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At least 19 recordsLinked to original sources
PubMed1996

Platelet-activating factor and leukotrienes in acute otitis media, secretory otitis media, and chronic otitis media on the acute excerbation.

The present study was carried out for the purpose of measuring platelet activating factor (PAF) and leukotrienes (LTs) in middle ear fluid (MEF) or in otorrhea of children with acute otitis media (AOM), with secretory otitis media (SOM), and with chronic otitis media (COM) on the acute exacerbation. PAF, LTC4, and LTD4+LTE4 concentrations were measured by radioimmunoassay in purulent MEFs obtained from 15 ears of 15 children with AOM, in mucoid or gluey MEFs from 16 ears of 15 children with SOM, and in purulent otorrhea from 9 ears of 9 children with COM on the acute exacerbation. PAF concentrations were 25.4 +/- 9.0 ng/mg total phospholipid (TPL) in AOM, 4.9 +/- 1.9 ng/mg TPL in SOM, 20.7 +/- 15.7 ng/mg TPL in COM, demonstrating significant differences between AOM and SOM (p < 0.05) and between COM and SOM (p < 0.01). LTC4 concentrations were 92.9 +/- 73.8 pg/mg total protein (TP) in AOM, 52.0 +/- 42.5 pg/mg TP in SOM, and 28.5 +/- 11.2 pg/mg TP in COM. LTD4+LTE4 concentrations were 326.5 +/- 177.0 pg/mg TP in AOM, 288.2 +/- 144.6 pg/mg TP in SOM, and 94.0 +/- 58.1 pg/mg TP in COM, demonstrating significant differences between AOM and COM and between SOM and COM (p < 0.01). The results obtained indicated that PAF was involved in the onset of AOM and COM on the acute exacerbation, and that LTs played an important role in SOM.

Acute Disease↗
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↗
PubMed2004

Medical home, obesity, acute otitis media, and otitis media with effusion.

Four areas of pediatric office practice are reviewed: the medical home concept, obesity, acute otitis media, and otitis media with effusion. The concept of the medical home in the care of children with special health care needs, its effect on health care outcomes, and its application to office practice are discussed. The epidemiology and causes of obesity are covered along with options for obesity screening and prevention. Diagnosis and therapy of acute otitis media and otitis media with effusion are reviewed along with discussion of recent practice guidelines for both entities.

Acute Disease↗
PubMed2005

Antimicrobial resistance in the nasopharyngeal flora of children with acute otitis media and otitis media recurring after amoxicillin therapy.

The objective of this study was to investigate the antimicrobial susceptibility of the organisms isolated from the nasopharynx of children who presented with acute otitis media (AOM) or otitis media that recurred after amoxicillin therapy. Nasopharyngeal cultures obtained from 72 patients, 40 with AOM and 32 with recurrent otitis media (ROM), were analysed. Thirty-six potentially pathogenic organisms were recovered in 34 (85 %) of the children from the AOM group, and 42 were isolated from 29 (91 %) of the children from the ROM group. The organisms isolated were Streptococcus pneumoniae (n = 26), Haemophilus influenzae non-type b (n = 22), Moraxella catarrhalis (n = 13), Streptococcus pyogenes (n = 8) and Staphylococcus aureus (n = 9). Resistance to the eight antimicrobial agents used was found in 37 instances in the AOM group as compared to 99 instances in the ROM group (P < 0.005). The difference between AOM and ROM was significant with Streptococcus pneumoniae resistance to amoxicillin (P < 0.005), to amoxicillin/clavulanate (P < 0.005), to trimethoprim/sulfamethoxazole (P < 0.01), to cefixime (P < 0.01) and to azithromycin (P < 0.01), and for H. influenzae resistance to amoxicillin (P < 0.025). These data illustrate the higher recovery rate of antimicrobial-resistant Streptococcus pneumoniae and H. influenzae from the nasopharynx of children who had otitis media that recurred after amoxicillin therapy than those with AOM.

Amoxicillin↗
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↗
PubMed1994

Microbiology and management of otitis media.

