Objectives Otitis media with effusion (OME) is a common pathology in children. Effusions contain Metalloproteinases (MMPs), which can lead to atrophy of the tympanic membrane (TM) due to destructive effect on the lamina propria. Not all cases of OME are complicated with atrophy, maybe explained by an inter-individual variation of MMP concentration in effusions. The purpose of this study was to determine the correlation between concentration of MMPs and existence of TM atrophy in children. Participants - Main outcome measures The effusion from thirty middle ears were collected during insertion of VT in children aged 15 months to 10 years, including 11 eardrums with tympanic atrophy and 19 without tympanic atrophy. ELISA tests were used to measure concentrations of MMP-2, MMP-7, MMP-9 and TIMP-2 in the effusions. Correlations between MMP levels and atrophy of eardrum was investigated, as well as correlation with age, gender, number of previous ventilation tube insertion, and viscosity of the glue. Results The mean concentration of MMP-2 was higher in the atrophic group than in effusions without TM atrophy (0.6 ng/mg versus 0.5 ng/mg total protein respectively), while the TIMP-2 concentration was lower in this group. The level of MMP-2 decreased with the age. Finally, a significantly higher concentration of MMP-9 and TIMP-2 was found in high-viscosity effusions. Conclusion This study suggests that MMP-2 activity could play an important role in destruction of the eardrum during OME in infancy. MMP-2 level assessment could be interesting for determining children with risk of lamina propria destruction.

Aim: Infantile haemangioma (IH) is the most common benign tumour in children. Since 2014, propranolol has become the first-choice therapy and currently Hemangiol® is the only approved drug for complicated haemangioma. This post-marketing study reported the use of Hemangiol® for IH in paediatric practice. Method and Results: From January 2014 to November 2018, 94 children (median age 4 [0;21] months; 75% female) treated with Hemangiol® for proliferative IH were enrolled in the study. The systematic paediatric cardiology consultation never contraindicated beta-blockers. Two Hemangiol® initiation protocols were used: a conventional ambulatory 3-week titration phase protocol (N=76, 80.9%), and a rapid initiation protocol with a 48-hour dose escalation in conventional hospitalization for severe proliferative IH (N=18, 19.1%). In both protocols, the haemodynamic tolerance was good. The mean maintenance dose of Hemangiol® was 2.7±0.8 mg/kg/day, with a median treatment duration of 7 [1.5;19] months. Adverse events (AEs) have been found in 25 (26,6%) patients including 8 (8.5%) patients with serious AEs (uncontrolled bronchial hyperreactivity, N=5; serious hypoglycaemia, N=3). Some patients had one or more AEs, a total of 24 non-serious AEs was reported in 19 patients (sleep disturbances, N=9; respiratory disorders, N=5; digestive disorders, N=6). No cardiac adverse event was reported. Conclusion: This post-marketing surveillance drug study supports the good tolerance of Hemangiol® in children with IH. A rapid initiation protocol is of interest when treatment is urgent. The pre-therapeutic paediatric cardiology consultation should not be systematic but only indicated on specific patients. ClinicalTrials.gov: NCT 04105517.