Publications by authors named "Ellen M Mandel"

38 Publications

Panel 7: Otitis Media: Treatment and Complications.

Otolaryngol Head Neck Surg 2017 04;156(4_suppl):S88-S105

5 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

Objective We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention.
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http://dx.doi.org/10.1177/0194599816633697DOI Listing
April 2017

Resolution of Otitis Media With Effusion in Children With Cleft Palate Followed Through Five Years of Age.

Cleft Palate Craniofac J 2016 09;53(5):607-13

Objective: To describe the temporal pattern of otitis media with effusion (OME) resolution for a cohort of nonsyndromic cleft palate children enrolled before palatoplasty and followed through 5 years of age.

Design: This is a prospective, longitudinal study of the time course for OME resolution in infants and children with palatal clefts.

Setting: Cleft Palate Craniofacial Center of a tertiary care pediatric hospital.

Participants: This study included 52 children with cleft palate (29 boys, 45 white, Veau 1 through 4) who had a Furlow-type palatoplasty between 10 and 24 months of age performed by one of six surgeons.

Interventions: Standard cleft palate management was supplemented with study visits to the research clinic pre- and postpalatoplasty and then yearly to 6 years of age for assessments of middle ear status by interval history, otoscopy, and tympanometry.

Main Outcome Measure: The main outcome measure was age at otitis media resolution defined as the age in years at the first in a sequence of "disease-free" diagnoses not interrupted or followed by any other diagnosis.

Results: The cumulative percent OME resolution for ears/children at ages <1, 1, 2, 3, 4, 5 years was 4.1/4.4, 14.3/10.9, 31.6/21.7, 45.9/37.0, 56.1/50.0, and 70.4/60.9%. OME resolution followed a simple linear time curve with slopes of 13.5% (confidence interval [CI] = 12.2% to 14.8%, r(2) = .99) and 11.9% (CI = 10.1% to 13.6%, r(2) = .99) resolutions per year for ears and children, respectively.

Conclusions: There is a natural, age-related pattern of resolution for persistent OME that affects most infants and young children with cleft palate that is not affected by palatoplasty.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5074527PMC
http://dx.doi.org/10.1597/15-130DOI Listing
September 2016

Information on co-morbidities collected by history is useful for assigning Otitis Media risk to children.

Int J Pediatr Otorhinolaryngol 2016 Jun 11;85:136-40. Epub 2016 Apr 11.

University of Pittsburgh School of Medicine, Department of Otolaryngology, Pittsburgh, PA, USA.

Objectives: Determine if a 2-Step multivariate analysis of historical symptom/sign data for comorbid diseases can abstract high-level constructs useful in assigning a child's "risk" for different Otitis Media expressions.

Methods: Seventeen items related to the symptom/sign expression of hypothesized Otitis Media comorbidities were collected by history on 141 3-year-old children. Using established criteria, the children were assigned to 1 of 3 groups: Control (no significant past Otitis Media, n=45), Chronic Otitis Media with Effusion (n=45) and Recurrent Acute Otitis Media (n=51). Principal Component Analysis was used to identify factors representing the non-redundant shared information among related items and Discriminant Analysis operating on those factors was used to estimate the best predictor equation for pairwise group assignments.

Results: Six multivariate factors representing the assignable comorbidities of frequent colds, nasal allergy, gastroesophageal disease (specific and general), nasal congestion and asthma were identified and explained 81% of the variance in the 17 items. Discriminant Analysis showed that, for the Control-Chronic Otitis Media with Effusion comparison, a combination of 3 factors and, for the Control-Recurrent Acute Otitis Media comparison, a combination of 2 factors had assignment accuracies of 74% and 68%, respectively. For the contrast between the two disease expressions, a 2-factor combination had an assignment accuracy of 61%.

Conclusion: These results show that this analytic methodology can abstract high-level constructs, comorbidities, from low-level data, symptom/sign scores, support a linkage between certain comorbidities and Otitis Media risk and suggest that specific comorbidity combinations contain information relevant to assigning the risk for different Otitis Media expressions.
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http://dx.doi.org/10.1016/j.ijporl.2016.03.040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890165PMC
June 2016

Eustachian Tube Function in 6-Year-Old Children with and without a History of Middle Ear Disease.

Otolaryngol Head Neck Surg 2016 Mar 1;154(3):502-7. Epub 2015 Dec 1.

Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

Objective: To test the hypothesis that eustachian tube opening efficiency, measured as the fractional gradient equilibrated (FGE), is lower in 6-year-old children with no middle ear disease but a well-documented history of recurrent acute otitis media, as compared with children with a negative disease history (control).

Study Design: Cross-sectional study.

Setting: Tertiary care pediatric hospital.

Subjects And Methods: Bilateral eustachian tube function was evaluated in 44 healthy 6-year-old children (19 boys, 29 white). None had middle ear disease at the time of testing, but 23 had a history of recurrent acute otitis media. Twenty-one had no significant past otitis media. Eustachian tube function was measured with a pressure chamber protocol that established negative middle ear gauge pressures (referenced to the chamber pressure) and recorded that pressure before and after a swallow. FGE was calculated as the change in middle ear gauge pressure with swallowing divided by the preswallow pressure. Between-group comparisons of the preswallow pressures and FGEs were made with a 2-tailed Student's t test.

Results: FGE was independent of the preswallow middle ear gauge pressure. For the 39 and 44 evaluable ears in the control and recurrent acute otitis media groups, the mean preswallow pressures were -194 daPa (95% confidence interval [95% CI] = -211 to -177) versus -203 (95% CI = -216 to -190; P > .40), and FGEs were 0.32 (95% CI = 0.21-0.43) vs 0.16 (95% CI = 0.08-0.24; P = .016), respectively.

