Otologic Findings Based on no Complaints in a Pediatric Examination

Introduction the otological evaluation is highly significant in those branches of medicine in which the general evaluation of the patient is conducted by general practitioners and pediatricians. Objectives To investigate the otologic findings and their incidences in the sample, which consisted of patients who presented to the pediatric outpatient clinic with non-otologic complaints. Methods Patients, aged between 2 and 16 years, who had neither otorhinolaryngological complaints nor history of surgery by the otolaryngology (ear, nose and throat, ENT) department were included in the present study. The findings detected in the external auditory system and in the tympanic membranes as well as the otorhinolaryngologists' otologic examination findings of the referred patients were recorded from the files of each patient along with the applied medical and surgical treatments, and diagnostic investigations. Results Of a total of 973 patients evaluated, 129 (13.2%) were referred to the ENT outpatient clinic due to any otologic pathology. In the otorhinolaryngological examinations, false positivity was detected in 12 (1.2%) patients, and pathological findings were detected in 117 (12%) patients who received the following diagnoses: 68 (6.9%) had otitis media with effusion(OME); 37 (3.8%) had cerumen impactions; 8 (0.8%) had acute otitis media (AOM); 2 (0.2%) had ticks in the external auditory canal; 2 (0.2%) had a retraction pocket in tympanic membrane; 1 (0.1%) had unilateral central dry perforation of the tympanic membrane; and 1(0.1%) had congenital cholesteatoma. Conclusion Any complications and sequelae that may develop due to any pathologies and predominantly infections can be prevented by an early diagnosis, which can be made by means of a simple examination, performed merely with an otoscope. Pediatricians and general practitioners should be in close contact with otorhinolaryngologists regarding the pathologies they identify.

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Factors Associated with Antibiotic Prescribing in Children with Otitis Media

ISRN Family Medicine ◽

10.5402/2013/587452 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Christina T. Ryborg ◽

Jens Søndergaard ◽

Jørgen Lous ◽

Anders Munck ◽

Pia V. Larsen ◽

...

Keyword(s):

Cohort Study ◽

Confidence Interval ◽

Tympanic Membrane ◽

Otitis Media ◽

General Practitioners ◽

Age Groups ◽

Acute Otitis Media ◽

Large Degree ◽

Antibiotic Prescribing ◽

Factors Associated

Background. Acute otitis media (AOM) is often treated with antibiotics. However, initial observation is recommended. Denmark has a low use of antibiotics compared with other countries, but the total use of antibiotics has increased by 32% during the last decade, and it is important to know whether general practitioners (GPs) prescribe antibiotics according to guidelines. Objective. The aim of the study was to analyse associations between GPs' antibiotic prescribing for AOM and symptoms, diagnoses, and characteristics of children. Methods. A cohort study where GPs consecutively included 954 children between 0 and 7 years old with a new ear symptom was carried out. The GPs registered symptoms, results of otoscopy and tympanometry, together with diagnosis and treatment. Results. Fever with and without earache was statistically associated with prescribing antibiotics, and it applies to both children up to two years of age (OR: 5.89 (confidence interval (CI): 2.62–13.21) and OR: 8.13 (CI: 4.61–14.32)) and children older than two years of age (OR: 4.59 (CI: 2.55–8.25) and OR: 19.45 (CI: 6.38–59.24)). A red tympanic membrane was statistically associated with the prescribing antibiotics in both age groups (0–2 years: OR: 4.73 (CI: 2.52–8.86) and >2–7 years: OR: 3.76 (CI: 2.13–6.64)). A flat tympanometry curve was only statistically associated with prescribing antibiotics in the oldest children (OR: 2.42 (CI: 1.17–5.00)). Conclusion. This study indicates that GPs to a large degree prescribe antibiotics appropriately according to guidelines.

