Acute Otitis Research Articles

Coronavirus Disease 2019 Pandemic: Impact Caused by School Closure and National Lockdown on Pediatric Visits and Admissions for Viral and Nonviral Infections-a Time Series Analysis.

A time series analysis of 871,543 pediatric emergency visits revealed that the COVID-19 lockdown and school closure were associated with a significant decrease in infectious diseases disseminated through airborne or fecal-oral transmissions: common cold, gastro-enteritis, bronchiolitis, acute otitis. No change was found for urinary tract infections.

A STUDY ON THE PRESCRIBING PATTERN OF ANTIMICOBIAL DRUGS IN PATIENTS ATTENDING THE EAR, NOSE, THROAT DEPARTMENT OF A TERTIARY CARE TEACHING HOSPITAL

Objective: The aim of the study is to evaluate the prescription pattern of antimicrobial drugs in the department of ear, nose, throat (ENT) of a tertiary care teaching hospital in Guwahati.
 Methods: The present study was conducted in the department of ENT after getting approval from the Institutional Ethics Committee (No MC/190/2007/Pt – 11 December -18/18). It was a prospective observational study for a period of 6 months. Prescriptions were collected from the outdoor and indoor patients of ENT.
 Results: In the present study, the majority of the patients were male (64.1%). Mostly, the patients belonged to the age group of 31–60 years (52%). Pharyngitis (20.8%) was the most commonly encountered disease which was reported followed by ear discharge (16.2%) and acute suppurative otitis media (15.8%). Total number of antimicrobial drugs prescribed for 240 patients was 303, amoxicillin-clavulanic acid being the most common (66%). About 89.4% of the drugs were included in the WHO Model List of Essential Medicines, 2019. Majority of the patients were prescribed only one drug.
 Conclusion: The drug prescribed commonly for ENT infections was amoxicillin-clavulanic acid combination. Around 71.6% of drugs were prescribed by their brand names. Intervention is needed to promote the use of generic drugs as these drugs are with the same composition and provide the same therapeutic benefit at reasonable price.

Etiological role and molecular-genetic features of <i>Streptococcus pneumoniae</i> in children’s infectious diseases

Objective: To study the etiological role, serotype distribution and prevalent Streptococcus pneumoniae genotypes (sequence types) in 459 children hospitalized with acute purulent otitis media, acute tonsillitis, community-acquired pneumonia, and purulent bacterial meningitis. Pneumococcal cultures isolated from patients were tested for sensitivity to antimicrobials, and presence of resistance genes. Materials and Methods: The cultural and molecular methods (PCR, sequencing) were used. Statistical analysis was carried out using Microsoft Excel 2007 and Statistica 6.0. Results: S. pneumoniae was detected in 16,8%. The prevalent serotypes were 19F (39.7%) and 19A (13.2%) — representatives of multidrug-resistant clonal com-plex 320. Isolates of serogroup 6 (6AB, 8.82%) belonged to clonal complex 315, and characterized by resistance to macrolides, clindamycin and tetracycline. From 70.6% to 88.2% of S. pneumoniae serotypes isolated from patients corresponded to «vaccine»-types.

Особенности клиники сочетанных форм гриппа у детей

Aim: to identify the clinical laboratory features of coinfection with flu and other respiratory viral infections. Patients and Methods: case records (inpatient files) of 139 children aged 2 months — 18 years who were admitted to Moscow hospitals from October 2017 to February 2020 with the clinical manifestations of acute respiratory infections (ARI) were analyzed. All children were divided into two groups. Group 1 included children with coexisted flu and other ARI (n=31). Group 2 included children with flu alone (n=108). The etiology of ARI was discovered by polymerase chain reaction (oral or nasal smears and/or discharge, sputum) and enzyme immunoassay (antibodies to herpesvirus type 1, 2, and 6, cytomegalovirus, Epstein-Barr virus, Chlamydia, and Mycoplasma). Results: respiratory syncytial virus and rhinovirus were the most common viruses coexisted with flu (8/31 and 5/31, respectively). The onset of ARI occurred 2.60±1.6 days before hospital admission in group 1 and 3.35±1.72 days before hospital admission in group 2 (p>0.05). In group 1, febrile temperature lasted for 4.72±1.25 days that is almost 2 days longer than in group 2 (p<0.01). The rate of complications in coinfection with flu and ARI vs. flu alone was different, i.e., acute (catarrhal, medium) otitis was diagnosed in 35.5% and 8.3.% (p<0.01), respectively, acute sinusitis in 12.9% and 8.3%, respectively, and pneumonia in 22.6% and 7.4%, respectively. Conclusion: in children, coinfection with flu and other respiratory virus is generally more severe as demonstrated by higher temperature, more severe intoxication symptoms, more common complications (e.g., otitis, sinusitis, pneumonia etc.), and a greater need in infusion therapy. Co-infected children are admitted to hospital more rapidly and stay in hospital for a longer period. KEYWORDS: acute respiratory infections, flu, rhinovirus, children, fever, intoxication, severity. FOR CITATION: Nikolaeva S.V., Usenko D.V., Shabalina S.V. et al. Clinical presentation of flu coinfections in children. Russian Medical Inquiry. 2020;4(11):665–669. DOI: 10.32364/2587-6821-2020-4-11-665-669.

