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Aino Ruohola - One of the best experts on this subject based on the ideXlab platform.

  • can trained nurses exclude acute otitis media with tympanometry or acoustic reflectometry in symptomatic children
    Scandinavian Journal of Primary Health Care, 2015
    Co-Authors: Miia K Laine, Paula A Tahtinen, Olli Ruuskanen, Eliisa Loyttyniemi, Aino Ruohola
    Abstract:

    AbstractObjective Since acute otitis media (AOM) is the most prevalent bacterial infection in young children, the reliable exclusion of AOM by nurses might save physicians’ time for other duties. The study aim was to determine whether nurses without otoscopic experience can reliably use tympanometry or spectral gradient acoustic reflectometry (SG-AR) to exclude AOM.Design Three nurses were trained, who performed examinations with tympanometry and SG-AR. Pneumatic Otoscopy by the study physician served as the diagnostic standard.Setting Study clinic at primary health care level.Patients. 281 children 6–35 months of age.Main outcome measures Predictive values (with 95% confidence interval) for tympanometry and SG-AR, and the clinical usefulness, i.e. the proportion of visits where nurses obtained the exclusive test result from both ears of the child.Results At 459 visits, the negative predictive value of type A and C1 tympanograms (tympanometric peak pressure >–200 daPa) was 94% (91–97%). Based on type A an...

  • can nurses exclude middle ear effusion without Otoscopy in young asymptomatic children in primary care
    Scandinavian Journal of Primary Health Care, 2015
    Co-Authors: Miia K Laine, Paula A Tahtinen, Olli Ruuskanen, Eliisa Loyttyniemi, Aino Ruohola
    Abstract:

    AbstractObjective. Scandinavian guidelines recommend controlling middle-ear effusion (MEE) after acute otitis media. The study aim was to determine whether nurses without otoscopic experience can reliably exclude MEE with tympanometry or spectral gradient acoustic reflectometry (SG-AR) at asymptomatic visits. Design. Three nurses were taught to perform examinations with tympanometry and SG-AR. Pneumatic Otoscopy by the study physician served as the diagnostic standard. Setting. Study clinic at primary health care level. Patients. A total of 156 children aged 6–35 months. Main outcome measures. Predictive values (with 95% confidence interval) for tympanometry and SG-AR, and the clinical usefulness, i.e. the proportion of visits where nurses obtained the exclusive test result from both ears of the child. Results. At 196 visits, the negative predictive value of type A and C1 tympanograms (tympanometric peak pressure > −200 daPa) was 95% (91–97%). Based on type A and C1 tympanograms, the nurse could exclude M...

  • parental role in the diagnostics of otitis media can parents be taught to use tympanometry reliably
    International Journal of Pediatric Otorhinolaryngology, 2014
    Co-Authors: Nora Erkkolaanttinen, Miia K Laine, Paula A Tahtinen, Aino Ruohola
    Abstract:

    Abstract Objective Tympanometry can be used to detect middle ear effusion (MEE). As the need for rearrangement of clinical resources at the primary care level increases, it is important to determine whether layman parents could be taught to use the tympanometer reliably, aiming to reduce unnecessary physician visits during respiratory tract infections. Methods From our AOM treatment trial we enrolled 78 children (age 6–35 months) who had persistent MEE, parents were voluntary and willing to use a tympanometer at home, the child was sufficiently co-operative, and parents learned technically the use of the tympanometer. At home, parents were asked to perform daily bilateral tympanometry on their child. We included those parental tympanometric examinations, to which the corresponding tympanometric examination, within one day by a study physician was available. Parental tympanometric examinations were compared to the Pneumatic Otoscopy by a study physician which served as the diagnostic standard. Results This study involved 78 children and a total of 432 parental tympanometric examinations. From these 432 examinations, parents obtained an interpretable tympanogram in 83% (359/432) and physicians in 91% (393/432) (absolute rate difference 8%, 95% CI 3–12%). Both obtained an interpretable tympanogram from the same ear in 75% (326/432) of the tympanometric examinations. Of these 326 interpretable examinations, parents and physicians were in accordance with either a peaked or a flat tympanogram in 88% of examinations (288/326) (kappa-value 0.77). When the tympanogram was peaked, Pneumatic Otoscopy indicated healthy middle ear in 72% (122/169) of parental and in 69% (149/217) of study physicians’ tympanometric examinations (absolute rate difference 4%, 95% CI −6% to 13%). When the tympanogram was flat, Pneumatic Otoscopy indicated any MEE in 92% of parental (174/190) and in 96% (169/176) of study physicians’ tympanometric examinations (absolute rate difference 4%, 95% CI −9% to 1%). Conclusion This study showed that layman parents are able to use tympanometry technically successfully, and that the parental tympanometric examinations are as reliable as those obtained by study physicians.