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A Myringotomy and Ventilating Tube Applicator: New Look at a Five-Century-Old Procedure

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v30i2.355 ◽

2015 ◽

Vol 30 (2) ◽

pp. 50-55

Author(s):

Jay Pee M. Amable ◽

Lily L. Sia-Vargas

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Study Design ◽

Private Hospital ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

Tube Insertion ◽

Polyethylene Tube ◽

Egg Membrane ◽

Single Instrument

Objective: To fabricate a single instrument that can be used to perform myringotomy and insert a pressure equalizing tube at almost the same time. Methods: Study Design: Surgical Instrumentation Setting: Tertiary Private Hospital Subject: A chicken egg membrane was used as a tympanic membrane model Result: The fabricated instrument was able to perforate the egg membrane and apply the modified polyethylene pressure equalizing tube in less than one minute without complications. Conclusion: The prototype applicator can facilitate myringotomy and pressure equalizing (PE) tube insertion at only a fraction of the time it usually takes to do the standard myringotomy and subsequent ventilating tube insertion. Keywords: Myringotomy, pressure equalizing tube, ventilating tube, acute otitis media, otitis media with effusion, polyethylene tube

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Workshop on Effects of Otitis Media on the Child

PEDIATRICS ◽

10.1542/peds.71.4.639 ◽

1983 ◽

Vol 71 (4) ◽

pp. 639-652

Author(s):

Charles D. Bluestone ◽

Jerome O. Klein ◽

Jack L. Paradise ◽

Heinz Eichenwald ◽

Fred H. Bess ◽

...

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Middle Ear ◽

Current Knowledge ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

Chronic Otitis Media ◽

Signs And Symptoms ◽

Middle Ear Effusion ◽

Ear Effusion

GOALS, DEFINITIONS, AND CLASSIFICATION OF OTITIS MEDIA —Charles D. Bluestone, MD The goal of this Workshop was to assess current knowledge concerning the effects of otitis media on the child. Experts in pediatrics, infectious disease, otolaryngology, audiology, speech, linguistics, and psychology met in Chicago on Aug 25, 1982 to participate in this Workshop. A summary of the discussions is presented here. Otitis media is broadly defined as an inflammation of the middle ear without reference to etiology or pathogenesis.1 Otitis media with effusion is an inflammation of the middle ear in which a collection of liquid (i.e., middle ear effusion) is present in the middle ear space (no perforation of the tympanic membrane is present). Atelectasis of the tympanic membrane, which may or may not be associated with otitis media, is defined as either collapse or retraction of the tympanic membrane. Acute otitis media implies a rapid and short onset of signs and symptoms lasting approximately 3 weeks. From 3 weeks to 3 months, the process may be resolving or subacute. If middle ear effusion persists beyond 3 months, the condition is classified as chronic otitis media with effusion. Many terms have been used for acute otitis media, such as "suppurative," "purulent," or "bacterial" otitis media; however, a "serous" effusion may also have an acute onset. Otitis media with effusion unaccompanied by signs and symptoms of acute inflammation has also had a plethora of other names: "serous," "secretory," "nonsuppurative," and "glue ear" have been the most commonly used. EPIDEMIOLOGY AND NATURAL HISTORY OF OTITIS MEDIA

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Consultation with the Specialist

Pediatrics in Review ◽

10.1542/pir.13.1.23 ◽

1992 ◽

Vol 13 (1) ◽

pp. 23-24

Author(s):

Gerald B. Healy

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

Disease Process ◽

Care Physician ◽

Ear Canal ◽

Patient Groups ◽

Partially Occluded

Otitis media with effusion (OME) offers the primary care physician both a diagnostic and a therapeutic challenge. The tympanic membrane of a child frequently is difficult to assess, especially in the uncooperative patient whose ear canal is partially occluded by cerumen. However, if the ear canal can be cleared to allow an unobscured view of the tympanic membrane, then pneumatic otoscopy and tympanometry can be extremely valuable in both the diagnosis and follow-up after initiation of treatment. Patient Groups The pediatrician usually is faced with two groups of patients in this disease process. The first group includes the young child who has recurrent episodes of acute otitis media. Frequently, affected patients can be subdivided into those who clear their middle ear space of fluid between episodes and those who do not. The second group consists of children who have asymptomatic chronic effusion, usually leading to persistent hearing loss. These children tend to be slightly older but are no less troublesome for the clinician. Treatment Controlled clinical trials have been extremely important in providing information about both of these groups. These studies have shown that chemoprophylaxis is extremely useful in managing the patient who has recurring acute suppurative episodes not complicated by persistent effusion during the interval periods.

