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Sun J, Tan H, Chen J, Guo J, Zhang C, Wang Z, Wu H, Jia H. Feasibility of Round Window Exposure via External Auditory Canal: Classification and Predictive Landmarks. Laryngoscope Investig Otolaryngol 2025; 10:e70127. [PMID: 40130168 PMCID: PMC11931666 DOI: 10.1002/lio2.70127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Accepted: 03/09/2025] [Indexed: 03/26/2025] Open
Abstract
Objective To clarify the feasibility and the anatomical characteristics related to round window exposure via the external auditory canal (EAC) without bony removal. Methods Surgical videos and radiological data from 50 adult patients who underwent endoscopic tympanoplasty type I were collected. According to surgical videos, round window niche (RWN) exposure was classified as "Certainly," "Possibly," and "None," and round window membrane (RWM) exposure was classified as "Clear visualization," "Incomplete visualization," "Just perceptible" and "Invisible." Basing on CT reconstruction, distances among RWM, RWN, tympanic annulus (TA), width, and orientation of scala tympani (ST) were measured under the Coordinate System of Cochlea, and anatomic features of EAC under the Coordinate System of EAC. Results 60% of RWNs were "Certainly," 24% "Possibly," and 16% "None" exposed. RWM exposure was 32% "Clear visualization," 22% "Incomplete visualization," 14% "Just perceptible," and 32% "Invisible." Longer distances between RWM and TA (RWM-TA), and the Width of ST in x and z sections were related to RWM exposure (RWM-TA: Spearman-r = 0.663, p < 0.001, ST in x: Spearman-r = -0.337, p = 0.017, z: Spearman-r = -0.586, p < 0.001). RWM-TA longer than 7.06 mm indicated a possibility of RWM exposure (AUC = 0.784, p = 0.011). Widths of ST in x and z sections shorter than 1.85 mm and 1.84 mm, respectively, indicated better RWM exposure (AUC = 0.887, p < 0.001). The size of EAC in axial and coronal sections could significantly predict RWM exposure (axial: AUC = 0.726, p = 0.011, coronal: AUC = 0.798, p = 0.001). Conclusion In adults, 54% of RWM could be partially visualized via EAC without bony removal. There are reliable pre-operative predictors for RWM exposure, which are helpful for future inner ear therapy. Level of Evidence 3.
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Affiliation(s)
- Jiayu Sun
- Department of Otolaryngology Head and Neck SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Ear Institute, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose DiseasesShanghaiChina
| | - Haoyue Tan
- Department of Otolaryngology Head and Neck SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Ear Institute, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose DiseasesShanghaiChina
| | - Jianqing Chen
- Department of Otolaryngology Head and Neck SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Ear Institute, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose DiseasesShanghaiChina
| | - Jia Guo
- Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Chengyu Zhang
- Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zhaoyan Wang
- Department of Otolaryngology Head and Neck SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Ear Institute, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose DiseasesShanghaiChina
| | - Hao Wu
- Department of Otolaryngology Head and Neck SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Ear Institute, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose DiseasesShanghaiChina
| | - Huan Jia
- Department of Otolaryngology Head and Neck SurgeryShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Ear Institute, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose DiseasesShanghaiChina
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Lin Q, Guo Q, Zhu M, Zhang J, Chen B, Wu T, Jiang W, Tang W. Application of Nanomedicine in Inner Ear Diseases. Front Bioeng Biotechnol 2022; 9:809443. [PMID: 35223817 PMCID: PMC8873591 DOI: 10.3389/fbioe.2021.809443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
The treatment of inner ear disorders always remains a challenge for researchers. The presence of various physiological barriers, primarily the blood–labyrinth barrier (BLB), limits the accessibility of the inner ear and hinders the efficacy of various drug therapies. Yet despite recent advances in the cochlea for repair and regeneration, there are currently no pharmacological or biological interventions for hearing loss. Current research focuses on the localized drug-, gene-, and cell-based therapies. Drug delivery based on nanotechnology represents an innovative strategy to improve inner ear treatments. Materials with specific nanostructures not only exhibit a unique ability to encapsulate and transport therapeutics to the inner ear but also endow specific targeting properties to auditory hair cells as well as the stabilization and sustained drug release. Along with this, some alternative routes, like intratympanic drug delivery, can also offer a better means to access the inner ear without exposure to the BLB. This review discusses a variety of nano-based drug delivery systems to the ear for treating inner ear diseases. The main factors affecting the curative efficacy of nanomaterials are also discussed. With a deeper understanding of the link between these crucial factors and the clinical effect of nanomaterials, it paves the way for the optimization of the therapeutic activity of nanocarriers.