  • bacterial and viral interactions within the nasopharynx contribute to the risk of acute otitis media
    Journal of Infection, 2013
    Co-Authors: Aino Ruohola, Miia K Laine, Paula A Tahtinen, Melinda M Pettigrew, Laura Lindholm, Jari Jalava, Kati Raisanen, Raija Vainionpaa, Matti Waris, Elina Lahti
    Abstract:

    Summary Objectives To understand relationships between microbes in pathogenesis of acute otitis media during respiratory tract infections, we compared nasopharyngeal bacteria and respiratory viruses in symptomatic children with and without AOM. Methods We enrolled children (6–35 months) with acute symptoms suggestive of AOM and analyzed their nasopharyngeal samples for bacteria by culture and for 15 respiratory viruses by PCR. Non-AOM group had no abnormal otoscopic signs or only middle ear effusion, while AOM group showed middle ear effusion and acute inflammatory signs in Pneumatic Otoscopy along with acute symptoms. Results Of 505 children, the non-AOM group included 187 and the AOM group 318. One or more bacterial AOM pathogen ( Streptococcus pneumoniae , Haemophilus influenzae , or Moraxella catarrhalis ) was detected in 78% and 96% of the non-AOM and AOM group, respectively ( P S. pneumoniae and H. influenzae , each alone, increased risk of AOM (odds ratio (OR) 2.92; 95% confidence interval (CI), .91–9.38, and 5.13; 1.36–19.50, respectively) and co-colonization with M. catarrhalis further increased risk (OR 4.36; 1.46–12.97, and 9.00; 2.05–39.49, respectively). Respiratory viruses were detected in 90% and 87% of the non-AOM and AOM group, respectively. RSV was significantly associated with risk of AOM without colonization by bacterial AOM pathogens (OR 6.50; 1.21–34.85). Conclusions Co-colonization by M. catarrhalis seems to increase risk of AOM and RSV may contribute to AOM pathogenesis even without nasopharyngeal bacterial colonization.

Stephen A. Boppart - One of the best experts on this subject based on the ideXlab platform.

  • Phase-based Eulerian motion magnification reveals eardrum mobility from Pneumatic Otoscopy without sealing the ear canal.
    Journal of Physics: Photonics, 2020
    Co-Authors: Jungeun Won, Pin-chieh Huang, Stephen A. Boppart
    Abstract:

