Acute Ear Infection Research Articles

Clinical significance of microbial flora in middle ear infections and its implications

Introduction: Chronic suppurative otitis media (CSOM) has a multifactorial etiology, which follows acute ear infection and leads to deafness. The present study was conducted to know the etiology and antibiotic susceptibility pattern of the isolates. Methods: Ear swabs were collected and processed as per standard procedures. Results: The organisms isolated were Pseudomonas aeruginosa, Staphylococcus aureus, coagulase negative Staphylococci, Klebsiella spp., Proteus spp., and Serratia and they showed variable susceptibility patterns. The fungi isolated were Candida spp. and Aspergillus niger. Conclusion: Proper diagnosis and selection of antibiotics reduce the damage and toxicity of the drugs.

Primary otological manifestations of granulomatosis with polyangiitis: a case series

A primary otological presentation of granulomatosis with polyangiitis is rare. We present four cases of granulomatosis with polyangiitis with different otological manifestations. A literature review of granulomatosis with polyangiitis cases presenting to otolaryngologists was undertaken. A case series review of four patients presenting within a 12-month period was also performed. One patient had serous otitis media which worsened after myringotomy. Two patients presented with acute ear infection and facial palsy and one with acute mastoiditis. All were positive for antineutrophilic cytoplasmic antibody, and three had positive findings upon histological analysis. When acute supposed ear infections fail to respond to treatment (antibiotics or surgery), rarer causes of the symptoms should be considered. By reporting this case series, we aim to improve the early diagnosis of granulomatosis with polyangiitis to enable timely treatment and prevent systemic involvement.

Otitis Media—Red Flags for Management: American Academy of Otolaryngology; Head and Neck Surgery 2013 Clinical Practice Guideline for Tympanostomy Tube Insertion

Otitis media with effusion (OME) is described as a collection of fluid in the middle ear, without signs or symptoms of acute ear infection ( Stool, Berg, Berman, & Carney, 1994). The accumulated fluid decreases the ability of both the tympanic membrane (eardrum) and the ossicles in the middle ear to vibrate, resulting in a mild conductive hearing loss. Although 28 decibels (dB) is the average hearing loss associated with OME, the range is quite wide. While some children experience no hearing loss, about 20% have hearing loss of 35 dB or greater ( Gravel, 2003).

Antibiotic Use in Children with Acute Respiratory or Ear Infections: Prospective Observational Comparison of Anthroposophic and Conventional Treatment under Routine Primary Care Conditions.

Children with acute respiratory or ear infections (RTI/OM) are often unnecessarily prescribed antibiotics. Antibiotic resistance is a major public health problem and antibiotic prescription for RTI/OM should be reduced. Anthroposophic treatment of RTI/OM includes anthroposophic medications, nonmedication therapy and if necessary also antibiotics. This secondary analysis from an observational study comprised 529 children <18 years from Europe (AT, DE, NL, and UK) or USA, whose caregivers had chosen to consult physicians offering anthroposophic (A-) or conventional (C-) treatment for RTI/OM. During the 28-day follow-up antibiotics were prescribed to 5.5% of A-patients and 25.6% of C-patients (P < 0.001); unadjusted odds ratio for nonprescription in A- versus C-patients 6.58 (95%-CI 3.45–12.56); after adjustment for demographics and morbidity 6.33 (3.17–12.64). Antibiotic prescription rates in recent observational studies with similar patients in similar settings, ranged from 31.0% to 84.1%. Compared to C-patients, A-patients also had much lower use of analgesics, somewhat quicker symptom resolution, and higher caregiver satisfaction. Adverse drug reactions were infrequent (2.3% in both groups) and not serious. Limitation was that results apply to children of caregivers who consult A-physicians. One cannot infer to what extent antibiotics might be avoided in children who usually receive C-treatment, if they were offered A-treatment.

A case study on prescribing for an acute ear infection in a child

In this case study, history taking, clinical examination, and diagnostic skills are described in relation to treating a child with ear infection. The importance of responsible prescribing of antibiotics is discussed.

