Daily home tympanometry to study the pathogenesis of otitis media

Abstract

A study was conducted to define the temporal relationship between a parent-identified cold episode and the diagnosis of otitis media. Forty children were studied in their homes with the use of daily tympanometry, symptom diaries and weekly otoscopy. A total of 136 patients identified colds, and 43 episodes of otitis media were recorded. New episodes of otitis media were observed in 22% of all colds, and 63% of all otitis media episodes occurred during a cold.

A high prevalence of new onset otitis media during parent diagnosed common colds

“…Indeed, our past studies that used paired symptoms and tympanometric measures available from daily parental assessments through the cold/flu season reported similar results with respect to OM/cold coincidence and OM (flat tympanogram) duration [20,21]. We expect that the prospective, longitudinal, high temporal resolution format of this study when coupled with specific host, bacterial and viral assays and applied to large populations (as is presently planned) will identify the moderating factors for OM expression during viral colds/flus and, thereby, define the characteristics of the subpopulation most likely to benefit from interventions.…”

“…A strict cost-benefit analysis of those potential interventions requires that, in addition to estimating the coincidence of OM and cold/flu, the average duration of the episode needs to be quantified [19]. This was not done in previous studies and requires a high temporal resolution with respect to OM duration in weeks, or ideally days [20,21].…”

A formal description of middle ear pressure-regulation

“…Also, it is known that ET opening efficiency has both a constitutive and a situational component and that constitutive efficiency is downgraded temporarily during conditional situations such as an extant viral upper respiratory infection (Doyle et al, 2014). Simulations 5 and 6 predict that a downgraded ET opening efficiency will be expressed as a less efficient MEPR for those periods which is accompanied by a consequent negative shift in the EV-MEEPG, effects validated by the change in MEEPG (tympanometric pressure) observed for children and adults during natural and experimental upper respiratory viral infections (Antonio et al, 2002; Buchman et al, 1995; Moody et al, 1998). In addition, emergent features of the model such as physiologic ME species-pressures (Simulation 6), the negative EV-MEEPG for all ET opening efficiencies not equal to 1 (Simulation 3), and the perfusion-limitation on the rate of MEEPG change (Simulations 2, 3) are consistent with clinical measurement (Antonio et al, 2002; Felding et al, 1987; Hergils et al, 1990; Hergils et al, 1997; Moody et al, 1998; Sade et al, 1993) and experimental results (Buchman et al, 1995; Teixeira et al, 2015; Teixeira et al, 2016).…”

Characterization of middle-ear condition of Oporto daycare children up-to 3 years-old: A cross sectional study

“…This occurs because ETD generally is a common endpoint for viral-induced pathology, including increased production and stasis of secretions, swelling of respiratory mucosa of the Eustachian tube (resulting in intrinsic obstruction), and enlargement of adenoids (resulting in extrinsic obstruction). These cause negative middle ear pressure which predispose to middle ear effusion by aspiration or nasopharyngeal's insufflations [21].…”