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Affiliation(s)
- Qianyu Lin
- Department of Molecular Pathology, Application Center for Precision Medicine, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Center for Precision Medicine, Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Qiong Guo
- Department of Molecular Pathology, Application Center for Precision Medicine, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Center for Precision Medicine, Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Mingchao Zhu
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Drug Discovery for Metabolic Diseases, Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing, China
| | - Juanli Zhang
- Henan Institute of Medical Device Inspection, Zhengzhou, China
| | - Bei Chen
- Department of Otology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tingting Wu
- Department of Molecular Pathology, Application Center for Precision Medicine, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Center for Precision Medicine, Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Wei Jiang
- Department of Molecular Pathology, Application Center for Precision Medicine, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Center for Precision Medicine, Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
- *Correspondence: Wei Jiang, ; Wenxue Tang,
| | - Wenxue Tang
- Department of Molecular Pathology, Application Center for Precision Medicine, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Center for Precision Medicine, Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
- *Correspondence: Wei Jiang, ; Wenxue Tang,
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Wang LC, Phyland D, Giddings CE. A randomised trial of single or extended dosing ciprofloxacin versus no intervention for Prevention of Ventilation Tube Otorrhoea and Obstruction (PreVenTO2). Clin Otolaryngol 2021; 47:287-294. [PMID: 34758186 DOI: 10.1111/coa.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/07/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the effectiveness of ciprofloxacin 0.3% antibiotic eardrops in preventing clinically significant postoperative otorrhoea and tube obstruction following grommet insertion in children. DESIGN 3-arm parallel assessor-blinded randomised controlled trial. Randomisation in 1:1:1 ratio to single intraoperative application of ciprofloxacin drops, extended 5-day postoperative application and no drops. Patients were assessed by blinded assessors at 6 weeks postoperatively. SETTING The study was conducted in a large tertiary health network in Melbourne, Australia. PARTICIPANTS All children, 17 years and under, undergoing bilateral MEVT surgery with or without concurrent upper airway surgery for recurrent acute otitis media and chronic otitis media with effusion were approached. MAIN OUTCOME MEASURES Presence of postoperative otorrhoea and ventilation tube obstruction at 6 weeks postoperatively. RESULTS 256 paediatric patients completed the study with a median age of 4.02 years. 153 participants were male. By ear-analysis (n=512) showed intraoperative antibiotics were more effective than no drops in preventing otorrhoea (RR=0.341, 95%CI 0.158-0.738, NNT= 11.25, p=.006). Postoperative antibiotics were more effective than no drops in preventing ventilation tube obstruction (RR=0.424, 95%CI 0.193 to 0.930, NNT=14.7 p=.032). CONCLUSION Intraoperative topical ciprofloxacin was effective at preventing early postoperative otorrhoea and a prolonged course was effective at preventing ventilation tube obstruction. Future studies on this topic should seek to clarify whether particular subgroups of patients benefit more from prophylactic topical antibiotics and model for cost-effectiveness.
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Affiliation(s)
- Luke Chenkan Wang
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of ENT Surgery, Monash Health, Melbourne, Australia
| | - Debra Phyland
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of ENT Surgery, Monash Health, Melbourne, Australia
| | - Charles Edward Giddings
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of ENT Surgery, Monash Health, Melbourne, Australia
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Habashi N, Marom T, Steinberg D, Zacks B, Tamir SO. Biofilm distribution on tympanostomy tubes: An ex vivo descriptive study. Int J Pediatr Otorhinolaryngol 2020; 138:110350. [PMID: 32911240 DOI: 10.1016/j.ijporl.2020.110350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tympanostomy tube (TT) insertion is a common procedure in children with otitis media with effusion. Post-TT otorrhea (PTTO) is a frequent post-operative complication. Biofilms are involved in chronic PTTO cases. OBJECTIVE To describe and qualitatively analyze the geometry and sites prone to biofilms on removed TTs, relatively to their position in the ear, past medical/surgical history and PTTO presence. METHODS Biofilms presence and topographic distribution on TTs were ex vivo evaluated by using scanning electron microscope, confocal microscope and stereo-microscope. RESULTS Forty-eight TTs from 30 children were analyzed. Indications for removal were: 71% due to retained TTs (average time from insertion: 24.4 ± 15.1 months), 23% due to chronic PTTO, and 6% due to TT obstruction/dysfunction. Different types of bacterial biofilms were detected on all TTs, regardless the time from their insertion nor their types. Biofilms were observed more on the perpendicular junction and on the internal lumen, and more biofilm colonies were detected on the medial part, facing the middle ear mucosa. TTs removed from children with PTTO exhibited more biofilm colonies when compared to their peers. Of the 16 children who underwent adenoidectomy concomitantly with TT insertion, 10 (62%) children were sent for TT removal due to retained TTs, and 6 (38%) children due to chronic PTTO (p = 0.03). CONCLUSION Descriptive analysis of biofilm topographic distribution demonstrated adhesions on specific TT areas: perpendicular junctions and the internal lumen. Such "prone zones" may be the future target areas for changes in TT geometry or can be specifically coated with anti-biofilm materials.
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Affiliation(s)
- Nadeem Habashi
- Department of Otolaryngology-Head and Neck Surgery, Samsun Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, 77476, Ashdod, Israel
| | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Samsun Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, 77476, Ashdod, Israel
| | - Doron Steinberg
- Biofilm Research Laboratory, Bio-Medical Program, Hebrew University-Hadassah Medical Center, 91120, Jerusalem, Israel
| | - Batya Zacks
- Biofilm Research Laboratory, Bio-Medical Program, Hebrew University-Hadassah Medical Center, 91120, Jerusalem, Israel
| | - Sharon Ovnat Tamir
- Department of Otolaryngology-Head and Neck Surgery, Samsun Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, 77476, Ashdod, Israel.
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Ma Q, Wang H, Chen ZN, Wu YQ, Yu DZ, Wang PJ, Shi HB, Su KM. Removal of biofilm is essential for long-term ventilation tube retention. World J Clin Cases 2020; 8:1592-1599. [PMID: 32432137 PMCID: PMC7211535 DOI: 10.12998/wjcc.v8.i9.1592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/04/2020] [Accepted: 04/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although long-term retention of a ventilation tube is required in many ear diseases, spontaneous removal of conventional ventilation tube is observed in patients within 3 to 12 mo. To address this issue, we aimed to determine a new method for long-term retention of the ventilation tube.
AIM To explore the value of removing the biofilm for long-term retention of tympanostomy ventilation tubes.
