Middle ear effusion among children diagnosed and treated actively for acute otitis media

We assessed the point prevalence of middle ear effusion among day care children in an area where acute otitis media is diagnosed, treated and followed actively. Minitympanometry was used to screen 850 day care centre attendants aged 0.6 to 6.9 years (mean 3.7 years). Tympanometry was performed by two trained nurses at the day care centres and pneumatic otoscopy was done by a paediatrician when effusion was suspected. We found 60 (7.1%) children to have middle ear effusion, which was bilateral in 23 (2.7%) cases. Of the children with bilateral effusion 13 had respiratory symptoms fulfilling the criteria of acute otitis media, 8 of them had experienced acute otitis media during the past 3 weeks and were diagnosed to have otitis media with effusion, and only 2 (0.2%) were asymptomatic children not identified earlier. Of the 37 (4.4%) children with unilateral effusion, 14 had acute otitis media and 23 otitis media with effusion, of whom 12 children (1.4%) had not been identified earlier. The point prevalence of acute otitis media was 3.2% and that of otitis media with effusion 3.9%. Conclusion We conclude that active diagnosis and treatment of acute otitis media practically eliminates such middle ear effusion that could cause significant hearing impairment. Received: 10 November 1997 / Accepted: 31 January 1998     

Disappearance of middle ear effusion in acute otitis media monitored daily with tympanometry

BACKGROUND: Disappearance of middle ear effusion is one of the most important outcomes in the treatment of acute otitis media (AOM). AIM: To evaluate the duration of effusion in AOM treated by antimicrobials and to find factors influencing it. METHODS: Parents of 90 children with AOM monitored daily the disappearance of effusion with tympanometry. The children were randomly allocated to be treated with either oral amoxicillin or cefuroxime-axetil for 10 d. Daily monitoring lasted for 14 d or until the tympanogram was normal (curve A or C) in both ears. Pneumatic otoscopy was carried out every 2 wk. RESULTS: Normal tympanograms were obtained after a median time of 7.5 d (range 1-58 d) among 75 successfully monitored patients. In two-thirds (69%) of them, effusion resolved in 14 d. The median duration of effusion did not differ significantly between the two treatment groups (8 vs 7 days, p=0.7). The children who had unilateral AOM cured more rapidly than those with bilateral AOM (5 vs 19 d, p<0.001). In logistic regression analysis adjusted for age, bilaterality explained treatment failure at 2 wk with an odds ratio of 28.1 (95% CI 4.6-169.5, p<0.001). CONCLUSION: The choice of antimicrobials did not influence the duration of middle ear effusion, which was much shorter than had been thought previously. Children with unilateral AOM were cured much more quickly than those with bilateral AOM.     

Parental suspicion of hearing loss in children with otitis media with effusion

Objective This study aimed to evaluate the parental suspicion of hearing loss in children with otitis media with effusion (OME). As part of a population-based survey in a screening programme among 6- to 7-year-old Chinese children in Hong Kong, OME cases and controls were studied for the value of parental observations in the prediction of OME and hearing test results.Subjects and methods Prior to the otoscopic and tympanometric examination of the children on school premises, a self-administered binary-choice question was sent to the parents asking whether there was any suspicion of hearing impairment. Positive screens and randomly selected negative screens were seen in a hospital clinic for the confirmation of case and control status 2 to 3 weeks after the school screening. Aural examination under microscopy, repeated tympanometry and stapedial reflex testing, and pure-tone audiometry (PTA) were conducted, and 117 cases and 159 controls were included in this study.Results The average PTA conductive threshold levels in the individual children with OME ranged from 3.8 dB to 40.0 dB with a group mean of 17.0 dB in the better-hearing ears. Parental suspicion of hearing deficit was significantly associated with OME (p<0.001) but not PTA findings (p=0.686). The sensitivity of parent-suspected hearing impairment to detect OME however was very low (19.7%).Discussion In other words, if we had relied on parental suspicion as the first screening, at least 80% of the OME cases would have been missed. We conclude that the parental suspicion of hearing loss is inadequate for the identification of mild hearing loss as caused by OME. Health education is recommended to improve parental awareness of the disease.     

Reduced iNOS expression in adenoids from children with otitis media with effusion

Granath A, Norrby‐Teglund A, Uddman R, Cardell L‐O. Reduced iNOS expression in adenoids from children with otitis media with effusion.
Pediatr Allergy Immunol 2010: 21: 1151–1156.
© 2010 John Wiley & Sons A/S Nitric oxide (NO) is a key mediator in the local immune response of human airways. Inducible NO‐synthases (iNOS), and endothelial NO‐synthases (eNOS) are two enzymes known to regulate its production. The role of NO in middle ear disease is not fully known. Previous studies suggest that NO might have a dual role, both promoting and suppressing middle ear inflammation. The aim of the present study was to compare the eNOS and iNOS expression in adenoids obtained from children with otitis media with effusion (OME) with the expression seen in adenoids derived from children without middle ear disease. In addition, the expression of IL‐1β and TNF‐α were analyzed, because of their role in the iNOS‐induction pathway. The iNOS and eNOS expression were analyzed with real‐time PCR in 8 OME and 11 control adenoids. The corresponding proteins were demonstrated by immunohistochemical staining of adenoid tissue. A Luminex^® assay was performed to analyze IL‐1β and TNF‐α in nasopharyngeal secretion in 10 OME and 8 controls, and immunohistochemistry was performed on adenoid tissue and imprints from the adenoid surface. Children with OME exhibited lower levels of iNOS than controls without middle ear disease. No such difference was seen for eNOS. The corresponding proteins were found mainly in conjunction with surface epithelium. No significant changes were seen among the cytokines tested. The present results indicate that local induction of iNOS in adenoids might be of importance for preventing development of OME.     

