A prerequisite for a functioning middle ear is an air-filled middle ear cavity. Aeration of the middle ear cavity is controlled by the Eustachian tube. Dysfunction of the Eustachian tube has long been acknowledged as a significant etiological factor in disorders of the middle ear, especially middle ear effusions. Artificial ventilation of the middle ear through the tympanic membrane has been practised for almost two centuries, but with varying degrees of success. In 1954, Armstrong reintroduced the method of inserting a transmyringeal tympanostomy tube into the ear drum. Since that time this ventilatory device has gained wide popularity and several types of tube have been designed. However, an increasing number of clinical reports have shown treatment with tympanostomy tubes to be followed by complications such as tympanosclerosis, atrophy, persistent perforations and cholesteatomas. In the present thesis, experiments were outlined in which the tympanostomy tube - tympanic membrane interaction was studied and in which tympanostomy tubes were also applied in a well-defined type of otitis media. Furthermore, alternative transmyringeal ventilatory procedures such as myringotomies with a delayed healing time were investigated. The results were evaluated with morphological and microbiological methods. Repeated tympanostomy tube insertions in ears of healthy rats caused a remarkable thickening (about 30-fold) of the tympanic membrane of the tubulated quadrants, but even the untouched quadrants were affected. The thickened areas were characterized mainly by an increase in dense connective tissue which also contained sclerotic plaques. The structural changes in the tympanic membrane were still present 3 months after the final ventilation episode. Cleavage of the rat soft palate caused an immediate accumulation of effusion material in the tympanic cavity due to disturbance of Eustachian tube function. The fluid turned purulent within one to two weeks. The microbial flora of the middle ear cavity correlated well with that of the nasopharynx, indicating an ascending infection. Insertion of a tympanostomy tube could prevent the accumulation of effusion material in the meso- and hypotympanon and significantly suppress bacterial growth in the middle ear cavity. Thermal energy-inflicted myringotomies were tested as an alternative method for establishing transmyringeal ventilation. Myringotomies performed either with a CCL-laser or by diathermy showed a delayed healing pattern, most probably due to widespread destruction of the outer keratinized squamous epithelium and damage to the vascular supply. Upon comparison, laser myringotomies appeared more favourable due to their longer closure times, whereas the perforations accomplished by diathermy were often complicated by otorrhea and showed more advanced structural changes. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1985, härtill 6 uppsatser.</p> / digitalisering@umu

Otitis media and consequent hearing loss are known to be high in Koori communities. Previous research on otitis media in Koori communities has focused on its identification, treatment and management. Little research has focused on the prevention of otitis media. Victorian Aboriginal communities often have small populations which result in small sample sizes for research projects. Consequently use of traditional quantitative methods to measure of change arising from health interventions can be problematic. The aim of the research was to describe Koori children’s otitis media risk factors using a Koori research method in order to develop, implement and evaluate preventative interventions.

Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 5 uppsatser.

