Bilateral Acute Otitis Media Research Articles

Этиология, диа гностика, осложнения и лечение острого среднего отита у детей. Современный взгляд на проблему

The article delves into the etiology, clinical manifestation, diagnosis, and treatment of acute otitis media (AOM), along with measures for preventing its complications. AOM is characterized by the rapid onset of symptoms indicative of inflammation in the middle ear. The paper examines AOM incidence rates across different countries, including Russia, highlighting the significance of this health issue. Various factors can contribute to the development of AOM, such as anatomical features of the middle ear, the cellular biology patterns of the nasopharynx, and variations in immune responses to microbial invasions. The condition is commonly associated with viral and bacterial pathogens, as well as genetic predisposition; however, bacteria are generally considered the primary causative agents. The article also addresses therapeutic approaches and the concern of overdiagnosis, which can lead to the excessive use of antibiotics and subsequent resistance. A retrospective analysis of 90 outpatient records was conducted, focusing on patients who received analgesic ear drops during the pre-perforated stage of AOM. Findings indicate that a combination drug containing lidocaine and phenazone was frequently prescribed in cases of recurrent AOM and for referrals to an otorhinolaryngologist within the initial two days of disease onset, particularly for patients with bilateral AOM. The importance of prompt diagnosis and appropriate treatment of AOM is underscored, as well as the necessity for preventive measures to decrease incidence rates. These insights can be highly beneficial for practitioners and specialists in the field of otorhinolaryngology. KEYWORDS: acute otitis media, otalgia, earache, ear drops, lidocaine, phenazone, compliance, drug choice. FOR CITATION: Kiselyov A.B., Chaukina V.A., Andamova O.V., Avtushko A.S., Vertakova O.V., Rudenskikh Yu.V. Etiology, diagnosis, complications and treatment of acute otitis media in pediatric population. Modern view of the problem. Russian Medical Inquiry. 2024;8(8):493–498 (in Russ.). DOI: 10.32364/2587-6821-2024-8-8-8.

Acute otitis media management: A survey of European primary care pediatricians

PurposeTo describe the management of Acute Otitis Media in European countries, comparing practices between countries and accordance with the American Academy of Pediatrics guidelines. MethodsThe study was completed via an internet survey. A coordinator per country obtained the local ethical approval, distributed the survey and collected responses. 2109 questionnaires were completed in 14 European countries. Results were analyzed by comparing answers within and between each country. ResultsOtoscope device used varied, including conventional (89%), fiber-optic (19%) and pneumatic (4.9%) otoscopes. Decision to treat: 78.1% (63.8–90.5%) would immediately initiate antibiotics for a 6-month-old with bilateral Acute Otitis Media; 73.2% (47.6%-82.9%) would use a delayed antibiotic therapy in a 25-month-old with bilateral Acute Otitis Media; 50.2% would immediately initiate antibiotic treatment in a first episode of Acute Otitis Media for a 3-year-old and 31.5% would defer antibiotics. Younger pediatricians tend to prescribe more antibiotics: 87.6% vs 77.2%, OR: 2.08 (1.31–3.29). Amoxicillin as a first-line treatment was nearly unanimous (88.5%). Influenza vaccine was recommended by 35.7% of physician, whereas anti-pneumococcus was recommended by 86.0%. ConclusionsAmong surveyed pediatricians, the diagnostic tools used and the decision to treat with antibiotics varied. Common practice guidelines for European pediatricians would unify current practices and reduce unnecessary antibiotic use.

Facial Palsy with Tongue Ulcer: A Rare Initial Presentation of Granulomatosis with Polyangiitis

Granulomatosis with polyangiitis (GPA) is a rare multisystem disease. Although GPA is rare, it commonly presents in a localised stage where its manifestation involves the upper or lower respiratory tract before progressing to a generalised stage. Therefore, most patients with GPA will visit an oral surgeon or an otolaryngologist to seek treatment. However, the diagnosis of GPA is often delayed as GPA is not frequently considered as a differential diagnosis in common oral and facial diseases. The lack of gold standard investigation for the diagnosis of GPA makes management of this case, a diagnostic conundrum. We herein report a patient who was diagnosed with bilateral acute otitis media and left mastoiditis complicated with facial nerve palsy, and later developed tongue ulceration one month after his initial presentation. The ear, facial and oral symptoms represent a diagnostic red herring to a fullblown generalised stage of GPA.

