History Of Acute Otitis Media Research Articles

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.

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

There Is No Relation between Epitympanic Recess Volume and Chronic Otitis Media.

Chronic otitis media is recurrent infection of the middle ear and mastoid air cells in the setting of perforation of the tympanic membrane. Risk factors for chronic otitis media include predisposing characteristics such as gender, allergies, Eustachian tube dysfunction, history of acute otitis media, and upper respiratory tract infection. The purpose of this study was to evaluate the potential relationship between chronic otitis media and epitympanic recess volume. A total of 197 patients with chronic otitis media had their epitympanic recess volume compared to the epitympanic volume of 99 healthy controls. The epitympanic recess volume was measured via the 3D volumetric measurement tool of the local PACS. Epitympanic recess volume measurement was performed using axial sections in a plane starting from the level of the malleus head-anvil body in the craniocaudal direction to the tegmen tympanum. It was shown that patients with bilateral involvement had an epitympanic recess volume of 75.00 mm3, compared to 72.30 mm3 in those with unilateral chronic otitis media. The healthy control group's median value for the epitympanic recess was 74.73 mm3. Epitympanic volume values did not differ substantially between patients with chronic otitis media and healthy persons, and epitympanic volume was not recognized as a predisposing factor (p = 0.686).

Parental experiences and opinions regarding the management of acute otitis media in Finland-a comparative questionnaire between 2006 and 2019.

Treatment guidelines for acute otitis media (AOM) have changed over the past 20 years. Watchful waiting is often recommended as an option for antibiotic treatment and the use of proper pain medication is emphasised. To study parental experiences and opinions regarding the management of AOM and compare our findings with our previous questionnaire submitted in 2006. We sent an online survey link through day-care centres and Facebook parental groups in Turku area. Children <4 years of age attending day care were included in the analysis. We asked about the child's history of AOM, parental opinions about AOM treatment, and antibiotic resistance. Results of 2019 were compared with those of 2006. Altogether 84% (320/381) and 83% (568/681) of children had had at least 1 episode of AOM in 2019 and 2006, respectively. In 2019, more children had been treated without antibiotics (30% vs. 13%, P < 0.001) and fewer parents thought that antibiotics are necessary for the treatment of AOM (70% vs. 85%, P < 0.001) compared with 2006. The use and knowledge of painkillers had increased over the past 13 years. Painkillers had been given at least once to 93% (296/320) of children in 2019 and 80% (441/552) of children in 2006 (P < 0.001). Today, more parents accept watchful waiting as a treatment option for AOM and give painkillers to their children, which indicates that the education about optimal management of AOM has reached parents.

Gradenigo's syndrome – A Diagnostic Challenge

We report a case of a 5-year-old healthy child that presented to the emergency department with a 4-day history of prostration, headache, cervical pain, and fever. She had a history of acute otitis media 8 weeks before. She presented a hyperaemic and bulged left tympanic membrane as well as limitation of left eye abduction. Blood tests showed increased inflammatory markers. She performed a cerebral, cervical and ear region computed tomography showing the left mastoid region, left ear, and left petrous apex filled with secretions in relation with mastoiditis and petrositis. A lumbar punction was performed and treatment with ceftriaxone 100mg/kg/day was initiated. After exclusion on meningitis, the antibiotic was changed cefuroxime 150mg/Kg/day. She was submitted to a left myringotomy with tympanostomy tube placement and, after, she presented a rapid improvement of cervical pain and headache with no more documented fever. During hospitalization, she performed a magnetic resonance imaging that show signs of mastoiditis and petrositis. There was no evidence of cerebral extension of inflammatory process and all the venous sinus presented preserved flow. At discharge, she was clinically asymptomatic with normalization of inflammatory parameters. At physical examination she still presented limitation of left eye abduction. She completed a total of 6 weeks of antibiotic treatment. Due to persistent VI cranial nerve palsy one month after discharge, an injection of botulinum toxin was performed, with complete resolution.

Pediatric Acute Mastoiditis: Our Experience in a Tertiary Care Center.

