Diagnosis Of Acute Otitis Media Research Articles

Nieuwe aanbevelingen voor de behandeling van acute otitis media in de eerste lijn

New recommendations for the management of acute otitis media in primary care This article is a summary of the recent clinical guideline update of acute otitis media with recommendations for its diagnosis, treatment and prevention, including complicated acute otitis media or acute otitis media at risk of complications in children and adults in general practice. The clinical practice guideline came about with the participation of all relevant disciplines and according to an internationally recognized methodology for guideline development (Adapte procedure). The elements of the medical history and clinical examination have limited diagnostic value. Moreover, symptoms alone are not enough to make the diagnosis of acute otitis media. The diagnostic hypothesis is based on the combination of these elements. The doctor pays attention to the patient’s experience and provides the necessary information to enable the patient to manage his/her disease properly (e.g. pain management). Shared decision-making is a key point. Antibiotics are justified in case of an unfavorable disease course and in the presence of major risk factors for complications. However, certain subgroups may benefit from antibiotic therapy. Effective pain or fever treatment (with paracetamol or ibuprofen) has become the cornerstone of acute otitis media management. More targeted antibiotic therapy is reserved for specific indications.

Development and Validation of an Automated Classifier to Diagnose Acute Otitis Media in Children

Acute otitis media (AOM) is a frequently diagnosed illness in children, yet the accuracy of diagnosis has been consistently low. Multiple neural networks have been developed to recognize the presence of AOM with limited clinical application. To develop and internally validate an artificial intelligence decision-support tool to interpret videos of the tympanic membrane and enhance accuracy in the diagnosis of AOM. This diagnostic study analyzed otoscopic videos of the tympanic membrane captured using a smartphone during outpatient clinic visits at 2 sites in Pennsylvania between 2018 and 2023. Eligible participants included children who presented for sick visits or wellness visits. Otoscopic examination. Using the otoscopic videos that were annotated by validated otoscopists, a deep residual-recurrent neural network was trained to predict both features of the tympanic membrane and the diagnosis of AOM vs no AOM. The accuracy of this network was compared with a second network trained using a decision tree approach. A noise quality filter was also trained to prompt users that the video segment acquired may not be adequate for diagnostic purposes. Using 1151 videos from 635 children (majority younger than 3 years of age), the deep residual-recurrent neural network had almost identical diagnostic accuracy as the decision tree network. The finalized deep residual-recurrent neural network algorithm classified tympanic membrane videos into AOM vs no AOM categories with a sensitivity of 93.8% (95% CI, 92.6%-95.0%) and specificity of 93.5% (95% CI, 92.8%-94.3%) and the decision tree model had a sensitivity of 93.7% (95% CI, 92.4%-94.9%) and specificity of 93.3% (92.5%-94.1%). Of the tympanic membrane features outputted, bulging of the TM most closely aligned with the predicted diagnosis; bulging was present in 230 of 230 cases (100%) in which the diagnosis was predicted to be AOM in the test set. These findings suggest that given its high accuracy, the algorithm and medical-grade application that facilitates image acquisition and quality filtering could reasonably be used in primary care or acute care settings to aid with automated diagnosis of AOM and decisions regarding treatment.