Unilateral left lateral rectus palsy: A rare complication of acute otitis media

Petrous apicitis is an extension of infection from mastoid air cells into the petrous apex. The infection may also spread outside the petrous apex to affect the meninges causing meningitis, cranial nerve palsies, encephalitis, brain abscess, cavernous sinus thrombosis, and even death; however, these complications are rare. Only a few patients with petrous apicitis exhibit the complete triad described by Gradenigo comprising retro-orbital pain, sixth nerve palsy, and otorrhea. We present a rare case of petrositis with pachymeningitis with unilateral abducens nerve palsy following acute suppurative otitis media, which was successfully managed medically.

Антибактериальная терапия острого среднего отита в амбулаторных условиях

Антибактериальная терапия острого среднего отита в амбулаторных условиях

Quality of Referral Letters Written by Family Physicians to Otologists -A Peer Assessment.

Introduction:Otolaryngology is a field with a high referral rate; however, there is a dearth of research on the quality of referral letters written in this field. This study was carried out to explicitly assess the quality of referral letters, more specifically in the field of otology.Materials and Methods:Two otologists assessed referral letters written by general practitioners or primary care physicians working as family physicians. They were asked to make independent assessment on different variables related to the quality of referral letters and their appropriateness. A “qualified referral letter” in the current study is defined as a letter with standard items, including, description of chief complaint, description of associated symptoms, relevant physical findings, past medical history, drug history, family history, and reasons for referral.Results:A total of 1000 referral letters written by 652 primary care physicians were investigated in the current study. The obtained results indicated that 74% of referral letters to otologists contained inadequate information regarding various items in the referral letters. Symptoms, diagnosis, and signs were only reported in 28.3%, 28.9%, and 3.6% of the letters, respectively. The findings showed that most common reasons for referrals were uncertainty in diagnosis (52.4%), persistence of the patient (32.6%), and failed therapy (32%). With regards to case-specific conditions, the highest referral rates were related to external otitis, otitis media with effusion, and acute otitis media. Conclusion:According to the obtained results of the current study, the content of referral letters were insufficient or inappropriate. Therefore, it is recommended to improve otolaryngology syllabus and provide suitable courses for undergraduate students in order to become familiar with the importance of referral letter writing.

Risk Factors of Acute Suppurative Otitis Media in Preschool Children

Risk Factors of Acute Suppurative Otitis Media in Preschool Children

Множественные отогенные абсцессы головного мозга у ребенка

Today, the relevance of the problem of ENT-associated inflammatory intracranial complications in children is out of the question, because despite the introduction of new diagnostic technologies, the increased possibilities of conservative medicine and the improvement of surgical treatment methods, the rates of hospital mortality and disability of children do not tend to decrease. It is primarily due to the lack of a uniform algorithm of early diagnosis and hospitalization of the patient, recommendations for treatment of this pathology, namely: the optimal technique of surgical interventions, the tactics of intensive treatment of patients, the methods of postoperative rehabilitation of this category of patients. All these factors testify of the absence of a unified concept of an interdisciplinary approach to the patients with ENT-associated intracranial complications at all the stages of care provision. The article presents a clinical case of otogenic meningoencephalitis, brain abscesses in a child as a result of acute suppurative otitis media. The authors present a plan of comprehensive examination and the tactics of surgical and conservative treatment of a patient.