METHODS A case-control study design was used to evaluate the safety and effectiveness of long-term tube retention by directly removing the biofilm (via surgical exfoliation) in patients who underwent myringotomy with ventilation tube placement. The patients were randomly divided into two groups: Control group and treatment group. Patients in the treatment group underwent regular biofilm exfoliation surgery in the clinic, whereas those in the control group did not have their biofilm removed. Only conventional ventilation tubes were placed in this study. Outcome measures were tube position and patency. Tube retention time and any complications were documented.
RESULTS Eight patients with biofilm removal and eight patients without biofilm removal as a control group were enrolled in the study. The tympanostomy tube retention time was significantly longer in the treatment group (43.5 ± 26.4 mo) than in the control group (9.5 ± 6.9 mo) (P = 0.003). More tympanostomy tubes were found to be patent and in correct position in the treatment group during the follow-up intervals than in the control group (P = 0.01).
CONCLUSION Despite the use of short-term ventilation tubes, direct biofilm removal can be a well-tolerated and effective treatment for long-term tube retention of tympanostomy ventilation tubes in patients who underwent myringotomy.
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Affiliation(s)
- Qiang Ma
- Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Hui Wang
- Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Zheng-Nong Chen
- Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Ya-Qin Wu
- Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Dong-Zhen Yu
- Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Peng-Jun Wang
- Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Hai-Bo Shi
- Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China
| | - Kai-Ming Su
- Department of Otorhinolaryngology–Head & Neck Surgery, the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
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Marom T, Habashi N, Cohen R, Tamir SO. Role of Biofilms in Post-Tympanostomy Tube Otorrhea. EAR, NOSE & THROAT JOURNAL 2020; 99:22S-29S. [PMID: 32204627 DOI: 10.1177/0145561320914437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Nearly half of children who undergo tympanostomy tube (TT) insertion may experience otorrhea following surgery. We sought to review the evidence for the role of bacterial biofilms in post-tympanostomy tube otorrhea (PTTO) and the accumulated experience regarding the preventive measures for biofilm formation/adhesion on TTs. METHODS English literature search for relevant MeSH keywords was conducted in the following databases: MEDLINE (via PubMed), Ovid Medline, Google Scholar, and Clinical Evidence (BMJ Publishing) between January 1, 1995, and December 31, 2019. Subsequently, articles were reviewed and included if biofilm was evident in PTTO. RESULTS There is an increased evidence supporting the role of biofilms in PTTO. Studies on TT design and material suggest that nitinol and/or silicone TTs had a lower risk for PTTO and that biofilms appeared in specific areas, such as the perpendicular junction of the T-tubes and the round rims of the Paparella-type tubes. Biofilm-component DNAB-II protein family was present in half of children with PTTO, and targeting this protein may lead to biofilm collapse and serve as a potential strategy for PTTO treatment. Novel approaches for the prevention of biofilm-associated PTTO include changing the inherent tube composition; tube coating with antibiotics, polymers, plant extracts, or other biofilm-resistant materials; impregnation with antimicrobial compounds; and surface alterations by ion-bombardment or surface ionization, which are still under laboratory investigation. CONCLUSIONS Currently, there is no type of TT on which bacteria will not adhere. The challenges of treating PTTO indicate the need for further research in optimization of TT design, composition, and coating.
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Affiliation(s)
- Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Samson 511918Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University, Ashdod, Israel
| | - Nadeem Habashi
- Department of Otolaryngology-Head and Neck Surgery, Samson 511918Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University, Ashdod, Israel
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint-Maur des Fossés, France.,Paris Est University, IMRB-GRC GEMINI, Créteil, France
| | - Sharon Ovnat Tamir
- Department of Otolaryngology-Head and Neck Surgery, Samson 511918Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University, Ashdod, Israel
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Ajdnik U, Zemljič LF, Bračič M, Maver U, Plohl O, Rebol J. Functionalisation of Silicone by Drug-Embedded Chitosan Nanoparticles for Potential Applications in Otorhinolaryngology. MATERIALS (BASEL, SWITZERLAND) 2019; 12:E847. [PMID: 30871195 PMCID: PMC6471903 DOI: 10.3390/ma12060847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 12/16/2022]
Abstract
Silicones are widely used medical materials that are also applied for tympanostomy tubes with a trending goal to functionalise the surface of the latter to enhance the healing of ear inflammations and other ear diseases, where such medical care is required. This study focuses on silicone surface treatment with various antimicrobial coatings. Polysaccharide coatings in the form of chitosan nanoparticles alone, or with an embedded drug mixture composed of amoxicillin/clavulanic acid (co-amoxiclav) were prepared and applied onto silicone material. Plasma activation was also used as a pre-treatment for activation of the material's surface for better adhesion of the coatings. The size of the nanoparticles was measured using the DLS method (Dynamic Light Scattering), stability of the dispersion was determined with zeta potential measurements, whilst the physicochemical properties of functionalised silicone materials were examined using the UV-Vis method (Ultraviolet-Visible Spectroscopy), SEM (Scanning Electron Microscopy), XPS (X-Ray Photoelectron Spectroscopy). Moreover, in vitro drug release testing was used to follow the desorption kinetics and antimicrobial properties were tested by a bacterial cell count reduction assay using the standard gram-positive bacteria Staphylococcus aureus. The results show silicone materials as suitable materials for tympanostomy tubes, with the coating developed in this study showing excellent antimicrobial and biofilm inhibition properties. This implies a potential for better healing of ear inflammation, making the newly developed approach for the preparation of functionalised tympanostomy tubes promising for further testing towards clinical applications.
