Middle ear status in children with recurrent pathology of respiratory tract

Catedra Otorinolaringologie USMF „Nicolae Testemiţanu”The aim of the study was to evaluate the middle ear status in children with recurrent pathology of respiratory tract. We performed a prospective study of 125 children (age range from 3 to 7 years) with recurrent pathology of respiratory tract. Scheme of examination included: analysis of quality of life by questionnaire and middle ear assessment by optic otoscopy and screening tympanometry. We detected otitis media in the majority of examined ears. Otitis media with effusion was diagnosed in 56 % of cases, acute otitis media – in 18 %, recurrent otitis media – in 3 %, adhesive otitis media – in 1 % of ears. The majority of otitis media cases were registered in children younger than 5 years of life. Inadequate reaction to sounds, sleeping disturbances were the most frequent signs of otitis media. We registered the persistence of otitis media in 40 % of cases in a month after recovery. The majority of children with persistent otitis media were younger than 5 years of life. Scopul lucrării a fost aprecierea stării urechii medii la copiii cu patologia recidivantă a tractului respirator. Am efectuat un studiu prospectiv asupra 125 copii în vârstă de la 3 până la 7 ani cu patologia recidivantă şi cronică a tractului respirator. Schema examinării a inclus: analiza calităţii vieţii prin chestionarea şi evaluarea urechii medii, prin otoscopia optică şi screening timpanometria de 2 ori: în timpul acutizării şi peste o lună după însănătoşire. Am detectat patologia urechii medii la majoritatea copiilor examinaţi. Otita medie exudativă a fost diagnosticată în 56 % de cazuri, otita medie acută – în 18 %, otita medie recidivantă – în 6 %, otita medie adezivă – în 1 % de cazuri. Majoritatea cazurilor de otită medie au fost înregistrate la copiii cu vârsta de până la 5 ani. Reacţia inadecvată la sunete, dereglările de somn au fost cele mai frecvente semne de otită medie. Am înregistrat persistenţa otitei medii peste o lună după suportarea patologiei tractului respirator în 40 % dintre cazuri. Majoritatea copiilor cu schimbări persistente ale urechii medii au fost cu vârsta de până la 5 ani

Оптимизация менеджмента хронического экссудативного среднего отита у детей

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Catedra OtorinolaringologieIntroduction. Children suffered from chronic otitis media with effusion (chronic OME), one of the most common disease of childhood, need comprehensive treatment for preventing of hearing loss and chronicity. Aim: to elaborate a system of management of otitis media with effusion in children and to analyze it effectiveness. Subjects and Methods. Children at the age between 1 and 7 years with chronic OME were treated by different methodological approaches. The effectiveness of different treatment modalyties was assessed by hearing dynamics, general health deterioration scores and quality of life deterioration scores. Results.The most effective treatment modality for chronic OME in children with recurrent and chronic somatic pathologywas myringotomy with tympanostomy tube insertion in combination with adenoidectomy. Conclusions. Comprehensive treatment which includes myringotomy with tympanostomy tube insertion in combination with adenoidectomy is recommended for improvement of hearing, quality of life and general health of children with chronic otitis media with effusion.Tympanostomy in proposed modification is recommended for treatment of chronic otitis media with effusion and recurrent otitis media in children.Дизайн исследования. Проспективное исследование с ретроспективным обзором анамнестических данных. Цель: На основании анализа эффективности различных схем диагностики и лечения разработать принципы менеджмента хронического ЭСО у детей. Материалы и методы. Дети в возрасте от 1 до 7 лет, страдающие хроническим ЭСО получали лечение в соответствии с существующими схемами. Эффективность лечения оценивалась по динамике слуха, индекса общего здоровья и индекса качества жизни. Результаты. Наибольшая эффективность была продемонстрирована для комнлексного метода, включающего миринготомию с введением тимпаностомической трубки и аденотомию. Заключение. Комплексное лечение, включающее миринготомию с введением тимпаностомической трубки и аденотомию рекомендуется для улучшения слуха, качества жизни и общего здоровья у детей с хроническим экссудативным средним отитом. Тимпаностомия по оптимизированной методике может быть рекомендована для лечения хронического экссудативного среднего отита

Monitorizarea post-chirurgicală noninvazivă a urechii medii în formele prelungite ale otitei medii

