Otitis Media

Pediatric Population ◽

Acute Otitis Media ◽

Line Treatment ◽

First Line ◽

Tympanostomy Tubes ◽

A reader questioned Dr. Howie's article on otitis media (PIR 1993;14: 320-323) on three counts: 1. His recommendation not to use amoxicillin as first-line treatment for acute otitis media; 2. His discussion of otitis media with perforation; and 3. His recommendation to place tympanostomy tubes in "any youngster who has otitis media with effusion that persists for 6 to 12 weeks." Dr. Howie responds: "I share with you the frustration of the ever-present challenge of otitis media with effusion (OME), whether acute, recurrent acute, or persistent, in the pediatric population that we serve. The `relapsogenic nature' of aminopenicillins (eg, ampicillin and amoxicillin) seems to be part and parcel of the problem.

Efficacy of balloon Eustachian tuboplasty as a first line treatment for otitis media with effusion in children

The Journal of Laryngology & Otology ◽

10.1017/s0022215120002340 ◽

2020 ◽

pp. 1-4

Author(s):

B Demir ◽

C Batman

Keyword(s):

Otitis Media ◽

Line Treatment ◽

Ventilation Tube ◽

First Line ◽

Tube Insertion ◽

The Mean ◽

Group 2 ◽

Balloon Eustachian Tuboplasty ◽

Abstract Objective This study aimed to compare the outcomes of ventilation tube insertion and balloon Eustachian tuboplasty as a first line treatment for otitis media with effusion in children. Method This was a retrospective evaluation of 62 children, 30 cases that underwent balloon Eustachian tuboplasty (group 1) and 32 cases that underwent ventilation tube insertion (group 2), from July 2016 to April 2018. Results The pre-operative air–bone gap of patients who underwent balloon Eustachian tuboplasty was 15–35 dB (mean: 27.6 ± 8.2 dB). The mean pre-operative air–bone gap decreased to 9.6 dB after a mean of 14.4 months (p < 0.05). The air–bone gap decreased from 25.6 dB to 17.6 dB in the ventilation tube group. There was a significant improvement in the air–bone gap values in both groups; however, this decrease was significantly higher in the balloon Eustachian tuboplasty group (p = 0.043). Conclusion Balloon Eustachian tuboplasty may be an effective and safe method for use as a first-line treatment of otitis media with effusion in children.

Developing Community-Specific Recommendations for First-Line Treatment of Acute Otitis Media: Is High-Dose Amoxicillin Necessary?

PEDIATRICS ◽

10.1542/peds.114.2.342 ◽

2004 ◽

Vol 114 (2) ◽

pp. 342-347 ◽

Cited By ~ 7

Author(s):

J. Garbutt ◽

J. W. St. Geme ◽

A. May ◽

G. A. Storch ◽

P. G. Shackelford

Keyword(s):

Otitis Media ◽

Acute Otitis Media ◽

High Dose ◽

Line Treatment ◽

First Line ◽

Delayed Onset Post-Tympanotomy Otorrhea

Otolaryngology ◽

10.1177/019459988809800203 ◽

1988 ◽

Vol 98 (2) ◽

pp. 111-115 ◽

Cited By ~ 26

Author(s):

George A. Gates ◽

Christine Avery ◽

Thomas J. Prihoda ◽

G. Richard Holt

Keyword(s):

Health Care ◽

Surgical Treatment ◽

Otitis Media ◽

Acute Otitis Media ◽

Chronic Otitis Media ◽

Secretory Otitis Media ◽

Delayed Onset ◽

Tympanostomy Tubes ◽

Care Costs

Otorrhea is the most frequent complication of the use of tympanostomy tubes. When it occurs after the immediate postoperative period, otorrhea is probably the result of external contamination of the middle ear or acute otitis media. We analyzed data from 627 operations upon 1248 ears of 491 children with chronic secretory otitis media and found that delayed onset (longer than 7 weeks) postoperative otorrhea occurred after 26.4 percent of the 382 operations in which tympanostomy tubes were used. The average number of episodes of otorrhea per case was 1.46 and ranged from 1 to 9. The rate of otorrhea occurrence in patients with tubes in place was significantly higher in the summer months. Otorrhea also occurred after 9.0 percent of 245 myringotomy procedures. The average number of episodes was 1.32 and ranged from 1 to 3. Treatment of postoperative otorrhea increases the health care costs of surgical treatment of chronic otitis media with effusion; this problem should be included in the calculation of cost-effectiveness.

