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At least 19 recordsLinked to original sources
PubMed1991

Antimicrobial therapy for otitis media with effusion ('secretory' otitis media).

OBJECTIVE: To determine the effectiveness of antimicrobial treatment for otitis media with effusion ("secretory" otitis media) in children. DATA SOURCE: We report the reexamination of a previously published study by Mandel et al that evaluated the efficacy of a 2-week course of antimicrobials (amoxicillin trihydrate) with and without a 4-week course of an oral decongestant-antihistamine combination in a double-blind, placebo-controlled, randomized trial involving 518 infants and children with otitis media with effusion. DATA SYNTHESIS: At 4 weeks, amoxicillin efficacy as determined by a tympanometric criterion (P = .121) or by a measure of improvement in hearing (P = .311) was insignificant. Only by otoscopic judgment, which is shown to contain a systematic bias as used in this clinical trial, could an argument be made for a marginal efficacy of amoxicillin at the 4-week end point. Logistic regression analyses of the combined effects of treatment and prognostic factors showed no significant differences between placebo- and antibiotic-treated groups for unilateral effusions and for bilateral effusions. When subjects with unilateral and bilateral effusions were combined, the estimated efficacy of antibiotic treatment was 12.3% by otoscopy (P = .014) and 4.8% by tympanometry (P = .171). We also demonstrate the sensitivity of outcome to diagnostic measures used and provide statistical evidence questioning the validity of otoscopic observations in this study. Six weeks after the termination of amoxicillin therapy, the recurrence of effusion was two to six times higher in the amoxicillin-treated children than in those treated with placebo (P = .001), and resolution of effusion was not significantly different among antibiotic and placebo groups (13.6% and 11.3%, respectively; P = .477). CONCLUSIONS: Amoxicillin with and without decongestant-antihistamine combination is not effective for the treatment of persistent asymptomatic middle-ear effusions in infants and children.

Amoxicillin↗
PubMed1986

Medical treatment of chronic otitis media with effusion (secretory otitis media).

To determine whether antimicrobial therapy is of value in the treatment of chronic otitis media with effusion (secretory otitis media), we treated 1,429 4- to 8-year-old children--2224 affected ears--with a fixed regimen of an antibiotic mixture (Pediazole) for 10 days and a decongestant (Novafed) for 30 days. We observed the children monthly to determine the rate of clearance. Validity of diagnosis was greater than 90% with an algorithm of pneumatic otoscopy and tympanometry. Medication compliance was not measured. At 1 month, 45% of the children (48% of the ears) had cleared and at 2 months, 60% of the children (63% of the ears) had cleared. Factors such as sex and prior treatment in the preceding 3 months were no different in the cured vs. the uncured groups. Age significantly influenced the cure rate (P less than 0.0001); the older the child, the higher the clearance rate. Tympanograms type 5, 8, and 12-14 were significantly more prevalent in the uncleared group (P = 0.0001). The clear rate for unilateral cases was 76% and for bilateral cases, 47% (P less than 0.0001). Children with chronic otitis media with effusion are most likely to be cured by medical therapy/time if they are older, have unilateral disease, or a peaked tympanogram. Surgery should be withheld in these children for 2 or more months to permit the highest rate of spontaneous resolution.

Age Factors↗
PubMed1983

Lack of efficacy of a decongestant-antihistamine combination for otitis media with effusion ("secretory" otitis media) in children. Results of a double-blind, randomized trial.

In a double-blind, randomized trial of 553 infants and children who had otitis media with effusion ("secretory" otitis media), we compared the efficacy of a four-week course of an oral decongestant-antihistamine combination (pseudoephedrine hydrochloride, 4 mg per kilogram of body weight per day, and chlorpheniramine maleate, 0.35 mg per kilogram per day) with that of placebo. Among patients with initially unilateral disease, resolution of middle-ear effusion occurred at four weeks in 38 per cent of those treated with placebo and 34 per cent of those treated with drug (P = 0.74). Among patients with initially bilateral disease the corresponding proportions were 19 and 21 per cent, respectively (P = 0.67). Side effects were reported more often among drug-treated than placebo-treated patients. Decongestant-antihistamine combinations do not appear to be indicated for the treatment of otitis media with effusion in infants and children.

Child↗
PubMed2001

A comprehensive model for the aetiology of otitis media with effusion.

Otitis media with effusion is highly prevalent among young children. Adverse effects of this disorder are mainly restricted to the group of children with a history of recurrent or persistent otitis media with effusion. Early identification, assessment and intervention might prevent these adverse effects. Up to now it is not possible to distinguish these children from those with transient otitis media with effusion. This article presents a comprehensive model for the aetiology of otitis media with effusion. Eustachian tube functioning and the immunological response to environmental pathogens are the two core elements. This model can be used to formulate specific hypotheses about the interaction of several factors that may lead to the early identification of children who are likely to develop persistent or recurrent otitis media with effusion.

