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PubMed1992

[Acute otitis media. Current therapeutic and clinical aspects].

Otitis media acuta is defined as an acute inflammation of the pneumatic spaces of the temporal bone, that means the middle ear including the mucous membranes of the mastoid cells and of the Eustachian tube; it is caused mainly by bacteria, rarely by viruses. When treated properly by antibiotics, otitis media acuta heals in the rule within two to three weeks completely. If more than three episodes of otitis media occur within one year, the disease is called recurrent otitis media. Secretory otitis media (mucoserotympanon) may be proceeded by an otitis media acuta, but it can also develop without any fore-going disease. If the inflammation of the middle ear is quite symptomless, it is called an occult otitis media or an occult mastoiditis; the causes are often insufficient antibiotic therapies. In these cases an operative treatment (paracentesis, mastoidectomy, antrotomy, adenoidectomy, ventilating tubes) may be necessary. If the defense of the mucous membranes respectively of the whole body is weak or the antibiotic treatment insufficient, there may develop some other sequelae like chronic otitis media, atelectasis, otitis media chronica adhesive, tympanosclerosis, with or without development of cholesteatoma. The typical clinical symptoms, possible complications and the recommended antibiotic and physical treatment are referred.

Acute Disease↗
PubMed2006

The role of multifrequency tympanometry in otitis media.

OBJECTIVE: To evaluate the diagnostic value of multifrequency tympanometry in otitis media with effusion and adhesive otitis media. METHODS: We selected 50 patients with long standing or recurrent attacks of otitis media with effusion from the outpatient clinic of the Ears, Nose and Throat (ENT) Department, Sohag Medical School, Egypt between May 2002 and December 2002. A control group was also selected, consisting of 25 patients with normal hearing levels and with no history of ENT problems. We conducted full audiological investigations in the form of pure tone audiometry, speech audiometry and immittancemetry. Immittancemetry included low probe tone frequency and multifrequency tympanometry. Each subject in the study group had undergone myringotomy and examination under microscope to decide if the case had either otitis media with effusion or adhesive otitis media. RESULTS: Resonant frequency proved to have the best performance in reflecting middle ear pathology. It was lowest in otitis media with effusion with a mean value of 428 +/- 159 Hz and it was highest in adhesive otitis media with a mean of 1336 +/- 230 Hz. CONCLUSION: Multifrequency tympanometry has an efficacy of 100% in the diagnosis of otitis media with effusion and 70% in the diagnosis of adhesive otitis media.

Acoustic Impedance Tests↗
PubMed2006

[Results of treatment with tympanostomy tubes in children with otitis media with effusion].

INTRODUCTION: Otitis media with effusion is a common problem in childhood. The tympanostomy tubes is a standard treatment of persistent otitis media with effusion in children which improves hearing level. However some pathological changes of the tympanic membrane and middle ear few years after treatment are observed. The aim of the study was prevalence of middle ear sequelaes in children with persistent otitis media with effusion treated by tympanostomy tubes 4-10 years after treatment. MATERIAL AND METHODS: The group of 61 patients aged between 1-13 with otitis media with effusion treated by tympanostomy tubes in Department of Otolaryngology Childrenís Hospital in Warsaw between 1994-2001 were controlled. 113 ears treated with tympanostomy tubes were examined 4-10 years after treatment. At the examination otomicroscope, pure-tone audiometry and tympanometry were used. RESULTS: Out of the 113 ears after ventilation tubes insertion as a method of otitis media with effusion treatment in 83 (73%) developed one or more middle ear sequelaes. Myringosclerosis in 47 ears (41,59%), segmental atrophy in 19 ears (16,81%), atrophy in 14 ears (12,38%), disfunction of Eustachian tube in 8 ears (7,07%), otitis media with effusion in 7 ears (6,19%), perforation of tympanic membrane in 6 ears (5,3%), chronic otitis media in 2 ears (1,76%), retraction pocket in 2 ears (1,76%) and tympanostomy tube in the middle ear cavity in 1 ear (0,88%) were found. No cases of cholesteatoma were found. In 22 ears (19,46%) the conductive hearing loss was greater than 20 dB. In 4 ears (3,5%) mixed hearing loss and in 3 ears (2,6%) receptable hearing loss was diagnosed. Tympanogram type A was in 86 ears (76,1%), tympanogram type B was in 11 ears (9,7%) and tympanogram type C was in 12 ears (12,6%). CONCLUSIONS: In children with otitis media with effusion treated with tympanostomy tubes the amount of sequelaes increased with time. In children with otitis media with effusion who started treatment with tympanostomy tubes in age to 4 years old the amount of sequelaes is less. The follow-up is recommended up to 8 years after the treatment.

