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PubMed1988

Surgical management of otitis media and otitis interna.

Surgical management of otitis media and otitis interna includes the following options: lateral bulla osteotomy, ventral bulla osteotomy, or curettage of the tympanic cavity. Because otitis media frequently accompanies chronic nonresponsive otitis externa, one of the above procedures may be combined with operative procedures of the external ear canal. Also, gentle selective curettage of the tympanic cavity may be combined with either lateral or ventral bulla osteotomy in the treatment of otitis media and interna. The choice of surgical procedure(s) should be based on the condition of the external ear canal (vertical and horizontal parts), the duration of clinical signs, response to previous surgery, and the familiarity of the surgeon with the different approaches and techniques. With the increased reporting of long-term results following surgical management of otitis externa, media, and interna, more meaningful conclusions concerning selection of surgical procedure may be made in the future.

Animals↗
PubMed1999

Immune response to pneumococcal conjugate and polysaccharide vaccines in otitis-prone and otitis-free children.

We compared responses to pneumococcal conjugate and polysaccharide vaccines in 48 otitis-free and 64 otitis-prone children. Pre- and postimmunization concentrations of antibodies to pneumococcal serotypes 6B, 14, 19F, and 23F were measured by enzyme-linked immunosorbent assay. Postimmunization mean concentrations of antibodies to all four serotypes were significantly higher for children receiving conjugate vaccine than for those receiving polysaccharide vaccine; the difference in responses was primarily due to a better response to conjugate vaccine in the otitis-prone group. Significantly higher postimmunization concentrations of antibodies to all four serotypes and to one of the four serotypes were found in otitis-prone children and otitis-free children who received conjugate vaccine, respectively. Pneumococcal conjugate vaccine has the potential to reduce the incidence of disease due to vaccine serotypes, even among children with recurrent otitis media.

Antibodies, Bacterial↗
PubMed1993

Micro-ecology of the nasopharyngeal bacterial flora in otitis-prone and non-otitis-prone children.

The quantitative bacteriology of the adenoid was studied in otitis-prone and non-otitis-prone children. alpha-hemolytic Streptococci (Viridans Streptococci) appeared to be predominant normal flora in the healthy nasopharynx. There was a decrease in alpha-hemolytic Streptococci in the otitis-prone child compared to the non-otitis-prone child. Concomitantly, there appears to be an increase in both nontypable Haemophilus influenzae (NTHI) and S. pneumoniae in the nasopharyngeal flora in the otitis-prone child. The mechanisms responsible for this alteration of the micro-ecology of bacteria of the nasopharynx may be related, in part, to factors that alter mucociliary function. These factors could be viral infection, allergy, local and systemic immunological deficiency and the indiscriminate use of antibiotics. An understanding of the relationship between the normal flora and the potential pathogens may be important in the understanding of both the pathogenesis of otitis media (OM) and possibly the treatment of this disease entity.

Child, Preschool↗
PubMed1994

Managing otitis media with effusion in young children. American Academy of Pediatrics The Otitis Media Guideline Panel.

This reference guide contains highlights from the Clinical Practice Guideline, Otitis Media with Effusion in Young Children. The Otitis Media Guideline Panel, a private-sector panel of health care providers, developed the Guideline after comprehensively analyzing the research literature and current scientific knowledge of the development, diagnosis, and treatment of otitis media with effusion in young children. Specific recommendations are given for the management of otitis media with effusion in young children age 1 through 3 years with no craniofacial or neurologic abnormalities or sensory deficits. The natural history of otitis media with effusion, the functional impairments that may result from otitis media with effusion, and the difficulty of measuring the effects of medical and surgical interventions on long-term outcomes are included. The medical interventions studied involve antibiotic, steroid, and antihistamine/decongestant therapies. The surgical interventions studied involve myringotomy with insertion of tympanostomy tubes, adenoidectomy, and tonsillectomy. Short-term outcomes addressed are resolution of effusion and restoration of hearing.

Algorithms↗
PubMed1994

Bacterial interference in nasopharyngeal bacterial flora of otitis-prone and non-otitis-prone children.