Child, Preschool↗
PubMed2002

Lymphocyte subpopulations in hypertrophied adenoid in children with otitis media with effusion.

Otitis media with effusion (OME) usually coexist with the adenoid hypertrophy. The aim of this study was a quantitative evaluation of the lymphocyte subpopulations in hypertrophied adenoid in children with persistent (ove three months) otitis media with effusion. We used flow cytometry for study the subpopulations of the lymphocytes in the pharyngeal adenoid during otitis media in the children, alternative group consist of children with simple adenoid hypertrophy. The monoclonal antibodies selected were specific markers for T lymphocytes (CD3), T-helper cells (CD4), T-suppressor cells (CD8), B cells (CD19) and NK cells (CD56). There were also analyzed T activation markers: HLA-DR and CD25. The percentage of NK cells was significantly decreased in the group of younger children with otitis media with effusion (0.81 +/- 0.51) in comparison to older ones (1.40 +/- 0.59%). Also, in the group of younger children with adenoid hypertrophy, the NK cells percentage was significantly lower (0.85 +/- 0.37%) than in the group of older children--(1.46 +/- 0.83). In both subgroups of younger children the percentage of lymphocytes T with HLA-DR activation marker was close, but it was significantly lower in the group of older children with otitis media with effusion (4.28 +/- 3.40%) in comparison to the group of older children with adenoid hypertrophy (5.03 +/- 3.00%).

Adenoidectomy↗
PubMed2001

Bacteriological and PCR analysis of clinical material aspirated from otitis media with effusions.

Otitis media with effusions (OME) can lead to significant hearing loss in childhood. Although previous studies have shown that bacterial DNA is present in a significant percentage of effusions sterile by culture, whether the DNA represents viable organisms or 'fossilized remains' is unknown. The aim of the present study was the determination of Streptococcus pneumonia, Moraxella catarrhalis and Haemophilus influenza in the clinical materials from OME. For this purpose, effusion samples aspirated from the mid-ear were analyzed bacteriologically. Samples were also tested with polymerase chain reaction (PCR) assay. A total of 37 samples obtained from 20 patients aging between 4 and 14 were analyzed. In 17 patients, both ears demonstrated effusions, whereas in three patients, only one ear had effusions. In aerobic bacterial culture assays, nine samples (24.3%) showed bacterial growth. None of the samples were positive for anaerobic culture experiments. PCR analysis of the samples showed that 35 samples (94.5%) contained bacterial DNA. In 19 samples, only one bacterial species and in 16 samples more than one bacterial species were detected. The results of this study demonstrate that effusion fluid from otitis media cases contain a battery of bacterial species and these bacteria might play roles in the pathogens of OME. Our results indicate the PCR technique is more specific and sensitive in detection of bacteria in middle-ear effusion of OME, compared with conventional methods.

Adolescent↗
PubMed2004

Antibiotics for otitis media with effusion.

Otitis media with effusion (OME) is defined as asymptomatic middle-ear effusion, that is, without the signs and symptoms of acute otitis media (AOM), such as fever, otalgia, or otorrhea. OME can occur after an episode of AOM or may occur without any prior or concurrent symptoms and is often noted on a routine physical examination or screening. Because children with OME are usually not ill, there is a question of whether treatment is warranted for this condition. Also adding to the complexity of this problem is the high spontaneous cure rate of OME. This paper will review the many clinical trials of the efficacy of antimicrobial therapy for OME. We have grouped the studies into 4 major categories: antibiotic vs no treatment, antibiotic vs placebo, antibiotic vs antibiotic, and antibiotic prophylaxis. While study designs, definitions, and quality vary widely, these studies show a trend toward short-term efficacy of antimicrobial treatment, but long-term efficacy is doubtful. In this age of antimicrobial resistance, coupled with the high natural cure rate, routine antimicrobial treatment of OME is not warranted. It may be useful in selected patients, particularly those with chronic OME (3 months or longer of bilateral effusion or 6 months or longer of unilateral effusion) for whom surgery is being considered: a 1-time short course of antibiotic may allow cancellation or at least postponement of a surgical procedure, particularly in spring/summer when one would like to avoid placing tubes in the ears and placing the child at risk for otorrhea due to water exposure. Also, antimicrobial therapy may provide at least short-term relief for symptomatic children (hearing loss, developmental delay, etc.) for whom surgery must be postponed or is contraindicated.

