. A tuba auditiva é parte da orelha média que se estende desde o osso temporal até a nasofaringe, cujo desenvolvimento é influenciado pelo crescimento craniofacial. As doenças da orelha média influenciadas pela função da tuba auditiva, também ocorrem em adultos, ainda que em menor proporção. Uma vez que a menor incidência das doenças em adultos é atribuída ao crescimento da tuba auditiva, e este é dependente do crescimento craniofacial, deve haver relação entre as doenças da orelha média em adultos com as características morfológicas da face. Desse modo, o objetivo deste estudo foi correlacionar as doenças da orelha média, influenciadas pela função da tuba auditiva com a morfologia e tipologia craniofacial e determinar um traçado cefalométrico como fator prognóstico para estas doenças. Foram selecionados 66 pacientes, entre 18 e 40 anos, do Ambulatório da Divisão de Clínica Otorrinolaringológica da FMUSP. Os indivíduos foram divididos em 2 grupos sendo 32 com doença da orelha média e 34 sem, que constituiu o grupo controle. Os indivíduos não apresentavam nenhum dos fatores de exclusão a seguir: história pessoal ou familiar de fissura palatina, cirurgia bucal, maxilar, faríngea, nasal ou facial prévias, tratamento ortodôntico ou processos obstrutivos do óstio da tuba auditiva. Os pacientes foram submetidos a exame físico otorrinolaringológico, videotoscopia, fibronasofaringoscopia e telerradiografia de perfil. As telerradiografias foram analisadas através de traçado cefalométrico. Observou-se diferenças das grandezas cefalométricas no grupo de indivíduos com doença da orelha média, referentes a base do crânio, projeção da maxila e altura facial. Não houve predomínio de um tipo facial em especial. Dessa forma, o seguinte traçado apresenta valor preditivo para a evolução das doenças da orelha média N-S (comprimento da base do crânio anterior), N-S.Ba (ângulo entre as bases anterior e média do crânio, PMax (profundidade maxilar) e N-ENA (altura facial anterior superior).' / There are thousand types of faces and each one is unique. Individual faces are the result from the combination of different kinds of maxillas, mandibles, and orbits. The face proportions, in children, are distinct of adult ones. Craniofacial growth and development depends on a diversity of factors, such as: genetic, metabolic, nasal breathing, teeth development, etc. The auditory tube is part of middle ear and extends from temporal bone to nasopharynx. It has a more horizontal position in children than in adults; therefore otitis media is more frequent in this age group. The type of cranial base and the displacement of the maxilla during craniofacial growth influence the growth of the auditory tube. The lower frequency of otitis media in adults relates to the development of auditory tube during craniofacial growth. So, there should be a correlation between caniofacial morphology and otitis media. The aims of this study are to correlate facial types and cephalometric measurement morphology to otitis media and suggest which measurements can be used as a prediction of the evolution of otitis media. Sixty-four patients, 18 to 40 years old, were selected from the Outpatient Center of the Department of Otolaryngology of the University of São Paulo Medical School. They were divided into two groups: 32 with otitis media and 34 controls. We excluded patients with personal or familiar history of cleft palate, previous buccal, maxillar, pharyngeal, facial or nasal surgery, orthodontic treatment or obstructive process of the auditory tube ostia. All subjects underwent to complete ENT physical examination, videotoscopy, fibernasalendoscopy and lateral cephalograms. Statistical analysis of the cephalometric measurements showed significant differences of cranial base; projection of maxilla and facial height, in patients with otitis media when compared to the control group or to the ideal measures of the harmonic face. There was no predominance of any facial type. The following measures were found to be predictive of the evolution of otitis media: N-S (anterior cranial base), N-S.Ba (angle between anterior and medial cranial base), PMax (projection of the maxilla) and N-ANS(superior anteior facial height).'