Dentre as doenças infecciosas que causam algum grau de comprometimento auditivo, a otite média é a mais prevalente. Esta é a patologia que mais frequentemente leva crianças ao atendimento médico. Quando não tratada adequadamente, suas complicações e sequelas podem persistir até a idade adulta, tornando-se crônica. Objetivo: comparar a perda auditiva resultante da Otite Média Crônica Supurativa (OMCS) colesteatomatosa e não colesteatomatosa entre crianças e adultos; comparar os valores de via aérea nas frequências de 250 a 8000Hz, entre crianças e adultos com OMCNC e OMCC; comparar os valores de via óssea nas frequências de 500 a 4000 Hz, entre crianças e adultos com OMCNC e OMCC; comparar os valores de gap aéreo-ósseos, nas frequências de 500 à 4000Hz, entre crianças e adultos com OMCNC e OMCC. Método: estudo transversal, observacional, comparativo e contemporâneo, com dados subindividuais (orelhas), tendo como sujeitos em estudo crianças e adultos com diagnóstico de OMCC ou OMCNC. Resultados e conclusões: os limiares de VA nas OMCNC nas frequências de 250 a 8000 Hz apresentaram-se significativamente menores nos pacientes pediátricos. No grupo de adultos, não houve diferença significativa nos limiares auditivos de VA. Os limiares de VO nas frequências de 500 a 4000 Hz apresentaram-se igualmente maiores no grupo dos adultos. No grupo pediátrico, não se observou diferença estatisticamente significativa entre os valores de VO. No grupo de crianças com OMCNC, os valores dos gap aéreo-ósseos nas frequências de 500 e 1000 Hz foram significativamente menores. Nos demais grupos, independentemente da faixa etária e do diagnóstico de OMCS, não foram encontradas diferenças estatisticamente significativas em nenhuma frequência testada entre os gap aéreo-ósseos. Considerando-se que o tempo de sintoma entre os adultos é maior, os resultados sugerem maior agressividade da OMCC entre as crianças em termos auditivos. / Among the infectious diseases that causes some degree of hearing loss, otitis media is the most predominant. This is the pathology that most often leads children to medical care and, if not treated properly, complications and sequels may persist into adulthood. Objective: Compare the values of air conduction thresholds (at frequencies from 250 to 8000Hz), bone conduction thresholds and air bone gap ( at frequencies from 500 to 4000Hz) among children and adults with Chronic suppurative otitis media (CSOM) with cholesteatoma (CCOM) and without cholesteatoma (NCCOM). Methods: Cross-sectional study, with 525 children and adults diagnosed with CCOM or NCCOM, submitted to pure tone audiometry. Results and Conclusions: The air conduction thresholds at frequencies of 250 to 8000 Hz were significantly lower in pediatric patients with NCCOM . Between adult groups, there was no significant difference in hearing in air bone threshold. The bone conduction thresholds at 500 to 4000 Hz were also higher in both adult groups. Between pediatric groups no statistically significant difference in bone conduction thresholds was observed. In the group of children with NCCOM values of air-bone gap at 500 and 1000 Hz were significantly lower. In the other groups, regardless of age and diagnosis of CSOM, no statistically significant differences were found in any frequency tested between the air-bone gap. Considering that the time of symptom among adults is higher, the results could suggest a more aggressive CCOM among children in hearing terms.

Otitis media is a quite common disease, especially in children due largely to their underdeveloped Eustachian tubes. One potential factor, thought to be a large contributor to the disease, is an allergic reaction causing congestion and blockage of the Eustachian tube, leaving the middle ear prone to bacterial infection and effusions. The H3 receptor has recently been discovered in the nasal mucosa of humans and rodents and is linked to the immune response. Excess histamine released in an allergic response causes nasal vascular constriction and congestion. By blocking the H3 receptor, the local vasculature may be allowed to dilate, resulting in decongestion. This could play a large role in the treatment of otitis media with effusion. The effectiveness of betahistine dihydrochloride, an H3 receptor blocker, in providing possible relief from middle ear congestion was tested using a rat model. An allergic response was induced in rats followed by one of two betahistine dihydrochloride treatment regimens: drug delivery via transtympanic or intranasal route. Changes in Eustachian tube function were monitored during this process. Four measurements were used to measure the function of the Eustachian tube: passive opening pressure, passive closing pressure, active clearance of negative pressure, and Mucociliary transit time. Lower opening pressure and closing pressure, higher clearance of negative pressure, and shorter Mucociliary transit time were indications of better Eustachian tube function. Regardless of delivery method, no significant results were found among the experimental groups to suggest improved Eustachian tube function after drug treatment. Although the middle dose of betahistine dihydrochloride (50 mg/mL) delivered transtympanically followed the expected response outcome, the trend did not achieve statistical significance. Overall, the results of this study are inconclusive for measuring the beneficial effects of betahistine dihydrochloride on Eustachian tube function. Further investigations are being conducted to measure the magnitude and duration of the effects of allergic responses on Eustachian tube anatomy and physiology.

