Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.

M.Tech.

Research was conducted on twenty-seven preoperative myringotomy patients to clarify the correlation between tympanometry type and the presence of middle ear effusion. Test results indicate that the relationship between tympanometry and middle ear effusion is dependent on the amount of fluid present. In impacted ears primarily Type B tympanograms were obtained whereas for less than impacted ears all tympanogram types were seen. Also suggested was that a combination of height of the tympanogram and the amount of negative pressure may be diagnostically more important than negative pressure alone as an indicator of effusion. It was recommended that other measures in addition to tympanometry be employed in the diagnosis of middle ear effusion and that further research is needed to achieve optimal use of impedance audiometry.

Purpose: Otitis media is a global middle ear disease with health and economic burden especially in Africa and other developing nations. Chronic suppurative otitis media is an important cause of preventable hearing loss which warrants attention; particularly in the developing world, as it may have important socio-economic implications over and above patients’ quality of life. When presenting with an infected ear due to chronic suppurative otitis media, one may have impaired hearing and a perforated eardrum/s. Thus a type 1 tympanoplasty, i.e. myringoplasty operation is indicated to seal the eardrum. A review of literature demonstrates that extensive evidence exists on the success rate and efficacy of myringoplasty surgery in terms of audiological improvement worldwide; however there is paucity of evidence within the developing world context. Numerous studies published are from developed countries which are vastly different to developing countries. Thus this study aimed to explore audiological function in a group of adults following myringoplasty within a developing country context. Participants: Participant files from the last six years were obtained from the Ear, Nose and Throat (ENT) and Audiology departments at two academic hospitals in Gauteng, Johannesburg. The total sample comprised of 52 participant files consisting of, 20 males (38%) and 32 females (62%), with ages ranging from 18-63years with a mean age of 39.9 years. All 52 participant files could not be included in all the analysis due to missing biographical and/or audiological information in some of the files. Design: This study was conducted using a retrospective record review quantitative research design; where specific objectives of the study were explored. These included; a description and comparison of hearing function pre and post myringoplasty and an exploration of the possible influence of factors such as HIV/AIDS and type of surgical technique on hearing outcome post-surgery. Data analysis: Data was analysed using both descriptive and inferential statistics. Inferential statistics in the form of Kolmogorov-Smirnov two sample test and two-tailed paired (dependent) t-test were used to establish statistical significance levels to determine where statistically significant changes occurred pre and post-operatively and to establish if these changes were dependent on specific variables (HIV status and type of surgical technique). Results: Clinically overall hearing improved post-operatively in terms of tympanometry, pure tone audiometry (air-conduction and bone-conduction testing) and speech reception threshold testing. The predictors for improved hearing outcome post-operatively were; HIV negative status and butterfly cartilage inlay surgery as a surgical technique adopted. Although clinically hearing outcomes improved post-operatively at all air-conduction frequencies; statistically the changes in air-conduction hearing function were only statistically significant at specific frequencies. HIV/AIDS appeared to have an influence on hearing outcome post surgery when investigating clinically but these changes were only statistically significant mainly in HIV negative patients at three air-conduction frequencies. No statistically significant differences were found in mean change in hearing function in both HIV negative and positive patients at all bone-conduction thresholds. Although the type of surgical technique (specifically the butterfly cartilage inlay surgery) had an influence on hearing outcome post-surgery; these changes in air-conduction hearing function in patients who underwent this surgical technique were only statistically significant at specific frequencies. For patients who underwent fascia underlay, no statistically significant changes were found postoperatively. Conclusion: Current findings offer valuable baseline evidence on hearing outcome pre and post myringoplasty within this developing country context. This evidence can serve as a baseline for future research in the South African population. The study yielded relevant information regarding variables affecting the outcome of myringoplasty surgery in a South African context which is essential in the management of patients from an audiological and surgical perspective.

While there is agreement in the literature that otitis media is an extremely prevalent disorder among young children, there is disagreement as to the effect that otitis media has on language development. The lack of definitive research attests to the complexity of the issue and to the need for continued research. This study examined the relationship between an early history of otitis media and the language development of a group of "late talkers". The 28 toddlers in this group, while otherwise normal, were late to begin to speak. Each of the subjects was placed into one of two subgroups, depending upon their reported experience with otitis media. When the children were four years old, they were evaluated using the TOLD-P and a spontaneous speech sample. A similar group of 25 children who had a history of normal language development was also examined.