Effects of Quarry Activities on some Selected Communities in the Lower Manya Krobo District of the Eastern Region of Ghana

Extraction of Limestone is an economically important and widespread activity in Ghana and has existed since historical times. However, in spite of its remarkable contribution towards economic development, some adverse impacts have been noticed, especially where extraction is carried out without proper planning and use of modern technology and scientific methods. We have carried out an assessment on the environmental effects of limestone quarrying on some communities in the Lower Manya Krobo District in the Eastern region of Ghana. Dust emission is one of the major effects of the practice of limestone extraction and as such, dust (PM10) sampling was conducted at the affected communities. Mean dry season results recorded in these communities stand at 125.0 μg/m3 or Bueryonye, 116.0 μg/m3 at Odugblase and 109.3 μg/m3 at Klo-Begoro. Oterkpolu community which served as the control recorded an average of 50.5 μg/m3. Average rainy season values recorded for the communities were 83.3 μg/m3 for Bueryonye, 113.1 μg/m3 at Odugblase and 74.4 μg/m3 at Klo-Begoro. The control community, Oterkpolu, had 43.3 μg/m3. These values are above the EPA, Ghana daily guideline level of 70 μg/m3 over a time-weighted average per 24 hours. Questionnaires administration and health records obtained from the health facilities in the communities revealed notable deteriorations in the health of the people as a result of the quarrying activities in the area. Notable among these is the prevalence of malaria though not related to dust emissions, it results from mosquitoes breeding in the stagnant pools of water found in pits created as a result of the mining activity. Other common health cases recorded were acute respiratory tract infection, ear and eye infections, cough and pneumonia.

Blood Group Antigen Recognition by a Solute-Binding Protein from a Serotype 3 Strain of Streptococcus pneumoniae

Streptococcus pneumoniae is a common bacterial pathogen that is well known for its ability to cause acute respiratory disease (pneumonia), ear infections, and other serious illnesses. This Gram-positive bacterium relies on its carbohydrate-metabolizing capabilities for full virulence in its host; however, the range of glycan targets that it can attack is presently not fully appreciated. S. pneumoniae is known to have a fucose utilization operon that in the TIGR4 strain plays a role in its virulence. Here we identify a second type of fucose utilization operon that is present in a subset of S. pneumoniae strains, including the serotype 3 strain SP3-BS71. This operon contains a transporter with a solute-binding protein, FcsSBP (fucose solute-binding protein), that interacts tightly ( K a ∼ 1 × 10 6 M − 1 ) and specifically with soluble A- and B-antigen trisaccharides but displays no selectivity between these two sugars. The structure of the FcsSBP in complex with the A-trisaccharide antigen, determined to 2.35 Å, reveals its mode of binding to the reducing end of this sugar, thus highlighting this protein's requirement for soluble blood group antigen ligands. Overall, this report exposes a heretofore unknown capability of certain S. pneumoniae strains to transport and potentially metabolize the histo-blood group antigen carbohydrates of its host.

Hipertensión intracraneal asociada a trombosis de senos venosos cerebrales y mastoiditis. A propósito de dos casos pediátricos

Cerebral venous sinus thrombosis is a rare condition that is generally associated with acute processes, one of the most important being mastoiditis. Associated prothrombotic disorders can be detected in approximately half of all cases, regardless of the aetiology. Patients usually present clinical symptoms like headache, convulsions and diminished level of awareness, this latter factor being linked to a poor prognosis.We report the cases of two paediatric patients with a clinical picture of intracranial hypertension within a context of mastoiditis as a complication of an acute ear infection, in whom cerebral venous sinus thrombosis was identified. Both patients were treated with lumbar punctures to evacuate cerebrospinal fluid and diuretic therapy. Anticoagulant therapy was added in the case of the second patient. Nevertheless, because of the persistence of the symptoms of intracranial hypertension, a ventriculoperitoneal shunt had to be performed in this patient.The preferred diagnostic method is magnetic resonance imaging with venography, although in an emergency computerised tomography can help reach a diagnosis in a third of cases. In addition to treating the symptoms, anticoagulation is also accepted (degree of evidence 1B) to prevent further progression.

