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Factors leading to chronic middle ear disease.

In an Australian Aboriginal community, 65% of all people examined had clinical evidence of pathology in the ear drum or middle ear, but active ear disease was found mainly in children. In most people, both ears showed similar clinical changes. Clinical nutritional status and hygienic factors did not correlate with the presence of ear disease. Some families had significantly more ear disease than did others, suggesting that there is some as yet unidentified familial factor.

Adolescent

Tomography of the vestibular aqueduct in ear disease.

A controversy exists concerning whether or not roentgenographic narrowing or nonvisualization of the vestibular aqueduct is a specific sign for Meniere's disease. Of 190 ears that were evaluated, abnormal aqueducts were seen in 42.9% of ears with Meniere's disease, 45.4% of contralateral, noninvolved ears from patients with Meniere's disease, 41.3% of ears with diseases other than Meniere's disease, 30.4% of ears with no disease, and 51.6% of normal ears. Narrowing or nonvisualization of the vestibular aqueduct is a nonspecific roentgenographic sign that is seen in diseased, as well as in normal ears, and should not be used to make a diagnosis of Meniere's disease. Indications for polytomography in Meniere's disease include (1) preoperative evaluation of the aqueduct prior to endolymphatic shunt procedures and (2) exclusion of acoustic neurinomas or other organic causes of vertigo.

Adolescent

Chronic ear disease along the coasts of Labrador and Northern Newfoundland.

The high incidence of chronic ear disease among the three ethnic groups, Eskimo, Algonkian Indians, and Caucasians living under the same environmental conditions is studied. The role of socio-economic factors in the incidence and sequelae of ear disease in this population was similar to other studies among the native peoples of Alaska, Canada, and Greenland. The variation in the disease pattern in the different ethnic groups was shown to be related to the aeration of the middle ear cleft. The air cell system of the mastoid is determined by x-rays and/or surgical exploration, but the patency of the Eustachian tube and its size is determined by impedance audiometry and use of ureteric catheters. The clinical and surgical findings of the behavior of chronic ear disease in the different ethnic groups is correlated to tissue culture experiments. The role of lowered oxygen tension in the formation and behavior of cholesteatoma is illustrated well among the Caucasians with poor aeration of the middle ear cleft who show a high incidence of cholesteatoma, unlike the Eskimos with good aeration who show a complete absnece of cholesteatoma.

Cholesteatoma

Middle ear pressure following tympanoplasty for various middle ear diseases. Pressure related to follow-up period and retractions.

In 512 ears with various middle ear diseases, the middle ear pressure was measured a minimum of 2 years and a maximum of 10 years after tympanoplasty. The findings were related to the length of the follow-up period and to retractions of the drum and/or in the epitympanum. The tympanometric findings were best in sequelae to otitis with dry perforations, poorest in cholesteatomas and adhesive otitis. Tubal function had not further deteriorated 4 years after the operation. There was a highly significant correlation between the middle ear pressure and the frequency of retractions, which also does not essentially increase--except in the cholesteatoma cases.

Acoustic Impedance Tests

Middle ear disease in native Indian children in British Columbia--incidence of disease and an evaluation of screening methods.

A total of 1,109 Indian children in five British Columbia communities were surveyed for middle ear disease. Evaluation included a history, pure screening, impedance audiometry, and otolaryngological examination. Of these, 12.7 per cent had middle ear disease requiring treatment, namely serous otitis media, perforated tympanic membrane, or cholesteatoma. Serous otitis media was the commonest disease and it was most prevalent in the 0-4 years age group. Pure tone audiometry and impedance audiometry were both unsatisfactory screening methods in this study. The tests could not be performed in the majority of patients four years of age or younger, and they both showed a high incidence of false positive results as well as a significant incidence of false negative results. On the basis of this preliminary report a proposal is made for a screening and continuing evaluation program involving local health care personnel, audiologists, and otolaryngologists.

Adolescent

Current concepts of treatment of ear disease in cleft palate children and adults.

This author had demonstrated that the incidence of conductive hearing loss in adults who have had cleft palates approximates 50%. That their ear disease arises during infancy has been well documented by Stool and Paradise. The serous otitis media which develops in infancy and persists through adolescence is presently best treated by tympanic aeration tubes. Whether or not a limited adenoidectomy is a useful adjunct in treatment remains to be conclusively demonstrated. That cleft palate repair and/or pharyngeal flap surgery is helpful in the eventual outcome of ear disease would seem to be so. The end product of recurrent serous effusions and/or ear infections can be a chronic draining ear and/or cholesteatoma which following the attainment of adolescence is best treated by mastoid tympanoplasty with ossicular reconstruction. The effect of hearing on the speech of palate patients is discussed and a new method for using visual cues in helping palate patients speak less hypernasally offered.

