Acute Otitis Media and Facial Palsy in Children

ABSTRACT. Two cases of facial palsy in connection with acute otitis media are presented. The patients were 2 months and 2 years old, respectively. In both cases the facial palsy disappeared after treatment with myringotomy and antibiotics. The etiological mechanisms behind and the different approaches to the treatment of facial palsy in children with acute otitis media are discussed.     

Sequelae of recurrent acute otitis media. Ten-year follow-up of a prospectively studied cohort of children

In a cohort of 113 children prospectively followed from birth to the age of 3, two subgroups were discerned: one with recurrent acute otitis media (rAOM), the other subgroup with no AOM at all ("healthy" children). At further follow-up at the age of 10, no child had AOM or secretory otitis media (SOM), but between 3 and 7 y of age the rAOM subgroup was characterized by a significantly higher incidence of AOM as well as protracted secretory otitis media (SOM) episodes than was the "healthy" subgroup. The two subgroups did not differ significantly in hearing-thresholds at pure tone audiometry. After the age of 7, the incidence of AOM was the same in both groups. It is concluded that children with frequent AOM episodes before the age of 3 need long-term follow-up to school age. but seem not to be predisposed to chronic SOM.     

Antibiotic prescribing rates for acute otitis media in a paediatric emergency department

OBJECTIVE: To audit antibiotic prescribing rates for acute otitis media (AOM) at a tertiary paediatric emergency department (ED). METHODS: All children who presented to the ED in 2002 (during defined 4-week periods in spring, summer, autumn and winter) and were given a diagnosis of AOM were eligible for analysis. Data were extracted retrospectively, providing information on demographics and antibiotic therapy. RESULTS: A total of 306 patients with AOM were available for analysis. Forty-three children (14%) were <1 year, 69 (23%) 1-2 years, and 194 (63%) > 2 years of age. Sixty-eight patients (22%) were receiving antibiotics prior to presentation to the ED, and antibiotics were prescribed for 206 (67%). Antibiotic prescribing was independent of patient age. CONCLUSIONS: Despite ready access to clinical guidelines that recommend an expectant approach for children with AOM who are older than 1 or 2 years of age, antibiotic prescribing rates were high in the ED.     

Rare but threatening complication of otitis media: Lateral sinus thrombosis

Although appropriate use of antibiotics has decreased mortality, lateral sinus thrombosis is a rare, important intracranial complication of acute otitis media. Herein is described the case of a 5‐year‐old patient with lateral sinus thrombosis after acute otitis media. We emphasize the need to be alert for lateral sinus thrombosis when treating acute otitis media.     

Should we now hold back from initially prescribing antibiotics for acute otitis media?

Abstract: The research literature provides surprisingly little evidence of benefit for initially treating acute otitis media in children with antibiotics. We show how to calculate the amount of benefit and harm from the evidence, and how this might be applied to change management practice.     

Factors Affecting the Occurrence of Acute Otitis Media during the First Year of Life

ABSTRACT. A regional birth cohort of 5356 infants was enrolled into a follow-up study in order to investigate the determinants of the development of infectious diseases in children. The infants were examined at three months, six months and twelve months of age by the physicians at the well-baby clinics. At these occasions the number of episodes of acute otitis media in the infants, the duration of breast-feeding, the number of siblings, the type of day care, parental smoking, the presence of animal pets at home and the number and type of other illnesses than otitis were registered. Two thirds of the infants had no episodes of acute otitis media. The median age for the first episode of acute otitis media was eight months. About 10% of the infants had experienced recurrent otitis media (three episodes or more) during their first year of life. Significant associations were found between the occurrence of acute otitis media and the number of siblings, the type of day care, the sex of the infant, the duration of breast feeding, maternal socioeconomic status and prematurity.     