The quantitative bacteriology of the adenoid was studied in 34 otitis-prone and 25 non-otitis prone children. Viridans streptococci appeared to be the predominant normal flora in children who are non-otitis prone. There was a significant decrease in viridans streptococci in the otitis-prone child compared to the non-otitis-prone child. There was a significant increase in nontypable Haemophilus influenzae (NTHI) in the otitis-prone child. The mechanisms responsible for this alteration of the microecology of bacteria of the nasopharynx may be related, in part, to bacterial interference or to the inappropriate use and over-use of antibiotics. In vitro inhibition of growth of NTHI was demonstrated with selective strains of viridans streptococci. A preliminary analysis of an inhibitory strain and a non-inhibitory strain of viridans streptococci are presented and their biochemical profiles and antibiotic sensitivities were entirely different. A possible mechanism for the inhibition on NTHI by viridans streptococci has been suggested. This mechanism may be related to an alteration of pH in the growth media or the possibility of the utilization of nutrients required for growth of NTHI.

Adenoids↗
PubMed1982

Moxalactam therapy. Its use in chronic suppurative otitis media and malignant external otitis.

Moxalactam disodium is a new broad-spectrum antibiotic structurally related to the cephalosporins. Eleven patients with chronic suppurative otitis media with mastoiditis and four patients with malignant external otitis were treated with moxalactam. Pseudomonas aeruginosa was isolated from external ear or mastoid in all patients. Twelve of 15 patients had undergone prior surgical procedures and 11 of 15 had failed recent antibiotic therapy. Three patients with malignant external otitis did not respond to parenteral carboxypenicillin and aminoglycoside therapy. Success rate for chronic suppurative otitis media was 73% as judged by eradication of P aeruginosa and resolution of symptoms 30 days after moxalactam therapy. Two patients with malignant external otitis were cured, and two were unevaluable since they may have died of noninfectious causes. Moxalactam disodium, at a dosage of 9 g/day, may be useful for serious Pseudomonas ear infections, including those refractory to other antibiotic therapy.

Aged↗
PubMed2000

Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children.

BACKGROUND: OME is common and may cause hearing loss with associated developmental delay. Treatment remains controversial. The effect of both systemic and intra-nasal steroids on effusions has been assessed by randomised controlled trials. OBJECTIVES: To examine evidence for or against treating children with hearing loss associated with OME with systemic or topical nasal steroids. SEARCH STRATEGY: Searches were conducted in February 2000. We searched the Cochrane Controlled Trials Register using the terms 'otitis-media', 'otitis media with effusion', 'glue ear', or 'OME', and 'steroids', 'glucocorticoids, synthetic', 'glucocorticoids, topical', 'anti-inflammatory agents, steroidal'. EMBASE and MEDLINE were also searched for additional information. SELECTION CRITERIA: Randomised controlled trials of oral and topical nasal steroids, either alone or in combination with another agent such as an antibiotic, were included. EXCLUSIONS: publications in abstract form only since adequate appraisal was not possible; uncontrolled, non-randomised or retrospective studies; studies reporting outcomes with ears (rather than children) as the unit of analysis. DATA COLLECTION AND ANALYSIS: Data were extracted from the published reports by the two authors independently (CCB and JH van der V) using standardised data extraction forms and methodology. The methodological quality of the included studies were independently assessed by the two authors using the scheme described in the Cochrane Handbook. Dichotomous results were expressed as an odds ratio using a fixed effects model together with the 95% confidence intervals. Continuous data were analysed using the weighted mean difference in a fixed effects model. Tests for heterogeneity between studies were performed using a Mantel-Haenszel approach. In trials with a cross over design, post-crossover treatment data were not used. MAIN RESULTS: No study prospectively documented hearing loss associated with OME prior to randomisation. Follow up was short term. No serious or lasting side effects were reported in the four studies that did mention side effects. Most comparisons involved small numbers of subjects. The odds ratio for OME persisting after short term follow up for children treated with oral steroids plus antibiotic compared to control plus antibiotic was 0.32 (95% CI 0.20 to 0.52). However there was significant heterogeneity between studies (p<0.01). Trends favoured steroids for most other comparisons, but confidence intervals included unity. There was no evidence of benefit for steroid treatment in the longer term, and no study assessed effect of steroid treatment on language development. REVIEWER'S CONCLUSIONS: There is evidence that steroids combined with an antibiotic lead to a quicker resolution of OME in the short term. However, there is not evidence for long term benefit from treating hearing loss associated with OME with either oral or topical nasal steroids. These treatments are therefore not recommended at the present time. Future studies should document hearing loss associated with OME before the start of study treatment. Follow up should be longer and ideally include symptom, audiometry and developmental outcomes. Data should not be presented with ears as the unit of analysis.