Otitis media is a complex and multifactorial condition with four defined stages: myringitis, acute otitis media, secretory (serous) otitis media and chronic otitis media. Drugs utilized in its treatment are antihistamines, decongestants, mucolytic agents, non-steroidal anti-inflammatory agents, corticosteroids, vaccine therapy and antibiotics. The rationale for using antibiotics is that inflammation has been associated with the presence of virulent bacteria in all types of otitis media. In acute otitis media the major organisms, present are Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. In chronic otitis media these organisms, plus Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and anaerobic bacteria are all prevalent. The microbiological flora of the middle ear in secretory otitis media is almost identical with that in acute otitis media. Empirical therapy can be given in most instances of acute and serous otitis media. However, in cases of failure, in the immunocompromised and in instances of chronic otitis media, establishing the individual microbiology of the inflamed middle ear is very helpful. The growing resistance of H. influenzae and M. catarrhalis to amoxycillin, due to beta-lactamase production, increases the risk of treatment failure of acute and serous otitis media. By adding a beta-lactamase inhibitor (clavulanic acid) to amoxycillin, or using second-generation cephalosporins, clearance can be achieved. Management of chronic otitis media requires surgical correction, drainage and coverage of anaerobic bacteria with agents such as amoxycillin plus clavulanic acid, or clindamycin plus antimicrobials against other pathogens such as Pseudomonas spp. where present.

Anti-Bacterial Agents↗
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↗
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↗
PubMed2006

Prospects for a vaccine against otitis media.

Otitis media is a major cause of morbidity in 80% of all children less than 3 years of age and often goes undiagnosed in the general population. There is evidence to suggest that the incidence of otitis media is increasing. The major cause of otitis media is infection of the middle ear with microbes from the nasopharynx. The anatomical orientation of the eustachian tube, in association with a number of risk factors, predisposes infants and young children to the infection. Bacteria are responsible for approximately 70% of cases of acute otitis media, with Streptococcus pneumoniae, nontypeable Haemophilus influenzae and Moraxella catarrhalis predominating as the causative agents. The respiratory viruses, respiratory syncytial virus, rhinovirus, parainfluenza and influenza, account for 30% of acute otitis media cases. Over the past decade, there has been a profound increase in the reported resistance to antibiotics, which, with increased disease burden, has focussed attention on vaccine development for otitis media. A polymicrobial formulation containing antigens from all major pathogens would have the greatest potential to deliver a sustained reduction in the disease burden globally. The disappointing outcomes for otitis media seen with the polysaccharide pneumococcal conjugate vaccine have raised major challenges for the vaccination strategy. Clearly, more knowledge is required concerning immune mechanisms in the middle ear, as well as vaccine formulations containing antigens that are more representative of the polymicrobial nature of the disease. Antigens that have been extensively tested in animal models are now available for testing in human subjects.

Bacterial Vaccines↗
PubMed1994

Otitis media.

Otitis media is the most common respiratory tract infection of infancy and early childhood that is managed with antibacterial agents. A bacterial pathogen is isolated from the middle ear fluids of approximately two-thirds of children with acute otitis media; S. pneumoniae is the leading bacterial pathogen followed by nontypable strains of H. influenzae and M. catarrhalis. Clearance of bacteria from middle ear fluid without use of antibacterial drugs is evident in studies in which a placebo is used. Whereas pneumococci continued to be isolated from middle ear fluids when the infection was not treated, approximately one-half of infections due to nontypable H. influenzae and up to 80% of those due to M. catarrhalis cleared. The microbiological data suggest that only one-third of patients with acute otitis media require antibacterial therapy for resolution of clinical signs and symptoms. However, without the results of prior tympanocentesis, the physician cannot identify the patients for whom the infection will resolve. Thus, the data support use of antibacterial agents for all episodes of acute otitis media to cover adequately the one-third of children who will need the antimicrobial agent to recover from the infection. Effusion persists in the middle ear for weeks to months after every episode of acute otitis media. Conductive hearing loss of some degree occurs whenever the middle ear space is filled with effusion. Decreased scores in tests of speech and cognitive abilities for infants and children who had prolonged middle ear effusion has stimulated investigators to seek means to reduce the duration of middle ear effusion following acute otitis media. Because the pathogenesis of persistent middle ear effusion is uncertain, the results with medical therapies, including antibiotics and steroids, have been inconsistent. Placement of ventilating or tympanostomy tubes to produce drainage and ventilation of the middle ear and to restore hearing is effective and is now the second most frequent surgical procedure in children (after circumcision), but the criteria for placement of tubes are controversial. Prevention of otitis media is possible by use of chemoprophylaxis or vaccines. Chemoprophylaxis has been effective in children with recurrent acute otitis media by reducing new episodes by 40%-90%. A serum antibody response that is age- and type-specific follows pneumococcal infection and protects against subsequent homotypic infection. Polysaccharide pneumococcal vaccines are not consistently immunogenic in children > 2 years of age, but experimental conjugate polysaccharide vaccines are immunogenic in infants as young as 2 months.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Disease↗
PubMedDate not supplied

Chronic silent otitis media.