An overview of the microbiology of acute ear, nose and throat infections requiring hospitalisation

This study is the first to provide an extensive overview of the microbiology of acute ear, nose and throat infections requiring hospitalisation. All 2,028 cases of acute infections admitted between 1 January 2001 and 31 December 2006 were reviewed to assess the use of pre-admission antibiotics, microbiological results, antibiotic and surgical management and length of hospitalisation. Infections of the oropharynx accounted for the vast majority of admissions, followed by ear infections, and cutaneous neck abscesses. Peritonsillar abscess was the most frequent diagnosis, accounting for over one third of admissions (39.8%, 808 out of 2,028). Complete microbiological data were available for 1,430 cultures, and were analysed for trends with respect to diagnosis, age, gender and use of pre-admission antibiotics. Forty-six percent (657 out of 1,430) of cultures yielded no growth or normal flora. This value increased to 77.0% (298 out of 387) in patients with pre-admission antibiotics. The distribution of microbiological isolates varied significantly between patients with and without pre-admission antibiotics, as well as with respect to age and gender. The most frequently isolated bacteria were Group A Streptococcus (13.7%, 196 out of 1,430), Fusobacterium necrophorum (13.6%, 195 out of 1,428) and Staphylococcus aureus (8.0%, 114 out of 1,430). Fusobacterium necrophorum was primarily isolated from cases of peritonsillar abscess (90.8%, 177 out of 195). This study suggests that F. necrophorum is a far more widespread pathogen in otorhinolaryngology than previously reported, and questions the value of routine culturing, as results rarely altered initial treatment. Further research on the microbiological variations with age and gender is recommended to better target culturing and treatment, and enhance our understanding of the pathogenesis of ear, nose and throat infections.

Comment on: A survey of community-associated methicillin-resistant Staphylococcus aureus in Korea

Results :O f 3251S. aureus, 1900 (58.4%) were MRSA. CA-MRSA accounted for 112 (5.9%) of the MRSA. Of the 112 CA-MRSA isolates, 27 and 33 were found to be pathogens and colonizers, respectively. Fifty-two isolates from the patients with chronic otitis media were classified as ‘undetermined’. Most of the 27 CA-MRSA patients had skin and soft tissue infections or acute ear infections. None of the patients died during the study period. Among 72 isolates tested, 64% were multidrug-resistant. SCCmec type IVa was the most common type among the colonizers and pathogens. On MLST analysis, ST72 was predominant, but ST5 and ST239 were prevalent in the ‘undetermined’ group. None possessed the PVL gene. Conclusions: Despite MRSA-endemic hospital settings, CA-MRSA infections are not common in Korea. A new clone of CA-MRSA, ST72-SCCmec type IVa without the PVL gene, is the most common form.

Conservative nonsurgical treatment of a child with otogenic lateral sinus thrombosis

We present the case of a 5-year-old boy with otogenic lateral sinus thrombosis that developed after acute mastoiditis, with no prior ear disease. He was treated with myringotomy and antibiotics alone, with no surgical intervention. This approach was followed owing to his good general condition, the prompt response to the antimicrobial treatment, and no evidence of suppurative disease. Sinus recanalization was evident on the follow-up computed tomography 4 months later. We believe that in selected cases of otogenic lateral sinus thrombosis, secondary to an acute ear infection with early response to antibiotic therapy, conservative treatment may be considered and surgical intervention may be withheld.

Can you hear me now? A genetic model of otitis media with effusion

Otitis media with effusion (OME) is characterized by the occurrence of fluid in the middle-ear cavity in the absence of any signs of acute ear infection and occurs most frequently in children with auditory or eustachian tube dysfunction. Its chronic form is an important clinical issue for pediatricians and otologists alike. The study by Depreux et al. in this issue of the JCI shows that absence of the transcriptional activator Eya4 in knockout mice results in abnormal structuring of the eustachian tube, thus predisposing these animals to OME (see the related article beginning on page 651). The development of this genetics-based animal model is an important advance for understanding OME and for exploring new avenues of treatment.

