Pediatric Acute Otitis Media in the Era of Pneumococcal Vaccination

2017 ◽  
Vol 156 (5) ◽  
pp. 938-945 ◽  
Author(s):  
Kareem O. Tawfik ◽  
Stacey L. Ishman ◽  
Mekibib Altaye ◽  
Jareen Meinzen-Derr ◽  
Daniel I. Choo
Keyword(s):  
Hospital Admission ◽  
Otitis Media ◽  
Pneumococcal Meningitis ◽  
Acute Otitis Media ◽  
Pneumococcal Vaccination ◽  
Acute Mastoiditis ◽  
Suppurative Otitis Media ◽  
Admission Rates ◽  
Annual Prevalence ◽  
Admission Prevalence

Objectives (1) Describe longitudinal trends in annual prevalence of hospital admission for pediatric acute otitis media (AOM) and complications of AOM (CAOM) since introduction of pneumococcal vaccination in 2000 and (2) describe the longitudinal trend of prevalence of hospital admission for pneumococcal meningitis in children with AOM-related diagnoses in the postvaccination era. Study Design Retrospective analysis of Kids’ Inpatient Database from 2000 to 2012. Setting Community, nonrehabilitation hospitals. Subjects and Methods To determine annual prevalence of admission for AOM/CAOM, nationally weighted frequencies of children aged <21 years with acute suppurative otitis media, acute mastoiditis, suppurative labyrinthitis, and/or acute petrositis were collected. The frequency of coexisting pneumococcal meningitis diagnoses among these patients was also collected. Trend analysis of prevalences of admission for AOM/CAOM and for pneumococcal meningitis occurring in the setting of AOM/CAOM from 2000 to 2012 was performed. Results Between 2000 and 2012, annual prevalence of admission for AOM/CAOM decreased from 3.956 to 2.618 per 100,000 persons ( P < .0001) (relative risk reduction 34%). Declines in admission prevalence were most pronounced in children <1 year of age (from 22.647 to 8.715 per 100,000 persons between 2000 and 2012, P < .0001) and 1 to 2 years of age (from 13.652 to 5.554 per 100,000 persons between 2000 and 2012, P < .0001). For all ages, the admission prevalence for pneumococcal meningitis and concomitant AOM/CAOM decreased (from 1.760 to 0.717 per 1,000,000 persons, P < .0001) over the study period. Conclusions The prevalence of hospital admission for pediatric AOM/CAOM has declined since the advent of pneumococcal vaccination. Admission rates for pneumococcal meningitis with AOM/CAOM have similarly declined.

Subperiosteal Mastoid Abscesses in Chronic Suppurative Otitis Media

1988 ◽  
Vol 97 (4) ◽  
pp. 373-375 ◽  
Author(s):  
A. Olu Ibekwe ◽  
Benjamin C. C. Okoye
Keyword(s):  
Otitis Media ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Mastoid Cavity ◽  
Radical Mastoidectomy ◽  
Acute Mastoiditis ◽  
Suppurative Otitis Media ◽  
Modified Radical Mastoidectomy ◽  
Radiographic Investigation ◽  
The Ideal

In Europe and America, acute mastoiditis usually appears as a complication of acute otitis media, and some patients develop subperiosteal mastoid abscesses. In Nigeria, however, most subperiosteal mastoid abscesses develop from chronic otitis media with cholesteatoma. Of the 16 patients with subperiosteal mastoid abscesses discussed, 11 (69 %) had cholesteatoma and only five (31 %) had granulation tissue in the mastoid cavity. The ideal treatment for these cases is modified radical mastoidectomy. Radiographic investigation of the mastoid can be useful in the diagnosis of cholesteatoma in the presence of a subperiosteal mastoid abscess.

scholarly journals Decline in Pneumonia and Acute Otitis Media after the Introduction of Childhood Pneumococcal Vaccination in Liguria, Italy

2008 ◽  
Vol 36 (6) ◽  
pp. 1255-1260 ◽  
Author(s):  
F Ansaldi ◽  
L Sticchi ◽  
P Durando ◽  
R Carloni ◽  
P Oreste ◽  
...  
Keyword(s):  
Otitis Media ◽  
Conjugate Vaccine ◽  
Pneumococcal Pneumonia ◽  
Hospital Admissions ◽  
Acute Otitis Media ◽  
Pneumococcal Vaccination ◽  
Birth Cohorts ◽  
Admission Rates ◽  
Immunization Programme ◽  
Before And After

The effect of the pneumococcal conjugate vaccine immunization programme on pneumococcal-associated or potentially pneumococcal-associated hospital admissions in the Italian region of Liguria was assessed. Hospital admission rates were compared in subjects belonging to birth cohorts before and after the introduction of widespread immunization for 0 − 2-year old children with a seven-valent conjugate vaccine (PCV7). Significant reductions in hospitalization rates for all-cause and pneumococcal pneumonia and for acute otitis media were observed in subjects born after widespread uptake of the vaccine. The preventive fraction (a measure of vaccine effectiveness) ranged from 15.2% for all-cause pneumonia to 70.5% for pneumococcal pneumonia. This study contributes to the growing body of information that supports the beneficial effect of PCV7 vaccination.

scholarly journals 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

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.

