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PubMed2003

Immunoglobulins in otitis-prone children.

Defective or immature antibody responses to pathogens in children may explain the increased susceptibility to acute otitis media (AOM) in otitis-prone children. In literature, data on immunology have been based on studies of small groups of severely otitis-prone children and have not been consistent. Humoral immune status was assessed in 365 children, 1-7 years old, with two or more documented episodes of AOM in the previous year. Children with 4 or more episodes in the preceding year were defined as otitis-prone. Serum immunoglobulin levels were determined by radial immunodiffusion. Immunoglobulin levels of otitis-prone children were compared with those of children who had experienced 2-3 AOM episodes per year. Children with recurrent episodes of AOM were found to have normal or increased serum IgA, IgM, IgG, and IgG1 levels compared with normal values for age, whereas the serum IgG2 levels were mostly in the lower normal range. Twenty-two percent of all children showed IgG2 levels lower than 2 SD below the age-specific mean. Interestingly, the otitis-prone group of children showed significantly lower median and mean levels for all immunoglobulins compared with those children with only 2-3 previous AOM episodes. Lower immunoglobulin levels in otitis-prone children suggest a generalized decreased antibody response in otitis-prone children.

Acute Disease↗
PubMed1997

Otitis media-related antibiotic prescribing patterns, outcomes, and expenditures in a pediatric medicaid population.

BACKGROUND: Treatment of otitis media is the most frequent reason for administering antibiotics to children in the United States. However, only limited data are available on medical effectiveness of antibiotic prescribing patterns for otitis media and their associated expenditures or the factors that influence antibiotic prescribing. METHODS: The study population consisted of 131 169 children during 1991 and 157 065 children during 1992 who were </=13 years of age and enrolled in Colorado's fee-for-service Medicaid program. Among these children, 5127 (1991) and 7254 (1992) were enrolled in the cohort treated for a "new" episode of acute otitis media. An analysis using this cohort was performed to document the antibiotics used to treat a new episode of acute otitis media, factors influencing antibiotic selection, and the short-term outcomes of therapy. An analysis using the entire Medicaid population was performed to document the annual use of antibiotics for otitis, the associated antibiotic expenditures, and factors influencing antibiotic selection. RESULTS: In the cohort analysis, office-based physicians prescribed second- and third-generation cephalosporins more often than did physicians in other settings (17% vs 9.7% and 11.8%), whereas hospital clinics prescribed trimethoprim plus sulfamethoxazole more frequently than did office-based physicians (19.2% vs 7.1% and 10.9%). Family physicians prescribed second- and third-generation cephalosporins more often than did pediatricians (16.6% vs 12.3%) but trimethoprim plus sulfamethoxazole and erythromycin plus sulfisoxazole less often than did pediatricians (10.5% vs 17%). The average rate of prescribing a second course of antibiotics within 24 days after initial antibiotic treatment of a new acute otitis media episode was 11.6% when less expensive antibiotics (amoxicillin, trimethoprim plus sulfamethoxazole, or erythromycin plus sulfisoxazole) were prescribed, and 13.2% when more expensive antibiotics (cefaclor, amoxicillin plus clavulanate, or cefixime) were prescribed. The average adverse drug reaction rate was 5.9% when less expensive antibiotics were prescribed, compared with 6.1% when more expensive antibiotics were prescribed. In each of the two study years, amoxicillin accounted for almost half of the total antibiotic fills but only 9% to 10% of the expenditures. Low-cost antibiotics (amoxicillin, trimethoprim plus sulfamethoxazole, and erythromycin plus sulfisoxazole) were prescribed for 66% to 67% of the total fills and accounted for 21% of the total projected expenditures. More expensive antibiotics (cefaclor, cefixime, amoxicillin plus clavulanate) prescribed for 30% of the fills generated 76% to 77% of expenditures. Cefaclor, prescribed for 17% to 18% of the total fills, generated 43% to 45% of total antibiotic expenses. CONCLUSIONS: The findings of this study document a preference for amoxicillin as the initial antibiotic for a new episode of acute otitis media. Although there was a wide variation in the selection of antibiotics to treat otitis, the more expensive antibiotics were not associated with better outcomes. This wide variation has important financial implications because of differences in antibiotic costs. Changes in prescribing patterns among initially uncomplicated children that reduce the use of high-cost antibiotics could reduce expenditures substantially without compromising short-term outcomes.

