International Journal of Otolaryngology Otitis Media and Relevant Clinical Issues Guest Editors: Jizhen Lin, Joseph E. Kerschner, Per Cayé-Thomasen, Tetsuya Tono, and Quan-An Zhang Otitis Media and Relevant Clinical Issues International Journal of Otolaryngology Otitis Media and Relevant Clinical Issues Guest Editors: Jizhen Lin, Joseph E. Kerschner, Per Caye-Thomasen,´ Tetsuya Tono, and Quan-An Zhang Copyright © 2012 Hindawi Publishing Corporation. All rights reserved. This is a special issue published in “International Journal of Otolaryngology.” All articles are open access articles distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Editorial Board Rolf-Dieter Battmer, Germany Ludger Klimek, Germany Leonard P. Rybak, USA Robert Cowan, Australia Luiz Paulo Kowalski, Brazil Shakeel Riaz Saeed, UK P. Dejonckere, The Netherlands Roland Laszig, Germany Michael D. Seidman, USA Joseph E. Dohar, USA Charles Monroe Myer, USA Mario A. Svirsky, USA Paul J. Donald, USA Jan I. Olofsson, Norway Ted Tew fik, Canada R. L. Doty, USA Robert H. Ossoff,USA Paul Van de Heyning, Belgium David W. Eisele, USA JeffreyP.Pearson,UK Blake S. Wilson, USA Alfio Ferlito, Italy Peter S. Roland, USA B. J. Yates, USA Contents Otitis Media and Relevant Clinical Issues, Jizhen Lin, Joseph E. Kerschner, Per Caye-Thomasen,´ Tetsuya Tono, and Quan-An Zhang Volume 2012, Article ID 720363, 1 page Pneumococcal Conjugate Vaccines and Otitis Media: An Appraisal of the Clinical Trials, Mark A. Fletcher and Bernard Fritzell Volume 2012, Article ID 312935, 15 pages Mucin Production and Mucous Cell Metaplasia in Otitis Media, Jizhen Lin, Per Caye-Thomasen, Tetsuya Tono, Quan-An Zhang, Yoshihisa Nakamura, Ling Feng, Jianmin Huang, Shengnan Ye, Xiaohua Hu, and Joseph E. Kerschner Volume 2012, Article ID 745325, 12 pages Measuring Thickness of Middle Ear Mucosa Using MRI and CT Imaging versus Histopathology, Mary Ann Nyc, Sang Gyoon Kim, Anil Kapoor, and Timothy Jung Volume 2012, Article ID 962496, 6 pages TheRoleofAtoh1inMucousCellMetaplasia, Yoshihisa Nakamura, Yuki Hamajima, Masahiro Komori, Makoto Yokota, Motohiko Suzuki, and Jizhen Lin Volume 2012, Article ID 438609, 5 pages A Review of Hearing Loss in Cleft Palate Patients, Bilal Gani, A. J. Kinshuck, and R. Sharma Volume 2012, Article ID 548698, 6 pages Transiently Evoked Otoacoustic Emissions in Children with Otitis Media with Effusion, Dimitris G. Balatsouras, George Koukoutsis, Panayotis Ganelis, George S. Korres, Andreas Aspris, and Antonis Kaberos Volume 2012, Article ID 269203, 4 pages Clinical Experience of Auditory Brainstem Response Testing on Pediatric Patients in the Operating Room, Guangwei Zhou, Briana Dornan, and Wheaton Hinchion Volume 2012, Article ID 350437, 6 pages Hindawi Publishing Corporation International Journal of Otolaryngology Volume 2012, Article ID 720363, 1 page doi:10.1155/2012/720363 Editorial Otitis Media and Relevant Clinical Issues Jizhen Lin,1 Joseph E. Kerschner,2 Per Caye-Thomasen,´ 3 Tetsuya Tono, 4 and Quan-An Zhang5 1 Department of Otolaryngology, Head and Neck Surgery, School of Medicine, University of Minneosta, Minneapolis, MN 55455, USA 2 Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA 3 Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Gentofte University Hospital of Copenhagen, 2900 Hellerup, Denmark 4 Department of Otorhinolaryngology, Head and Neck Surgery, University of Miyazaki, Miyazaki 889-1692, Japan 5 Department of Otolaryngology, Head and Neck Surgery, Second Clinical Medical College, Xi’An Medical University, Xi’An 710049, China Correspondence should be addressed to Jizhen Lin, [email protected] Received 23 April 2012; Accepted 23 April 2012 Copyright © 2012 Jizhen Lin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Otitis Media (OM), an infection in the space behind the emissions in children with OM with effusion, and appraisal ear drum, is one of the most common childhood infectious of pneumococcal vaccine trials. In the basic sciences, there diseases worldwide. More than 70% of all children have at are two review articles, focusing on the role of Atoh1 in least one middle ear infection by the age of six years. Among mucous cell metaplasia and mucin production and mucous them, approximately 5–10% of patients turn to chronic OM cell metaplasia/hyperplasia, respectively. which eventually causes hearing loss and sequelae. In these two review articles, what has been discussed The pathogenesis of chronic and/or recurrent OM are includes the cellular events through which mucous cells are