Reliability, validity and responsiveness of a Norwegian version of the Chronic Sinusitis Survey

Background

Nasal colonisation with otitis media (OM) pathogens, particularly Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, is a precursor to the onset of OM. Many children experience asymptomatic nasal carriage of these pathogens whereas others will progress to otitis media with effusion (OME) or suppurative OM. We observed a disparity in the prevalence of suppurative OM between Aboriginal children living in remote communities and non-Aboriginal children attending child-care centres; up to 60% and <1%, respectively. This could not be explained by the less dramatic difference in rates of carriage of respiratory bacterial pathogens (80% vs 50%, respectively). In this study, we measured nasal bacterial load to help explain the different propensity for suppurative OM in these two populations.

Methods

Quantitative measures (colony counts and real-time quantitative PCR) of the respiratory pathogens S. pneumoniae, H. influenzae and M. catarrhalis, and total bacterial load were analysed in nasal swabs from Aboriginal children from remote communities, and non-Aboriginal children attending urban child-care centres.

Results

In both populations nearly all swabs were positive for at least one of these respiratory pathogens. Using either quantification method, positive correlations between bacterial load and ear state (no OM, OME, or suppurative OM) were observed. This relationship held for single and combined bacterial respiratory pathogens, total bacterial load, and the proportion of respiratory pathogens to total bacterial load. Comparison of Aboriginal and non-Aboriginal children, all with a diagnosis of OME, demonstrated significantly higher loads of S. pneumoniae and M. catarrhalis in the Aboriginal group. The increased bacterial load despite similar clinical condition may predict persistence of middle ear effusions and progression to suppurative OM in the Aboriginal population. Our data also demonstrated the presence of PCR-detectable non-cultivable respiratory pathogens in 36% of nasal swabs. This may have implications for the pathogenesis of OM including persistence of infection despite aggressive therapies.

Conclusion

Nasal bacterial load was significantly higher among Aboriginal children and may explain their increased risk of suppurative OM. It was also positively correlated with ear state. We believe that a reduction in bacterial load in high-risk populations may be required before dramatic reductions in OM can be achieved.     

Interventions for prevention of otitis media may be most effective if implemented in the first weeks of life

OBJECTIVE: For Indigenous Australian children living in remote communities, onset of otitis media commences within weeks of birth and is associated with early nasopharyngeal colonisation with multiple respiratory bacterial pathogens: Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. The high prevalence of eardrum perforation and the failure of standard therapies to cure or prevent OM in this population require urgent attention. The objective of this study was to measure the changes in nasopharyngeal bacterial flora between birth and first episode of otitis media. METHODS: For 10 randomly selected Indigenous children with early onset otitis media, S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, and total bacterial load were enumerated in serial nasopharyngeal swabs using real-time quantitative PCR. RESULTS: Between 0 and 3 weeks of age, all 10 infants had bilaterally normal ears. At 3-6 weeks of age, seven of eight infants examined had otitis media. By 6-13 weeks of age, all 10 infants had otitis media. The relative density of respiratory pathogens among total nasopharyngeal flora increased significantly with onset of otitis media, and the majority of children became colonised with the three respiratory pathogens. There was no association between OM onset and S. aureus load. CONCLUSIONS: Onset of otitis media between 3 and 6 weeks of life was associated with a significant increase in all major bacterial OM pathogens (S. pneumoniae, H. influenzae, M. catarrhalis), as well as total bacterial load in the nasopharynx. Interventions to prevent acquisition of multiple OM pathogens in the first weeks of life are needed.     

Nasopharyngeal flora in the first three years of life in normal and otitis-prone children

Nasopharyngeal carriage of the three major middle ear pathogens (Streptococcus pneumoniae, nontypeable Hemophilus influenzae, and Moraxella catarrhalis) was evaluated prospectively in a group of 110 children followed up for the first 3 years of life. The findings suggested that nasopharyngeal carriage of middle ear pathogens increases significantly during respiratory illness among the general population of young children; however, otitis-prone children demonstrated a tendency to carry nontypeable H influenzae at an unusually high rate even during health. This propensity to carry nontypeable H influenzae might explain why nontypeable H influenzae is a major cause of recurrent or chronic otitis media.     