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The validity of topical drug therapy for otitis media with effusion

Medical Council ◽

10.21518/2079-701x-2021-18-80-84 ◽

2021 ◽

pp. 80-84

Author(s):

S. V. Morozova ◽

K. V. Eremeeva ◽

W. H.A. Suaifan

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Otitis Media With Effusion ◽

Age Groups ◽

Acute Otitis Media ◽

Combination Drug ◽

Initial Stage ◽

Topical Analgesics ◽

Anti Inflammatory ◽

Inflammatory Effect

Otitis media with effusion is difficult to diagnose, since the course of the disease is mostly asymptomatic, while the initial stage of the disease is very similar to Eustachiitis or the pre-perforative stage of acute otitis media. At this stage, dysfunction of the auditory tube and negative pressure in the tympanic cavity creates the conditions for the production of transudate, which clinically, in addition to hearing loss, is accompanied by soreness, a feeling of congestion, pressure, fluid transfusion in the ear. When conducting local medical procedures, they are primarily guided by the condition of the mucous membrane of the eustachian tube, nasopharynx and nasal cavity, but changes in the eardrum are no less important. Thus, the use of topical analgesics with an anti-inflammatory effect becomes no less relevant in the treatment.A literature review was carried out with an analysis of scientific research data on the use of a topical combination drug that has a local anesthetic and anti-inflammatory effect in the treatment of diseases of the external and middle ear.Analysis of the literature showed that the use of lidocaine-phenazone-containing drops promotes rapid regression of the inflammation in the external auditory canal and the tympanic membrane, as well as relieving of pain. It can be used both in children (including newborns) and in adults who are suffering from otitis media but with intact tympanic membrane, including otitis media with effusion.Combined topical drugs containing lidocaine-phenazone demonstrate efficacy and safety in the treatment of catarrhal and otitis media with effusion in all age groups.

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First Forty-Eight Hours of Developing Otitis Media: An Experimental Study

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940311200614 ◽

2003 ◽

Vol 112 (6) ◽

pp. 558-566 ◽

Cited By ~ 9

Author(s):

Per Olof Eriksson ◽

Cecilia Mattsson ◽

Sten Hellström

Keyword(s):

Tympanic Membrane ◽

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Light And Electron Microscopy ◽

Acute Otitis Media ◽

Clinical Appearance ◽

Filamentous Material ◽

Type 3 ◽

Inflammatory Changes

The early inflammatory changes in the tympanic membrane were explored in 2 rat models. Acute otitis media was induced by instillation of Streptococcus pneumoniae type 3 into the middle ear cavity, and otitis media with effusion was induced by blockage of the eustachian tube. Otomicroscopic examination was performed before the rats were painlessly sacrificed at 3, 6, 9, 12, 18, 24, or 48 hours after initiation of the otitis media conditions. The tympanic membrane was studied by light and electron microscopy. Both acute otitis media and otitis media with effusion caused early inflammatory changes of the tympanic membrane, and the pars flaccida was the portion that reacted first. The inflammatory alterations were most pronounced in the acute otitis media model. The course of inflammation showed a bimodal pattern with an early deposition of a filamentous material with a band pattern, typical of fibrin. Despite a fluid-filled middle ear cavity, the inflammatory changes in the otitis media with effusion model were moderate, as was consistent with the clinical appearance of the tympanic membrane.

