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Article
Otitis Media with Effusion in association with Nasal and Nasopharyngeal Diseases

Authors: Mohammad Hassan Al Baldawi محمد حسن --- Ali Hashoosh Abdulla علي حاشوش --- Ali Mohamed Abdul Qader. علي محمد
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2017 Volume: 30 Issue: 3 Pages: 148-153
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

AbstractBackground: Otitis media with effusion results when the ventilation and drainage functions of the Eustachian tube are impaired. This occurs either in the presence of nasopharyngeal disorders or Eustachian tube dysfunction.Aims: review of otitis media with effusion associated with nasal and nasopharyngeal diseases ; causes& clinical manifestations.Patients and Methods: Seventy two patients of different age groups suffered from unilateral or bilateral OME were reviewed , and their relation with nasal and nasopharyngeal diseases were assessed clinically , endoscopically, audiologically and radiologically. Those 72 patients have been divided into three groups according to their age .Results: The results were 64% males & 36% females with male to female ratio was (1.67:1) .The commonest age was in the 1st decade of life ( 55.6%). Otitis media with effusion was bilateral in 72% , with different clinical presentations found but hearing loss is the most frequent one (76.4%) , it was mainly conductive type (85.5%) with tympanometric curve frequently of type B (87%) . The tympanic membranes were commonly immobile (72.6%) & retracted (76%) . There were many variable different causes for OME.Conclusion:. - OME have different manifestations mainly due to otological problems but can be due to nasopharyngeal problems. The effect of the nose and nasopharynx on Eustachian tube is highly significant & consequently plays an important role in the health of the middle ear , so it is essential to treat these diseases (OME and nasopharyngeal pathologies) in continuity rather than separately.


Article
Middle ear effusion: tympanometry versus operative findings

Author: Ali A. Muttalib علي عبد المطلب
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2005 Volume: 31 Issue: 1 Pages: 22-26
Publisher: Mosul University جامعة الموصل

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Abstract

Objective: To evaluate the role of tympanometry in predicting middle ear effusion by comparing results with the operative findings.
Design: A descriptive study concerned with 105 ears (57 patients) diagnosed as middle ear
effusion by tympanometry; type B, flat curve; that underwent myringotomy operation (with or without ventilation tube insertion).
setting: Department of ENT-Al-salam Teaching Hospital/Mosul for the period (April 2003 to September 2004). Tympanometry was performed in the Outpatient Clinic of Al-Jamhoori
Teaching Hospital.
Subjects: The study included 36 males and 21 females with a ratio of 1.7:1. The average age
was 6 years with a range of 3-12 years.
Methods: The parameters analyzed included age, sex and tympanometric results. Matching
between the suspected ears for middle ear effusion; type B, flat curve; and the operative
findings (fluid found in the middle ear at the time of myringotomy) was recorded.
Results: The diagnostic accuracy and examination success rate of tympanometry; type B, flat
curve; in predicting middle ear effusion was 71.4%. Moreover, the sensitivity, specificity, positive and negative predictive values were 97.2% , 57.3%,55.3% and 97.5% respectively. Thus, the positive likelihood ratio was 2.3.
Conclusion: The accuracy rate of tympanometry in predicting middle ear effusion showed a fair validity for its exclusion. The use of pneumatic otoscopy and tympanometry together improves the accuracy of diagnosis.
Key words: Tympanometry, middle ear effusion, myringotomy.


