Frequency Of Acute Otitis Media Research Articles

Anticipated Effects of Higher-valency Pneumococcal Conjugate Vaccines on Colonization and Acute Otitis Media.

Bacterial etiologies of acute otitis media (AOM) have shifted from the introduction of pneumococcal conjugate vaccines (PCVs), antibiotic selection and competition among species. We characterized Streptococcus pneumoniae (Spn), Haemophilus influenzae (Hflu) and Moraxella catarrhalis (Mcat) in the nasopharynx during well-child healthy visits and at the onset of AOM, and in middle ear fluid (MEF) of children with AOM to assess anticipated effects of higher-valency PCVs (PCV15 and PCV20). From September 2021 to September 2023, we conducted a prospective longitudinal cohort study of PCV13 immunized children 6-36 months old. MEF was collected via tympanocentesis. Serotyping and antibiotic susceptibility testing were performed on Spn, Hflu and Mcat isolates. We obtained 825 nasopharyngeal and 216 MEF samples from 301 children. The order of frequency of nasopharyngeal colonization was Mcat, Spn and Hflu; Hflu was the predominant otopathogen in MEF. Among Spn isolates, non-PCV15, non-PCV20 serotypes predominated in the nasopharynx and in MEF; the most frequent serotype was 35B. Among MEF samples, 30% of Spn isolates were amoxicillin nonsusceptible; 23% of Hflu isolates and 100% of Mcat isolates were β-lactamase-producing. The majority of Spn isolates among young children were non-PCV15, non-PCV20 serotypes, especially serotype 35B; therefore, the impact of higher-valency PCVs in reducing pneumococcal colonization or AOM is expected to be limited. Hflu continues to be the most frequent AOM pathogen. Antibiotic susceptibility data suggest a high dose of amoxicillin/clavulanate or alternative drugs that are effective against contemporary mix of otopathogens could be considered for optimal empiric selection to provide the best efficacy.

Long-term clinical results of power-assisted adenoidectomy with torus tubarius correction

In patients with hypertrophy of the pharyngeal tonsil, hypertrophy of the lymphoid tissue of the torus tubarius is often observed. The application of power-assisted technologies allows for precise correction of the torus tubarius simultaneously with adenoidectomy. The purpose of the study was to investigate the clinical effectiveness of power-assisted endoscopic adenoidectomy with additional correction of the torus tubarius in the presence of its hypertrophy, based on postoperative survey results. For this purpose, we surveyed of 209 patients who underwent endoscopic power-assisted adenoidectomy. In 107 of them additional correction of torus tubarius hypertrophy was performed in case of its presence (main group), while in 102, only adenoidectomy was performed in all patients (control group). The prevalence of main group complaints before adenoidectomy and their dynamics were assessed based on a survey 12–24 months post-intervention. It was found that the additional removal of hypertrophied torus tuba­rius in children during power-assisted endoscopic adenoidectomy significantly reduces the risk of frequent upper respiratory tract infections and acute otitis media. The proportion of individuals who assessed the adenoidectomy effect as "significant improvement" in terms of "frequent upper respiratory tract infections" in the main group was 20.4% higher, and for "frequent acute otitis media" it was 41.3% higher. Conclusion: Endoscopic power-assisted adenoidectomy with torus tubarius correction is an effective and safe method for children with hypertrophy of the pharyngeal tonsil in combination with torus tubarius hypertrophy, especially in cases where indications for intervention include frequent upper respiratory tract infections and acute otitis media. Keywords: scoring system, tonsils hypertrophy, tonsil pharingeal, hypertrophy, otitis, inflammatory diseases of the nose and paranasal sinuses.

The role of the otorhinolaryngologist nurse in treatment acute diseases of the middle ear

Inflammatory diseases of the middle ear often consistently affect the mucous membrane of all its parts: the auditory tube, the tympanic membrane, and the mastoid cells. Acute otitis media is the most common complication of acute respiratory infections. According to statistics, the frequency of acute otitis media ranges from 25 to 30 % of the total number of ear diseases, which indicates its fairly wide prevalence. Inflammation of the middle ear often leads to a disorder in the auditory function, and in order to prevent hearing loss, it is necessary to start following the doctor's prescriptions in a timely manner.