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Affiliation(s)
- Urban Ajdnik
- University of Maribor, Faculty of Mechanical Engineering, Institute for Engineering Materials and Design, Smetanova 17, 2000 Maribor, Slovenia.
| | - Lidija Fras Zemljič
- University of Maribor, Faculty of Mechanical Engineering, Institute for Engineering Materials and Design, Smetanova 17, 2000 Maribor, Slovenia.
| | - Matej Bračič
- University of Maribor, Faculty of Mechanical Engineering, Institute for Engineering Materials and Design, Smetanova 17, 2000 Maribor, Slovenia.
| | - Uroš Maver
- Faculty of Medicine, Institute of Biomedical Sciences, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia.
| | - Olivija Plohl
- University of Maribor, Faculty of Mechanical Engineering, Institute for Engineering Materials and Design, Smetanova 17, 2000 Maribor, Slovenia.
| | - Janez Rebol
- University Medical Centre Maribor, Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
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A randomized study of four different types of tympanostomy ventilation tubes - One-year follow-up. Int J Pediatr Otorhinolaryngol 2016; 89:159-63. [PMID: 27619049 DOI: 10.1016/j.ijporl.2016.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/12/2016] [Accepted: 08/15/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare four different types of tympanostomy ventilation tubes (VT); long-shaft and short-shaft silicone tubes and long-shaft and short-shaft fluoroplastic tubes, regarding time to extrusion and events of otorrhea. METHODS A prospective randomized controlled trial in children with bilateral recurrent acute otitis media or secretory otitis media; four hundred children were randomized to receive one type of VT in the right ear and another type in the left ear. Postoperatively the children were assessed every third month by an otolaryngologist to monitor the incidence of otorrhea and tube extrusion. RESULTS Out of the 400 children, 22 were excluded during surgery. Mean age was 35.3 months. A majority (63.8%) were boys. Forty-eight children were lost to follow up during the first year. Significantly more short-shaft VTs were extruded after 12 months compared to long-shaft VTs, regardless of material. Significantly higher incidence of otorrhea was found in the fluoroplastic VT ears compared to the silicone ones, regardless of length of tube. CONCLUSION Long-shaft VTs last longer in the eardrum during the first year of treatment. Silicone tubes render a reduced risk of otorrhea during the first year of treatment.
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Dirain CO, Silva RC, Antonelli PJ. Prevention of biofilm formation by polyquaternary polymer. Int J Pediatr Otorhinolaryngol 2016; 88:157-62. [PMID: 27497405 DOI: 10.1016/j.ijporl.2016.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/01/2016] [Accepted: 07/02/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Biofilm formation has been linked to device-associated infections in otolaryngology. This study was conducted to determine if a microbicidal polyquaternary polymer, poly diallyl-dimethylammonium chloride (pDADMAC) could prevent biofilm development by pathogens that commonly cause implant infections, Staphylococcus aureus and Pseudomonas aeruginosa. METHODS AND MATERIALS This study was prospective and controlled in vitro microbiological study. Polyurethane tubes (20 per treatment) with and without a polyquaternary polymer coating were briefly exposed to plasma or saline, then to S. aureus or P. aeruginosa. Polyurethane tubes were incubated in growth media. After 4 days, antibiotics were added to kill planktonic bacteria. S. aureus or P. aeruginosa bacterial counts and scanning electron microscopy (SEM) were performed. RESULTS S. aureus biofilm counts were reduced by 8 logs on tubes with polyquaternary polymer coating compared to the control tubes, either with plasma (3.67E+01 ± 7.30E+01 vs 1.08E+09 ± 4.81E+08; P < 0.0001) or without plasma (3.70E+00 ± 1.10E+01 vs 6.50E+08 ± 2.79E+08; P < 0.0001). P. aeruginosa biofilm formation was also reduced on tubes with polyquaternary polymer, either with plasma (2.90E+07 ± 1.71E+07 vs 9.16E+08 ± 4.43E+08; P < 0.0001) or without plasma (2.50E+07 ± 9.54E+06 vs 3.35E+08 ± 2.18E+08; P < 0.001), but the reduction was only 1 log. On control tubes, plasma promoted S. aureus (1.08E+09 ± 4.81E+08 vs 6.05E+08 ± 2.79E+08; P < 0.0001) and P. aeruginosa (9.16E+08 ± 4.43E+08 vs 3.35E+08 ± 2.18E+08; P < 0.0001) bacterial counts but not on the tubes coated with polyquaternary polymer. CONCLUSIONS Incorporation of the microbicidal polyquaternary polymer, pDADMAC, into polyurethane dramatically inhibits S. aureus biofilm formation. Further research is warranted to evaluate the efficacy and safety of this technology in otolaryngologic implants.