Acute Disease↗
PubMedDate not supplied

Treatment of otitis externa in children.

Inflammation of the external auditory canal can be localised or diffuse, and acute or chronic. Predisposing conditions include external trauma, loss of the canal's protective coating, maceration of the skin from water or humidity, and glandular obstruction. Acute otitis externa is generally caused by Pseudomonas aeruginosa or Staphylococcus aureus. Management of patients with otitis externa includes debridement, topical therapy with acidifying and antimicrobial agents, and systemic antimicrobial therapy when indicated. The management of patients with chronic otitis externa includes cleansing and debridement accompanied by topical acidifying and drying agents. This is followed by topical antibiotics and corticosteroid preparations. Surgery is mainly used to allow cleansing and aeration and/or removal of the scarred tissue. Patients with acute localised otitis externa (furunculosis) are treated with local heat and systemic antibiotics in the inflammatory stage, and drainage in the abscess state. Mycotic external otitis is managed with topical acidifying and antifungal agents, while viral (herpes) infection is treated with topical and systemic aciclovir (acyclovir). Patients with necrotising (malignant) external otitis, which is mainly caused by P. aeruginosa and S. aureus, are treated with systemic antibiotics and, rarely, by surgical debridement. Therapy for eczematous otitis externa is first directed at the secondary infection, and thereafter at the primary dermatological condition. Prevention of recurrent external otitis is aimed at minimising ear canal trauma and the avoidance of exposure to water. Preventative use of topical acidifying agents or 70% alcohol is also advocated.

Child↗
PubMed1997

Otitis-prone children and controls: a study of possible predisposing factors. 2. Physical findings, frequency of illness, allergy, day care and parental smoking.

In a retrospective study of 179 otitis-prone children and 305 controls, various possible predisposing factors for acute otitis media (AOM) were compared. The children were matched with the controls for age and sex. There were 61% boys and 39% girls in the otitis-prone group and 58% boys and 42% girls among the controls. Information about the family and living conditions, the children's illnesses, ear, nose and throat (ENT) operations and possible allergies were obtained from a questionnaire, and the children were called for a physical examination. The otitis-prone children had more middle-ear problems with pathological tympanograms and conductive hearing loss than the controls. No differences were found in bacterial colonization of the nasopharynx. Besides AOM and secretory otitis media, the otitis-prone children had more other ENT diseases and had consequently undergone more ENT operations and hospitalizations than the controls. There were no differences between the two groups regarding allergy, day care or parental smoking alone, but on comparing children with combinations of these factors there were more otitis-prone children than controls exposed, indicating an additive effect. The combination of different factors, less important separately, may for some children mean the difference between becoming otitis-prone or not.

Acoustic Impedance Tests↗
PubMed1996

New prospects in the prevention of otitis media.

Otitis media is the most common bacterial infection in children, accounting for a substantial economic burden to the health care system. Together with concern for long-term developmental sequelae, prevention of otitis media has become a high priority area of research. A wide range of factors has been associated with an increased risk of acute otitis media. Most of these factors, however, predispose to upper respiratory tract infection which, in turn, can be considered the most important risk factor for acute otitis media. Conventionally, antimicrobial prophylaxis, tympanostomy tubes and adenoidectomy have been used for prevention of otitis media. At present, the vaccine approach seems to hold the greatest promise for ultimate prevention of otitis media. In addition to the bacterial vaccines, vaccines against the most common viruses predisposing to acute otitis media may also prove valuable in the prevention of otitis media.

Adenoidectomy↗
PubMed1998

The prevalence of otitis media with effusion among Inuit children.

