Otitis Media In Children Research Articles

Pathomorphosis of acute otitis media in children: when does a pediatric infection become surgical?

The incidence of complications from acute otitis media in children, such as mastoiditis, tends to increase. We analyzed 57 case histories of children who had undergone an anthromastoidotomy. The main reasons for treatment failures in acute otitis media include underestimating the vaccination status of the child, lack of antibiotic therapy, prescribing antibiotics in low doses or for a short period of time, using drugs that are not active against pneumococcal infections, and prescribing only topical therapy. Considering these factors can reduce the need for surgery in pediatric patients with this infection.

Artificial Intelligence as an Auxiliary Tool in Pediatric Otitis Media Diagnosis

ObjectivesIn order to promote the use of AI technology as the auxiliary tool in pediatric otitis media diagnosis, we use the convolutional neural networks and deep learning for image classification and disease diagnosis. We also designed a Pediatric Otitis Media Classifier to analyze and classify the images for physicians. MethodsA pediatric otitis media classifier was designed for junior physicians (doctors who have been engaged in clinical practice for a short time) as an auxiliary diagnostic tool. To design this classifier for children with otitis media, we used a large number of images of acute otitis media (AOM), secretory otitis media (OME), and normal otoscope images to obtain the optimal convolutional neural network model. ResultsThe average recognition accuracies of the ZFNet and the TSL16 for classification were 97.87% and 97.62%, far exceeding the accuracy of human diagnosis. The results of using the Pediatric Otitis Media Classifier show that we can use the classifier to correctly identify the image types of child middle ear infections. ConclusionsWe developed the Pediatric Otitis Media Classifier for the successful automated classification of AOM and OME in children using otoscopic images. In contrast to the traditional diagnosis of pediatric otitis media, which relies heavily on the experience of doctors, the diagnostic accuracy of even experienced physicians is only approximately 80%. With AI technology, we can improve the accuracy rate to over 98%, which can effectively assist doctors in auxiliary diagnosis. It also reduces delayed treatment, antibiotic misuse, and unnecessary surgery caused by misdiagnosis.

Long-term outcomes of childhood otitis media and hearing loss: a systematic review

ABSTRACT Otitis media (OM) is a common childhood illness which can cause hearing loss and developmental delays. This is the first systematic review to investigate the long-term, longitudinal health and social outcomes of OM and hearing loss in childhood. The study was registered in PROSPERO (CRD42023396318). A structured search strategy identified literature in the following databases: CINAHL, Scopus, Medline, PsychInfo, and EmCare. Articles were independently dual-screened and extracted data were synthesised. From 2825 potential studies, 25 were selected for inclusion. These assessed broad outcomes: physical health, audiological health academic, behavioural, social function, service use, and housing. Overall, 28% of papers found no difference between those with a childhood history of OM and those without, 40% found poorer outcomes for those with a history of OM, and 32% found mixed results. This is the first study of its kind to explore the long-term effects of otitis media and resultant hearing loss in children. Trends of poor academic, behavioural, and audiological outcomes were identified in children with OM and hearing loss. Multiple gaps in the literature were identified including a paucity of recent research, studies extending into adulthood, and studies focusing on high-risk populations.

Clinical and economic burden of otitis media in children under 5 years of age in the United States: A retrospective study

ABSTRACT Reductions in all-cause otitis media (OM) following widespread pneumococcal conjugate vaccine use have plateaued. Granular burden of disease data are needed to guide evaluation and implementation of new measures targeting OM prevention. We conducted a retrospective study to assess the incidence and treatment costs of OM, tympanostomy tube placement (TTP), and hearing loss in children aged <5 years in the United States (US). OM episodes and TTP between 2016 and 2017 were identified in IBM MarketScan Commercial Claims and Encounters, Medicare Supplemental and Coordination of Benefits, and Multi-Medicaid databases using diagnosis codes (ICD-10). The incidence rate per 100,000 person-years (IR) of OM in <5-year-olds was 62,726 in Commercial/Medicare databases and 55,874 in Medicaid. IRs peaked at 9–<12 months (115,552 and 110,960, respectively). Approximately 5% and 4% of OM episodes in the respective databases had TTP (IR 3233 and 2404). Around 2% of children with OM had hearing loss (IR 1468 and 1109, respectively), of whom 41% had TTP. We estimated that there were 11.1 million OM episodes in 2020 costing USD 4.8 billion. 243,618 children were estimated to have OM with hearing loss at a direct total cost of USD 637 million, or 13% of the overall cost. The clinical and economic burden attributable to OM in the US was high in children aged <5 years during the study period. Novel approaches are needed to improve and broaden vaccine-induced protection against OM and its complications. The study results could guide policymakers considering age-specific interventions to reduce the OM burden.

A Systematic Review and Meta-Analysis of the Efficacy of Antimicrobial Chemoprophylaxis for Recurrent Acute Otitis Media in Children.

