scholarly journals Diagnostic Accuracy, Prescription Behavior, and Watchful Waiting Efficacy for Pediatric Acute Otitis Media

2018 ◽  
Vol 58 (1) ◽  
pp. 60-65 ◽  
Author(s):  
David L. Brinker ◽  
Erina L. MacGeorge ◽  
Nicole Hackman
Keyword(s):  
Physical Examination ◽  
Otitis Media ◽  
Chart Review ◽  
Watchful Waiting ◽  
Acute Otitis Media ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Central Pennsylvania ◽  
Current Guidelines ◽  
Prescription Behavior

Current guidelines recommend “watchful waiting” (WW) as an alternative to immediate antibiotic treatment. Continued high rates of antibiotic use suggest that WW may be underutilized. We conducted a retrospective chart review of 474 pediatric acute otitis media (AOM) cases at a clinic in central Pennsylvania. We assessed physical examination findings, diagnostic behavior, WW utilization, prescription writing, and filling in cases of pediatric AOM to evaluate the underutilization of WW. We evaluate diagnostic consistency with published guidelines and rates of antibiotic prescription resulting from misdiagnosis. We report WW instructions and compliance, and prescription filling behaviors. Fifty percent of AOM diagnoses in this sample were not supported by physical examination findings. The majority of these AOM diagnoses received antibiotic prescriptions, suggesting that unsupported diagnoses translated to injudicious prescribing. WW instructions corresponded to 57% fewer filled prescriptions and longer fill delay. We discuss the implications and recommendations to improve antibiotic stewardship.

Post-operative complications of cochlear implantation in adults and children: five years' experience in Maastricht

2006 ◽  
Vol 121 (4) ◽  
pp. 318-323 ◽  
Author(s):  
J T F Postelmans ◽  
B Cleffken ◽  
R J Stokroos
Keyword(s):  
Otitis Media ◽  
Cochlear Implantation ◽  
Chart Review ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Retrospective Chart Review ◽  
Operative Complications ◽  
Ventilation Tubes ◽  
Adults And Children ◽  
Post Operative Complications

Although cochlear implantation is considered a safe method of rehabilitation for profoundly deaf individuals, a number of these patients suffer complications after surgery. To evaluate post-operative complications after cochlear implantation, a retrospective chart review was performed for 112 patients who had undergone implantation in the Maastricht Academic Hospital. Minor complications were defined as those that could be overcome by medical or audiological management. These occurred in 36 patients (32 per cent) and all were managed successfully. Major complications were defined as device extrusion and those requiring further surgery, and these were identified in four patients (3.6 per cent). These complications included wound infection and device failure mediated by middle-ear pathology. In cases of chronic otitis media, we recommend performance of cochlear implantation as a staged procedure. In order to reduce the post-operative incidence of acute otitis media, we recommend adenoidectomy, placement of ventilation tubes and early antibiotic treatment.

scholarly journals Inflammatory cast of the tympanic membrane after acute otitis media

2013 ◽  
Vol 127 (3) ◽  
pp. 314-317
Author(s):  
J Byun ◽  
DS Massi ◽  
A Sehgal ◽  
M Saadia-Redleaf
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Primary Care Physicians ◽  
Otitis Externa ◽  
Chart Review ◽  
Acute Otitis Media ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Patient Treatment

AbstractObjective:To describe a relatively unknown clinical entity – inflammatory cast of the tympanic membrane after acute otitis media – and its simple out-patient treatment.Study design:Retrospective review of case series.Setting:Subspecialty practice at a tertiary hospital.Patients:Seven patients diagnosed previously with acute otitis media with perforation or otitis externa, and with persistent ear discomfort.Methods:Retrospective chart review.Results:The patients presented with weeks to months of persistent hearing loss after acute otitis media with perforation or acute otitis externa. Visits to their primary care physicians had been uninformative. After comparison of the affected and unaffected tympanic membranes, a thin, hard cast was identified and removed from the affected tympanic membrane. Improvement in hearing was documented in the three patients who underwent audiometric testing; the remainder had subjective improvement without audiometric evaluation.Conclusion:Otolaryngologists should be aware of the possibility of an inflammatory cast of the tympanic membrane following acute otitis media with perforation or otitis externa, and should carefully compare the unaffected and affected ears in such cases. Treatment – removal of the rigid cast – is both simple and effective.