Administration, Intranasal↗
PubMed1981

Upon the relationship between secretory otitis in childhood and chronic otitis and its sequelae in adults.

A new theory is put forward to the effect that chronic middle-ear disease results directly from secretory otitis in childhood. The theory is based on an analysis of different materials, including healthy children in various age groups who were followed with tympanometry over a long period of time; children with secretory otitis who were re-evaluated 3-8 years after treatment, with special reference to changes in the tympanic membrane; and an otosurgical group comprising 1,100 ears, which were re-evaluated 3-14 years after operation. Chronic secretory otitis and chronic tubal dysfunction, which are particularly frequent in childhood, may cause such changes in the tympanic membrane and/or middle ear, that conditions are created which later on, maybe years after remission of secretory otitis, may favour the development of cholesteatoma, non-cholesteatomatous chronic otitis and perforation of the tympanic membrane.

Adolescent↗
PubMed1997

Acute otitis media and otitis media with effusion in children with bacterial meningitis.

Acute otitis media and otitis media with effusion (OME) have often been observed in children with bacterial meningitis. OME has also been proposed as the mechanism of reversible hearing loss after meningitis. In this controlled study, children with acute bacterial meningitis were studied using auditory brainstem responses (ABR), otoacoustic emissions, tympanometry and otoscopy. An age- and sex-matched control was recruited for each patient and the incidence of acute otitis media and OME was compared between the two groups. One hundred and twenty-four children with meningitis were studied. Ninety-two children (74 per cent) had meningococcal meningitis. Five patients (4 per cent) had conductive hearing loss (ABR threshold > or = 30 dB HL) at the time of discharge from hospital. None of the patients or controls had acute otitis media. Patients and controls were well matched for risk factors for OME and the prevalence of middle ear effusion in patients and controls was 7.2 per cent and 11.3 per cent respectively. The relative risk of OME in the children with meningitis was 0.64 (95 per cent confidence interval 0.29 to 1.42). After nine months, three of the five children with meningitis and conductive hearing loss had regained normal hearing. In contrast to previous reports, there was no relationship between bacterial meningitis and acute otitis media or OME in this study. Nevertheless, coincidental conductive hearing defects were identified as the cause of reversible hearing loss in three patients.

Acute Disease↗
PubMed1999

Evolution of the bacteriologic features of persistent acute otitis media compared with acute otitis media: a 15-year study.