PURPOSE: Studies over the past 30 years have shown a decline in the prevalence of chronic otitis media in some parts of the Arctic, presumably largely due to more prompt treatment, preventing acute infections from becoming chronic. In contrast, some researchers have suggested that the prevalence of otitis media with effusion has increased. The purpose of this study was to determine the prevalence of otitis media with effusion among children aged 6-17 years in Sanikiluaq, an Inuit community in the Keewatin District of the Northwest Territories. METHODS: A cohort of 126 children at the local community school was examined and assessed by otoscopy, audiometry, and impedance testing. RESULTS: Four percent of children were found to have otitis media with effusion causing significant hearing loss. An additional 17% had otitis media with effusion, with minimal or no detectable hearing loss. Thus, the prevalence of otitis media with effusion in Sanikiluaq school-age children is 4% to 21%. There are few previously published data with which to compare these findings. In the past, otitis media with effusion was infrequently reported among the Inuit. Therefore, our results may suggest an increasing prevalence over the past several decades. If these results are representative of other communities, otitis media with effusion is a significant health problem among the Inuit.

Adolescent↗
PubMed2000

Labeling of the glucocorticoid receptor and Na,K-ATPase in a rat otitis media model.

HYPOTHESIS: Glucocorticoid hormones exert an influence on the inflammatory response of the middle ear during acute otitis media. Rats with experimentally induced purulent otitis media were given either glucocorticoid hormones in excess or a glucocorticoid hormone blocker that deprived the animals of the hormone. BACKGROUND: Acute otitis media is a common inflammatory disease among children. Streptococcus pneumoniae is the most usual causative agent. The standard treatment today is phenoxymethylpenicillin. The role of glucocorticoid hormones in inflammatory reactions in the middle ear has been widely debated. METHODS: In an otitis media model, a suspension of pneumococci was inoculated into the bulla of the rat, after the animals were pretreated with either a dose of corticosteroid hormones or the glucocorticoid receptor blocking agent RU 486. Rats with induction of otitis media only, but no pretreatment, were used as control subjects, as were the left control-operated ears of all rats. The inflammatory response in the inner ear and in the middle ear was evaluated. The presence of glucocorticoid receptors and the enzyme Na,K-ATPase was investigated with immunohistochemistry. RESULTS: The inflammatory response in the animals with untreated otitis media and in the group with otitis media in rats pretreated with the receptor blocker was much more extensive than in the group of animals pretreated with corticosteroids. In the corticosteroid-treated group, the tympanic membrane and the mucous membrane of the middle ear were less edematous, but the middle ear cavity contained more pus. Only a few lymphocytes were found in the inner ears of these rats. When the inner ear was labeled with antibodies against glucocorticoid receptors, there seemed to be no difference between the labeling patterns in the three groups. This was also the case for antibody labeling against Na,K-ATPase. CONCLUSION: The present results indicate that the reaction in the middle ear mucous membrane is more pronounced in rats that had been pretreated with the hormone receptor blocking drug. An increase of corticosteroid hormone levels during the inflammatory process seem to diminish the reaction in the tympanic membrane and the middle ear mucosa. Neither the hormone receptor blocking drug nor the steroid hormones change the content of glucocorticoid receptors and Na,K-ATPase in the inner ear in the otitis media rat model.

Acute Disease↗
PubMedDate not supplied

[Recurrent otitis media with effusion and food allergy in pediatric patients].

INTRODUCTION: Recurrent otitis media with effusion continues to be important pediatric clinical problem and is related to food allergy. OBJECTIVE: The purpose of the present investigation was to determine if the recurrent otitis media with effusion was associated to food allergy. METHODS: We reviewed medical charts from children with food allergy and otitis media with effusion for a period of three months of duration or every month for the last six months seen in an allergy clinic. Patients with anatomic abnormalities, polypous or immunologic deficiencies were excluded. Every patient was challenged with foods to which he/she was allergic in order to demonstrate cause-effect. In all patients we performed tympanometries. RESULTS: We found twenty five patients with recurrent otitis media with effusion and food allergy demonstrated by positive skin testing. The most common food found to be associated was milk, egg, beans, citrus, and tomato. The elimination of the food diet led to a significant amelioration of the otitis in 22 patients, in whom clinical and tympanometry evaluation was performed. The challenge diet with suspected offending food provoked a recurrence of the otitis problem. CONCLUSION: These results demonstrated the association between recurrent otitis media with effusion and food allergy. Therefore, all patients with recurrent otitis media with effusion should be investigated for food allergy.