IntroductionAcute mastoiditis (AM) is a common intra-temporal complication of acute otitis media (AOM) and is more commonly seen in children. Occasionally, it presents as the first sign of ear disease. This study aimed to evaluate the clinical course of AM and determine therapeutic options for pediatric patients presenting with AM.MethodsThis was a prospective, observational study conducted on patients with AM presenting at a tertiary center during one year period. Convenience sampling was employed and 79 pediatric patients (18 years or below) were recruited for the study. Data on the demographic profile of patients, the treatment offered, duration of hospital stay, and outcome were analyzed.ResultIn our study, 62% were male patients (n = 49) and 38% (n = 30) were females. The mean age of patients was 9.32 ± 5.3 years and a history of AOM was present in 60 (75.9%). On admission, the most common presentation was post-auricular inflammation (100%) followed by otalgia (79.7%), fever (59.5%), aural protrusion (54.4%), and otorrhoea (51.9%). Culture reports were available for 54 (68.4%) patients and 30 (38%) grew organisms. The cultured organisms were Streptococcus pneumonia (20.3%), Pseudomonas aeruginosa (10.1%), Streptococcus pyogenes (3.8%), and Staphylococcus aureus (3.8%). Most patients were managed conservatively (n = 66, 83.5%) whereas surgery was performed in 16.5% (n = 13) patients. The mean hospital stay was 5.58 ± 1.99 days. The need for surgical management was significantly associated with age >5 years (p = 0.006), history of AOM (p = 0.026) and the presence of complications (p = 0.012). Subperiosteal abscess (SA) was present in 21 (26.6%) patients and one had facial palsy. SA along with AM had a mean hospital stay of 8.5 ± 0.77 days compared to 4.94 ± 1.43 days in case of isolated AM (p < 0.001) and the mean age of presentation in SA with AM was 11.97 ± 5.13 years compared to 8.29 ± 5.14 years in case of isolated AM (p = 0.006). All patients recovered and were followed up to three months with no recurrence, complications, or sequelae.ConclusionMost of the cases of acute mastoiditis follow previous AOM episodes. With early recognition and effective treatment, the prognosis is good.

Diagnostic assessment and various treatment modalities of secretary otitis media

Background: Secretary Otitis Media (SOM) is the commonest cause of hearing difficulty in childhood encountered by the Otologist. It is characterized by accumulation of effusion in the middle ear cavity due to altered mucociliary system within middle ear and Eustachian tube.Objectives: To study the common clinical features of Secretary Otitis Media (SOM) and its various treatment modalities.Methods: In our study total 55 subjects with secretary otitis media in less than or equal to 13 years of age were assessed. Demographic data, detail case history and Clinical examination were recorded. Complete otolaryngological examination including ear, TFT, ET Function, nose and throat. Blood investigations, urine examination, audiological examinations like pure tone audiometry and impedance audiometry, Urine investigation, Radiological examinations were performed. Microbiological testing of ear effusion and diagnostic nasal endoscopy (DNE) were performed. All the patients were treated first on medical line then followed up for 4 weeks. Refractory cases were considered for surgical modality of treatment like myringotomy with grommet insertion, adenoidectomy with grommet insertion and adenotonsillectomy with grommet insertion.Results: Most of the cases showed significant improvement in signs and symptoms. Good results were seen mostly in patients who had undergone adenotonsillectomy, adenoidectomy with grommet insertion and in hearing threshold. Post operatively most common complication found was mucopurulent discharge after grommet insertion and at electasis changes. Conclusion: Attention should be paid to parental concern regarding their child’s hearing particularly if there is a recent history of acute otitis media.

Association between otitis media infection and failed hearing screenings in children

This study aims to assess prospectively whether there is an association between frequencies of upper respiratory tract infections (URTI) or asthma in early childhood and failed otoacoustic emission (OAE) screenings later in life. There are no clear recommendations for hearing testing following acute otitis media (AOM) infection. This is a retrospective, practice based chart review. Participants from a primary care setting were 517 pre-adolescent and adolescent children (49.9% female) (ages 10–21; mean, 15 y/o), who had presented with at least one specific bacterial URTI (AOM, Group A Streptococcus (GAS) tonsillitis, or Influenza) during childhood. Hearing testing was recorded incidentally at all subsequent routine health care maintenance visits (OAE hearing screen). Simple linear regression analyses were performed using R (v3.4.4). We found that number of episodes of AOM infections strongly correlated with number of failed OAE screenings later in life (F = 76.37; P = <0.001; R2 = 0.1279), while GAS (F = 1.859; P = 0.1733; R2 = 0.0016) or Influenza infection (F = 2.624; P = 0.1059; R2 = 0.0031) were not associated with failed OAE screening. Correlation between number of AOM infections and number of failed OAE screenings was not strengthened by presence of asthma. This study found evidence of an association between childhood history of AOM and failed OAE screenings in adolescence. Since this population may be at a higher risk for developing permanent or fluctuating hearing losses, further studies to clarify indications and timing of standard audiological testing among these children should be considered.