ACUTE OTALGIA IN CHILDREN - FINDINGS AND DIAGNOSIS

ABSTRACT. One hundred and seventy-one children up to 15 years of age and with acute otalgia were examined to find out whether otalgia or any other symptoms were so closely related to acute otitis media (AOM) as to make otoscopic examination unnecessary. AOM was diagnosed in 46%, simplex otitis in 15%, serous otitis media (SOM) in 17%, and normal eardrums in 22%. Children with AOM had fever and spontaneous perforation of the eardrums in 78% and 30% of the cases, respectively. Of the children who had not AOM (54%), the otalgia could in most cases be classified as referred pain due to, for instance, discomfort when swallowing, nasal obstruction or throat pain. Other reasons were general irritability due to fever, teething or moderate hearing loss. The difficulties in diagnosing AOM simply on the basis of symptoms were demonstrated in the investigation. Symptoms such as otalgia, otorrhea, fever or upper respiratory tract infection (URI), possibly except for the combination of otorrhea and fever, can occur without AOM. A correct otoscopic examination and evaluation of the eardrums is necessary in children with otalgia, other symptoms of URI or in doubtful cases of acute illness. Physicians without possibilities to evaluate the eardrums properly should thus refer the patient to an otologist without delay.     

PROLONGED BREAST FEEDING AS PROPHYLAXIS FOR RECURRENT OTITIS MEDIA

ABSTRACT. The incidence of otitis media was studied in 237 healthy children in reference to the duration of breast-feeding, with a follow-up from birth to three years of age. Recurrent otitis media was strongly associated with early bottle-feeding, in contrast to prolonged breast-feeding which had a long-term protecting effect up to three years of age. It is uncertain whether the prophylactic effect of prolonged breast-feeding on recurrent otitis is due to protection by human milk from infections or allergy, or to avoidance of harmful effects caused by cow's milk.     

Teaching Pediatric Otoscopy Skills to Pediatric and Emergency Medicine Residents: A Cross-Institutional Study

Objective

To evaluate a pediatric otoscopy curriculum with the use of outcome measures that included assessment of skills with real patients.

Paranasal sinuses and middle ear infections: what do they have in common?

Otitis media and sinusitis are among the most common pediatric diseases and they share common features. Although the anatomy, physiology and disease processes are not identical, knowledge of the pathophysiology of middle ear disorders often provides to the pediatrician a useful understanding of sinus diseases. The same risk factors identified for otitis media may play a pivotal role in the development of sinusitis. Moreover, as both paranasal sinuses and middle ear acquire respiratory pathogens from nasopharynx, acute sinusitis is usually caused by the same bacterial pathogens that cause acute otitis media, with a major role for Streptococcus pneumoniae , Haemophilus influenzae and Moraxella catarrhalis , while anaerobes may predominate in chronic disease. A responsibility of bacterial biofilms in chronic sinusitis, similarly to otitis media, has been recently suggested. Biofilms, three-dimensional aggregates of bacteria, are refractory to antibiotics and thus might explain why some patients improve while on antibiotics but relapse after completion of therapy.     

Incidence of hearing impairment among rural and urban school going children: A survey

A total of 1,670 school going children (urban 1030 and rural 640) in the age range of 12–14 years were screened for hearing loss during a survey conducted by the Department of Otolaryngology of the Postgraduate Institute of Medical Education & Research, Chandigarh. 6.31% of cases in the urban group were found to be having hearing loss as compared to 32.81% of cases in the rural group. Secretory otitis media was found to be the commonest cause of hearing impairment in both the urban and rural group accounting for 5.33% and 33.59% respectively.     

Pneumococcal vaccination in children at risk of developing recurrent acute otitis media - a randomized study

Aim: Acute otitis media (AOM) is a common childhood disease, which often becomes recurrent (rAOM). A small reduction in AOM episodes has been noted in unselected child cohorts after vaccination with heptavalent conjugate pneumococcal vaccine (PCV7). The purpose of this study was to investigate how vaccination affects young children at risk of developing rAOM. Methods: Ninety‐six children with an AOM onset before 6 months of age, implying a high risk for rAOM, were closely monitored until the age of 2 years. Forty‐six were vaccinated with PCV7 and 50 were not. All episodes of AOM, emergency visits and ventilation tube insertions were registered. Results: A total of 363 AOM episodes were diagnosed. The incidence was reduced by 26% (p = 0.03), the number of emergency visits because of suspected AOM by 36% (p = 0.01) and the proportion of children who received ventilation tubes was halved in the vaccine group (p = 0.02). Conclusions: During the first 2 years of life, PCV7 significantly reduced AOM episodes, emergency visits and ventilation tube insertions in children with rAOM. Pneumococcal vaccine may be a future route to reduce antibiotic use and health care consumption in otitis‐prone children.     