Age Factors↗
PubMed1997

[Antibiotics in otitis media with effusion].

Otitis media with effusion usually resolves spontaneously. If not, long-term hearing impairment has to be prevented. The available literature indicates that antibiotic treatment has at most a short-term effect. Therefore it is not indicated for the treatment of otitis media with effusion.

Anti-Bacterial Agents↗
PubMed1981

Current concepts in the management of otitis media with effusion.

Otitis media with effusion is the leading cause of hearing loss in children. The pathogenesis of this disease process continues to be controversial. Diagnosis requires precise otoscopic evaluation coupled with audiometric investigation. Therapy has traditionally included medical and surgical regimens. Recent findings indicate that some basic changes may be required in both these therapeutic avenues. Aggressive therapeutic intervention may be required in patients presenting with complications of otitis media with effusion. Available information strongly indicates that a more intensified research effort must be undertaken to better identify and treat this difficult disease process.

Anti-Bacterial Agents↗
PubMed1985

Clinical and experimental studies on the pathogenesis of otitis media with effusion.

Otitis media is the most common pediatric disease as a complication of the upper respiratory infection and at least 10% of the otitis prone children will suffer from prolonged episodes of minor conductive hearing loss and communication disorder due to the presence of middle ear effusion (MEE). In spite of exhaustive studies presented in the past three international symposia on otitis media with effusion (OME), there still remain wide gaps in our knowledge regarding the etio-pathogenesis and appropriate treatments of the disease. A couple of years ago, a new project of clinical and laboratory researches on OME were initiated in the Department of Otolaryngology, Tohoku University School of Medicine and some results of the studies have been reported in recent Japanese academy meetings as well as in the 2nd and 3rd International Symposium of Recent Advances in OME. The purpose of this paper is to summarize the results of our recent studies performed by several investigators in our department and related hospitals.

Animals↗
PubMedDate not supplied

Results after treatment of otitis media with effusion.

Otitis media with effusion will be observed in every fifth child admitted for adenoid surgery; in children with cleft palates the incidence is 50%. With adenoidectomy alone, normal hearing can be restored in 50% and improved in further 25% of the patients. Over a 12-year period 1,683 patients with otitis media with effusion were treated with adenoidectomy and with insertion of tympanostomy tubes in those cases where adenoidectomy proved to be ineffective. Since the tubes only substitute tubal function, recurrences have to be expected in more than 30% after spontaneous extrusion of the tubes. Of all recurrences, 93% occur within two years after tube insertion. With thorough follow-up and repeated insertion of tubes, deterioration of the middle-ear can be avoided and hearing kept normal. Impaired bone conduction does not reflect inner ear damage, but will improve with ventilation of the middle ear. Infections occur in 15% (5% postoperatively, 10% later); persistent perforations in 2.5% and cholesteatoma in 0.9%.

Adenoidectomy↗
PubMedDate not supplied

Autoimmunity in the etiology of otitis media with effusion.

Otitis media with effusion (OME) is one of the most common health problems seen in children. The role of autoimmunity in the etiology of OME has been discussed for a long time. The purpose of this investigation is to determine the role of circulating antibodies in the pathogenesis of OME. The presence of antibodies against rabbit tympanic bulla epithelium was investigated by indirect immunoflouresence in the serum samples of 25 patients with OME and serum samples of 25 healthy children as a control group. In the control group, positive staining was seen in only 1 case (4%), whereas 8 cases with OME were positively stained (%32). There was statistically significant difference between the 2 groups. The presence of antibodies against middle ear epithelium in the cases with OME suggest that autoimmunity might play a role in the formation of effusion in the tympanic cavity.

Animals↗
PubMed1991

The management of otitis media with effusion.

Otitis media with effusion is one of the most common otologic diseases encountered by the clinician. This is primarily a pediatric problem although it can be seen in all age groups. The etiology, diagnosis, and treatment of this disorder will be discussed in this manuscript.

Humans↗
PubMedDate not supplied

Drugs affecting clearance of middle ear secretions: a perspective for the management of otitis media with effusion.

Otitis media with effusion (OME) is characterized by the production and accumulation in the middle ear of mucus secretions, whose physicochemical properties are an important feature in the etiology and treatment of the disease. Many types of pharmaceutical agents, including anti-inflammatory agents, antihistamines, antibiotics, and mucolytics, have been used in attempts to improve the clinical status of patients with OME. This study critically reviews the literature from the point of view of possible changes induced by these agents in the physicochemical properties of the secretions and hence their clearance from the middle ear. In vitro studies on mucociliary clearance of respiratory (tracheobronchial) secretions and middle ear effusions are cited as the basis for analyzing the important parameters expected to govern middle ear clearance and to determine the rationale for use (or nonuse) of various classes of drugs. It is expected that this analysis will prove useful in the design of properly controlled trials of such agents.