Therapeutics for acute otitis media

Background: Acute otitis media (AOM) is diagnosed in patients with acute onset of signs and symptoms of inflammation in the middle ear, accompanied by middle ear effusion. AOM is a common infectious disease in children, and its diagnosis and treatment can have significant impacts on the health of children.Current Concepts: The evidence-based clinical practice guidelines in Korea and other countries provide recommendations to primary care clinicians regarding the management of children with AOM. The treatment strategy for AOM depends on the patient’s age, severity of symptoms, the presence of otorrhea, and the laterality.Discussion and Conclusion: For children aged from 6-months to 2-years with unilateral non-severe AOM and children aged 2 years or older with unilateral or bilateral non-severe AOM, the published guidelines provide the option of observation rather than immediate treatment with antibiotics. High-dose amoxicillin (80 to 90 mg a day) is the firstline antibiotic for treating AOM in patients without penicillin allergies. Children in whom symptoms persist after 48 to 72 hours of antibiotic treatment should be re-examined and amoxicillin/clavulanate should be used as second-line antibiotics. Careful follow-up is required to identify the complications and sequelae of AOM, and to determine the optimum treatment.

Nystagmus in adult patients with acute otitis media or otitis media with effusion without dizziness.

The present study aimed to investigate the incidence and patterns of nystagmus in adult patients with acute otitis media (AOM) or otitis media with effusion (OME) without dizziness or vertigo, and discuss possible mechanisms. From February 2018 to November 2018, 34 consecutive patients with AOM or OME without dizziness were included. Nystagmus was examined with video Frenzel glasses. Of 34 adult AOM or OME patients without dizziness, nystagmus was observed in 28 patients (82%). In unilateral AOM or OME (n = 30), the most commonly observed nystagmus pattern was irritative-type direction-fixed nystagmus (n = 13), followed by paretic-type direction-fixed nystagmus (n = 8), and direction-changing positional nystagmus (n = 4). In bilateral AOM or OME (n = 4), direction-fixed nystagmus and direction-changing positional nystagmus were observed in two and one patients, respectively. Nystagmus was observed in as many as 82% of adult AOM or OME patients even though they did not complain of dizziness, and the pattern of nystagmus was either direction-fixed or direction-changing. Direct effect of inflammatory mediators penetrated from the middle ear and biochemical alteration in the inner ear fluids due to blood-perilymph barrier dysfunction may result in the presence of nystagmus in AOM or OME patients without dizziness.

Acute mastoiditis in infants younger than 6months: is an alternative treatment protocol needed?

Several studies have reported that younger children suffer from increased incidence and more severe episodes of acute mastoiditis (AM) than older children, whereas other researchers have found the opposite. The aim of our study was to describe the occurrence, clinical, and microbiological aspects of AM in children 6months or younger, and compare them with the results in an older reference age band. The medical files of children hospitalized with a diagnosis of AM during 2001-2016 were retrospectively reviewed. Diagnosis of AM was based on the presence of clinical signs of acute otitis media (AOM) accompanied by two or more of the following: auricle protrusion, retro-auricular erythema, swelling, and local tenderness. Children were divided into two age bands, 6months or younger, and older than 6months. Fifty patients in the young age band and 335 in the older reference age band were included. Bilateral AOM was identified in 14 (28%) children under 6months, and 50 (14.9%) in the reference age band (p < 0.001). Fever, mean WBC, and CRP values were similar in both age bands; 4 (8%) children under 6months had pre-auricular/zygomatic area swelling, as compared to 1(0.02%) in the reference age band (p < 0.001). Complication rates (subperiosteal abscess, sinus vein thrombosis, and epidural abscess) were similar in both age bands. All children were treated with myringotomy and IV antibiotics. Cortical mastoidectomy with the insertion of ventilation tube was performed in 10 (20%) children in the younger age band and 58(17.3%) in the reference age band. Streptococcus pneumoniae was the most common (38%) isolated bacteria in the younger age band, and Group A streptococcous (GAS) (20.6%) in the reference age band. AM in children 6months or younger has similar presentation and characteristics as in older children. Pre-auricular swelling and bilateral AOM are more typical in the younger age band; Streptococcus pneumoniae is the most common pathogen in the younger children. We suggest that the treatment approach should be the same for both groups.