Bacterial pathogens and antimicrobial resistance in acute otitis media

IntroductionRecent studies show an increase in the prevalence of Haemophilus influenzae and a decrease in Streptococcus pneumoniae among the bacteria that cause acute otitis media (AOM). The objective of our study was to analyse the distribution of pathogens identified in children aged less than 14 years presenting to the emergency department with AOM and their patterns of antimicrobial resistance. Patients and methodsSingle centre retrospective, analytical study in patients aged less than 14 years with a diagnosis of AOM in whom an ear drainage sample was collected for culture in the paediatric emergency department of a tertiary care hospital between 2013 and 2021. ResultsDuring the study period, there were 14 684 documented care episodes corresponding to children with a diagnosis of AOM. An ear drainage culture was performed in 768 of those episodes. The median age of the patients was 2 years, 57% were male and 70% had a previous history of AOM. The most frequently isolated pathogens were: Haemophilus influenzae (n = 188 [24.5%]; 15.5% of them resistant to ampicillin), Streptococcus pyogenes (n = 86 [11.2%]), Staphylococcus aureus (n = 82 [10.7%]), Streptococcus pneumoniae (n = 54 [6.9%]; 9.4% with intermediate resistance to penicillin), Pseudomonas aeruginosa (n = 42 [5.5%]) and Moraxella catarrhalis (n = 11 [1.4%]). No pathogen was isolated in 34.9% of cases. ConclusionsHaemophilus influenzae is the leading cause of AOM in children aged less than 14 years. This, combined with the low frequency of isolation and penicillin resistance of Streptococcus pneumoniae, calls into question the appropriateness of high-dose amoxicillin for empiric treatment of AOM.

Acute otitis media diagnosis in childhood: still a problem in 2023?

BackgroundDiagnosis of acute otitis media (AOM) in children can be challenging, given that symptoms are often non-specific or absent, and that the direct observation of the tympanic membrane in its entirety through otoscopy can sometimes be difficult. The aim of this study is to assess the diagnostic concordance in detection of AOM episodes between primary care paediatricians and physicians especially trained in paediatric otoscopy, and to characterize the most misleading elements in diagnostic failure.MethodsConsecutive clinical charts of children regularly followed for recurrent AOM (RAOM, i.e.: >3 episodes in 6 months or > 4 episodes in 1 year) at our Otitis Media paediatric outpatient clinic were retrospectively screened, in order to collect any diagnosis of AOM episode (and the related clinical findings/middle ear complaints) performed by primary care paediatricians/emergency room paediatricians. Diagnosis of AOM episode was validated by the same experienced physician (FF) in case of otoscopic relief of a bulging eardrum with at least one of the following: hyperaemia or yellow-like colour. The diagnostic concordance in detection of AOM episodes between primary care/emergency room paediatricians and our internal validator was expressed as the percentage of matching diagnosis.ResultsOne hundred and thirty-four single AOM episodes occurring in 87 children (mean age: 26.9 +/- 18.9 months) were included in the analysis. Diagnostic concordance in detection of AOM episodes between primary care/emergency room paediatricians and our internal validator was reported in 72.4% of cases. The most common pitfall found in our study was the misleading diagnosis of AOM in case of hyperaemic tympanic membrane without bulging (32/37 out of non-validated diagnoses).ConclusionsAOM diagnosis still represents a relevant issue among paediatricians in our country, and the presence of tympanic membrane hyperaemia without concomitant bulging can be confusing.

Patógenos bacterianos y resistencia a los antibióticos en otitis media aguda

IntroductionRecent studies show an increase in the prevalence of Haemophilus influenzae and a decrease in Streptococcus pneumoniae among the bacteria that cause acute otitis media (AOM). The objective of our study was to analyse the distribution of pathogens identified in children aged less than 14 years presenting to the emergency department with AOM and their patterns of antimicrobial resistance. Patients and methodsSingle centre retrospective, analytical study in patients aged less than 14 years with a diagnosis of AOM in whom an ear drainage sample was collected for culture in the paediatric emergency department of a tertiary care hospital between 2013 and 2021. ResultsDuring the study period, there were 14,684 documented care episodes corresponding to children with a diagnosis of AOM. An ear drainage culture was performed in 768 of those episodes. The median age of the patients was 2 years, 57% were male and 70% had a previous history of AOM. The most frequently isolated pathogens were: Haemophilus influenzae (n=188 [24.5%]; 15.5% of them resistant to ampicillin), Streptococcus pyogenes (n=86 [11.2%]), Staphylococcus aureus (n=82 [10.7%]), Streptococcus pneumoniae (n=54 [6.9%]; 9.4% with intermediate resistance to penicillin), Pseudomonas aeruginosa (n=42 [5.5%]) and Moraxella catarrhalis (n=11 [1.4%]). No pathogen was isolated in 34.9% of cases. ConclusionsHaemophilus influenzae is the leading cause of AOM in children aged less than 14 years. This, combined with the low frequency of isolation and penicillin resistance of Streptococcus pneumoniae, calls into question the appropriateness of high-dose amoxicillin for empiric treatment of AOM