Local therapy of acute otitis media in children

Acute otitis media (AOM), one of the most common infectious and inflammatory diseases in infants, toddlers and young children, is defined as an infectious inflammation of the middle ear, usually bacterial, often with earache, fever, and possibly otorrhea. Almost all children suffer from otitis media, 80–90% – at preschool age. The frequency of acute otitis media in children in a megapolis is more than 4 000 cases per 100 000 population, however, given the large proportion of asymptomatic variants against the background of acute respiratory infections, insufficient equipment of pediatricians with otoscopes, registration of acute otitis media almost exclusively by ENT doctors, the frequency of acute otitis media may be significantly higher. The clinical picture may be nonspecific. Ear pain and otoscopy are decisive for the diagnosis. The severity of inflammation correlates well with the scale of visual assessment of pain according to the child’s facial expressions. The aims of treatment are to relieve pain using topical or systemic analgesics, decide together with an ENT specialist on the need for antibiotic therapy, avoid not indicated antibiotic therapy, prevent complications (tympanic membrane perforation, acute mastoiditis, meningitis). With unexpressed otitis media, it is advisable to use symptomatic therapy and drops. A complex of compounds (lidocaine, phenazone) provides a quick therapeutic effect. Topical anaesthetics block the transmission of the pain signal from the receptor to the central nervous system through the inhibition of voltage-gated sodium channels. The symptomatic treatment (analgesics, antipyretics, topical therapy) results in improvement in 60% of patients within the next 24 hours, and in 80% within the next 3 days.For prophylaxis of otitis, it is necessary to prevent acute respiratory infections, do vaccination against influenza and pneumococcal infections, avoid exposure to tobacco smoke, and keep babies breastfeeding.

Comparing Watchful Waiting Approach vs. Antibiotic Therapy in Children with Nonsevere Acute Otitis Media: A Randomized Clinical Trial.

Objective To compare both approaches for the treatment of nonsevere acute otitis media (AOM) in Iran. Methods This randomized clinical trial was performed at a pediatric infectious diseases clinic in Buali tertiary hospital in Sari, north of Iran, from 2016 to 2018. All participants in this study were previously healthy children with AOM diagnosis, who were 6 months to 6 years old. The patients were randomly assigned into two groups: the intervention (80 mg/kg/day amoxicillin for 7-10 days) and the control group (watchful waiting approach). AOM recovery and adverse drug reactions were evaluated after 72 hours, and the patients were followed for the frequency of AOM and middle ear effusion 1 and 3 months' postintervention. Results A total of 396 children have participated in this study. AOM recovery was significantly different in the two groups (73% vs. 44% in the intervention and control groups, respectively). Recurrence of AOM and middle ear effusion (MEE) persistence, one month following the intervention, have not shown any significant differences between the two groups. However, the AOM recurrence between 1 and 3 months was more frequent in the control group. The frequency of diarrhea was also higher in the intervention group compared to the control but no significant difference was found between the two groups regarding vomiting and skin rash. Conclusion The faster recovery from AOM is achieved when an antibiotic treatment regimen is applied, although the risk of potential side effects should be considered.

Pneumococcal conjugate vaccines for preventing acute otitis media in children.

Pneumococcal conjugate vaccines for preventing acute otitis media in children.

Pneumococcal conjugate vaccines for preventing acute otitis media in children.

Pneumococcal conjugate vaccines for preventing acute otitis media in children.