Este estudo apresenta os resultados de tratamento em 83 pacientes com Idade entre 2–10 anos, que apresentaram otite média secretora com efusão, bilateral ou unilateral, acompanhada ou não de hipertrofia de adenóides e cornetos, no Hospital Universitário São Francisco de Paula da Universidade Católica de Pelotas – UCPel, no período de julho de 1997 a julho de 1999. Os pacientes foram submetidos a timpanocentese com uso do Microcautério por Rádio-freqüência (modelo Lavinsky – HCPA), uni ou bilateralmente. Na avaliação periódica de 15 dias, um mês e três meses, observamos dois pontos principais: a) a cura dos pacientes (que apresentaram membrana e caixa timpânica normais); b) a relação com a literatura em trabalhos semelhantes com uso do Laser CO2. Relatamos também a incidência em percentuais, com identificação das alterações de imagem da membrana timpânica nestes três períodos cronológicos, e na distribuição conforme cor, sexo e idade, uni/bilateralidade e simultaneidade na presença das duas afecções relatadas. Na avaliação final, percebemos 80,5% de cura da patologia. Na comparação com a literatura existente sobre o uso de Laser CO2, os nossos resultados mostraram-se homogêneos. O tempo de oclusão da membrana timpânica foi de 2,73 meses (desvio – padrão = 1,39 meses), normalizando a secreção da caixa timpânica. / This study refers to the results of treatment carried out in the São Francisco de Paula University – UCPel, from July, 1997 to July 1999 on 83 patients aged between 2 and 10 who suffered from bilateral or unilateral secretory otitis media with or without hypertrophy of adenoids and turbinal bones. The patients were subjected to otological microsurgery by using Microelectrocauterization by Radio frequency (Lavinsky pattern – HCPA), unilaterally or bilaterally simultaneously, with the presence of adenoids and hypertrophical turbinal bones whenever they appeared. Check ups at regular intervals of 15 days, a month and three months disclosed two topics. First, all the patients who had normal eardrums and membrane were cured. Secondly the relation with books on similar studies using CO2 LASER. We have also reported the eardrums membrane in these three chronological periods and in the distribution according to colour, sex and age, unilateral or bilateral nature and simultaneity in the presence of the two diseases reported. At the final evaluation we noticed 80,5% of cure of the nosology. Our results when compared with the information in the books which referred to CO2 LASER were homogeneous. The time of obstruction of the eardrums membrane was 2,73 months (standard deviation = 1,39 months), and the secretion of the eardrums became normal.

Introdução: A otite média crônica é definida pela presença de alterações inflamatórias teciduais irreversíveis na fenda auditiva. A teoria do continuum a respeito da sua patogênese sugere que as fases mais precoces da otite média, aguda, serosa ou secretora podem progredir para cronificação. Desta forma, pode-se supor que a grande prevalência de bilateralidade da otite média secretora também pode ser observada na otite crônica. Objetivo: determinar a prevalência de alterações na orelha contralateral em ossos temporais humanos de portadores de otite média crônica. Metodologia: Os ossos temporais humanos foram analisados sob microscopia óptica. Definiu-se como orelha contralateral a orelha normal ou menos comprometida. As alterações histopatológicas foram classificadas por ordem crescente de gravidade. Para comparação entre as variáveis qualitativas, utilizou-se o teste de Chi-quadrado, nas correlações o coeficiente de Spearman, sendo estatisticamente significativos P≤0,05. Resultados: Foram estudados 85 pares de ossos temporais, 22,4% com colesteatoma no lado mais comprometido. A prevalência de orelhas contra laterais com alterações foi de 91,8%, sendo as principais tecido de granulação (81%), efusão (58%) e retração da membrana timpânica (35%). Não houve diferença na prevalência de alterações significativas na orelha contralateral entre os gêneros, crianças e adultos, imunossuprimidos ou não e com ou sem colesteatoma na pior orelha. Houve correlação da extensão do tecido de granulação (rS=0,345, P=0,004) e do colesteatoma (rS=0,617, P<0,0001) entre as orelhas. Conclusão: Podemos observar alta prevalência de alterações orelha contralateral. A correlação entre a extensão tanto do tecido de granulação quanto do colesteatoma entre os dois lados, sugere, corroborando a hipótese do continnuum, que as alterações constitucionais do indivíduo podem estar implicadas na cascada de eventos que leva à cronificação e que isto pode ocorrer bilateralmente. / Objective: To determine the prevalence of contra lateral middle ear cleft pathologic findings in human temporal bones with chronic otitis media. Study design: Transversal Material and Methods: The humam temporal bones was analised under optical microscopy. Chronic otites media was definied by the presence of irreversible inflammatory alterations in the middle ear cleft. The contralateral ear was defined as the normal or the less alterated one. The histopathologic alterations were described and classified in a crescent severity order. To compare the quantitative variables it was used the Chi square test and for correlations it was used Sperman coefficient (P≤0.05) Results: It has been studied 85 pairs of temporal bones. 22.4% had cholesteatoma in the most damaged ear. The prevalence of contra lateral ears with alterations was 91.8%. The main alterations were granulation tissue (81%), effusion (58%) and tympanic membrane retractions (35%). There was not difference between the genders, adults and children, imunossupressed or not, with or without cholesteatoma. There was a direct correlation between the both ears in relation to granulation tissue (rS=0.345, P=0.004) or cholesteatoma extension (rs=0.617, P<0.001). Conclusion: We can observe a high prevalence of contralateral ears alterations and the granulation tissue was the most frequent. The correlation between the ears about the granulation tissue and cholesteatoma extension suggest, in agreement with the continuum, that the individual constitutional alterations are involved in the sequential events that go to cronification.

