Over the past 2 decades, the increasing availability of computed tomography (CT) and magnetic resonance imaging (MRI) as well as the growing professional expertise have significantly improved the diagnostics of middle and inner ear diseases in dogs and cats. In answering some of the diagnostic questions, CT and MRT demonstrate equivalent performance. For most questions, however, there are differences in the diagnostic performance due to the physical imaging properties of the 2 modalities.CT is more sensitive in demonstrating involvement of the bulla wall and is more effective for detecting abnormal content within the tympanic bulla. In addition, with CT it is often easier to guide tissue samplings. On the other hand, structural changes of the soft tissues of the skull, head, meninges, brain, and nerves are not or only insufficiently detectable on CT images. MRI is clearly superior here. Therefore, MRI is essential for the characterization of materials inside the bulla cavity and for demonstrating the extent of any central spread of otitis media (OM).In this image essay, CT and MRI features of OM and resulting secondary lesions described in the literature are analyzed and summarized. Own image examples are used for illustration. Information on the etiology, pathogenesis, pathomorphology, and clinical signs important for understanding these changes are presented in concise descriptions.
Über die letzten 2 Jahrzehnte haben die zunehmende Verfügbarkeit von Computertomografen (CT) und Magnetresonanztomografen (MRT) sowie die gewachsene fachliche Expertise die Diagnostik von Mittel- und Innenohrerkrankungen bei Hunden und Katzen erheblich verbessert. Bei der Beantwortung von einer Reihe diagnostischer Fragestellungen können CT und MRT als gleichwertige Verfahren angesehen werden. Bei anderen Fragestellungen wiederum bestehen Unterschiede in der diagnostischen Leistungsfähigkeit aufgrund der physikalischen Abbildungseigenschaften. Sensitiver ist die CT bei der Darstellung von Veränderungen der Bullawand. Die CT ist auch das effektivere Verfahren, wenn abnormaler Inhalt in der Bulla tympanica nachgewiesen werden soll. Darüber hinaus ist es mit der CT oft einfacher, die Entnahme von Gewebeproben zu planen und durchzuführen. Andererseits sind strukturelle Veränderungen der Weichteile des Kopfes, der Meningen, des Gehirns und von Nerven in der CT nicht oder nur unzureichend erkennbar. Hier ist die MRT klar überlegen. Daher ist die MRT für die Typisierung von Materialen in der Bulla sowie die Darstellung des Ausmaßes einer eventuell existierenden zentralen Ausbreitung einer Otitis media (OM) unerlässlich.In diesem Bildessay werden die in der Literatur beschriebenen bildmorphologischen Merkmale einer OM und die durch sie bedingten sekundären Pathologien analysiert und zusammengefasst. Eigene Bildbeispiele dienen der Illustration. Für das Verständnis der Veränderungen wichtige Informationen zur Ätiologie, Pathogenese, Pathomorphologie und dem klinischen Erscheinungsbild werden in kurzer Form dargestellt.

Myhre syndrome (MS) is a rare genetic condition that presents with multiple genetic anomalies including cleft lip and palate and Eustachian tube dysfunction. These patients are at a high risk for airway scarring from intubation and mucosal inflammation. Hearing loss (conductive or mixed, of varying severity) is a common comorbidity in these patients, the exact etiology of which is still unclear. We present the cases of 2 unrelated children with MS who suffered progressive mixed hearing loss from fibrosis and obliteration of the middle ear spaces. Both patients had multiple sets of ear tubes that demonstrated early extrusion. The older patient underwent bone conduction implantation at age 11 which resulted in dramatic improvement of speech recognition and interactive skills. The other younger patient demonstrates a similar trajectory but has not yet undergone implantation. Otolaryngologists should take a cautious approach to surgery of the eardrum and middle ear to avoid unnecessary induction of fibrosis in this susceptible patient population. These cases highlight a newly described etiology for hearing loss and suggest a benefit to bone conduction implantation.

BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is a potentially life-threatening syndrome for which early recognition and treatment are essential for improving outcomes. HLH is characterized by uncontrolled immune activation leading to fever, cytopenias, hepatosplenomegaly, coagulation abnormalities, and elevated typical markers. This condition can be genetic or secondary, with the latter often triggered by infections. Here, we present a unique case of HLH secondary to acute otitis media (AOM), a common ear infection.
METHODS: We describe a 4-year-old boy who initially presented with a high fever and otalgia, later diagnosed with bilateral AOM. Despite antibiotic treatment, his condition deteriorated.
METHODS: The patient fulfilled diagnostic criteria for HLH.
METHODS: Aggressive treatment by using combination therapy with immunoglobulins, intravenous steroids (dexamethasone), cyclosporine, and etoposide was performed.
RESULTS: After 1 month of treatment, improvement in the otologic symptoms was observed, and hematological findings gradually improved and normalized.
CONCLUSIONS: The link between AOM and HLH may be associated with inflammatory responses and immunological mechanisms, highlighting the importance of considering HLH in severe infection cases. This case emphasizes the need for prompt diagnosis and management, especially in secondary HLH scenarios, to improve patient outcomes. It is imperative to be aware of the potential correlation between these 2 conditions, and healthcare professionals should consider the likelihood of HLH.

BACKGROUND: Otitis media (OM) refers to a common clinical ear disease. Noise seriously damages human hearing function. This study aimed to investigate the effects of various noise types on the hearing function of patients who have recovered from mild OM.
METHODS: A total of 160 patients with mild OM treated at our hospital from May 2020 to May 2023 were retrospectively selected for this study. Based on clinical data, the patients were divided into the non-noise group (n = 80) and the noise (n = 80) group. The hearing thresholds of the two groups were compared across various noise types at 500, 1000, and 2000 Hz. In addition, the hearing thresholds of the noise group were compared under the same conditions.
RESULTS: The noise group exhibited significantly higher hearing thresholds at 500, 1000, and 2000 Hz than the non-noise group (P < 0.05). Under traffic, urban construction, and industrial noises, the auditory thresholds at 500, 1000, and 2000 Hz in the noise group were significantly higher than those observed under domestic and speech noises (P < 0.05).
CONCLUSIONS: Noise shows a close relationship with the hearing function of patients with OM. Traffic, urban construction, and industrial noises greatly influence the hearing function of patients who have recovered from mild OM.

BACKGROUND: The high incidence of pediatric acute otitis media (AOM) makes the implications of overdiagnosis and overtreatment far-reaching. Quality indicators (QIs) for AOM are limited, drawing from generalized upper respiratory infection QIs, or locally developed benchmarks. Recognizing this, we sought to develop pediatric AOM QIs to build a foundation for future quality improvement efforts.
METHODS: Candidate indicators (CIs) were extracted from existing guidelines and position statements. The modified RAND Corporation/University of California, Los Angeles (RAND/UCLA) appropriateness methodology was used to select the final QIs by an 11-member expert panel consisting of otolaryngology-head and neck surgeons, a pediatrician and family physician.
RESULTS: Twenty-seven CIs were identified after literature review, with an additional CI developed by the expert panel. After the first round of evaluations, the panel agreed on 4 CIs as appropriate QIs. After an expert panel meeting and subsequent second round of evaluations, the panel agreed on 8 final QIs as appropriate measures of high-quality care. The 8 final QIs focus on topics of antimicrobial management, specialty referral, and tympanostomy tube counseling.
CONCLUSIONS: Evidence of variable and substandard care persists in the diagnosis and management of pediatric AOM despite the existence of high-quality guidelines. This study proposes 8 QIs which compliment guideline recommendations and are meant to facilitate future quality improvement initiatives that can improve patient outcomes.

