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Introduction With the growing popularity of telemedicine and tele-diagnostics, clinical validation of new devices is essential. This study sought to investigate whether high-definition digital still images of the eardrum provide sufficient information to make a correct diagnosis, as compared with the gold standard view provided by clinical microscopy. Methods Twelve fellowship-trained ear physicians (neurotologists) reviewed the same set of 210 digital otoscope eardrum images. Participants diagnosed each image as normal or, if abnormal, they selected from seven types of ear pathology. Diagnostic percentage correct for each pathology was compared with a gold standard of diagnosis using clinical microscopy with adjunct audiometry and/or tympanometry. Participants also rated their degree of confidence for each diagnosis. Results Overall correctness of diagnosis for ear pathologies ranged from 48.6-100%, depending on the type of pathology. Neurotologists were 72% correct in identifying eardrums as normal. Reviewers' confidence in diagnosis varied substantially among types of pathology, as well as among participants. Discussion High-definition digital still images of eardrums provided sufficient information for neurotologists to make correct diagnoses for some pathologies. However, some diagnoses, such as middle ear effusion, were more difficult to diagnose when based only on a still image. Levels of confidence of reviewers did not generally correlate with diagnostic ability.

OBJECTIVE Otitis media is a common problem in the pediatric population. Despite antibiotic therapy, post-tympanostomy otorrhea can be difficult to treat. Biofilms have been shown to play a role in chronic and recurrent otitis media and are implicated in otorrhea. This study investigated both the microbial composition and the presence of biofilm fragments rich in extracellular DNA (eDNA) and the bacterial DNA-binding protein, integration host factor (IHF) in post-tympanostomy tube otorrhea STUDY DESIGN clinical samples METHODS Institutional review board approval was obtained and samples were recovered from pediatric patients with tympanostomy tubes and persistent otorrhea for both microbial culture and biofilm analysis. For biofilm assessment, frozen samples were sectioned then labeled using a rabbit anti-IHF which was detected with goat anti-rabbit IgG conjugated to AlexaFluor 594. Samples were then counterstained with DAPI to detect DNA and images were captured by inverted light microscopy. RESULTS Of 15 pediatric otorrhea samples analyzed, 9 (60%) contained solids that were positive for labeling of IHF in association with a lattice of eDNA, and 75% yielded positive bacterial cultures. Bacterial culture results included H. influenzae, MRSA, S. pneumoniae, M. catarrhalis, and P. aeruginosa. CONCLUSION Positive labeling of otorrhea solids for eDNA and IHF in combination with microbiological culture results indicated that biofilms likely played a key role in chronic otorrhea. Moreover, as a known critical structural component of biofilms, these findings suggest that DNABII proteins in association with eDNA may serve as an important therapeutic target in post-tympanostomy tube otorrhea.

Objective To investigate the effects of nasal continuous positive airway pressure (CPAP) and cannula use in the neonatal intensive care unit. Design Cross-sectional study. Setting Tertiary care children’s hospital. Patients One hundred patients (200 nasal cavities), younger than 1 year, who received at least 7 days of nasal CPAP (n = 91) or cannula supplementation (n = 9) in the neonatal intensive care unit. Interventions External nasal examination and anterior nasal endoscopy with photographic documentation. Main Outcome Measures The incidence and characteristics of internal and external nasal findings of patients with nasal CPAP or cannula use. Results Nasal complications were seen in 12 of the 91 patients (13.2%) with at least 7 days of nasal CPAP exposure, while no complications were seen in the 9 patients with nasal cannula use alone. The external nasal finding of columellar necrosis, seen in 5 patients (5.5%), occurred as early as 10 days after nasal CPAP use. Incidence of intranasal findings attributed to CPAP use, in the 182 nostrils examined, included ulceration in 6 nasal cavities (3.3%), granulation in 3 nasal cavities (1.6%), and vestibular stenosis in 4 nasal cavities (2.2%). Intranasal complications were seen as early as 8 to 9 days after nasal CPAP administration. Nasal complications from CPAP were associated with lower Apgar scores at 1 (P = .02) and 5 (P = .06) minutes. Conclusions External or internal complications of nasal CPAP can be relatively frequent (13.2%) and can occur early, and patients with lower Apgar scores may be at higher risk. Close surveillance for potential complications should be considered during nasal CPAP use.

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Significant changes in the intracuff pressure occur with changes in head and neck position. In several cases, this resulted in a significant increase in the intracuff pressure. For prolonged cases with the head and neck turned from the neutral position, the intracuff pressure should be measured following patient positioning to ensure that the intracuff pressure is within the clinically recommended range.

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