A survey of community-associated methicillin-resistant Staphylococcus aureus in Korea

Methicillin-resistant Staphylococcus aureus (MRSA), originally restricted to hospitals, has emerged as a significant pathogen in the community. Although MRSA accounts for over 60% of S. aureus in tertiary hospitals in Korea, little is known about the epidemiology of community-associated MRSA (CA-MRSA). From January to July 2005, a hospital laboratory-based survey was conducted in seven community-based or tertiary hospitals. The medical records and Health Insurance Review Agency databases were reviewed and MRSA isolated from patients without apparent risk factors was defined as CA-MRSA. Susceptibilities to 12 antibiotics were tested by the disc diffusion method. SCCmec typing, Panton-Valentine leucocidin (PVL) gene detection and multilocus sequence typing (MLST) were performed according to published protocols. Of 3,251 S. aureus, 1,900 (58.4%) were MRSA. CA-MRSA accounted for 112 (5.9%) of the MRSA. Of the 112 CA-MRSA isolates, 27 and 33 were found to be pathogens and colonizers, respectively. Fifty-two isolates from the patients with chronic otitis media were classified as 'undetermined'. Most of the 27 CA-MRSA patients had skin and soft tissue infections or acute ear infections. None of the patients died during the study period. Among 72 isolates tested, 64% were multidrug-resistant. SCCmec type IVa was the most common type among the colonizers and pathogens. On MLST analysis, ST72 was predominant, but ST5 and ST239 were prevalent in the 'undetermined' group. None possessed the PVL gene. Despite MRSA-endemic hospital settings, CA-MRSA infections are not common in Korea. A new clone of CA-MRSA, ST72-SCCmec type IVa without the PVL gene, is the most common form.

Pattern of pathogens in ear discharge of HIV-infected children in Nnewi, Southeast Nigeria.

This is a descriptive, prospective, hospital-based study designed to determine the prevalent organisms in ear infections and their antimicrobial susceptibility patterns in HIV-infected children compared to age-and sex-matched HIV sero-negative patients. Two hundred and fifty eight HIV-infected children being followed up at the Paediatric HIV clinic had their ears examined for middle ear infection. All those with discharging ears had swabs taken. Culture and antimicrobial sensitivities were ascertained. The same was done for another cohort of 57 age-and sex-matched HIV-negative patients with discharging ears. Twenty eight (10.9%) of 258 HIV-infected children had discharging ears and were made up of 13 females and 15 males aged between 7 and 132 months. Out of this number 85.7% had chronically discharging ears, 96.4% of the 28 children acquired the HIV infection vertically. 78.6% had been on antiretroviral drugs from one to twenty-one months. 67.9% of the patients had associated opportunistic infections. Acute ear infections were predominant among the control group. Klebsiella, Proteus, Staphylococcus and Pseudomonas were major pathogens isolated among the HIV-infected group and Streptococcus, Klebsiella and Pseudomonas for the HIV-negative group. A hundred percent sensitivity was recorded among the quinolones for all bacterial organisms isolated. HIV-infected children tend to have more of chronic than acute ear infections and this is reflected in the causative organisms. Similar antimicrobial sensitivity patterns apply to HIV-infected and HIV-negative children. There is a need to revisit the use of quinolones in children.

Cochrane review: Antibiotics for the prevention of acute and chronic suppurative otitis media in children

