The insertion of ventilation tubes to equalize pressure in the middle ear is the most common procedure used to treat otitis media. This article evaluates the advantages and drawbacks of ventilation and explores the various roles of the components of middle ear pressure, with special emphasis on oxygen-derived free radicals.
Get full access to this article
View all access options for this article.
References
1.
BluestoneCD. Current concepts in otolaryngology. Otitis media in children: To treat or not to treat? N Engl J Med1982;306:1399–1404.
2.
MøllerP.Tympanosclerosis of the ear drum in children. Int J Pediatr Otorhinolaryngol1984;7:247–56.
3.
MøllerP.Hearing, middle ear pressure and otopathology in a cleft palate population. Acta Otolaryngol1981;92:521–8.
4.
LildholdtT, FeldingJU. Tympanosclerosis. Proceedings of the Third International Symposium on Recent Advances in Otitis Media. Toronto, Philadelphia: BC Decker Inc., 1984;51–2.
5.
MøllerH, TosM.Point and period prevalence of otitis media with effusion evaluated by daily tympanometry. J Laryngol Otol1990;104:937–41.
6.
Fiellau-NikolajsenM.Tympanometry and secretory otitis media. Acta Otolaryngol1983;Suppl 394.
7.
CantekinEI, CasselbrantML, DoyleWJ, Prospective study of eustachian tube function and otitis media. Proceedings of the Fourth International Symposium on Recent Advances in Otitis Media. Toronto, Philadelphia: B.C. Decker Inc., 1987;58–60.
8.
CasselbrantML, CantekinEI, DirkmaatDC, Experimental paralysis of tensor veli palatini muscle. Acta Otolaryngol1988;106:171–8.
9.
OvesenT, PaaskePB, BlegvadS, Histological examination of the rabbit middle ear in secretory otitis media with and without a ventilation tube. APMIS1992;100:839–44.
10.
OvesenT, PaaskePB, LedetT, Immunohistochemical quantitation of collagen types I, II, IV, and V in the ventilated and non-ventilated rabbit middle ear with otitis media with effusion. Eur Arch Otorhinolaryngol1994;251:137–42.
11.
SadéJ.Gas exchange. Proceedings of the Third Extraordinary International Symposium on Recent Advances in Otitis Media. 1997;87–92.
12.
MillsRP. A bacteriological study of the middle ear and upper respiratory tract in children with chronic secretory otitis media. Clin Otolaryngol1985;10:335–41.
13.
CabendaSI. Serous otitis media (SOM): A bacteriological study of the ear canal and the middle ear. Int J Pediatr Otorhinolaryngol1988;16:119–24.
14.
KammeC.Secretory otitis media: Microbiology of the middle ear and the nasopharynx. Scand J Infect Dis1984;16:291–6.
15.
SørensenCH. Nasopharyngeal bacteriology and secretory otitis media in young children. Acta Otolaryngol1988;105:126–31.
16.
BunseT.A bacteriological study of otitis media with effusion: Concurrent coagulase-negative staphylococcal infections in the middle ear. Eur Arch Otorhinolaryngol1987;243:387–91.
17.
OvesenT, ElbröndO.The microbiology of middle ear fluid and its relationship to the course of secretory otitis media. In press.
18.
IinoY, YuasaR, KanekoY, Prognosis and endotoxin contents in middle ear effusions in cases after acute otitis media. Acta Otolaryngol1987;435:85–9.
19.
TeeleDW, KleinJO, RosnerBA. Epidemiology of otitis media in children. Ann Otol Rhinol Laryngol1980;89:5–6.
20.
MarchantCD, ShurinPA, TurczykVA. Course and outcome of otitis media in early infancy: A prospective study. J Pediatr1984;104:826–31.
21.
HowieVM, PloussardJH, SloyerJ.The “otitis-prone” condition. Am J Dis Child1975;129:676–8.
22.
JinninT, DakeY, KusumotoT, Quantitative determination of bacterial endotoxin in middle ear effusions by chromogenic substrate method. Auris Nasus Larynx1985;12:97–9.
23.
DeMariaTF. Endotoxin and otitis media. Ann Otol Rhinol Laryngol1988;97:31–4.
24.
IinoY, KanekoY, TakasakaT.Endotoxin in middle ear effusions tested with limulus assay. Acta Otolaryngol1985;100:42–50.
25.
DeMariaTF, PriorRB, BriggsBR, Endotoxin in middle-ear effusion from patients with chronic otitis media with effusion. J Clin Microbiol1984;20:15–7.
26.
DeMariaTF, TatsujiY, LimDJ. Quantitative cytologic and histologic changes in the middle ear after injection of nontypable Haemophilus influenzae endotoxin. Proceedings of the Fourth International Symposium on Recent Advances in Otitis Media. Toronto, Philadelphia: BC Decker Inc., 1987;320–3.
27.
OvesenT, LedetT.Bacteria and endotoxin in middle ear fluid and their correlation to the course of secretory otitis media. Clin Otolaryngol1992;17:531–4.
28.
OvesenT, GaihedeM, ElbröndO.The influence of endotoxin upon middle ear fibroblasts cultured in normal middle ear gas and atmospheric air. APMIS1994;102:743–52.
29.
FeldingJU, RasmussenJB, LildholdtT.Gas composition of the normal and the ventilated middle ear cavity. Scand J Clin Lab Invest1987;47:31–41.
30.
JacklerRK. Experimental evidence against middle ear oxygen absorption [letter]. Laryngoscope1985;95:1281–2.
31.
ElnerA.Gas diffusion through the tympanic membrane. Acta Otolaryngol1970;69:185–91.
32.
