Chronic Suppurative Otitis Media In Children Research Articles

Type 1 Tympanoplasty with and Without Mastoidectomy in Children

Objective: Assessment of the surgical benefit in children of a canal wall up mastoidectomy with Tos Type 1 tympanoplasty over Tos Type 1 tympanoplasty alone in patients with chronic suppurative otitis media (CSupOM) with tympanic membrane (TM) perforation. Study Design: Retrospective study. Setting: Tertiary care hospital. Methods: A retrospective chart review of CSupOM patients younger than 18-years old and admitted for elective tympanoplasty between 2010 and 2013 was conducted. Primary cases of patients submitted to Type 1 tympanoplasty (according to Tos classification 1993) were selected and were divided into two groups: tympanoplasty with canal wall up mastoidectomy and tympanoplasty without mastoidectomy. Surgical success was defined as the presence of an intact TM with no disease recurrence after 2 years of follow-up. Results: From a total of 125 ears (88 pediatric patients), 59 were selected according to the inclusion criteria. The mean age of the patients was 12.5 years, with 5.1% being 7 years old or younger, 67.8% between the ages of 8 and 14 years old, and 27.1% from 15 to 18 years old. 67.8% of the patients were boys and 32.2% girls. The overall surgical success rate was 89.8%, with 88.9% in the tympanoplasty group and 90.2% in the tympanoplasty with mastoidectomy group. Audiometric improvement was observed in both groups with a mean gap closure of 14 dB ± 8.4 dB in the tympanoplasty without mastoidectomy group and 12.5 dB ± 9.5 dB in the tympanoplasty with mastoidectomy group. Conclusion: Type 1 tympanoplasty is an effective treatment of CSupOM in children. In these cases, performing mastoidectomy at the time of primary Type 1 tympanoplasty is not associated with improved outcomes.

Leukocyte Shift Index in Purulent-Inflammatory Pathology of the Middle Ear in Children in the Age Aspect

The aim of the study was a comparative analysis of the blood value of the leukocyte shift index (LSI) in acute suppurative otitis media (ASOM) and chronic suppurative otitis media (CSOM), depending on the age of children. Methods and Results: This study included 100 children (62 boys and 38 girls) aged 1-16 years who were diagnosed with ASOM and CSOM. The mean age of all patients was 7.59±0.50 years. Group 1 included 50 patients (30 boys and 20 girls) with ASOM. Group 2 included 50 patients (20 boys and 30 girls) with CSOM. As a marker for determining the activity of the inflammatory process, we chose LSI, calculated taking into account the parameters of the general blood test. LSI levels in the patients of Group 1 and Group 2 were 2.08±0.23 and 1.51±0.16, respectively (P=0.0446). The results obtained indicate that in children with mean age of 3.44±0.31 years, the LSI level of 2.08±0.23 can suggest the formation of ASOM. In children with mean age of 11.56±0.46 years, the LSI level of 1.51±0.16 can suggest the formation of CSOM. Conclusion: The proposed method for predicting CSOM in children has enough grounds for clinical application in practical health care.

Characteristics of hearing impairment in Yemeni children with chronic suppurative otitis media: A case–control study

Background Chronic suppurative otitis media (CSOM) is a serious disorder particularly in low resource settings. It can lead to disabling hearing impairment and sometimes life-threatening infective complications. Objective The aim of the present study was to describe the characteristics of hearing impairment associated with CSOM in Yemeni children. Methods A case–control study of 75 children with CSOM and 74 healthy controls. Hearing was assessed by behavioural testing and audiometry. Results Cases had lower academic performance than controls (OR 15.31, 95% CI 1.99–322.14, p < 0.001). Disabling hearing impairment >30 dB was present in 51.5% (right ear) and 66.7% (left ear) of children with CSOM. Conclusion Disabling hearing impairment was identified as a major health problem in these Yemeni children with CSOM. There is a need for investment to reduce the burden of CSOM and its complications in these communities. Greater attention to the chronic disabling effects of CSOM in children is required in poor communities and low resource settings.