Article
Significance of Tympanometry in Children with Acute Otitis Media (AOM): a Prospective Study
أهمية قياس ضغط الأذن الوسطى عند الأطفال المصابين بالتهاب الأذن الوسطى الحاد: دراسة استطلاعية

Author: Firas M. Hassan
Journal: journal of kerbala university مجلة جامعة كربلاء ISSN: 18130410 Year: 2016 Volume: 14 Issue: 2 Pages: 10-15
Publisher: Kerbala University جامعة كربلاء

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Abstract

Introduction: Tymanometry is the most commonly used aspect of impedance audiometry and is particularly useful in evaluating children with otitis media with effusion. Although its application in diagnosis of AOM is not routinely performed, this study was carried out to demonstrate the usefulness of performing the typmanometry test in children with AOM and to regard it as a prognostic index in accordance to its results by identifying which of those patients were at a great risk of treatment failure.Aim of the study: To analyze the prognostic significance of tympanometry by assessing its ability to identify the ratio of children with AOM who are at great risk of treatment failure.Patients and methods: This is a prospective study of 80 pediatric patients with recent attacks of acute otitis media attending the ENT clinic of Al-Sader medical city in Najaf during one year period from 1-6-2014 to 1-6-2015. The diagnosis of the AOM was done based on the presence of the clinical signs and symptoms of this disease. The patients had been sent for tympanometry and the results of tympanogram had been documented. All the patients treated in regard of the AOM by giving them antibiotics in the form of oral suspension for 14 days and their signs and symptoms assessed again at the end of treatment period.Data analysis: The statistical calculations were carried out using chi-square test. The p value <0.05 was considered statistically significant.Results: 80 patients(115 infected ears), their age ranged from 2 to 12 years with mean age of 6.25. 53 (66.25%) were males and 27(33.75%) were females with M:F is 1.96:1. Tympanometric results of the total 115 infected ears with AOM revealed that type A tympanograph appeared in 57 (49.6%) of the ears and type B appeared in 35(30.4%), while 23(20%) of the ears had type C graph. After treatment with antibiotics for 14 days, 53 of the ears who had type A tympanogram from the start showed a complete recovery. For those ears with type B tympanometric results, 22 ears showed a complete cure and of those 23 ears with type C tymanogram , 16 had complete cure.

المقدمة: إن قياس ضغط الأذن الوسطى باستخدام التيمبانومتري له أهمية خاصة في تشخيص الأطفال الذين يعانون من التهاب الأذن الوسطى مع تجمع السوائل خلف طبلة الأذن. على الرغم من أن تطبيقه في تشخيص التهاب الأذن الوسطى الحاد لا يتم بشكل روتيني، أجريت هذه الدراسة لإثبات فائدة إجراء الفحص عند الأطفال الذين يعانون من هذه الالتهابات واعتبار نتائجه مؤشرا لتحديد أي من المرضى معرضين أكثر من غيرهم لخطر فشل العلاج.الهدف من الدراسة: تحليل أهمية قياس ضغط الأذن الوسطى للأطفال الذين يعانون من التهاب الأذن الوسطى الحاد و تقييم قدرته على تحديد أي من هؤلاء الأطفال هم في خطر كبير من فشل العلاج.المنهجية: دراسة استطلاعية أجريت في عيادة الأنف والأذن والحنجرة في مدينة الصدر الطبية في النجف الأشرف خلال سنة واحدة من 1-6-2014 إلى 1-6-2015 . اشتملت الدراسة على 80 طفلا مريضا كانوا يعانون من التهاب الأذن الوسطى الحاد وقد تم تشخيص الالتهاب في الأذن على أساس وجود العلامات والأعراض السريرية لهذا المرض. تم إرسال المرضى لقياس ضغط الأذن الوسطى، وقد تم توثيق نتائج الفحص. عولجوا جميع المرضى من خلال منحهم المضادات الحيوية عن طريق الفم لمدة 14 يوما وتم تقييم علامات وأعراض المرض مرة أخرى في نهاية فترة العلاج.النتائج: 80 مريضا (115 أذن مصابة)، تراوحت أعمارهم بين السنتان و12 سنة مع متوسط عمر 6.25. عدد الذكور كانوا 53 (66.25٪) طفلا و كان ما مجموعه 27 (33.75٪) طفلا منهم من الإناث . أظهرت نتائج قياس ضغط الأذن الوسطى من مجموع 115اذن مصابه بالتهاب الأذن الوسطى الحاد بان نوع أ كان في 57 (49.6٪) من الحالات ونوع ب ظهر في 35 (30.4٪)، في حين أنه في 23 (20٪) من الحالات كان نوع ج هو الحاضر. بعد العلاج بالمضادات الحيوية لمدة 14 يوما، 53 من الذين كان لديهم نوع أ من البداية أظهروا الشفاء الكامل. بالنسبة لأولئك الذين ظهرت لديهم نوع ب فان 22 منهم حصلوا على الشفاء التام , وبالنسبة للحالات التي كانت لديها نوع ج فقد ظهر الشفاء التام في 16 حاله.الاستنتاج: من خلال مراقبة الفرق في مدة العلاج وفترة النقاهة بين الأنواع المختلفة من قياس ضغط الأذن الوسطى عند الأطفال الذين يعانون من التهاب الأذن الوسطى الحاد، خلص إلى أن إجراء هذا الفحص قادر على توفير مؤشرا لتحديد أي من المرضى معرضين أكثر من غيرهم لخطر فشل العلاج.