Waldeyer's ring and otitis media: the nasopharyngeal tonsil and otitis media

This overview of the relationship between the nasopharyngeal tonsil and otitis media will review three important concepts: (1) Adenoid inflammation leads to inflammatory obstruction of the Eustachian tube; (2) early colonization of the adenoid with the three major bacterial pathogens of otitis media is the most important factor in the early pathogenesis of otitis media; (3) the local immune system in the adenoid particularly specific secretory IgA directed against both viruses and bacterial pathogens are probably genetically controlled and represent the immunological factor in protecting the host against invasion of these agents in the Eustachian tube and middle ear. This overview of the relationship between the adenoid and the development of otitis media emphasizes that nasopharyngeal colonization with the three major middle ear pathogens is among the most important risk factors in the pathogenesis of otitis media. Inasmuch as these pathogens normally reside in the nasopharynges of most healthy children, the factors which trigger development of otitis media need to be carefully evaluated. Among these two triggers are viral infections and upper respiratory tract allergy.     

Negative pressure tympanograms in children less than 2 years of age--different bacterial findings in otitis media by tympanometric results

OBJECTIVE: The interpretation of negative pressure tympanograms as indicators of the presence of middle ear fluid has been ambiguous. Our purpose was to assess the occurrence and implications of negative pressure tympanograms and to study their association with bacterial pathogens in otitis media. METHODS: Altogether 329 infants were enrolled at a well-baby clinic for the Finnish Otitis Media Cohort Study, a longitudinal prospective cohort study. The children were closely followed in a special study clinic from 2 to 24 months of age for respiratory diseases, especially acute otitis media. Children were examined at the study clinic with tympanometry and pneumatic otoscopy whenever visiting the study clinic for respiratory disease. Myringotomy with aspiration was performed if middle ear fluid was suspected in otoscopy. Occurrence of middle ear fluid in ears with negative pressure tympanograms (less than -100 daPa) was assessed. Nested case control design matched by visit type (acute or follow-up visit) and month of visit was used for analysis of association of bacterial pathogens and tympanometric results. RESULTS: Middle ear fluid was encountered in 15% of ears with negative tympanometric peak pressure, a lower proportion than described previously. In otitis media with a negative tympanometric peak pressure, 71% of bacterial cultures remained negative for the main pathogens, compared to 36% in matched controls (P<0.001). Especially Streptococcus pneumoniae but also Haemophilus influenzae were rarely found in samples from negative pressure ears. Moraxella catarrhalis was equally often found. CONCLUSIONS: Negative pressure tympanogram is a poor indicator for the presence of middle ear fluid. Furthermore, if otitis media is diagnosed with negative tympanometric peak pressure negative middle ear bacterial culture for the main pathogens is highly probable. Expectant follow-up might be more appropriate than routine antibiotic treatment.     

慢性化脓性中耳炎分泌物的细菌培养及药敏试验

目的 :了解慢性化脓性中耳炎 (CSOM )患耳脓性分泌物的细菌分布及药物敏感性 ,以指导临床用药。方法 :采集 92例武汉地区CSOM患者手术中的中耳炎性分泌物 ,分别进行需氧菌、厌氧菌培养及药物敏感试验。结果 :需氧菌培养阳性者 75例 ,阳性率 81.5 % ,主要致病菌为绿脓杆菌、金黄色葡萄球菌和变形杆菌。 3种致病菌均对环丙沙星敏感 (敏感率为 89.0 %、88.2 %和 85 .0 % )。厌氧菌培养阳性者 10例 ,阳性率 10 .9%。结论 :绿脓杆菌、金黄色葡萄球菌和变形杆菌是武汉地区CSOM的主要致病菌 ,三者对环丙沙星类抗生素的敏感率均较高。厌氧菌在CSOM的发病中起着重要的作用。     

Effect of pneumococcal conjugate vaccination on nasopharyngeal carriage in children with early onset of acute otitis media – a randomized controlled trial

Conclusion: Although children vaccinated with heptavalent pneumococcal conjugate vaccine (PCV) had fewer episodes of acute otitis media (AOM), this trial was unable to prove a simultaneous decrease in nasopharyngeal carriage. Objective: Carriage rates of AOM pathogens in the nasopharynx are high among children, and colonization is the first step towards infection. The possible impact of PCV on carriage is therefore of interest, particularly in children with recurrent AOM. The aims of this study were to examine the effect of heptavalent PCV on carriage of AOM pathogens in children at high risk of developing recurrent disease, and to monitor carriage of resistant pathogens in vaccinated and unvaccinated children. Methods: A total of 109 children with an onset of AOM before 6 months of age, 89 of whom developed recurrent disease, were enrolled in a trial. Fifty-two children were vaccinated and all were closely monitored for 3 years. Results: There was no difference statistically between vaccinated children and controls concerning the carriage of any of the major AOM pathogens. There was evidence of within-child clustering for S. pneumoniae (p = 0.002) and H. influenzae (p < 0.001), indicating that children continued to carry either species over time. Resistance rates were generally low and comparable with national levels.     