Background. Prolonged forms of otitis media (OM) lead to chronic hearing loss and disability from childhood. Objective evaluation of middle ear after different treatment approaches help in analysis of treatment feasibility. Objective of the study. The purpose of this article is to compare the results of middle ear noninvasive monitoring after different modalities of treatment in order to select the most effective one in prolonged otitis media forms. Material and Methods. Children with recurrent or persistent OM forms. Analyzed treatment modalities: I - myringotomy, II - classical tympanostomy, III - modified tympanostomy. Middle ear monitoring included otoscopy and audiometry during 2 years and impedance audiometry in 2 years after surgery. Results. Otoscopic and audiometric data showed stable improvement in 61% of children after myringotomy, 90% of children after classical tympanostomy and 97% of children after modified tympanostomy. Impedance audiometry in 2 years after surgery demonstrated complete restoration of middle ear function in 52% of children after myringotomy, in 83% of children after classical tympanostomy, and in 96% of children after modified tympanostomy. Conclusion. Post-surgical noninvasive monitoring demonstrated advantages of tympanostomy and especially in modified version: improvement and stability of middle ear function and low rate of otitis media persistence or recurrence. Introducere. Formele prelungite de otită medie (OM) duc la pierderea cronică a auzului și la dizabilitate din copilărie. Evaluarea obiectivă a urechii medii (UM) după diferite abordări de tratament, ajută la analiza fezabilității tratamentului. Scopul lucrării. Evidențierea eficacității diferitor modalități de tratament la copii cu otită medie, în forma prelungită, în baza analizei comparative a monitorizării neinvazive a urechii medii la pacienți în perioada postoperatorie. Material și Metode. Pacienți: Copiii cu otita medie în forma recidivantă și persistentă, care au suportat tratament chirurgical. Modalități de tratament: I - miringotomie, II - timpanostomia clasică, III - timpanostomia modificată. Monitorizarea neinvazivă a urechii medii a inclus otoscopia și audiometria pe parcursul 2 ani și impedansmetria peste 2 ani, după tratamentul chirurgical. Rezultate. Îmbunătățire stabilă a stării urechii medii a fost constatată în baza datelor otoscopice și audiometrice la 61% dintre copii după miringotomie, 90% dintre copii după timpanostomia clasică și 97% dintre copii după timpanostomia modificată. Restabilirea completă a funcției urechii medii a fost înregistrată la 52% dintre copii după miringotomie, 83% dintre copii după timpanostomia clasică și 96% dintre copii după timpanostomia modificată. Concluzii. Monitorizarea post-chirurgicală non-invazivă a demonstrat avantajele timpanostomiei, în special, în versiunea modificată: îmbunătățirea și stabilitatea funcției urechii medii și rata scăzută de persistență sau recidivarea otitei medii

Оптимизация Тимпаностомии у детей

USMF “Nicolae Testemiţanu”, Catedra ORLIntroduction. Tympanostomy or Myringotomy with insertion of Tympanostomy tube, the most common surgery is used for treatment of different forms of otitis media, can provoke some complications. Aim: to analyze the results of Tympanostomy in our modification. Material and Methods. Patients with chronic otitis media with effusion and recurrent otitis media who underwent Tympanostomy in our modification. Results. Different clinical forms of recurrent and chronic otitis media with effusion in childhood are characterized by similar pathological changes in tympanic cavity. The proposed variant of Tympanostomy is effective surgical method of prevention of further otitis media evolution. Conclusions. The majority of Tympanostomy complications are manifestations of the nature of otitis media. Tympanostomy in proposed modification is recommended for treatment of chronic otitis media with effusion and recurrent otitis media in children.Введение. Тимпаностомия или Миринготомия с введением тимпаностомической трубки, одно из наиболее частых оперативных вмешательств в мире, используется для лечения различных форм среднего отита у детей, но может вызывать осложнения. Цель: проанализировать результаты применения оптимизированной методики тимпаностомии. Материал и Методы. Пациенты с хроническим экссудативным средним отитом и рецидивирующим средним отитом, прооперированные методом тимпаностомии по оптимизированной методике. Результаты. Различные клинические формы рецидивирующего и хронического экссудативного среднего отита имеют схожие изменения в барабанной полости. Предложенный вариант тимпаностомии является эффективным хирургическим методом в профилактике дальнейшей эволюции среднего отита и возникновении осложнений. Заключение. Большинство осложнений тимпаностомии являются проявлением природы самого среднего отита. Тимпаностомия по оптимизированной методике может быть рекомендована для лечения хронического экссудативного среднего отита и рецидивирующего среднего отита

Post-surgical noninvasive monitoring of middle ear in otitis media prolonged forms