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Association of Receipt of Antibiotics with Patient Satisfaction for Caregivers of Children Presenting to Urgent-Care Settings

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.647 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s134-s135

Author(s):

Diane Liu ◽

NORA FINO ◽

Benjamin Haaland ◽

Adam Hersh ◽

Emily Thorell ◽

...

Keyword(s):

Patient Satisfaction ◽

Otitis Media ◽

Respiratory Infections ◽

Otitis Media With Effusion ◽

Multivariable Analysis ◽

Acute Otitis Media ◽

Skewed Distribution ◽

Urgent Care ◽

Provider Type ◽

Patient Dissatisfaction

Background: The Press Ganey (PG) Medical Practice Survey is a commonly used questionnaire for measuring patient experience in healthcare. Our objective was to evaluate the PG surveys completed by caregivers of children presenting for urgent care evaluation of acute respiratory infections (ARIs) to determine any correlation with receipt of antibiotics during their visit. Methods: We evaluated responses to the PG urgent-care surveys for encounters of children <18 years presenting with ARIs (ie, sinusitis, bronchitis, pharyngitis, upper respiratory infection, acute otitis media, or serous otitis media with effusion) within 9 University of Utah urgent-care centers. Scores could range from 0 to 100. Because the distributions of scores followed right- skewed distribution with a high ceiling effect, we defined scores as dissatisfied with their care (≤25th percentile) and satisfied with their care (scores >25th percentile). Univariate and multivariable generalized mixed-effects logistic regression was used to assess correlates of patient dissatisfaction. Random intercepts were included for each provider to account for correlation within the same provider. Separate models were used for each PG component score. Multivariable models adjusted for receipt of antibiotics, age, gender, race, ethnicity, and provider type. Results: Overall, 388 of 520 responses (74.6%) indicated satisfaction and 132 responses (25.4%) indicated dissatisfaction. Among patients who did not receive antibiotics, 87 of 284 responses (30.6%) indicated dissatisfaction versus 45 of 236 (19.1%) who did receive antibiotics. Among patients who were dissatisfied with their clinician, raw clinician PG scores were higher among patients who received antibiotics (mean, 64.5; standard deviation [SD], 16.9) versus those who did not receive antibiotics (mean, 54.7; SD, 24.4; P = .015) (Table 1). In a multivariable analysis, receipt of antibiotics was associated with a reduction in patient dissatisfaction overall (odds ratio, 0.55; 95% CI, 0.36–0.85). Conclusions: Overall, most responses for patients seen for ARIs in pediatric urgent care were satisfied. However, a significantly higher proportion of responses for patients who did not receive antibiotics were dissatisfied than for those patients who received antibiotics. Antibiotic stewardship strategies to communicate appropriate prescribing while preserving patient satisfaction are needed in pediatric urgent-care settings.Funding: NoneDisclosures: None

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Effects of COVID-19 Lockdown on Otitis Media With Effusion in Children: Future Therapeutic Implications

Otolaryngology ◽

10.1177/0194599820987458 ◽

2021 ◽

pp. 019459982098745

Author(s):

Mirko Aldè ◽

Federica Di Berardino ◽

Paola Marchisio ◽

Giovanna Cantarella ◽

Umberto Ambrosetti ◽

...

Keyword(s):