Pattern and causes of tympanic membrane perforation at a private hospital in Dar es Salaam, Tanzania

Introduction: There is variation in the size, shape and position of tympanic membrane perforations; the degree of conductive hearing loss depends on the sizeand position of perforation.Objective: To determine the pattern and causes of tympanic membrane perforation at a private health facility in TanzaniaMethod: A hospital-based cross-sectional study in the ENT clinic at Ekenywa Specialised Hospital was conducted from January to May 2019. Ears were examined thoroughly by an Otorhinolaryngologist. Data were analysed using SPSS Version 21Results: Two hundred and fifty patients were examined and 50 (20%) were foundto have tympanic membrane perforations. Thirty (60%) were new patients while twenty (40%) were under review. Most 35(70%) were males. Central perforation predominated in 30 (60%), followed by subtotal in 10 (20%), total in 8 (16%) andmarginal perforations in 2 (4%). The left ear was more affected in (60%) than theright ear. Bilateral perforations accounted for 5 (10%) of cases. Chronic suppurative otitis media was found in 35 (70%); other causes were acute suppurative otitis media in 13 (26%) and trauma in 2 (4%) patientsConclusions: The clinical picture depicted in this study is similar to that found elsewhere. There is a need for prompt diagnosis of tympanic membrane perforation. Proper education on ear care in patients with perforated tympanic membrane is of paramount importance.Keywords: Pattern, Causes, tympanic membrane, perforation, Tanzania

Особенности диагностики и современного хирургического лечения острого среднего отита с выпотом

The study involved 172 patients with acute exudative otitis media treated at the period of 2013 through 2016. All the patients underwent a complex examination, systemic and local conservative therapy. The examination of the results of the temporal bones computer tomography was conducted to assess the eardrum thickness, which was significantly increased in an acute inflammatory process in the middle ear due to the thickening of the tympanic cavity mucous membrane. The values ranged from 0.2 mm to 0.9 mm (the normal thickness of the eardrum is 0.1 mm). In the absence of positive dynamics in the clinical picture and according to the results of objective examination, the surgical treatment – CO2-laser myringotomy – was performed. On average, in 12–14 days after surgery, most patients reported of hearing restoration in the affected ear, which, as a rule, coincided with the eardrum integrity restoration period. The average time of closure of a 1.2 mm eardrum perforation was 7 days, of 1.6 mm – 12 days, of 2.0 mm – 14 days. In the patients with eardrum thickness equal to or less than 0.5 mm, the complete restoration of the eardrum integrity took place on average in 11 days. In the patients with the eardrum thickness above 0.5 mm, the complete restoration of the eardrum integrity took place on average in 14 days.

Sudden Severe Unilateral Vestibulo-Cochlear Loss Due to Acute Staphylococcal Otitis Media

Sudden Severe Unilateral Vestibulo-Cochlear Loss Due to Acute Staphylococcal Otitis Media

Complications of acute and chronic otitis media in the child - Review Article

Complications of acute and chronic otitis media in the child - Review Article

Pattern of ear nose and throat diaseses in a tertiary hospital of Dhaka city

Background and objectives: The magnitude of health problems related to ear, nose and throat (ENT) in Bangladesh has not been estimated in a larger scale and very little is known about the prevalence and types of ENT diseases. Some studies, however, addressed the prevalence of otitis among school children and very few of them reported hearing defect. This study aims to assess the overall types of ENT diseases encountered by the otolaryngologists at a referral or tertiary hospital.Methods: The cross sectional study was conducted in Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM). All patients registerd in the ENT-OPD from January to April in 2017 were included in the study for analysis. Diseases were diagnosed on the basis of clinical history, general and systemic examinations and relevant laboratory and imaging investigations.Results: A total of 435 (M :F=177:258) registered patients were analyzed. 44 0f them had no ENT diseases. Diseases of ear showed the highest prevalence (41.1%) followed by that of throat (31.7%) and nose (17.1%). There was no significant difference in ear and nose diseases between male and female groups. The throat diseases were significantly higher in female than the male group (37.2% vs.22.6%, p=0.018). Regarding infections of the specific organs: suppurative otitis media was the most common (acute and chronic suppurative otitis media 25.5%) followed by tonsillitis (7.1%), rhinitis (4.4%) and sinusitis (1.4%). These infections showed no significant difference between male and female patients; neither there was any significant difference between the diabetic and non-diabetic groups.Conclusion: Diseases of ear were most common followed by throat and nose. Both acute and chronic otitis media constituted one-fourth of all registered cases. The diabetic patients showed no increased risk for ENT diseases.IMC J Med Sci 2018; 12(1): 22-26