    Pneumatic Otoscopy is the recommended diagnostic method for middle ear infections. Physicians use a Pneumatic otoscope to assess the position of the eardrum (bulging or retraction) as well as the eardrum mobility while an insufflation bulb is squeezed to generate air pressure changes in a sealed ear canal. While Pneumatic Otoscopy provides increased sensitivity and specificity by detecting decreased eardrum mobility, there exist many challenges to correctly perform and interpret results. For example, the ear canal must be sealed using a specialized ear speculum to deliver sufficiently large pressure changes that can induce visible movements of an eardrum. To overcome this challenge, video motion magnification is proposed to amplify Pneumatic-induced motions of the eardrum without sealing of the ear canal. Pneumatic Otoscopy is performed on adult subjects using a smartphone camera with an otoscope attachment at 60 frames per second, with pressure inputs at 5 Hz. Phase-based Eulerian motion magnification is applied to magnify spatiotemporal dependent motions in the video. As a result, the motion magnification of unsealed Pneumatic Otoscopy reveals comparable eardrum motions as in standard Pneumatic Otoscopy with a sealed ear canal. Furthermore, the estimated motions (in pixels) are quantified to examine the spatial and the temporal variations of the eardrum motions. The motion magnification may avoid the need for sealing the ear canal as well as decrease patient discomfort in Pneumatic Otoscopy, improving the capability and the usability as a point-of-care diagnostic tool in primary care and otology.

  • in vivo detection of nanometer scale structural changes of the human tympanic membrane in otitis media
    Scientific Reports, 2018
    Co-Authors: Roshan Dsouza, Guillermo L Monroy, Michael A Novak, Ryan G Porter, Malcolm C Hill, Stephen A. Boppart
    Abstract:

    Otitis media (OM) is a common ear infection and a leading cause of conductive hearing loss in the pediatric population. Current technologies such as Otoscopy, Pneumatic Otoscopy, tympanometry, and acoustic reflectometry are used to diagnose OM, which can reasonably diagnose the infection with a sensitivity and specificity of 50–90% and 60–90%, respectively. However, these techniques provide limited information about the physical architecture of the tympanic membrane (TM), or what may lie behind it. Here, we report the detection of nanometer-scale structural changes of the TM using nano-sensitive optical coherence tomography (nsOCT). In total, an image dataset from 65 pediatric subjects from three different groups (normal, acute OM, and chronic OM) and with longitudinal image-based analysis of ear infections were included in this study. The nsOCT data were correlated with physician diagnosis and with OCT thickness measurements and were found to be in good agreement with these results. We report that nsOCT detects in vivo structural deformations of the TM earlier than OCT alone, and enhances the detection sensitivity of OCT measurements. This unique technique for early detection of nano-scale structural modifications in the TM has the potential to aid in our understanding of microbiological effects, and possibly for early diagnosis and more effective treatment of OM.

  • quantitative Pneumatic Otoscopy using a light based ranging technique
    Jaro-journal of The Association for Research in Otolaryngology, 2017
    Co-Authors: Ryan L Shelton, Ryan M Nolan, Guillermo L Monroy, Paritosh Pande, Michael A Novak, Ryan G Porter, Stephen A. Boppart
    Abstract:

    Otitis media is the leading cause of hearing loss in children. It is commonly associated with fluid in the ear, which can result in up to 45 dB of hearing loss for extended periods of time during a child's most important developmental years. Accurate assessment of middle ear effusions is an important part of understanding otitis media. Current technologies used to diagnose otitis media with effusion are Pneumatic Otoscopy, tympanometry, and acoustic reflectometry. While all of these techniques can reasonably diagnose the presence of an effusion, they provide limited information about the infection present behind the tympanic membrane.We have developed a technique based on low-coherence interferometry-a non-invasive optical ranging technique capable of sensing depth-resolved microscopic scattering features through the eardrum-to quantify eardrum thickness and integrity, as well as detect any effusion, purulence, or biofilm behind the tympanic membrane. In this manuscript, the technique is coupled with a Pneumatic otoscope to measure minute deflections of the tympanic membrane from insufflation pressure stimuli. This results in quantitative measurements of tympanic membrane mobility, which may be used to gain a better understanding of the impact of infection on the membrane dynamics. A small pilot study of 15 subjects demonstrates the ability of Pneumatic low-coherence interferometry to quantitatively differentiate normal ears from ears with effusions present. Analysis of the strengths and weaknesses of the technique, as well as focus areas of future research, is also discussed.

Ryan G Porter - One of the best experts on this subject based on the ideXlab platform.

