(2) For each target otologic condition, categorize the current state of knowledge regarding the condition and its interventions (if any) and the stage of research necessary for full development of the intervention.
|Understanding of Dz/Disorder/ Condition e.g., natural hx, treatment altering natural course
||Understanding of patho-physiology
||Is there a therapeutic targett
||Is there Intervention geared to therapeutic target
||Describe intervention: any modality e.g., surgery, drug, device, drug, behavior
||Stage of development of intervention e.g., basic understanding/early translation, preclinical, clinical, definitive clinical trials, late translation
|Acute Otitis Media
Moderate. Questions exist about genetics, biofilm disease, viral etiologies, immunocom-petency. Extensive information about some pathogens.
|Poor. Questions of genetics, eustachian tube dysfunction, bacterial biofilm/ colonies
||Yes. Bacteria, mucins, viruses, environment/ habits Some NO: genetic factors.
||Yes but not satisfactory. Prevention strategies - some understood
||Avoid smoking parents, avoid daycare, possible role of vaccines Over- prescription of antibiotics a problem
||All available for widespread testing. Definitive studies require large multicenter studies.
|Otitis Media with Effusion
Lots of evidence but some conflicting.
- Role of antibiotics
- Role of adenoidectomy
|Conflicted: bacterial, viral, eustachian tube, allergy, genetic.
Root cause(s) unclear
|Yes - some bacterial, yes for allergic, no for viral, no for ET, no for biofilm.
Pragmatic Rx (tubes) established
|antibiotica, tubes, allergic management, adenoidectomy
Available but new strategies are needed. Some strategies are ineffective but widely used (antibiotics, steroids, decongestants late translation to practitioners issues
|Congenital Syndromic ME problems
||Good understanding of anatomy, some understanding of genetics of syndromes but little insight into genetics of atresia. Much understanding through human temporal bone labs.
||Anatomically - yes. Genetically - no or unsure
||Yes but not satisfactory
||Innovative procedures by surgeons and BAHA development.
Hearing aid development
|Atelectasis/ Retraction Eustachian tube problems
||Poor. Unsure of genetic contribution to ET dysfunction. Pathophysiology of ET dysfunction?
||Yes - eustachian tube function.
||Good. Clinical and imaging
||Yes. Mechanical reconstructive techniques, adhesives. Compromised by ET function problems and inflammatory disease.
||Mechanical prostheses. Biocompatible tissue cement. Unsure of ME ventilation
||Mature - late translation to practitioners
||Good in animal models and through human temporal bone histopathology.
||Good but various mechanisms cause controversy. Congenital cholesteatoma poorly understood.
||Keratinocytes? Early detection/ diagnosis
||Early detection is a major problem. Earlier detection more satisfactory? Visual markers for keratinocytes (during surgery)
||Surgery - type of surgery. Evidence for second looks?
||Empirical, but improvements in imaging technology may improve diagnosis and management. Early detection - little progress. Prevention - unknown. Unsure if tubes prevent
||Yes - Bacteria/ fungi
||Appropriate antimiobials and steroids
||Good. Some opportunities for very very recalcitrant cases.
|Incomplete. Most understanding from human temporal bone histopathology. Genetic disorder but several loci map but no genes identified; viral etiology also possible. OI better genetic understanding. Paget's Disease poorly understood - unsure if viral.
||Anatomically good - bone remodeling of the otic capsule. Molecular mechanism not understood - genetic viral.
||Yes. Bone cells osteoclasts/ blasts
||Fluorides and bisphosphonates
||Knowledge of reconstructive procedures is good (post translation) Mechanism of fluorides
Poorly understood. Mechanism of bisphosphonates is good.
|Tympanic membrane perforation
||Good. Most understanding from clinical observations and human temporal bone histopathology.
||Good. Some healing issues. Wound healing research incomplete
||Yes - fibrous and epithelial growth. Spontaneous closure ? Mechanism
||Common clinical practice - grafting surgery
||Fairly mature - late translation to practitioners standard of care. Room for improvement.
|Post tympanostomy tube otorrhea
||Moderate - bacterial etiology but question the role of biofilm.
||Moderate. Unsure how infections persist
||Yes - bacteria in various phenotypes (sessile and planktonic)
||Yes but not entirely satisfactory
||Remove tubes, antibiotics, prevention
||Primary care docs giving oral antibiotics inappropriately Not following evidence
Electromecha-nical implants (ME procedure for inner ear problems - see inner ear group)