A rare cause of bilateral facial nerve paralysis due to acute otitis media in a 52-year-old man

Facial nerve paralysis is a known complication of middle ear diseases such as chronic otitis media. However, it is rarely seen in acute otitis media (AOM). Bilateral facial nerve paralysis is an extremely rare incidence in AOM in an adult patient. As it is a rare clinical entity, the management of this condition is not very well outlined as per the standard guidelines. Aggressive and appropriate treatment in the earliest period helps patients to recover from facial nerve paralysis. Here, we present a case of bilateral facial nerve paralysis in a 52-year-old male with bilateral AOM. Facial nerve paralysis in both sides recovered to normal with appropriate treatment along with myringotomy.

Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Treatment.

New insights into the diagnosis, treatment and prevention of acute otitis media (AOM) have been gained in recent years. For this reason, the Italian Paediatric Society has updated its 2010 guidelines. A literature search was carried out on PubMed. Only pediatric studies published between January 1, 2010 and December 31, 2018 in English or Italian were included. Each included study was assessed according to the GRADE methodology. The quality of the systematic reviews was assessed using AMSTAR 2. The recommendations were formulated by a multidisciplinary panel of experts. Prompt antibiotic treatment is recommended for children with otorrhea, intracranial complications and/or a history of recurrence and for children under the age of 6 months. For children 6 months to 2 years of age, prompt antibiotic treatment is recommended for all forms of unilateral and bilateral AOM, whether mild or severe. Prompt antibiotic treatment is also recommended for children over 2 years with severe bilateral AOM. A watchful-waiting approach can be applied to children over 2 years with mild or severe unilateral AOM or mild bilateral AOM. High doses of amoxicillin, or amoxicillin-clavulanic acid for patients with a high risk of infection by Beta-lactamase producing strains, remain the first-line antibiotics. AOM should be managed on a case-by-case basis that takes account of the child's age, the severity of the episode and whether it is unilateral or bilateral. In patients under 2 years, prompt antibiotic treatment is always recommended.

A rare case of bilateral acute otitis media leading to bilateral facial paresis in an adult

&lt;p class="abstract"&gt;Facial nerve paresis is a known complication of middle ear disease. However it is more commonly seen as a complication of chronic otitis media as compared to acute otitis media (AOM). There are very few reported cases of AOM leading to facial palsy and even fewer ones of bilateral acute otitis media leading to bilateral facial palsy. Since this is a very rare presentation its management and treatment are not very well outlined as per standard guidelines. Here we have presented a very rare case of bilateral AOM leading to bilateral facial paresis, how the case progressed and how it was managed. We have tried to bring forth the salient features of the presentation, the progression and the resolution of the disease due to the successful management&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Antibiotics for acute otitis media in children.

Antibiotics for acute otitis media in children.

