Recurrent acute otitis media: a survey of current management in England.

T Hampton,E Whitehall,S Sharma,C Beasley,E Hogg,M Krishnan,J Bhat,K Stevens,H Emerson,N Lowe

doi:10.1017/s0022215121001924

Abstract

Recurrent acute otitis media is common in children. The preferred treatment measures for recurrent acute otitis media have a mixed evidence base. This study sought to assess baseline practice across ENT departments in England. A national telephone survey of healthcare staff was conducted. Every ENT centre in England was contacted. A telephone script was used to ask about antibiotic and grommet use and duration in recurrent acute otitis media cases. Ninety-six centres (74 per cent) provided complete information. Recurrent acute otitis media treatment across England by ENT departments varied. The antibiotic first- and second-line prophylaxis offered varies, with trimethoprim used in 33 centres and 29 centres not offering any antibiotics. The timing or choice about when to use grommets also varies, but 87 centres (91 per cent) offer grommet surgery at one stage. The treatments received by children in England for recurrent acute otitis media vary by centre; collaborative research in this area is advised.

Highlights

Acute otitis media is a common ear condition in childhood and a principle reason for children to be seen in primary care, with approximately 75 per cent of children experiencing an episode by the age of five years.[1]
Not every centre in England was included in this comparison of practice, almost three-quarters of centres contributed, and our survey offers a meaningful insight into practice across the nation
It is important to establish reliable recommendations to effectively reduce recurrence, as symptoms in young children can have a significant effect on their quality of life, as well as on that of their families and carers.[8]

Summary

Introduction

Acute otitis media is a common ear condition in childhood and a principle reason for children to be seen in primary care, with approximately 75 per cent of children experiencing an episode by the age of five years.[1]. Conservative and medical measures for recurrent acute otitis media have a mixed evidence base.[3] Methods to prevent recurrent acute otitis media can include advising parents on modifiable risk factors, or advocating for pneumococcal and Haemophilus influenzae type B vaccinations, which are known to reduce the frequency of otitis media caused by these organisms.[2] Medical treatment requires either repeated acute courses with a variety of antibiotics, or long-term low-dose antibiotic prophylaxis. Concerns about complications of persistent recurrent acute otitis media may have driven a tendency to prescribe antibiotics, but UK evidence reassuringly suggests a number needed to treat of 4831 to prevent 1 child from developing mastoiditis.[6]. Given a desire to optimise our service, and the varied strategies available to manage recurrent acute otitis media, our hypothesis was that treatment would be varied between centres. We sought to assess the baseline practice of National Health Service (NHS) ENT departments across England

Materials and methods

Results

Discussion