Conclusion: In children with past recurrent acute otitis media, residual eustachian tube opening inefficiency is maintained after they have "outgrown" their middle ear disease.
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http://dx.doi.org/10.1177/0194599815620149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769931PMC
March 2016

Predisposition to Childhood Otitis Media and Genetic Polymorphisms within the Toll-Like Receptor 4 (TLR4) Locus.

PLoS One 2015 15;10(7):e0132551. Epub 2015 Jul 15.

Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland.

Background: Predisposition to childhood otitis media (OM) has a strong genetic component, with polymorphisms in innate immunity genes suspected to contribute to risk. Studies on several genes have been conducted, but most associations have failed to replicate in independent cohorts.

Methods: We investigated 53 gene polymorphisms in a Finnish cohort of 624 cases and 778 controls. A positive association signal was followed up in a tagging approach and tested in an independent Finnish cohort of 205 cases, in a British cohort of 1269 trios, as well as in two cohorts from the United States (US); one with 403 families and the other with 100 cases and 104 controls.

Results: In the initial Finnish cohort, the SNP rs5030717 in the TLR4 gene region showed significant association (OR 1.33, P = .003) to OM. Tagging SNP analysis of the gene found rs1329060 (OR 1.33, P = .002) and rs1329057 (OR 1.29, P = .003) also to be associated. In the more severe phenotype the association was stronger. This finding was supported by an independent Finnish case cohort, but the associations failed to replicate in the British and US cohorts. In studies on TLR4 signaling in 20 study subjects, the three-marker risk haplotype correlated with a decreased TNFα secretion in myeloid dendritic cells.

Conclusions: The TLR4 gene locus, regulating the innate immune response, influences the genetic predisposition to childhood OM in a subpopulation of patients. Environmental factors likely modulate the genetic components contributing to the risk of OM.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0132551PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4503307PMC
May 2016

Eustachian tube function in young children without a history of otitis media evaluated using a pressure chamber protocol.

Acta Otolaryngol 2014 Jun;134(6):579-87

Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine , Pittsburgh, PA , USA.

Conclusions: Protocol limitations were identified and accounted for in the analysis. Percent gradient equilibrated (PGE) was affected by driving gradient direction in a similar manner to other efficiency measures. A finer resolution of possible age-related changes in eustachian tube opening efficiency is expected with the application of more sophisticated statistical models to the complete dataset at study end.

Objective: To report the results of an interim analysis for an ongoing study designed to characterize the age-related changes in eustachian tube opening efficiency measured using a pressure chamber protocol in children without a history of middle ear disease.

Methods: To date, 41 children aged 3 years without a history of otitis media have been enrolled in a longitudinal study of the age-related changes in eustachian tube function and evaluated at yearly intervals between 3 and 7 years of age. Eustachian tube opening efficiency, the percent of the applied pressure gradient equilibrated by swallowing, was measured by repeat tympanometry during a pressure chamber protocol. Data (120 tests) were analyzed using an ANOVA with variance partitioned by age (3 through 6 years), gradient direction (positive/negative), and ear (left/right).

Results: PGE was higher for left ears and positive driving gradients, but was not different among age groups.
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http://dx.doi.org/10.3109/00016489.2014.882017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4380175PMC
June 2014

The forced-response test does not discriminate ears with different otitis media expressions.

Laryngoscope 2014 Nov 11;124(11):2619-23. Epub 2014 Aug 11.

Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.

Objectives/hypothesis: Test the hypothesis that the eustachian tube (ET) function measured using standard manometric test methods is different between groups of ears with tympanostomy tubes inserted for recurrent acute otitis media (RAOM) and for chronic otitis media with effusion (COME).

Study Design: A cross-sectional study of ET function in populations of young children with different otitis media expressions.

Methods: The results for forced-response testing of ET function were compared using a general linear model between 37 ears of 26 children and 34 ears of 26 children, aged 3 and 4 years, with ventilation tubes inserted for COME and RAOM, respectively.

Results: There were no significant between-group differences in either the active measure of ET opening function, dilatory efficiency, or in the passive measures reflecting the magnitude of the forces that tend to hold the ET lumen closed, the opening and closing pressures, and passive trans-ET conductance.

Conclusions: The results do not support the hypothesis that ET closing forces are less in ears with RAOM when compared to ears with COME, and from the results of earlier studies, ears without disease. Both groups were characterized by a low ET opening efficiency (referenced to ears of adults with no disease history). Because both disease expressions present the same pattern of ET dysfunction, other factors are required to explain why a subset of ears with that type of dysfunction develop RAOM, as opposed to the default expression of COME.

Level Of Evidence: 2b
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http://dx.doi.org/10.1002/lary.24647DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4136992PMC
November 2014

A genome-wide association study of chronic otitis media with effusion and recurrent otitis media identifies a novel susceptibility locus on chromosome 2.

J Assoc Res Otolaryngol 2013 Dec 23;14(6):791-800. Epub 2013 Aug 23.

Center for Public Health Genomics, University of Virginia, P.O. Box 800717, Charlottesville, VA, USA.

Chronic otitis media with effusion (COME) and recurrent otitis media (ROM) have been shown to be heritable, but candidate gene and linkage studies to date have been equivocal. Our aim was to identify genetic susceptibility factors using a genome-wide association study (GWAS). We genotyped 602 subjects from 143 families with 373 COME/ROM subjects using the Illumina Human CNV370-Duo DNA Bead Chip (324,748 SNPs). We carried out the GWAS scan and imputed SNPs at the regions with the most significant associations. Replication genotyping in an independent family-based sample was conducted for 53 SNPs: the 41 most significant SNPs with P < 10(-4) and 12 imputed SNPs with P < 10(-4) on chromosome 15 (near the strongest signal). We replicated the association of rs10497394 (GWAS discovery P = 1.30 × 10(-5)) on chromosome 2 in the independent otitis media population (P = 4.7 × 10(-5); meta-analysis P = 1.52 × 10(-8)). Three additional SNPs had replication P values < 0.10. Two were on chromosome 15q26.1 including rs1110060, the strongest association with COME/ROM in the primary GWAS (P = 3.4 ×10(-7)) in KIF7 intron 7 (P = 0.072), and rs10775247, a non-synonymous SNP in TICRR exon 2 (P = 0.075). The third SNP rs386057 was on chromosome 5 in TPPP intron 1 (P = 0.045). We have performed the first GWAS of COME/ROM and have identified a SNP rs10497394 on chromosome 2 is significantly associated with COME/ROM susceptibility. This SNP is within a 537 kb intergenic region, bordered by CDCA7 and SP3. The genomic and functional significance of this newly identified locus in COME/ROM pathogenesis requires additional investigation.
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http://dx.doi.org/10.1007/s10162-013-0411-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825021PMC
December 2013