Retrospective Study ◽

Otitis Media ◽

Outpatient Clinic ◽

Otitis Media With Effusion ◽

Tertiary Level ◽

Vestibular Disorders ◽

Therapeutic Implications ◽

History Of ◽

Clinic Population

Objective To evaluate the role of social isolation during the lockdown due to the SARS-CoV-2 outbreak (severe acute respiratory syndrome coronavirus 2) in modifying the prevalence of otitis media with effusion (OME) and the natural history of chronic OME. Study Design Retrospective study. Setting Tertiary level referral audiologic center. Methods We assessed the prevalence of OME among children aged 6 months to 12 years who attended the outpatient clinic for hearing or vestibular disorders during 2 periods before the lockdown, May-June 2019 (n = 350) and January-February 2020 (n = 366), and the period immediately after the lockdown, May-June 2020 (n = 216). We also compared the disease resolution rates between a subgroup of children with chronic OME (n = 30) who were diagnosed in summer 2019 and reevaluated in May-June 2020 and a similar subgroup (n = 29) assessed in 2018-2019. Results The prevalence of OME in this clinic population was 40.6% in May-June 2019, 52.2% in January-February 2020, and 2.3% in May-June 2020. Children with chronic OME had a higher rate of disease resolution in May-June 2020 (93.3%) than those examined in May-June 2019 (20.7%, P < .001). Conclusion Closure of schools and the physical distancing rules were correlated with a reduction in the prevalence of OME and favored the resolution of its chronic forms among children who attended the outpatient clinic. These data could suggest that in the presence of chronic OME, keeping young children out of group care settings for a period might be beneficial to allow for OME resolution.

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Otitis media outcomes of a combined 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine and 13-valent pneumococcal conjugate vaccine schedule at 1-2-4-6 months: PREVIX_COMBO, a 3-arm randomised controlled trial

BMC Pediatrics ◽

10.1186/s12887-021-02552-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Amanda Jane Leach ◽

Edward Kim Mulholland ◽

Mathuram Santosham ◽

Paul John Torzillo ◽

Peter McIntyre ◽

...

Keyword(s):

Haemophilus Influenzae ◽

Otitis Media ◽

Conjugate Vaccine ◽

Otitis Media With Effusion ◽

Controlled Trial ◽

Acute Otitis Media ◽

Trial Registration ◽

Open Label ◽

Suppurative Otitis Media ◽

Link Type

Abstract Background Aboriginal children living in Australian remote communities are at high risk of early and persistent otitis media, hearing loss, and social disadvantage. Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) are the primary pathogens. We compared otitis media outcomes in infants randomised to either a combination of Synflorix™ (PHiD-CV10, with protein D of NTHi) and Prevenar13™ (PCV13, with 3, 6A, and 19A), with recommended schedules for each vaccine alone. We previously reported superior broader overall immunogenicity of the combination schedule at 7 months, and early superiority of PHiD-CV10 compared to PCV13 at 4 months. Methods In an open-label superiority trial, we randomised (1:1:1) Aboriginal infants at 28 to 38 days of age, to either Prevenar13™ (P) at 2–4-6 months (_PPP), Synflorix™ (S) at 2–4-6 months (_SSS), or Synflorix™ at 1–2-4 months plus Prevenar13™ at 6 months (SSSP). Ears were assessed using tympanometry at 1 and 2 months, combined with otoscopy at 4, 6, and 7 months. A worst ear diagnosis was made for each child visit according to a severity hierarchy of normal, otitis media with effusion (OME), acute otitis media without perforation (AOMwoP), AOM with perforation (AOMwiP), and chronic suppurative otitis media (CSOM). Results Between September 2011 and September 2017, 425 infants were allocated to _PPP(143), _SSS(141) or SSSP(141). Ear assessments were successful in 96% scheduled visits. At 7 months prevalence of any OM was 91, 86, and 90% in the _PPP, _SSS, and SSSP groups, respectively. There were no significant differences in prevalence of any form of otitis media between vaccine groups at any age. Combined group prevalence of any OM was 43, 57, 82, 87, and 89% at 1, 2, 4, 6, and 7 months of age, respectively. Of 388 infants with ear assessments at 4, 6 and 7 months, 277 (71.4%) had OM that met criteria for specialist referral; rAOM, pOME, or CSOM. Conclusions Despite superior broader overall immunogenicity of the combination schedule at 7 months, and early superiority of PHiD-CV10 compared to PCV13 at 4 months, there were no significant differences in prevalence of otitis media nor healthy ears throughout the first months of life. Trial registration ACTRN12610000544077 registered 06/07/2010 and ClinicalTrials.govNCT01174849 registered 04/08/2010.

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