scholarly journals 1473. Guideline Adherence in Pediatric Ambulatory Visits for Acute Otitis Media

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S738-S738
Author(s):  
Joshua C Herigon ◽  
Sarah Mousseau ◽  
Amir Kimia ◽  
Jonathan Hatoun ◽  
Louis Vernacchio
Keyword(s):  
Otitis Media ◽  
Watchful Waiting ◽  
Treatment Guidelines ◽  
Medical Condition ◽  
Acute Otitis Media ◽  
Antibiotic Use ◽  
The United States ◽  
Chronic Medical Condition ◽  
Cross Sectional ◽  
Strict Adherence

Abstract Background Acute otitis media (AOM) is the most common pediatric outpatient condition treated with antibiotics in the United States. Over 30% of children receive inappropriate antibiotics for AOM, contributing to increasing antimicrobial resistance and unnecessary adverse events. Strict adherence to diagnostic and treatment guidelines has been proposed by the American Academy of Pediatrics (AAP) Committee on Infectious Diseases as one strategy to combat inappropriate antibiotic use. Our objective was to describe adherence to the 2013 AAP guidelines on AOM. Methods We performed a cross-sectional study on a random sample of visit notes for patients 3 to 59 months old diagnosed with otitis media based on ICD-10-CM codes (H65, H66, H67) and treated with antibiotics between 9/1/2017 and 8/31/2018 in an association of pediatric practices across Massachusetts. Children with tympanostomy tubes or a chronic medical condition increasing their risk for AOM were excluded. Based on the 2013 AAP diagnostic criteria, tympanic membrane exam descriptions were reviewed and classified as describing AOM or not. Antibiotic choices were classified as appropriate or inappropriate. Notes were then labeled as “fully adherent” (exam consistent with AOM and appropriate antibiotic choice), “partially adherent” (exam inconsistent with AOM or inappropriate antibiotic choice), and “non-adherent” (exam inconsistent with AOM and inappropriate antibiotic choice). Results Three hundred and ninety-four visit notes from 39 different practices were analyzed. One hundred and sixty-six notes (42%) were “fully adherent” to the AAP guidelines, 183 (46%) were “partially adherent” and 45 (11%) were “non-adherent” (Figure 1). In the “partially adherent” and “non-adherent” groups combined, exams were inappropriate in 179 notes (45.4%) and antibiotic choice was inappropriate in 94 notes (23.9%). Cefdinir was the most frequent inappropriate antibiotic (44/94, 46.8%) (Table 1). “Watchful waiting” occurred in only 7% (16/229) of eligible cases. Figure 1. Breakdown of encounters by adherence type Table 1. Cross-table of indicated and prescribed antibiotics Conclusion Our analysis of independent pediatric practices showed moderate adherence to the AAP guidelines for AOM. Substantial room exists for improvement in diagnosing and treating AOM in young children, especially regarding the potential for watchful waiting. Disclosures All Authors: No reported disclosures

scholarly journals Otogenic Intracranial Complications in Bir Hospital; an Eight Years Retrospective Review

2018 ◽  
Vol 6 (1) ◽  
pp. 25-28
Author(s):  
Lal Kishor Yadav ◽  
Prakash Bahadur Thapa ◽  
Jayendra Pradhananga
Keyword(s):  
Otitis Media ◽  
Chart Review ◽  
Early Recognition ◽  
Sinus Thrombosis ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Retrospective Chart Review ◽  
Neck Surgery ◽  
Lateral Sinus ◽  
Intracranial Complications

Objectives: To review our experiences on intracranial complications secondary to otitis media and to compare the results with other studies.Material and Methods: A retrospective chart review of  all patients with intracranial complications secondary to otitis media over eight years period in Bir hospital was done. Clinical presentation, radiological findings, microbiology, surgical management and antibiotics used were studied.Results: Forty eight cases were included in this study of which 23 had meningitis, 15 had brain abscess, 7 had lateral sinus thrombosis and 3 had petrositis. 37 of these were secondary to chronic otitis media and 11 were secondary to acute otitis media. Otorrhoea, headache, earache, fever, vertigo and vomiting were the main symptoms. Staphylococcus aureus was the most common bacteria isolated followed by Pneumococcus, Haemophilus influenzae and Klebsiella.Conclusion: Early recognition, multi drug treatment with broad spectrum antibiotic and multi disciplinary approach are the mainstay of management of otogenic intracranial complications.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

scholarly journals Antibiotics versus placebo or watchful waiting for acute otitis media: a meta-analysis of randomized controlled trials