AbstractBackgroundAcute otitis media (AOM) is a common childhood illness. These middle ear infections may be frequent and painful. AOM may be associated with perforation of the tympanic membrane and can progress to chronic suppurative otitis media (CSOM).ObjectivesTo determine the effectiveness of long‐term antibiotics (for longer than six weeks) in preventing any AOM, AOM with perforation and CSOM.Search strategyWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006), MEDLINE (January 1966 to March Week 3 2006), OLD MEDLINE (1950 to 1965), EMBASE (1990 to December 2005) and the references of relevant studies.Selection criteriaAll randomised controlled trials of long‐term (longer than six weeks) antibiotics versus placebo or no treatment for the prevention of AOM, AOM with perforation, or CSOM were eligible.Data collection and analysisTwo authors independently extracted the data for: any AOM; episodes of AOM; any recurrent AOM; episodes of illness; any side effects; any antibiotic resistance, as well as outcomes at end of intervention (any AOM); and following cessation of intervention (any AOM). For dichotomous outcomes, the summary risk ratio (fixed and random‐effects models) was calculated. For rate outcomes, the summary incidence rate ratio was calculated.Main resultsSixteen studies involving 1483 children met our inclusion criteria. All studies enrolled children at increased risk of AOM, and in seven studies the children were prone to otitis media. The majority of studies were high quality and most (15 studies) reported data for our primary outcomes. None reported AOM with perforation or CSOM. Long‐term antibiotics reduced any episode of AOM (13 studies, 1358 children, risk ratio (RR) 0.62, 95% CI 0.52 to 0.75; random‐effects model) and number of episodes of AOM (12 studies, 1112 children, incidence rate ratio (IRR) 0.48, 95% CI 0.37 to 0.62; random‐effects model). Approximately five children would need to be treated long term to prevent one child experiencing AOM whilst on treatment. Antibiotics prevented 1.5 episodes of AOM for every 12 months of treatment per child. Statistical heterogeneity was explored. Long‐term antibiotics were not associated with a significant increase in adverse events (11 studies, 714 children, RR 1.99, 95% CI 0.25 to 15.89; random‐effects model).Authors' conclusionsFor children at risk, antibiotics given once or twice daily will reduce the probability of AOM while the child is on treatment. Antibiotics will reduce the number of episodes of AOM per year from around three to around 1.5. We believe that larger absolute benefits are likely in high‐risk children. These conclusions were not affected by sensitivity analyses.Plain language summaryAntibiotics can prevent acute ear infections in childrenAcute otitis media (infection in the middle ear space) is common in children, causing pain and deafness. This review found that long‐term antibiotics (over at least six weeks) almost halved the risk of further infections. There was not enough information to know if antibiotics reduced acute otitis media with perforation or chronic suppurative otitis media, or improved long‐term outcomes. Antibiotics did not appear to be a frequent cause of significant side effects (for example, allergic reactions or diarrhoea). Parents must balance these potential side effects plus the cost and inconvenience associated with antibiotics against the likely benefits of treatment. Antibiotic resistance from the long‐term use of these drugs is also an issue which should be considered, particularly for children with recurring infections.

Use and Safety of Anthroposophic Medications for Acute Respiratory and Ear Infections: A Prospective Cohort Study

Objective: Anthroposophic medications (AMED) are widely used, but safety data on AMED from large prospective studies are sparse. The objective of this analysis was to determine the frequency of adverse drug reactions (ADR) to AMED in outpatients using AMED for acute respiratory and ear infections. Methods: A prospective four-week observational cohort study was conducted in 21 primary care practices in Europe and the U.S.A. The cohort comprised 715 consecutive outpatients aged ≥1 month, treated by anthroposophic physicians for acute otitis and respiratory infections. Physicians’ prescription data and patient reports of adverse events were analyzed. Main outcome measures were use of AMED and ADR to AMED. Results: Two patients had confirmed ADR to AMED: 1) swelling and redness at the injection site after subcutaneous injections of Prunus spinosa 5%, 2) sleeplessness after intake of Pneumodoron® 2 liquid. These ADR lasted one and two days respectively; both subsided after dose reduction; none were unexpected; none were serious. The frequency of confirmed ADR to AMED was 0.61% (2/327) of all different AMED used, 0.28% (2/715) of patients, and 0.004% (3/73,443) of applications. Conclusion: In this prospective study, anthroposophic medications used by primary care patients with acute respiratory or ear infections were well tolerated. Abbreviations: A-: anthroposophy; ADR: adverse drug reactions; AE: adverse events; AM: anthroposophic medicine; AMED: AM medication; C-: conventional; ENE-patients: eligible, not enrolled patients; IIPCOS: International Primary Care Outcomes Study