Animals↗
PubMedDate not supplied

Otitis media with effusion.

Otitis media with effusion is common in young children and varies widely in duration and severity. Defined as fluid in the middle ear without signs or symptoms of infection, it is generally asymptomatic. However, it has the potential to adversely affect hearing, speech development, and language acquisition.

Anti-Bacterial Agents↗
PubMed1988

Inflammatory mediators in chronic otitis media with effusion.

Otitis media with effusion (OME) is a common middle ear inflammatory disease in the pediatric population. This article determines concentrations of three functionally and metabolically distinct inflammatory mediators in middle ear effusions (MEE) and corresponding plasma of children with OME. One hundred two patients (mean age, 4.9 years) with persistent OME were studied. Middle ear effusions were collected from all subjects and plasma from a subset at the time of tympanostomy tube insertion. Histamine was assayed radioisotopically, 13,14-dihydro-15-keto-prostaglandin F2 alpha (stable PGF2 alpha metabolite) by radioimmunoassay, and neutrophil chemotactic factor of anaphylaxis by modified Boyden chamber. Mean MEE levels of the mediators (39 +/- 13 ng/mL, 462 +/- 179 pg/mL, and 264% +/- 57% positive control, respectively) were markedly higher than those of corresponding plasma (0.5 +/- 0.1 ng/mL, 285 +/- 127 pg/mL, and 47% +/- 5% positive control, respectively). The mean histamine content of mucoid effusions (43.2 +/- 56.9 ng/mL) was significantly higher than that of purulent (22.5 +/- 10.5 ng/mL) and serous (17.9 +/- 16.8 ng/mL) effusions. Higher histamine levels were observed in effusions positive for Haemophilus influenzae when compared with those with other pathogenic isolates. The high concentrations of these mediators in MEE and their potential for inducing or sustaining the inflammatory process supports a role in the pathogenesis of OME.

Adolescent↗
PubMed2001

Cytolytic complement activity in otitis media with effusion.

Otitis media with effusion (OME) is a chronic inflammation persisting in the middle ear cavity of at least 8 weeks duration. Middle ear effusion (MEE; n = 38), samples from children suffering from OME were investigated for their direct cytolytic activity or an ability to enhance complement lysis of unsensitized bystander cells. Thirteen of the 38 MEEs had direct endogenous haemolytic activity and 27 samples had an ability to enhance serum-initiated lysis. Using an enzyme immunoassay, high levels of terminal complement complexes (TCC) were detected in the MEE samples (mean 34.1 microg/ml, range 5--89 microg/ml). This indicated strong local complement activation that had progressed to the terminal stage. As one potential factor promoting complement activation we identified both monomeric and trimeric properdin in MEE by Western blotting. By stabilizing C3 and C5 convertases properdin accelerates the alternative and terminal pathways of complement. On the other hand, the membrane attack complex (MAC) inhibitor CD59, which was found to be extensively shed into the MEE in a functionally active form, may control excessive cytotoxicity of the MEE. In conclusion, intense complement activation, up to the terminal level, maintains ongoing inflammation in the middle ear cavity and can pose a threat to the local epithelium.

CD59 Antigens↗
PubMed2001

Complement-regulator factor H and related proteins in otitis media with effusion.

Otitis media with effusion (OME) is a common disease in childhood. It is characterized by chronic inflammation in which the proinflammatory activity of the complement (C) system is one of the underlying factors. The C system becomes strongly activated in the middle ear effusion (MEE) fluid, but the reasons for this are not known. Here we demonstrate by using complement Bb fragment ELISA that MEE specimens strongly activate the alternative C pathway (AP) in normal human serum (NHS). Some of the MEEs were also found to promote lysis of rabbit erythrocytes by NHS. These findings indicated a disturbance in the fluid-phase regulation of the AP in MEE. The main regulator of the AP, factor H (FH), and proteins structurally related to it (FHL-1, FHR-1, -2, -3, and -4) were present in the MEE fluids of OME patients. Relative to serum, the FHR proteins were more abundant in the MEEs. In addition, we detected the recently discovered 65-kDa FH-related protein FHR-5 in the MEE. The FHR proteins share binding sites with FH in the C3d region of C3b. Thus they may compete with FH in binding to C3b and interfere with the regulatory activity of FH. Consequently, a disturbance in AP control in the MEE may lead to an ongoing excessive C activation and inflammation in OME.

Apolipoproteins↗