Department of Otorhinolaryngology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, the Republic of Moldova, The 75th anniversary of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova (1945-2020)Background: Prolonged forms of otitis media (OM) lead to chronic hearing loss and disability from childhood. Wide spectrum of therapeutic approaches is used in management of OM in children. Objective evaluation of the middle ear after different curative modalities will help in analysis of treatment feasibility. The objective of this article was to compare the results of middle ear noninvasive monitoring after different surgical procedures in order to select the most effective one in prolonged otitis media forms. Material and methods: Patients represent 150 children with prolonged OM. Analyzed treatment modalities: I – myringotomy, II – classical tympanostomy, III – modified tympanostomy. Middle ear monitoring included otoscopy and audiometry what was repeated 4 times during 2 years, otomicroscopy in 1 and 2 years and impedance audiometry in 2 years after surgery. The quality of life and general health scores were analyzed before surgery and in 1 and 2 years after surgery. Results: Otoscopic and audiometric data showed stable improvement in 32% of children after myringotomy, 90% of children after classical tympanostomy and 97% of children after modified tympanostomy. Impedance audiometry in 2 years after surgery demonstrated complete restoration of middle ear function in 32% of children after myringotomy, in 78% of children after classical tympanostomy, and in 94% of children after modified tympanostomy. Conclusions: Post-surgical noninvasive monitoring demonstrated advantages of tympanostomy and especially in modified version: improvement and stability of middle ear function and low rate of otitis media persistence or recurrence

Posibilităţile impedansmetriei în diagnosticul otitelor medii la copii

Otita medie la copii în primii 7 ani de viaţă decurge relativ asimptomatic. Impedansmetria este o metodă obiectivă, de certitudine înaltă, neinvasivă în diagnosticul otitelor medii. Am elaborat un sistem de evaluare a rezultatelor impedansmetriei pe baza analizei detaliate a caracteristicilor de timpanogramă – complianţa, gradient absolut, gradient relativ şi presiunea. Am analizat corelaţiile acestor date cu descoperirile intraoperatorii din cavitatea timpanică la copiii cu diferite forme de otită medie. Investigaţiile noastre au demonstrat o informativitate înaltă al acestei evaluări detaliate. Această sistemă este utilă în diagnosticul complex. Rezultatele noastre au îmbunătăţit înţelegerea patogenezei otitelor medii la copii

Natural evolution of otitis media with effusion in children

Catedra Otorinolaringologie USMF „Nicolae Testemiţanu”We present the results of functional dynamic investigation of children suffering from Otitis media with effusion. The work up included otoscopy, pneumatic otoscopy, otomicroscopy, tympanometry, registration of acoustic reflex, conventional audiometry, surgical findings, functional results in dynamics. The majority of patients had received comprehensive treatment in time, but 30 of them underwent surgery later (in 3 – 5 years). We compared the results of noninvasive examinations in children and analyzed surgical findings in these 2 groups. Our research revealed that in all patients who hadn’t received in time adequate treatment more severe forms of otitis media were registered. Various forms of otitis media are dynamically interrelated and can be transformed one to other in case of lack of comprehensive management. Prezentăm rezultate examinărilor funcţionale a copiilor cu otită medie exsudativă în dinamică. Pacienţii au fost examinaţi corespunzător «Schemei examinării otologice a copilului», elaborate de noi, care include datele anamnezei minuţioase, otoscopiei optice, otoscopiei pneumatice, otomicroscopiei, timpanometriei şi înregistrării reflexului stapedian, audiometriei, rezultatele investigaţiilor intraoperatorii, rezultatele funcţionale pe parcursul 5 ani. Majoritate pacienţilor au primit tratament, dar 30 din copii din diferite motive au suportat tratament chirurgical numai peste 3 – 5 ani. Comparând rezultate investigaţiilor funcţionale şi descoperirile intraoperatorii concluzionăm că la pacienţii care nu au primit tratament adecvat la timp proces patologic în urechea medie s-a transformat în forme mai severe. Diferite forme de otită medie interrelatează dinamic şi în lipsa tratamentului adecvat se transformă din una în alta

Скрининг среднего отита у детей с хроническими и рецидивирующими соматическими заболеваниями