Acoustic Impedance Tests↗
PubMed1975

[Noise-induced hearing loss with chronic otitis media (author's transl)].

Two different otological noxes add up in their effect. In some cases, however, the first one may cause a reduction of the noxious effect of the second one. Opinions are divided as to whether the susceptibility to noise of an ear with chronic otitis media is increased or decreased. From 14,300 audiograms we selected those 131 cases with unilateral chronic otitis media and, at the same time, with a typical noise-induced recruitment-positive c5-dip on the other side. There were 86 cases with larger bone conduction hearing loss on the ear with chronic otitis media. In these cases, the bone conduction hearing loss, by all differential diagnostic criteria, could be judged to be caused by the chronic otitis media. On the other hand, in all those 45 cases which, on the side with chronic otitis media, had a bone conduction loss in form of a c5-dip, this was in each single case less pronounced than on the other ear. Regarding the susceptibility to noise, the reduction of sound intensity by the conductive deafness seems to be more important than noxious effects of the chronic otitis. Generally a substantial bone conduction hearing loss with chronic otitis media and noise exposure should be attributed to effects of the otitis.

Adult↗
PubMedDate not supplied

[Otitis media in childhood: a critical review of the literature].

Infection of the middle ear is one of the most common childhood illnesses accounting for one-third of the pediatrics practice during the first five years of life. Therefore treatment and prevention of the otitis media are of considerable importance. A review of the literature of the otitis media during the pediatric age is reported. In fact in the last years a large amount of knowledge, sometimes referring discordant opinions, has been acquired. The Authors report epidemiology, anatomy, pathology, physiology, microbiology, classification, clinical data diagnosis and therapy of the otitis media. Common conditions of the middle ear (normal, acute otitis media, chronic otitis media, recurrent otitis media) are described. In particular acute otitis media, otitis media with effusion, perforation of the tympanic membrane, fluid level in the middle ear, severe retraction or bulging of the tympanic membrane are pointed out in color-photographs.

Acute Disease↗
PubMed1990

Therapy of otitis media.

The epidemiology, pathogenesis, diagnosis, complications and sequelae, and therapy of otitis media are reviewed. Otitis media is one of the most common infections in infants and children. Epidemiologic studies have identified season of the year, bottle versus breast feeding, socioeconomic status, race, sex, and daycare attendance as factors associated with the occurrence of otitis media. The condition is believed to arise secondary to eustachian tube dysfunction in the presence of viral or bacterial invasion of the nasopharynx. Diagnosis is often made by direct observation of the tympanic membrane with an otoscope. If untreated, the infection can spread to other structures in the aural cavity or even to the brain and meninges. The most frequent complication of otitis media is hearing loss, which may result in speech and learning difficulties. Oral antimicrobial agents--notably ampicillin, amoxicillin, amoxicillin-clavulanate, cefaclor, cefuroxime axetil, bacampicillin, cyclacillin, erythromycin ethylsuccinate-sulfisoxazole, cefixime, and trimethoprim-sulfamethoxazole--are the mainstay of treatment. Selection of the agent should be based primarily on its spectrum of activity against Streptococcus pneumoniae and Haemophilus influenzae. Other considerations include the presence of beta-lactamase-producing strains of H. influenzae and Branhamella catarrhalis, adverse effects, cost, and compliance. In cases of recurrent otitis media, antimicrobial prophylaxis or surgery may be indicated. Chronic otitis media with effusion may be treated with oral antimicrobials, but surgery may also be necessary. Chronic suppurative otitis media often requires hospitalization and intravenous antimicrobial therapy with agents effective against Pseudomonas aeruginosa. Oral antimicrobial agents represent the treatment of choice for otitis media, but such therapy addresses only one of the several etiologic factors identified.

Humans↗
PubMed1977

Middle ear ventilation after acute otitis media.