Otologic disorders in Turner syndrome

IntroductionPatients with Turner syndrome (TS) have craniofacial malformations, such as Eustachian tube hypoplasia and dysfunction and velar dysfunction, which foster acute otitis media. The aim of this study was to inventory pediatric otologic disorders in patients with TS at their first ENT consultation in our center. Patients and methodsWe reviewed the ENT consultation data of pediatric TS patients followed in our center between 2005 and 2015: otoscopy, hearing threshold, and history of acute otitis media or ENT surgery. Data were compared according to karyotype: X monosomy (45,X), mosaic (45,X/46,XX), isochromosome (46,Xi [Xq]), X ring chromosome X (XrX), with Y material, and “other”. ResultsNinety patients, with mean age 11.9years (±4.8years) at first ENT consultation, were included: 29% showed tympanic abnormality on otoscopy, 21% had hearing loss, 24% had history of recurrent acute otitis media; 18% had undergone adenoidectomy, 24% T-tube insertion, and 5.6% tympanoplasty. No particular karyotype was associated with higher risk of hearing loss or acute otitis media. ConclusionPatients with TS showed high prevalence of pediatric otologic disorders; they therefore require close and prolonged ENT follow-up.

Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era.

To study the epidemiology of acute otitis media (AOM), especially the otitis-prone condition, during the pneumococcal conjugate vaccines 7 and 13 era. Six hundred and fifteen children were prospectively managed from 6 to 36 months of life during a 10-year time frame (June 2006-June 2016). All clinical diagnoses of AOM were confirmed by tympanocentesis and bacterial culture of middle ear fluid. By 1 year of age, 23% of the children experienced ≥1 episode of AOM; by 3 years of age, 60% had ≥1 episodes of AOM, and 24% had ≥3 episodes. The peak incidence occurred at 6 to 12 months of life. Multivariable analysis of demographic and environmental data revealed a significantly increased risk of AOM associated with male sex, non-Hispanic white race, family history of recurrent AOM, day care attendance, and early occurrence of AOM. Risk factors for stringently defined (tympanocentesis-confirmed) otitis proneness, in which children suffered at least 3 episodes of AOM in a 6-month period or at least 4 within a year, were male sex, day care attendance, and family history of AOM, whereas breastfeeding in the first 6 months of life was protective. Stringently defined otitis prone children were also likely to experience their first AOM episode at a younger age. The proportion of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis causing AOM had dynamic changes during the past decade. We conclude that the epidemiology but not the risk factors for AOM have undergone substantial changes since the introduction of pneumococcal conjugate vaccines.

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.

Will parents participate in and comply with programs and regimens using xylitol for preventing acute otitis media in their children?

Antiadhesive properties in xylitol, a natural sugar alcohol, can help prevent acute otitis media (AOM) in children by inhibiting harmful bacteria from colonizing and adhering to oral and nasopharyngeal areas and traveling to the Eustachian tube and middle ear. This study investigated parents' willingness to use and comply with a regimen of xylitol for preventing AOM in their preschool- and kindergarten-aged children. An Internet questionnaire was designed and administered to parents of young children in preschool and kindergarten settings. Most parents were unaware of xylitol's use for AOM and would not likely comply with regimens for preventing AOM in their children; however, parents having previous knowledge of xylitol and whose children had a history of AOM would be more likely to do so. Generally, most of these parents did not know about xylitol and probably would not use it to prevent ear infections. Unfortunately, these results parallel earlier findings for teachers and schools, which present obstacles for establishing ear infection prevention programs using similar protocols for young children. The results showed that considerable education and age-appropriate vehicles for administering xylitol are needed before establishing AOM prevention programs in schools and/or at home.