Otitis media with effusion and chronic upper respiratory tract infection in children: a randomized, placebo-controlled clinical study.

This study was performed to investigate the course of spontaneous recovery from otitis media with effusion in children with chronic rhinosinusitis treated in various ways. One hundred forty-one children between 3 and 10 years of age were selected for the presence of chronic rhinosinusitis and unilateral or bilateral otitis media with effusion. The children were assigned at random to one of four treatment groups, i.e., placebo, amoxicillin combined with xylometazoline hydrochloride nose drops, maxillary sinus drainage, or a combination of the latter two forms of therapy. The follow-up period was 6 months. Drainage of the maxillary sinus had no effect on either the recovery of the chronic upper respiratory tract infection or otitis media with effusion. Amoxicillin combined with xylometazoline nose drops had no significant effect on recovery from the upper respiratory tract infection, but did have a small but significant effect on recovery from otitis media with effusion. However, the general tendency of the upper respiratory tract and ears to recover was poor. Persistence of the chronic upper respiratory tract infection during the follow-up period proved to be a negative prognostic factor with respect to cure of otitis media with effusion. Children with chronic rhinosinusitis as defined in this study appear to have a high risk of developing chronic otitis media with effusion. The results of the study are discussed.     

A long term follow up of conchal flap meatoplasty in chronic otitis externa

A long-standing diffuse chronic otitis externa can lead to itching. Resultant scratching may then lead to irreversible skin changes with canal stenosis by scar tissue. The poor ventilation and increased humidity gives rise to bacterial and fungal growths leading to breakdown of the skin defences and worsening itching. This vicious itching-scratch cycle or downward spiral often fails to respond to medical treatment. For these cases a simple conchal flap meatoplasty may improve ventilation of the external auditory canal and may lead to a self cleaning ear. We reviewed 84 patients who had undergone conchal flap meatoplasty in Calderdale and Huddersfield NHS Trust Hospitals from April 1993 to June 2002. A long-term follow up of conchal flap meatoplasty in chronic otitis externa showed no records of complications or further otitis in 93.2 per cent of cases. Thus surgical intervention plays an important role in the treatment of otitis externa not responding to treatment.     

Nasopharyngeal flora and drug susceptibility in children with macrolide therapy

OBJECTIVES/HYPOTHESIS: Low-dose, long-term administration of macrolides (macrolide therapy) has been used as an effective treatment for chronic respiratory tract diseases. The authors reported on the nasopharyngeal flora in children treated with macrolide therapy. STUDY DESIGN: Prospective study. METHODS: Nasopharyngeal cultures were obtained from 73 children with chronic rhinosinusitis and/or otitis media with effusion at the end of the low-dose administration of clarithromycin (macrolide group). As control subjects, 98 children with chronic rhinosinusitis and/or otitis media with effusion who were not given macrolides were also included in the study. The culture results were evaluated with respect to antimicrobial susceptibility patterns, risk factors for carriage of erythromycin-resistant Streptococcus pneumoniae, and the clinical efficacy of the therapy. RESULTS: The macrolide therapy did not have a significant effect on the incidence or the susceptibility patterns of potential pathogens except for Moraxella catarrhalis. Most of children in the macrolide group possessed a normal flora compared with the control children. The risk factors for carriage of erythromycin-resistant S pneumoniae were male gender in the macrolide group and age under 6 years and use of antimicrobial drugs other than macrolides in the control group. The clinical efficacy of the therapy was independent of carriage of erythromycin-resistant S pneumoniae. CONCLUSION: Macrolide therapy has little effect on carriage of drug-resistant pathogens, and the efficacy of the therapy depends on the anti-inflammatory effect of the drugs, which is independent of their antimicrobial effect.     

Bacteriology of chronic suppurative otitis media--a multicenter study

CONCLUSIONS: Bacterial predominance and antibiotic sensitivity have changed over time, making continuous and periodic surveillance necessary in guiding appropriate antibacterial therapy. OBJECTIVES: With the development and widespread use of antibiotics, the types of pathogenic microorganisms and their resistance to antibiotics have changed. Knowledge of the species and resistance rates of current pathogens is important for determining the appropriate antibiotics for patients with chronic suppurative otitis media. We investigated the current bacteriology of chronic suppurative otitis media. SUBJECTS AND METHODS: This was a retrospective study of 1102 patients with chronic suppurative otitis media seen at six hospitals in Korea from January 2001 to December 2005. RESULTS: The most commonly identified pathogenic bacterial species was Pseudomonas, with the next most prevalent being methicillin-resistant Staphylococcus aureus (MRSA).     