OBJECTIVES: To define the epidemiologic features of persistent acute otitis media (PAOM) and modifications of these features during the past 15 years and to investigate for possible differences in bacterial resistance between acute otitis media (AOM) and PAOM. DESIGN: Retrospective patient series. SETTING: Academic tertiary care center. PATIENTS AND METHODS: Persistent acute otitis media was defined as AOM lasting longer than 3 weeks despite 1 or several courses of antibiotic therapy, with the persistence of clinical and otoscopic signs of AOM. From 1982 to 1997, 475 children with PAOM were seen in our department. Every patient had 1 or several specimens of aspirations or swabs of spontaneous otorrhea (or both). Microbiologic characteristics of the isolated strains (including antibiotic susceptibility) were analyzed. Four successive series of specimens were analyzed-group 1: from October 1, 1982, to June 30, 1986 (136 patients); group 2: from January 1, 1987, to December 31, 1989 (165 patients); group 3: from January 1, 1992, to April 30, 1993 (73 patients); and group 4: from January 1, 1994, to January 31, 1997 (101 patients). During the same study periods, the bacteriologic results of patients with AOM in the same geographic region were recorded. MAIN OUTCOME MEASURES: A longitudinal comparison between the groups of patients with PAOM and a cross-comparison within each group between patients with PAOM and those with AOM. RESULTS: Obtaining repeated and multiple specimens from patients with PAOM led to a progressive decrease in the rate of sterile specimens, from 35.3% (group 1, 48 patients) to 14.9% (group 4, 15 patients) (P<.01). During this period, the prevalence of Streptococcus pneumoniae increased in patients with positive culture results, from 18.2% (group 1, 16 of 88 patients) to 44.2% (group 4, 38 of 86 patients) (P<.001). These strains rapidly and dramatically became resistant to penicillin (amoxicillin) (0% through 1989, 76.2% [16 of 21 patients] in 1993, and 97.4% [37 of 38 patients] in 1996) (P = .01). The overall prevalence of Haemophilus influenzae remained stable (between 31.4% [27 of 86 patients] and 45.4% [40 of 88 patients]), but the proportion of beta-lactamase-producing strains increased from 30.0% (group 1, 12 patients) to 55.6% (group 4, 15 patients) (P=.04). The prevalences of Pseudomonas aeruginosa and Staphylococcus aureus did not vary significantly (from 23.1% [group 2, 30 patients] to 10.7% [group 3, 6 patients] and from 10.2% [group 1, 9 patients] to 4.6% [group 4, 4 patients], respectively). Comparing data from patients with PAOM with those with AOM revealed that the increased resistance of H influenzae and, in particular, of S pneumoniae was more rapid and more marked in patients with PAOM than in those with AOM (highest rate of resistance in AOM: 36.0% [271 of 753 specimens] and 50.6% [398 of 787 specimens] for H influenzae and S pneumoniae, respectively; P<.001 for S pneumoniae). CONCLUSIONS: The increase in bacterial resistance frequently encountered during otitis media is even more marked in patients with PAOM. The identification of the organism is essential when the otitis does not resolve, especially in patients with PAOM. Obtaining repeated specimens helps to decrease the rate of sterile cultures.

Acute Disease↗
PubMed1991

Quantitative bone and 67Ga scintigraphy in the differentiation of necrotizing external otitis from severe external otitis.

Qualitative technetium Tc 99m bone scintigraphy using phosphate compounds and gallium 67 scintigraphy were described as a helpful means in diagnosing necrotizing external otitis (NEO). They were, however, claimed to be nonspecific. Quantitative Tc 99m methylene diphosphonate bone scintigraphy and gallium 67 scintigraphy were performed in eight patients with NEO and in 20 patients with severe external otitis, in order to prove usefulness of scintigraphy in the diagnosis of NEO. Ratios of lesion to nonlesion for bone scintigraphy were 1.67 +/- 0.16 in patients with NEO and 1.08 +/- 0.09 in patients with severe external otitis, and for gallium 67 scintigraphy they were 1.35 +/- 0.24 in NEO patients and 1.05 +/- 0.03 in patients with severe external otitis. There was no difference in uptake between diabetic patients with severe external otitis and nondiabetic patients. The scintigraphic studies were also evaluated using a qualitative scoring method (scores 0 to +4), according to the intensity of the radiopharmaceutical uptake. This method was found to be inferior in the diagnosis of NEO compared with the quantitative method. We conclude that lesion-to-nonlesion ratios greater than 1.5 and 1.3 on bone and gallium 67 scintigraphy, respectively, are indicative of NEO. Quantitative bone scintigraphy, which is quicker to perform, may be used as a single imaging modality for the diagnosis of NEO.

Adult↗
PubMed2001

Prevalence and impact of chronic otitis media in school age children in Brazil. First epidemiologic study concerning chronic otitis media in Latin America.