Sensitivity and specificity of eustachian tube function tests in adults.

JAMA Otolaryngol Head Neck Surg 2013 Jul;139(7):719-27

Division of Pediatric Otolaryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

Importance: The study demonstrates the utility of eustachian tube (ET) function (ETF) test results for accurately assigning ears to disease state.

Objectives: To determine if ETF tests can identify ears with physician-diagnosed ET dysfunction (ETD) in a mixed population at high sensitivity and specificity and to define the interrelatedness of ETF test parameters.

Design, Setting, And Participants: Through use of the forced-response, inflation-deflation, Valsalva, and sniffing tests, ETF was evaluated in 15 control ears of adult subjects after unilateral myringotomy (group 1) and in 23 ears of 19 adult subjects with ventilation tubes inserted for ETD (group 2). Data were analyzed using logistic regression including each parameter independently and then a step-down discriminant analysis including all ETF test parameters to predict group assignment. Factor analysis operating over all parameters was used to explore relatedness.

Exposures: ETF testing.

Main Outcomes And Measures: ETF parameters for the forced response, inflation-deflation, Valsalva, and sniffing tests measured in 15 control ears of adult subjects after unilateral myringotomy (group 1) and in 23 ears of 19 adult subjects with ventilation tubes inserted for ETD (group 2).

Results: The discriminant analysis identified 4 ETF test parameters (Valsalva, ET opening pressure, dilatory efficiency, and percentage of positive pressure equilibrated) that together correctly assigned ears to group 2 at a sensitivity of 95% and a specificity of 83%. Individual parameters representing the efficiency of ET opening during swallowing showed moderately accurate assignments of ears to their respective groups. Three factors captured approximately 98% of the variance among parameters: the first had negative loadings of the ETF structural parameters; the second had positive loadings of the muscle-assisted ET opening parameters; and the third had negative loadings of the muscle-assisted ET opening parameters and positive loadings of the structural parameters.

Conclusions And Relevance: These results show that ETF tests can correctly assign individual ears to physician-diagnosed ETD with high sensitivity and specificity and that ETF test parameters can be grouped into structural-functional categories.
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http://dx.doi.org/10.1001/jamaoto.2013.3559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792585PMC
July 2013

Eustachian tube function as a predictor of the recurrence of middle ear effusion in children.

Laryngoscope 2013 Sep 10;123(9):2285-90. Epub 2013 Apr 10.

Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.

Objectives/hypothesis: In children with ventilation tubes (VTs) inserted for chronic otitis media with effusion (COME), the authors sought to determine whether any parameter of Eustachian tube (ET) function measured by the forced response test (FRT) predicts disease recurrence after the VT becomes nonfunctional.

Study Design: Prospective study of those factors that predict disease recurrence in children with VTs inserted for COME.

Methods: Forty-nine subjects (73 ears; 28 male, 34 white, aged 5.3 ± 1.2 years) with COME had VTs inserted and were evaluable for disease status after the VT(s) became nonfunctional. The FRT was done when the VTs were patent, and results for the last test before the VT became nonfunctional were used in the analysis. After each VT became nonfunctional, the children were followed for disease recurrence over a 12-month period. Logistic regression was used to determine whether the ET opening pressure, closing pressure, and/or dilatory efficiency predicted disease recurrence. That model was expanded to include age, sex, race, history of adenoidectomy, previous VTs, and duration of VT patency as potential predictive factors.

Results: Twenty-nine (40%) ears had recurrence of significant disease within 12 months after the VT became nonfunctional. For the complete logistic regression model, male gender (P = .03), nonwhite race (P = .02), shorter period of VT patency (P = .01), and low dilatory efficiency (P = .01) were significant predictors of disease recurrence.

Conclusions: A measure of active ET function, dilatory efficiency, but not measures of passive function predicted disease recurrence within the 12 months after the VT became nonfunctional in children with COME.
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http://dx.doi.org/10.1002/lary.24021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3711968PMC
September 2013

The Cephalic Index is not different among groups of children aged 36-48 months with chronic otitis media with effusion, recurrent acute otitis media and controls.

Int J Pediatr Otorhinolaryngol 2013 Mar 30;77(3):334-7. Epub 2012 Dec 30.

Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Objectives: The Cephalic Index, an anthropometric measure of head shape, was reported to be different between individuals with and without signs of past or concurrent otitis media (OM). In this study, we compared the Cephalic Index and other measures of head shape among groups of children aged 36-48 months with a documented history of chronic OM with effusion (COME), recurrent acute OM (RAOM) and CONTROLS (few to no OM episodes) to test that hypothesis.

Methods: In 41 CONTROL, 36 COME and 42 RAOM children, Maximum Head Width, Maximum Head Length and Head Circumference were measured and the Cephalic Index (Head Width/Head Length×100) was calculated. The four measures were compared among the three groups using a General Linear Model that included group, sex and race as factors and age as a covariate.