Acute mastoiditis in children under 15 years of age in Southern Israel following the introduction of pneumococcal conjugate vaccines: A 4-year retrospective study (2009–2012)

ObjectivesTo describe the epidemiologic, microbiologic, clinical and therapeutic aspects of acute mastoiditis (AM) in children <15 years of age during the 4-year period (2009–2012) following the introduction of pneumococcal conjugate vaccines in Israel. Patients and methodsThe medical records of all children with a discharge diagnosis of AM were reviewed. ResultsA total of 66 AM episodes occurred in 61 patients. Forty-four (66.6%) cases occurred among patients <4 years, recent acute otitis media (AOM) history was reported in 27.1% and 28.8% patients received previous antibiotics for AOM. Postauricular swelling, postauricular sensitivity, protrusion of auricle and postauricular edema (93.8%, 90.6%, 85.9% and 95.7%, respectively) were the most common signs of AM. Leukocytosis >15000WBC/mm3 was found in 39 (59.1%) cases. Cultures were performed in 52/66 episodes (positive in 27, 51.92% episodes), with recovery of 32 pathogens. The most frequently isolated pathogens were Streptococcus pneumoniae (15/52, 28.85%), Streptococcus pyogenes (9, 17.3%) and nontypeable Haemophilus influenzae (5, 9.62%). Eight (53.3%) S. pneumoniae isolates were susceptible to penicillin. Mean incidence of overall and pneumococcal AM were 11.1 and 2.58 cases/100000, with no significant changes during the study years. Surgical intervention was required in 19 (28.8%) patients. Conclusions(1) AM occurs frequently in patients without previous AOM history and with no previous antibiotic treatment; (2) S. pneumoniae and S. pyogenes continued to be the main etiologic agents of AM during the postvaccination period; (3) No changes were recorded in overall AM incidence and in pneumococcal AM incidence during the postvaccination period.

Pneumococcal conjugate vaccines for preventing otitis media

Acute otitis media (AOM) is a very common respiratory infection in early infancy and childhood. The marginal benefits of antibiotics for AOM in low-risk populations in general, the increasing problem of bacterial resistance to antibiotics and the huge estimated direct and indirect annual costs associated with otitis media (OM) have prompted a search for effective vaccines to prevent AOM. To assess the effect of pneumococcal conjugate vaccines (PCVs) in preventing AOM in children up to 12 years of age. We searched CENTRAL (2013, Issue 11), MEDLINE (1995 to November week 3, 2013), EMBASE (1995 to December 2013), CINAHL (2007 to December 2013), LILACS (2007 to December 2013) and Web of Science (2007 to December 2013). Randomised controlled trials (RCTs) of PCVs to prevent AOM in children aged 12 years or younger, with a follow-up of at least six months after vaccination. Two review authors independently assessed trial quality and extracted data. We included 11 publications of nine RCTs (n = 48,426 children, range 74 to 37,868 per study) of 7- to 11-valent PCV (with different carrier proteins). Five trials (n = 47,108) included infants, while four trials (n = 1318) included children aged one to seven years that were either healthy (one study, n = 264) or had a previous history of upper respiratory tract infection (URTI), including AOM. We judged the methodological quality of the included studies to be moderate to high. There was considerable clinical diversity between studies in terms of study population, type of conjugate vaccine and outcome measures. We therefore refrained from pooling the results.In three studies, the 7-valent PCV with CRM197 as carrier protein (CRM197-PCV7) administered during early infancy was associated with a relative risk reduction (RRR) of all-cause AOM ranging from -5% in high-risk children (95% confidence interval (CI) -25% to 12%) to 7% in low-risk children (95% CI 4% to 9%). Another 7-valent PCV with the outer membrane protein complex of Neisseria meningitidis (N. meningitidis) serogroup B as carrier protein, administered in infancy, did not reduce overall AOM episodes, while a precursor 11-valent PCV with Haemophilus influenzae (H. influenzae) protein D as carrier protein was associated with a RRR of all-cause AOM episodes of 34% (95% CI 21% to 44%).A 9-valent PCV (with CRM197 carrier protein) administered in healthy toddlers was associated with a RRR of (parent-reported) OM episodes of 17% (95% CI -2% to 33%). CRM197-PCV7 followed by 23-valent pneumococcal polysaccharide vaccination administered after infancy in older children with a history of AOM showed no beneficial effect on first occurrence and later AOM episodes. In a study in older children with a previously diagnosed respiratory tract infection, performed during the influenza season, a trivalent influenza vaccine combined with placebo (TIV/placebo) led to fewer all-cause AOM episodes than vaccination with TIV and PCV7 (TIV/PCV7) when compared to hepatitis B vaccination and placebo (HBV/placebo) (RRR 71%, 95% CI 30% to 88% versus RRR 57%, 95% CI 6% to 80%, respectively) indicating that CRM197-PCV7 after infancy may even have negative effects on AOM. Based on current evidence of the effects of PCVs for preventing AOM, the licensed 7-valent CRM197-PCV7 has modest beneficial effects in healthy infants with a low baseline risk of AOM. Administering PCV7 in high-risk infants, after early infancy and in older children with a history of AOM, appears to have no benefit in preventing further episodes. Currently, several RCTs with different (newly licensed, multivalent) PCVs administered during early infancy are ongoing to establish their effects on AOM. Results of these studies may provide a better understanding of the role of the newly licensed, multivalent PCVs in preventing AOM. Also the impact on AOM of the carrier protein D, as used in certain pneumococcal vaccines, needs to be further established.