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Affiliation(s)
- Carolyn O Dirain
- Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Rodrigo C Silva
- Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Patrick J Antonelli
- Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, FL, USA
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Idicula WK, Jurcisek JA, Cass ND, Ali S, Goodman SD, Elmaraghy CA, Jatana KR, Bakaletz LO. Identification of biofilms in post-tympanostomy tube otorrhea. Laryngoscope 2016; 126:1946-51. [PMID: 27426942 DOI: 10.1002/lary.25826] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 11/05/2015] [Accepted: 11/16/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Otitis media is a common problem in the pediatric population. Despite antibiotic therapy, post-tympanostomy otorrhea can be difficult to treat. Biofilms have been shown to play a role in chronic and recurrent otitis media and are implicated in otorrhea. This study investigated both the microbial composition and the presence of biofilm fragments rich in extracellular DNA (eDNA) and the bacterial DNA-binding protein, integration host factor (IHF), in post-tympanostomy tube otorrhea. STUDY DESIGN Clinical samples. METHODS Institutional review board approval was obtained, and samples were recovered from pediatric patients with tympanostomy tubes and persistent otorrhea for both microbial culture and biofilm analysis. For biofilm assessment, frozen samples were sectioned and then labeled using a rabbit anti-IHF, which was detected with goat anti-rabbit IgG conjugated to AlexaFluor 594. Samples were then counterstained with 4',6-diamidino-2-phenylindole (DAPI) to detect DNA, and images were captured by inverted light microscopy. RESULTS Of 15 pediatric otorrhea samples analyzed, nine (60%) contained solids that were positive for labeling of IHF in association with a lattice of eDNA, and 75% yielded positive bacterial cultures. Bacterial culture results included H. influenzae, Methicillin-resistant Staphylococcus aureus, S. pneumoniae, M. catarrhalis, and P. aeruginosa. CONCLUSION Positive labeling of otorrhea solids for eDNA and IHF, in combination with microbiological culture results, indicated that biofilms likely played a key role in chronic otorrhea. Moreover, as a known critical structural component of biofilms, these findings suggest that DNABII proteins in association with eDNA may serve as an important therapeutic target in post-tympanostomy tube otorrhea. LEVEL OF EVIDENCE NA. Laryngoscope, 126:1946-1951, 2016.
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Affiliation(s)
- Winslo K Idicula
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University.,Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital
| | - Joseph A Jurcisek
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital
| | - Nathan D Cass
- The Ohio State University College of Medicine, Columbus, Ohio, U.S.A
| | - Syed Ali
- The Ohio State University College of Medicine, Columbus, Ohio, U.S.A
| | - Steven D Goodman
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital
| | - Charles A Elmaraghy
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University.,Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital
| | - Kris R Jatana
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University.,Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital
| | - Lauren O Bakaletz
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital
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11
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Banerjee D, Tran PL, Colmer-Hamood JA, Wang JC, Myntti M, Cordero J, Hamood AN. The antimicrobial agent, Next-Science, inhibits the development of Staphylococcus aureus and Pseudomonas aeruginosa biofilms on tympanostomy tubes. Int J Pediatr Otorhinolaryngol 2015; 79:1909-14. [PMID: 26388185 DOI: 10.1016/j.ijporl.2015.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/30/2015] [Accepted: 09/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if the recently developed novel antimicrobial/antibiofilm agent Next-Science (NS) inhibits biofilm development by Staphylococcus aureus or Pseudomonas aeruginosa on tympanostomy tubes (TT) and to define the concentration of NS at which this inhibition occurs. METHODS Preliminary titration experiments determined the effective concentrations of NS that completely inhibit the planktonic growth of S. aureus and P. aeruginosa. Since NS has the potential to inhibit both planktonic growth and biofilm development, we examined the antibiofilm effect using the established concentrations that inhibited planktonic growth. Biofilms developed on TT using the microtiter plate assay were assessed quantitatively by determining the number of microorganisms per tube (CFU/tube) and qualitatively by visualization with confocal laser scanning microscopy (CLSM). RESULTS Planktonic growth of S. aureus and P. aeruginosa was inhibited by 20.3 μg/mL and 325 μg/mL of NS, respectively. While S. aureus and P. aeruginosa formed well-developed biofilms on TT at 24 h without treatment, addition of the indicated concentrations of NS at the time of inoculation of the TT inhibited the formation of biofilms by both organisms. CLSM confirmed the absence of biofilms on either the inner or outer surface of the treated TTs. At 8 h post-inoculation, P. aeruginosa formed a partial biofilm on the TT when untreated. In comparison, the NS-treated biofilms failed to develop further and the CFU/TT were significantly reduced. CONCLUSION The novel antimicrobial agent NS inhibited the development of S. aureus and P. aeruginosa biofilms on TTs. The same concentrations of NS inhibited both planktonic growth and biofilm development.
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Affiliation(s)
- Debdeep Banerjee
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Phat L Tran
- Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jane A Colmer-Hamood
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA; Department of Medical Education, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - James C Wang
- Department of Surgery/Division of Otolaryngology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Joehassin Cordero
- Department of Surgery/Division of Otolaryngology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Abdul N Hamood
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA; Department of Surgery/Division of Otolaryngology, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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12
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Balain M, Oddie SJ, McGuire W, Cochrane Neonatal Group. Antimicrobial-impregnated central venous catheters for prevention of catheter-related bloodstream infection in newborn infants. Cochrane Database Syst Rev 2015; 2015:CD011078. [PMID: 26409791 PMCID: PMC9240922 DOI: 10.1002/14651858.cd011078.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Central venous catheter-related bloodstream infection is an important cause of mortality and morbidity in newborn infants cared for in neonatal units. Potential strategies to prevent these infections include the use of central venous catheters impregnated with antimicrobial agents. OBJECTIVES To determine the effect of antimicrobial-impregnated central venous catheters in preventing catheter-related bloodstream infection in newborn infants. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 8), MEDLINE (1966 to September 2015), EMBASE (1980 to September 2015), CINAHL (1982 to September 2015), conference proceedings and previous reviews. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing central venous catheters impregnated or coated with any antibiotic or antiseptic versus central venous catheters without antibiotic or antiseptic coating or impregnation in newborn infants. DATA COLLECTION AND ANALYSIS We extracted data using the standard methods of the Cochrane Neonatal Group, with independent evaluation of risk of bias and data extraction by two review authors. MAIN RESULTS We found only one small trial (N = 98). This trial found that silver zeolite-impregnated umbilical venous catheters reduced the incidence of bloodstream infection in very preterm infants (risk ratio 0.11, 95% confidence interval 0.01 to 0.87; risk difference -0.17, 95% CI -0.30 to -0.04; number needed to treat for benefit 6, 95% CI 3 to 25]. AUTHORS' CONCLUSIONS Although the data from one small trial indicates that antimicrobial-impregnated central venous catheters might prevent catheter-related bloodstream infection in newborn infants, the available evidence is insufficient to guide clinical practice. A large, simple and pragmatic randomised controlled trial is needed to resolve on-going uncertainty.