Tympanostomy Tube Controversies and Issues: State-of-the-Art Review

Ear Nose & Throat Journal ◽

10.1177/0145561320919656 ◽

2020 ◽

Vol 99 (1_suppl) ◽

pp. 15S-21S

Author(s):

Richard M. Rosenfeld

Keyword(s):

Otitis Media ◽

Expert Opinion ◽

Acute Otitis Media ◽

Tube Insertion ◽

Published Evidence ◽

Recommendations For Action ◽

Tympanostomy Tubes ◽

High Level

Objective: To review current pragmatic issues and controversies related to tympanostomy tubes in children, in the context of current best research evidence plus expert opinion to provide nuance, address uncertainties, and fill evidence gaps. Methods: Each issue or controversy is followed by the relevant current best evidence, expert insight and opinion, and recommendations for action. The role of expert opinion and experience in forming conclusions is inversely related to the quality, consistency, and adequacy of published evidence. Conclusions are combined with opportunities for shared decision-making with caregivers to recommend pragmatic actions for clinicians in everyday settings. Results: The issues and controversies discussed include (1) appropriate tube indications, (2) rationale for not recommending tubes for recurrent acute otitis media without persistent middle ear effusion, (3) role of tubes in at-risk children with otitis media with effusion, (4) role of new, automated tube insertion devices, (5) appropriateness and feasibility of in-office tube insertion in awake children, (6) managing methicillin-resistant Staphylococcus aureus acute tube otorrhea, and (7) managing recurrent or persistent tube otorrhea. Conclusions: Despite a substantial, and constantly growing, volume of high-level evidence on managing children with tympanostomy tubes, there will always be gaps, uncertainties, and controversies that benefit from clinician experience and expert opinion. In that regard, the issues discussed in this review article will hopefully aid clinicians in everyday, pragmatic management decisions.

Autoinflation: Historical Highlights and Clinical Implications

Ear Nose & Throat Journal ◽

10.1177/014556139807700910 ◽

1998 ◽

Vol 77 (9) ◽

pp. 737-742 ◽

Cited By ~ 6

Author(s):

Sven-Eric Stangerup

Keyword(s):

Surgical Treatment ◽

Otitis Media ◽

Transient Condition ◽

Control Group ◽

Clinical Implications ◽

Line Treatment ◽

First Line ◽

Secretory Otitis Media ◽

Ventilation Tubes ◽

In 1563, Eustachius first described the tube that came to be named for him. In 1704, Valsalva described the maneuver that bears his name, and in 1836 Deleau became one of the first to advocate infusion of pure air through the eustachian tube using a catheter. Politzer devised his own method for actively inflating the middle ear without using a catheter in 1863. Most modern studies examining the use of autoinflation in the treatment of secretory otitis media have shown a beneficial effect, with effusion being cleared in 52 to 62% of ears up to nine months after the treatment. In two studies, no effect of autoinflation could be demonstrated, and in one publication the autoinflation group had deteriorated compared to the control group. In light of the fact that secretory otitis media is a benign and transient condition, that treatment with antibiotics or insertion of ventilation tubes is not without problems, and that the chance of improving the condition by autoinflation is approximately 50%, it is concluded that autoinflation should be considered first-line treatment, before antibiotic or surgical treatment is planned.

Long-Term Otitis Media Outcomes in Infants With Early Tympanostomy Tubes

Otolaryngology ◽

10.1177/0194599820931414 ◽

2020 ◽

Vol 163 (6) ◽

pp. 1258-1263

Author(s):

Kimberly Luu ◽

James Park ◽

Amber D. Shaffer ◽

David H. Chi

Keyword(s):

Hearing Loss ◽

Logistic Regression ◽

Otitis Media ◽

Tertiary Care ◽

Acute Otitis Media ◽

Case Series ◽

Craniofacial Anomalies ◽

Tympanostomy Tubes

Objective To review the otologic outcomes of infants who failed the newborn hearing screen (NBHS) and received early tympanostomy tubes for otitis media with effusion (OME). Study Design Retrospective case series. Setting Tertiary care pediatric hospital. Subjects and Methods Consecutive patients (2007-2018) who failed an NBHS and required tympanostomy tubes before 6 months of age were included. Variables including hearing loss and otitis media risk factors, episodes of acute otitis media (AOM), number of subsequent tympanostomy tubes, and posttympanostomy tube audiogram results were recorded. Results The cohort included 171 patients. Median age at referral to otolaryngology was 2.7 months. Sensorineural hearing loss (SNHL) was subsequently identified in 22 (12.9%) of infants after resolution of the effusion. The peak incidence of AOM was during the second year of life (1-1.9 years), with a median of 1 episode. Ninety-five patients (55.6%) had replacement of tubes, 41 of 171 (24.0%) had 2 or more additional sets of tubes, and long-term tubes were eventually placed in 8 of 95 (8.4%) patients. Craniofacial anomalies were identified in 43.3% of patients. Tube replacement (hazard ratio, 3.00; 95% CI, 1.95-4.63; P < .01, log-rank) and AOM (β, 1.04; 95% CI, 0.43-1.65; P = .04, ordered logistic regression) were more common, and SNHL less common (odds ratio, 0.17; 95% CI, 0.031-0.61; P < .01, logistic regression), in children with craniofacial anomalies. Conclusion OME is a common cause of failed NBHS. A notable proportion was subsequently found to have SNHL, reiterating the need for postoperative hearing assessments. Infants meeting indication for early tympanostomy tubes for resolution of OME have a high incidence of recurrent AOM and require subsequent tubes.