Risk Factors for Chronic and Recurrent Otitis Media–A Meta-Analysis

Risk factors associated with chronic otitis media (COM) and recurrent otitis media (ROM) have been investigated in previous studies. The objective of this study was to integrate the findings and determine the possible risk factors for COM/ROM based on our meta-analysis. A comprehensive search of electronic bibliographic databases (PubMed, Embase, CNKI and Wanfang database) from 1964 to Dec 2012, as well as a manual search of references of articles, was performed. A total of 2971 articles were searched, and 198 full-text articles were assessed for eligibility; 24 studies were eligible for this meta-analysis. Regarding risk factors for COM/ROM, there were two to nine different studies from which the odds ratios (ORs) could be pooled. The presence of allergy or atopy increased the risk of COM/ROM (OR, 1.36; 95% CI, 1.13–1.64; P = 0.001). An upper respiratory tract infection (URTI) significantly increased the risk of COM/ROM (OR, 6.59; 95% CI, 3.13–13.89; P<0.00001). Snoring appeared to be a significant risk factor for COM/ROM (OR, 1.96; 95% CI, 1.78–2.16; P<0.00001). A patient history of acute otitis media (AOM)/ROM increased the risk of COM/ROM (OR, 11.13; 95% CI, 1.06–116.44; P = 0.04). Passive smoke significantly increased the risk of COM/ROM (OR, 1.39; 95% CI, 1.02–1.89 P = 0.04). Low social status appeared to be a risk factor for COM/ROM (OR, 3.82; 95% CI, 1.11–13.15; P = 0.03). Our meta-analysis identified reliable conclusions that allergy/atopy, URTI, snoring, previous history of AOM/ROM, Second-hand smoke and low social status are important risk factors for COM/ROM. Other unidentified risk factors need to be identified in further studies with critical criteria.

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.

Suture restriction of the temporal bone as a risk factor for acute otitis media in children: cohort study.

BackgroundEustachian tube (ET) dysfunction plays an important role in the pathogenesis of acute otitis media (AOM). Unfortunately, there is a lack of knowledge about the exact role of the ET’s bony support, the temporal bone, on occurrence of AOM. This study investigates whether severe suture restriction of the temporal bone is a risk factor for development of AOM in young children.MethodsUsing a prospective cohort design, 64 children aged 6 to 18 months without prior history of AOM were followed during the cold season (September 2009 to April 2010). Temporal bone status (categorized as with or without severe suture restriction) was evaluated using palpation and a cranial bone mobility test. Information about potential baseline confounders and risk factors for AOM (gender, age, birth weight, gestational age, use of pacifier, daycare attendance, presence of siblings, low socioeconomic status, breastfeeding ≥ 6 months, parental smoking and history of upper respiratory tract infection) were also collected. Occurrence of AOM diagnosed by physicians blinded to temporal bone status was the main outcome. Data were analyzed using hierarchical linear and nonlinear (multilevel) models.ResultsSevere suture restriction of the temporal bone was identified in 23 children (35.9%). At least one AOM episode was diagnosed in 14 (48.3%) of the ears associated with temporal bones previously identified as having severe suture restriction and in 28 (28.3%) of those without severe suture restriction. Higher risk for AOM was explained by severe suture restriction of the temporal bone (adjusted relative risk (RR), 2.26, 95% CI 1.43 to 2.91, p<.01), pacifier use (RR, 2.59, 95% CI 1.51 to 3.22, p<.01) and younger age (RR, 0.22, 95% CI 0.10 to 0.52, p=.001).ConclusionsThe study results indicate that severe suture restriction of the temporal bone is a risk factor for AOM in young children. Subsequent intervention studies are needed to determine if this mechanical risk factor can be modified in young children.

