Effect of Naproxen, a Prostaglandin Inhibitor, on Acute Otitis Media and Persistence of Middle Ear Effusion in Children

Prostaglandins are thought to be of importance in the pathophysiology of otitis media with effusion (OME), and the possibility of reducing the frequency and persistence of this condition by using prostaglandin inhibitors has been suggested. In a double blind manner, naproxen was administered to children with acute otitis media, in addition to amoxicillin, and its influence on the subsequent occurrence and persistence of middle ear effusion was evaluated. Eighty-one children participated in the study. No significant difference was found in the number of patients with tympanograms consistent with OME in the two groups. After 10 days of treatment, 63% in the naproxen and 58% in the placebo group, and after 30 days, 41% and 59%, respectively, had type B tympanograms. Similarly, there were no differences between the two groups with respect to other parameters studied (duration of otalgia, fever, otoscopic findings). No side effects related to naproxen were observed.

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Tympanostomy Tube Selection: A Review of the Evidence

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1259 ◽

2016 ◽

Vol 7 (1) ◽

pp. 17-22

Author(s):

Ho Sandra ◽

David J Kay

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

The United States ◽

Tube Placement ◽

Tympanostomy Tube ◽

Middle Ear Effusion ◽

Surgeon Experience ◽

Ear Effusion

ABSTRACT Tympanostomy tube (TT) insertion for ventilation of the middle ear is one of most commonly performed procedures in the United States. Indications for tube insertion include otitis media with effusion, recurrent acute otitis media, hearing loss caused by middle ear effusion and persistent acute otitis media. In general, TTs are divided into two categories, short-term tubes and long-term tubes. Depending on the indications for tube placement and surgeon experience with the TT, different tubes can be used. A myriad of tubes have been created since their first documented use in 1845 in attempts to provide better middle ear ventilation, improve ease of placement and prevent complications, such as post-tube otorrhea, persistent perforation and tube occlusion. In order for a tube to be effective, it should be biocompatible with the middle ear to minimize a foreign body reaction. Teflon and silicone remain two of the most commonly used materials in TTs. In addition, the tube design also plays a role for insertion and retention times of TTs. Lastly, TTs can also be coated with various substances, such as silver-oxide, phosphorylcholine and more recently, antibiotics and albumin, in order to prevent biofilm formation and decrease the rate of post-TT otorrhea. Persistent middle ear effusion affects many children each year and can impact their quality of life as well as hearing and language development. With nearly 1 out of every 15 children by the age of 3 years receiving TTs, it is imperative that the right tube be chosen to facilitate optimal ventilation of the middle ear while minimizing complications. How to cite this article Ho S, Kay DJ. Tympanostomy Tube Selection: A Review of the Evidence. Int J Head Neck Surg 2016;7(1):17-22.

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MIDDLE EAR EFFUSION CONCENTRATIONS OF CEFIXIME DURING ACUTE OTITIS MEDIA WITH EFFUSION AND OTITIS MEDIA WITH EFFUSION

The Pediatric Infectious Disease Journal ◽

10.1097/00006454-199708000-00016 ◽

1997 ◽

Vol 16 (8) ◽

pp. 816-817 ◽

Cited By ~ 5

Author(s):

Christopher J. Harrison ◽

Stephen A. Chartrand ◽

William Rodriguez ◽

Richard Schwartz ◽

Jay Pollack ◽

...

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

Middle Ear Effusion ◽

Ear Effusion

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Comparative Treatment Trial of Augmentin Versus Cefaclor for Acute Otitis Media with Effusion

PEDIATRICS ◽

10.1542/peds.75.5.819 ◽

1985 ◽

Vol 75 (5) ◽

pp. 819-826

Author(s):

Carla M. Odio ◽

Helen Kusmiesz ◽

Sharon Shelton ◽

John D. Nelson

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

Middle Ear Effusion ◽

Recurrent Acute Otitis Media ◽

Potassium Clavulanate ◽

Branhamella Catarrhalis ◽

Viridans Group Streptococci ◽

Ear Effusion

A total of 150 children with acute otitis media were randomly allocated to treatment with amoxicillin-potassium clavulanate (Augmentin) or with cefaclor. Each drug was given in a daily dosage of approximately 40 mg/kg in three divided doses for ten days. Tympanocentesis done before treatment yielded specimens that contained pneumococcus or Haemophilus sp or both in 67% of specimens. Viridans group streptococci were isolated from 10% of specimens and Branhamella catarrhalis from 6%. Patients were scheduled for followup examinations at midtreatment, end of therapy, and at 30, 60, and 90 days. Of the 150 children, 130 were evaluable. Five of 60 patients (8%) treated with cefaclor were considered therapeutic failures because of persistent purulent drainage and isolation of the original pathogen or suprainfection. There were no failures among patients treated with Augmentin (P = .019). Rates of relapse, recurrent acute otitis media with effusion, and persistent middle ear effusion were comparable in the two groups of patients. Diaper rash, or loose stools, or both were significantly more common in children treated with Augmentin (34%) than in those taking cefaclor (12%), but in no case was it necessary to discontinue medication because of these mild side effects (P = .002). Cefaclor therapy was discontinued in one patient because of severe abdominal pain and vomiting. In this study, treatment with Augmentin was superior to treatment with cefaclor in the acute phase of acute otitis media with effusion, but Augmentin produced more adverse effects. The rates of persistent middle ear effusion and recurrent acute otitis media with effusion were comparable with the two regimens.