Risk factors of acute otitis media among children in Mosul

Context: Acute otitis media (AOM) is the most frequent diagnosis in the children visiting offices. The prolonged and recurrent episodes of AOM may lead to hearing impairment and delayed speech development, which will influence the child's performance at school. Aim: The aim of this study is to identify the risk factors of acute otitis media in preschool children attending ENT clinics at Al-jamhory Teaching Hospital in Mosul. Methods: To achieve this aim, a case control study design was adopted. The sample of the present study included 150 children (cases) who have been diagnosed by the responsible ENT specialist according to the otoscopic examination with another 150 children (controls) who were diagnosed not to have AOM. Period of data collection was from 1st of October 2011 to the 1st of April 2012. Results: The present study showed that the highest frequency of acute otitis media occurred in the age group 1-2 years 39 patients (26%), and more frequent AOM attacks occurred in males. Clinical presentation among the cases were fever, otalgia, otorrhea, irritability, loss of appetite, vomiting, diminished hearing, and few patients presented with tinnitus and vertigo. The significant risk factors for AOM were day care attendance, bottle feeding for the 1st 6 months of life, supine bottle feeding, pacifier use in the second 6 months of life, parental tobacco smoking, preterm baby, and allergy. No association was found between craniofacial anomaly and occurrence of AOM in the present study. Conclusion: Day care attendance, bottle feeding during the 1st 6 months of life, supine bottle feeding, pacifier use in the second 6 months of life, parental tobacco smoking, preterm baby, and allergy were found to be a significant risk factors for AOM among study population. Recommendation: Additional studies on potential measures to prevent AOM through the reduction of risk factors are needed..

Understanding Parents' Experiences and Information Needs on Pediatric Acute Otitis Media: A Qualitative Study.

Background:Acute otitis media (AOM) is the most common pediatric bacterial ear infection, affecting up to 75% of children younger than 5 years. Despite the high incidence of AOM in children, the condition presents a number of challenges to parents. The objectives of this study were to describe parents’ experiences of taking care of a child with AOM and to identify their information needs to manage their child with AOM.Methods:A qualitative, descriptive design was used to gain insight into information needs of parents’ of children with AOM. Participants were recruited from a specialized pediatric emergency department in a major Canadian urban center (Edmonton, Alberta). Individual semi structured interviews were conducted with 16 parents.Results:Seven major themes were identified and described: (1) frequency of AOM, (2) symptoms of AOM experienced by children and parents, (3) AOM symptom management strategies used by parents, (4) parent’s beliefs about AOM, (5) parent’s satisfaction with treatment prescribed by physicians, (6) the effect of AOM on family’s quality of life, and (7) parent’s information needs about AOM. Findings indicate that AOM has considerable negative outcomes for both children and families and that parents would benefit from having more evidence-based resources.Conclusions:This study provides important information around parents’ experiences and information needs for pediatric AOM. Identifying parents’ information needs and developing innovative and communicatively responsive educational approaches for parents are warranted that reflect patient-centered nursing care.

Frequency of Acute Otitis Media in Children Under 24 Months of Age Before and After the Introduction of the 10-valent Pneumococcal Conjugate Vaccine Into the National Immunization Program in Chile

Streptococcus pneumoniae is the leading cause of acute otitis media (AOM). Ten-valent pneumococcal conjugated vaccine (PCV-10) was introduced to the Chilean National Immunization Program (NIP) in 2011. The aim of this study was to estimate the frequency of AOM in children <24 months of age attending the emergency department (ED) of Hospital Sótero del Río (HSR) 4 years before and 4 years after the introduction of PCV-10 in the Chilean NIP. Register-based nested case-control study. Cases (n = 1907) were all children <24 months of age with a clinical diagnosis discharge of AOM at the ED of HSR, and controls (n = 244,334) were all other children <24 months of age attended at the same ED in the same time period, with any other discharge diagnosis. The data were obtained through HSR Statistical Service. In the study period, there was a mean of 30,695 children <24 months managed each year at the ED of HSR. The percentage with AOM in the prevaccine period was 0.94% and in the postvaccine period was 0.62%, respectively (P = 0.026). Exposure to the PCV-10 was associated with a decreased risk to develop AOM in children <24 months, with an odds ratio of 0.659 (95% confidence interval: 0.60-0.72). Our study showed a significant decrease in the percentage and risk of AOM in children <24 months of age who visited the ED of HSR after implementation of PCV-10 in the NIP in Chile.