Acute otitis media is the most common illness diagnosed during early childhood that can cause significant morbidity (Brook, 1994) and sometimes can cause irreversible sequelae such as a hearing defect and subsequent learning difficulties (Klein, 1994). The aims of the research presented here were to study some aspects of the middle ear defence mechanisms in both immune and non-immune rats following experimental otitis media (OM) with two pathogens nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis (M. catarrhalis). This study also aimed at developing a suitable technique for preparing immunohistochemical staining of middle ear sections (chapter 2). A previous study has shown that a regime where rats received an IPP immunisation combined with an IT boost was effective in enhancing clearance of a middle ear infection with the same strain of NTHi and also in the presence of a concomitant viral infection (Moore et al, 2001). Results of this study have shown that for NTHi infection a distinct cellular influx to the middle ear in the immune rats was accompanied by an enhanced bacterial clearance compared to the non-immunised rats (chapter 3). This cellular influx was responsible for the remarkable reduction in the bacterial number. The sharp decline in PMNs numbers in the NTHi immunised rats that followed complete bacterial clearance at 72h post infection (Table 3.1) indicate a more effectively controlled down regulation of this cell infiltrate than the non-immunised rats. For M. catarrhalis infection, there was no difference in cell infiltrate between immune and non-immune rats, but enhanced clearance of the bacteria were observed for the immune animals. The histopathological changes in the middle ear mucosa of rats with experimentally induced infection were studied to provide a better understanding about the distribution of the inflammatory cells and changes in the mucosa during the first 24h post challenge with NTHi and M. catarrhalis (Chapter 4). These changes have not been previously studied for the two pathogens at 24h post challenge in rats. Induced infections with the two pathogens were found to produce similar histopathological changes but more inflammatory infiltration was observed within the infected mucosa with NTHi than that seen with M. catarrhalis. The infections were characterized by increased thickness of the middle ear mucosa, Eustachian tube mucosa, periosteum and tympanic membrane. There was also an increase in the number and size of small blood vessels at all sites, and these small blood vessels seem to be the source of the inflammatory infiltration into the middle ear mucosa and middle ear cavity during the infection. These findings provided an essential background to the immunohistochemical study. The effect of mucosal immunisation on the distribution of CD4+T cells and CD8+T cells has not been investigated previously. Results of the present study (Chapter 5) show the pattern of distribution of these cells during the first 48h post infection with NTHi in the rat. The number of CD4+and CD8+T cells peaked at 24h post infection in the nonimmunised animal and were highest at 48h post-infection in the immunised rats. The difference in response in the immunised rats may represent regulation of the inflammatory response by the immune system. The inflammatory response regulation is indicated by the difference in cellular influx into the immune rats and the response in the immune rats that corresponds to enhanced bacterial clearance prior to a decrease in numbers of inflammatory cells once the bacteria was no longer detected (Chapter 3). This resolution of the inflammatory mass would reduce the opportunity for continued damage to local tissue. These changes are also supported by the reduction in the thickness of the middle ear mucosa of the immunised rats especially at 24h and 48h post-infection (Chapter 5). This study has shown that there are distinct differences in the rate of bacterial clearance and cellular changes in the middle ear mucosa and tympanic bulla in immunised rats during a middle ear infection. Future studies are still required to gain a better understanding of differences in the inflammatory response for both pathogens, NTHi and M. catarrhalis.

Diss. (sammanfattning) Umeå : Univ., 2003. / Härtill 4 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 5 uppsatser.

Thesis (M.A.)--Northern Kentucky University, 2008. / Made available through ProQuest. Publication number: AAT 1450592. ProQuest document ID: 1495953201. Includes bibliographical references (p. 30-32)

The purpose of this study is to evaluate the past and recent literature in order to determine the role of pre-operative CT scans in chronic otitis media. We aim to find consensus on the diagnostic ability of CT imaging in various anatomical parts of the middle ear and mastoid, and how this knowledge can affect clinical and surgical management. In context of all literature, there has been mixed results when looking at the sensitivity and specificity of middle ear structures. There was favorable consensus for CT's diagnosis of erosion of the malleus-incus complex, lateral semicircular canal, the facial nerve canal, and presence of soft tissue in the middle ear cavity. There were mixed results with respect to the erosion of tegmen tympani, and sigmoid sinus. Lastly, there was an unfavorable consensus when looking at the erosion of the stapes, oval window, and round window. Various studies conclude that the information gained from CT regarding the condition of the mastoid and middle ear can influence both the type of surgical method used and the success rate by reducing the risk of complications and recurrence of disease. In many studies, the methodology and interpretation of the CT scans are not very well presented. This unfortunately disallows meta-analysis between studies as the number of uncontrolled variables is too large. In the future, we hope that more information is provided as to the method of interpretation as well as the type of CT scanner and dosage. This will allow for a more meaningful result when comparing sensitivities and specificities towards middle ear pathologies, and it will allow for better examination of image quality and usefulness in context of the risk of radiation. Many otologists make routine use pre-operative CT scans in cases of chronic otitis media while others are more selective. In order to reach a consensus, however, more research focused on specific the decision-making process of physicians.