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PubMed1989

Automatic immittance audiometry on children with transtympanic ventilation tubes.

The use of automatic immittance audiometers for detection of middle ear abnormalities in children is becoming a popular practice in pre-schools, headstart programs, and elementary schools. Oftentimes the screening is being performed by personnel who are not clinical audiologists and who do not routinely otoscopically examine the ear prior to testing. This report tells of a clinical case in which the use of automatic immittance audiometry on a child with transtympanic ventilation tubes resulted in the occlusion of one of the tubes. An explanation of the events causing the occlusion and a word of caution are given.

Audiometry↗
PubMed1994

Identification of middle ear effusion by aural acoustic admittance and otoscopy.

The ability of aural acoustic immittance measures and validated pneumatic otoscopy to identify middle ear effusion (MEE) was determined for a group of children with chronic or recurrent otitis media. The measures were made immediately prior to surgery for placement of tympanostomy tubes, with the validating diagnosis of MEE made by the surgeons. Aural acoustic admittance measures were made by a certified and licensed clinical audiologist using an instrument that meets current standards and otoscopic examinations were made by a nurse practitioner validated for use of otoscopy in the identification of MEE. Logistic regression analyses were done to determine the ability of admittance variables, otoscopy, and their combination to discriminate between ears with and ears without MEE. Of the individual admittance variables, tympanometric width had the best performance. Otoscopy alone had good sensitivity but only fair specificity. Combining acoustic admittance data with the otoscopist's findings did not improve sensitivity greatly, but improved the specificity relative to that of the otoscopist. The criterion tympanometric width > 150 daPa or Ytm < 0.2, a criterion commonly used based on interim norms published in an appendix of ASHA guidelines for screening, had good sensitivity but very poor specificity in the group of children scheduled for surgery. Also, a comparison was made for tympanometric width measures from the children undergoing surgery with those from a group of children more representative of the general population. Three distributions were found; one for ears with MEE, one for ears with no MEE of children scheduled for otologic surgery and one for ears with no MEE from the group of children from the general population. The data illustrate the importance of the population characteristics on the test measure used and have implications for choosing test criteria. In addition, group estimates of performance of acoustic admittance variables were approximately the same when otoscopy was used as the gold standard for identification of MEE as when findings at surgery were used. However, when comparing the two diagnostic methods on a case-by-case basis, it was determined that the otoscopist's diagnosis disagreed with the diagnosis of the surgeons in over 21% of the ears.

Acoustic Impedance Tests↗
PubMed1997

Standard and multifrequency tympanometry in normal and otosclerotic ears.

OBJECTIVES: The primary goal of this study was to evaluate alternative tympanometric parameters for distinguishing normal middle ears from ears with otosclerosis. A secondary goal was to provide guidelines and normative data for interpreting multifrequency tympanometry obtained using the Virtual 310 immittance system. DESIGN: Nine tympanometric measures were examined in 68 normal ears and 14 ears with surgically confirmed otosclerosis. No subjects in either group had a history of head trauma or otoscopic evidence of eardrum abnormalities. Two parameters, static admittance and tympanometric width, were derived from standard low-frequency tympanometry and two parameters, resonant frequency and frequency corresponding to admittance phase angle of 45 degrees (F45 degrees), were derived from multifrequency tympanometry. RESULTS: Differences between normal and otosclerotic ears were statistically significant only for resonant frequency and F45 degrees. Group differences in resonant frequency were larger when estimated using positive tail, rather than negative tail, compensation. Group differences in both resonant frequency and F45 degrees were larger when estimated from sweep frequency (SF), rather than sweep pressure, tympanograms. Test performance analysis and patterns of individual test performance point to two independent signs of otosclerosis in the patient group; 1) an increase in the stiffness of the middle ear, best indexed by F45 degrees derived from SF recordings, and 2) a change in the dynamic response of the tympanic membrane/middle ear system to changes in ear canal pressure, best indexed by tympanometric width. Most patients were correctly identified by only one of these two signs. Thus, optimal test performance was achieved by combining F45 degrees derived from SF recordings and tympanometric width. CONCLUSIONS: The findings confirm the advantage of multifrequency tympanometry over standard low-frequency tympanometry in differentiating otosclerotic and normal ears. Recommendations for interpreting resonant frequency and F45 degrees measures obtained using the Virtual Immittance system are also provided. In addition, the relationship among different tympanometric measures suggests a general strategy for combining tympanometric measures to improve the identification of otosclerosis.

