Moacyr Saffer

Chronic Secretory Otitis Media: Negative Bacteriology

There is disagreement on the role of bacteria in the genesis and maintenance of chronic secretory otitis media (CSOM). Extensive studies from other countries report up to 40% of middle ear cultures with bacterial growth. For the present study, material was collected from 94 ears of children with both clinical and tympanometric diagnoses of CSOM. The samples were sent for bacteriological analysis, in there it was stained according to Grams method and put into growing media: MacConkey (for gram-negative bacteria) and blood agar (for gram-positive bacteria) for 24 h, at 37 degrees C. If germs were identified by Grams method, antibiograms would be carried out as well, with the Mueller Hington medium. No cultures were made for anaerobes. Only one ear had grown bacteria (Staphylococcus epidermidis), which was deemed contamination. No other ear studied bore bacteria. The possible causes for this disagreement between our study and the literature are discussed.

Lateral sinus thrombosis and cervical abscess complicating cholesteatoma in children: Case report and review

To call attention to complications of chronic otitis media, the case of a patient who simultaneously developed lateral sinus thrombosis and Bezolds abscess is reported. A 7 year old boy presented with fever, drowsiness, cervical mass and otorrhea not responding to medical management. Work-up revealed lateral sinus thrombosis and cervical abscess secondary to right ear cholesteatoma. After treatment with surgery and antibiotics, he had a favorable outcome. We review the literature regarding the diagnosis and management of these complications and concluded that although less frequent they remain a clinical challenge.

Encephalocraniocutaneous lipomatosis with otolaryngologic manifestations: a rare neurocutaneous syndrome

Encephalocraniocutaneous lipomatosis (ECCL) is a rare congenital disorder and was first described in 1970. The main clinical features of the syndrome include convulsions beginning in infancy, mental retardation, and unilateral cutaneous and ophthalmologic lesions with ipsilateral cerebral manifestations. A 14-year-old caucasian boy with ECCL associated with otolaryngologic manifestations is reported. To our knowledge, this is the first case of ECCL with otolaryngologic manifestation in the English literature.

[Otitis media with effusion: expectant management]

OBJECTIVE: Despite the fact that chronic otitis media with effusion (OME) is an entity with a high prevalence among children, the real effectiveness of most treatments in use nowadays has not been completely established. Based on its natural course, we defend an expectant management as the initial treatment. METHODS: We undertook a review of the available data taking into consideration the natural history, epidemiology and therapeutic options for OME. We looked for a guideline concerning the best treatment for OME in children. RESULTS: The treatment of OME still remains controversial, in spite of many therapeutic options. In children, the best management still seems to be the observation, probably for a period of three to six months. However, interventionist treatment should be done earlier on those patients considered as high risk or in which a problem happened with their development, due to hearing loss secondary to OME. CONCLUSIONS: The understanding of the several factors involved in the pathogenesis of OME, as well as of the features in its evolutive course, encourage the idea of a conservative expectant approach at first or up to the moment in which an interventionist approach (clinical or surgical) is justified.

Otoscopy and tympanometry in the diagnosis of secretory otitis media

OBJECTIVE: To study the sensitivity and specificity of otoscopy and tympanometry in the diagnosis of secretory otitis media. METHODS: A prospective study was performed in 98 children (196 ears) with indication of myringotomy with placement of tympanostomy tube because of the diagnosis of secretory otitis media. All these patients had conductive hearing loss and/or delay of speech and/or low school performance. To evaluate the diagnostic power of the tests, both otoscopy and tympanometry were performed. Myringotomy was established as the gold-standard. The statistical analysis was done using the chi-square test, being significant a p<0.05.RESULTS: The mean age of the patients was 6.02 years (sd: 2.93 years). The otoscopy presented sensitivity of 87.5% and specificity of 61.1% and the tympanometry presented sensitivity of 93.75% and specificity of 72.2%. CONCLUSIONS: There was no statistically significant difference in sensitivity between otoscopy and tympanometry for the diagnosis of secretory otitis media, however, tympanometry was significantly more specific than otoscopy (p< 0.01).

Tympanostomy tubes and water

OBJECTIVE An in vitro study was conducted to set the necessary pressure in fluids that could break resistance and cross the opening of a tympanostomy tube. METHODS A water column model was created and graduated in centimeters from base to top. We adapted three sorts of tympanostomy tubes. In each model, fluids were tested (tap water, seawater, river water, soapy water and eardrops). The column was filled with fluid until a threshold was reached, flowing through the tube opening. The threshold was registered and represented the pressure in cmH2O. RESULTS The results show that pressure is necessary so that a fluid can cross the opening of a ventilation tube. CONCLUSION In spite of limitations of our in vitro study, the literature suggests that no ear protection is needed during shower, since there is neither direct flow of water nor pressure in the ear. Bathing with soapy water is potentially dangerous due to the reduction in surface tension. The direct relation of pressure and surface tension through the opening of tympanostomy tubes indicates the need to decrease pressure when diving and to avoid strong head movements in the water.

Tubos de ventilação e Água

Objetivo: Foi realizado pelos autores um estudo in vitro, com o proposito de determinar a pressao necessaria de diferentes tipos de liquido para vencer a resistencia a passagem pelo orificio do tubo de ventilacao. Metodos: Foi criado um modelo de coluna de agua graduado em centimetros a partir da base. Foram adaptados 3 tipos de tubo de ventilacao. Em cada um dos modelos, foi colocado agua da torneira, do mar, da piscina, do rio, agua da torneira com sabao e gota otologica. Preenchia-se o recipiente com microgotas, formando uma coluna liquida ate ocorrer escape. Anotava-se a altura da coluna de agua quando isso ocorria, sendo equivalente a pressao em centimetros de agua (cmH2O). Resultados: Os resultados obtidos mostram que e necessario uma determinada pressao para que liquidos atravessem o orificio dos tubos de ventilacao. Conclusao: Apesar das limitacoes dos resultados in vitro, a literatura atual demonstra que nao ha razao para proteger a orelha durante banho de chuveiro, onde a agua cai de forma indireta e sem pressao. Banheira com agua e sabao e potencialmente perigoso devido a reducao da tensao superficial do liquido. A relacao direta entre pressao dos liquidos versus a tensao superficial sobre o orificio do tubo de ventilacao implica na necessidade de diminuir de alguma forma esta pressao durante os mergulhos em qualquer meio liquido e evitar movimentos bruscos da cabeca dentro da agua