Results: There were no differences among groups in the Cephalic Index or Head Length. Head Width was significantly smaller in the RAOM when compared to the CONTROL group and Head Circumference was significantly smaller in the RAOM and COME groups when compared to the CONTROL group. For all measures, the distribution of values showed significant overlap among groups.

Conclusions: These results do not support the hypothesis that the Cephalic Index is different between young children with and without OM, but did document differences in Head Width and Circumference among groups. However, the large overlap in each measure for the three groups suggests that none capture sufficient information on Eustachian tube anatomy to predict disease presentation.
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http://dx.doi.org/10.1016/j.ijporl.2012.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3570633PMC
March 2013

Reproducibility of the forced response test in children with chronic otitis media with effusion.

Otol Neurotol 2013 Jan;34(1):16-21

Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.

Hypothesis: Eustachian tube function is stable over time in children with ventilation tubes for chronic otitis media with effusion.

Background: Clinical studies report that Eustachian tube function tests in patients with a persistent tympanic membrane perforation predict the success of myringoplasty, and those in patients with ventilation tubes for chronic otitis media predict disease recurrence after the tubes become nonfunctional. In those studies, Eustachian tube function was usually tested only once, which presumes a semi-stable basal level of function for greatest diagnostic and prognostic usefulness. We investigated the stability of repeated measurements of Eustachian tube function using the forced response test.

Methods: Thirty-nine children aged 36 to 83 months with bilateral ventilation tubes for chronic otitis media with effusion were evaluated using the forced response test 3 times at 3- to 4-month intervals. The variability across test sessions in the Eustachian tube opening pressure, closing pressure, and dilatory efficiency was estimated using regression/correlation analyses.

Results: For all test parameters, the between-session and between-ear correlation coefficients were significant, but the shared variance in the parameters among test sessions and between ears at the same test session was relatively low. The average slope for each parameter as a function of the time with a ventilation tube was zero.

Conclusion: The low between-test shared variance for the test parameters raises questions as to whether a single forced response test captures sufficient information to accurately diagnose the cause of any dysfunction or to predict with high specificity and sensitivity future disease experience or surgical results.
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http://dx.doi.org/10.1097/MAO.0b013e31827853f4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3523714PMC
January 2013

Treatment of acute otitis media in young children.

Curr Allergy Asthma Rep 2012 Dec;12(6):559-63

University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Faculty Pavilion, Pittsburgh, PA 15224, USA.

Although acute otitis media (AOM) is one of the most common pediatric problems, the debate over treatment, especially in young children, continues. The 2004 Guideline on treatment of AOM stated that observation without antimicrobial therapy was an option for selected children 6-24 months of age with AOM. Two recent randomized trials sought to determine the necessity of antimicrobial treatment in young children; both studies found modest, statistically significant, positive effects of treatment. However, these studies provoked a flurry of discussion in the literature and the issue remains unsettled. That prevention is preferable to treatment is not controversial. Eliminating or modifying risk factors and use of vaccines, both bacterial and viral, may help decrease the number of AOM episodes. The discussion on treatment of AOM in young children must also take into account side effects of treatment and effect of treatment on possible long-lasting sequelae of AOM, such as developmental outcomes.
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http://dx.doi.org/10.1007/s11882-012-0309-9DOI Listing
December 2012

Pre- and post-palatoplasty Eustachian tube function in infants with cleft palate.

Int J Pediatr Otorhinolaryngol 2012 Mar 9;76(3):388-91. Epub 2012 Jan 9.

Department of Otolaryngology, Children's Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, United States.

Objective: One past study conducted in 1986 reported Eustachian tube dilation with swallowing during the forced response test (FRT) in a very high percentage (>80%) of cleft palate patients both before and after palatoplasty. The present study was designed to determine the reproducibility of those results.

Methods: The FRT was used to evaluate Eustachian tube function in a cohort of cleft palate children before and after palatoplasty. Pre-palatoplasty FRT data were available for 25 ears and post-palatoplasty data were available for 31 ears; 14 ears had paired pre-post palatoplasty test data. The results for the FRT tests were compared between the pre- and post-palatoplasty groups for the cross-sectional data and for the paired subset of ears.

Results: The 3 passive function measures of the FRT, the opening pressure, closing pressure and passive resistance were not different before and after palatoplasty for either data set. Similarly, 2 of the 3 active function measures, active resistance and dilatory efficiency, were not different pre- and post-palatoplasty, but the percent of ears evidencing tubal dilation for the cross-sectional data was 39% and 62% (p=NS) and for the paired subset was 33% and 83% (p=0.04) at the pre- and post-palatoplasty tests.

Conclusion: Palatoplasty had no effect on most measures of the FRT, but may have had a positive effect on the ability to dilate the Eustachian tube during swallowing. The high frequency of ears with tubal dilation before palatoplasty reported in the 1986 study was not reproduced but that frequency after palatoplasty was similar.
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http://dx.doi.org/10.1016/j.ijporl.2011.12.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3615537PMC
March 2012

Evaluation of 15 functional candidate genes for association with chronic otitis media with effusion and/or recurrent otitis media (COME/ROM).

PLoS One 2011 16;6(8):e22297. Epub 2011 Aug 16.

Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, United States of America.