2009 ◽  
Vol 64 (1) ◽  
pp. 16-24 ◽  
Author(s):  
Evridiki K. Vouloumanou ◽  
Drosos E. Karageorgopoulos ◽  
Maria S. Kazantzi ◽  
Anastasios M. Kapaskelis ◽  
Matthew E. Falagas
Keyword(s):  
Randomized Controlled Trials ◽  
Otitis Media ◽  
Watchful Waiting ◽  
Meta Analysis ◽  
Acute Otitis Media ◽  
Controlled Trials ◽  
Randomized Controlled

Cofactors of Pediatric Tinnitus: A Look at the Whole Picture

2018 ◽  
Vol 58 (3) ◽  
pp. 320-327
Author(s):  
Jessica Levi ◽  
Krystyne Basa ◽  
Kevin Wong ◽  
Thierry Morlet ◽  
Robert O’Reilly
Keyword(s):  
General Population ◽  
Otitis Media ◽  
Chart Review ◽  
Noise Exposure ◽  
Historical Data ◽  
Age Distribution ◽  
Retrospective Chart Review ◽  
Psychiatric Diagnoses ◽  
Laboratory Results ◽  
Tube Dysfunction

Retrospective chart review of 248 children (1-19 years old) with tinnitus who presented to a tertiary pediatric hospital between 2006 and 2011, looking at which cofactors are predictors of pediatric tinnitus. In our review, we extracted demographics, symptoms, historical data, imaging, and laboratory results; we compared with the general population. Eighty-seven percent had normal hearing. Age distribution, noise exposure, and frequency of psychiatric diagnoses in our cohort were consistent with previous reports. We found a lower incidence of otitis media and the same prevalence of dizziness, asthma, and hearing loss as the general population, a lower prevalence of Eustachian tube dysfunction, otitis media, headaches, and higher incidence of rhinosinusitis. Lack of patient reporting and objective testing complicate the ability to detect pediatric tinnitus. We revealed a gap in the literature regarding rhinosinusitis as a cofactor, imaging during diagnosis, and if psychiatric diagnoses are associated with tinnitus in younger children.

scholarly journals Particular matter influences the incidence of acute otitis media in children

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mina Park ◽  
Jiyeon Han ◽  
Jiwon Park ◽  
Myoung-jin Jang ◽  
Moo Kyun Park
Keyword(s):  
Air Pollution ◽  
Otitis Media ◽  
Demographic Data ◽  
Age Groups ◽  
Acute Otitis Media ◽  
Antibiotic Use ◽  
Claim Data ◽  
Environmental Research ◽  
Main Component ◽  
The Relationship

AbstractParticulate matter (PM) is the main component of air pollution. Children are vulnerable to PM and acute otitis media (AOM), which is one of the most common diseases in children. However, studies on the relationship between AOM in children and PM are rare and their results are inconsistent. The aim of this study is to investigate the effect of PM on AOM in children on the basis of the Korea National Health Insurance service (NHIS) claims data. NHIS claim data from 2008 to 2015 was used to identify outpatient visits, antibiotic use to treat AOM, and demographic data. This data was combined with the data on PM2.5 (≤ 2.5 μm) and PM10 (≤ 10 μm according to its aerodynamic diameter) level extracted from air pollution data from Korean National Institute of Environmental Research for 16 administrative regions. The children with AOM were divided into three age groups (< 2, 2–4, 5–10 years). Generalized linear Poisson regression model was used to estimate the association between AOM and PM using daily counts of AOM and daily mean PM concentrations. It was adjusted to temperature, wind, humidity, season, year, age, and region. With an increase in PM2.5 of 10 μg/m3, the relative risk of OM increased by 4.5% in children under 2 years of age. The effect of PM2.5 was strongest influence on the day of exposure. The exposure to PM10 was related to the incidence of AOM on the day of exposure and the following seven days in all three age groups. The PM concentrations did not strongly affect either AOM duration or the use of antibiotics to cure AOM. The RR in the each lag day after exposure to PM10 was diverse according to the age groups. Regardless of PM size and children’s age, the PM levels are positively related to the incidence of AOM. Both PM2.5 and PM10 have the most adverse effects on children under 2 years of age and on the day of exposure.

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