Effect of pneumococcal vaccination on otitis media with effusion in children older than 1 year

Pneumococcal vaccines may be effective in preventing or decreasing the burden of disease related to otitis media. In study reported here, we investigated the effectiveness of pneumococcal vaccination on otitis media with effusion (OME) in children (n = 383 children aged 1–7 years) with a history of recurrent otitis media within the framework of a randomized double blind placebo controlled trial. Children were randomized to be immunized with either a 7-valent pneumococcal conjugate vaccine followed by the 23-valent pneumococcal polysaccharide vaccine, or by hepatitis A or B vaccines. The proportion of children diagnosed with OME at the scheduled follow-up visits – 7, 14, 20 and 26 months after randomization – was then calculated. OME was diagnosed according to an algorithm combining tympanometry and otoscopy. The percentage of children diagnosed with OME was similar in the pneumococcal vaccination group and control group at both baseline and the follow-up visits at 7, 14, 20 and 26 months – 52.9 versus 52.7, 44.9 versus 44.2, 34.9 versus 31.5, 40.8 versus 32.2 and 31.4 versus 26.1, respectively (corresponding to p-values of 0.96, 0.89, 0.51, 0.13 and 0.36, respectively). We conclude that the combined pneumococcal conjugate and the polysaccharide vaccination have no beneficial effect on OME in children aged 1 year or older with a history of recurrent otitis media. Therefore, these vaccinations are not indicated in the prevention of OME in these children.     

Middle ear effusion in children

Acute otitis media (AOM) and otitis media with effusion (OME) in children can present with a variety of middle ear effusions (MEE). Even though the character of the effusion may vary, the underlying pathogenesis is often similar. In the last decade, there has been an abundance of new information in the fields of immunobiology and immunochemistry to explain the chronicity of MEE. There are also studies examining the efficacy of vaccination and immunoprophylaxis for recurrent AOM. Diagnosis of otitis media (OM) in a child can be difficult but good visualization by pneumatic otoscopy improves the accuracy of diagnosis of OME. The development of increasing bacterial resistance to antimicrobial therapy reinforces the need to be more rational in treating AOM and OME. The variability of the natural history and the long term sequelae of OME makes medical management more difficult. All children with chronic MEE should have audiologic evaluation. Surgery is recommended should the condition be refractory to medical therapy or if the complications of MEE develop.     

儿童慢性分泌性中耳炎鼓室外耳道置管手术治疗的探讨

目的：探讨鼓室外耳道置管手术治疗儿童慢性分泌性中耳炎的适应证及治疗效果。方法：回顾性分析接受鼓室外耳道置管手术的30例40耳慢性分泌性中耳炎儿童患者的临床资料。其中23耳鼓膜菲薄甚至部分粘连。40耳均接受了外耳道上、后壁皮肤切开,鼓室探查,鼓室外耳道置管手术。其中10例双耳手术病人1耳咽鼓管注药后行咽鼓管置管,1耳仅咽鼓管注药;余20例单耳手术病人仅行咽鼓管注药。结果：咽鼓管置管于术后5~8 d自行脱落,鼓室置管无1例脱落,术后6~8月拔管,鼓膜愈合良好。术后临床症状及听力检查达治愈标准35耳（35/40,87.5％）,好转5耳（5/40,12.5％）。术后随访0.5～2年,1耳因鼓室积液再发再次置管,3耳间歇性有耳闷胀感而无主观听力下降,鼓室功能曲线C型4耳有3耳转为A型。结论：对于复发性、鼓膜菲薄弹性差或是部分粘连的慢性分泌性中耳炎儿童患者,采用鼓室外耳道置管手术便于探查清理鼓室咽鼓管病变,防止鼓膜损伤及置管脱落,减少复发;同时行咽鼓管置管对提高疗效无明显帮助。     

The use of acoustic reflectometry in the study of middle ear effusion in children suffering from acute otits media,upper respiratory tract infection and in healthy children

This report focuses on the occurrence of middle ear effusion in children with acute otitis media (n = 62), upper respiratory tract infection (n = 81) as well as in healthy control children (n = 152). Data are reported in age categories 0–4 and 5–13 years. Middle ear effusion was found in 86% of children with acute otitis media, 49% of children with upper respiratory infection and 13% of healthy children. The younger the child, the more likely the presence of middle ear effusion in all groups. Acute otitis media and upper respiratory tract infection were clinically indistinguishable in infants. Conclusion Middle ear effusion is not generally a particularly significant clinical problem in children. Received: 31 January 1996 Accepted: 12 April 1996     