Proposed Quality Indicators for Aspects of Pediatric Acute Otitis Media Management

Background The high incidence of pediatric acute otitis media (AOM) makes the implications of overdiagnosis and overtreatment far-reaching. Quality indicators (QIs) for AOM are limited, drawing from generalized upper respiratory infection QIs, or locally developed benchmarks. Recognizing this, we sought to develop pediatric AOM QIs to build a foundation for future quality improvement efforts. Methods Candidate indicators (CIs) were extracted from existing guidelines and position statements. The modified RAND Corporation/University of California, Los Angeles (RAND/UCLA) appropriateness methodology was used to select the final QIs by an 11-member expert panel consisting of otolaryngology—head and neck surgeons, a pediatrician and family physician. Results Twenty-seven CIs were identified after literature review, with an additional CI developed by the expert panel. After the first round of evaluations, the panel agreed on 4 CIs as appropriate QIs. After an expert panel meeting and subsequent second round of evaluations, the panel agreed on 8 final QIs as appropriate measures of high-quality care. The 8 final QIs focus on topics of antimicrobial management, specialty referral, and tympanostomy tube counseling. Conclusions Evidence of variable and substandard care persists in the diagnosis and management of pediatric AOM despite the existence of high-quality guidelines. This study proposes 8 QIs which compliment guideline recommendations and are meant to facilitate future quality improvement initiatives that can improve patient outcomes.

Factors associated with inappropriateness of antibiotic prescriptions for acutely ill children presenting to ambulatory care in high-income countries: a systematic review and meta-analysis.

Acutely ill children are at risk of unwarranted antibiotic prescribing. Data on the appropriateness of antibiotic prescriptions provide insights into potential tailored interventions to promote antibiotic stewardship. To examine factors associated with the inappropriateness of antibiotic prescriptions for acutely ill children presenting to ambulatory care in high-income countries. On 8 September 2022, we systematically searched articles published since 2002 in MEDLINE, Embase, CENTRAL, Web of Science, and grey literature databases. We included studies with acutely ill children presenting to ambulatory care settings in high-income countries reporting on the appropriateness of antibiotic prescriptions. The quality of the studies was evaluated using the Appraisal tool for Cross-Sectional Studies and the Newcastle-Ottawa Scale. Pooled ORs were calculated using random-effects models. Meta-regression, sensitivity and subgroup analysis were also performed. We included 40 articles reporting on 30 different factors and their association with inappropriate antibiotic prescribing. 'Appropriateness' covered a wide range of definitions. The following factors were associated with increased inappropriate antibiotic prescribing: acute otitis media diagnosis [pooled OR (95% CI): 2.02 (0.54-7.48)], GP [pooled OR (95% CI) 1.38 (1.00-1.89)] and rural setting [pooled OR (95% CI) 1.47 (1.08-2.02)]. Older patient age and a respiratory tract infection diagnosis have a tendency to be positively associated with inappropriate antibiotic prescribing, but pooling of studies was not possible. Prioritizing acute otitis media, GPs, rural areas, older children and respiratory tract infections within antimicrobial stewardship programmes plays a vital role in promoting responsible antibiotic prescribing. The implementation of a standardized definition of appropriateness is essential to evaluate such programmes.

A Previously Healthy Infant with Lemierre Syndrome in the Emergency Department: Case Report.