The investigation includes 43 children (82 ears) with acute otitis media who were treated with paracentesis and antibiotics. The middle ear pressure was measured 7 days, 14 days, 1 month, and 2 months after the otitis. A follow-up examination was performed 4-12 months after the otitis. The normalization process was extremely slow: 3 months after the otitis only 37% of the ears had a pressure between 0 and -50 mm H2O, and 24% had flat curves and chronic secretory otitis. 3-12 months after, 49% of the ears had a normal pressure. A discussion on whether the middle ear ventilation had been reduced before the present otitis, or whether the slow normalization process is due to the changes in the mucous membrane is presented. The first assumption seems to be more probable. The significance of poor ventilation in the occurrence of recurrency is emphasized. Tympanometry is recommended 1-3 months after otitis, especially in recurrent otitis media.

Acute Disease↗
PubMed1995

The surprisingly high acceptability of low-efficacy vaccines for otitis media: a survey of parents using hypothetical scenarios.

OBJECTIVE: To determine parental thresholds for accepting vaccines for otitis media prevention given tradeoffs of efficacy, adverse effects, and administration mode. METHOD: We interviewed 601 randomly selected parents with children 0 through 6 years of age presenting to our community pediatric clinic. For each of five hypothetical vaccines, which varied administration mode from nasal spray to two injections and adverse effects from mild to severe, parents indicated the lowest number of otitis media episodes that the vaccine had to prevent in the next 6 months for them to accept the vaccine. RESULTS: About half the parents would accept any one of the vaccines if it would prevent three or more infections in the next 6 months. When the vaccine would prevent one episode of otitis media over the next 6 months, 33% of parents would accept the medial vaccine (one injection in the thigh, with some children getting a red, sore injection site and a few having a fever of < or = 102 degrees F for one day). Seventeen percent accepted a vaccine requiring two injections (influenza vaccine-like) or having increased adverse effects (pneumococcal vaccine-like) despite the vaccine only preventing one episode of otitis media over the next 6 months. No substantial differences in these proportions were found when compared among groups by reason-for-visit, recent occurrence of otitis media, or a history of recurrent otitis media in a sibling. CONCLUSION: Many parents will accept low efficacy vaccines for otitis media prevention. Parental acceptance does not vary with the child's otitis media experience but does vary with severity of adverse effects and administration mode of the vaccine.

Child↗
PubMed1995

Outcome-oriented managed care comparing efficacies of cefaclor and amoxicillin in acute and recurrent acute otitis media.

A study utilizing outcome-oriented cure is employed to show the effectiveness of a given medical treatment. A specific patient population is studied in order to determine the most effective treatment for a common clinical disorder. A total of 201 children were retrospectively studied to evaluate the efficacy and side effects of amoxicillin and cefaclor in the treatment of acute otitis media and recurrent acute otitis media. There were 456 episodes of acute otitis media; 245 episodes were treated with amoxicillin with an efficacy of 91%, while 211 episodes were treated with cefaclor with an efficacy of 97%. The dosage of 40 mg/kg/day, divided in three equal doses, was employed for both antibiotics in the treatment of acute otitis media, while half of this amount was given once daily for the chemoprophylaxis of recurrent acute otitis media. In the 87 courses of chemoprophylaxis with cefaclor for recurrent otitis media, the efficacy was found to be 53%; while amoxicillin was found to be effective in 30% of the 33 patients studied. There were fewer side effects noted in the cefaclor group than in the amoxicillin group (4% vs. 12%). Both drugs caused diarrhea, while cefaclor also caused a mild maculopapular rash in two patients (1.67%). While amoxicillin remains the drug of choice for acute otitis media (AOM), this study suggests that cefaclor may be a better selection in the chemoprophylaxis of recurrent acute otitis media.

Acute Disease↗
PubMed1996

[Clinical and microbiological study of otitis media in infants].

