Progress in Understanding the Pathophysiology of Otitis Media

1989 ◽  
Vol 11 (5) ◽  
pp. 133-137
Author(s):  
G. Scott Giebink
Keyword(s):  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Therapeutic Interventions ◽  
Antimicrobial Drugs ◽  
Middle Ear Disease ◽  
Inflammatory Drugs ◽  
Recurrent Otitis Media ◽  
Infants And Young Children ◽  
Bacteriologic Response

Otitis media is one of the most common diseases of infants and young children, and its complications and sequelae may persist into adult years. The disease affects at least 7 of every 10 children, with one third of those affected having repeated episodes, and chronic middle ear disease, commonly called otitis media with effusion, developing in 5% to 10% of them. The management of childhood otitis media has changed considerably during the past five decades. Before the introduction of antimicrobial drugs, myringotomy was, and in some countries remains today, the treatment of choice. The introduction of sulfonamides and penicillin four decades ago and their widespread use in treating acute otitis media led to a great reduction in the incidence of suppurative complications. Of the new orally administered antibiotics, many have been found to be efficacious in treating acute otitis media. Sophisticated methods of measuring treatment outcome suggest, however, that there are differences in rates of bacteriologic response to these drugs. Moreover, adjunctive therapies such as decongestants, antihistamines, steroidal and nonsteroidal anti-inflammatory drugs, and topical drugs, in addition to myringotomy and adenoidectomy, have been advocated by some in treating acute and recurrent otitis media. These newer therapeutic interventions have led to controversies regarding management of the disease.

Antimicrobial Prophylaxis for Recurrent Acute Otitis Media

1992 ◽  
Vol 101 (1_suppl) ◽  
pp. 33-36 ◽  
Author(s):  
Jack L. Paradise
Keyword(s):  
Native American ◽  
Otitis Media ◽  
Pathogenic Bacteria ◽  
Antimicrobial Prophylaxis ◽  
Acute Otitis Media ◽  
Optimal Dosage ◽  
Antimicrobial Drugs ◽  
American Children ◽  
Long Acting ◽  
Recurrent Otitis Media

Antimicrobial prophylaxis for recurrent otitis media was first reported in 1960 in an uncontrolled study using a long-acting sulfonamide in Native American children younger than 11 years of age. In subsequent controlled studies using various antimicrobial drugs (primarily aminopenicillins or sulfonamides) subjects receiving prophylaxis continued to have episodes of acute otitis media, but at rates substantially lower than those of controls. More recently, prophylaxis has appeared effective in reducing the number of acute recurrences, but not the cumulative proportion of time with middle ear effusion that was present independent of such recurrences. Although questions remain about choice of drug, optimal dosage schedules, risk of untoward drug reactions, duration of use, and the risk of encouraging the emergence of resistant strains of pathogenic bacteria, antimicrobial prophylaxis currently appears to be the most logical first approach in the management of the child with recurrent otitis media.

scholarly journals Role of Biofilms in Children with Chronic Adenoiditis and Middle Ear Disease

2019 ◽  
Vol 8 (5) ◽  
pp. 671 ◽  
Author(s):  
Sara Torretta ◽  
Lorenzo Drago ◽  
Paola Marchisio ◽  
Tullio Ibba ◽  
Lorenzo Pignataro
Keyword(s):  
Antibiotic Therapy ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Subsequent Development ◽  
Current Evidence ◽  
Bacterial Biofilms ◽  
Middle Ear Disease ◽  
Chronic Adenoiditis

Chronic adenoiditis occurs frequently in children, and it is complicated by the subsequent development of recurrent or chronic middle ear diseases, such as recurrent acute otitis media, persistent otitis media with effusion and chronic otitis media, which may predispose a child to long-term functional sequalae and auditory impairment. Children with chronic adenoidal disease who fail to respond to traditional antibiotic therapy are usually candidates for surgery under general anaesthesia. It has been suggested that the ineffectiveness of antibiotic therapy in children with chronic adenoiditis is partially related to nasopharyngeal bacterial biofilms, which play a role in the development of chronic nasopharyngeal inflammation due to chronic adenoiditis, which is possibly associated with chronic or recurrent middle ear disease. This paper reviews the current evidence concerning the involvement of bacterial biofilms in the development of chronic adenoiditis and related middle ear infections in children.

scholarly journals Adenoidectomy for middle ear disease in cleft palate children: a systematic review

2021 ◽  
Author(s):  
Cecilia Rosso ◽  
Antonio Mario Bulfamante ◽  
Carlotta Pipolo ◽  
Emanuela Fuccillo ◽  
Alberto Maccari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cleft Palate ◽  
Otitis Media ◽  
Middle Ear ◽  
Acute Otitis Media ◽  
Case Series ◽  
Velopharyngeal Insufficiency ◽  
Middle Ear Disease ◽  
Conductive Hearing