multifactorial, including genetic predisposition, dysfunction induced from general epithelial stem cells; bacterial metabo- of the Eustachian tube, impairment of the mucociliary lites/inflammatory cytokines that modulate the development system, hyperproduction of mucins, metaplasia/hyperplasia of mucous cells in the middle ear, transcription factors and of mucous cells, and active secretion of ions and water. No other molecules that are responsible for differentiation of matter what contributes to the development of the disease, mucous cells in the middle ear, possible factors that increase mucin production and mucous cell metaplasia/hyperplasia the risks for mucous cell metaplasia/hyperplasia, and signal are always problems in this disease. pathways that are involved in the mucin disorders and Mucous cell metaplasia/hyperplasia occur in the middle mucous cell metaplasia/hyperplasia. ear mucosa and tend to drive OM into a chronic status, leading to abundant production and accumulation of mucus Jizhen Lin in the middle ear cavity. Under the circumstances, this leads Joseph E. Kerschner to the development of an OM entity, that is, OM with mucoid Per Cay´e-Thomasen effusion. Mucous cell metaplasia/hyperplasia is frequently Tetsuya Tono associated with chronic purulent otorrhea when the tym- Quan-An Zhang panic membrane is performed, making OM irreversible and intractable. However, it is unclear how this event initiates at an acute setting of OM and deteriorates in the chronic stage of OM. In this particular issue, there are seven papers in total, covering the clinical areas and basic sciences relevant to OM. In the clinical areas, there are five papers, dealing with application of auditory brainstem response in the operating room, measuring thickness of middle ear mucosa with MRI and CT, hearing loss in cleft palate patients, otoacoustic Hindawi Publishing Corporation International Journal of Otolaryngology Volume 2012, Article ID 312935, 15 pages doi:10.1155/2012/312935 Review Article Pneumococcal Conjugate Vaccines and Otitis Media: An Appraisal of the Clinical Trials Mark A. Fletcher and Bernard Fritzell Pfizer Specialty Care Business Unit-Vaccines, International Scientific & Clinical Affairs, Pfizer Inc., Cedex 14, 75668 Paris, France Correspondence should be addressed to Mark A. Fletcher, mark.a.fletcher@pfizer.com Received 15 September 2011; Revised 18 December 2011; Accepted 3 February 2012 Academic Editor: Joseph E. Kerschner Copyright © 2012 M. A. Fletcher and B. Fritzell. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Streptococcus pneumoniae is the predominant otitis media pathogen and its prevention through effective vaccination could diminish childhood illness and antibiotic use. This paper reviews 5 pneumococcal conjugate vaccine (PCV) trials that used otitis media as an endpoint: Northern California Kaiser Permanente (NCKP; vaccine, 7-valent PCV [PCV7]-CRM); Finnish Otitis Media (FinOM; vaccines, PCV7-CRM or PCV7-OMPC); Native American Trial (vaccine, PCV7-CRM); Pneumococcal Otitis Efficacy Trial (POET; vaccine, 11-valent PCV [PCV11]-PD). For the microbiological endpoint, vaccine efficacy against vaccine-serotype pneumococcal otitis media was about 60% across trials. Against the clinical endpoint of all episodes, vaccine efficacy was 7% (PCV7-CRM/NCKP), 6% (PCV7-CRM/FinOM), −1% (PCV7-OMPC/FinOM), and −0.4% (PCV7-CRM/Native American Trial); 34% against first episodes of ear, nose, and throat specialist-referral cases (PCV11-PD/POET). Both follow-up through 2 years of age, for the 5 trials, and long-term follow-up, for PCV7-CRM/NCKP and PCV7-CRM/FinOM, demonstrated greater vaccine efficacy against recurrent AOM and tympanostomy-tube placement, suggesting that vaccination against early episodes of AOM may prevent subsequent episodes of complicated otitis media. Although study designs varied by primary endpoint measured, age at follow-up, source of middle-ear fluid for culture, case ascertainment, and type of randomization, each clinical trial demonstrated vaccine efficacy against microbiological and/or clinical otitis media. 1. Introduction suggesting middle-ear effusion plus at least one sign of acute infection (e.g., fever), the rates of AOM episodes in control Otitis media is commonly an acute infection of childhood groups generally ranged from 1.2 to 1.8 per child per year that is most prevalent in children during their first years of (PCPY) in the first 2 years of life [1–4]. Identification of life. Otitis media leads to substantial healthcare costs related