Use and Safety of Anthroposophic Medications for Acute Respiratory and Ear Infections: A Prospective Cohort Study

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Anthroposophic vs. conventional therapy of acute respiratory and ear infections

CONTEXT: Acute respiratory and ear symptoms are frequently treated with antibiotics. Anthroposophic treatment of these symptoms relies primarily on anthroposophic medications. OBJECTIVE: To compare anthroposophic treatment to conventional treatment of acute respiratory and ear symptoms regarding clinical outcome, medication use and safety, and patient satisfaction. DESIGN: Prospective, non-randomised comparison of outcomes in patients self-selected to anthroposophic or conventional therapy under real-world conditions. SETTING: 29 primary care practices in Austria, Germany, Netherlands, UK, and USA. PARTICIPANTS AND THERAPY: 1016 consecutive outpatients aged ≥1 month, consulting an anthroposophic (n = 715 A-patients) or conventional physician (n = 301 C-patients) with a chief complaint of acute (≤7 days) sore throat, ear pain, sinus pain, runny nose or cough. Patients were treated according to the physician’s discretion. PRIMARY OUTCOME: Patients’ self-report of treatment outcome (complete recovery, major improvement, slight to moderate improvement, no change, deterioration) at day 14. RESULTS: Most common chief complaints were cough (39.9% of A-patients vs. 33.9% of C-patients, p = 0.0772), sore throat (26.3% vs. 23.3%, p = 0.3436), and ear pain (20.0% vs. 18.9%, p = 0.7302). Baseline chief complaint severity was severe or very severe in 60.5% of A-patients and 53.3% of C-patients (p = 0.0444), mean severity (0–4) of complaint-related symptoms was 1.3 ± 0.7 vs. 1.2 ± 0.6 (p = 0.5197). During the 28-day follow-up antibiotics were prescribed to 5.5% of A-patients and 33.6% of C-patients (p < 0.0001), anthroposophic medicines were prescribed to all A-patients and no C-patient. OUTCOMES: Improvement within 24 hours occurred in 30.9% (221/715) of A-patients and 16.6% (50/301) of C-patients (p < 0.0001), improvement within 3 days in 73.1% and 57.1% (p < 0.0001). At day 7 complete recovery or major improvement was reported by 77.1% of A-patients and 66.1% of C-patients (p = 0.0004), at day 14 by 89.7% and 84.4% (p = 0.0198). Complete recovery rates at day 7 were 30.5% and 23.3% (p < 0.0001); at day 14 they were 64.2% and 49.5% (p < 0.0001). 69.9% of A-patients and 60.5% of C-patients were very satisfied with their physician (p = 0.0043); 95.7% and 83.4% would choose the same therapy again for their chief complaint (p < 0.0001). After adjustment for country, gender, age, chief complaint, duration of complaint, previous episode of complaint within last year, and baseline symptom severity, odds ratios favoured the A-group for all these outcomes. Adverse drug reactions were reported in 2.7% of A-patients and 6.0% of C-patients (p = 0.0157). CONCLUSION: Compared to conventional treatment, anthroposophic treatment of primary care patients with acute respiratory and ear symptoms had more favourable outcomes, lower antibiotic prescription rates, less adverse drug reactions, and higher patient satisfaction.

Single megadose vitamin A supplementation of Indian mothers and morbidity in breastfed young infants

Background and objective: In developing countries low maternal vitamin A stores combined with increased demands of pregnancy and lactation may lead to its deficiency in breastfed infants. This study evaluates...

Pneumococcus genome sequence completed

Pneumococcus (Streptococcus pneumoniae) is the most common cause of acute respiratory and ear infections. Worldwide, more than 3 million children die every year from pneumococcus-triggered pneumonia, bacteraemia or meningitis. The Institute for Genomic Research (TIGR, Rockville, MD, USA) have announced the complete genome sequence of a highly virulent isolate of S. pneumoniae. Herve Tettelin led the team on TIGR's 26th genome sequencing project, which revealed 2326 genes (Science, 20 July and http://www.tigr.org/index.shtml). DM