BACKGROUND: Most US children with acute otitis media [AOM] receive prompt antibiotic treatment, though guidelines encourage watchful waiting. Previous systematic reviews of antibiotics versus watchful waiting have focused on symptom resolution and RCTs, limiting the assessment of serious, rare complications. We sought to evaluate these complications by including observational studies.
METHODS: RCTs and observational studies that compared antibiotics to placebo or watchful waiting for pediatric clinician diagnosed AOM were identified [PubMed/MEDLINE, Embase, Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, and Web of Science] and reviewed for meta-analysis. Two reviewers independently extracted study characteristics, patient characteristics, and outcomes. We assessed publication bias, study bias with ROBINS-1 and RoB-2 and used random-effects models to assess treatment effects.
RESULTS: 24 studies were included. Antibiotics decreased the risk of acute mastoiditis [incidence 0.02%, RR 0.48, 95% CI 0.40-0.59; NNT 5,368]. This protective effect may be underestimated because of misclassification of non-suppurative conditions as AOM. Intracranial complications remained too rare to assess. Antibiotics markedly increased the risk of adverse effects [incidence 10.5%, RR 1.49, 1.27-1.73; NNH 23]. Studies used non-specific criteria for acute mastoiditis, potentially underestimating treatment effects.
CONCLUSIONS: Prompt antibiotic therapy reduces the risk for some AOM complications. The NNT to prevent serious, rare complications is high, while the NNH is relatively low. Large-scale population-based observational studies using real-world datasets with validated measures of severe complications are needed to improve understanding of risk factors for serious AOM complications, facilitate more selective antibiotic therapy, and optimize individual outcomes and public health.

Otitis media is a common childhood disease in developing countries and is the most important cause of preventable hearing loss among Indian children. To study the knowledge, attitude, and practices regarding risk factors for otitis media among caretakers of children in Puducherry. This was a questionnaire based descriptive cross-sectional study conducted from April 2023 to June 2023. All the caregivers of children aged 2-12 years presented or diagnosed with otitis media under our inclusion criteria were interviewed. Overall, most caretakers displayed good knowledge (67%), positive attitude (62%) and good care-seeking practices (49%). There was a positive correlation with sociodemographic parameters. The odd\'s ratio for overcrowding was high (OR = 4, p = 0.042 for knowledge and attitude, OR = 3.929, p = 0.041 for practices). Higher score was seen among middle class with odd\'s ratio 1.417 for knowledge and attitude and 4.875 for practices (p = 0.041). Graduate parents had higher score with the odd\'s ratio that was statistically significant. Most of the caregivers had a good knowledge regarding symptoms of otitis media and an acceptable level of caregivers\' attitude and care seeking practices. Higher scores were associated with overcrowding, socioeconomic status, parental education. Improvement in risk factors and providing health education will reduce prevalence of OM in children and thereby reduce preventable hearing loss in children.
UNASSIGNED: The online version contains supplementary material available at 10.1007/s12070-024-04551-9.

BACKGROUND: The purpose of this study was to investigate the prevalence of otitis media and other otolaryngologic disorders in children with Obstructive Sleep Apnea (OSA) compared to those without OSA in a large cohort.
METHODS: A retrospective cohort study was carried within the US Collaborative Network within TriNetX. The OSA group was defined by ICD-10 code G47.33 and non-OSA group excluded patients with OSA. Both groups were required to have a CPT code for an outpatient visit to act as a control: 99202-99215. Propensity score matching for age, sex, and race was performed. Prevalence of otitis media (ICD-10H65, H66), chronic otitis media (ICD-10H66.1, H66.2, H66.3, H65.2, H65.3, and H65.4), tympanostomy (CPT 69433, 69436), adenoidectomy (CPT 42830, 42831), tonsillectomy (CPT 42825, 42826), adenotonsillectomy (CPT 42820, 42821), and allergic rhinitis (ICD-10 J30.9) were compared in this cohort.
RESULTS: Propensity score matching yielded 165,665 (M = 95949, F = 69901) patients with a mean age of 10.7 (SD = 4.07) for each cohort. Children with OSA were 1.27x and 3.86x more likely to be diagnosed with otitis media and chronic otitis media, respectively (P<.0001). They were 3.81x more likely to undergo a tympanostomy (P<.0001). Children with OSA were 4.1x, 18.2x, and 24.7x more likely undergo an adenoidectomy, tonsillectomy, and adenotonsillectomy, respectively (P<.0001). Children with OSA were also 2.03x as likely to have a diagnosis of allergic rhinitis (P<.0001).
CONCLUSIONS: Children with OSA experience otitis media and related surgical intervention more than children without OSA. Since allergic rhinitis and adenoid hypertrophy are contributors to both OSA and AOM, their increased prevalence in children with OSA may explain their increased frequency of AOM.