Lemierre syndrome (LS) is a rare condition with a high mortality risk. It is well described in older children and young adults involving bacteremia, thrombophlebitis, and metastatic abscess commonly due to Fusobacterium infections. Young, pre-verbal children are also susceptible to LS; thus, careful attention must be given to their pattern of symptoms and history to identify this condition in the emergency department (ED). A 12-month-old previously healthy boy with a recent diagnosis of acute otitis media and viral illness presented to the ED with a complaint of fever. Additional symptoms developed at the head and neck and were noted on subsequent ED visits. Advanced imaging revealed significant lymphadenopathy and deep space inflammation extending to the mediastinum. Subsequent imaging confirmed extensive sinus and deep vein thromboses, consistent with LS. Methicillin-resistant Staphylococcus aureus (MRSA) was the only organism identified. After surgical debridement, appropriate intravenous antibiotics, and heparin anticoagulation therapy, the patient experienced full recovery after prolonged hospitalization. A febrile infant with multiple acute care visits and development of lymphadenopathy, decreased oral intake, decreased cervical range of motion, and sepsis should raise suspicion for Lemierre syndrome. The medical evaluation of deep neck spaces and deep veins should be similar to that of older children and adults with LS, including advanced imaging of the head and neck. However, medical management should particularly target MRSA due to its emerging prevalence among infantile LS cases. Further research is necessary to determine the optimal management strategies of LS for this age group.

Congruence between International Classification of Disease, Tenth Revision (ICD-10) code and written documentation for outpatient encounters with antibiotic prescriptions

Background: Antimicrobial stewardship programs (ASPs) often rely on International Classification of Diseases, Tenth Revision (ICD-10) codes to assess antibiotic appropriateness for provider feedback. Concordance between encounter ICD-10 codes and documented indication for antibiotics based on manual chart review varies greatly (74%–95%) in the inpatient setting. Data on concordance between documented indication and ICD-10 code in the outpatient setting are scarce. Methods: We conducted a retrospective cohort study of 650 randomly selected outpatient encounters with antibiotic prescriptions from walk-in and retail clinics between July 15 and September 15, 2021, at Vanderbilt University Medical Center. We performed chart review to compare documented antibiotic indication to the 3 most frequent encounter-associated ICD-10 codes. Also, 12 encounters were excluded due to insufficient available written documentation. The 95% CI for proportion of encounters with concordant antibiotic indications was calculated using Stata version 15.1 software. Results: Of the 638 antibiotic prescriptions with written documentation available for chart review, 204 (32%) were for amoxicillin, 102 (16%) were for amoxicillin-clavulanate, 61 (10%) were for cefdinir, and 56 (9%) were for azithromycin. Overall, 540 (84.6%; 95% CI, 81.6%–87.4%) of 638 encounters had concordant antibiotic indication based on documentation in the note and associated ICD-10 for the encounter. Of the 540 encounters with concordant ICD-10 and documented indications, 348 (64%), 130 (24%), and 35 (6%) were listed as the first, second, and third ICD-10 codes, respectively. An additional 27 (5%) had a concordant ICD-10 code listed beyond the third position. In total, 125 (19.6%) of 638 encounters did not have the intended antibiotic indication as documented in the note in the 3 most frequent encounter-associated ICD-10 codes (whether a lower position or incongruent ICD-10 code with documentation). Of those 125 encounters, 42 (34%) had a documented diagnosis of strep pharyngitis, 16 (13%) had a documented diagnosis of skin or soft-tissue infection, 11 (9%) had a documented diagnosis of urinary tract infection, and 11 (9%) had a documented diagnosis of acute otitis media. Conclusions: Our data suggest that outpatient antimicrobial prescriptions correlate relatively well with encounter ICD-10 codes. However, most ASP prescribing goals aim to reduce inappropriate prescribing to 10% or fewer of prescriptions based on indication. Therefore, providers may not trust individual prescribing feedback that is based on data that is only correct 85% of the time. For ASPs to accurately assess prescribing and provide trusted, meaningful recommendations and specific feedback to individual prescribers, more reliable and valid data are needed. We intend to evaluate whether requiring outpatient antibiotic indications on prescriptions increases data reliability and validity.Disclosures: None

Acute otitis media

Otitis media is defined as a group of inflammatory conditions that affect the middle ear cleft; it consists of acute otitis media (AOM), otitis media with effusion, and chronic otitis media. These terms are often used interchangeably, but should be differentiated from one another by their clinical signs and symptoms, as well as the duration of disease, to ensure the correct diagnosis is reached. Correct diagnosis enables appropriate management of patients within the community, including urgent referral for ear, nose and throat review. This article focuses on the diagnosis and management of AOM for GPs.