Acoustic Impedance Tests↗
PubMed1993

Exclusive breast-feeding for at least 4 months protects against otitis media.

OBJECTIVE: This study was designed to assess the relation of exclusive breast-feeding, independent of recognized risk factors, to acute and recurrent otitis media in the first 12 months of life. METHODS: Records of 1220 infants who used a health maintenance organization and who were followed during their first year of life as part of the Tucson Children's Respiratory Study were reviewed. Detailed prospective information about the duration and exclusiveness of breast-feeding was obtained, as was information relative to potential risk factors (socioeconomic status, gender, number of siblings, use of day care, maternal smoking, and family history of allergy). Acute otitis media and recurrent otitis media, defined as three or more episodes of acute otitis media in a 6-month period or four episodes in 12 months, were the outcome variables. RESULTS: Of the 1013 infants followed for their entire first year, 476 (47%) had at least one episode of otitis and 169 (17%) had recurrent otitis media. Infants exclusively breast-fed for 4 or more months had half the mean number of acute otitis media episodes as did those not breastfed at all and 40% less than those infants whose diets were supplemented with other foods prior to 4 months. The recurrent otitis media rate in infants exclusively breast-fed for 6 months or more was 10% and was 20.5% in those infants who breast-fed for less than 4 months. This protection was independent of the risk factors considered. CONCLUSION: These findings suggest that exclusive breast-feeding of 4 or more months protected infants from single and recurrent episodes of otitis media.

Acute Disease↗
PubMed1987

Thickness of the human round window membrane in different forms of otitis media.

The thickness and morphologic characteristics of the round window membrane were evaluated in temporal bones from normal subjects as well as those with serous otitis media, purulent otitis media, and chronic otitis media. Temporal bones were studied in chronological order in six age ranges to determine the possibility of age-related differences. No significant difference in the mean thickness of the round window membrane was observed in terms of age groups in normal temporal bones or temporal bones from patients with otitis media; however, a significant difference in the mean thickness was observed in the various forms of otitis media compared with the normal round window membrane in all age groups. The membrane was thickest in patients with chronic otitis media when compared with that in normal subjects or those with serous or purulent otitis media. The epithelial layer (including the subepithelial space) and the fibrous layer were measured individually to determine in which layer the change in mean thickness occurred. These measurements showed an involvement of all layers of the round window membrane in those groups with otitis media, with maximal involvement of the combined epithelial layer and subepithelial space.

Adolescent↗
PubMed1993

Arachidonic acid metabolites in experimental otitis media and effects of anti-inflammatory drugs.

Previous studies have shown that arachidonic acid (AA) metabolites are important in the pathogenesis of otitis media with effusion. The AA metabolites in 4 different experimental models for otitis media were analyzed, and the effect of anti-inflammatory drugs was studied. Purulent otitis media was induced in rats by inoculation of Streptococcus pneumoniae in the tympanic bulla, serous otitis media by blocking the tympanal orifice of the eustachian tube, and mucoid otitis media by combining the two procedures. Middle ear effusion was also induced by stimulating the external auditory canal with cold air. Indomethacin and hydrocortisone were used to inhibit AA metabolism in the latter model. Lipoxygenase products dominated in the purulent and cold air otitis media models. Cyclooxygenase products dominated in the mucoid and serous models. Indomethacin inhibited accumulation of middle ear effusion in the cold air otitis media model, whereas hydrocortisone did not. Apart from AA metabolites, other mechanisms and mediators appear to be responsible for the increased vessel permeability observed in the cold air otitis media model, such as interactions between mast cells and nerves in the middle ear mucosa.