Acoustic Impedance Tests↗
PubMed2000

High-frequency hearing loss and wideband middle ear impedance in children with otitis media histories.

OBJECTIVE: This study was undertaken to determine the relationship between extended-high-frequency (EHF) hearing losses and wideband middle ear impedance in children with chronic otitis media (OM) histories. DESIGN: Children with OM histories were selected from a prospective study cohort if they had normal tympanograms, no air-bone gaps, and no otoscopic evidence of active OM at the time of testing. OM subjects were divided into two groups, those with Better Hearing in the EHF range and those with Worse Hearing in the EHF range. The OM groups were compared with an age-matched, healthy Control group that had no more than five documented episodes of OM and no more than two in any 1 yr. All children were 9 to 16 yr of age. Subjects were tested by standard audiometric methods in the conventional audiometric range (0.25 to 8.0 kHz) and the EHF range (8 to 20 kHz). Middle ear impedance and reflectance were measured with an experimental system over the frequency range 0.25 to 10.08 kHz. RESULTS: The Worse Hearing OM group had slightly poorer hearing in the conventional audiometric frequency range compared with the other two groups. The Better Hearing OM group and the Control group had nearly identical EHF hearing. The Worse Hearing OM group had significantly poorer EHF hearing compared with the other two groups, the difference increasing exponentially with frequency. Middle ear impedance differences among groups were confined to low frequencies (<2 kHz). The Control group had significantly higher negative reactance than the two OM groups. There were no significant group differences in impedance or reflectance in the high frequencies (2 to 10 kHz). CONCLUSIONS: The results of this study confirm those of previous reports that children who have recovered from chronic OM have significantly poorer hearing in the EHF range compared with children without significant OM histories. The EHF hearing losses that occur in children with OM histories are strongly frequency dependent, suggesting a preferential effect on the base of the cochlea. Middle ear impedance and reflectance differences do not account for the EHF hearing losses observed in children with OM histories. The results support the hypothesis that OM-related EHF hearing losses are cochlear in origin.

Acoustic Impedance Tests↗
PubMed2002

Middle ear dynamic characteristics in patients with otosclerosis.

OBJECTIVE: To investigate the middle ear dynamic characteristics in patients with otosclerosis using the sweep frequency impedance meter (SFI test) and conventional tympanometry, and also to evaluate the diagnostic efficiency of the SFI test for otosclerosis. DESIGN: The study was designed to collect a total of 25 (36 ears) consecutive patients with otosclerosis. All subjects followed a clinical protocol, which consisted of a hearing problem questionnaire, otoscopic examination, and audiometric measurements. These included pure tone audiometry, conventional tympanometry, and SFI test. RESULTS: In the SFI test, the middle ear dynamic characteristics were measured in terms of the resonance frequency and middle ear mobility. Three distinct categories of middle ear dynamic characteristics were found in patients with otosclerosis, i.e., high stiffness, normal stiffness, and low stiffness middle ear status. On comparison of the results of SFI with conventional tympanometry, a significantly higher percentage of abnormal stiffness was found when using the SFI test than that when using conventional tympanometry. CONCLUSIONS: The present findings confirm the advantage of the SFI test over conventional tympanometry in detecting middle ear status and mechanics in patients with otosclerosis. Moreover, different middle ear dynamic characteristics in patients with otosclerosis are most likely to be related to the different stages of the pathological changes.