Abstract Purpose Cleft palate children have a higher incidence of otitis media with effusion, more frequent recurrent acute otitis media episodes, and worse conductive hearing losses than non-cleft children. Nevertheless, data on adenoidectomy for middle ear disease in this patient group are scarce, since many feared worsening of velopharyngeal insufficiency after the procedure. This review aims at collecting the available evidence on this subject, to frame possible further areas of research and interventions. Methods A PRISMA-compliant systematic review was performed. Multiple databases were searched with criteria designed to include all studies focusing on the role of adenoidectomy in treating middle ear disease in cleft palate children. After duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for clinical indications and outcomes. Results Among 321 unique citations, 3 studies published between 1964 and 1972 (2 case series and a retrospective cohort study) were deemed eligible, with 136 treated patients. The outcomes were positive in all three articles in terms of conductive hearing loss improvement, recurrent otitis media episodes reduction, and effusive otitis media resolution. Conclusion Despite promising results, research on adenoidectomy in treating middle ear disease in the cleft population has stopped in the mid-Seventies. No data are, therefore, available on the role of modern conservative adenoidectomy techniques (endoscopic and/or partial) in this context. Prospective studies are required to define the role of adenoidectomy in cleft children, most interestingly in specific subgroups such as patients requiring re-tympanostomy, given their known risk of otologic sequelae.

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

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

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.

Antimicrobial Treatment of Acute Otitis Media

1994 ◽  
Vol 103 (5_suppl) ◽  
pp. 11-14 ◽  
Author(s):  
Daniel M. Canafax ◽  
G. Scott Giebink
Keyword(s):  
Hearing Loss ◽  
Otitis Media ◽  
Antimicrobial Agents ◽  
Acute Otitis Media ◽  
Antimicrobial Treatment ◽  
Speech Delay ◽  
Significant Morbidity ◽  
Antimicrobial Drugs ◽  
Etiologic Role ◽  
History Of

Episodes of acute otitis media frequently occur in childhood and are attended by significant morbidity, such as hearing loss and possible speech delay. Bacteria play an important etiologic role in the pathogenesis of otitis media; therefore, antimicrobial agents are the cornerstone in the treatment of this disease. Many antimicrobial choices are available for treating children with acute otitis media. To choose an antimicrobial for each patient, consideration must be given to the patient's age, history of otitis media episodes, and responses to previously used antimicrobial drugs, and the regional antimicrobial susceptibility of the otitis media pathogens.

Otitis Media

PEDIATRICS ◽  
1984 ◽  
Vol 74 (5) ◽  
pp. 948-949
Author(s):  
Charles M. Ginsburg
Keyword(s):  
Otitis Media ◽  
Viral Infections ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Medical Personnel ◽  
Medical Attention ◽  
Common Symptom ◽  
Upper Respiratory Tract ◽  
Primary Responsibility ◽  
Printed Materials

Earache, a common symptom in children, causes many parents to seek medical attention. Aside from trauma and the discomfort that often accompanies viral infections of the upper respiratory tract, acute otitis media with effusion is the commonest cause of otalgia in infants and children. Proper management requires a team effort between the physician and the child's parents or caretaker. The physician must transmit to the parents a concise but thorough overview of the problem and a plan for management. This should include information on the pathophysiology of ear disease, its incidence, therapy and the potential adverse effects, and any measures that the parents may take to prevent recurrence. The primary responsibility for transmittal of this information lies with the physician. Ancillary medical personnel and communication aids (videotapes, computers, printed materials) should be utilized, if available, to reinforce the physician's "message.'

scholarly journals Auditory temporal abilities in children with history of recurrent otitis media in the first years of life and persistent in preschool and school ages

CoDAS ◽  
2014 ◽  
Vol 26 (6) ◽  
pp. 494-502 ◽  
Author(s):  
Priscila Cruvinel Villa ◽  
Sthella Zanchetta
Keyword(s):  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Temporal Frequency ◽  
Control Group ◽  
First Year ◽  
Normal Range ◽  
Frequency Pattern ◽  
History Of ◽  
First Year Of Life ◽  
Recurrent Otitis Media

PURPOSE: To study the temporal auditory ordering and resolution abilities in children with and without a history of early OME and ROME, as well as to study the responses according to age. METHODS: A total of 59 children were evaluated, and all of them presented pure tone thresholds within the normal range at the time of the conduction of the hearing tests. The children were divided into two groups according to the occurrence of episodes of recurrent otitis media. Then, each group was divided into two subgroups according to age: 7- and 8-year olds, and 9- and 10-year olds. All children were assessed with standard tests of temporal frequency (ordination) and gaps-in-noise (resolution). RESULTS: For the temporal abilities studied, children with a history of otitis media presented significantly lower results compared to the control group. In the frequency pattern test, the correct answers increased with age in both groups. In the identification of silence intervals, the control group showed no change in threshold regarding to age, but this change was present in the group with a history of otitis media. CONCLUSION: Episodes of otitis media with effusion in the first year of life, recurrent and persistent in preschool and school ages, negatively influence the temporal ordering and resolution abilities.

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