DNA sequence variants in genes involved in the innate immune response and secondary response to infection may confer susceptibility to chronic otitis media with effusion and/or recurrent otitis media (COME/ROM). We evaluated single nucleotide polymorphisms (SNPs) in 15 functional candidate genes. A total of 99 SNPs were successfully genotyped on the Sequenom platform in 142 families (618 subjects) from the Minnesota COME/ROM Family Study. Data were analyzed for association with COME/ROM using the Generalized Disequilibrium Test (GDT). Sex and age at exam were adjusted as covariates, relatedness was accounted for, and genotype differences from all phenotypically discordant relative pairs were utilized to measure the evidence of association between COME/ROM and each SNP. SNP rs2735733 in the region of the mucin 5, subtypes A/C gene (MUC5AC) exhibited nominal evidence for association with COME/ROM (P = 0.002). Two additional SNPs from this region had P values<0.05. Other variants exhibiting associations with COME/ROM at P<0.05 included the SCN1B SNP rs8100085 (P = 0.013), SFTPD SNP rs1051246 (P = 0.039) and TLR4 SNP rs2770146 (P = 0.038). However, none of these associations replicated in an independent sample of COME/ROM families. The candidate gene variants examined do not appear to make a major contribution to COME/ROM susceptibility, despite a priori evidence from functional or animal model studies for a role in COME/ROM pathology.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0022297PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156706PMC
February 2012

A pilot study of the ability of the forced response test to discriminate between 3-year-old children with chronic otitis media with effusion or with recurrent acute otitis media.

Acta Otolaryngol 2011 Nov 17;131(11):1150-4. Epub 2011 Aug 17.

Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC and the University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA.

Conclusions: When used to test 3-year-old children within 3 months of tympanostomy tube placement for recurrent acute otitis media (rAOM) or chronic otitis media with effusion (cOME) the forced response test (FRT) showed relatively minor differences in the active and passive functions of the eustachian tube. While the sample size was small, the high variability in all test parameters suggests that the FRT alone is not capable of distinguishing between children with different expressions of otitis media.

Objective: The FRT was designed to measure the passive and active properties of the eustachian tube. We evaluated the ability of that test to discriminate groups of children with rAOM or cOME.

Methods: Twenty-two ears (15 children) with a confirmed history of rAOM and 24 ears (17 children) with a confirmed history of cOME were tested at 3 years of age within 3 months of ventilation tube placement. The parameters of the FRT were compared between these groups using a two-tailed Student's t test and the frequencies of ears evidencing eustachian tube dilation with swallowing were compared between groups using a χ(2) test.

Results: Passive resistance and one measure of active function were significantly higher in the rAOM group. The frequency of tubal dilation was not significantly different between groups. There were no differences in any of the FRT measures between cOME ears that did and did not have acute otitis media by history.
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http://dx.doi.org/10.3109/00016489.2011.603137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663051PMC
November 2011

Postpalatoplasty Eustachian tube function in young children with cleft palate.

Cleft Palate Craniofac J 2012 Jul 8;49(4):504-7. Epub 2011 Jul 8.

Department of Plastic Surgery, Children's Hospital of Pittsburgh of UPMC, One Children's Hospital Drive, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.

Objective: To characterize Eustachian tube function using the forced response test in young children with cleft palate with or without cleft lip after palatoplasty with tympanostomy tubes inserted prepalatoplasty and compare these results with those of a 1986 study that evaluated a similar population using identical methods.

Setting: Outpatient research clinic.

Patients/participants: A total of 34 children with cleft palate were tested at an average age of 18.6 ± 4.0 months. MAIN OUTCOME MEASUREs: Passive and active measures for the forced response test.

Results: Of the sample, 13 ears could not be tested, and tests on 24 ears were incomplete. The forced response test showed that the passive Eustachian tube function parameters were similar to those of normal adults and children. The percentage of ears that showed tubal dilation with swallowing was 60%. The active resistance and dilatory efficiency were similar to those of a normal adult population.

Conclusions: A 1986 study of Eustachian tube function in postpalatoplasty subjects with cleft palate (37 ears) aged 15 to 26 months documented Eustachian tube dilation with swallowing in 84% of the ears. In the present study, which focused on a similar population, the frequency of tubal dilation was 60%. Nonetheless, both frequencies are significantly greater than the dilation frequency of 27% reported for 56 ears of subjects with cleft palate tested between 3 months and 18 years with tympanostomy tubes inserted for persistent otitis media with effusion. This suggests that dilation during the forced response test may be a prognostic marker for those children with cleft palate who will resolve their ear disease at an early age.
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http://dx.doi.org/10.1597/11-065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616454PMC
July 2012

Tympanostomy tube placement and vestibular function in children.

Otolaryngol Head Neck Surg 2011 Oct 15;145(4):666-72. Epub 2011 Jun 15.

Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania 15224, USA.

Objective: To determine the effect of bilateral myringotomy with tube placement (BMT) on balance in children 4 to 7 years old.

Study Design: Case-control study.

Setting: Tertiary-care academic hospital.

Subjects And Methods: Children with otitis media with effusion (OME) who were scheduled for BMT underwent rotational chair testing (RCT) and computerized dynamic posturography (CDP) preoperatively and at 1, 3, and 6 months postoperatively. Control children without a significant history of middle ear disease were tested at the same intervals. Analysis of covariance was performed to evaluate the effect of BMT on RCT and CDP outcomes with age as a covariate.

Results: Seventy-two cases and 56 controls were enrolled. Mean (SD) age was 69 (12) months for cases and 72 (15) months for controls. No difference was seen between groups on RCT outcomes or sensory organization test (SOT) scores. Higher sway velocity during CDP was observed in the OME group both preoperatively and 1 month postoperatively. This difference was not statistically significant. There was no difference between groups 3 months postoperatively. At 6 months, the BMT group had a statistically significant decrease in sway velocity compared with the control group.

Conclusion: No difference was observed between children with OME and controls in RCT or SOT scores. Gradual improvement in sway velocity was observed after BMT. At the final time point, the groups did significantly differ in speed of sway, although the preoperative baseline difference failed to reach statistical significance. The authors suggest that physicians continue to inquire about balance development in patients with OME.
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http://dx.doi.org/10.1177/0194599811412038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3856627PMC
October 2011

Eustachian tube function in adults without middle ear disease.

Ann Otol Rhinol Laryngol 2011 Apr;120(4):220-5

Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, USA.

Objectives: We sought to develop normative values for 5 eustachian tube function (ETF) test protocols in adults without otitis media (OM).