Acoustic Impedance Tests↗
PubMed1996

Otitis media, communication style of primary caregivers, and language skills of 2 year olds: a preliminary report.

The association between early otitis media, styles of primary caregivers, and language development was prospectively examined in 26 2-year-old children from lower socioeconomic backgrounds (of mixed perinatal status) followed prospectively since birth. Based on otoscopic evaluations during the first year of life, there were 14 children who were classified as bilaterally otitis-free (OM-) and 12 children who were classified as bilaterally otitis-positive (OM+). At 2 years of age, all children were administered standardized measures of cognitive and language function along with a 20-minute videotaped play session with one of their primary caregivers. The language of both the children and caregivers was analyzed. Results indicate that caregivers of OM+ and OM- children used language nearly identically when interacting with their children. However, caregivers of OM+ children whose communication style was marked by a high percentage of directives and a corresponding low percentage of both questions and information-giving had the children with the lowest scores on all measures of naturalistic language. Controlling for neonatal illness did not alter the relationships found. The results suggest that caregiver language may compensate for some of the auditory deprivations associated with otitis media.

Brain Damage, Chronic↗
PubMed1999

Tympanic membrane/middle ear pathologic correlates in chronic otitis media.

OBJECTIVE: To correlate pathologic findings of the tympanic membrane with pathologic changes in the middle ear cleft in chronic otitis media. STUDY DESIGN: Retrospective. MATERIAL AND METHODS: One hundred-fifty temporal bones from 97 subjects with chronic otitis media (defined as middle ear pathologic changes including granulation tissue, fluid, cholesteatoma, cholesterol granuloma, tympanosclerosis, and ossicular changes) were selected to correlate the presence of these middle ear pathologies with histopathologic changes of the tympanic membrane. The tympanic membrane pathologies included perforation, myringosclerosis, retraction, hemorrhage, fluid-filled cystic spaces, or dilated vessels. Temporal bones were also assessed for atelectasis. Fifty-six normal temporal bones were taken as controls for measurements. RESULTS: Significant correlations between tympanic membrane and middle ear pathology included myringosclerosis and granulation tissue, myringosclerosis and ossicular pathology, retraction and cholesterol granuloma, retraction and cholesteatoma, retraction and ossicular pathology, perforation and ossicular pathology, and hemorrhage and granulation tissue. Additive effects of some pathologies were also observed. Almost half the bones with middle ear pathology had no associated tympanic membrane pathology, whereas multiple pathologic changes in the tympanic membrane generally showed underlying multiple pathologic changes in the middle ear. CONCLUSION: When tympanic membrane pathology is detected otoscopically, its presence, alone or in combination, can be a strong indicator of underlying middle ear pathology. However, a normal-appearing tympanic membrane does not exclude the possibility of middle ear pathology. These findings suggest the need for other diagnostic tools such as multifrequency tympanometry and otoacoustic emissions to complement otoscopy for diagnosis of middle ear pathology, especially in a tympanic membrane that appears "normal."

Adolescent↗
PubMed2002

Phenotype of DFNA11: a nonsyndromic hearing loss caused by a myosin VIIA mutation.

OBJECTIVES/HYPOTHESIS: To characterize the audiovestibular phenotype of DFNA11, an autosomal dominant nonsyndromic hearing impairment caused by a mutation in the myosin VIIA gene (MYO7A), including whether DFNA11-affected subjects have retinal degeneration as is characteristic of Usher syndrome type 1B, caused by different MYO7A mutations. STUDY DESIGN: Retrospective study of audiovestibular and ophthalmological data in a Japanese family linked to DFNA11. METHODS: Otoscopic examination and pure-tone audiometry were performed in all participants in the family. Selected subjects underwent additional examinations including speech discrimination scoring, acoustic reflex measurements, Békésy audiometry, evoked and distortion-product otoacoustic emissions, auditory brainstem responses, and bithermal caloric testing; visual acuity, ocular tonometry, slit-lamp examination, ophthalmoscopy, and electroretinography; and computed tomography of the temporal bone. RESULTS: Most affected individuals had moderate cochlear hearing loss beginning in the second decade and progressing at all frequencies. Variable degrees of asymptomatic vestibular dysfunction were present. Computed tomography showed normal inner and middle ear structures. No evidence suggested retinitis pigmentosa. CONCLUSIONS: The phenotype of DFNA11 is postlingual, nonsyndromic sensorineural hearing loss with gradual progression. Showing moderate hearing loss with asymptomatic variable vestibular dysfunction and no retinal degeneration, the DFNA11 phenotype is mildest among phenotypes caused by MYO7A mutations.