OvesenT.Implications of middle ear hyperoxia induced by ventilation tubes in otitis media with effusion. APMIS1995; Suppl 54;103:1–36.
33.
OvesenT, GaihedeM, SchousboeLP, Atmospheric air vs. normal middle ear gas: Effects on in vitro growth and collagen synthesis in normal middle ear fibroblasts. In Vitro Cell Devel Biol1994;30A:249–55.
34.
SchousboeLP, OvesenT.Effect of oxygen tension on in vitro growth and synthesis of rabbit middle ear epithelium and auditory meatal epithelium. Int J Pediatr Otolaryngol. In press.
35.
ClarkJM, LambertsenCJ. Pulmonary oxygen toxicity: A review. Pharmacol Rev1971;23:37–133.
CadenasE.Biochemistry of oxygen toxicity. Annu Rev Biochem1989;58:79–110.
40.
OberleyLW. Superoxide dismutase. Vol II. Florida: CRS Press, 1982.
41.
BulkleyGB. The role of oxygen free radicals in human disease processes. Surgery1983;94:407–12.
42.
WeisigerRA. Oxygen radicals and ischemic tissue injury. Gastroenterology1986;90:494–6.
43.
JacksonCV, MickelsonJK, PopeTK, O2 free radical-mediated myocardial and vascular dysfunction. Am J Physiol1986; 251:H1225–31.
44.
BassDA, OlbrantzP, SzejdaP, Subpopulations of neutrophils with increased oxidative product formation in blood of patients with infection. J Immunol1986;136:860–6.
45.
RepineJE, TateRM. Oxygen radicals and lung edema. Physiologist1983;26:177–81.
46.
KriegerBP, LoomisWH, CzerGT, Mechanisms of interaction between oxygen and granulocytes in hyperoxic lung injury. J Appl Physiol1985;58:1326–30.
47.
MassaroD.Oxygen: Toxicity and tolerance. Hosp Pract1985;21:95–101.
48.
McCordMJ. Free radicals and inflammation: Protection of synovial fluid by superoxide dismutase. Science1974;185:529–31.
49.
BaggioliniM, WymannMP. Turning on the respiratory burst. Trends Biochem Sci1990;15:69–72.
50.
HolmBA, NotterRH, LearyJF, Alveolar epithelial changes in rabbits after a 21-day exposure to 60% O2. J Appl Physiol1987;62:2230–6.
51.
AdamsonIYR, YoungL, BowdenDH. Relationship of alveolar epithelial injury and repair to the induction of pulmonary fibrosis. Am J Pathol1988;130:377–83.
52.
HolmBA, NotterRH, SiegleJ, Pulmonary physiological and surfactant changes during injury and recovery from hyperoxia. J Appl Physiol1985;59:1402–9.
53.
RileyDJ, KerrJS, YuSY, Pulmonary oxygen toxicity: Connective tissue changes during injury and repair. Chest1983; 83:98–9S.
54.
SandholmRE, JohnsonK, KillenP, Alveolar injury by oxygen metabolites alters the composition of extracellular matrix. Chest1983;83:42–3S.
55.
JonesR, ZapolWM, ReidL.Pulmonary arterial wall injury and remodelling by hyperoxia. Chest1983;83:40–2S.
56.
GreenwaldRA, MoyWW. Inhibition of collagen gelation by action of the superoxide radical. Arthritis Rheum1979;22:251–60.
57.
WardPH, MaldonadoM, MorenoM, Oxygen-derived free radicals mediate the cutaneous necrotizing vasculitis induced by epinephrine in endotoxin-primed rabbits. J Infect Dis1990; 61: 1020–2.
58.
BergJT, SmithRM. Protection against hyperoxia by serum from endotoxin treated rats: Absence of superoxide dismutase induction. Proc Soc Exp Biol Med1988;187:117–22.
59.
OlsonNC, GrizzleMK, AndersonDL. Effects of polyethylene glycolsuperoxide dismutase and catalase on endotoxemia in pigs. J Appl Physiol1987;63:1526–32.
60.
HazinskiTA, KennedyKA, FranceML, Pulmonary O2 toxicity in lambs: Physiological and biochemical effects of endotoxin infusion. J Appl Physiol1988;65:1579–85.
61.
ShikiY, MeyrickBO, BrighamKL, Endotoxin increases superoxide dismutase in cultured bovine pulmonary endothelial cells. Am J Physiol1987;252:C436–40.
62.
BergJT, AllisonRC, PrasadVR, Endotoxin protection of rats from pulmonary oxygen toxicity: Possible cytokine involvement. J Appl Physiol1990;68:549–53.
63.
OvesenT, BørglumJD. Superoxide dismutase in middle ear fluid from children with secretory otitis media. Acta Otolaryngol1992;112:1017–24.
64.
OvesenT, LedetT, ElbröndO.Superoxide dismutase in in vitro cultures of middle ear fibroblasts from the rabbit. Eur Arch Otorhinolaryngol1994;251:319–24.
65.
WagnerPD, Mathieu-CostelloO, BeboutDE, Protection against pulmonary O2 toxicity by N-acetylcysteine. Eur Respir J1989;2:116–26.
66.
KharazmiA, NielsenH, SchiøtzPO. N-acetylcysteine inhibits human neutrophil and monocyte chemotaxis and oxidative metabolism. Int J Immunopharmacol1988;10:39–46.
67.
OvesenT, PaaskePB, ElbröndO.Local application of N-acetylcysteine in secretory otitis media in rabbits. Clin Otolaryngol1992;17:327–31.
68.
OvesenT, GaihedeM, LedetT.The effect of N-acetylcysteine on the in vitro growth of normal rabbit middle ear fibroblasts. Clin Otolaryngol1993;18:400–5.