Clinical characteristics of respiratory syncytial virus infection-associated acute otitis media

Background:  It is known that children with respiratory syncytial virus (RSV) infection frequently have complications of acute otitis media (AOM).
Methods:  The hospital records of 148 inpatients aged 6–35 months who had RSV infection between January 2004 and December 2007, were retrospectively investigated.
Results:  Forty-six out of 148 children (31%) had AOM. There was a significantly greater number of children with fever who had AOM ( P  = 0.005). The percentage of children with β-lactamase-non-producing ampicillin-resistant (BLNAR) Haemophilus influenzae in nasopharyngeal culture who had AOM showed a tendency to be greater than that of those who did not have AOM, but this was not statistically significant ( P  = 0.068). Moreover, BLNAR H. influenzae was positive in middle ear fluid specimens from four of five children with AOM who underwent tympanocentesis. There were no significant differences in the incidence of lower airway infection, leukocytes counts, or serum C-reactive protein levels between children with and without AOM.
Conclusions:  Children who had RSV infection with AOM had a higher incidence of fever than those without AOM.     

Use of Medical Care and Antibiotics among Preschool Children in Different Day Care Settings

ABSTRACT. The use of medical care among 880 1-5 year olds in different day care settings was studied using register information on physician visits, purchases of antibiotics and municipal day care in 1984. The unit of analysis was months in the different day care settings and not children. The rates of physician visits were 1.4 to 1.8 times higher for acute upper respiratory tract infections and all acute infections and 2 to 3 times higher for secretory otitis media during day care centre months and family day care months as compared to home care months. The rate of visits for bronchial asthma was 5 times higher during day care centre months than during home care months. No differences were found between day care centre months and family day care months with respect to the rates of physician visits for acute upper respiratory tract infections, acute otitis media and all acute infections. Among children in family day care, the daily number of hours in day care, and size, average age and age homogeneity of the groups were not significantly associated with rates of visits for all acute infections or purchases of antibiotics.     

C1q and C1 Subcomponent Complexes in Otitis-Prone and Non-Otitis-Prone Children A Prospective Study of Children during their First Years of Life

ABSTRACT. Children with recurrent acute otitis media (rAOM) often show reduced C1q concentrations and an excess of (C1r-C1s)₂ complexes. It is not known if such C1 aberrations precede development of rAOM or are a consequence of the infections. For this reason, serial investigation of C1q and C1 subcomponent complexes from birth until the age of three was performed in 113 children, 13 of whom developed rAOM. Clq concentrations at birth were found to be lower in the rAOM group than in children who did not experience acute otitis media, and were also correlated with age at the time of the first AOM episode. However, the wide variation of C1q within the groups precluded the use of C1q as a predictive marker. Excess (C1r-C1s)₂ complexes were consistently absent at birth. High concentrations were found in children with established otitis media and the complexes persisted in association with recurrent disease. In conclusion, the C1 aberrations characteristic of rAOM were mainly acquired as a result of infection.     

The burden of acute otitis media on the patient and the family

The aim of our study was to determine the burden of acute otitis media (AOM) on patients and their families. Parents of children with AOM were interviewed with regard to the week preceding the AOM diagnosis and every 3 days henceforth for an additional 21 days. The interview included information on loss of workdays, use of health care services and impact on the patient's and family's quality of life. Parents of age- and neighbourhood-matched controls were interviewed in an identical manner. A total of 150 patients and 51 controls were included in the analysis. The following variables differed significantly ( P <0.001) between patients and controls (mean ± SD): non-routine days 18.5±11.0 in patients versus 3.4±6.5 in controls; number of visits to primary health centres 2.6±1.6 versus 0.4±0.6; number of emergency room visits 0.2±0.5 versus 0.1±0.02 and number of visits to an otolaryngology clinic 0.3±0.6 versus 0. Days of antibiotic and over the counter drug use were 9.0±5.6 versus 0.3± 0.9 and 7.0±6.0 versus 4.9±6.0, respectively per episode. The mean loss of workdays per child was 1.6±1.8 in patients versus 0.25±0.6 in controls, for working mothers and 0.6±1.1 versus 0.1±0.4 for working fathers; duration of absenteeism from day care facilities was 3.5±2.5 versus 0.9±2.7. Conclusion: Acute otitis media significantly reduces the quality of life of both child and parents, causes substantial use of medical services and significant loss of workdays.Abbreviations AOM acute otitis media - OTC over the counter