Evidence and evidence gaps in the treatment of Eustachian tube dysfunction and otitis media

Teschner, Matthias

doi:10.3205/cto000132

Cited by 9 publications

(3 citation statements)

References 111 publications

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“… 7 ). One theory is that initial viral infection of the nasopharynx leads to an inflammatory reaction in the Eustachian tube, causing Eustachian tube dysfunction, and translocation of bacteria into the middle ear cavity (Refs 8 , 9 ). This is also consistent with the notion that the Eustachian tube is shorter and more horizontal in children than adults, which could facilitate bacterial translocation and contribute to their relatively higher risk of OM.…”

Section: Methodsmentioning

confidence: 99%

Dysregulation of immune response in otitis media

Mather

Powell

Talks

et al. 2021

Expert Rev. Mol. Med.

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Objective Otitis media (OM) is a common reason for children to be prescribed antibiotics and undergo surgery but a thorough understanding of disease mechanisms is lacking. We evaluate the evidence of a dysregulated immune response in the pathogenesis of OM. Methods A comprehensive systematic review of the literature using search terms [otitis media OR glue ear OR AOM OR OME] OR [middle ear AND (infection OR inflammation)] which were run through Medline and Embase via Ovid, including both human and animal studies. In total, 82 955 studies underwent automated filtering followed by manual screening. One hundred studies were included in the review. Results Most studies were based on in vitro or animal work. Abnormalities in pathogen detection pathways, such as Toll-like receptors, have confirmed roles in OM. The aetiology of OM, its chronic subgroups (chronic OM, persistent OM with effusion) and recurrent acute OM is complex; however, inflammatory signalling mechanisms are frequently implicated. Host epithelium likely plays a crucial role, but the characterisation of human middle ear tissue lags behind that of other anatomical subsites. Conclusions Translational research for OM presently falls far behind its clinical importance. This has likely hindered the development of new diagnostic and treatment modalities. Further work is urgently required; particularly to disentangle the respective immune pathologies in the clinically observed phenotypes and thereby work towards more personalised treatments.

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Section: Methodsmentioning

confidence: 99%

Dysregulation of immune response in otitis media

Mather

Powell

Talks

et al. 2021

Expert Rev. Mol. Med.

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show abstract

“…Adenoids obstruct the posterior nostrils and affect ventilation and drainage in the nasal cavity and sinuses, leading to chronic sinusitis. Pathogenic microorganisms and secretions pass through the eustachian tube (ET) and oropharynx to cause ET mucosal inflammation, congestion, edema, and retrograde infection, thereby aggravating or inducing OME (5). AH is the main predisposing factor for OME that often accompanies it in children (6).…”

Section: Introductionmentioning

confidence: 99%

Analysis of factors that influence the occurrence of otitis media with effusion in pediatric patients with adenoid hypertrophy

Chen

Yin²,

Chen³

et al. 2023

Front. Pediatr.

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ObjectiveAdenoid hypertrophy (AH) and otitis media with effusion (OME) are common pediatric otolaryngological diseases and often occur concurrently. The purpose of this study was to comprehensively analyze the factors that influence the occurrence of OME pediatric patients with AH.MethodsPatients younger than 12 years with AH, who were hospitalized for treatment at Beijing Tsinghua Changgung Hospital in Beijing, China, between March 2018 and February 2022 were enrolled. The patients were divided into an AH group and an AH + OME group based on the presence of OME. The authors collected the following clinical data for univariable analysis: sex; age; body mass index (BMI); comorbid nasal congestion/rhinorrhea, recurrent tonsillitis, or allergic rhinitis (AR); adenoid and tonsil grade; tonsillar hypertrophy; food/drug allergy; history of adenoidectomy and congenital diseases; breastfeeding status; preterm birth; exposure to environmental tobacco smoke (ETS); family history of adenotonsillectomy, otitis media, and AR; main data of polysomnography and oropharyngeal conditional pathogen culture data of some patients. Univariate analysis was performed as a basis for logistic regression analysis.ResultsA total of 511 children (329 boys and 182 girls) were included, their mean age was 5.37 ± 2.10 years. Of them, 407 (79.6%) were in the AH group and 104 (20.4%) in the AH + OME group. Univariate analysis revealed statistically significant differences in age, BMI, adenoid grade, AR, breastfeeding status, and ETS exposure between the two groups. Multivariate stepwise logistic regression analysis showed that age, adenoid grade, AR, breastfeeding status, and ETS influenced the occurrence of OME in pediatric patients with AH. The risk of OME decreased with increasing age. High adenoid grade, ETS exposure, and comorbid AR were risk factors for OME in pediatric patients with AH, but breastfeeding was a protective factor. The final analytical results of the oropharyngeal conditional pathogen culture data showed that Streptococcus pneumoniae positivity was associated with OME in AH.ConclusionThe pathogenesis of AH with OME is complex. Young age, high adenoid grade, ETS exposure, non-breastfed status, comorbid AR, and the presence of S. pneumoniae in the oropharynx are risk factors for OME in pediatric patients with AH.

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“…Eustachian tube dysfunction (ETD) is characteristic of several otologic diseases and symptoms 1 , 2 . Although the diagnostic criteria for ETD are not firmly defined, there have been efforts to reach a consensus in Europe and America 3 , 4 .…”

Section: Introductionmentioning

confidence: 99%

Results of Eustachian tube balloon dilation measured using the nine-step test

Bae,

Kwak,

Han

et al. 2023

Sci Rep

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Suggested several decades ago, the nine-step test is an intuitive test of Eustachian tube function. However, studies employing the nine-step test to assess the results of Eustachian tube balloon dilation (EBD) are limited. We aimed to objectively evaluate the efficacy of EBD in opening failure patients with decreased maximal peak pressure difference (MPD) using the nine-step test. Patients who had MPD values ≤ 13 daPa in the nine-step test were enrolled. The patients were categorized into two groups according to treatment decisions after discussion with a clinician: an EBD group (N = 26) and a medication group (N = 30). One month after treatment, the seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ7) and the nine-step test were administered to all participants and subgroups of symptomatic participants (ETDQ7 > 15). MPD improved (increased) in both the EBD group and the medication group. ETDQ7 values improved (decreased) in the EBD group, but not in the medication group. In subgroup analysis, MPD and ETDQ7 values improved only in the symptomatic EBD group. According to the nine-step test, EBD can normalize 53.8% of decreased MPD. Posttreatment MPD and ETDQ7 scores were significantly better in the EBD group than in the medication group. However, EBD in patients with abnormal nine-step test results seemed less efficacious when the treatment results of the medication group were considered.

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Evidence and evidence gaps in the treatment of Eustachian tube dysfunction and otitis media

Cited by 9 publications

References 111 publications

Dysregulation of immune response in otitis media

Dysregulation of immune response in otitis media

Analysis of factors that influence the occurrence of otitis media with effusion in pediatric patients with adenoid hypertrophy

Results of Eustachian tube balloon dilation measured using the nine-step test

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