Otitis Media Practice During the COVID-19 Pandemic.

The global coronavirus disease-2019 (COVID-19) pandemic has changed the prevalence and management of many pediatric infectious diseases, including acute otitis media (AOM). Coronaviruses are a group of RNA viruses that cause respiratory tract infections in humans. Before the COVID-19 pandemic, coronavirus serotypes OC43, 229E, HKU1, and NL63 were infrequently detected in middle ear fluid (MEF) specimens and nasopharyngeal aspirates in children with AOM during the 1990s and 2000s and were associated with a mild course of the disease. At times when CoV was detected in OM cases, the overall viral load was relatively low. The new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative pathogen responsible for the eruption of the COVID-19 global pandemic. Following the pandemic declaration in many countries and by the World Health Organization in March 2020, preventive proactive measures were imposed to limit COVID-19. These included social distancing; lockdowns; closure of workplaces; kindergartens and schools; increased hygiene; use of antiseptics and alcohol-based gels; frequent temperature measurements and wearing masks. These measures were not the only ones taken, as hospitals and clinics tried to minimize treating non-urgent medical referrals such as OM, and elective surgical procedures were canceled, such as ventilating tube insertion (VTI). These changes and regulations altered the way OM is practiced during the COVID-19 pandemic. Advents in technology allowed a vast use of telemedicine technologies for OM, however, the accuracy of AOM diagnosis in those encounters was in doubt, and antibiotic prescription rates were still reported to be high. There was an overall decrease in AOM episodes and admissions rates and with high spontaneous resolution rates of MEF in children, and a reduction in VTI surgeries. Despite an initial fear regarding viral shedding during myringotomy, the procedure was shown to be safe. Special draping techniques for otologic surgery were suggested. Other aspects of OM practice included the presentation of adult patients with AOM who tested positive for SARS-2-CoV and its detection in MEF samples in living patients and in the mucosa of the middle ear and mastoid in post-mortem specimens

Wideband measurements in newborns: relationship to otoscopic findings

Introduction: Current newborn hearing screening include testing with otoacoustic emission and automated auditory brainstem response. Unfortunately, both tests are affected by the presence of material in the ear canal and middle ear such as vernix, meconium and amniotic fluid. The primary objective of this study was to perform wideband measurements and otoscopy on newborns in order to determine whether occlusion of the ear canal affects the wideband measurements. A secondary objective was to compare the wideband measurements obtained after birth to those taken at 14 to 28 days later. A third objective was to obtain additional wideband normative data in newborns. Materials and Methods: Newborns from a well-baby nursery were enrolled. Wideband measurements under both ambient and pressurized conditions and otoscopy were done immediately after the hearing screening and between 14 and 28 days later. Occlusion of the ear canal as seen on otoscopy was described on a scale of 0 to 100% in increments of 10.Results: A total of 156 babies were enrolled. On the first measurement, a statistically significant difference in reflectance was found between 0-70% and 80-100% occlusion groups and between 6 groups of frequencies between 250 Hz and 8 kHz. There was no significant difference in reflectance between the right and the left ears. A comparison of reflectance under pressurised conditions between the first and second measurements has shown a higher reflectance at the negative pressure region during the first few days of life. Conclusion: Significant increase in reflectance occurs when 70% to 80% of the ear-canal diameter is occluded. A trend of higher reflectance appears to be present when the canal is pressurized to negative values. A comparison of reflectance between the present study and previous studies is given.Introduction: Le dépistage néonatal de la surdité actuel inclut l'évaluation d'émissions oto-acoustiques automatisées et la réponse évoquée auditive du tronc cérébral. Malheureusement, les résultats de ces tests peuvent être affectés par la présence de matériaux transitoires dans le conduit auditif externe et l'oreille moyenne comme par exemple le vernix, le méconium et le liquide amniotique. L'objectif primaire de cette étude était d'effectuer des mesures de réflectance à large bande et un examen otoscopique sur les nouveau-nés afin de déterminer si l'occlusion du conduit auditif externe affecte les mesures à large bande. Un objectif secondaire était de comparer les mesures après la naissance à celles obtenues 14 à 28 jours plus tard. Le troisième objectif était d'obtenir des données normatives supplémentaires. Matériels et méthodes: De nouveau-nés d'une pouponnière de bébés en santé ont été inscrits. Les mesures à large bande, effectuées dans des conditions ambiantes et sous pression, et l'examen otoscopique ont été exécutés immédiatement après le dépistage de la surdité et entre 14 et 28 jours plus tard. L'occlusion du conduit auditif externe, vu par examen otoscopique, a été décrite par une échelle de 0 à 100% d'obstruction, par étapes de 10%. Résultats: Un total de 156 bébés ont été inscrits. Lors de la première mesure, une différence statistiquement significative a été observée entre les groupes 0-70% et 80-100% d'obstruction du conduit, et également entre les 6 groupes de fréquences auditives comprises entre 250 Hz et 8 kHz. Il n'y avait aucune différence significative entre l'oreille droite et la gauche. Une comparaison des résultats dans des conditions sous pression, entre la première et la deuxième mesure, a démontré un coefficient de réflectance supérieur à la zone de pression négative pendant les premiers jours de vie.Conclusion: Une augmentation significative de la réflectance se produit lorsque le conduit auditif externe est obstrué de 70% à 80%. Une tendance de réflectance plus élevée semble être présente lorsque le canal est sous pression, à des valeurs négatives. Une comparaison des résultats de cette étude et d'études antérieures est discutée

Extended High Frequency Audiometry for Revealing Sudden Sensory Neural Hearing Loss in Acute Tinnitus Patients

Introduction The measurement of extended high-frequency (EHF) audiometry has become more popular recently, mainly in connection with ototoxicity and noiseinduced hearing loss. New-onset tinnitus evaluation includes a standard hearing test that shows no pathology. Objective The aim of the present study was to evaluate the possibility that acute tinnitus is essentially connected to sudden sensory neural hearing loss (SSNHL), by utilizing EHF audiometry in cases in which standard audiometry for frequencies between 250 Hz to 8 kHz is within normal limits. Methods A retrospective study was conducted between January 2009 and May 2014 that included all patients presenting with acute tinnitus and normal standard audiometry. All patients underwent EHF audiometry and were treated accordingly. Results Thirty-two patients with acute tinnitus and asymmetric sensorineural hearing loss on EHF audiometry were identified. The average deltas between the ears were between 9.2 and 33dB (worse in the affected ear). Conclusion Extended high-frequency audiometry up to 20,000 Hz should be performed in all patients with acute tinnitus and standard audiometry within normal limits