  • in vivo detection of nanometer scale structural changes of the human tympanic membrane in otitis media
    Scientific Reports, 2018
    Co-Authors: Roshan Dsouza, Guillermo L Monroy, Michael A Novak, Ryan G Porter, Malcolm C Hill, Stephen A. Boppart
    Abstract:

    Otitis media (OM) is a common ear infection and a leading cause of conductive hearing loss in the pediatric population. Current technologies such as Otoscopy, Pneumatic Otoscopy, tympanometry, and acoustic reflectometry are used to diagnose OM, which can reasonably diagnose the infection with a sensitivity and specificity of 50–90% and 60–90%, respectively. However, these techniques provide limited information about the physical architecture of the tympanic membrane (TM), or what may lie behind it. Here, we report the detection of nanometer-scale structural changes of the TM using nano-sensitive optical coherence tomography (nsOCT). In total, an image dataset from 65 pediatric subjects from three different groups (normal, acute OM, and chronic OM) and with longitudinal image-based analysis of ear infections were included in this study. The nsOCT data were correlated with physician diagnosis and with OCT thickness measurements and were found to be in good agreement with these results. We report that nsOCT detects in vivo structural deformations of the TM earlier than OCT alone, and enhances the detection sensitivity of OCT measurements. This unique technique for early detection of nano-scale structural modifications in the TM has the potential to aid in our understanding of microbiological effects, and possibly for early diagnosis and more effective treatment of OM.

  • quantitative Pneumatic Otoscopy using a light based ranging technique
    Jaro-journal of The Association for Research in Otolaryngology, 2017
    Co-Authors: Ryan L Shelton, Ryan M Nolan, Guillermo L Monroy, Paritosh Pande, Michael A Novak, Ryan G Porter, Stephen A. Boppart
    Abstract:

    Otitis media is the leading cause of hearing loss in children. It is commonly associated with fluid in the ear, which can result in up to 45 dB of hearing loss for extended periods of time during a child's most important developmental years. Accurate assessment of middle ear effusions is an important part of understanding otitis media. Current technologies used to diagnose otitis media with effusion are Pneumatic Otoscopy, tympanometry, and acoustic reflectometry. While all of these techniques can reasonably diagnose the presence of an effusion, they provide limited information about the infection present behind the tympanic membrane.We have developed a technique based on low-coherence interferometry-a non-invasive optical ranging technique capable of sensing depth-resolved microscopic scattering features through the eardrum-to quantify eardrum thickness and integrity, as well as detect any effusion, purulence, or biofilm behind the tympanic membrane. In this manuscript, the technique is coupled with a Pneumatic otoscope to measure minute deflections of the tympanic membrane from insufflation pressure stimuli. This results in quantitative measurements of tympanic membrane mobility, which may be used to gain a better understanding of the impact of infection on the membrane dynamics. A small pilot study of 15 subjects demonstrates the ability of Pneumatic low-coherence interferometry to quantitatively differentiate normal ears from ears with effusions present. Analysis of the strengths and weaknesses of the technique, as well as focus areas of future research, is also discussed.

Kenneth M. Grundfast - One of the best experts on this subject based on the ideXlab platform.

  • clinical practice guideline otitis media with effusion
    Otolaryngology-Head and Neck Surgery, 2004
    Co-Authors: Richard M Rosenfeld, Kenneth M. Grundfast, Larry Culpepper, Karen J Doyle, Alejandro Hoberman, Margaret A Kenna, Allan S Lieberthal, Martin C Mahoney, Richard A Wahl, Charles R Woods
    Abstract:

    The clinical practice guideline on otitis media with effusion (OME) provides evidence-based recommendations on diagnosing and managing OME in children. This is an update of the 1994 clinical practice guideline "Otitis Media With Effusion in Young Children," which was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality). In contrast to the earlier guideline, which was limited to children aged 1 to 3 years with no craniofacial or neurologic abnormalities or sensory deficits, the updated guideline applies to children aged 2 months through 12 years with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Otolaryngology-Head and Neck Surgery selected a subcommittee composed of experts in the fields of primary care, otolaryngology, infectious diseases, epidemiology, hearing, speech and language, and advanced practice nursing to revise the OME guideline. The subcommittee made a strong recommendation that clinicians use Pneumatic Otoscopy as the primary diagnostic method and distinguish OME from acute otitis media (AOM). The subcommittee made recommendations that clinicians should (1) document the laterality, duration of effusion, and presence and severity of associated symptoms at each assessment of the child with OME; (2) distinguish the child with OME who is at risk for speech, language, or learning problems from other children with OME and more promptly evaluate hearing, speech, language, and need for intervention in children at risk; and (3) manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known), or from the date of diagnosis (if onset is unknown). The subcommittee also made recommendations that (4) hearing testing be conducted when OME persists for 3 months or longer, or at any time that language delay, learning problems, or a significant hearing loss is suspected in a child with OME; (5) children with persistent OME who are not at risk should be reexamined at 3- to 6-month intervals until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; and (6) when a child becomes a surgical candidate, tympanostomy tube insertion is the preferred initial procedure. Adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); repeat surgery consists of adenoidectomy plus myringotomy, with or without tube insertion. Tonsillectomy alone or myringotomy alone should not be used to treat OME. The subcommittee made negative recommendations that (1) population-based screening programs for OME not be performed in healthy, asymptomatic children and (2) antihistamines and decongestants are ineffective for OME and should not be used for treatment; antimicrobials and corticosteroids do not have long-term efficacy and should not be used for routine management. The subcommittee gave as options that (1) tympanometry can be used to confirm the diagnosis of OME and (2) when children with OME are referred by the primary clinician for evaluation by an otolaryngologist, audiologist, or speech-language pathologist, the referring clinician should document the effusion duration and specific reason for referral (evaluation, surgery), and provide additional relevant information such as history of AOM and developmental status of the child. The subcommittee made no recommendations for (1) complementary and alternative medicine as a treatment for OME based on a lack of scientific evidence documenting efficacy and (2) allergy management as a treatment for OME based on insufficient evidence of therapeutic efficacy or a causal relationship between allergy and OME. Last, the panel compiled a list of research needs based on limitations of the evidence reviewed. The purpose of this guideline is to inform clinicians of evidence-based methods to identify methods to identify, monitor, and manage OME in children aged 2 months through 12 years. The guideline may not apply to children older than 12 years because OME is uncommon and the natural history is likely to differ from younger children who experience rapid developmental change. The target population includes children with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for use by providers of health care to children, including primary care and specialist physicians, nurses and nurse practitioners, physician assistants, audiologists, speech-language pathologists, and child development specialists. The guideline is applicable to any setting in which children with OME would be identified, monitored, or managed. This guideline is not intended as a sole source of guidance in evaluating children with OME. Rather, it is designed to assist primary care and other clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all children with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.

  • Role of Pneumatic Otoscopy in the evaluation of tympanic membrane and middle ear diseases.
    East African medical journal, 1998
    Co-Authors: K. Shamboul, Kenneth M. Grundfast
    Abstract:

    Many middle ear diseases show visible changes on the tympanic membrane which can be identified with Pneumatic Otoscopy. With practice and patience the technique can be easily performed even on infants and very young children and can reveal what may guide therapeutic approach. Careful positioning of the patient and proper insertion of a fitting ear speculum are of paramount importance. Mobility of the tympanic membrane may be absent in certain conditions and decreased or increased in other conditions. White masses are sometimes observed in the tympanic membrane or in the middle ear. These may be normal bony structures, tympanosclerosis or cholesteatoma and Pneumatic Otoscopy may help differentiate these conditions.

Sung Hwa Hong - One of the best experts on this subject based on the ideXlab platform.