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.     

Management of children with otitis media: A summary of evidence from recent systematic reviews

Health-care professionals who manage children are regularly confronted with clinical questions regarding the management of the full spectrum of otitis media: acute otitis media; otitis media with effusion; and chronic suppurative otitis media. Given the variety of potential therapies available, the wide spectrum of middle ear disorders, and the lack of consensus about management strategies, clinicians are in a difficult position when managing these children. In this review, we seek to summarise the current best evidence for answering otitis media management questions by collating existing systematic reviews.     

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.     

Missed opportunities for a diagnosis of acute otitis media in Aboriginal children

OBJECTIVE: Severe otitis media and its sequelae are common in rural and remote Aboriginal children. Identification of acute otitis media (AOM) is likely to reduce the number of children who go on to develop chronic suppurative otitis media and associated complications. The aim of this study was to compare the diagnoses made by researchers with that documented in the medical records of children admitted to the paediatric isolation ward of the Royal Darwin Hospital, Darwin, Northern Territory. METHODS: Children aged <8 years admitted to Royal Darwin Hospital were eligible for assessment by pneumatic otoscopy, video-otoscopy and tympanometry. A diagnosis was made for each child according to the state of their worst ear. Comparisons were made between the researcher diagnoses of ear disease and those documented in the hospital notes by medical staff. RESULTS: Thirty-one children were enrolled during 32 admissions. Most were aged <2 years, Aboriginal, and resided in remote communities. Sixty-one video-otoscopic assessments were attempted and sufficiently good images to allow diagnosis were obtained in 105 of 122 ears. Acute otitis media was diagnosed by the research team in 20 of 32 child admissions. Of 29 children who had ear examinations documented by hospital staff, only seven had a diagnosis of AOM recorded. Overall, the research team were almost three times more likely to make this diagnosis (relative risk 2.9, 95% confidence interval 1.6, 5.2). This difference was unlikely to have occurred by chance (P = 0.0002, McNemar's Chi-squared test). CONCLUSIONS: In this small study, young Aboriginal children with clear bulging of their tympanic membrane were not diagnosed with AOM by medical staff. Further training in diagnosis, including cleaning of the ear canal, may lead to more accurate assessment and appropriate recommendations for ongoing management.     

A systematic review of clinical research addressing the prevalence, aetiology, diagnosis, prognosis and therapy of otitis media in Australian Aboriginal children

The objective of this review was to systemically identify and summarize all the clinically relevant evidence available from studies addressing the prevalence, aetiology, diagnosis, prognosis and therapy of otitis media in Australian Aboriginal children. Electronic searching of Medline, the Australian Medical Index and the Aboriginal and Torres Strait Islander Health Bibliographic Index was performed. This was supplemented by hand searching the Menzies School of Health Research otitis media collection, the Aboriginal and Torres Strait Islander Health Information Bulletin and Aboriginal Health: an annotated bibliography. Data were extracted and placed in a series of evidence tables relevant to clinical practice. There were 59 studies that met the inclusion criteria. The majority were surveys, and only 19 addressed diagnosis, prognosis or therapy. Severe otitis media in rural Aboriginal children does not occur in isolation but as part of a spectrum of chronic bacterial infections of the respiratory tract. Although the aspects of poverty that result in this condition remain to be clarified, exposure to other young children with chronic nasal discharge is likely to be important. Whilst there is a considerable amount of literature on otitis media in Australian Aboriginal children, the number of studies most relevant to improving health outcomes is small. A systematic approach to disease surveillance, diagnosis, and application of medical interventions is required urgently. Future medical research should be concerned with the evaluation of interventions and the generalisabilty of studies from different populations.     

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     

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.     

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 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     

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.     

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??Immaturity of the immune system and exposure to infectious agents contribute to the susceptibility of RRTIs in children?? and RRTIs are usually treated with immunomodulating agents. The administration of probiotics plays a role in modulation of immune responses by various methods, including colonization resistance?? increased number and activity of natural killer cells?? release of cytokines?? and enhanced antibody response?? et al. Data show that probiotics may be bene?cial to preventing respiratory tract infections??RTIs???? reducing the number of episodes of RTIs?? diminishing the severity of infection symptoms?? and reducing duration of episodes?? antibiotic use and the number of days absent from day care/school. Probiotics appear to be a feasible way to decrease the incidence of RTIs in children??but further well-designed studies are needed to evaluate the strains?? dosing?? and frequency in the use of probiotics for RRTIs.     

Bezold's abscess: A serious complication of otitis media

This report describes a case of Bezold's abscess, a rare complication of mastoiditis, following otitis media. Included is a discussion of mastoiditis and its management.     

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.     

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