Modeling specific antibody responses to natural immunization to predict a correlate of protection against infection before commencing a clinical vaccine trial

ABSTRACT Background Clinical trials of vaccines for children to prevent acute otitis media (AOM) infections caused by the bacteria Streptococcus pneumonia (Spn) are in Phase I. The objective of this study was to use serum antibody measurements to pneumococcal purified protein candidate antigens that occurred after natural “immunization” to predict a correlate of protection response needed following an injectable vaccine against AOM in children. Methods 590 nasal and serum samples were collected from 129 healthy children at 6, 9, 12, 15, 18, 24 and 30–36 months of age and when the child developed AOM. Middle ear fluid to detect Spn was collected at every episode of AOM. Quantitative ELISA was used to determine serum IgG against 7 Spn vaccine antigens: PspA clade 3, PspA clade 5, PhtD, PhtE, LytB, PcpA and Ply. A correlate of protection (COP) was estimated by regressing AOM events against age adjusted antibody levels induced by nasopharyngeal colonization and AOM infections, using logistic regression and generalized estimating equation methods. Results A significant COP was found for Spn PhtD (p = 0.0015), PhtE (p = 0.00034), LytB (p = 0.004), PcpA (p = 0.002), and Ply (p = 0.007) between higher antibody levels and reduced frequency of AOM. We estimated that a 2-fold higher antibody level in a child than the mean antibody level induced by NP colonization (after adjusting for subject age) to PhtD, LytB, PcpA, PhtE or Ply reduced the risk of AOM by 14–21%, a 4-fold higher level reduced it by 25–38% and a 10-fold higher level reduced it by 39–54%. Conclusion We developed a model to predict the necessary level of serum antibody and fold higher above a threshold to PhtD, PhtE, LytB, PcpA and Ply that would correlate with a reduced likelihood of AOM in children age 6–24 months old if enrolled in a Phase III clinical efficacy trial.

Risk Factors for Acute Otitis Media in Children Aged 0 to 5 Years in Parakou

Introduction: Acute otitis media (AOM) is one of the most common ENT childhood diseases. Objective: To identify risk factors for AOM in children aged 0 to 5 years. Methods: This research work was a cross-sectional, descriptive and analytical study. It focused on 2040 children aged 0 to 5 years from both sexes, who were healthy or sick, and living in the Local government of Parakou for at least one year. Those children were randomly selected in all three districts of Parakou. Results: Frequency of AOM was 2.8% and their prevalence was estimated at 16.3%. The identified risk factors were persistent or chronic cases of rhinitis, exposure to charcoal and wood smoke, low socioeconomic status, personal history of AOM, AOM history among the siblings, and children’s poor nutritional status. No relationship could be established between AOM occurrence and factors like sex, passive smoking, attendance of a day-care centre or stay in nursery, prematurity, exclusive breastfeeding and large number of siblings. Conclusion: The identification of those risk factors will help put in place appropriate measures to reduce AOM prevalence in Parakou.

Otitis-prone Children Have Immunologic Deficiencies in Naturally Acquired Nasopharyngeal Mucosal Antibody Response after Streptococcus pneumoniae Colonization.

Acute otitis media (AOM) is the most common pediatric bacterial infection, and stringently defined otitis-prone (sOP) children have immunologic deficiencies. We recently found that nasopharyngeal (NP) colonization by Streptococcus pneumoniae (Spn) elicits a NP mucosal antibody response to vaccine candidate pneumococcal proteins that correlate with protection from AOM in non-sOP (NOP) children. Here, we sought to determine if sOP children experience significantly higher colonization rates with Spn than NOP children, develop lower naturally acquired NP mucosal antibody responses to those same pneumococcal proteins after colonization by Spn, and suffer greater frequency of AOM as a consequence. NP samples were collected from 130 NOP and 45 sOP children during 270 healthy visits and 201 AOM visits between 6 and 24 months of age. Spn were identified by standard culture. NP mucosal IgG and IgA levels to vaccine candidate proteins pneumococcal histidine triad protein D, pneumococcal choline binding protein A (PcpA) and pneumolysin D1 were measured by quantitative enzyme-linked immunosorbent assay. sOP children had significantly higher colonization frequency by Spn (P < 0.0001) and significantly lower IgG and IgA levels to all 3 vaccine candidate proteins studied compared with NOP children (all P values <0.05) except IgG to Ply D1 (P = 0.31). Spn colonization in NOP children led to 2-fold to 5-fold increase in mucosal IgG and IgA levels to all 3 proteins (all P values <0.01), whereas Spn colonization in sOP children generally failed to elicit antibody responses (all P values >0.05). PcpA was unique in inducing significant increases in mucosal IgA (P = 0.02). When high mucosal IgG levels to all 3 proteins and IgA to PcpA were measured, they correlated with reduced AOM in sOP children. sOP children experience significantly higher colonization rates with Spn, develop lower naturally acquired NP mucosal antibody responses to pneumococcal vaccine candidate proteins pneumococcal histidine triad protein D, PcpA and pneumolysin D1 after colonization by Spn, and suffer greater frequency of AOM if they do not generate high mucosal antibody to the studied proteins.