PD58 Cost-Effectiveness Of Quinolone For Acute External Otitis In Brazil

Introduction:In Brazil, the medicines marketed for acute external otitis are ciprofloxacin and the combination polymyxin B, neomycin, and fluocinolone. The aim of this study was to evaluate the proportion of cure and cost-effectiveness of quinolone versus polymyxin B, neomycin, and steroid combined (PNS) for acute external otitis from the perspective of the Brazilian Public health system.Methods:A systematic review was conducted using Medline, Cochrane Library, CRD and Lilacs databases. Studies evaluating quinolones versus PNS in the treatment of acute external otitis were included. A cost-effectiveness model was made using a decision tree, considering the direct cost of treatment. Univariate sensitivity analysis was conducted, considering the confidence interval of clinical outcomes and a 15 percent variation in cost.Results:The proportion of cure in up to 10 days was 70.1 percent with quinolone and 60.4 percent with PNS (p = 0.004). The treatment costs were BRL 16.22 (USD 5.02) with quinolone and BRL 3.04 (USD 0.94) with PNS. The incremental cost-effectiveness ratio was BRL 136.25 (USD 42.15) per cure in up to 10 days for quinolone in relation to PNS. This value was more sensitive to clinical outcomes, ranging from BRL 95.48 (USD 29.54) to BRL 254.25 (USD 78.65) for cure with quinolone and from BRL 90.77 (USD 28.08) to BRL 262.57 (USD 81.23) for cure with PNS. These values should be considered with caution because acute external otitis is resolved within a few days and treatment effectiveness is not measured by life years.Conclusions:There are few studies on therapeutic alternatives available in Brazil. Through the available evidence, there is a lack of results on the effects attributed to each drug. Considering the higher effectiveness, low cost and rational use of antibiotics, quinolone is considered a cost-effective alternative for acute external otitis in Brazil.

Giant subdural empyema in adult

Subdural empyema (SDE) is a fairly uncommon diagnosis, accounting for only 20% of intracranial infections, the usual source for SDE is direct extension from a contiguous source, such as acute sinusitis or otitis media, although in one-fourth of cases no source of infection is found. An 18-year-old man was admitted to our Institution because of dysarthria, lethargy and fever for 2 days. His medical history was marked by chronic otitis media badly treated by self-medication with several antibiotics. The first clinical examination revealed an increased body temperature of 37.6°C, heart rate of 82 beats per minute, blood pressure 140/74mmHg and respiratory rate of 18 breaths/minute. He was disorientated, his cranial nerves were intact and his pupils were reactive, round and equal. His white cell count was 6,620 per ¼L. His hemoglobin was 11.1g/dL and C-reactive protein was 80mg/L. The levels of his chemistries were normal. A computed tomography (CT) scan with contrast in emergency was performed and showed an extensive subdural fluid collection in the parietal site on the left side with peripheral enhancement, a mass effect was evident with displacement of the middle line structures toward the opposite side (A). An emergent craniotomy was done to evacuate the subdural empyema (B). A cultural examination was attempted with the fluid evacuation and showed no presence of bacteroides. Ceftriaxone and metronidazole were administered for 6 weeks. The patient was improved without neurological sequalae.

Этиологическая роль мультирезистентных Streptococcus pneumoniae при остром среднем гнойном отите у детей

Этиологическая роль мультирезистентных Streptococcus pneumoniae при остром среднем гнойном отите у детей

