A systematic review of the effect of tympanostomy tubes in children with recurrent acute otitis media

Objective

Documentation of the effect of tympanostomy tubes in children with recurrent acute otitis media (RAOM) is limited. A recently published Cochrane review on the effect of tympanostomy tubes in children with RAOM was based on only two studies. Could the documentation be increased by including other randomized studies?

Methods

A MEDLINE and EMBASE search for randomized controlled trials was performed and 143 eligible papers were found. Only five studies could be included. All five were randomized studies with a total of 519 children, four randomized by children and one by ears. All five studies had different designs and control groups, making a proper meta-analysis impossible. Three studies had an antibiotic treated group, two studies a placebo group, and two studies a no treatment group as comparison group. Outcome measures were rates of AOM or fraction free of AOM in six or 12 months.

Results

Between two and five children have to be treated with tympanostomy tubes to prevent one child from attacks of acute otitis media (AOM) in six months. Tube treatment could reduce AOM with about one attack in six months after operation. Six months treatment with antibiotics was not different from treatment with tubes. No study reported quality of life for child and family or parental absence from day care or work.

Conclusion

Insertion of tympanostomy tubes or long-term treatment with antibiotics seems to prevent one attack of AOM or keep one child out of three free from AOM in six months.     

HLA frequency in patients with recurrent acute otitis media.

Clinical data suggest the involvement of hereditary factors in children susceptible to recurrent acute otitis media. That relationships of varying degree exist between the frequencies of certain HLA antigens and various disease entities is well established. In the present study, we investigated the frequencies of a number of HLA antigens in 45 patients with clinical recurrent acute otitis media and compared these frequencies with those in a control group from the same district. The HLA-A2 antigen occurred in 80% (36/45) of the group with recurrent acute otitis media, as compared with 56% of controls. Of a subgroup of 11 children with recurrent acute otitis media who were prospectively followed up, 10 (91%) were HLA-A2 positive. The HLA-A3 antigen occurred in only 11% (5/45) of the group with recurrent acute otitis media as a whole (n = 45) in comparison with 28% of controls. Among 22 prospectively followed up children without any episode of acute otitis media during the first 3 years of life, the frequency of HLA-A2 was 45% (10/22) and that of HLA-A3, 32% (7/22). The results indicate the existence of a relationship between recurrent acute otitis media and the HLA-A locus, suggesting the involvement of genetic factors in the disease.     

Persistent middle ear effusions in children with recurrent acute otitis media

Children with recurrent acute otitis media have been studied in a group general practice. They were seen as soon as possible after an episode of infection and the presence or absence of middle ear effusion was determined by a combination of tympanometry and pneumatic otoscopy. The sensitivity (87.5%) and specificity (90%) of this method were determined by comparing the prediction of effusions using this method with the results of myringotomy in a group of children with chronic secretory otitis media. The parents of the children with recurrent otitis media were questioned about previous aural discharge, chronic nasal symptoms, family history of atopy, numbers of siblings and breast feeding in infancy. Forty-one per cent of the 58 children studied had effusion(s) 2 months after their presenting episodes, while by 3 months this figure had fallen to 33%. Significantly more of the children with persistent effusions at 2 months had received cephalexin than of those who were effusion free at that stage (P less than 0.05). There were no other statistically significant differences between the 2 groups. Nine children had had aural discharge during the presenting episode and 5 of these developed persistent effusions.     

The effect of intravenous immunoglobulin treatment in recurrent acute otitis media

The effect of serial intravenous infusion of human immunoglobulin on the frequency of acute otitis media (AOM) episodes and on other upper respiratory tract infections was prospectively studied in a group of 22 otitis-prone children, 1-4 years old. After pair-matching, the children were allocated to immunoglobulin treatment or to a control group. Increased specific IgG antibody activities against pneumococcal types associated with recurrent AOM (rAOM) were generally achieved, but no significant difference was noted in the frequency of AOM attacks or other respiratory tract infections between the immunoglobulin-treated children and their pair-matched untreated controls. The results indicate that, although serum antibody activities against bacteria associated with AOM are increased by immunoglobulin infusions, this does not prevent the development of AOM in children suffering from rAOM.     

Children with recurrent episodes of acute otitis media: the effect of local administration of immunoglobulin G on acute otitis media, colonization and turnover of non-encapsulated Haemophilus influenzae in the nasopharynx

In most children with recurrent episodes of acute otitis media (AOM), tube treatment is successful, but there are those who nevertheless suffer from middle ear infections. The aim of the present study was to ascertain whether local administration of immunoglobulin could reduce the number of episodes of otorrhoea in otitis-prone infants <2 years old who were treated with tubes, or whether it could affect the nasopharyngeal colonization and turnover of bacterial pathogens in the nasopharynx. IgG or placebo were also administered intranasally daily for 6 months to 50 infants, randomized in a double-blind study. An arbitrarily primed polymerase chain reaction (AP-PCR) was used to characterize the different isolates of NTHI (non-encapsulated, non-typable Haemophilus influenzae). Three infants in the IgG group and six infants in the control group suffered from > or =3 episodes of acute otitis media. No effect on the nasopharyngeal colonization or the turnover of non-encapsulated H. influenzae in the nasopharynx could be detected in either group.     