Differential impact of respiratory syncytial virus and parainfluenza virus on the frequency of acute otitis media is explained by lower adaptive and innate immune responses in otitis-prone children.

Acute otitis media (AOM) is a leading cause of bacterial pediatric infections associated with viral upper respiratory infections (URIs). We examined the differential impact of respiratory syncytial virus (RSV) and parainfluenza virus URIs on the frequency of AOM caused by Streptococcus pneumoniae (Spn) and nontypeable Haemophilus influenzae (NTHi) in stringently defined otitis-prone (sOP) and non-otitis-prone (NOP) children as a potential mechanism to explain increased susceptibility to AOM. Peripheral blood and nasal washes were obtained from sOP and NOP children (n = 309). Colonization events and antiviral responses consisting of total specific immunoglobulin G (IgG) responses, neutralizing antibody responses, and T-cell responses were determined. Isolated neutrophils were infected with varying multiplicities of infection of both viruses, and opsonophagocytosis potential was measured. A significant increase was found in frequency of AOM events caused by Spn and NTHi, with a concurrent RSV infection in sOP children. These results correlated with diminished total RSV-specific IgG, higher viral nasal burdens, and lower IgG neutralizing capacity. The sOP children had diminished T-cell responses to RSV that correlated with lower Toll-like receptor 3/7 transcript and decreased expression of HLA-DR on antigen-presenting cells. RSV interfered with the Spn phagocytic capacity of neutrophils in a dose-dependent manner. Parainfluenza virus infections did not differentially affect AOM events in sOP and NOP children. Lower innate and adaptive immune responses to RSV in sOP children may slow the kinetics of viral clearance from the nasopharynx and allow for viral interference with antibacterial immune responses, thus contributing to increased frequency of AOMs.

Reducing the Frequency of Acute Otitis Media by Individualized Care

We sought to determine if use of more stringent diagnostic criteria for acute otitis media (AOM) than currently advocated by the American Academy of Pediatrics, tympanocentesis and pathogen-specific antibiotic treatment (individualized care) would result in reducing the incidence of recurrent AOM and consequent tympanostomy tube surgery. A 5-year longitudinal, prospective study in Rochester, NY, was conducted from July 2006 to July 2011 involving 254 individualized care children. When this individualized care group developed symptoms of AOM, strict diagnostic criteria were applied and a tympanocentesis was performed. Pathogen resistance to empiric high-dose amoxicillin/clavulanate (80 mg/kg of amoxicillin component) caused a change in antibiotic to an optimized choice. Legacy controls (n = 208) were diagnosed with the same diagnostic criteria by the same physicians as the individualized care group and received the same empiric amoxicillin/clavulanate (80 mg/kg of amoxicillin component) but no tympanocentesis or change in antibiotic. Community control children (n = 1020) were diagnosed according to current American Academy of Pediatrics guidelines and treated with high-dose amoxicillin (80 mg/kg) without tympanocentesis as guideline recommended. 5.9% of children of the individualized care group compared with 14.4% of Legacy controls and 27.3% of community controls became otitis prone, defined as 3 episodes of AOM within a 6-month time span or 4 AOM episodes within a 12-month time span (P < 0.0001). 2.4% of the individualized care group compared with 6.3% of Legacy controls, and 14.8% of community controls received tympanostomy tubes (P < 0.0001). Individualized care of AOM significantly reduces the frequency of AOM and tympanostomy tube surgery. Use of strict diagnostic criteria for AOM and empiric antibiotic treatment using evidence-based knowledge of circulating otopathogens and their antimicrobial susceptibility profile also produces improved outcomes.