Methods: Twenty adults (19 to 48 years of age) without a recent history of OM (5 had OM in childhood) underwent unilateral myringotomy and were evaluated for ETF by use of the forced response, inflation, deflation, forcible "sniff", and Valsalva test protocols. When possible, these tests were repeated on a second day.

Results: Normative values for the parameters of these protocols in adult subjects without a recent history of OM were developed. Between-day data for the forced response test were highly correlated. A percentage of these tests showed eustachian tube "constriction" during swallowing--an abnormal condition. The percent reduction in applied pressures for the inflation and deflation tests was high, indicative of good ETF. Few subjects had a positive "sniff" test, whereas most had a positive Valsalva test, and the results for both tests were effort-dependent.

Conclusions: Results of ETF tests in adults with and without recent OM have not been published. Normative data are now available for comparison with ETF test results in adults with OM. These protocols will be used to evaluate the efficacy of surgical procedures designed to improve ETF.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616372PMC
http://dx.doi.org/10.1177/000348941112000401DOI Listing
April 2011

Reply to Letter to the Editor.

Int J Pediatr Otorhinolaryngol 2010 Aug 10;74(8):971. Epub 2010 Apr 10.

Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, 4401 Penn Ave. Pittsburgh, PA 15224, United States.

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http://dx.doi.org/10.1016/j.ijporl.2010.03.011DOI Listing
August 2010

Post-tonsillectomy bleeding in children with von Willebrand disease: a single-institution experience.

Otolaryngol Head Neck Surg 2010 May;142(5):715-21

Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA.

Objectives: 1) Compare rates of post-tonsillectomy bleeding in pediatric patients with and without von Willebrand disease (vWD). 2) Identify factors that may increase the risk for post-tonsillectomy bleeding in children with and without vWD.

Study Design: Historical cohort study.

Setting: Tertiary care, university-based pediatric hospital.

Subjects And Methods: Medical records were examined for 99 patients with vWD and 99 patients without vWD younger than 18 years who underwent tonsillectomy with or without adenoidectomy from August 1997 to October 2005. Subjects were matched for age, year of surgery, type of surgery, and indication for surgery.

Results: Post-tonsillectomy hemorrhage occurred in eight of 99 (8%) vWD patients and in six of 99 (6%) non-vWD patients (P = 0.58, odds ratio 1.36, 95% CI 0.45-4.08). A two-sample test of proportions demonstrated lower and upper limits of -0.051 and 0.092. Four of eight children with vWD and two of six non-vWD patients required surgical intervention for control of bleeding. Ninety-three of 99 vWD patients received desmopressin acetate (DDAVP) preoperatively. In patients with vWD who responded to DDAVP challenge, there was no increased likelihood of post-tonsillectomy bleeding compared with non-vWD patients. No significant difference in the number of bleeding events was noted on the basis of demographics, preoperative laboratories, or use of aminocaproic acid.

Conclusion: Children with vWD undergoing tonsillectomy have a postoperative bleeding rate similar to that of a matched group. However, the sample size was not sufficient to eliminate the possibility of a clinically important difference between the two groups.
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http://dx.doi.org/10.1016/j.otohns.2010.01.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275349PMC
May 2010

Longitudinal posturography and rotational testing in children three to nine years of age: normative data.

Otolaryngol Head Neck Surg 2010 May;142(5):708-14

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA 15224, USA.

Objective: To obtain normative longitudinal vestibulo-ocular and balance test data in children from ages three to nine years with normal middle ear status.

Study Design: Prospective, longitudinal cohort.

Setting: Tertiary care pediatric hospital.

Subjects And Methods: Three-year-old children were entered and tested yearly. Subjects underwent earth vertical axis rotation testing using sinusoidal and constant velocity stimuli and performed the Sensory Organization Test.

Results: One hundred forty-eight children were entered, and usable data were collected on 127 children. A linear increase in the vestibulo-ocular reflex gain as children aged was found, without a change in the phase of the response. An age-related linear increase in equilibrium scores, indicating reduced postural sway, was also observed.

Conclusion: These normative data can be used in the evaluation of dizziness and balance disorders in children.
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http://dx.doi.org/10.1016/j.otohns.2010.01.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900920PMC
May 2010

Adenoidectomy for otitis media with effusion in 2-3-year-old children.

Int J Pediatr Otorhinolaryngol 2009 Dec 12;73(12):1718-24. Epub 2009 Oct 12.

Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA 15213, United States.

Objective: To compare the efficacy of three surgical treatment combinations - myringotomy and tympanostomy tube insertion (M&T), adenoidectomy with M&T (A-M&T), and adenoidectomy with myringotomy (A-M) - in reducing middle-ear disease in young children with chronic OME.

Methods: Children 24-47 months of age, with a history of bilateral middle-ear effusion (MEE) for at least 3 months, unilateral for 6 months or longer or unilateral for 3 months after extrusion of a tympanostomy tube, unresponsive to recent antibiotic, were randomly assigned to either M&T, A-M&T, or A-M. Treatment assignment was stratified by age (24-35 months, 36-47 months), nasal obstruction (no, yes) and previous history of M&T (no, yes). Subjects were followed monthly and with any signs or symptoms of ear disease for up to 36 months.

Results: Ninety-eight subjects were randomly assigned to the three treatment groups. Fifty-six subjects (57%) were 24-35 months of age; 63% had nasal obstruction, and 36% had previously undergone M&T. During the 36 months after entry, subjects were noted to have MEE for the following percentages of time: 18.6% in the M&T group, 20.6% in the A-M&T group, and 31.1% in the A-M group (M&T vs. A-M&T, p=0.87; M&T vs. A-M, p=0.01). By 36 months, there were no differences in the number of further surgical procedures for ear disease needed among the groups.