BACKGROUND: Acute otitis media (AOM) is a prevalent childhood acute illness, with 13.6 million pediatric office visits annually, often stemming from upper respiratory tract infections (URI) and affected by environmental factors like air pollution and cold seasons.
METHODS: Herein, we made use of territory-wide hospitalization data to investigate the relationships between meteorological factors, air pollutants, influenza infection, and AOM for children observed from 1998 to 2019 in Hong Kong. Quasi-Poisson generalized additive model, combined with a distributed-lag non-linear model, was employed to examine the relationship between weekly AOM admissions in children and weekly influenza-like illness-positive (ILI +) rates, as well as air pollutants (i.e., oxidant gases, sulfur dioxide, and fine particulate matter), while accounting for meteorological variations.
RESULTS: There were 21,224 hospital admissions due to AOM for children aged ≤ 15 years throughout a 22-year period. The cumulative adjusted relative risks (ARR) of AOM were 1.15 (95% CI, 1.04-1.28) and 1.07 (95% CI, 0.97-1.18) at the 95th percentile concentration of oxidant gases (65.9 ppm) and fine particulate matter (62.2 μg/m3) respectively, with reference set to their medians of concentration. The ARRs exhibited a monotone increasing trend for all-type and type-specific ILI + rates. Setting the reference to zero, the cumulative ARRs of AOM rose to 1.42 (95% CI, 1.29-1.56) at the 95th percentile of ILI + Total rate, and to 1.07 (95% CI, 1.01-1.14), 1.19 (95% CI, 1.11-1.27), and 1.22 (95% CI, 1.13-1.32) for ILI + A/H1N1, A/H3N2, and B, respectively.
CONCLUSIONS: Our findings suggested that policy on air pollution control and influenza vaccination for children need to be implemented, which might have significant implications for preventing AOM in children.

BACKGROUND: Group A streptococcal(GAS) meningitis is a severe disease with a high case fatality rate. In the era of increasing GAS meningitis, our understanding about this disease is limited.
OBJECTIVE: To gain a better understanding about GAS meningitis.
METHODS: Five new cases with GAS meningitis were reported. GAS meningitis related literatures were searched for systematic review in PUBMED and EMBASE. Case reports and case series on paediatric cases were included. Information on demographics, risk factors, symptoms, treatments, outcomes, and emm types of GAS was summarized.
RESULTS: Totally 263 cases were included. Among 100 individuals, 9.9% (8/81) had prior varicella, 11.1% (9/81) had anatomical factors, and 53.2% (42/79) had extracranial infections. Soft tissue infections were common among infants (10/29, 34.5%), while ear/sinus infections were more prevalent in children ≥ 3 years (21/42, 50.0%). The overall case fatality rate (CFR) was 16.2% (12/74). High risk of death was found in patients with shock or systemic complications, young children(< 3 years) and cases related to hematogenic spread. The predominate cause of death was shock(6/8). Among the 163 patients included in case series studies, ear/sinus infections ranged from 21.4 to 62.5%, while STSS/shock ranged from 12.5 to 35.7%, and the CFR ranged from 5.9 to 42.9%.
CONCLUSIONS: A history of varicella, soft tissue infections, parameningeal infections and CSF leaks are important clinical clues to GAS in children with meningitis. Young children and hematogenic spread related cases need to be closely monitored for shock due to the high risk of death.