Otitis media and chronic middle ear effusion in the asthmatic pediatric patient.

In a retrospective study, a high incidence of otitis media and chronic middle ear effusion was recognized in pediatric patients with allergies, in particular, asthma. Five hundred and nineteen cases were examined to see if significant correlations could be made between asthma and 1) the development of otitis media, 2) the placement of multiple tubes, and 3) the incidence of mucoid otitis media, or "glue ear." The results of this preliminary report indicate that otitis media in the asthmatic patient seems to be a reflection of a disease affecting the entire mucociliary system in the respiratory tract and that this information should be used when making a prognosis for an asthmatic patient.     

The effects of antimicrobials and exposure to smoking on bacterial interference in the upper respiratory tract of children

Interactions between micro-organisms that include antagonism (interference) and synergism maintain balance between members of the normal endogenous flora, and play a role in preventing colonization by potential pathogens. Bacteria with interference capability of potential respiratory tract pathogens include alpha-hemolytic streptococci, non-hemolytic streptococci, Prevotella spp. and Peptostreptococcus spp. The role of bacterial interference in the occurrence of upper respiratory tract infections and its effect on their eradication is discussed. The infections include otitis media, sinusitis and pharyngo-tonsillitis. Treatment with antimicrobial agents and direct and indirect exposure to smoking, can affect the balance between the interfering organisms and potential pathogens. Introduction into the indigenous microflora of low virulence bacterial strains that are capable of interfering with colonization and infection with virulent organisms has been used to prevent the failure of antimicrobials in the treatment of pharyngo-tonsillitis and otitis media.     

The potential effect of widespread use of pneumococcal conjugate vaccines on the practice of pediatric otolaryngology: the case of acute otitis media

PURPOSE OF REVIEW: This review provides the otolaryngologist with the evolving understanding of various aspects of pneumococcal conjugate vaccines (PCVs) that are related to their effect on the respiratory tract RECENT FINDINGS: The efficacy of PCVs against invasive pneumococcal disease and pneumonia is well established and is documented in several well-conducted studies. However, the effect of PCVs on otitis media is less obvious and more complex. PCVs clearly reduce diseases caused by vaccine-type (VT) pneumococci, but replacement of VT serotypes by non-VT serotypes in nasopharyngeal carriage of Streptococcus pneumoniae is responsible for the increase in acute otitis media (AOM) caused by non-VT serotypes. Furthermore, an increased rate of AOM caused by Haemophilus influenzae and Moraxella catarrhalis was found. Since most antibiotic-resistance in S. pneumoniae is confined to VT serotypes, vaccine use also reduces antibiotic resistance. The reduction of carriage by PCVs is responsible for the reduction of spread of VT pneumococci (herd immunity). Thus a modification of AOM rather than just a simple reduction is seen with the widespread use of PCV. SUMMARY: Acute otitis media in the era of widespread use of PCV is modified. A disease with reduced VT serotypes, reduced antibiotic resistance, and a lower rate of sequelae is to be expected. However, replacement with potential virulent organisms and development of antibiotic resistance in non-VT pneumococci is a possibility that needs careful monitoring.     

Epidemiology of otitis media

Although otitis media (OM) incidence and prevalence estimates from around the world vary widely, it is clear that OM is a very common childhood disease. It is especially prevalent in children younger than 2 years of age. Furthermore, the earlier the first episode of OM, the greater the risk of subsequent recurrent OM and chronic otitis media with effusion. In addition, a number of other host, agent, and environmental factors have been associated with increased risk of otitis media. Environmental factors that favor the transmission of upper respiratory pathogens increase the risk of OM, recurrent OM, and chronic OME with effusion. Several factors suggest a genetic role in OM susceptibility, which needs further exploration.     