A otite média crônica supurativa caracteriza-se como uma condição inflamatória associada a perfurações amplas e persistentes da membrana timpânica. Na otite média crônica supurativa colesteatomatosa, ocorre a presença do colesteatoma na fenda auditiva, sendo este definido como o acúmulo de queratina esfoliada originada de epitélio escamoso queratinizado na orelha média. Dentre as manifestações mais comuns da otite média crônica supurativa colesteatomatosa (OMCSC), encontram-se perda auditiva, otorreia crônica, sangramentos, otalgia, cefaleia e vertigem. A OMCSC pode afetar o equilíbrio corporal, por estar associada a danos funcionais de orelha interna, podendo resultar em alterações de labirinto posterior, que é o responsável pela percepção da posição e do movimento da cabeça no espaço. Objetivos: avaliar o funcionamento labiríntico de orelhas com OMCSC e observar associações com diferentes faixas etárias. Método: estudo transversal, descritivo e comparativo. A amostra estudada foi constituída por um grupo pesquisa, composto por 72 orelhas com OMCSC, e um grupo controle, constituído de 62 orelhas médias normais. Os indivíduos foram submetidos a avaliação otorrinolaringológica, exame videotoscópico digital, anamnese otoneurológica, avaliação audiológica e exame video Head Impulse Test, capaz de detectar déficits vestibulares periféricos, a partir de uma medida objetiva do ganho do reflexo vestíbulo-ocular. Resultados e conclusões: foram encontradas diferenças no funcionamento labiríntico do canal semicircular lateral dos grupos pesquisa e controle, sendo a média do ganho do reflexo vestíbulo-ocular no grupo com OMCSC significativamente menor que nas orelhas normais. Quando analisadas as faixas etárias, o canal semicircular anterior apresentou média de ganho do reflexo significativamente inferior nas orelhas de indivíduos com OMCSC até 18 anos, quando comparado com as orelhas de indivíduos com OMCSC com mais de 18 anos. Em relação à comparação entre os grupos pesquisa e controle por faixa etária, não foram observadas diferenças entre os grupos, acima de 18 anos, com OMCSC e normal. Contudo, no grupo com menos de 18 anos, as orelhas com OMCSC apresentaram o canal semicircular posterior significativamente mais alterado que as orelhas normais. / Chronic suppurative otitis media is characterized as an inflammatory condition associated with broad and persistent tympanic membrane perforations. In chronic suppurative otitis media with cholesteatoma occurs the presence of cholesteatoma in the middle ear, which is defined as the accumulation of exfoliated keratin originated from squamous keratinized epithelium in the middle ear. The most common manifestations of chronic suppurative otitis media with cholesteatoma (CSOMC) is hearing loss, chronic otorrhea, bleeding, ear pain, headache and dizziness. Thus, the CSOMC can affect the body balance, since it is associated with inner ear functional damage and may result in posterior labyrinth changes, which is responsible for the perception of the position and movement of the head in space. Objective: To assess the labyrinthine functioning of CSOMC ears and observe associations with different age groups. Methods: Cross-sectional, descriptive and comparative study. The sample was made up of a research group, composed of 72 ears with CSOMC, and a control group consisting of 62 normal middle ears. The subjects were submitted to ENT examination, digital videotoscópico examination, otoneurological clinical history, audiological evaluation and examination with Video Head Impulse Test, capable of detecting peripheral vestibular deficits from an objective measure of the gain of the vestibular-ocular reflex. Results and conclusions: Differences were found in the labyrinthine functioning of the lateral semicircular canal of the research and control groups, being that the average gain of the vestibulo-ocular reflex in the group with CSOMC was significantly less than the average gain in normal ears. When analyzed age groups, the anterior semicircular canal presented reflex gain average significantly lower in the ears of individuals with CSOMC under 18 years, when compared to the ears of individuals with CSOMC over 18 years. Regarding the comparison of research and control group by age, there were no differences between the groups with CSOMC and normal group above 18 years. However, in the group under 18 years, the CSOMC ears presented the posterior semicircular canal significantly more altered than the normal ears.