Conclusions: Adenoidectomy with or without tube insertion provided no advantage to young children with chronic OME in regard to time with effusion compared to tube insertion alone. Fewer tympanostomy tubes were placed in children undergoing A-M as their initial procedure, but this should be balanced by the performance of the more invasive surgical procedure and their increased time with effusion.
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http://dx.doi.org/10.1016/j.ijporl.2009.09.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2787742PMC
December 2009

Otitis media: a genome-wide linkage scan with evidence of susceptibility loci within the 17q12 and 10q22.3 regions.

BMC Med Genet 2009 Sep 3;10:85. Epub 2009 Sep 3.

Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA.

Background: Otitis media (OM) is a common worldwide pediatric health care problem that is known to be influenced by genetics. The objective of our study was to use linkage analysis to map possible OM susceptibility genes.

Methods: Using a stringent diagnostic model in which only those who underwent tympanostomy tube insertion at least once for recurrent/persistent OM are considered affected, we have carried out a genome-wide linkage scan using the 10K Affymetrix SNP panel. We genotyped 403 Caucasian families containing 1,431 genotyped individuals and 377 genotyped affected sib pairs, and 26 African American families containing 75 genotyped individuals and 27 genotyped affected sib pairs. After careful quality control, non-parametric linkage analysis was carried out using 8,802 SNPs.

Results: In the Caucasian-only data set, our most significant linkage peak is on chromosome 17q12 at rs226088 with a p-value of 0.00007. Other peaks of potential interest are on 10q22.3 (0.00181 at rs1878001), 7q33 (0.00105 at rs958408), 6p25.1 (0.00261 at rs554653), and 4p15.2 (0.00301 at rs2133507). In the combined Caucasian and African American dataset, the 10q22.3 peak becomes more significant, with a minimal p-value of 0.00026 at rs719871. Family-based association testing reveals signals near previously implicated genes: 513 kb from SFTPA2 (10q22.3), 48 kb from IFNG (12q14), and 870 kb from TNF (6p21.3).

Conclusion: Our scan does not provide evidence for linkage in the previously reported regions of 10q26.3 and 19q13.43. Our best-supported linkage regions may contain susceptibility genes that influence the risk for recurrent/persistent OM. Plausible candidates in 17q12 include AP2B1, CCL5, and a cluster of other CCL genes, and in 10q22.3, SFTPA2.
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http://dx.doi.org/10.1186/1471-2350-10-85DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751750PMC
September 2009

Rate of concurrent otitis media in upper respiratory tract infections with specific viruses.

Arch Otolaryngol Head Neck Surg 2009 Jan;135(1):17-21

Department of Otolaryngology, Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.

Objective: To estimate the coincidence of new otitis media (OM) for first nasopharyngeal detections of the more common viruses by polymerase chain reaction (PCR). New OM episodes are usually coincident with a viral upper respiratory tract infection (vURTI), but there are conflicting data regarding the association between specific viruses and OM.

Design: Longitudinal (October-March), prospective follow-up of children for coldlike illness (CLI) by diary, middle ear status by pneumatic otoscopy, and vURTI by PCR.

Setting: Academic medical centers.

Participants: A total of 102 families with at least 2 children aged between 1 and 5 years (213 children; mean [SD] age, 3.7 [1.5] years; 110 male; and 176 white) were recruited from the local communities at 2 study sites by advertisement.

Main Outcome Measures: New OM and CLI episodes and nasopharyngeal virus detections.

Results: A total of 176 children (81%) had isolated PCR detection of at least 1 virus. The OM coincidence rates were 62 of 144 (44%) for rhinovirus, 15 of 27 (56%) for respiratory syncytial virus, 8 of 11 (73%) and 1 of 5 (20%) for influenza A and B, respectively, 6 of 12 (50%) for adenovirus, 7 of 18 (39%) for coronavirus, and 4 of 11 (36%) for parainfluenza virus detections (P = .37). For rhinovirus, new OM occurred in 50% of children with and 32% without a concurrent CLI (P = .15), and OM risk was predicted by OM and breastfeeding histories and by daily environment outside the home.

Conclusions: New OM was associated with nasopharyngeal detection of all assayed viruses irrespective of the presence or absence of a concurrent CLI. Differences among viruses were noted, but statistical significance was not achieved, possibly because of the low power associated with the small number of nonrhinovirus detections.
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http://dx.doi.org/10.1001/archotol.135.1.17DOI Listing
January 2009

Balance and otitis media with effusion.

Int J Audiol 2008 Sep;47(9):584-9

Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15213, USA.

Dizziness can be caused by a variety of peripheral vestibular, central, and systemic disease processes. Eustachian tube dysfunction with and without middle-ear effusion has been considered one of the most common causes of balance disturbances in young children. Several studies have indicated that during an episode of otitis media the child's balance deteriorates and the child may become clumsy and fall more often. Thus, not only the adverse effect on hearing should be considered in the management of a child with otitis media, but also the child's balance.
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http://dx.doi.org/10.1080/14992020802331230DOI Listing
September 2008

The incidence, prevalence and burden of OM in unselected children aged 1-8 years followed by weekly otoscopy through the "common cold" season.

Int J Pediatr Otorhinolaryngol 2008 Apr 12;72(4):491-9. Epub 2008 Feb 12.

Department of Otolaryngology, Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Background: There is a continuing interest in defining the incidence, prevalence and burden of otitis media (OM) in the individual and population for purposes of assigning "risk factors". Often overlooked in past studies are the contributions of cold-like illnesses (CLIs) and sampling interval to those estimates.

Objective: Describe the incidence of symptomatic (AOM) and asymptomatic (OME) OM, the prevalence of OM, the contribution of CLI incidence, burden and other OM "risk factors" to the incidence and burden of OM, and the effect of sampling interval on those measures in children.