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.

Objetivos: analisar a associação entre otite média crônica não colesteatomatosa (OMCNC) e os resultados obtidos no video head impulse test (vHIT). Delineamento: tipo transversal. Métodos: a amostra foi selecionada em ambulatório especializado de um hospital universitário. A inclusão dos pacientes neste estudo obedeceu aos seguintes critérios: idade entre 7 e 59 anos; diagnóstico de OMCNC unilateral, com orelha contralateral normal; não ter realizado cirurgia otológica prévia; não ter comprometimentos cognitivos e/ou neurológicos e/ou motores registrados nos prontuários. Os critérios de exclusão foram: impossibilidade de retirada de maquiagem nos olhos (impossibilita a execução do exame); não compreensão ou dificuldade na execução das ordens do exame. Os pacientes foram divididos em Grupo A (7 a 19 anos) e Grupo B (20 a 59 anos). Todos foram avaliados por meio de exame otorrinolaringológico padrão do ambulatório, anamnese e vHIT. Os exames com valor de ganho superior a 0,8 foram considerados normais. Os canais com valores de ganho entre 0,6 e 0,8 foram classificados, nesta pesquisa, como limítrofe. Nos casos considerados limítrofes, foi analisado o valor da assimetria para diagnóstico, que foi considerada anormal acima de 20%. Para o cálculo amostral evidenciou que o número mínimo de indivíduos avaliados seria de, 10 sujeitos no grupo A e 20 sujeitos no grupo B. Resultados: a amostra total foi composta por 32 indivíduos. O grupo A foi formado por 11 indivíduos, com idade média de 12,7 ± 3,9 anos e o grupo B por 21 indivíduos, com idade média de 46,3 ± 11,1 anos. A análise dos resultados do vHIT revelou que não houve diferença significativa entre o lado considerado normal e o lado considerado afetado, considerando-se a análise intragrupo e entre grupos. Conclusão: a pesquisa evidenciou que, na amostra estudada, não houve diferença nos resultados obtidos no vHIT entre os lados afetados e não afetados pela OMCNC. / Objectives: To analyze the association between chronic otitis media (COM) without cholesteatoma and results in the video head impulse test (vHIT). Design: Cross sectional. Methods: The sample was selected in a specialized clinic of a university hospital. Patient inclusion in this study obeyed the following criteria: age between 7 and 59 years; diagnosis of unilateral COM without cholesteatoma with normal contralateral ear; not having done previous ear surgery; not having cognitive impairment and / or neurological and / or motor recorded in the medical records. The exclusion criteria were: patients with eye makeup, which cannot be removed (makes it impossible to perform the exam); patients who did not understand the operation of the test and therefore could not accomplish it. Patients were divided in group A (7 to 19) and group B (20 to 59) years of age. Both groups performed standard outpatient otolaryngology evaluation, clinical history and video head impulse test. Exams with a gain above 0.8 were considered normal. Canals gain values between 0.6 and 0.8 were classified in this study as borderline. In borderline cases considered, we analyzed the value of asymmetry for diagnosis, which was considered abnormal over 20%. For sample size calculation showed that the minimum number of individuals assessed was of 10 subjects in group A and 20 subjects in group B. Results: The total sample consisted of 32 individuals. Group A consisted of 11 subjects mean with an average age of 12.7 ± 3.9 years and the group B of 21 subjects with an average age of 46.3 ± 11.1 years. Analysis of the vHIT results showed no significant difference between the side considered normal and the side considered affected, considering the intra-group and between groups analysis. Conclusion: The research showed that, in our sample, there was no difference in the results obtained in vHIT between the affected side and the not affected by COM without cholesteatoma.