USMF “Nicolae Testemiţanu”, Catedra ORLIntroduction. Otitis media (OM), the most common disease in children, often has asymptomatic evolution to chronic forms, which need surgical treatment. Study design. Prospective survey with retrospective charts review. Aim: to analyze and compare the incidence and clinical evolution of otitis media (OM) in children with recurrent and chronic respiratory pathology, gastrointestinal pathology, and healthy children. Subjects. Children at the age between 1 and 7 years with no any evident ear problem with recurrent and chronic somatic pathology and healthy children were accepted for screening. Methods. Tympanometry and otoscopy were performed every three months during 1 year on each child. Complete audiology assessment and otomicroscopy were carried out for children who failed the screening tests during 6 months. Results. Screening revealed high incidence of OM with effusion in children with recurrent and chronic somatic pathology and it predisposition to chronic evolution. Medical treatment in such cases was not effective. Conclusions. Screening for OM in children with chronic and recurrent somatic pathology determined patients, who need comprehensive treatment, including surgical. In healthy children OM is relatively rare and temporary condition.Введение. Средний отит (СО), наиболее частое заболевание у детей, характеризуется бессимптомной эволюцией до хронических форм, нуждающихся в хирургическом лечении. Дизайн исследования. Проспективное исследование с ретроспективным обзором анамнестических данных. Цель: Целью исследования было проанализировать частоту встречаемости и особенности эволюции СО у детей с рецидивирующей и хронической патологией дыхательных путей, желудочно-кишечного тракта и сравнить их с показателями у здоровых детей. Пациенты. Дети в возрасте от 1 до 7 лет без какой-либо явной ушной патологии с рецидивирующими и хроническими соматическими заболеваниями и здоровые дети были включены в группу скрининга. Методы. Тимпанометрия и отоскопия выполнялись каждые 3 месяца в течение 1 года каждому ребенку. Полное аудиологическое и отомикроскопическое обследование было выполнено детям, у которых патологические изменения выявлялись в течение 6 месяцев. Результаты. Скрининг выявил частую встречаемость экссудативного среднего отита у детей с рецидивирующей и хронической соматической патологией и предрасположенность его к хроническому течению. Медикаментозное лечение в таких случаях было неэффективным. Заключение. Скрининг по выявлению СО у детей с хронической и рецидивирующей соматической патологией позволил выявить детей, нуждающихся в комплексном лечении, включая хирургическое. У здоровых детей это относительно редкое и временное состояние

Surgical findings in tympanic cavity of children suffering from otitis media

Catedra Otorinolaringologie USMF „Nicolae Testemiţanu”We described and compared the surgical findings in 38 children suffering from different forms of otitis media – otitis media with effusion and recurrent otitis media. We have shown that various forms of otitis media are dynamically interrelated regarding their causes and pathogenesis and do not represent separate entities. Rather, they represent the same disease process as it progresses in continuum. Am descris şi comparat descoperiri intraoperatorii la copiii cu diferite forme de otita medie – otita medie exudativă şi otita medie recidivantă. Am demonstrat că forme variate de otita medie interrelatează dinamic şi nu prezintă entităţi separate, dar sunt manifestări clinice al aceiaşi proces patologic în continuitate

Principles of otitis media with effusion management in children with somatic pathology

Catedra Otorinolaringologie, IP USMF „Nicolae Testemiţanu”, Primul Congres Naţional al Societăţii Endocrinologilor cu participare internaţională dedicat jubileului de 50 ani de la fondarea serviciului endocrinologic din Republica Moldova 9-11 octombrie 2014Introducere. Copii cu otita medie (OM) - una din cele mai răspândite afecţiuni în copilăria mică necesită tratamentul efectiv pentru prevenirea scăderii de auz și a cronicizării. Scopul: elaborarea sistemului de management de OM la copii cu patologia somatică și analiza efecacității lui. Material și Metode. Copiii de vîrstă între 1 și 7 ani cu patologia somatică au fost supuși monitoringului pentru depistarea OM. Cazuri de OM au fost tratate prin diferite aborduri metodologice. Eficacitatea modalităților diferite de tratament a fost apreciată prin analiza dinamicii auzului, scorului deteriorării stării generale și scorului deteriorării a calității vieții. Rezultate. Cea mai efectivă modalitate de tratament al OM la copii cu patologia somatică a fost miringotomia cu inserția tubului timpanostomic în combinație cu adenotomie. Concluzii. Tratamentul complex adecvat care include miringotomia modificată cu inserția tubului timpanostomic în combinație cu adenotomie este recomandat pentru îmbunătățirea auzului, calității vieții și a stării generale la copiii cu OM. Timpanostomia în modificare propusă este efectivă și inofensivă.Summary Introduction. Children suffered from otitis media (OM), one of the most common disease of childhood, need comprehensive treatment for preventing of hearing loss and chronicity. Aim: to elaborate a system of management of OM in children with somatic pathology and to analyze it effectiveness. Subjects and Methods. Children at the age between 1 and 7 years with somatic pathology were monitorised for diagnostics of OM. Cases of OM were treated by different methodological approaches. The effectiveness of different treatment modalities was assessed by hearing dynamics, general health deterioration scores and quality of life deterioration scores. Results. The most effective treatment modality for OM in children was modified myringotomy with tympanostomy tube insertion in combination with adenoidectomy. Conclusions. Comprehensive treatment which includes modified myringotomy with tympanostomy tube insertion in combination with adenoidectomy is recommended for improvement of hearing, quality of life and general health of children with recurrent otitis media. Tympanostomy in proposed modification is effective and safe