Methods: 148 children (74 male; 131 white, aged 1.0-8.6 years) were followed from November 1 to April 30 by weekly pneumatic otoscopy to diagnose OM presence/absence and by daily parental diary to assign CLI episodes. Data for previously identified OM "risk factors" were collected on 127. Results were summarized using standard measures of incidence, prevalence and burden, and multiple regression techniques were used to identify OM "risk factors".

Results: The basal OM prevalence was 20% with peaks in December and March and the temporal pattern was correlated with CLI prevalence. The incidence of OME (per 27,232 child-days) was 317, AOM was 74 and CLI was 456. The seasonal pattern of AOM and OME incidences tracked and was correlated with that for CLIs. New OM episodes were usually of short duration (
Conclusions: These results demonstrate a high incidence and prevalence of OM, most OM episodes were of short duration and longer sampling intervals introduced biases into some parameter estimates. There was a significant relationship between OM and CLI incidence, prevalence and burden suggesting that CLI experience should be controlled for in assessing independent "risk factors" for AOM and OME.
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http://dx.doi.org/10.1016/j.ijporl.2007.12.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2292124PMC
April 2008

Contribution of vision to balance in children four to eight years of age.

Ann Otol Rhinol Laryngol 2007 Sep;116(9):653-7

Department of Otolaryngology, University of Pittsburgh School of Medicine, Pennsylvania, USA.

Objectives: The use of sensory feedback for postural control develops throughout childhood. The aim of this study was to determine how children use cues from anterior-posterior optic flow for balance from 4 to 8 years of age.

Methods: One hundred forty-eight children were enrolled. The subjects had yearly otologic and posturographic examinations between the ages of 4 and 8 years. Balance was assessed only if the subject had no evidence of middle ear effusion. The subject stood for 30 seconds with eyes open without optic flow and for 30 seconds while viewing 0.1, 0.25, and 0.4 Hz anterior-posterior optic flow. The center of pressure (COP) was recorded from the force platform. The root-mean-square of the COP during the periods of quiet stance and with optic flow was computed.

Results: The root-mean-square COP was significantly larger during the optic flow stimulation as compared with during quiet stance. The subjects had a significant decrease in COP during optic flow from year 5 to year 6 of life (p = .005).

Conclusions: A change in the response to optic flow was seen from age 5 to age 6. This change is consistent with transitional changes in postural responses that have been observed during quiet standing.
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http://dx.doi.org/10.1177/000348940711600905DOI Listing
September 2007

Temporal relationships for cold-like illnesses and otitis media in sibling pairs.

Pediatr Infect Dis J 2007 Sep;26(9):778-81

Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.

Background: New otitis media (OM) episodes are most frequently a complication of cold-like illnesses (CLIs) which are often virus infections that can be exchanged within the family unit. Interference with intrafamily CLI transmission may present a strategy for OM prophylaxis in high risk children. This study estimated factors relevant to strategy efficiency.

Methods: Two siblings (ages, 1.0-4.3 and 1.7-6.1 years) from 69 families were followed for 193 days beginning in October using daily parental diaries focused on CLI signs and weekly pneumatic otoscopy to diagnose OM presence/absence. An algorithm converted the signs to presence/absence of a cold-day; cold-days were grouped into CLI episodes, and episodes were examined for intersib transmission and OM complications.

Results: We identified 267 CLIs in the younger siblings and 221 in the older siblings. Twenty-seven percent of the CLI episodes in one sibling occurred after CLI onset in the other with a median interval of 3 days. Sixty-two percent of newly diagnosed OM episodes occurred during a CLI and 27% of CLIs were complicated by OM. Analysis of factors that could affect CLI incidence documented significant contributions of gender, age, daily environment and the CLI burden in the sibling with expected directionalities.

Conclusion: The results document intrafamily transmission of CLIs that is often associated with the development of OM as a complication. These observations and the measured interval between primary and secondary CLI onsets support the possibility of preventing OM by strategies that target intrafamily CLI transmission.
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http://dx.doi.org/10.1097/INF.0b013e318124aa31DOI Listing
September 2007

Temporal relationships between colds, upper respiratory viruses detected by polymerase chain reaction, and otitis media in young children followed through a typical cold season.

Pediatrics 2007 Jun;119(6):1069-75

Department of Otolaryngology, University of Virginia Health System, Charlottesville, Virginia, USA.

Introduction: Otitis media is a frequent complication of a viral upper respiratory tract infection, and the reported co-incidence of those diseases increases with assay sensitivity and sampling density. We determined the incidence of otitis-media complications in young children when referenced to cold-like illnesses and to concurrent virus recovery from the nasopharynx.

Methods: A total of 60 children from 24 families were followed from October 2003 through April 30, 2004, by daily parental recording of illness signs, weekly pneumatic otoscopic examinations, and periodic polymerase chain reaction assay of collected nasal fluids for common viruses.

Results: One hundred ninety-nine cold-like illnesses were observed, but a sample for virus assay was not collected concurrent with 71 episodes. Of the remainder, 73% of cold-like illnesses were temporally related to recovery of 1 or a combination of the assayed viruses, with rhinovirus predominating. For non-cold-like illness periods, 54 (18%) of 297 assays were positive for virus, and the virus frequency distribution was similar to that for cold-like illnesses. There were 93 diagnosed otitis-media episodes; 65 (70%) of these occurred during a cold-like illness. For the 79 otitis-media episodes with available nasal samples, 61 (77%) were associated with a positive virus result. In this population, the otitis-media complication rate for a cold-like illness was 33%.

Conclusions: A cold-like illness was not a prerequisite for polymerase chain reaction detection of viruses in the nose and nasopharynx of young children. Viral detection by polymerase chain reaction in the absence of a cold-like illness is associated with complications in some subjects. Otitis media is a complication of viral infection both with and without concurrent cold-like illnesses, thus downwardly biasing coincidence estimates that use cold-based illnesses as the denominator.
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http://dx.doi.org/10.1542/peds.2006-3294DOI Listing
June 2007