Dentre as doenças infecciosas que causam algum grau de comprometimento auditivo, a otite média é a mais prevalente. Esta é a patologia que mais frequentemente leva crianças ao atendimento médico. Quando não tratada adequadamente, suas complicações e sequelas podem persistir até a idade adulta, tornando-se crônica. Objetivo: comparar a perda auditiva resultante da Otite Média Crônica Supurativa (OMCS) colesteatomatosa e não colesteatomatosa entre crianças e adultos; comparar os valores de via aérea nas frequências de 250 a 8000Hz, entre crianças e adultos com OMCNC e OMCC; comparar os valores de via óssea nas frequências de 500 a 4000 Hz, entre crianças e adultos com OMCNC e OMCC; comparar os valores de gap aéreo-ósseos, nas frequências de 500 à 4000Hz, entre crianças e adultos com OMCNC e OMCC. Método: estudo transversal, observacional, comparativo e contemporâneo, com dados subindividuais (orelhas), tendo como sujeitos em estudo crianças e adultos com diagnóstico de OMCC ou OMCNC. Resultados e conclusões: os limiares de VA nas OMCNC nas frequências de 250 a 8000 Hz apresentaram-se significativamente menores nos pacientes pediátricos. No grupo de adultos, não houve diferença significativa nos limiares auditivos de VA. Os limiares de VO nas frequências de 500 a 4000 Hz apresentaram-se igualmente maiores no grupo dos adultos. No grupo pediátrico, não se observou diferença estatisticamente significativa entre os valores de VO. No grupo de crianças com OMCNC, os valores dos gap aéreo-ósseos nas frequências de 500 e 1000 Hz foram significativamente menores. Nos demais grupos, independentemente da faixa etária e do diagnóstico de OMCS, não foram encontradas diferenças estatisticamente significativas em nenhuma frequência testada entre os gap aéreo-ósseos. Considerando-se que o tempo de sintoma entre os adultos é maior, os resultados sugerem maior agressividade da OMCC entre as crianças em termos auditivos. / Among the infectious diseases that causes some degree of hearing loss, otitis media is the most predominant. This is the pathology that most often leads children to medical care and, if not treated properly, complications and sequels may persist into adulthood. Objective: Compare the values of air conduction thresholds (at frequencies from 250 to 8000Hz), bone conduction thresholds and air bone gap ( at frequencies from 500 to 4000Hz) among children and adults with Chronic suppurative otitis media (CSOM) with cholesteatoma (CCOM) and without cholesteatoma (NCCOM). Methods: Cross-sectional study, with 525 children and adults diagnosed with CCOM or NCCOM, submitted to pure tone audiometry. Results and Conclusions: The air conduction thresholds at frequencies of 250 to 8000 Hz were significantly lower in pediatric patients with NCCOM . Between adult groups, there was no significant difference in hearing in air bone threshold. The bone conduction thresholds at 500 to 4000 Hz were also higher in both adult groups. Between pediatric groups no statistically significant difference in bone conduction thresholds was observed. In the group of children with NCCOM values of air-bone gap at 500 and 1000 Hz were significantly lower. In the other groups, regardless of age and diagnosis of CSOM, no statistically significant differences were found in any frequency tested between the air-bone gap. Considering that the time of symptom among adults is higher, the results could suggest a more aggressive CCOM among children in hearing terms.