OBJECTIVE: The first epidemiological study carried out in Latin America to investigate the prevalence of otological disease and its impact in a representative random sample of the school children population. METHODS: A cross sectional epidemiological survey to investigate the epidemiology of otitis in a representative random sample of 1119 children and adolescents from a total of 486166 elementary and high-school students, aged 6-18 years, regularly registered in one of the 521 public and private schools of the city of Belo Horizonte, in the state of Minas Gerais, southern Brazil. The interviews were conducted individually, in the school, by an otolaryngologist or a pediatrician. The interview included all of the personal data and also detailed questions regarding otological disorders and hearing. The otological examination was carried out with Mini-Heine otoscopes and the audiometric evaluation with the AudioScope 3 with 25dB intensity. The questionnaire and basic procedures for medical examination had been previously tested through a pilot test in two schools. RESULTS: The prevalence of chronic otitis media was 0.94%. Impacted wax was found in 12.3% of the students. The prevalence of abnormalities (excluding wax) in the otoscopy examination was 10.5%. It was found that 8.3% of students had a past history of otitis and 7.7% had a past history of otorrhea. These two special groups presented statistically significant associations with chronic otitis media, hearing loss and otolaryngological surgeries (when compared with the other school children). Parents and school children seemed significantly able to identify a special group of children with past history of otitis during childhood.

Adolescent↗
PubMed1999

High incidence of Alloiococcus otitis in otitis media with effusion.

BACKGROUND: The etiology of otitis media with effusion (OME) is unclear. Although the majority of effusions show inflammation, culture methods yield positive results for bacteria in only 20 to 30% of cases. METHODS: The polymerase chain reaction was used for detection of three upper respiratory tract pathogens, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae, and a fairly recently described bacterium, Alloiococcus otitis (A. otitidis), that is solely found in OME. The study included 67 middle ear effusions that were collected from 48 pediatric OME patients during ventilation tube placement. RESULTS: PCR tested positive for 57 (85.1%) of the middle ear effusions. Thirty-one (46.3%) A. otitis-, 12 (17.9%) H. influenzae-, 25 (37.3%) M. catarrhalis- and 14 (20.9%) S. pneumoniae-positive effusions were obtained. All four study organisms showed similar distribution in effusions of various duration (P = 0.72) and in different effusion types (P = 0.59). Only the proportion of M. catarrhalis-positive effusions was lowered by recent antimicrobial therapy (P < 0.05). Although the study organisms had equal distributions among singly and multiply positive specimens (P = 0.90), A. otitis was detected significantly more often with one of the three other species (15 of 19, 78.9%) than the other species with each other (4 of 19, 21.1%, P < 0.001). CONCLUSIONS: The findings suggest a bacterial etiology for OME. Association of A. otitis with the three other species implies that this organism might have the capability of augmenting bacterial colonization in the middle ear.

Child↗
PubMed2003

Open label, multicenter study of gatifloxacin treatment of recurrent otitis media and acute otitis media treatment failure.

BACKGROUND: Recurrent otitis media and treatment failures of acute infections are refractory to therapy. Newer fluoroquinolones have excellent activity against respiratory pathogens, but their use in children has been limited because of concerns about adverse effects. METHODS: This was an open label, multicenter trial in which patients with recurrent otitis media or acute otitis media (AOM) treatment failure were treated with 10 mg/kg gatifloxacin oral suspension once daily for 10 days. Before treatment a tympanocentesis or a swab of middle ear fluid was obtained. Nasopharyngeal swabs were obtained at baseline and at the end of therapy. Efficacy was evaluated 3 to 10 days after cessation of treatment and at 3 to 4 weeks. Safety monitoring included special attention to any sign or symptom suggestive of joint or bone abnormality. RESULTS: The study enrolled 254 patients 6 months to 7 years of age, with one-half (52%) of the patients having recurrent otitis media, 17% having AOM treatment failure and 28% having both. Cure was achieved posttreatment in 88% of 198 clinically evaluable patients, with similar outcomes for patients younger or older than 2 years of age. Of the 45 evaluable patients with Streptococcus pneumoniae, 38 (84%) were cured, including 25 of 28 with penicillin-nonsusceptible strains. Also cured were 89% of those with Haemophilus influenzae and those with Moraxella catarrhalis. No selection of resistance to gatifloxacin was detected among nasopharyngeal pathogens. Eighty-three percent of the children had sustained cure at the 4 weeks follow-up visit. Adverse events were primarily mild gastrointestinal, with no occurrences of arthropathy. CONCLUSION: Gatifloxacin is safe and effective for treatment of recurrent otitis media and AOM treatment failure in children.