Chronic suppurative otitis media in Tanzanian school children and its effects on hearing

To compare different treatment regimens of chronic suppurative otitis media (CSOM) in school children, in regard to their consequence in hearing and discharge from the ear drum perforation. Randomised controlled trial. Randomly selected primary schools within Dar es Salaam. Three hundred and twenty eight children between 5-17 years of age with CSOM in one or both ears. Three to four months after the onset of treatment 31% of group 1, 54% of group 2, and 56% of group 3, had dry ears. Treatment with dry mopping and boric acid in alcohol ear drops was significantly better than dry mopping alone. Adding amoxicillin to the treatment did not improve the end results. Hearing test performed before and after treatment showed that the hearing thresholds were the same or better after the treatment. The possible risk that boric acid in alcohol ear drops should lead to sensorineural hearing loss has not been confirmed. Based on the above results, the treatment of choice for CSOM in children in Dar es Salaam should be dry mopping and boric acid in spirit ear drops.

Predictors of Chronic Suppurative Otitis Media in Children

To determine which factors predict development of chronic suppurative otitis media (CSOM) in children. Case-control study, with univariate and multivariate logistic regression analysis applied to determine which factors independently predict CSOM. Prognostic factors for CSOM were identified in (1) 100 children with CSOM and 161 controls aged 1 to 12 years and (2) 83 children who developed CSOM in the presence of a tympanostomy tube and 136 children with tympanostomy tubes who did not develop CSOM. Independent predictors for CSOM were previous tympanostomy tube insertion (odds ratio [OR], 121.4 [95% confidence interval {CI}, 38.9-379.3]); having had more than 3 upper respiratory tract infections in the past 6 months (OR, 12.2 [95% CI, 3.5-42.3]); having parents with a low education level (OR, 14.1 [95% CI, 2.9-68.6]); and having older siblings (OR, 4.4 [95% CI, 1.6-12.6]). Independent predictors for CSOM after tympanostomy tube insertion were having experienced more than 3 episodes of otitis media in the past year (OR, 4.9 [95% CI, 2.2-11.0]; attending day care (OR, 3.6 [95% CI, 1.7-7.8]); and having older siblings (OR, 2.6 [95% CI, 1.2-5.5]). Treatment with tympanostomy tubes is the most important prognostic factor for CSOM in children. In children who are being treated with tympanostomy tubes for persistent middle ear effusion, the most important prognostic factor for CSOM is a history of recurrent episodes of acute otitis media. This information should be taken into consideration and discussed with parents when considering insertion of tympanostomy tubes in children.

Topical Ciprofloxacin/Dexamethasone Found Superior to Oral Amoxicillin/Clavulanic Acid in Acute Otitis Media with Otorrhea

The outcomes of treatment of chronic suppurative otitis media (CSOM) are disappointing and uncertain, especially in developing countries. Because CSOM is the commonest cause of hearing impairment in children in these countries, an effective method of management that can be implemented on a wide scale is needed. We report a randomised, controlled trial of treatment of CSOM among children in Kenya; unaffected schoolchildren were taught to administer the interventions.We enrolled 524 children with CSOM, aged 5–15 years, from 145 primary schools in Kiambu district of Kenya. The schools were randomly assigned treatments in clusters of five in a ratio of two to dry mopping alone (201 children), two to dry mopping with topical and systemic antibiotics and topical steroids (221 children), and one to no specific treatment (102 children). Schools were matched on factors thought to be related to their socioeconomic status. The primary outcome measures were resolution of otorrhoea and healing of tympanic membranes on otoscopy by 8, 12, and 16 weeks after induction. Absence of perforation was confirmed by tympanometry, and hearing levels were assessed by audiometry. 29 children were withdrawn from the trial because they took non-trial antibiotics. There was no evidence of differences in timing of withdrawals between the groups.By the 16-week follow-up visit, otorrhoea had resolved in a weighted mean proportion of 51% (95% CI 42–59) of children who received dry mopping with antibiotics, compared with 22% (14–31) of those who received dry mopping alone and 22% (9–35) of controls. Similar differences were recorded by the 8-week and 12 week visits. The weighted mean proportions of children with healing of the tympanic membranes by 16 weeks were 15% (10–21) in the dry-mopping plus antibiotics group, 13% (5–20) in the dry-mopping alone group, and 13% (3–23) in the control group. The proportion with resolution in the drymopping alone group did not differ significantly from that in the control group at any time. Hearing thresholds were significantly better for children with no otorrhoea at 16 weeks than for those who had otorrhoea, and were also significantly better for those whose ears had healed than for those with otorrhoea at all times.Our finding that dry mopping plus topical and systemic antibiotics is superior to dry mopping alone contrasts with that of the only previous community-based trial in a developing country, though it accords with findings of most other trials in developed countries. The potential role of antibiotics needs further investigation. Further, similar trials are needed to identify the most cost-effective and appropriate treatment regimen for CSOM in children in developing countries.

