Ultrasound characterization of middle ear effusion

Abstract

Purpose To further enhance and assess the ability to characterize middle ear effusion (MEE) using non-invasive ultrasound technology. Materials and Methods This is a prospective unblinded comparison study. Fifty-six children between the ages of 6 months and 17 years scheduled to undergo bilateral myringotomy with pressure equalization tube placement were enrolled. With the child anesthetized, the probe was placed into the external ear canal after sterile water was inserted. Ultrasound recordings of middle ear contents were analyzed by computer algorithm. Middle ear fluid was collected during myringotomy and analyzed for bacterial culture and viscosity. Results Ultrasound waveforms yielded a computer algorithm interpretation of middle ear contents in 66% of ears tested. When a result was obtained, the sensitivity and specificity for successfully characterizing middle ear fluid content as either void of fluid, thick fluid (mucoid), or thin fluid (serous or purulent) was at least 94%. Mucoid effusions had higher measured viscosity values (P=0.002). Viscosity measures were compared to culture result, and those with low viscosity (thin consistency) had a higher likelihood of having a positive culture (P=0.048). Conclusion The device sensitivity and specificity for fluid detection was 94% or greater among interpretable waveforms (66% of those tested). Although this technology provides important information of the middle ear effusion presence and characteristic, further technological improvements are needed.

Role of pepsin and pepsinogen: Linking laryngopharyngeal reflux with otitis media with effusion in children

“…The severity of the lesion in the middle ear cavity varies, as the consistency of MEE changes in patients with OME . In this study, we found that the concentration of pepsin gradually increased when the viscosity of the middle ear cavity fluid increased.…”

“…The severity of the lesion in the middle ear cavity varies, as the consistency of MEE changes in patients with OME. 31 In this study, we found that the concentration of pepsin gradually increased when the viscosity of the middle ear cavity fluid increased. These data suggest that pepsin aggravates OME, and that MEE appearing in the middle cavity is likely caused by pepsin, because the pepsin level in the dry ear subgroup was significantly lower than that in the serous and ear mucoid subgroups.…”

Ultrasound characterization of the mastoid for detecting middle ear effusion: A preliminary clinical validation

“…Compared with the results of previous studies10111314 the proposed Nakagami approach uses the mastoid as an acoustic window, thus allowing physicians to simply position an ultrasound probe on the mastoid and transmit an ultrasound pulse into the mastoid to determine MEE. Such a noninvasive technique allows patient comfort during examination.…”

“…Several studies have reported the advantages of ultrasound in assessing MEE91011121314. The previously proposed ultrasound technique involves positioning an ultrasound probe in front of the tympanic membrane through the external ear canal.…”

“…Although this ultrasound technology provides crucial clues associated with MEE, it is relatively invasive and requires injecting sterile water into the external ear canal to provide a coupling medium for ultrasound propagation. Conscious patients may be intolerant to this approach, thus limiting its clinical applicability14. Moreover, an increase in the thickness of the tympanic membrane because of postsurgery or inflammation may cause the attenuation of ultrasound, which is another possible reason affecting ultrasound measurements because of a poor signal-to-noise ratio.…”