Adaptor Proteins, Signal Transducing↗
PubMedDate not supplied

Duration of middle ear effusion after acute otitis media.

In approximately 50% of young children persistent otitis media with effusion (POME) is found by otoscopic examination or by tympanometry 10 to 14 days after the physician institutes antimicrobial treatment for acute otitis media. Over a 180-day period the course of persistent otitis media with effusion was studied in predominantly middle class, otherwise healthy white children under 3 years of age. One month after POME was first diagnosed, 22 (29%) of the children still had POME. By the second month 11 (14%) of these children still had POME. Only 5 (6%) of the study population had POME which persisted for more than 90 days. The mean duration of POME was 40 days; (median 14 days). These data suggest that in most cases POME is a self-limiting condition when found in young, otherwise healthy, middle class white children.

Child, Preschool↗
PubMed1987

Comparative efficacies of erythromycin-sulfisoxazole and cefaclor in acute otitis media: a double blind randomized trial.

A prospective double blind trial compared the fixed combination of erythromycin-sulfisoxazole (E/S) with cefaclor in the treatment of acute otitis media. One hundred nineteen children in six centers across Canada were studied. Diagnostic tympanocentesis of 134 ears yielded 135 bacterial isolates: Streptococcus pneumoniae (42%); Haemophilus influenzae (21%); Branhamella catarrhalis (10%); Streptococcus pyogenes (5%); and other bacteria (22%). Seventy-seven percent of strains of B. catarrhalis and 14% of strains of H. influenzae were beta-lactamase producers. E/S exhibited greater in vitro activity against H. influenzae and B. catarrhalis. Twenty-three patients had bacteriologically sterile middle ear fluid. The overall clinical outcome at Days 10 and 31 was identical in both treatment groups. Otoscopic findings improved more rapidly in the E/S group than in the cefaclor group at 10 and 31 days (P less than or equal to 0.04). In cases where pre-treatment middle ear fluid was negative on routine bacterial culture, complete cure at 10 days was observed in 75% of patients treated with E/S but only in 14% of those treated with cefaclor (P = 0.02). Side effects were infrequent and comparable between the test drugs. E/S is at least as effective as cefaclor in the management of acute otitis media and may be superior, particularly for cases not yielding bacteria on routine culture.

Acute Disease↗
PubMed1989

Single vs. double acoustic reflectometry tracings.

Impedance tympanometry and acoustic reflectivity tests were obtained on 503 infants and children ranging from 3 months to 12 years of age during a 6-week period in a solo primary care practice. One hundred eighty-five of 1005 tracings from the acoustic otoscope with recorder demonstrated 2 reflectivities. This phenomenon occurred more commonly in infants than in older children and was not seen with reflectivities higher than 7 units. One hundred thirty-eight of the 185 double reflectivity tracings were associated with abnormal impedance tympanometry. The double reflectivity phenomenon may be important in helping to explain the false negative results occasionally seen with this technology in low and intermediate reflectometry scores. Future clinical research involving acoustic reflectometry should utilize the recording device and single and double reflectivity tracings should be handled separately in any analysis of data. Use of the recorder will also prevent false positive errors in the interpretation of some intermediate reflectivities.

Acoustic Impedance Tests↗
PubMed1991

Evaluation of ventilating tubes and myringotomy in the treatment of recurrent or persistent otitis media.