Otitis media occurs along a continuum. For example, otitis media with effusion characterized by fluid pathology can lead to chronic otitis media plus chronic mastoiditis, characterized by the presence of intractable tissue pathology such as cholesteatoma, cholesterol granuloma or granulation tissue. The literature defines chronic otitis media as having a tympanic membrane perforation and otorrhea. Amongst many other sequelae, which can result from the continuum, an important common one is chronic silent otitis media. This overlooked entity which includes pathology beneath an intact tympanic membrane is commonly seen in our human temporal bone laboratory and in patients. The clinical pathological correlates of this important disease are discussed herein.

Cholesteatoma, Middle Ear↗
PubMed2006

Emerging therapies for the treatment and prevention of otitis media.

Otitis media is one of the most common disorders occurring in children, and there is growing concern that bacteria are quickly becoming resistant to antimicrobials. As a result, global antibiotic treatment is no longer the standard of care and treatment of otitis media has changed dramatically in the last decade. In addition to new antimicrobials currently in development, the effects of the pneumococcal conjugate vaccine are just beginning to be understood. Furthermore, new surgical techniques are for the first time being tested as alternatives for tympanostomy tubes for recurrent acute otitis media. This review discusses current and emerging otitis media therapeutics, with particular attention to acute otitis media. Topics include antimicrobial use, antimicrobial resistance, effects of vaccination and new surgical techniques.

Anti-Bacterial Agents↗
PubMed2002

Influenza virus vaccines in children and their impact on the incidence of otitis media.

Otitis media has been identified as the most frequent reason for outpatient antibiotic therapy. Several studies have linked viral respiratory infections with bacterial otitis media. In light of rising concerns about antibiotic resistance, the possibility of reducing the incidence of otitis media through vaccination against respiratory viruses has received increasing attention. This article reviews inactivated and live attenuated influenza virus vaccines and their possible impact on the incidence of otitis media. Inactivated and live attenuated influenza virus vaccines are safe and immunogenic in children older than 6 months and are linked to a decrease in the incidence of otitis media. Influenza vaccination of infants younger than 6 months has resulted in less predictable immunogenicity and deserves further investigation.

Child↗
PubMedDate not supplied

Do we need to treat otitis media?

Otitis media is a common pediatric problem. It is well established that over half of infants and children with acute otitis media may have spontaneous recovery. Since it is difficult to predict the course (self-limited versus serious disease) all the children with acute suppurative otitis media need to be treated with antibiotics. Amoxicillin is still the initial antibiotic of choice. There are several alternate antibiotics available with activity against beta-lactamase positive bacteria. These agents have no advantage over amoxicillin in infections due to penicillin resistant pneumococci. Recent use of beta-lactam antibiotics and/or attendance in a day care where there is frequent use of antibiotics are predisposing factors for penicillin resistant pneumococcal infection. In such cases after tympanocentesis, higher dose of amoxicillin, clindamycin or intramuscular ceftriaxone should be considered. Secretory otitis media does not need to be treated with antibiotics unless the patient is in high risk group. Prophylactic use of antibiotics should be actively discouraged. Influenza and pneumococcal vaccination (2 years or older) should be encouraged in children with recurrent episodes of acute otitis media. Breast feeding should be encouraged.

Anti-Bacterial Agents↗
PubMed2003

Host-derived sialic acid is incorporated into Haemophilus influenzae lipopolysaccharide and is a major virulence factor in experimental otitis media.

Otitis media, a common and often recurrent bacterial infection of childhood, is a major reason for physician visits and the prescription of antimicrobials. Haemophilus influenzae is the cause of approximately 20% of episodes of bacterial otitis media, but most strains lack the capsule, a factor known to play a critical role in the virulence of strains causing invasive H. influenzae disease. Here we show that in capsule-deficient (nontypeable) strains, sialic acid, a terminal residue of the core sugars of H. influenzae lipopolysaccharide (LPS), is a critical virulence factor in the pathogenesis of experimental otitis media in chinchillas. We used five epidemiologically distinct H. influenzae isolates, representative of the genetic diversity of strains causing otitis media, to inoculate the middle ear of chinchillas. All animals developed acute bacterial otitis media that persisted for up to 3 wk, whereas isogenic sialic acid-deficient mutants (disrupted sialyltransferase or CMP-acetylneuraminic acid synthetase genes) were profoundly attenuated. MS analysis indicated that WT bacteria used to inoculate animals lacked any sialylated LPS glycoforms. In contrast, LPS of ex vivo organisms recovered from chinchilla middle ear exudates was sialylated. We conclude that sialylated LPS glycoforms play a key role in pathogenicity of nontypeable H. influenzae and depend on scavenging the essential precursors from the host during the infection.

Animals↗