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Comparison of Cefaclor and Amoxicillin for Acute Otitis Media with Effusion

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894810903s212 ◽

1981 ◽

Vol 90 (3_suppl2) ◽

pp. 48-52 ◽

Cited By ~ 13

Author(s):

Ellen M. Mandel ◽

Charles D. Bluestone ◽

S. Nasrin Ghorbanian ◽

Erdem I. Cantekin ◽

Howard E. Rockette

Keyword(s):

Clinical Trial ◽

Otitis Media ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

Middle Ear Effusion ◽

Double Blind ◽

Days Of Therapy ◽

The Difference ◽

Reasonable Choice ◽

Ear Effusion

A double-blind randomized clinical trial was conducted comparing cefaclor and amoxicillin for the treatment of acute otitis media with effusion in 110 children (150 ears). Each child underwent unilateral or bilateral tympanocentesis and then randomly received a 14-day course of either amoxicillin or cefaclor. Of 57 children in the cefaclor group, only 3 children (5.3%) had persistent or recurrent symptoms during the 14-day course of treatment, as compared to 5 of 53 children (9.4 %) in the amoxicillin group, but this difference is not significant. After completion of the 14 days of therapy, 45 of 76 ears (59.2%) of the children in the cefaclor group were effusion-free, as compared to only 28 of 64 ears (43.7%) of the children in the amoxicillin group. When adjusted for age and race, this difference is statistically significant (p = .03). However, the difference between the effect of the two antimicrobials is not statistically significant in children. Cefaclor is a reasonable choice for antimicrobial therapy for acute otitis media with effusion, and from these study findings, it appears that cefaclor may be more effective than amoxicillin in resolving the middle ear effusion at the completion of 14-day therapy.

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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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Validity of Acoustic Reflectometry in Detecting Middle Ear Effusion

PEDIATRICS ◽

10.1542/peds.79.5.739 ◽

1987 ◽

Vol 79 (5) ◽

pp. 739-742

Author(s):

Daniel M. Schwartz ◽

Richard H. Schwartz

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Simple Technique ◽

Otitis Media With Effusion ◽

Acute Otitis Media ◽

Middle Ear Effusion ◽

Ear Effusion

Pneumootoscopy, tympanometry, and acoustic reflectometry were performed in 256 middleclass children seen in a surburban pediatric office. The results demonstrated that relectometry, when validated by otoscopic findings, detected middle ear effusion with 88% sensitivity and 83% specificity when a cut-off of 5 linear units was used. Corresponding values for tympanometry were 87% and 77.5%. These results are in keeping with those of earlier studies on acoustic reflectometry and demonstrate the usefulness of this simple technique in detecting chronic and acute otitis media with effusion.

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The management of acute otitis media

Drug and Therapeutics Bulletin ◽

10.1136/dtb.22.14.53 ◽

1984 ◽

Vol 22 (14) ◽

pp. 53-54

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Clinical Examination ◽

Middle Ear ◽

Acute Otitis Media ◽

Infectious Complications ◽

Middle Ear Effusion ◽

Suppurative Otitis Media ◽

Painful Condition ◽

Ear Effusion

Acute suppurative otitis media (AOM) is a common, painful condition affecting 20% of children under 4 years at least once a year,1 and perhaps more in infancy when clinical examination is most difficult. Infectious complications such as mastoiditis, meningitis and cerebral abscess are now rare, but chronic middle ear effusion and hearing loss remain common. Hearing loss may persist long after the infective episode,2 and may impair learning.

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To Tube or Not to Tube: That Continues to Be the Question

PEDIATRICS ◽

10.1542/peds.76.2.332a ◽

1985 ◽

Vol 76 (2) ◽

pp. 332-332

Author(s):

DAVID W. TEELE ◽

BERNARD ROSNER ◽

JEROME O. KLEIN

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Middle Ear Effusion ◽

Speech And Language ◽

Clinically Significant ◽

Ear Effusion

In Reply.— We appreciate Chamberlin's thoughtful comments about the associations between otitis media with effusion and development of speech and language and his concern about results that are statistically significant but may not be "clinically significant." We share his view that measurements of the sequelae of disease should include those that are meaningful to the child. We reported results of tests of speech and language that indicated that children who had spent many days with middle ear effusion during the first years of life scored significantly lower than did children who had not spent such time.

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Efficacy of medical treatment as an adjunct to surgery in the treatment of secretory otitis media

The Journal of Laryngology & Otology ◽

10.1017/s0022215100101124 ◽

1986 ◽

Vol 100 (12) ◽

pp. 1347-1350 ◽

Cited By ~ 8

Author(s):

T. H. J. Lesser ◽

M. I. Clayton ◽

D. Skinner

Keyword(s):

Medical Treatment ◽

Otitis Media ◽

Middle Ear ◽

Otitis Media With Effusion ◽

Randomised Trial ◽

Control Group ◽

Middle Ear Effusion ◽

Secretory Otitis Media ◽

Ear Effusion

AbstractIn a pilot controlled randomised trial of 38 children who had bilateral secretory otitis media, with effusion demonstrated at operation, we compared the efficacy of a six-week course of an oral decongestant—antihistamine combination and a mucolytic preparation with a control group in preventing the presence of middle-ear effusion six weeks after myringotomy and adenoidectomy. The mucolytic preparation decreased the presence of middle-ear effusion when compared to the decongestant-antihistamine combination and the control group (p=0.06).

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