Clinical and audiological findings in children with acute otitis media

Conclusion: It is recommended to perform follow-up tympanometry and if necessary tonal audiometry in children who have normal plain otoscopy findings after recovering from acute otitis media (AOM). Children with Type B tympanogram, 3 months following the onset of AOM, are very likely to have a conductive hearing loss. Type B tympanogram is a much better indicator of effusion in the middle ear compared to plain otoscopy. Objective: This study was undertaken to investigate the frequency and duration of middle ear effusion in children following an episode of acute otitis media, to track changes in tonal audiometry and tympanometry findings in the post-AOM period, and recognize the optimal timing for performing both tests. Methods: In this study, 125 children aged 5–7 years with bilateral AOM were randomly selected and separately followed up for 3 months. The children underwent six ear, nose, and throat (ENT 1–6) examinations, six tympanometries (TM 1–6), and three tonal audiometries (TA 1–3). Evaluation of nasopharynx was done at the ENT 1 examination. Children who received ventilation tubes were followed for 21 month altogether. Results: At the first otoscopy, pathological findings were recorded in 250 ears/125 children (100.0%). The number of pathological otoscopy findings decreased at each subsequent examination. At ENT 6 all children had normal otoscopy findings. Type B tympanogram was detected in 49/250 (19.6%) ears at TM 6, performed 3 months following the onset of the disease. At the TA 1 conductive hearing impairment was recorded in 158/250 (63.2%) ears, at TA 2 in 66/250 (26.4%), and at TA 3 in 39/250 (15.6%). Most of them were associated with Type B tympanogram.

Chronic lymphocytic leukemia relapse presenting as acute otitis media with facial palsy

ObjectiveTo describe a case of chronic lymphocytic leukemia relapses presenting as bilateral acute otitis media with left facial paralysis. MethodsCase report and review of the literature. IntroductionChronic lymphocytic leukemia is the most common leukemia in adults predominantly the elderly. Despite advances in treatment still chronic Lymphocytic leukemia is an incurable disease; relapse of leukemia may occur several months to years after a complete remission. Extramedullary manifestations of relapsed chronic lymphocytic leukemia (CLL) present with a wide range of symptoms and signs yet involvement of temporal bone is a rare presentation of the disease.9,10We present a patient who was diagnosed with chronic lymphocytic leukemia (CLL) who presented with bilateral acute otitis media and mastoiditis with left facial paralysis.

Is Bilateral Acute Otitis Media Clinically more Refractory than Unilateral Acute Otitis Media?

Objective: To compare the clinical characteristics of bilateral acute otitis media (BAOM) with unilateral acute otitis media (UAOM) in children and to find risk factors of refractory otitis media.Patients and Methods: Four hundred and sixty-six children aged 0 to 14 years old (median age; 1 year old) with AOM were enrolled during January 2010 and June 2011.Diagnosis of acute otitis media, the severity classification by clinical/ontological scores, and treatments were based on Clinical Practical Guidelines for Acute Otitis Media in Children in Japan 2009. Refractory acute otitis media (RAOM) was designated as recurrent acute otitis media with more than 3 episodes in 6 months or more than 4 episodes in 12 months and/or persistent otitis media with a prolonged course of otitis media more than 3 weeks after the treatment. A multivariate logistic regression analysis was used to estimate the risk of BAOM and UAOM presenting with RAOM.Results: One hundred and thirty-seven (29.4%) patients were diagnosed as having RAOM. Two hundred and seventy-eight (60%) patients were diagnosed as having BAOM, 45.3% of whom had RAOM, whereas 11 (5.9%) of 188 patients with UAOM showed a refractory clinical course. One hundred and fifty-four (33%) patients were under 2 years of age and 71.3% of them had RAOM. The odds ratio for BAOM patients (compared with UAOM patients) to present with RAOM was 8.7 (95% confidence interval; 4.4-17.1). The odds ratio for patients under 2 years of age (compared with patients aged 2 or over) to present with RAOM was 7.1 (95% confidence interval; 4.4-11.8).Conclusions: BAOM patients and UAOM patients aged under 2 years of age were significantly associated with an intractable clinical course, and simultaneous occurrence of otitis media and an age under 2 years were apparent risk factors for refractory otitis media.