Article
The Effect of Amoxicillin-Clavulanate and Actifed Versus Actived Only in treatment of Otitis Media with Effusion

Authors: Ahmed Muhei Rasheed*,FIBMS(Otolaryngology) --- Yusra Hayder Taha**, FICMS(Otolaryngology احمد محي رشيد
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2008 Volume: 50 Issue: 3 Pages: 327-331
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Otitis media with effusion(OME)is a common cause of deafness in childrenwith subsequent impairment of speech development and scholastic difficulties.Treatmentremains controversial.Aim: To study the effect of amoxicillin-clavulanate in treatment of OMEPatients and methods: A prospective study of a target sample consisting of sixty childrenunder the age of 12 years presented with chief complaints duration for at least 6 weeks andon examination there were bilateral red and retracted tympanic membranes withoutoversized adenoids and no underlying causes require surgical correction e.g cleft palate.Thepatients were divided into two groups;group A which received Actifed for 4 weeks andgroup B which received Actifed +Amoxicillin-clavulanate for 4 weeks treatmentcourse.After complete history and otolaryngological examination,all the patients were sent tox-ray of postnasal space( to exclude oversized adenoids),audiometry andtympanometry.Assessment was repeated at the end of 2 and 4 weeks of treatment courseincluding audiometry and tympanometry.The response to treatment in group B wascompared to that in group A at the end of 4 weeks treatment course.In this study,we referedto improvement in otoscopic findings and tympanometry results to show the response to 4weeks treatment course.Results: Eight patients(25.81%)in group A have shown response to treatment at the end of 4weeks treatment course,while the response in group B was seen in 15 patients( 51.72%).Conclusion: Amoxicillin-clavulanate has statistically significant effect in treatment of otitismedia with effusion(OME)in short term follow-up and the clearance of middle ear efussionin response to amoxicillin-clavulanate indicates that bacterial infection may play a role in theaetiology of OME.Keywords: Otitis media with effusion,Amoxicillin-clavulanate,Tympanometry.


Article
The effect of adenoid size on tympanometric finding in children
تأثير حجم الغدانية على إيجاد طبلة الأذن عند الأطفال

Authors: Bashir Jalal Jamil --- Hanna Hanano Kasho --- Said Mustafa Said --- Farhad Jalil Khayat
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2016 Volume: 20 Issue: 3 Pages: 1396-1403
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: There are controversial reports regarding the effect of adenoid size on middle ear conditions. Enlarged adenoid size may cause nasopharyngeal obstruction or may act as a reservoir for infection and cause tympanometric changes. This study aimed to determine the correlation between adenoid size and tympanometric findings in children.Methods: This prospective study included 71 children aged 3-10 years old attending Rizgary Teaching Hospital for adenotonsillectomy between August 2013 to January 2014. Questions about upper airway obstruction symptoms were directed to parents and patients. Tympanometry and plane radiological study of lateral soft tissue of the neck were done for each case. Tympanometric type A and C1 were considered normal while B and C2 as abnormal. The adenoid size was measured by using adenoidal/nasopharyngeal ratio. Results: Of 71 children (142 ears), 20 children (40 ears) had gross adenoid enlargement, of which tympanometry was found to be normal in 75% and abnormal in 25%. In 28 children (56 ears) with moderate adenoid enlargement, tympanometry was normal in 78.6% and abnormal in 21.4%. Twenty three children (46 ears) had minimal adenoid enlargement, in which tympanometry was normal in 91.3% and abnormal in 8.7%. Conclusion: The study showed that adenoid size in children had an effect on tympanometric readings. Although the incidence of abnormal tympanometry was higher with the increased adenoid size but it was statistically non-significant.