In a prospective controlled study of the efficacy and sequelae of ventilating tubes, 44 children with bilateral recurrent acute otitis media (greater than 6 episodes/year) and 13 children with bilateral persistent middle ear effusion (greater than 3 months) received unilateral ventilating tube insertion in a randomly selected ear. The contralateral ears were randomized to receive either myringotomy alone or no surgery. Clinical, otoscopic, tympanometric and audiologic examinations were performed before the study and 2 to 4 weeks later, then at 3-month intervals for up to 2 years and at 36 months after surgical randomization. Medical therapy and antibiotic prophylaxis were used whenever indicated. While the ventilating tubes remained functional (mean duration, 10 months) the ears with a tube had significantly fewer episodes of otitis media than their contralateral ear (P less than 0.001; 95% confidence intervals -0.7, -1.7) and had more hearing improvement (P = 0.005; 95% confidence intervals, -5.9, -1.2). After tube extrusion there was a tendency for surgically treated ears to have more otitis and worse hearing, but not at a significant level. Tympanosclerosis, retraction and atrophy were more common in ears that received tubes. The majority of ears treated medically also improved. There is need for a more cautious and selective use of ventilating tubes.

Acoustic Impedance Tests↗
PubMed1993

Cefixime vs. cefaclor in the treatment of acute otitis media in children: a randomized, comparative study.

The efficacy of cefixime was compared with that of cefaclor in the treatment of 63 patients with acute otitis media. Patients received either a single dose of cefixime (8 mg/kg/day) or 3 divided doses of cefaclor (40 mg/kg/day). On the basis of otoscopic and tympanometric results at 10 to 14 days after the start of treatment, 28 (97%) of 29 cefixime-treated patients and 25 (78%) of 32 cefaclor-treated patients had resolution of acute otitis media. The clinical cure rate associated with all organisms was 94% for cefixime (16 of 17 isolates) and 68% (13 of 19 isolates) for cefaclor. The cure rate for Streptococcus pneumoniae was 12 of 12 (100%) for cefixime and 7 of 7 (100%) for cefaclor; the cure rate for Haemophilus influenzae (which includes 2 patients with mixed infections) was 3 of 4 (75%) for cefixime and 2 of 7 (29%) for cefaclor. One clinical relapse occurred among 29 cefixime-treated patients; however, at 28 days 9 recurrences were observed. Three of 25 (9%) cefaclor-treated patients failed and 4 (13%) relapsed at 10 to 14 days, an additional 2 (10%) experienced recurrence by Day 28. Eight (28%) cefixime-treated patients experienced adverse events (7 gastrointestinal and 1 diarrhea and rash); 8 (25%) cefaclor-treated patients experienced adverse events (all gastrointestinal). Our data suggest that both at end of therapy and for 14 days thereafter, cefixime given once a day for acute otitis media is clinically equivalent to cefaclor given 3 times a day.

Acute Disease↗
PubMed1995

Increasing incidence of penicillin- and ampicillin-resistant middle ear pathogens.