Animals↗
PubMed1984

[Role of azlocillin in the treatment of Pseudomonas aeruginosa otitis in children].

From May, 1978 to October, 1983, 88 children with otitis due to Pseudomonas aeruginosa were seen at Paediatric Unit E.N.T. consultation of the University Hospital of Tours. Epidemiologically, it is worth mentioning that the majority of these infections was not of nosocomial origin: 56 children were infected outside the hospital and 26 during their stay in hospital; 3 neonates were referred directly from the Maternity Unit. Most strains of Ps. aeruginosa, with various serotypes, were sensitive to azlocillin. Twenty-four children received a systemic treatment required by their local or general condition. Azlocillin was used in 24 cases on the basis of positive sensitivity tests and was occasionally combined with topical treatment using antiseptics or the antibiotic itself. Or the 3 failures observed, 2 were due to acquired resistance to azlocillin and 1 to chronic otitis. An incomplete result was obtained in a case of otitis externa caused by a strain of intermediate sensitivity. The remaining 19 cases were cured, including 3 neonates with otitis externa or media, 1 child with otitis externa, 1 with combined otitis externa and media, 10 with otitis media, usually protracted, 2 with mastoiditis medically cured and 1 with superinfection following mastoidectomy for cholesteatoma. Secretions dried up within 3 to 4 days and treatment was discontinued after clinical cure was obtained in 9 to 19 days. Fever, which was present in 7 cases, abated within 2 to 8 days. The only relapse that occurred, one month after treatment of an otitis media, responded to a second course of azlocillin.

Adolescent↗
PubMed2002

Quality-of-life outcomes after surgical intervention for otitis media.

OBJECTIVE: To assess the change in disease-specific quality of life in children with recurrent acute otitis media and/or chronic otitis media with effusion treated with surgical intervention. DESIGN: Prospective questionnaire-based outcome study. SETTING: An academic pediatric otolaryngology practice. PARTICIPANTS: Consecutive series of 123 children referred for surgical treatment of recurrent acute otitis media and/or chronic otitis media with effusion. INTERVENTION AND METHODS: Surgery included bilateral myringotomy and tympanostomy tube placement either alone or with adenoidectomy. An otitis media disease-specific questionnaire was administered before and after surgical intervention. MAIN OUTCOME MEASURES: Comparison of the mean percentage change in total ear symptom score between presurgery and postsurgery scores at 1 and 6 months after surgery. RESULTS: The mean percentage change in total ear symptom score was a 74.5% improvement (P<.001) at the 1-month follow-up and a 59.8% improvement (P<.001) at the 6-month follow-up. Parental worry related to the child's ear problems was also significantly decreased, with a mean otitis media disease-specific questionnaire score of 3.43 (P<.001) at 1 month and 2.64 (P<.001) at 6 months after surgery. When caregivers were asked if they would have their child undergo tympanostomy tube placement if they had to make the decision again, 91% and 84% responded yes at the 1- and 6-month follow-up, respectively. CONCLUSIONS: The disease-specific quality of life of children with recurrent acute otitis media and/or chronic otitis media with effusion with appropriate surgical indications significantly improved after surgical intervention. The amount of parental worry concerning their children's ear problems also significantly improved following surgery, and most caregivers would opt again for tube placement.

Acute Disease↗
PubMed1994

General illness and need of medical care in otitis prone children.

The frequency of acute infectious diseases and allergy was investigated in a group of 'otitis prone' children and a control group. A total of 252 children born between 1977 and 1981, prospectively followed and with six or more episodes of acute otitis media (AOM), were defined as an 'otitis prone' group. Of the children, 61% were boys and 39% were girls. The controls were 252 children randomly chosen from the population of Malmö and matched for age and sex. The medical records for both groups from the ages of 2 to 7 years were compared. The 'otitis prone' children accounted for an average number of ambulatory visits to the ENT or Paediatric clinics of 38.8 per child, compared with 9.2 in the control group, and had been hospitalized three times more often in the ENT department than the controls, and twice as often in the Paediatric department. The 'otitis prone' children accounted for more visits to the Orthopaedic clinic than the controls, but had not been hospitalized more often in the Surgical or orthopaedic departments. The 'otitis prone' children accounted for 2-4 times as many diagnoses of rhinopharyngitis, bacterial rhinitis/sinusitis and tonsillitis as controls, and significantly more diagnosed episodes of broncho/pulmonary, gastrointestinal and urinary tract infections. There were twice as many children in the 'otitis prone' group with allergic diseases as in the control group (37% vs. 17%). The findings showed the 'otitis prone' children to be more susceptible than the controls to different acute infectious diseases.