Appropriateness of Diagnosis and Management for Otitis Media With Effusion in Pediatric Urgent Care Clinics.

Otitis media with effusion (OME)'s clinical presentation is often confused with acute otitis media (AOM) by clinicians. Despite OME guidelines recommending watchful waiting with no antibiotics, rates of antibiotic use remain elevated. The aim of this study was to determine the clinician diagnosis validity and the rates of antibiotics prescribed among pediatric OME patients evaluated in 3 urgent care clinics within a pediatric health care system. We retrospectively reviewed a random sample of encounters for children aged 0 to 18 years with a billing diagnosis of OME in 2019. We recorded clinical symptoms, antibiotic prescribed, and the clinicians' diagnosis. We used the American Academy of Pediatrics guidelines to assign an AOM diagnosis and compared those with the clinicians' final diagnoses using Pearson χ 2 . Of the 912 eligible charts, clinicians' final diagnoses were as follows: AOM for 271 (29.7%) patients, OME for 638 (70.0%) patients, and no ear pathology for 3 (0.3%) patients. Antibiotics were prescribed for 519 (56.9%) patients; of those, only 242 (46.6%) had a final clinician diagnosis of AOM. Antibiotic prescribing rates were higher when a clinician diagnosed AOM compared with OME (89.3% vs 43.2%; P < 0.001). Per American Academy of Pediatrics guidelines, up to 273 (29.9%) patients qualified for an AOM diagnosis, but those were not the same as those diagnosed with AOM by clinicians ( P < 0.001). When evaluating children with a billing diagnosis of OME, a third fit a diagnosis of AOM. Clinicians commonly misdiagnosed AOM, but also prescribed antibiotics to almost half of those they diagnose with OME.

Update of the consensus document on the aetiology, diagnosis and treatment of acute otitis media and sinusitis

Update of the consensus on acute otitis media (AOM) (2012) and sinusitis (2013) following the introduction of pneumococcal vaccines in the immunization schedule, and related changes, such as epidemiological variation, colonization by of nonvaccine serotypes and emerging antimicrobial resistances. A majority of studies show that the introduction of the pneumococcal 13-valent conjugate vaccine has been followed by a reduction in the nasopharyngeal carriage of pneumococcus, with an increase in the proportion of drug-resistant nonvaccine serotypes. The diagnosis of AOM is still clinical, although more stringent criteria are proposed, which are based on the visualization of abnormalities in the tympanic membrane and the findings of pneumatic otoscopy performed by trained clinicians. The routine diagnosis of sinusitis is also clinical, and the use of imaging is restricted to the assessment of complications. Analgesia with acetaminophen or ibuprofen is the cornerstone of AOM management; watchful waiting or delayed antibiotic prescription may be suitable strategies in select patients. The first-line antibiotic drug in children with AOM and sinusitis and moderate to severe disease is still high-dose amoxicillin, or amoxicillin-clavulanic acid in select cases. Short-course regimens lasting 5–7 days are recommended for patients with uncomplicated disease, no risk factors and a mild presentation. In allergic patients, the selection of the antibiotic agent must be individualized based on severity and whether or not the allergy is IgE-mediated. In recurrent AOM, the choice between watchful waiting, antibiotic prophylaxis or surgery must be individualized based on the clinical characteristics of the patient.