During a 13-month period ending in January, 1995, we obtained 159 samples of middle ear exudate through tympanocentesis (n = 155) or acute spontaneous otorrhea (n = 4) from 151 children enrolled in therapeutic trials of acute otitis media in a pediatric practice in Northern Virginia. Their ages ranged from < 1 to > 6 years of age (mean, 35 months; median, 22 months). Precise diagnostic criteria for acute otitis media always included bulging outward of all or part of the eardrum, opacification of the eardrum regardless of color and impaired mobility to positive and negative pressure via the pneumatic otoscope. Bacterial pathogens were isolated from middle ear fluid in 95% of these children: Streptococcus pneumoniae was recovered from 61 (37%); Haemophilus influenzae from 45 (27%); Moraxella catarrhalis from 41 (25%); Group A streptococcus from 6 (4%); Staphylococcus aureus from 4 (2%); and no growth or microbes of uncertain significance from 8 (5%). Six of the patients had mixed bacterial cultures; 2 of the 6 had at least one ampicillin-resistant bacteria, and a third had 2 ampicillin-resistant bacteria. Eight patients who failed to improve with antimicrobial treatment had a second tympanocentesis performed or developed spontaneous drainage; on that follow-up culture 3 of 8 cultures had different microorganisms; and 5 of the 8 bacterial specimens were resistant to ampicillin or penicillin. Twenty-one percent of the S. pneumoniae strains recovered from the middle ear were resistant to penicillin. Sixty-two percent of the H. influenzae and 98% of the M. catarrhalis isolates were resistant to ampicillin. Overall bacteria resistant to penicillin or ampicillin were recovered in 54% of middle ear fluid from 46 patients who had received a beta-lactam antibiotic in the preceding month as well as in 57% of middle ear fluids from 105 patients who had not. The empiric use of amoxicillin for treatment of acute otitis media should be reexamined in our community particularly in those who appear ill, have a high fever or have severe unremitting otalgia.

Acute Disease↗
PubMed1997

Comparison of the efficacy, safety and acceptability of cefixime and amoxicillin/clavulanate in acute otitis media.

BACKGROUND: Use of a beta-lactamase stable antibiotic is called for in cases of acute otitis media (AOM) likely to be caused by beta-lactamase-producing Haemophilus influenzae or Moraxella catarrhalis. Two beta-lactamase-stable agents commonly used for empirical treatment of AOM are amoxicillin/clavulanate and cefixime. METHODS: A multicenter, randomized clinical trial compared cefixime (CFX; 8 mg/kg once daily) with amoxicillin/clavulanate (A/C; 40 mg/kg/day in three divided doses) for the treatment of children with AOM. Three hundred thirteen children were randomly assigned to a 10-day course of either CFX (n = 158) or A/C (n = 155). Based on history, physical examinations and otoscopic and tympanometric assessments, clinical responses were evaluated as cure, improvement, failure, relapse or nonevaluable. Compliance and patient/parent acceptability were also analyzed. RESULTS: Overall favorable clinical responses (cure plus improvement) were comparable post-therapy for the two treatments (CFX = 76%; A/C = 77%). Significant differences in response rates for both treatments were noted among different geographic regions, with the highest response rates observed in the Northeast and South. Acceptability of CFX was significantly better than that of A/C (P = 0.0001), and the adverse experience rate was lower (P = 0.001). The most frequently reported adverse experiences were diarrhea (CFX 15.2%, A/C 29.7%) and vomiting (CFX 3.2%, A/C 10.32%). Relapse rates were 26% for CFX and 29% for A/C. CONCLUSION: This study demonstrated that CFX has comparable clinical efficacy and a better adverse events profile than A/C when used to treat AOM of childhood.

Acute Disease↗
PubMed2000

Management of otitis media: 2000 and beyond.

BACKGROUND: In the next few years what will alter our modes of diagnosis, choice of therapies and strategies for prevention of acute otitis media (AOM)? These issues, as well as whether antibiotic resistance will continue to threaten the efficacy of currently available antimicrobial agents, whether industry and academia will be able to respond to bacterial resistance with effective new antimicrobial drugs and whether the pneumococcal conjugate vaccine will substantially reduce the incidence of AOM provide a basis for discussing the problems and possible solutions related to AOM. ANTIMICROBIAL DRUGS: Bacteria and viruses will continue to find ways to survive the activity of currently available antimicrobial drugs. Among the new antibacterial drugs under consideration are ketolides, oxazolodinones and quinolones. Guidelines stress limiting usage of antimicrobial agents to diseases that are likely caused by bacterial pathogens. Antiviral drugs are now available against influenza virus and respiratory syncytial virus infections. DIAGNOSIS: Tympanometry and/or acoustic reflectometry are adjunctive techniques for assisting in the diagnosis of middle ear effusion in children whose otoscopic examination is ambiguous. Laser myringotomy has been used in several hundred children; however, there are no published studies of randomized trials. NEW VACCINES: Investigators have evaluated the safety and efficacy of a heptavalent pneumococcal polysaccharide vaccine conjugated with CRM197 (a diphtheria toxin mutant). The results showed a reduction in the overall burden of severe and recurrent AOM. Respiratory syncytial virus is the viral pathogen most frequently associated with AOM. For this reason safe and effective viral vaccines are needed to complement the efficacy of bacterial vaccines for prevention of AOM. CONCLUSIONS: Parents influence decisions by pediatricians to use antimicrobial agents and should be informed about the appropriate usage of antibiotics. Educators and public health officials must find techniques to distinguish WebSites that provide information of value from those that are not credible. Of paramount importance is the development of techniques to increase the accuracy of clinical and microbiologic diagnosis. Finally there is a need for studies of appropriate scientific design that can assess the efficacy and safety of alternative therapies.