High pneumococcal serotype specific IgG, IgG1 and IgG2 levels in serum and the middle ear of children with recurrent acute otitis media receiving ventilation tubes

Recurrent acute otitis media (AOM), frequently caused by Streptococcus pneumoniae, is a major paediatric health problem. A reduced antibody response against pneumococcal polysaccharides may contribute to an increased susceptibility to AOM. Using a multiplex bead-based assay we measured IgG, IgG1 and IgG2 levels against 11 pneumococcal polysaccharides in serum samples from 166 children below 3 years of age with a history of at least 3 episodes of acute otitis media receiving ventilation tubes, and 61 healthy controls. Pneumococcal serotype specific IgG was also determined in 144 middle ear effusion samples. Pneumococcal serotype specific IgG, IgG1 and IgG2 levels were similar in children with or without AOM, except for IgG and IgG1 levels against serotype 5, which were significantly higher in children with a history of frequent AOM (IgG: 137.5μg/ml vs. 84.0μg/ml; p=0.02; IgG1: 24.5μg/ml vs. 18.2μg/ml; p=0.05). The age-related development of pneumococcal serotype-specific IgG, IgG1 and IgG2 levels was similar in children with or without a history of AOM. Pneumococcal serotype specific IgG was present in middle ear effusion and these levels correlated significantly with serum titres. Children with a history of frequent AOM receiving ventilation tubes do not have a deficient IgG, IgG1 or IgG2 response against pneumococcal polysaccharides, either induced by vaccination or due to natural exposure. The strong correlation between IgG levels in serum and the middle ear suggests parenteral pneumococcal conjugate vaccination induces antibodies in the middle ear which may therefore contribute to reducing the burden of AOM.

Breast-Feeding Is Associated With a Reduced Frequency of Acute Otitis Media and High Serum Antibody Levels Against NTHi and Outer Membrane Protein Vaccine Antigen Candidate P6

Nontypeable Haemophilus influenzae (NTHi) causes acute otitis media (AOM) in infants. Breast-feeding protects against AOM and/or nasopharyngeal (NP) colonization; however, the mechanism of protection is incompletely understood. Children with AOM and healthy children were studied according to feeding status: breastfed,breast/formula fed, or formula fed. Cumulative episodes of AOM, ELISA titers of serum IgG antibodies to whole-cell NTHi and vaccine candidate outer membrane protein P6, bactericidal titers of serum and NP colonization by NTHi were assessed. A lower incidence of AOM was found in breast- versus formula-fed children. Levels of specific serum IgG antibody to NTHi and P6 were highest in breast-fed, intermediate in breast/formula fed, and lowest in formula-fed infants. Serum IgG antibody to P6 correlated with bactericidal activity against NTHi. Among children with AOM, the prevalence of NTHi in the NP was lower in breast- versus nonbreast-fed infants. We conclude that breast-feeding shows an association with higher levels of antibodies to NTHi and P6, suggesting that breast-feeding modulates the serum immune response to NTHi and P6. Higher serum IgG might facilitate protection against AOM and NP colonization in breast-fed children.