Actualización del documento de consenso sobre etiología, diagnóstico y tratamiento de la otitis media aguda y sinusitis

Update of the consensus on acute otitis media (AOM) (2012) and sinusitis (2013) following the introduction of pneumococcal vaccines in the immunization schedule, and related changes, such as epidemiological variation, colonization by of nonvaccine serotypes and emerging antimicrobial resistances. A majority of studies show that the introduction of the pneumococcal 13-valent conjugate vaccine has been followed by a reduction in the nasopharyngeal carriage of pneumococcus, with an increase in the proportion of drug-resistant nonvaccine serotypes. The diagnosis of AOM is still clinical, although more stringent criteria are proposed, which are based on the visualization of abnormalities in the tympanic membrane and the findings of pneumatic otoscopy performed by trained clinicians. The routine diagnosis of sinusitis is also clinical, and the use of imaging is restricted to the assessment of complications. Analgesia with acetaminophen or ibuprofen is the cornerstone of AOM management; watchful waiting or delayed antibiotic prescription may be suitable strategies in select patients. The first-line antibiotic drug in children with AOM and sinusitis and moderate to severe disease is still high-dose amoxicillin, or amoxicillin-clavulanic acid in select cases. Short-course regimens lasting 5–7 days are recommended for patients with uncomplicated disease, no risk factors and a mild presentation. In allergic patients, the selection of the antibiotic agent must be individualized based on severity and whether or not the allergy is IgE-mediated. In recurrent AOM, the choice between watchful waiting, antibiotic prophylaxis or surgery must be individualized based on the clinical characteristics of the patient.

Unilateral Increase of Gustatory Thresholds in Acute Otitis Media: A Pilot Study.

To evaluate chorda tympani nerve function as measured by unilateral increases of gustatory thresholds in the presence of ipsilateral acute otitis media. Prospective clinical study comparing electrogustometric measurements was conducted to evaluate the taste thresholds of each side of the tongue in a patient during an acute episode of unilateral acute otitis media. Included were patients aged 12-40 who presented to the emergency department and outpatient ear, nose, and throat clinic of a university-affiliate tertiary medical center with unilateral acute otitis media between January 2019 and January 2020 and consented to the study. Eleven patients were initially recruited into the study, and 10 patients aged (mean ± standard deviation) 26.1 ± 11.2 years comprised the final study group. Taste thresholds were significantly elevated on the side ipsilateral to the ear affected by acute otitis media (P < .05). Chorda tympani nerve conductance is impaired during the acute stage of acute otitis media. This may have implications in the understanding of peripheral neural properties during acute middle ear inflammatory conditions and on the diagnosis of acute otitis media.

Epidemiological, Clinical and Therapeutic Aspects of Acute Otitis Media in the Otorhinolaryngology and Cervicofacial Surgery Department of the Sikasso Hospital / Mali

Acute otitis media (AOM) is a viral or bacterial infection of the middle ear most often following nasopharyngitis. It is seen at any age, but particularly common in children. The aim of this work is to describe the main clinical and therapeutic epidemiological aspects of acute otitis media.in the ENT department of Sikasso hospital. This is a prospective and descriptive study carried out in the ENT department of Sikasso hospital over a period of 04 months. Two hundred and ten patients were included in this study. The following variables: Ages, sex, residence, reason for consultation, time to consultation, risk factors, clinical and therapeutic aspects were collected. The study population consisted of patients seen in the service in whom the diagnosis of AOM was retained and who gave their verbal consent/assent. We identified 210 cases of AOM in 04 months out of 1716 consultations, i.e. a prevalence of 12.20%. The average age of the patients was 14 years old, with extremes of 24 days to 75 years old, children under 05 years old accounted for 46.02%. We recorded a female predominance of 51.90%. The majority of patients 82.90% resided in the city Sikasso. I'otalgia was the main reason for consultation with 50.48%, followed by otorrhea 25.24%, hearing loss with or without tinnitus in 17.61%, the presence of foreign bodies 5.71% and traumatic causes 0.96% of cases. The average consultation time was less than one week in 74.29% of cases. Among the predisposing factors, nasopharyngitis and purulent rhinitis were associated with AOM in 64.30% of cases, followed by adenotonsillitis in 23.33%, passive smoking in 4.76% and 1 case (0.47%) of soft palate. The AOM was congestive in 57.14%, suppurative in 42.86 of which 32.38% were perforated. Treatment was with antibioticsin 90.95% of cases. The evolution under treatment was favorable at 07 days in 81.42% of cases. Two cases of paracentesis were made. Acute otitis media affects all ages, particularly common in children under .....