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Affiliation(s)
| | - Sam J Oddie
- Bradford Royal InfirmaryDuckworth LaneBradfordUKBD9 6RJ
| | - William McGuire
- Hull York Medical School & Centre for Reviews and Dissemination, University of YorkYorkY010 5DDUK
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13
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The rationale for preventive treatments for early post-tympanostomy tube otorrhea in persistent otitis media with effusion. Eur Arch Otorhinolaryngol 2015; 273:1405-10. [PMID: 26153378 DOI: 10.1007/s00405-015-3706-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
Abstract
Some studies have shown that post-tympanostomy tube otorrhea (PTTO) is a common complication after tympanostomy tube insertion. There are wide range of controversies about the incidence of PTTO and different methods of preventive treatment. The aim of this study was to determine the incidence of early PTTO in persistent otitis media with effusion in our centers. We also investigated the effect of preventive treatments on the incidence of early PTTO in children with persistent otitis media with effusion. This multi-central study comprised 536 ears belonging to children with otitis media and effusion for at least 3 months, referred for complications arising from post-tympanostomy tube insertion. The patients were randomly divided into three treatment and control groups. In the first group of patients, the middle ear cavity was irrigated with isotonic saline after myringotomy. The second group received oral amoxicillin three times a day for 7 days postoperatively. The third group had similar treatment as the second group, in addition to topical ciprofloxacin drop, 4 drops three times a day for 3 days after operation. The control group did not undergo any treatment. Early post-tympanostomy tube otorrhea was detected in 6 ears (1.1 %), including 3 (2.2 %) from the control group and 3 (2.3 %) from the first group. There was no statistically significant difference in early PTTO between integrated treatment groups and control group (P = 0.111). As the total rate of early post-tympanostomy tube otorrhea was very low, there was no significant difference between the 3 treatment groups and control group. Our study did not support the routine use of preventive therapy. A period of at least 3 months watchful waiting before tympanostomy tube insertion may help reduce the incidence of PTTO.
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14
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Verkerk M, Fishman JM, Browning GG, Schilder AGM. Interventions for the prevention of postoperative grommet (ventilation tube) obstruction. Hippokratia 2015. [DOI: 10.1002/14651858.cd011685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Misha Verkerk
- Faculty of Brain Sciences, University College London; evidENT, Ear Institute; 330 Gray's Inn Road London UK WC1X 8DA
| | | | - George G Browning
- Glasgow Royal Infirmary; MRC Institute of Hearing Research (Scottish Section); Queen Elizabeth Building 16 Alexandra Parade Glasgow UK G31 2ER
| | - Anne GM Schilder
- Faculty of Brain Sciences, University College London; evidENT, Ear Institute; 330 Gray's Inn Road London UK WC1X 8DA
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15
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Wang JC, Hamood AN, Saadeh C, Cunningham MJ, Yim MT, Cordero J. Strategies to prevent biofilm-based tympanostomy tube infections. Int J Pediatr Otorhinolaryngol 2014; 78:1433-8. [PMID: 25060938 DOI: 10.1016/j.ijporl.2014.05.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/09/2014] [Accepted: 05/20/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To review the potential contributory role of biofilms to post-tympanstomy tube otorrhea and plugging as well as the available interventions currently utilized to prevent biofilm formation on tympanostomy tubes. DATA SOURCES A literature review was performed utilizing the MEDLINE/Pubmed database from 1980 to 2013. REVIEW METHODS Electronic database was searched with combinations of keywords "biofilm", "tympanostomy tube", "ventilation tube", and "post-tympanostomy tube otorrhea". RESULTS Two of the most common sequelae that occur after tympanostomy tube insertion are otorrhea and tube occlusion. There is an increased evidence supporting a role for biofilms in the pathogenesis of otitis media. In this review, we have shown a multitude of novel approaches for prevention of biofilm associated sequelae of otitis media with effusion. These interventions include (i) changing the inherent composition of the tube itself, (ii) coating the tubes with antibiotics, polymers, plant extracts, or other biofilm-resistant materials, (iii) tubal impregnation with antimicrobial compounds, and (iv) surface alterations of the tube by ion-bombardment or surface ionization. CONCLUSION Currently, there is not one type of tympanostomy tube in which bacteria will not adhere. The challenges of treating chronic post-tympanostomy tube otorrhea and tube occlusion indicate the need for further research in optimization of tympanostomy tube design in addition to development of novel therapies.