Bacterial Labyrinthitis in an Adult with Acute Otitis Media

We report a rare case of fulminate suppurative bacterial labyrinthitis in an otherwise healthy female who presented with bilateral acute otitis media. The presentation of purulent otorrhea with concurrent vertigo, vigorous spontaneous left-beating nystagmus, and hearing loss was compelling for the diagnosis. This report discusses the clinical and radiographic presentation and findings consistent with bacterial labyrinthitis and stresses the importance of expedited diagnosis and medical and surgical intervention to avoid further complication as well as minimize permanent inner ear damage. We also discuss posttreatment inner ear evaluation and rehabilitative options based on permanent insults.

High-Dose Amoxicillin with Clavulanate for the Treatment of Acute Otitis Media in Children

Objective. This study uses the acute otitis media clinical practice guideline proposed in 2004 as a reference to evaluate whether antibiotics doses that are in line with the recommendations lead to better prognosis. The study also attempts to clarify possible factors that influence the outcome. Study Design. Retrospective cohort study. Subjects and Methods. A total of 400 children with acute otitis media were enrolled. The dosage of amoxicillin was considered to be appropriate when in accord with clinical practice guidelines, that is, 80–90 mg/kg/day. The outcome was defined according to the description of tympanic membrane on medical records. Multivariate logistic regression was used to analyze the relationship between antibiotic dosage and prognosis after adjusting for baseline factors. Results. The majority of prescriptions were under dosage (89.1%) but it was not noticeably associated with outcome (P = 0.41). The correlation between under dosage and poor prognosis was significant in children below 20 kg with bilateral acute otitis media (odds ratio 1.63; 95% CI 1.02–2.59, P = 0.04). Conclusion. Treating acute otitis media in children, high-dose amoxicillin with clavulanate as recommended in the clinical practice guideline was superior to conventional doses only in children under 20 kg with bilateral diseases.

両側性急性中耳炎は一側性急性中耳炎よりも難治性か？

両側性急性中耳炎は一側性急性中耳炎よりも難治性か？

Análise da Revisão Cochrane: Antibioticoterapia na Otite Média Aguda da Criança. Cochrane Database Syst Rev. 2013;1:CD000219.

Acute otitis media is one of the most common infections in children and one of the leading causes for antibiotic prescription. In this paper, we assess and comment the Cochrane systematic review 'Antibiotics for acute otitis media in children', which aimed at assessing the efficacy and safety of antibiotics for acute otitis media in children and identifying subgroups of children who might benefit more than others from antibiotic treatment. This review showed spontaneous resolution of acute otitis media in most children (82%) and a favorable but modest effect of antibiotics, namely in pain control (number needed to treat to benefit: 20), reduction of tympanic membrane perforations and reduction of contralateral acute otitis media. Adverse effects such as vomiting, diarrhea or rash were more common in the antibiotic group (number needed to treat to harm: 14). Thus, for most children, an expectant observational approach during 48-72h without immediate antibiotic prescription seems justified. An additional meta-analysis found that antibiotics appear to be most useful in children with both acute otitis media and otorrhoea and children under two years of age with bilateral acute otitis media.

Symptoms and Otoscopic Signs in Bilateral and Unilateral Acute Otitis Media

Bilateral acute otitis media (AOM) is considered more severe than unilateral AOM, and several guidelines recommend more active treatment and/or follow-up of bilateral AOM. We studied whether bilateral AOM is a clinically more severe illness than unilateral AOM by comparing symptoms and otoscopic signs between bilateral and unilateral AOM. Two hundred thirty-two children aged 6 to 35 months diagnosed with AOM were eligible. We surveyed the symptoms with a structured questionnaire and recorded the otoscopic signs systematically. Ninety-eight children had bilateral and 134 children unilateral AOM. Children with bilateral AOM were more often <24 months than children with unilateral AOM (87% vs 75%; P = .032). Fever (≥38°C) occurred in 54% and 36% (P = .006) and severe conjunctivitis in 16% and 44% (P = .047) of children with bilateral and unilateral AOM, respectively. In 15 other symptoms, we found no overall differences even when adjusted with age. We observed the following severe otoscopic signs in the bilateral and unilateral AOM group, respectively: moderate/marked bulging of tympanic membrane (63% and 40%; P = .001), purulent effusion (89% and 71%; P = .001), bulla formation (11% and 10%; P = .707), and hemorrhagic redness of tympanic membrane (7% and 10%; P = .386). Bilateral AOM seems to be a clinically only slightly more severe illness than unilateral AOM. Therefore, when assessing AOM severity, bilaterality should not be used as a determining criterion; instead, the child's symptomatic condition together with otoscopic signs should also be taken into consideration.