The impact of recurrent acute otitis media on the quality of life of children and their caregivers

Objective: To assess the quality of life of 384 Dutch children aged 1–7 years with recurrent acute otitis media (AOM), and compare it with that of children from four reference populations: (i) children from a general population; (ii) children with mild‐to‐moderate asthma, (iii) children with mild‐to‐moderately severe chronic illness, and (iv) US children with persistent or recurrent otitis media. Design: Survey. Setting: A general and an academic hospital (study population of children with recurrent AOM, n = 384); general population (n = 225 and 117); primary care (children with asthma, n = 64); community care (children with chronic illness, n = 82); and a general hospital (children with persistent or recurrent otitis media, n = 169). Participants: A total of 384 children aged 1–7 years who had experienced at least two episodes of AOM in the preceding year and their caregivers. Main outcome measures: Generic and disease‐specific quality of life as judged by the children's caregivers. Age‐adjusted total and subscale scores were compared with those of the reference populations. Results: For all generic questionnaires, children with recurrent AOM had poorer scores than children from the general population. Quality of life of children with four or more episodes of AOM in the preceding year was poorer than that of children with two to three episodes. Children with recurrent AOM scored lower on the health‐related questionnaire than children with mild‐to‐moderately severe chronic illness. Quality of life of the present study population was similar to those of children with asthma and US children with chronic otitis media with effusion or recurrent AOM. Conclusion: Recurrent AOM has a considerable negative impact on the quality of life of children and causes concern to their caregivers. These effects are proportional to the severity of the condition. Professionals involved in the care of children with OM should be aware that OM not only affects physical functioning but also general well‐being of the child and its family. These outcomes should therefore be included in the evaluation of the child with otitis media both in the clinical and research setting.     

Beta-lactamase production and bacterial tolerance in recurrent acute otitis media

Different reasons for treatment failure or relapse of acute otitis media (AOM) have been suggested. In this study 38 children (8 treatment failures, 13 relapses of AOM within one month and 17 with a new AOM) were compared to 25 matching healthy children, regarding beta-lactamase producing bacteria and tolerance to penicillin V and ampicillin. Branhamella catarrhalis was the most common bacteria found in the nasopharynx and was isolated in 60% of children with AOM and in 48% of the control group. Fifty-two percent of the children classified as treatment failure or relapse of AOM had aerobic beta-lactamase producing bacteria in NPH. No bacteria tolerant to penicillin or ampicillin were found. Thus, beta-lactamase-producing bacteria seem to play a decisive role in treatment failure and relapse of AOM. On the other hand, tolerance to penicillin V or ampicillin does not seem to have any impact on healing of AOM.     

Co-amoxiclav antibiotic therapy of acute otitis media, exacerbation of otitis media chronica and sinusitis in children]

A comparative trial was performed of two regimens of antibiotic therapy in acute otitis, exacerbation of otitis media chronica and sinusitis in children. 100 children received combined treatment with amoxycilline and clavulanic acid (amoxiclav and autmentin). 50 control children were i.m. injected ampicilline. Oral co-amoxiclavs proved highly effective in ENT diseases in children and are superior to intramuscular ampicilline.     

Clinical observation of acute otitis media in children

This report presents the results of the clinical observation of 96 children under ten years of age with acute otitis media (107 ears) who visited our out-patient clinic from May 1986 to August 1987. The patients were classified into the following three groups according to clinical course: Group 1: 25 cases (26.0%) in which acute inflammatory findings rapidly disappeared and otitis media was cured within two weeks with no evidence of effusion; Group 2: 62 cases (64.6%) in which acute inflammatory findings rapidly disappeared but obvious accumulation of effusion which resolved gradually was observed and in which otitis media was cured from two weeks to three months after onset; Group 3: 9 cases (9.4%) in which persistent accumulation of effusion for more than three months was observed and which required myringotomy and insertion of a ventilation tube and in which a diagnosis of otitis media with effusion was made. The presence or absence of allergic diseases, adenoid symptoms, and otorrhea, or history of tonsillitis had no affect on the prognosis of acute otitis media. However, patients with a history of acute otitis media were at a significantly higher risk of developing the disease chronically. At the time of the resolution of the tympanic redness, abnormal findings in the tympanic membrane and tympanogram (TG), suggestive of the presence of middle ear effusion, were observed in approximately 80% of the patients. Approximately 20% of the patients who showed Type Cs or B in TG at that time developed otitis media with effusion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevention of recurrent acute otitis media: chemoprophylaxis versus tympanostomy tubes

Otitis media has long been recognized as one of the most common diseases of childhood. Several therapeutic modalities have been advocated for the prevention of recurrent episodes of acute otitis media (AOM). A blinded, prospective, randomized study was designed to determine the efficacy of tympanostomy tubes, antibiotic prophylaxis, and placebo. Children with recurrent AOM were entered in the study and followed for at least 6 months. A total of 65 children completed the protocol. Sixty-three of those were under the age of 4 years. Treatment failure was defined as two or more episodes of AOM or otorrhea in less than 3 months. Five of 22 children in the tympanostomy tube group failed, compared to 12 of 20 in the placebo group (p = .02). There were 8 or 21 treatment failures in the sulfisoxazole group. Children with otitis media with effusion (OME) at the time of their initial visit had significantly less middle ear disease when treated with tympanostomy tubes. Tympanostomy tube insertion for prophylaxis of recurrent acute otitis is supported by these findings. Improvement of recurrent AOM was observed in the sulfisoxazole group, but was not statistically significant.     

Development of speech intelligibility in children with recurrent otitis media

This study defined developmental functions for Pediatric Speech Intelligibility word and sentence materials presented in quiet and in competition for 25 normal children and 25 children with recurrent otitis media. Ages ranged from 24 to 56 mos. In normal children, developmental functions for Pediatric Speech Intelligibility speech materials showed earlier development of performance (1) in quiet than in competition and (2) for words than for sentences (competing condition). In children with otitis media, developmental functions were normal for both words and sentences in quiet and for sentences in competition. However, developmental functions were grossly abnormal for words in competition.