Upper respiratory morbidity in preschool children: a cross-sectional study

OBJECTIVES: To estimate the occurrence of and associations between upper respiratory tract infections in preschool children, and to assess constitutional and environmental factors as determinants of these infections. DESIGN: Population-based cross-sectional study. SETTING: Oslo, Norway. PARTICIPANTS: Preschool children, aged 4 to 5 years (3853 completed questionnaires). MAIN OUTCOME MEASURES: Acute and recurrent acute otitis media, tonsillopharyngitis, common cold, and rhinitis. RESULTS: Upper respiratory tract infections were common at age 4 years. During the last month, 7.1% of the children had acute otitis media and 7.5% experienced tonsillopharyngitis. Corresponding figures for common cold and rhinitis were 58.3% and 16. 4%, respectively. During the last 12 months, 9.5% of the children experienced more than 1 bout of acute otitis media, 6.9% had more than 1 tonsillopharyngitis episode, 47.7% contracted more than 2 common colds, and 3.2% had rhinitis weekly or monthly. The lifetime prevalence of recurrent acute otitis media (>/=4 episodes in any 12-month period) was 12.7% (n = 473). Bivariate correlations showed small-to-moderate relationships between the infections. Common cold was only weakly related to otitis media, tonsillopharyngitis, and chronic rhinitis. The probability for developing acute otitis media was almost 4-fold increased in children who had tonsillopharyngitis in the last year (adjusted odds ratio = 4.19; 95% confidence interval, 3.09-5.66). In logistic regression analysis, atopic disease was a strong determinant of all upper respiratory tract infections. Low birth weight increased the risk of acute otitis media. Day care attendance and the presence of siblings, which were considered to be indicators of exposure to respiratory pathogens, increased the risk of upper respiratory tract infections. CONCLUSIONS: In preschool children, acute otitis media, tonsillopharyngitis, and common cold were quite common, while chronic rhinitis was less prevalent and strongly associated with atopic disease. Attendance at day care centers increased the risk of upper respiratory tract infections in this age group, although the effect was weaker than that in younger children.     

慢性化脓性中耳炎病原菌分析及临床意义

目的分析慢性化脓性中耳炎患者病原菌群分布及对抗生素的耐药性，指导临床用药。方法对收治的163例慢性化脓性中耳炎患者中耳分泌物进行细菌及真菌分离培养和药物敏感试验。结果163例患者中，有136例检出病原菌，检出率为83.4％。以金黄色葡萄球菌(42株)、铜绿假单胞菌(29株)和肺炎克雷伯菌（22株）为主,真菌6株。结论慢性化脓性中耳炎患者感染病原菌中以金黄色葡萄球菌多见，不同病原菌对药物的耐药性不同，临床使用抗生素时应行细菌培养及药物敏感试验，使用敏感抗生素治疗。     

重庆地区慢性化脓性中耳炎分泌物培养及药敏试验结果分析

目的 分析重庆地区慢性化脓性中耳炎患者外耳道脓性分泌物细菌培养及药敏试验结果,为慢性化脓性中耳炎手术前后合理用药提供依据.方法 以2020年1月-2021年5月收集的106例慢性中耳炎患者为研究对象,取患耳脓性分泌物进行细菌培养和药敏试验.结果 106例患者中85例检测出病原菌,检出率80.19％,共检出病原菌107株...     

慢性化脓性中耳炎病原菌及耐药性分析

目的研究慢性化脓性中耳炎的主要病原菌种类及对抗生寨的耐药情况。方法对132例慢性化脓性中耳炎患者的脓性分泌物进行细菌培养并对分离的病原菌进行药物敏感试验。结果分离出病原菌152株,以金黄色葡萄球菌（49株）和铜绿假单胞菌（25株）为主,真菌5株。金黄色葡萄球菌对喹诺酮类敏感,敏感率为79．6％。铜绿假单胞菌对头孢他啶和喹诺酮类敏感,敏感率分别为84％和64％。结论金黄色葡萄球菌和铜绿假单胞菌是聊城地区慢性化脓性中耳炎主要致病菌,二者均对喹诺酮类敏感,铜绿假单胞菌亦对三代头孢类的头孢他啶敏感。临床医师在对慢性化脓性中耳炎患者治疗时应根据细菌培养和药敏结果用药,准确有效的治疗,以防耐药菌株的发生。真菌在慢性化脓性中耳炎致病菌中不容忽视。     

Aetiological factors in chronic secretory otitis in relation to age

The prevelance of chronic secretory otitis media was studied in 5414 children aged 2–12 yr. The maximum incidence of the disease was at the age of 2 yr decreasing progressively to the age of 12, the results fitting a logarithmic curve. Of all the children, 8.7% had chronic otitis media, 0.59% had adhesive otitis and 0.35% chronic suppurative otitis media. The prevalence of secretory otitis was, significantly, related to infections of the upper respiratory tract and to nasal obstruction. The part played by the adenoid was more questionable. Purulent otorrhoea was more frequent in those children with secretory otitis than normal children.