Quality Assessment of the Clinical Practice Guideline for Tympanostomy Tubes in Children

Otolaryngology ◽

10.1177/0194599818789877 ◽

2018 ◽

Vol 159 (5) ◽

pp. 914-919 ◽

Cited By ~ 1

Author(s):

Joshua J. Sturm ◽

Phillip Huyett ◽

Amber Shaffer ◽

Dennis Kitsko ◽

David H. Chi

Keyword(s):

Clinical Practice ◽

Otitis Media ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Tertiary Care ◽

Acute Otitis Media ◽

Case Series ◽

Annual Number ◽

Tympanostomy Tubes

Objectives To determine the association between the introduction of statements 6 and 7 in the 2013 clinical practice guideline (CPG) for tympanostomy tubes in children and the identification of preoperative middle ear fluid (acute otitis media / otitis media with effusion [AOM/OME]) in children undergoing bilateral myringotomy and tube (BMT) placement. Study Design Case series with chart review. Setting Tertiary care children’s medical center. Subjects and Methods Patients who underwent BMT for recurrent AOM were retrospectively reviewed. We examined 240 patients before (BG; 2012) and 240 patients after (AG; 2014) the introduction of the CPG. Results The baseline characteristics of the 2 groups were comparable. The total annual number of BMT placements performed at our institution decreased from 3957 (BG) to 3083 (AG). There was no significant increase in the rate of preoperative AOM/OME identification following CPG introduction (BG 78.3% vs AG 83.3%, P = .164). The rate of identification of AOM/OME in the operating room (OR) increased from 54.2% (BG) to 71.3% (AG, P < .001). The rate of identification of AOM/OME both in the clinic and in the OR increased from 55.1% (BG) to 71.3% (AG, P < .001). Cases with concordant clinic and OR AOM/OME occurred among younger children ( P = .045), those with fewer episodes of AOM ( P = .043), and those with shorter time between the clinic and OR dates ( P = .008). Conclusions Following the introduction of the CPG, there was no change in the rate of identification of AOM/OME prior to recommending BMT placement in children with recurrent AOM. The lack of improved compliance with statements 6 and 7 may be related to multiple clinician- and patient-derived factors.

Management of Acute Demyelinating Attacks in the Pediatric Population: A Swiss Consensus Statement

Clinical and Translational Neuroscience ◽

10.3390/ctn5020017 ◽

2021 ◽

Vol 5 (2) ◽

pp. 17

Author(s):

Seline Hofer ◽

Florian Bauder ◽

Andrea Capone Mori ◽

Andrew Chan ◽

Patricia Dill ◽

...

Keyword(s):

Pediatric Population ◽

Oral Steroid ◽

Future Research ◽

High Dose ◽

Line Treatment ◽

Second Line ◽

First Line ◽

Delphi Approach ◽

Line Therapy ◽

Background and methods: Acquired demyelinating syndromes (ADS) encompass distinct entities and occur in approximately 1/100,000 children. While the use of high dose intravenous corticosteroids is well-established, agreement on steroid taper and type of second line therapy is lacking. A comprehensive, unified and standardized treatment approach is crucial in the management of patients with rare diseases. Therefore, this study performed from July 2018 to June 2020 aimed at developing a national consensus on the management of ADS in the pediatric population using the Delphi approach. Consensus was defined as agreement in >75%. Designated Neuropediatricians with an expertise in the management of pediatric neuroinflammatory diseases in all university and cantonal hospitals of Switzerland were included. The response rate was 100%. Results: High-dose i.v. methylprednisolone (20–30 mg/kg/die for 5 days) is the first line treatment irrespective of the distinct entity of the ADS. An oral steroid taper is recommended in acute demyelinating encephalomyelitis (ADEM) and in neuromyelitis optica spectrum disorder (NMO-SD). However, in the latter more in the sense of bridging. The choice of second line treatment depends on the entity of ADS: in optic neuritis (ON) and ADS due to relapsing remitting multiple sclerosis, first line treatment should be repeated, whereas plasma exchange is recommended in NMO-SD, ADEM and transverse myelitis. Conclusions: A national guideline allowing for a more unified approach in the management of pediatric ADS will enhance future research in this field, making data more comparable. The definition of inadequate treatment response to first line therapy remains a challenge and requires future research.