Ambulatory Care↗
PubMed1989

Modern management of otitis media.

In summary, infants and children who have acute otitis media should receive antimicrobial therapy. Amoxicillin is the standard of therapy for infants and children with acute otitis media, because it is safe and effective for most of the causative bacterial pathogens. Amoxicillin has also been shown to be effective for treatment of selected children with otitis media with effusion ("secretory" otitis media) and is the recommended prophylactic antimicrobial agent for prevention of frequently recurrent acute otitis media. During the past decade, however, an increasing rate of bacteria that are resistant to amoxicillin has occurred, primarily beta-lactamase-producing H. influenzae and B. catarrhalis. Because of the emergence of these bacteria, other antimicrobial agents, both old and new, have been advocated for treatment and prevention of otitis media; amoxicillin-clavulanate, cefuroxime axetil, and cefixime are the newer agents. These agents are indicated for selected infants and children; however, for most patients, amoxicillin remains a safe and relatively inexpensive effective drug. The common surgical procedures, such as myringotomy with tympanostomy tube insertion, and adenoidectomy with myringotomy with or without tympanostomy tube insertion, have now been shown to be effective for patients who have recurrent acute otitis media and chronic otitis media with effusion. The decision for or against these procedures should not only include consultation with an otolaryngologist but should also involve the parents and the child, if old enough. The risks, costs, and benefits of nonsurgical and surgical management should be discussed with all parties concerned.

Acute Disease↗
PubMed2001

Effect of recolonisation with "interfering" alpha streptococci on recurrences of acute and secretory otitis media in children: randomised placebo controlled trial.

OBJECTIVE: To study the effect of recolonisation with alpha streptococci with the ability to inhibit the growth of otopathogens ("interfering" activity) on the recurrence of acute otitis media in susceptible children and the effect on the frequency of secretory otitis media. DESIGN: Double blind, randomised, placebo controlled study. SETTING: Ear, nose, and throat clinic with three doctors. PARTICIPANTS: 130 children prone to otitis media aged between 6 months and 6 years, 108 of whom were eligible and followed for 3 months. MAIN OUTCOME MEASURES: Recurrence of otitis media during follow up and a normal tympanic membrane at the last valid visit. INTERVENTIONS: Children with no recurrences during the last month received phenoxymethylpenicillin (n=22), and those with a recurrence within 1 month received amoxicillin clavulanic acid (n=86), both twice daily for 10 days. These were followed by a streptococcal or placebo solution sprayed into the nose for a further 10 days. At day 60 the same spray was started for another 10 days. RESULTS: At 3 months 22 children (42%) given the streptococcal spray were healthy and had a normal tympanic membrane compared with 12 (22%) of those given placebo. This difference was shown separately for recurrences of both acute otitis media and secretory otitis media. CONCLUSIONS: Selected bacteria with the ability to inhibit the growth of common otopathogens can be used to protect against recurrent acute otitis media and secretory otitis media in children.

Aerosols↗
PubMed2005

Adenoidectomy does not significantly reduce the incidence of otitis media in conjunction with the insertion of tympanostomy tubes in children who are younger than 4 years: a randomized trial.