Comparison of Cefpodoxime Proxetil and Cefixime in the Treatment of Acute Otitis Media in Infants and Children

PEDIATRICS ◽  
1994 ◽  
Vol 94 (6) ◽  
pp. 847-852
Author(s):  
Basim I. Asmar ◽  
Adnan S. Dajani ◽  
Mark A. Del Beccaro ◽  
Paul M. Mendelman ◽  
Keyword(s):  
Otitis Media ◽  
Acute Otitis Media ◽  
Drug Efficacy ◽  
Oral Suspension ◽  
Suppurative Otitis Media ◽  
Once Daily ◽  
Cefpodoxime Proxetil ◽  
Long Term Follow Up ◽  
Cure Rates

Objective. To compare the use of once-a-day cefpodoxime proxetil to once-a-day cefixime in the treatment of acute suppurative otitis media. Design. Randomized, multicenter, investigator-blinded. Setting. Outpatient. Patients. A total of 368 patients (age 2 months to 17 years) were randomized to receive either cefpodoxime or cefixime in a 2:1 ratio (245 cefpodoxime, 123 cefixime); 236 patients (155 cefpodoxime, 81 cefixime) were evaluable for drug efficacy. Interventions. Patients received either cefpodoxime proxetil oral suspension (10 mg/kg/day, once daily for 10 days) or cefixime oral suspension (8 mg/kg/day, once daily for 10 days). Main outcome measures. Clinical evaluations were performed before treatment (study day 1), at an interim visit (study day 3 through 6), at the end of therapy (study day 12 through 15), and at final follow-up (study day 25 through 38). Microbiologic evaluations were performed at enrollment and whenever appropriate thereafter. Results. End-of-therapy clinical cure rates in evaluable patients were 56% for the cefpodoxime group and 54% for the cefixime group. Clinical improvement rates were 27% for both groups. Clinical response rates were not significantly different between treatment groups (P = .541; 95% confidence interval = -8.1%, 15.2%). At long-term follow-up, 17% of patients in the cefpodoxime group and 20% in the cefixime group had a recurrence of infection. Drug-related adverse events (eg, diarrhea, diaper rash, vomiting, rash) occurred in 23.3% of cefpodoxime-treated patients and 17.9% of cefixime-treated patients (P = .282). Conclusions. These findings suggest that cefpo-doxime proxetil administered once daily is as effective and safe as cefixime given once daily in the treatment of acute suppurative otitis media in pediatric patients.

scholarly journals Relationship between Acute Suppurative Otitis Media and Chronic Secretory Otitis Media: Role of Antibiotics

1984 ◽  
Vol 77 (9) ◽  
pp. 754-757 ◽  
Author(s):  
Robert Mills ◽  
Ann Uttley ◽  
Michelle McIntyre
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Acute Otitis Media ◽  
Secretory Otitis Media ◽  
Sensitivity Testing ◽  
Suppurative Otitis Media ◽  
In Vitro Sensitivity ◽  
Resistance To Penicillin

A total of 204 chronic middle ear effusions from 122 children have been studied. Bacteria were isolated from 30 effusions. The commonest species found were Strep. pneumoniae and H. influenzae. These are also the commonest organisms causing acute otitis media (AOM). A similar pattern of serotypes was also demonstrated. In vitro sensitivity testing showed that most of the organisms isolated were sensitive to most commonly-used antibiotics. The main exception was resistance to penicillin amongst strains of H. influenzae and Staph. aureus. It is suggested that some cases of chronic secretory otitis media (SOM) may arise as a result of incomplete resolution of AOM and that the use of penicillin to treat AOM may be one factor in this process.

scholarly journals The management of acute otitis media

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.

Acute Suppurative Otitis Media

PEDIATRICS ◽  
1975 ◽  
Vol 56 (2) ◽  
pp. 285-294
Author(s):  
D. Stewart Rowe
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Pathogenic Bacteria ◽  
Acute Otitis Media ◽  
Polymorphonuclear Cells ◽  
Secretory Otitis Media ◽  
Middle Ear Mucosa ◽  
Suppurative Otitis Media ◽  
Middle Ear Fluid ◽  
Purulent Fluid

Most pediatricians recognize and treat acute otitis media several times each day. Yet there is wide disagreement about certain aspects of its diagnosis and treatment, despite a large and growing literature on the subject. This review attempts to summarize what is known about acute otitis media in children. DEFINITION Acute suppurative otitis media is distinguished from secretory (serous) otitis media by the presence of purulent fluid in the middle ear. Pathogenic bacteria may be cultured from the majority of needle aspirates of this purulent fluid. In secretory otitis media, relatively few polymorphonuclear cells are present in the middle ear fluid, which is either thin and straw-colored (serous) or thick and translucent grey (mucoid). The fluid has the chemical characteristics either of a transudate of plasma or of a mucoid secretion, presumably produced by goblet cells and mucous glands which are greatly increased in the middle ear mucosa of patients with secretory otitis media. Cultures of this middle ear fluid are usually negative for pathogenic bacteria and viruses. Suppurative otitis media can be diagnosed positively only by aspiration of purulent fluid from the middle ear, but this procedure is rarely necessary for initial diagnosis and management. Clinical findings helpful in distinguishing suppurative from secretory otitis media are discussed below. INCIDENCE In a study of 847 British children during the first five years of life, 19% had at least one episode of otitis media; one third of these had more than one episode. This was considered to be a minimal estimate in these children, since otorrhea was the chief criterion for diagnosis.

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