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Affiliation(s)
- James C Wang
- School of Medicine, Texas Tech University Health Sciences Center, 3601 4th Street STOP 8312, Lubbock, TX 79430, USA.
| | - Abdul N Hamood
- Department of Microbiology & Infectious Diseases, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Charles Saadeh
- School of Medicine, Texas Tech University Health Sciences Center, 3601 4th Street STOP 8312, Lubbock, TX 79430, USA
| | - Michael J Cunningham
- Department of Otolaryngology and Communication Enhancement, Children's Hospital Boston, Boston, MA, USA
| | - Michael T Yim
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Joehassin Cordero
- Division of Otolaryngology, Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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16
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After myringotomy, can topical Mesna application be an alternative method to ventilation tube application? Eur Arch Otorhinolaryngol 2014; 272:1099-102. [DOI: 10.1007/s00405-014-2906-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/21/2014] [Indexed: 11/25/2022]
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Wallace IF, Berkman ND, Lohr KN, Harrison MF, Kimple AJ, Steiner MJ. Surgical treatments for otitis media with effusion: a systematic review. Pediatrics 2014; 133:296-311. [PMID: 24394689 DOI: 10.1542/peds.2013-3228] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The near universality of otitis media with effusion (OME) in children makes a comparative review of treatment modalities important. This study's objective was to compare the effectiveness of surgical strategies currently used for managing OME. METHODS We identified 3 recent systematic reviews and searched 4 major electronic databases. Eligible studies included randomized controlled trials, nonrandomized trials, and cohort studies that compared myringotomy, adenoidectomy, tympanostomy tubes (tubes), and watchful waiting. Using established criteria, pairs of reviewers independently selected, extracted data, rated risk of bias, and graded strength of evidence of relevant studies. We incorporated meta-analyses from the earlier reviews and synthesized additional evidence qualitatively. RESULTS We identified 41 unique studies through the earlier reviews and our independent searches. In comparison with watchful waiting or myringotomy (or both), tubes decreased time with OME and improved hearing; no specific tube type was superior. Adenoidectomy alone, as an adjunct to myringotomy, or combined with tubes, reduced OME and improved hearing in comparison with either myringotomy or watchful waiting. Tubes and watchful waiting did not differ in language, cognitive, or academic outcomes. Otorrhea and tympanosclerosis were more common in ears with tubes. Adenoidectomy increased the risk of postsurgical hemorrhage. CONCLUSIONS Tubes and adenoidectomy reduce time with OME and improve hearing in the short-term. Both treatments have associated harms. Large, well-controlled studies could help resolve the risk-benefit ratio by measuring acute otitis media recurrence, functional outcomes, quality of life, and long-term outcomes. Research is needed to support treatment decisions in subpopulations, particularly in patients with comorbidities.
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Affiliation(s)
- Ina F Wallace
- Division for Health Services and Social Policy Research, RTI International, Research Triangle Park, North Carolina; and
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18
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Adherence of Randomized Trials Within Children's Surgical Specialties Published During 2000 to 2009 to Standard Reporting Guidelines. J Am Coll Surg 2013; 217:394-399.e7. [DOI: 10.1016/j.jamcollsurg.2013.03.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/02/2013] [Accepted: 03/05/2013] [Indexed: 02/07/2023]
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Gan CW, Chooi WH, Ng HCA, Wong YS, Venkatraman SS, Lim LHY. Development of a novel biodegradable drug-eluting Ventilation tube for chronic otitis media with effusion. Laryngoscope 2013; 123:1770-7. [DOI: 10.1002/lary.23895] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Chee Wee Gan
- Department of Otolaryngology-Head and Neck Surgery; National University of Singapore; Singapore
| | - Wai Hon Chooi
- Department of Otolaryngology-Head and Neck Surgery; National University of Singapore; Singapore
| | - Herr Cheun Anthony Ng
- School of Materials Science and Engineering; Nanyang Technological University; Singapore
| | - Yee Shan Wong
- School of Materials Science and Engineering; Nanyang Technological University; Singapore
| | - Subbu S. Venkatraman
- School of Materials Science and Engineering; Nanyang Technological University; Singapore
| | - Lynne Hsueh Yee Lim
- Department of Otolaryngology-Head and Neck Surgery; National University of Singapore; Singapore
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Abstract
OBJECTIVES Tympanostomy tube (TT) surface modifications have been promoted as a means of reducing biofilm formation, otorrhea, and occlusion. The goal of this study was to determine if biofilm formation on silicone TTs could be prevented by commercially available surface coatings. METHODS Silicone TTs with and without polyvinylpyrrolidone (PVP) or/and silver oxide were exposed to human plasma and cultured with Pseudomonas aeruginosa or Staphylococcus aureus (22 TTs per group). After 4 days, antibiotics were added to kill planktonic bacteria. Biofilm formation was assessed by quantitative bacterial counts and scanning electron microscopy. RESULTS PVP, silver, and PVP-silver coatings reduced P. aeruginosa biofilm formation relative to silicone by over 1 log (p<0.0001). PVP was superior to silver (p=0.04) and PVP-silver (p<0.0001). PVP and PVP-silver coatings increased S. aureus biofilm formation nominally (p=0.01 & 0.003). CONCLUSION PVP and silver coatings reduce P. aeruginosa biofilm formation on silicone TTs. Combining PVP and silver coatings does not further improve biofilm resistance. TT surface coatings warrant further study through clinical trials.
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22
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Effect of tympanostomy tube surface on occlusion. Int J Pediatr Otorhinolaryngol 2012; 76:960-2. [PMID: 22456168 DOI: 10.1016/j.ijporl.2012.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 03/01/2012] [Accepted: 03/03/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Premature tympanostomy tube (TT) occlusion frequently leads to TT replacement surgery. TT surface preparations have been suggested as a means of reducing TT occlusion. The purpose of this study is to determine if commercial TT compositions or surface preparations impact the rate of TT occlusion using an in vitro model. METHODS Commercial TTs composed of titanium, fluoroplastic, and silicone, as well as human serum albumin coated titanium, phosphorylcholine coated fluoroplastic, and polyvinylpyrrolidone coated silicone TTs, were tested for occlusion development in a previously validated in vitro model that simulates middle ear air and mucus flow. RESULTS Time to occlusion was longer with all coated TTs relative to all uncoated TTs (p=0.038). Polyvinylpyrrolidone coated silicone TTs had the lowest rate of occlusion and improvement relative to silicone (36% vs. 70%). Time to occlusion was longer in all coated TTs, but individually, none reached statistical significance. CONCLUSION TT composition and surface preparations do not dramatically impact the development of TT occlusion. All tested surface coatings seem to delay TT occlusion in this in vitro model. In vivo testing will be necessary to validate these findings.