IgG Responses to Pneumococcal and Haemophilus Influenzae Protein Antigens Are Not Impaired in Children with a History of Recurrent Acute Otitis Media

BackgroundVaccines including conserved antigens from Streptococcus pneumoniae and nontypeable Haemophilus influenzae (NTHi) have the potential to reduce the burden of acute otitis media. Little is known about the antibody response to such antigens in young children with recurrent acute otitis media, however, it has been suggested antibody production may be impaired in these children.MethodsWe measured serum IgG levels against 4 pneumococcal (PspA1, PspA 2, CbpA and Ply) and 3 NTHi (P4, P6 and PD) proteins in a cross-sectional study of 172 children under 3 years of age with a history of recurrent acute otitis media (median 7 episodes, requiring ventilation tube insertion) and 63 healthy age-matched controls, using a newly developed multiplex bead assay.ResultsChildren with a history of recurrent acute otitis media had significantly higher geometric mean serum IgG levels against NTHi proteins P4, P6 and PD compared with healthy controls, whereas there was no difference in antibody levels against pneumococcal protein antigens. In both children with and without a history of acute otitis media, antibody levels increased with age and were significantly higher in children colonised with S. pneumoniae or NTHi compared with children that were not colonised.ConclusionsProteins from S. pneumoniae and NTHi induce serum IgG in children with a history of acute otitis media. The mechanisms in which proteins induce immunity and potential protection requires further investigation but the dogma of impaired antibody responses in children with recurrent acute otitis media should be reconsidered.

The Impact of the Heptavalent Pneumococcal Conjugate Vaccine on Risk Factors for Streptococcus pneumoniae Carriage in Children

The aim of the study was to investigate whether the 7-valent pneumococcal conjugate vaccine (PCV7) alters common risk factors of nasopharyngeal carriage by Streptococcus pneumoniae in children. From July 2005 through December 2010, we performed a cross-sectional study investigating risk factors associated with pneumococcal carriage in children. Parents of participating children completed questionnaires including whether or not the children received PCV7 vaccination. Among 9705 children, 20.2% of them received at least 1 dose of the PCV7 vaccine. Multivariate logistic regression models identified older age, having 1 sibling in a family, history of acute otitis media and household exposure to smoking as independent risk factors for pneumococcal carriage in the unvaccinated group, but not associated with pneumococcal carriage in the vaccinated group. The number of siblings ≥2 in a family, history of upper respiratory tract infection and child-care attendance were strong factors associated with pneumococcal carriage in children, regardless of vaccination. In vaccinated group, breast-feeding was associated with increased nonvaccine type pneumococcal carriage, mainly in children with upper respiratory tract infection. PCV7 decreased the association between pneumococcal carriage and older age, 1 sibling in a family, history of acute otitis media and household exposure to smoking, but increased the association between pneumococcal carriage and breast-feeding.

Bilateral scleritis and sclerokeratitis associated with IgA nephropathy.

PurposeThe purpose of this study is to report a case of bilateral nodular scleritis in a patient with final diagnosis of IgA nephropathy.MethodsThis is an observational case report.ResultsA male patient, 42 years old, presented with a bilateral nodular scleritis and OD sclerokeratitis. He had a previous history of acute otitis media and developed posterior renal failure and arterial hypertension. Clinical and systemic findings suggest Wegener's granulomatosis. A kidney biopsy was performed, and immunoflourescence findings demonstrated granular deposits of IgA in a mesangial pattern confirming the diagnosis of IgA nephropathyConclusionsIgA nephropathy should be a differential diagnosis in patients with scleritis and nephropathy.