Acute Disease↗
PubMed2001

Bacteriologic and clinical efficacy of high dose amoxicillin/clavulanate in children with acute otitis media.

OBJECTIVES: To determine the bacteriologic and clinical efficacy of high dose amoxicillin/clavulanate (90/6.4 mg/kg/day) against common bacterial pathogens causing acute otitis media (AOM), including penicillin-resistant Streptococcus pneumoniae (PRSP). METHODS: In this open label multicenter study, 521 infants and children with AOM [mean age, 18.6 months; age < 24 months, n = 375 (72%)] were treated with amoxicillin/clavulanate 90/6.4 mg/kg/day in two divided doses for 10 days. Bilateral otitis media, previous episodes of AOM, antibiotic treatment within 3 months and day-care attendance were recorded in 60.1, 35.7, 50.2 and 38.2% of the children, respectively. Tympanocentesis was performed before the first dose and repeated on Days 4 to 6 for all children with S. pneumoniae at 22 centers and for all children with any pathogen at 3 centers. Clinical response was assessed at end of therapy. RESULTS: Pathogens were isolated from 355 (68%) of 521 enrolled children; 180 children underwent repeat tympanocentesis and were bacteriologically evaluable. Baseline pathogens were S. pneumoniae (n = 122 enrolled/93 bacteriologically evaluable), Haemophilus influenzae (n = 160/51), both (n = 37/32) and others (n = 36/4). Pathogens were eradicated from 172 (96%) of 180 bacteriologically evaluable children. Overall 122 (98%) of 125 isolates of S. pneumoniae were eradicated, including 31 (91%) of 34 PRSP isolates (penicillin MICs 2 to 4 micrograms/ml). Seventy-eight (94%) of 83 isolates of H. influenzae were eradicated. Symptoms and otoscopic signs of acute inflammation were completely resolved or improved on Days 12 to 15 in 263 (89%) of 295 clinically evaluable children with bacteriologically documented AOM. CONCLUSIONS: On the basis of bacteriologic outcome on Days 4 to 6 and clinical outcome on Days 12 to 15, we found that high dose amoxicillin/clavulanate (90/6.4 mg/kg/day) was highly efficacious in children with AOM, including those most likely to fail treatment, namely children < 24 months of age and those with infectious caused by PRSP.

Acute Disease↗
PubMed1992

The effect of palate repair on otitis media with effusion.

Cleft palate in children is very frequently associated with otitis media with effusion. In this prospective study of 150 cleft palate children aged between 2 and 18 months, the prevalence of otitis media with effusion at myringotomy before palate repair was 92 percent. Otoscopic and tympanometric follow-up assessments for 140 children indicate that there is minimal improvement in middle ear status after palate repair. The condition is persistent in 70 percent of children up to 4 years of age. Furthermore, there is no evidence that age at repair or type of cleft is influential. These findings have implications for otologic management of cleft palate children. Early routine unilateral ventilation to ensure adequate hearing but minimize the morbidity of ventilation tubes is advocated.

Cleft Palate↗