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Abstract
INTRODUCTION Advances in molecular biology and in the basic understanding of the mechanisms associated with sensorineural hearing loss and other diseases of the inner ear are paving the way towards new approaches for treatments for millions of patients. However, the cochlea is a particularly challenging target for drug therapy, and new technologies will be required to provide safe and efficacious delivery of these compounds. Emerging delivery systems based on microfluidic technologies are showing promise as a means for direct intracochlear delivery. Ultimately, these systems may serve as a means for extended delivery of regenerative compounds to restore hearing in patients suffering from a host of auditory diseases. AREAS COVERED Recent progress in the development of drug delivery systems capable of direct intracochlear delivery is reviewed, including passive systems such as osmotic pumps, active microfluidic devices and systems combined with currently available devices such as cochlear implants. The aim of this article is to provide a concise review of intracochlear drug delivery systems currently under development and ultimately capable of being combined with emerging therapeutic compounds for the treatment of inner ear diseases. EXPERT OPINION Safe and efficacious treatment of auditory diseases will require the development of microscale delivery devices, capable of extended operation and direct application to the inner ear. These advances will require miniaturization and integration of multiple functions, including drug storage, delivery, power management and sensing, ultimately enabling closed-loop control and timed-sequence delivery devices for treatment of these diseases.
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Affiliation(s)
- Jeffrey T Borenstein
- Biomedical Engineering Center, Draper Laboratory, Cambridge, MA 02139, United States.
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Thomas RG, Ojano-Dirain C, Antonelli PJ. Topical antibiotic treatment reduces tympanostomy tube biofilm formation. Laryngoscope 2011; 121:1067-71. [DOI: 10.1002/lary.21748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 01/07/2011] [Indexed: 11/06/2022]
Affiliation(s)
- Robert G Thomas
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville, Florida 32610-0264, USA
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Hong P, Smith N, Johnson LB, Corsten G. A randomized double-blind controlled trial of phosphorylcholine-coated tympanostomy tube versus standard tympanostomy tube in children with recurrent acute and chronic otitis media. Laryngoscope 2010; 121:214-9. [DOI: 10.1002/lary.21156] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Delivery of medications to the inner ear has been an area of considerable growth in both the research and clinical realms during the past several decades. Systemic delivery of medication destined for treatment of the inner ear is the foundation on which newer delivery techniques have been developed. Because of systemic side effects, investigators and clinicians have begun developing and using techniques to deliver therapeutic agents locally. Alongside the now commonplace use of intratympanic gentamicin for Meniere's disease and the emerging use of intratympanic steroids for sudden sensorineural hearing loss, novel technologies, such as hydrogels and nanoparticles, are being explored. At the horizon of inner ear drug-delivery techniques, intracochlear devices that leverage recent advances in microsystems technology are being developed to apply medications directly into the inner ear. Potential uses for such devices include neurotrophic factor and steroid delivery with cochlear implantation, RNA interference technologies, and stem-cell therapy. The historical, current, and future delivery techniques and uses of drug delivery for treatment of inner ear disease serve as the basis for this review.
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Wang C, Javadi A, Ghaffari M, Gong S. A pH-sensitive molecularly imprinted nanospheres/hydrogel composite as a coating for implantable biosensors. Biomaterials 2010; 31:4944-51. [DOI: 10.1016/j.biomaterials.2010.02.073] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 02/28/2010] [Indexed: 12/24/2022]
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Effect of vancomycin-coated tympanostomy tubes on methicillin-resistant Staphylococcus aureus biofilm formation: in vitro study. The Journal of Laryngology & Otology 2010; 124:594-8. [DOI: 10.1017/s0022215109992672] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground and objective:Bacterial biofilm formation has been implicated in the high incidence of persistent otorrhoea after tympanostomy tube insertion. It has been suggested that the tube material may be an important factor in the persistence of such otorrhoea. Development of methicillin-resistant Staphylococcus aureus otorrhoea after tympanostomy tube placement is a growing concern. We evaluated the effect of using vancomycin and chitosan coated tympanostomy tubes on the incidence of methicillin-resistant Staphylococcus aureus biofilm formation in vitro.Materials and methods:Three sets each of vancomycin-coated silicone tubes (n = 5), commercial silver oxide coated silicone tubes (n = 5) and uncoated tympanostomy tubes (as controls; n = 5) were compared as regards resistance to methicillin-resistant Staphylococcus aureus biofilm formation after in vitro incubation.Results:Scanning electron microscopy showed that the surfaces of the silver oxide coated tubes supported the formation of thick biofilms with crusts, comparable to the appearance of the uncoated tubes. In contrast, the surface of the vancomycin-coated tympanostomy tubes was virtually devoid of methicillin-resistant Staphylococcus aureus biofilm.Conclusion:Vancomycin-coated tympanostomy tubes resist methicillin-resistant Staphylococcus aureus biofilm formation. Pending further study, such tubes show promise in assisting the control of methicillin-resistant Staphylococcus aureus biofilm formation.
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