Neutrophil Extracellular Traps and Fibrin in Otitis Media

Bacterial resistance in acute otitis can result in bacterial persistence and biofilm formation, triggering chronic and recurrent infections. To investigate the middle ear inflammatory response to bacterial infection in human and chinchilla temporal bones. Six chinchillas underwent intrabullar inoculations with 0.5 mL of 106 colony-forming units (CFUs) of Streptococcus pneumoniae, serotype 2. Two days later, we counted bacteria in middle ear effusions postmortem. One ear from each chinchilla was processed in paraffin and sectioned at 5 µm. The opposite ear was embedded in epoxy resin, sectioned at a thickness of 1 µm, and stained with toluidine blue. In addition, we examined human temporal bones from 2 deceased donors with clinical histories of otitis media (1 with acute onset otitis media, 1 with recurrent infection). Temporal bones had been previously removed at autopsy, processed, embedded in celloidin, and cut at a thickness of 20 µm. Sections of temporal bones from both chinchillas and humans were stained with hematoxylin-eosin and immunolabeled with antifibrin and antihistone H4 antibodies. Histopatological and imminohistochemical changes owing to otitis media. Bacterial counts in chinchilla middle ear effusions 2 days after inoculation were approximately 2 logs above initial inoculum counts. Both human and chinchilla middle ear effusions contained bacteria embedded in a fibrous matrix. Some fibers in the matrix showed positive staining with antifibrin antibody, others with antihistone H4 antibody. In acute and recurrent otitis media, fibrin and neutrophil extracellular traps (NETs) are part of the host inflammatory response to bacterial infection. In the early stages of otitis media the host defense system uses fibrin to entrap bacteria, and NETs function to eliminate bacteria. In chronic otitis media, fibrin and NETs appear to persist.

The treatment of chronic ear itching. Interdisciplinary approach to the problem

The article presents the data of observation and treatment of patients with chronic ear itching according to the author’s method performed in 104 patients aged 19–75 years over more than 10 years. The author monitors the long-term results. The objective is to improve the efficacy of treatment and diagnostics of the patients with chronic itching in the external auditory canal resulting in deformation of the auditory canal and concha, prevent the aggravation in the form of external bacterial and mycotic external otitis, improve the patients’ life quality. Patients and methods: all the patients have undergone ear, throat, nose examination; general blood test, general urine test; biochemical blood assay: ALT, AST, alkaline phosphatase, total bilirubin, GGTP, ultrasonic test of liver, pancreas and gall bladder, microscopic examination of the external auditory canal secretion and the secretion inoculation for microflora. The treatment regimen included peroral administration of cholagogue and hepatoprotective preparations (soya bean phospholipids, Silybum marianum) and topical application of antiallergic preparation into ear in the form of a gel – histamine H1 receptor antagonist (dimethindene maleate, diphenhydramine hydrochloride). Results: a significant intensity reduction or cessation of itching in the external auditory canal; a considerable decrease of frequency of the acute external bacterial or mycotic otitis relapse or absence thereof; restoration of ceruminous and sebacerous glands of the external auditory canal skin which results in regeneration of protective function of the external auditory canal skin cover; improvement of liver and gall bladder function; in a number of cases – cessation or reduction of genital itch. Conclusion. In the process of diagnostics and treatment appointment as well as for reaching the clinical efficacy of the treatment it is necessary to consider the role and pathological changes of the patient’s hepatobiliary system.

Antibiotic Resistance Pattern in Healthy Children Diagnosed with Community Acquired Respiratory Tract Infections in King Abdulaziz University Hospital

Objectives: To identify the prevalent organisms associated with respiratory tract infections according to age groups. To identify the most common antibiotics prescribed among pediatric age groups. Methods: A retrospective cohort study conducted on patients aged 0-18 years, admitted to the inpatient department (IPD) diagnosed with respiratory tract infection between Jan 1 2009 to Jan 31 2015 in King Abdulaziz University Hospital (KAUH). Demographic information, diagnosis, date of admission, laboratory investigations, and treatment were collected from patients’ electronic and paper records then analyzed. Exclusion criteria were based on congenital defects, chronic diseases, and compromised immunity. Results: 122 patients with respiratory tract infections were selected for the study (73 males and 49 females). 45.9% of which were infants-toddlers (n=56). The most common diagnosis was pneumonia unspecific (n=32), followed by acute tonsillitis (n=24) and otitis media (n=22). 52 microorganisms were isolated from clinical samples, 14% being Pseudmonas aeruginosa and 13% Streptococcus pneumoniae. 171 antimicrobials were prescribed during the study period. Penicillins were the most frequent (n=78), followed by Cephalosporins (n=45) and Macrolides (n=22). 6.897% resistance was detected among 87 files with culture and sensitivity tests, 30% of which were positively cultured, ranking resistance with 20%. Conclusions: Despite the results showing minimal resistance, antibiotic resistant organisms remain a global concern that needs to be addressed to prevent the spread of antimicrobial resistant infections.