Randomised controlled trial of treatment of chronic suppurative otitis media in Kenyan schoolchildren

The outcomes of treatment of chronic suppurative otitis media (CSOM) are disappointing and uncertain, especially in developing countries. Because CSOM is the commonest cause of hearing impairment in children in these countries, an effective method of management that can be implemented on a wide scale is needed. We report a randomised, controlled trial of treatment of CSOM among children in Kenya; unaffected schoolchildren were taught to administer the interventions. We enrolled 524 children with CSOM, aged 5-15 years, from 145 primary schools in Kiambu district of Kenya. The schools were randomly assigned treatments in clusters of five in a ratio of two to dry mopping alone (201 children), two to dry mopping with topical and systemic antibiotics and topical steroids (221 children), and one to no specific treatment (102 children). Schools were matched on factors thought to be related to their socioeconomic status. The primary outcome measures were resolution of otorrhoea and healing of tympanic membranes on otoscopy by 8, 12, and 16 weeks after induction. Absence of perforation was confirmed by tympanometry, and hearing levels were assessed by audiometry. 29 children were withdrawn from the trial because they took non-trial antibiotics. There was no evidence of differences in timing of withdrawals between the groups. By the 16-week follow-up visit, otorrhoea had resolved in a weighted mean proportion of 51% (95% CI 42-59) of children who received dry mopping with antibiotics, compared with 22% (14-31) of those who received dry mopping alone and 22% (9-35) of controls. Similar differences were recorded by the 8-week and 12-week visits. The weighted mean proportions of children with healing of the tympanic membranes by 16 weeks were 15% (10-21) in the dry-mopping plus antibiotics group, 13% (5-20) in the dry-mopping alone group, and 13% (3-23) in the control group. The proportion with resolution in the dry-mopping alone group did not differ significantly from that in the control group at any time. Hearing thresholds were significantly better for children with no otorrhoea at 16 weeks than for those who had otorrhoea, and were also significantly better for those whose ears had healed than for those with otorrhoea at all times. Our finding that dry mopping plus topical and systemic antibiotics is superior to dry mopping alone contrasts with that of the only previous community-based trial in a developing country, though it accords with findings of most other trials in developed countries. The potential role of antibiotics needs further investigation. Further, similar trials are needed to identify the most cost-effective and appropriate treatment regimen for CSOM in children in developing countries.

Microbiology of chronic suppurative otitis media in children in Surabaya, Indonesia

The aerobic and anaerobic microbiology of 38 children from Surabaya, Indonesia, who suffered from chronic suppurative otitis media (CSOM) was studied using strict microbiological methodology. A total of 106 isolates (49 anaerobic and 57 aerobic) were recovered. Aerobic organisms alone were isolated from 11 (29%), anaerobic bacteria only in 4 (11%) and mixed aerobic and anaerobic flora were present in 23 (60%). The predominant organisms were Peptostreptococcus sp, Prevotella sp, Bacteroides sp, Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae and Fusobacterium sp Thirty-nine β-lactamase-producing bacteria were recovered from 22 (58%) patients. These findings demonstrate the role of penicillin resistant aerobic and anaerobic bacteria in the polymicrobial etiology of CSOM in children from Indonesia. Judicious use of antimicrobial therapy may prevent the development of antimicrobial resistance.

Medical management of chronic suppurative otitis media without cholesteatoma in children

Tympanomastoid surgery is considered standard management for chronic suppurative otitis media (CSOM) without cholesteatoma, which is unresponsive to ototopical/oral antimicrobial therapy. The following makes this sequence of management less attractive today: 1. potential ototoxicity of ototopical agents; 2. lack of oral antimicrobial agents effective against most common pathogens (e.g., Pseudomonas aeruginosa); 3. frequent occurrence in children who have tympanostomy tubes; and 4. failure of tympanomastoid surgery to eradicate the disease in all cases. We conducted a study in 36 pediatric patients with chronic suppurative otitis media, in which all received parenteral antimicrobial therapy and daily aural toilet (mean duration of treatment = 9.7 days). Thirty-two patients (89%) had resolution of their infection with medical therapy alone; four children required tympanomastoidectomy. Further investigation is needed to understand the etiology, pathogenesis, and most effective methods of management/prevention of CSOM in children.