Effectiveness of analgesic ear drops as add-on treatment to oral analgesics in children with acute otitis media: study protocol of the OPTIMA pragmatic randomised controlled trial

IntroductionEar pain is the most prominent symptom of childhood acute otitis media (AOM). To control the pain and reduce reliance on antibiotics, evidence of effectiveness for alternative interventions is urgently...

Modern aspects of immune protection of the middle ear in the pathogenesis of acute otitis media and its complications

The relevance of the study is due to the need for an extended search for information on the current state of the problem of acute otitis media in adults based on the experience of Ukrainian and foreign authors. The aim of our research: To analyze the world experience on the etiology, pathogenesis and diagnosis of acute otitis media in adults. Materials and methods: 125 modern literature sources of electronic databases PubMed, EMBASE, MED-LINE, U.S. National Library of Medicine Clinical Trials, Research Gate and Cochrane Library. Introduction: The problem of otitis media as a component of the problem of inflammatory diseases of the upper respiratory tract remains relevant in modern medicine, based on its incidence and prevalence in the structure of otolaryngological diseases. Despite the achievements of modern medical science, these indicators remain consistently substantial, which determines the relevance of further research to improve diagnosis and treatment. Results: By conducting a bibliographic method of research it was found that most scientific articles are devoted to the problem of acute otitis media in children, while the problem of acute otitis media in adults is not sufficiently studied. Clinical and experimental studies have established that the function of immune protection of the middle ear is present at almost all physiological levels from epithelial cells to intracellular nuclear factor. This function is realized through the messengers of the cytokine network. Among the pool of cytokines, IL-1, IL-6 and TNF-α are important for the pathogenesis of acute otitis media. One of the features of the immune defense is a clear succession of stages of inflammation with its own features at each stage. It is shown that each of the links of immune defense (including cytokines) is able to detect (in case of discrepancy in strength and time) a negative effect with the maintenance or intensification of inflammation. The data of experimental analysis of pathomorphological changes in the middle ear depending on the duration of the disease are presented. It is also shown that the issue of complicated course (in particular mastoiditis) is still relevant. The role of acute otitis media in the deveopment of intracranial complications (meningitis) has been established. The significance of comorbidity for the pathogenesis of acute otitis media and the role of diabetes mellitus in the structure of comorbidity was proved. The main factors of reducing the effectiveness of diagnosis and treatment of acute otitis media are convincingly outlined: the multifactorial nature of the etiology, the peculiarities of immune protection and the tendency of otopathogens to evade the host's immune response, the importance of comorbid pathology in adult pat ients with ENT diseases. A certain number of literature sources are devoted to the features of the course of acute otitis media in diabetes mellitus. The shortcoming identified by the results of the analysis of literature sources: the lack of research on the peculiarities of the clinic and diagnosis of acute otitis media in adults, especially in the setting of comorbid pathology, primarily type 2 diabetes mellitus, indicates the relevance of further research on this problem.

The association between exposure to antibiotics in the first week of life and later otitis media: The INCA study.

A prospective birth cohort of 436 term-born infants was followed up at 4-6 years of age. Parents reported (recurrent) AOM and OME through online questionnaires, sent to parents of 418 eligible children. Doctors' diagnoses of AOM and OME were collected after additional informed consent. Multivariate logistic regression analyses were used to study the association between antibiotic exposure and AOM and OME. Of the 436 infants, 151 infants received antibiotics in the first week of life. In total, 341 (82%) questionnaires were collected. The parental-reported prevalence was 45% (155/341) for AOM. Of these 155 children, 33 children also had OME (10% of the total cohort). Doctor's diagnoses were obtained from 308 (74%) children, of which 30% (91/308) had AOM. Of these 91 children, 12 children also had OME and 8 children had OME without a diagnosis of AOM (6% of the total obtained diagnoses). Antibiotic treatment in the first week of life was not significantly associated with parent-reported nor doctor-diagnosed (recurrent) AOM and OME in the first 4-6 years of life in the regression models. Antibiotic treatment in the first week of life was not associated with AOM and OME in the first 4-6 years of life in this prospective cohort of Dutch infants. More insight into the pathophysiology of OM is warranted to determine whether antibiotic-induced microbiome changes play a role in the susceptibility to OM.

