Autoinflation reduces middle ear effusion in children with otitis media with effusion.

Otitis media with effusion (OME) is defined as accumulation of fluid in the middle ear in absence of signs or symptoms of an acute ear infection.1 OME is usually associated with a conductive hearing loss that may affect the quality of life.1 Surgical treatment of OME with grommets is associated with substantial healthcare costs and is usually considered after a period of watchful waiting, leaving most children with OME untreated during this period.1 This raises the need for an efficient, non-invasive treatment option that can be offered to children with OME at an early stage. In 1968, Hunt-Williams presented a new method for autoinflation involving a plastic end-piece connected to a balloon, later developed into the Otovent device.2 The present study evaluates the effect of autoinflation with this method on children with OME

Mattress and pillow for prone positioning for treatment of obstructive sleep apnoea

Conclusion: The new mattress and pillow for prone positioning (MPP) is efficient in reducing the apnoea-hypopnoea index (AHI) and oxygen desaturation index (ODI) in most patients with obstructive sleep apnoea (OSA), with satisfactory compliance. Objective: The aim of the present study was to evaluate the effect of the prone body and head sleep position on severity of disease in patients with OSA after 4 weeks of adaptation to a mattress and pillow facilitating prone positioning. Methods: Fourteen patients with mild to severe OSA, 11 men and 3 women with a mean AHI of 26 (min, 6; max, 53) and mean ODI of 21 (min, 6; max, 51) were evaluated. Two polysomnographic (PSG) studies were performed. The first PSG study was without any treatment and the second was after 4 weeks of adaptation to the MPP for prone positioning of the body and the head. Results: Mean AHI and ODI decreased from 26 and 21 to 8 and 7, respectively (p 4 h per night during the 4-week study.Acta Otolaryngologica Foundation, Swede

Panel 7: otitis media:treatment and complications

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

Two New Non-invasive Treatment Methods for Otitis Media with Effusion in Children and Obstructive Sleep Apnoea in Adults

Otitis media with effusion (OME) in children and obstructive sleep apnoea (OSA) in adults are common conditions in medicine. Several surgical and non-surgical methods have been suggested for treatment of these diseases. However, to find an appropriate treatment option is a challenging task for the clinician and many patients do not have an optimal treatment for their disease. In this thesis two new non-invasive treatment options were developed and evaluated. Papers 1 and 2 deal with OME in children and papers 3 and 4 concern OSA in adults. Paper 1 deals with the development of a new device for autoinflation and evaluation of the effect on OME. In a pilot study, the effect of the new device on middle ear pressure was studied in 21 children with persistent OME. In the treatment group 83% of the ears were considered to be responders compared to 30% improvement in the control group during the follow up period. Paper 2 was a randomised controlled cross-over study evaluating the effect of the new method for autoinflation, with respect to middle ear pressure and hearing thresholds in 45 children with persistent OME awaiting grommet surgery. After four weeks of treatment the mean middle ear pressure and the mean hearing thresholds were improved by 166 daPa and 6 dB hearing level respectively compared to non-significant alterations in the control group. After the cross-over of the control group to treatment, equivalent improvements were achieved. After four weeks of treatment in both groups only four of the 45 included children were operated with grommet due to persistent disease. Both groups were followed up during additional 10 months whereby another five children were submitted to grommet surgery due to disease recurrence. Compliance was satisfactory with all the children performing the manoeuvre. Paper 3 concerns evaluation of the effect of the prone sleeping position on severity of disease in OSA with polysomnograpic (PSG) and polygraphic (PG) sleep studies. During the two-night study, first on a normal mattress with optional positioning and then on a mattress and pillow facilitating prone positioning, the median apnoea-hypopnoea index (AHI) was reduced from 23 to 7 and the oxygen desaturation index (ODI) from 21 to 6. This improvement was achieved by a reduction in the supine and an increase in the prone sleep time. Paper 4 was an evaluation of the four-week compliance and the effect of the mattress and pillow for prone positioning (MPP) on severity of disease in OSA patients evaluated by PSG. The mean AHI and ODI were reduced from 26 and 21 to 8 and 7 respectively with the MPP. This was achieved with no significant disruption of the sleep architecture and satisfactory compliance in the four-week study

The effect of the prone sleeping position on obstructive sleep apnoea

Conclusions: Prone positioning reveals promising results in improving the apnoea-hypopnoea index (AHI) and oxygen desaturation index (ODI) in patients with obstructive sleep apnoea (OSA). Objective: To evaluate the effect of the prone position on OSA. Methods: Thirty-two patients with mild to severe OSA were included in the study. This was a two-night study to evaluate the effect of the prone position on OSA; a first night in a normal bed with optional positioning and a second night on a mattress and pillow facilitating prone positioning. Results: A total of 27 patients, 22 males and 5 females, with a mean age of 51 years, 15 patients with positional OSA (POSA) and 12 patients with non-POSA with a total median AHI of 23 (min 5, max 93) completed the study protocol. The median AHI decreased from 23 to 7 (p < 0.001) and the median ODI from 21 to 6 (p < 0.001). The median time spent in the supine position decreased from 142 to <1 min (p < 0.0001) and the median time in the prone position increased from <1 to 330 min (p < 0.0001). In all, 17 of 27 patients (63%) were considered to be responders to prone positioning, 12 of 15 (80%) with POSA and 5 of 12 (42%) with non-POSA. Five patients did not complete the study protocol due to sleep time <4 h