Adenoidectomy

Patterns of ear disease in the southwestern American Indian.

Native Americans are predisposed to one of the highest incidences of otitis media in mankind. The origin of otitis media in Indians remains multifaceted. However, an unusually high prevalence of congenital anomalies of the ear and oral cavity, ie, oral clefts, facial paralysis in diabetics, and the absence of otosclerosis, suggest racial inheritance as a predominant factor for their pattern or ear disease. An analysis of outpatient and operative records at the Phoenix (Ariz) Indian Medical Center substantiates this hypothesis and shows contrasts in ear disease between American Indians and white persons.

Acute Disease

Tympanometry in middle ear disease.

Tympanometry is an objective procedure which can aid in the identification of middle ear disease and eustachian tube dysfunction. This paper reviews its rationale, operation, and applications. The test procedure is simple and can be performed by trained personnel. The test is valid and reliable and can be used with children without discomfort. The results of tympanometry are quantifiable, recordable, and easy to interpret. The routine use of tympanometry in the family physician's office would offer a valuable tool in the identification and management of middle ear problems.

Air Pressure

The prevalence of middle ear disease among learning impaired children. Does a higher prevalence indicate an association?

The prevalence of middle ear disease among children who are educationally classified as learning disabled as compared to that found in normal children is discussed. A higher incidence of middle ear pathology was found among the learning impaired children. The potentially hazardous effects that middle ear disease can have upon academic and linguistic development are emphasized.

Adolescent

Inflammatory middle ear diseases in patients with cystic fibrosis.

111 patients with cystic fibrosis (CF), aged 7 months to 29 years, were examined to detect inflammatory middle ear diseases. 35% had a history of one or more attacks of acute otitis media, an incidence at the same level as in non-CF patients. None had chronic suppurative otitis. Only 4 out of the 88 patients able to cooperate in audiometry had a hearing impairment. In 2, the hearing loss was perceptive, in 3 very mild, and in the fourth case, moderately severe. The middle ear pressure was measured in 108 patients, in 86 of whom it proved normal. In 15 patients the middle ear pressure was lower than--100 mmH2O, indicating tubal occlusion, and in 7 patients the impedance minimum was lacking, indicating an accumulation of mucus. These 7 patients (6%) had secretory otitis media. Nasal polyps were or had been present in 32%. There was no correlation between nasal polyps and tubal occlusion or secretory otitis. The incidence of inflammatory middle ear diseases in CF patients was in the same range as in non-CF patients, a finding at variance with some previous investigations showing middle ear pathology in 25--48%.

Acoustic Impedance Tests

The natural history of chronic middle ear disease in Australian Aboriginals: a cross-sectional study.

One hundred and sixty-three Australian Aboriginals, who were aged from four months to 60 years, were examined clinically and otologically. Audiometric tests were completed on 110 of these subjects. On the assumptions that the aural health of these people has remained stable for many years, the cross-sectional data which were obtained have been used to infer the natural history of ear disease. Seromucinous otitis media is manifest as a disease of early childhood, which recovers spontaneously in most cases and has no obvious sequelae. Perforated tympanic membranes likewise seem to heal spontaneously in the majority of cases. The evidence suggests that hearing loss is the main problem and treatment should be directed towards the level of hearing loss and its effects.

Adolescent

Ear disease in relation to age in the cleft palate child and adolescent.

Ninety-eight cleft palate subjects were studied to ascertain the eventual adolescent and adult hearing. There were 72 complete clefts of lip and palate and 26 clefts of the palate alone. The incidence or side of ear disease did not appear to be influenced by this type of cleft. Other systemic anomalies were present in 11 cases with congenital middle ear abnormalities in 3 and sensory neural hearing loss in 8 subjects. Progressive improvement in incidence of hearing loss from 94% at 4 years to 42% at 20 years was noted with the strict definition of hearing loss as 10 dB conductive loss at any one frequency. 10% of ears were left with permanent structural changes in the middle ear. In only 2 patients was there a bilateral hearing loss of 20 dB or more through the speech range.

Adolescent