Article
Adenoidectomy with Myringotomy and Tympanostomy Tube Versus Adenoidectomy with Myringotomy in Treatment of Otitis Media with Effusion in 5-7 Years Old Children

Author: Dr. Ahmed Muhei Rasheed
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2016 Volume: 12 Issue: 1 Pages: 83-86
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Adenoiditis is a common cause of otitis media with effusion (OME) in children & perhaps OME is one of the most common diseases leads to hearing impairment in children with subsequent impairment of speech development & learning difficulties , however, treatment remains controversial. Objectives: To evaluate if there is a significant advantage of tympanostomy tube insertion in association with adenoidectomy over adenoidectomy in association with myringotomy alone in treatment of children with OMEType of the study: This is a prospective study. Patients & methods: The study consisted from 63 children diagnosed as cases of bilateral OME & variable degrees of adenoid hypertrophy. The patients were divided randomly into two groups, group A (32) were subjected to adenoidectomy & myringotomy with tympanostomy tube insertion & group B (31) were subjected to adenoidectomy & myringotomy alone. Pure tone hearing threshold was measured preoperatively & at the 3rd month and 6th month postoperatively. Statistical analysis is done to compare the means of pure tone hearing threshold between group A & B. Results: The mean pure tone hearing threshold preoperatively in group A was 28.3 dB, while it was 27.9 dB in group B. Three and six months postoperatively the means in group A were 13.2 dB and 6.8 dB respectively , while the means were 19.4 dB and 13.6 dB respectively in group B. Statistical analysis showed statistically significant difference between the means of pure tone hearing thresholds in both groups during the whole follow up period (P value less than 0.05). Conclusion: There is statistically significant advantage of tympanostomy tube insertion in association with adenoidectomy compared to adenoidectomy with myringotomy alone in treatment of OME in term of hearing level.


Article
CLINICAL AND TYMPANOMETRIC ASSESSMENT OF MIDDLE EAREFFUSION VERSUS MYRINGOTOMY FINDING

Authors: Mazin N. Fatoohi --- Hani Musa Bader --- Hamed M. Mohammed
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2008 Volume: 50 Issue: 3 Pages: 321-326
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The present study was planned to show the accuracy of clinical examination and
tympanometry in diagnosis of middle ear effusion.
Patients and Methods: The study involved 80 patients (160 ears )suspected to have otitis media
with effusion (OME) from different age groups ; 56 were males and 24 were females .
Clinical assessment for all patients included otoscopy , pneumatic otoscopy and audiological
assessment by using pure tone audiometry and tympanometry then comparing the results to
findings at myringotomy as the gold standard for presence or absence of fluid in the middle ear .
Results : Fluid whether serous or glue was found in 100 ears ( 62.5 %) where as sixty ears were
dry, sensitivity , specificity and accuracy of tympanometry were 90 % , 70 % and 85 %
respectively , and for clinical assessment were 82 % , 52% and 71 % respectively . A combined
clinical and tympanometry sensitivity and specificity were calculated and found to be 96 % and
92 % respectively.
Conclusion : clinical examination as a method for diagnosis of middle ear effusion depend on
experience of the examiner . tympanometry proved to be a reliable diagnostic tool for the
diagnosis of OME , it appeared significantly better at determining non effusion state.

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