Acute Disease↗
PubMed1994

Prevention of recurrent acute otitis media in otitis-prone children by intermittent prophylaxis with penicillin.

The question whether penicillin V (pcV) given intermittently upon signs of upper respiratory tract infections (URTI) in otitis-prone children might prevent recurrent bouts of acute purulent otitis media (AOM) is addressed. As compared with continuous long-term antibiotic treatment as prophylaxis in otitis-prone children, intermittent administration would reduce the overall consumption of antibiotics. Seventy-six otitis-prone children less than 18 months of age were included in this double-blind, randomized, placebo-controlled multicentre study. Follow-up was from January till June. One hundred and twenty-three episodes of AOM occurred. The number of AOM episodes was reduced by 50% in the children on pcV during URTI episodes as compared with those on placebo. No obvious ecological drawbacks were noted. Thus, the described mode of pcV administration seems to be a rational and safe way to reduce the number of AOM episodes in otitis-prone children.

Acute Disease↗
PubMed1982

Panel discussion: pathogenesis of otitis media. Pathology and microbiology of otitis media.

Otitis media (OM) can be subdivided into purulent, serous, mucoid, and chronic forms. It may occur in the absence of tympanic membrane changes and involve the inner ear. Purulent otitis media is characterized early by edema, hyperemia, and polymorphonuclear leukocyte infiltration in the subepithelial space (SES) and later by mucosal metaplasia, granulation tissue, and osteitis. S. pneumoniae and H. influenza are most commonly identified. Serous and mucoid OM frequently develop from eustachian tube dysfunction. Serous transudate from vessels in the SES passes to the middle ear (serous otitis media). Basal cells differentiate into goblet cells and subepithelial glandular formation occurs. This secretory activity, coupled with fluid reabsorption, results in a mucoid effusion. Bacteria can be cultured from about 30% of these effusions. Chronic otitis media denotes irreversible tissue pathology. It may be sterile although S. aureus and coliform bacteria are frequently isolated.

Animals↗
PubMed1989

[Personal studies on the current spectrum of pathogenic bacteria in otitis externa and chronic otitis media].

From 1985-1987 smears (for Gram staining) and swabs (for culture and antibiogram) were done in 294 patients suffering from chronic otitis media, and in 67 cases of external otitis. Besides the comparison of these two procedures, the microbial spectrum in case of external otitis and chronic otitis media is considered and compared to the literature. Pseudomonas aeruginosa and Staphylococcus aureus are the most frequent pathogens. Often gram-positive rod-shaped bacilli were also found, the pathogenicity of which has been underestimated in the literature up to now. The anaerobes did not play an important role in our patients. The value of gram staining (immediate information and safer antibiotic therapy) is pointed out on the basis of the reported results.

Bacteria↗
PubMed2000

Role of Streptococcus pneumoniae and Haemophilus influenzae in the development of acute otitis media and otitis media with effusion in a gerbil model.

The efficacy of amoxicillin/clavulanate and cefuroxime was determined in a gerbil model of otitis media with a mixed Streptococcus pneumoniae plus Haemophilus influenzae middle ear (ME) infection. Results were compared with those obtained in a previous single H. influenzae model. All untreated animals inoculated with the mixed inoculum developed acute otitis media (AOM), whereas 86.7% of those inoculated with H. influenzae developed otitis media with effusion (OME). Antibiotics eradicated H. influenzae from the ME more efficiently in AOM than in OME, and this difference was highly significant (P</=.001) after administration of 5 mg/kg of either drug (amoxicillin/clavulanate, 100% vs. 10%; cefuroxime, 73.3% vs. 10%). Efficacy was predicted by the relation of in vitro susceptibility and ME antibiotic concentration, which was 2.7 times higher in AOM than in OME. In the mixed otitis model, the most efficacious antibiotic was able to prevent AOM, but >80% of animals developed culture-negative OME.

Acute Disease↗