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Middle Ear Effusion in Intensive Care Unit Patients at Al-Sadder Teaching Hospital in Al-Najaf City-Iraq (A Prospective Randomized Comparative Clinical Study)

Author: Yasir Lafta Hassoun ياسر لفتة حسون
Journal: KUFA MEDICAL JOURNAL مجلة الكوفة الطبية ISSN: 1993517X Year: 2017 Volume: 17 Issue: 1 Pages: 1-12
Publisher: University of Kufa جامعة الكوفة

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Abstract

Background: Middle ear effusion (MEE) is one of the commonest chronic otological conditions in childhood but has a lower incidence in normal adult. By definition it is an accumulation of non-purulent fluid in the middle ear. It is an inflammatory effusion behind an intact tympanic membrane that is not associated with acute otological symptoms or systemic signs.Aim: To explore factors related to the occurrence of MEE in the intensive care unit (ICU) patients with prolonged oral endotracheal intubation in Al-Najaf city/Iraq.Methods: Forty patients (80 ears) with a prolonged endotracheal intubation (> 5 days) in the ICU were studied. Information of the age, gender, level of consciousness, duration of endotracheal intubation and placement of nasogastric tube were retrospectively collected from history and patient`s data. All patients were subjected to otoscopic examination, tympanometry studies and acoustic reflectometry for evidences of MEE. Results: Out of the 80 earsexamined, 46 ears had MEE (57.5%), 22 ears were normal (27.5%), and 12 ears (15%) had negative pressure in the middle ear by tympanometry. Patients who were intubated for more than 11 days and those with conscious disturbance had a significantly high incidence of MEE. No episodes of acute otitis media or systemic infection were encountered.Conclusion: Prolonged endotracheal intubation (more than 11 days), age advancing and conscious disturbance contribute significantly to the occurrence of MEE in adult ICU patients.Recommendation: Middle ear pathology like MEE in the ICU patients with prolonged intubation should not be underestimated


Article
Frequency of Otitis Media with Effusion in Children with Adenoid Hypertrophy
مدى الاصابة بالتهاب الاذن الوسطى مع انثقاب الطبله عند متضخمي العقد اللمفاويه للتجاويف

Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2017 Volume: 30 Issue: 2 Pages: 95-100
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Abstract:Background: Otitis Media with Effusion (OME) is a chronic accumulation of mucous within the middle ear , and sometimes the mastoid air cell system .Objective: To study the frequency of otitis media with effusion in relation to the effect and size of adenoid hypertrophy as an aetiological factor , in addition to others like presenting symptoms, risk factors and the changes of tympanometry in otitis media with effusion.Patients and methods: A cross sectional study for 12 months (January 2011-january 2012) in Al-Yarmouk Teaching Hospital, ENT department. One hundred children with adenoid hypertrophy aged (3-12years) were included. All of them were evaluated by clinical ENT examination, tympanometry and lateral plane x-ray of nasopharynx to assess the size of hypertrophied adenoid and classified into 3 grades (I, II and III) and asses the frequency of otitis media with effusion in each grade.Results: Only 38 children out of one hundred (38%) were diagnosed as having otitis media with effusion; with 26 patients were bilaterally involved (68.5%) and 12 patients were unilaterally involved (31.5%). According to adenoid grade, the incidence of otitis media with effusion was as follow: grade I: 19 patients (38ears) only 7 ear with effusion (18%) , grade II : 47 patients (94ears)only 26 ear with effusion (27%) and grade III : 34 patients (68 ears) only31 ears with effusion (45%). Type B tympanometry was more in grade III adenoid hypertrophy 47%.Conclusion and Recommendation: The frequency of otitis media with effusion is directly proportional to the size of adenoid. It is recommend that early diagnosis and proper management of adenoid hypertrophy to reduce the incidence of otitis media with effusion and its sequels of hearing loss and poor speech development in children .


Article
Efficacy of Intranasal Beclomethasone in the Treatment of Children with Otitis Media with Effusion and/or Adenoid Hypertrophy

Author: Firas Baheej Abdul Aema*, Hassan Mohammed Abbas Al-Timim
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 2 Pages: 176-183
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Adenoid hypertrophy and otitis media with effusion are very frequent indications for surgery in children. Otitis media with effusion is the commonest cause of their hearing difficulty.A potential role of corticosteroids in the treatment of both diseases has emerged "6". Short-term use of systemic steroids provides a temporary improvement but long-term use of systemic steroids is not appropriate in children due to severe side-effects. On the other hand, topical nasal steroids without systemic side-effects might be used"7" .OBJECTIVE:To prove that intranasal steroid treatment can be a useful alternative to surgery in the treatment of children with otitis media with effusion and/or adenoid hypertrophyPATIENTS AND METHODS: A total of 68 children (4–14-year-old) on the waiting list for an adenoidectomy and/or myringotomy with or without ventilation tube placement were enrolled into the study and control groups. The study group (38 patients with adenoid hypertrophy, 19 of them with otitis media with effusion) received intranasal beclomethasone dipropionate (aqueous suspension) 168 mcg daily, and the control group (30 patients with adenoid hypertrophy, 16 of them with otitis media with effusion) was followed up without any treatment. All patients were evaluated at 0 and 8 weeks. The assessment of each patient included history, a symptom questionnaire, a tympanogram, a pure tone audiogram, and otoscopic examination and a plain radiograph (lateral soft tissue X-ray of postnasal space). The size of adenoid tissue was graded as a percentage according to obliteration of the airway of the postnasal space. The adenoid/postnasal (A/P) airway ratio was recorded for each patient. Symptoms were scored as 0 (absent), 1 (intermittent/periodic), or 2 (continuous). The data were analyzed with the “Statistical Package for the Social Sciences” (SPSS 9.0).RESULTS:Resolution of otitis media with effusion in the study group (41.6%) was significantly higher than that in the control group (13.3%) (p < 0.001). Twenty -six patients (68.4%) with adenoid hypertrophy in the study group showed a significant decrease in adenoid size according to the plain radiograph evaluation compared to the control group (p < 0.001). A significant improvement in obstructive symptoms was seen in the study group (p < 0.001). The radiographically measured adenoid/postnasal airway ratio and degree of obstructive symptoms showed a significant correlation (r = 0.838 p < 0.001, r = 0.879 p < 0.001, r = 0.838 p < 0.001, r = 0.879 p < 0.001). CONCLUSION: Nasal beclomethasone dipropionate treatment can significantly reduce adenoid hypertrophy and eliminate obstructive symptoms. It is a useful alternative to surgery (in good percentage of cases), at least in the short term (8weeks ), for otitis media with effusion.

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