The objective of this study was to determine the prevalence of bacteria isolated from middle ear effusions in infants with otitis media in our environment. Data collected from 50 patients of the Infant Section of the Unidad Integrada Hospital Clínico-San Juan de Dios were evaluated prospectively from October 1, 1992 to March 7, 1994. Patients between 1 month and 1 year of age, with unilateral or bilateral otitis media diagnosed by otoscopy criteria and positive myringotomy, were recruited for study. Those who had received any antibiotic during the previous 3 days or had been admitted to the hospital more than 5 days before were excluded. We found that failure to thrive (18%) is a common form of onset of otitis media in children under one year of age. Rhinorrhea and nasal obstruction (60%), cough (50%) and fever (46%) were the most frequent symptoms at the moment of diagnosis. Blood analysis does not add any information for diagnosing otitis media. The difference between acute otitis media and otitis media with effusion is likely to be more clinical rather than microbiological. The recovery of pathogens from 62% of the ear cultures correlates with the figures reported in the literature. The predominance of S. pneumoniae (38%), followed by H. influenzae (25%), is in agreement with previous findings internationally. In our study, there is no evidence of viruses alone causing otitis media in infants. Consequently, antibiotic therapy should be indicated in every child with otitis media.

Amoxicillin↗
PubMed1998

Otitis media: pathogenesis and medical sequelae.

Eustachian tube abnormalities are a primary determinant of otitis media. Other determinants include viral infections and local and systemic immune deficiencies, which predispose to superimposed bacterial disease. Local infection induces inflammation, which can be exacerbated by the presence of antibiotics. The degree of inflammation determines the extent of damage and the oedema and histological damage correlate with the white blood cell count and not the bacterial count. Local sequelae include recurrent or persistent acute otitis media, recurrent or chronic otitis media with effusion and chronic suppurative otitis media. Other local sequelae include occasional perforation of the tympanic membrane, sensorineural hearing loss, acute serous labyrinthitis, and facial palsy, which can occur associated with the course of the facial nerve across the middle ear. Acute otitis media can lead to persistent loss of a significant amount of sensorineural hearing after treatment and resolution of the effusion. Damage is usually very mild or nonexistent in the speech frequency ranges, but detectable if high frequency audiometry is performed. Studies in otitis media with effusion have shown a mild association between its presence and speech and language development in children under the age of 4 years. But also in older children, there is a continued association between otitis media with effusion, affecting expressive language development, reading skills and behavior. Therefore physicians have a major responsibility in managing otitis media.

Acute Disease↗
PubMed1987

The use of fluoroquinolones in chronic otitis suppurativa.

The present review covers fluoroquinolone usage in chronic otitis suppurativa (COS) in case of chronic otitis media, cholesteatoma, radical mastoid cavity infection and chronic or relapsing otitis externa. A total of six publications were included in the final evaluation. Enoxacin was effective in 35%; ciprofloxacin (five publications) was used in 82 patients with 67% effectivity in otitis externa and otitis media and 61% effectivity in radical mastoid cavity infection. No serious adverse reactions were reported. The promising efficacy of otitis media and otitis externa and safety profile needs further confirmation in double blind prospective clinical studies, that will provide a firm basis for changing the current treatment schedules of COS.

Cholesteatoma↗
PubMed1983

Prediction of serous versus purulent otitis media by otoscopy and tympanometry in an animal model.

Non-invasive methods for distinguishing different types of otitis media would have clinical value in predicting otologic morbidity. Two such methods, otoscopy and tympanometry, were used in two experimental models of otitis media to determine whether there are unique otoscopic and tympanometric characteristics of serous and purulent otitis media. A flat (type B or B+) tympanogram and yellow tympanic membrane each had a high likelihood of predicting middle ear effusion in these models, and the best prediction was obtained using both parameters simultaneously. A yellow tympanic membrane color predicted purulent otitis media in one model but did not distinguish purulent from serous ears in the other model. In one model, serous otitis media was frequently associated with a type C (negative pressure) tympanogram. Tympanometry provided a valuable adjunct to otoscopy in detecting effusion and in distinguishing serous and purulent disease. These observations may apply to otitis media in humans, although the variable etiologies of otitis media in humans may confound the ability of otoscopy and tympanometry to distinguish middle ear effusion types.

Acoustic Impedance Tests↗