OBJECTIVE: To evaluate the efficacy of adenoidectomy in reducing the incidence of otitis media among children who are younger than 4 years and receive tympanostomy tubes. METHODS: A randomized trial was conducted at a tertiary center clinic. A total of 217 children who were aged 12 to 48 months and had recurrent acute otitis media (>3 episodes during the past 6 months) or chronic otitis media with effusion, no obstructive symptoms as a result of adenoid enlargement, and no previous surgical intervention were enrolled in the study. Adenoidectomy in conjunction with the insertion of tympanostomy tubes or insertion of tympanostomy tubes without adenoidectomy was studied. The number of otitis media episodes during the follow-up period of 12 months was measured. RESULTS: During the follow-up, the mean number of otitis media episodes was 1.7 among children who underwent adenoidectomy with concurrent insertion of tympanostomy tubes and 1.4 among children who received tympanostomy tubes only. The risk for recurrent otitis media (>or=3 episodes) could not be reduced by adenoidectomy (odds ratio: 1.66; 95% confidence interval: 0.80-3.46). CONCLUSION: Adenoidectomy does not significantly reduce the incidence of acute otitis media in otitis prone children who are younger than 4 years and receive tympanostomy tubes.

Acute Disease↗
PubMed2003

[Role of cytokines in pathomechanism of otitis media].

Otitis media is one of the most common diseases in children. A variety if cytokines, potent inflammatory mediators, play a crucial role in the initiation and maintenance of the immunological response in otitis media. We discussed a profile of cytokines in various forms of otitis media (otitis media acute, chronic otitis media with effusion) and we underlined the differences between these types. We also described the influence of the most common pathogens of otitis media (S. pneumoniae and H. influenzae) on the cytokine panel in middle ear effusion. We discussed the current data supporting the hypothesis that in some cases the middle ear may act as a target organ for allergic inflammation. Since numerous authors demonstrated that the cytokine profiles are relevant for the evolution of otitis media it has been proposed that measurement of some proinflammatory cytokines in the middle ear effusion may be used in order to monitor the inflammatory process. It has been also proposed using cytokines as a target for pharmacological manipulation in the treatment of otitis media.

Child↗
PubMed2003

Otitis media. A scholarly review of the evidence.

Antibiotic therapy remains the treatment of choice for otitis media in most countries despite persuasive evidence that antibiotic therapy provides limited clinical benefit and promotes bacterial resistance. Meta-analysis of randomized, placebo-controlled trials demonstrated that antibiotics increased resolution at 1 week by only 13%. Amoxicillin remains as effective as any other antibiotic, despite increasing resistance to amoxicillin among the major bacterial pathogens. Immediate antibiotic treatment has been shown to reduce the duration of symptoms by 1 day but not until after the first 24 hours when symptoms were already improving. A delayed prescribing strategy is currently utilized in most children for management of acute otitis media in the Netherlands; this method is now being evaluated elsewhere. Antibiotic therapy is delayed for 48-72 hours after diagnosis; thereafter, antibiotics are initiated only if symptoms persist or worsen. In 2 studies utilizing this strategy (England and the United States), only 24-30% of the patients in the delayed treatment group initiated antibiotic therapy; a majority of parents of children in the delayed group were satisfied with their child's treatment. Treatment of bacterial otitis media ("pus drum") with high dose amoxicillin (80-100 mg/kg/kd) is recommmended; for acute otitis media without bulging, watchful waiting with a delayed prescribing strategy and treatment of pain is preferred. Yearly administration of the influenza vaccine and/or treatment of influenza with an antiviral (oseltamivir) can significantly decrease the incidence of acute otitis media during influenza season. Although pneumococcal vaccination effectively reduces the incidence of acute otitis media due to vaccine-related serotypes, there is a significant increase in the number of episodes of acute otitis media due to other serotypes of S. pneumoniae such that the overall incidence of acute otitis media is reduced only minimally by pneumoccocal vaccine. The careful use of strict diagnostic criteria coupled with judicious use of antibiotic therapy will direct antibiotic treatment to only those patients likely to benefit.

Acetamides↗
PubMed1981

Pharmacologic compliance with antibiotic therapy for acute otitis media: influence on subsequent middle ear effusion.