Ostre zapalenie ucha środkowego (OMA)

Acute otitis media (AOM) is the inflammation of the middle ear cleft of rapid onset with the presence of local and general signs and symptoms of inflammatory reaction associated with purulent effusion in the middle ear. Acute otitis media is one of the most frequent diseases in young children, its incidence appears highest between 6–18 months of age. Usually it is caused by ascending infection from the nasopharyngs through the Eustachian tube. Both bacterial and viral infections are implicated. Most common bacterial pathogens are: S. pneumoniae, H. influenzae, M. catharralis. Diagnosis is based on otoscopic examination. In otoscopy bulging tympanic membrane Has highest predictive value for AOM. In majority of children above the age of 2 years spontaneous resolution of AOM can be observed. For this reason “watchful waiting” strategy is recommended which means limiting management to adequate pain relief and introducing antibiotics only in children who fail to improve. Antibiotic are indicated for children <6 months of age, with severe course of disease – high fever and vomiting, discharge from the ear, bilateral AOM, from the group of risk of abnormal clinical course (Down syndrome, cleft palate, recurrent AOM etc.) and lack of spontaneous improvement after 24–48 hours of symptomatic treatment. The preferred antibiotic is amoxicillin. Myringotomy is reserved for severe cases with potential or confirmed complications, lack of response on antibacterial therapy, patients with immunological deficiencies or when microbiology is strongly required.

Análisis crítico de un artículo: antibióticos en otitis media aguda, ¿son necesarios?, ¿existe algún subgrupo que se beneficia?

Background: Acute otitis media (AOM) is one of the most common diseases in early infancy and childhood. Antibiotic use for AOM varies from 56% in the Netherlands to 95% in the USA and Australia. Objectives: To assess the effects of antibiotics for children with AOM. Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008, issue 2) which contains the Acute Respiratory Infections (ARI) Group's Specialized Register; MEDLINE (1966 to June week 4 2008); OLDMEDLINE (1958 to 1965); EMBASE (January 1990 to July 2008); and Current Contents (1966 to July 2008). Selection criteria: Randomised controlled trials comparing 1) antimicrobial drugs with placebo 2) immediate antibiotic treatment with observational treatment approaches in children with AOM. Data collection and analysis: Three review authors independently assessed trial quality and extracted data. Main results: We found 10 trials (2928 children) from high income countries with low risk of bias. Pain was not reduced by antibiotics at24 hours, but was at two to seven days, (relative risk (RR) 0.72; 95% confidence interval 0.62 to 0.83). However four trials (1271 children) comparing antibiotics prescribed immediately rather than initial observation found no difference at three to seven days. Antibiotics did not reduce tympanometry, perforation or recurrence. The only case of mastoiditis was in an antibiotic treated child. Vomiting, diarrhoea or rash was higher in children taking antibiotics (RR 1.37; 95% CI 1.09 to 1.76). Individual patient data meta-analysis of a subset of the included trials found antibiotics to be most beneficial in children: aged less than two; with bilateral AOM and with both AOM and otorrhoea. Authors' conclusions: Antibiotics slightly reduce the number of children with acute middle ear infection experiencing pain after a few days. However, most (78%) settle spontaneously in this time, meaning 16 children must be treated to prevent one suffering ear pain. This benefit must be weighed against the possible harms: 1 in 24 children experience symptoms caused by antibiotics. Antibiotics are most useful in children under two years of age, with bilateral AOM, and with both AOM and discharging ears. For most other children with mild disease, an expectant observational approach seems justified. We have no data on populations with higher risks of complications.