A randomized, placebo-controlled trial of the effect of antihistamine or corticosteroid treatment in acute otitis media

OBJECTIVES: To determine whether the adjunctive drugs antihistamine and corticosteroid improve immediate and long-term outcomes of acute otitis media (AOM). STUDY DESIGN: Children with AOM (3 mos-6 y) were enrolled in a randomized, double-blind, placebo-controlled trial. All 179 children received one dose of intramuscular ceftriaxone and were assigned to receive either chlorpheniramine maleate (0.35 mg/kg/d) and/or prednisolone (2 mg/kg/day) or placebo for 5 days. Main outcome measures were rate of treatment failure during the first 2 weeks, duration of middle ear effusion, and rate of recurrences of AOM to 6 months. RESULTS: Clinical outcomes and recurrence rates did not differ significantly with treatment. Children who received antihistamine alone had significantly longer duration of middle ear effusion (median, 73 days) than subjects in other treatment groups (median, 23 to 36 days, P=.04). Temporary normalization of tympanometric findings on day 5 occurred more frequently in the corticosteroid-treated group (P=.04). CONCLUSIONS: Five-day treatment with antihistamine or corticosteroid, in addition to antibiotic, did not improve AOM outcomes. Antihistamine use during an acute episode of OM should be avoided, since the drug may prolong the duration of middle ear effusion. The efficacy of 7- to 10-day treatment of AOM with corticosteroid, in addition to antibiotic, deserves further investigation.     

Petrositis and cerebellar abscess complicating chronic otitis media

A 12-year-old girl with chronic otitis media complicated by petrositis and cerebellar abscess is presented. Early surgical intervention, in combination with broad-spectrum antibiotics, provided a good outcome. Life-threatening complications of otitis media, although rare, still occur in developed countries.     

Intramuscular ceftriaxone compared with oral amoxicillin-clavulanate for treatment of acute otitis media in children

Two hundred and fifteen children aged 4 months–6 years with acute otitis media (AOM) were randomized to be treated either by a single i.m. injection of ceftriaxone, 50 mg/kg, with a second dose in the event of unsatisfactory response after 48 h or a history of recurrent AOM (109 patients) or amoxicillin clavulanate 12.5 mg tid (106 patients). The failure rate was similar in children treated by ceftriaxone and amoxicillin clavulanate, 4.6% and 4.7%, respectively (standard error for intergroup difference −2.87%, 95% confidence interval −5.62% to 5.87%). No significant differences between the groups were found in the dynamics of the resolution of the acute symptomatology, otoscopy findings, relapse rate at 30 days or tympanographic evidence of middle ear effusion at the scheduled visits on days 30, 60 and 90. Recurrence of AOM between days 31 and 90 was observed significantly in more children treated with amoxicillin clavulanate than with ceftriaxone – 25 out of 84 (29.4%) versus 11 out of 81 (13.6%) (P=0.012). Conclusion Ceftriaxone injection(s) is as efficient at least as 10-day oral amoxicillin clavulanate for treatment of acute otitis media in children. Although not recommended as routine, ceftriaxone can be considered in the management of acute otitis media under special circumstances, particularly in cases when the ability to tolerate or absorb oral drugs is compromised, in children refusing or unable to take oral therapy or when the compliance is questionable. Received: 17 January 1997 / Accepted: 22 May 1997     

Myringoplasty for chronic otitis media

Methods :25 children in the age group of 8—-14 years suffering from chronic suppurative otitis media were taken up for myringoplasty using onlay technique under general anaesthesia.Results: All selected cases had a central type of dry perforation, good cochlear reserve and healthy middle ear mucosa. Cases having enlarged adenoids, infection in nose or throat, any traumatic perforation or previous attempt at closure were excluded from the study. It was found that there was 76% take up of graft after two months who also had improvement in hearing.Conclusion: We conclude that myringoplasty stands a good chance in children.     

Prediction of acute otitis media with symptoms and signs

We carried out a prospective study to analyse if it would be possible to predict the coexistence of acute otitis media on the basis of symptoms and signs of infection. Of the 658 patients admitted to hospital during the period concerned, 197 (29.9%) had otitis media. For each child with otitis, the next patient of the same age was chosen as a control. The risk of having otitis media was increased among patients with cough, rhinitis and earache. All three variables together correctly classified 67% of those not having otitis media and 63% of those with acute otitis, compared with the 50% which would theoretically be achieved by chance alone. Prediction was worst (55%) among patients younger than 2 years of age not having otitis media and best among older patients who had otitis media, i.e. 78%. Prediction on these grounds would have caused significant over-treatment, and one-third of the otitis cases among the youngest group would have been missed. Thus it is important to always examine the ears of a child with an infection in order to reliably exclude the possibility of acute otitis media.