The frequency of otitis media with effusion (serous otitis media, secretory otitis media) detected after conventional antibiotic treatment of acute otitis media is approximately 50%. The relationship between pharmacologic compliance and the frequency of otitis media with effusion was studied. A Micrococcus lutea bioinhibition test was used to detect the presence of a substances in the urine that inhibited the growth of this antibiotic-sensitive organism. On the fourth, seventh, and tenth days of antibiotic treatment for acute otitis media urine specimens were collected. Otitis media with effusion was detected in 53% of 66 children who had positive results for M lutea bioinhibition compliance test for all three urine specimens. Electro-acoustic impedance measurements (tympanograms) confirmed the presence of effusion in all children in the effusion group tested by this method. The M lutea bioinhibition assay is a practical, in-office method to validate periodically, during treatment, pharmacologic compliance with antibiotics used for treatment of acute otitis media. Pediatrics 68:619-622, 1981.

Acoustic Impedance Tests↗
PubMed1997

Otitis media treatment in New Zealand general practice.

AIMS: To compare incidence and general practice treatments for acute (AOM), serous (OME), and recurrent (ROM) otitis media in New Zealand. METHODS: A retrospective analysis of 2901 consultations for otitis media was undertaken. Specific diagnostic groups were compared for antibiotic treatments offered, duration of therapy, and treatment success. Twenty New Zealand general practices contributed 290100 computerised consultation records generated between 1 July 1993 and 30 June 1994. Records from 2089 otitis media patients were examined to determine incidence and treatment success. RESULTS: Most initial acute otitis media and recurrent otitis media presentations resulted in antibiotic treatment (96.6% and 94.9%): fewer otitis media with effusion presentations (77.6%) were initially treated with antibiotics. Age and treatment success were significantly associated for patients with acute otitis media: patients < 2 years were least likely to be successfully treated (p < 0.0001). There was no difference in success rates between antibiotic and no antibiotic therapies. Antibiotic therapy duration ranged from < 6 days to 40 days. Shorter courses were as likely as longer courses to be successful for all diagnoses. CONCLUSIONS: The outcome of otitis media episodes is more closely related to patients' age than to specific diagnosis, type or duration of therapy.

Acute Disease↗
PubMed1976

Otitis externa in children.

The commonest cause of ear-ache in children is otitis externa and five new cases of otitis externa will be seen for every case of otitis media.ACUTE OTITIS EXTERNA AND OTITIS MEDIA ARE QUITE DIFFERENT AND DISTINCT CLINICAL ENTITIES IN CHILDREN: the former is a tender, dirty, pruritic ear, often recurring in children with simple febrile illnesses; the latter is more isolated than is realised, non-recurrent and usually accompanying upper respiratory catarrhal illness.The fleeting nature of otitis externa as seen in childhood is typical of clinical material in general practice that presents quite differently from that in hospital practice. The long aetiological lists quoted in all series of cases of otitis externa in adults do not apply to otitis externa as seen in children.

Adolescent↗
PubMed1995

Chronic otitis media with effusion in infancy. How frequent is it? How does it develop?

OBJECTIVE: To study the occurrence and development of chronic otitis media with effusion in infancy. DESIGN: A retrospective birth cohort with a 2-year follow-up. Infection data were gathered from medical records; background information came from questionnaires. SETTING: Primary health care centers, hospitals, and private practices in 10 randomly selected local government districts in the two northernmost provinces of Finland. SUBJECTS: A random sample of 2512 children from the cohort. MAIN OUTCOME MEASURES: Chronic otitis media with effusion determined as a minimum of 2 months of asymptomatic middle ear effusion revealed by tympanocentesis and specific operative findings. RESULTS: The periodic prevalence rate of chronic otitis media with effusion up to the age of 24 months was 4.4% (95% confidence interval, 3.5 to 5.3). The maximum risk was at age 16 months. The number of acute otitis media episodes among children who developed chronic otitis media with effusion was more than double that of normal healthy children before the onset of chronic inflammation and about five times as high during prolonged mucous middle ear effusion. Inadequate treatment of prior acute otitis media was not the reason for the chronic inflammation, which was a direct continuation of an acute episode in only half of the cases and was otherwise preceded by a latent period of varying duration. CONCLUSIONS: Chronic otitis media with effusion, which may cause adverse developmental effects such as delayed language development, is a fairly common disease in infancy and is closely related to acute otitis media episodes.

Acute Disease↗