Обоснованность местной обезболивающей терапии при лечении острого среднего отита у детей

Acute otitis media (AOM) in children is one of the most common diseases. The provision of medical care in AOM is performed in accordance with the relevant clinical recommendations approved by the Ministry of Health of the Russian Federation. The article presents the risk factors concerning the AOM development in children, gives a brief description of the etiological factors and specifics about the pathogenetic mechanism. The clinical symptom patterns and diagnosis of AOM in infants are analyzed. In the treatment of AOM in children, antibiotics are prescribed more commonly than in other diseases. The article also considers the basic principles of prescribing systemic antibacterial drugs in AOM, as well as indications and benefits of using high doses of antibacterial drugs. In otalgia, the relief of ear pain is precisely the primary task. The positive role of topical otic anesthetics as first-line drugs is discussed, which helps to reduce the frequency of antibiotic use. Topical analgesic treatment in AOM is preferable because it avoids adverse events from systemic antibacterial drugs, and anesthesia may be faster, more intense and last longer versus oral analgesia. Special attention is paid to the description of the benefits, efficacy and safety of topical otic anesthetic drops with a combination of lidocaine + phenazone. The results of researches and clinical studies are presented, pathogenetically substantiating the expediency of using the lidocaine + phenazone combination in AOM and confirming its efficacy and safety. KEYWORDS: acute otitis media, conservative treatment, risk factors, clinical recommendations, phenazone, lidocaine, children. FOR CITATION: Karpova E.P., Belov V.A., Asmanov A.I. Validity of topical analgesic therapy in the treatment of acute otitis media in children. Russian Journal of Woman and Child Health. 2023;6(4):411–416 (in Russ.). DOI: 10.32364/2618-8430-2023-6-4-14

Fluctuations in Pediatric Acute Otitis Media Burden During the First Two COVID-19 Years in Israel.

To study pediatric acute otitis media (AOM) burden fluctuations before and during the first two COVID years, which were characterized by measures to reduce the spread of airborne diseases. We used urinary tract infection (UTI) as a comparison infection. This was a cross-sectional study encompassing three pre-COVID years (March 1, 2017-February 29, 2020) and the first two COVID years (March 1, 2020-February 28, 2021, and March 1, 2021-February 28, 2022). Records were retrieved from the Clalit Health Services database, Israel's largest healthcare maintenance organization. Children 0-15 years with AOM and UTI episodes were categorized according to age (1>, 1-4, 5-15 years). We collected demographics, seasonality, AOM complications, antibiotic prescriptions, and recent COVID-19 infections. The average AOM/UTI rates of the three pre-COVID years vs. two COVID years were used to calculate the incidence rate ratios (IRRs). We identified 1,102,826 AOM and 121,263 UTI episodes. The median age at AOM diagnosis was 2.0 years (IQR, 1.1-4.1). Male predominance, age at presentation, and the dominant age group of 1-4 years did not change during the COVID years. While UTI episode rates decreased during the COVID years (IRR 0.76, 95% CI, 0.68-0.84, P < 0.001), the reduction in AOM episode rates was >2-fold (IRR 0.46, 95% CI, 0.34-0.63, P < 0.001). The largest decrease was observed among children 1-4 years old during the first COVID year (β=-1,938 AOM episodes/100,00 children, 95% CI, -2,038 to -1,912, P < 0.001). Recent COVID-19 infection was associated with low AOM morbidity (IRR 0.05, 95% CI 0.05-0.05, P < 0.001). AOM burden substantially decreased during the first COVID year but almost reached pre-pandemic levels during the second year.