Prevalence and risk factors for persistent otitis media with effusion in primary school children in Istanbul, Turkey

Objective To determine the impact of environmental, epidemiologic and familial factors in the development of persistent otitis media with effusion (OME-OME treated with antibiotics and followed additional 12 weeks) in primary school children in Istanbul. Materials and methods A total of 1800 children who were attending 4 different primary schools in Sisli and Beyoglu districts of Istanbul were screened and 1740 children who met the inclusion criteria were enrolled into this study. Questionnaires prepared in the Otorhinolaryngology Clinics of Taksim Research and Training Hospital and the forms were delivered to the parents to be filled the day before examination of each child. The forms were collected during the otoscopic examinations. Pure tone audiometry and tympanometry tests and pneumatic otoscopy were performed on the children who were diagnosed as OME by otoscopic examination. The association between the children diagnosed as OME and the answers to the questionnaires was evaluated. Results The prevalence of persistent OME in this paper was 8.7% (152/1740). Frequency of smoking in both parents ( p < 0.01) and mothers alone ( p < 0.0001), the frequency of acute otitis media (AOM) and upper respiratory tract infection (URTI) in past 1 year ( p < 0.0001), incidence of attending day care centers and crèches ( p < 0.0001), allergy history ( p < 0.05), the number of siblings ( p < 0.0001) and poor educational status of the parents ( p < 0001) were statistically significant factors among children with OME compared to normal children. Sex factors ( p > 0.05), mothers smoke history during pregnancy ( p > 0.05), relative marriage ( p > 0.05), smoking history of the fathers ( p > 0.05) and duration of breastfeeding ( p > 0.05) were not statistically significant. Conclusion Environmental, epidemiologic and familial factors in the etiology of OME are important. The parents must be informed about the risk factors and symptoms of OME and by this way, the development or delayed diagnosis of the disease that may lead to permanent hearing loss may be prevented.

Effects of Japanese herbal medicine, Juzen-taiho-to, in otitis-prone children – a preliminary study

Conclusion: Juzen-taiho-to (JTT, TJ-48), a Japanese herbal medicine that improves immune function, was found to be effective in otitis-prone in children. Objective: To evaluate the efficacy of JTT against intractable and recurrent infections in immature immune systems, we administered JTT to otitis-prone infants and investigated clinical changes before and during JTT administration. Subjects and methods: Twenty-four otitis-prone infants were administered JTT at 0.10–0.14 g/kg/day twice a day for 3 months. We compared clinical course, such as frequency of acute otitis media (AOM), duration of fever and antibiotics administration, and hospital visits for the periods before and during JTT administration. Results: Medication compliance rate was 87.5%, and administration of JTT led to remission in 95.2% patients. No apparent side effects were observed. The frequency of AOM decreased significantly (Wilcoxon signed rank test, p=0.000) with JTT. The duration of fever (p=0.000) and administration of antibiotics (p=0.001), as well as the number of hospital visits (p=0.001) and emergent hospital visits (p=0.000) showed significant decreases after JTT administration. After the end of the JTT period, 14 of 21 (66.7%) patients started to take it again, as they experienced purulent otitis media and/or other infections after discontinuation. The frequency of AOM increased significantly after stopping JTT (p=0.004) and decreased again with JTT resumption (p=0.005).

Effectiveness of Inactivated Influenza Vaccine for Prevention of Otitis Media in Children

The objective of this study was to evaluate the effectiveness of inactivated influenza vaccine in preventing acute otitis media (AOM) and otitis media with effusion (OME) in children aged 6 to 60 months who attend day care. This prospective, single-blind study was conducted in 8 day care centers in Ankara, Turkey. One hundred nineteen (61 vaccinated and 58 unvaccinated against influenza) healthy children were examined at study entry and at 6-week intervals for 6 months by the same 2 otorhinolaryngologists who were blinded about the vaccination status of the children. The frequency of AOM and OME is compared between the 2 groups and the effect of influenza season on frequency of episodes was evaluated. Based on national influenza laboratory data, the influenza season was determined to be the period between December 15, 2003, and January 31, 2004. The frequencies of AOM, OME and total otitis media episodes in vaccinated children were 2.3%, 22.8% and 25.2%, respectively, and these frequencies were 5.2%, 31.1% and 36.3% in the unvaccinated group. The difference was statistically significant (P < 0.01). This difference was especially prominent in the influenza season (P < 0.05). Influenza vaccine is effective in reducing AOM and OME episodes in 6- to 60-month-old day care children, especially during influenza season.