Acute otitis media (AOM) is a common childhood infection. Recurrent AOM affects a subset of children, resulting in an adverse impact on quality of life, socioeconomic disadvantage, and risk of long-term sequelae. Antimicrobial chemoprophylaxis is used in some settings but is increasingly controversial due to an awareness of adverse long-term effects and contribution to global antibiotic resistance. A comprehensive literature search was undertaken using Medline (1946-October 2023) and Embase (1974-October 2023). The primary aim was to assess the efficacy of antimicrobial chemoprophylaxis on AOM episodes in children < 18 years of age. Bias and quality assessment was performed. Dichotomous data were analysed using risk ratio with 95% confidence intervals. Meta-analysis was carried out using random-effects models for pooled analysis, independent of heterogeneity. Heterogeneity was assessed using the I2 statistic. The effect of antimicrobial chemoprophylaxis in children with rAOM on the number of individual AOM episodes. assessment of antimicrobial agents and outcomes in children with risk factors. Assessment of qualitative data was performed on 20 studies (n = 2210). No controlled trials were identified post-multivalent pneumococcal conjugate vaccine (PCV) introduction, restricting current generalisability. Quantitative meta-analysis on nine pre-PCV studies (n = 1087) demonstrated antimicrobial chemoprophylaxis reduced any episode of AOM with a risk ratio 0.59 (95% CI 0.45-0.77). Families and clinicians must balance marginal short-medium term benefit (based on pre-PCV data), and the potential for adverse effects to that individual, and the societal risk of antimicrobial resistance with prolonged antibiotic use.

Early-life ozone exposure and childhood otitis media: Unveiling critical windows of risk

BackgroundDespite increasing evidence of a strong correlation between air pollution and otitis media (OM), the impact of early-life ozone (O3) exposure on the development of OM in children remains uncertain. ObjectivesTo explore the connection between early-life O3 exposure and OM, and to identify the critical time period(s) during which O3 exposure significantly influences the development of OM in children. MethodsWe conducted a study involving 8689 children living in Changsha, China. Information regarding personal factors, health conditions, and the indoor environment was gathered using questionnaires. Personal exposure to outdoor O3 and other major pollutants at the place of residence during the periods before conception, prenatal periods, and after birth was calculated by applying the inverse distance weighted (IDW) method with data gathered from ten air quality monitoring stations. Multiple logistic regression analyses were employed to investigate the associations between O3 exposure and children's OM. ResultsAfter controlling for covariates and ambient temperature, exposure to O3 during the year preceding pregnancy was correlated with childhood lifetime OM, showing ORs (95 % CI) of 1.28 (1.01–1.64). O3 exposures in the 10th–12th, 7th–9th, and 4th–6th months before pregnancy were all linked to children's lifetime OM. Within the multi-window model, we detected that O3 exposure in the 10th to 12th month prior to pregnancy was significantly related to lifetime OM, showing ORs (95 % CI) of 1.28 (1.05–1.55). A significant link was discovered between childhood OM and O3 exposure after controlling for six other pollutants (SO2, PM2.5, NO2, PM2.5–10, CO, and PM10) during the 10th to 12th month prior to conception. Exposure to O3 during the 36th gestational week significantly raised the likelihood of childhood lifetime OM. There is a significant interaction between O3 and temperature exposure during the first trimester of pregnancy and one year before pregnancy on childhood lifetime OM. ConclusionsPreconceptional O3 exposure and its interaction with low temperature played critical roles in children's OM development, backing the hypothesis of “(pre) fetal origins of childhood OM”.

Otitis in paediatric practice: clinic presentation, diagnosis, role of topical therapy

The article considers the main pathological processes in the outer and middle ear, which are detected at the primary paediatric visit. A particular focus has been placed on the importance of otoscopy and the need for sustainable routing of a child with ear pain. The basic principles for the treatment of acute external and otitis media in children are outlined, and indications for additional examinations and systemic antimicrobial therapy are determined. The benefits of topical combination ear drops in the treatment of acute external and otitis media are presented. The benefits of combination ear drops in the treatment of ear pathology in children from 6 years of age are demonstrated by examples of clinical studies and retrospective analysis of clinical efficacy. Clinical cases from our own observations are presented: a 7-year-old patient with acute non-perforative otitis media and a 12-year-old patient with acute exacerbation of chronic external otitis, myringitis. The combination ear drops containing chloramphenicol, beclomethasone dipropionate (anhydrous), clotrimazole and lidocaine hydrochloride monohydrate demonstrated high clinical efficacy. The combination drug with a beneficial and clinically proven effect can help solve the issue of otitis in children from 6 years of age. The authors have developed a treatment and prevention reminder for ear pathologies in children, which will help the paediatrician explain the main principles of treatment and prevention of otitis media to parents in an easily accessible form. It was concluded that ear pathology is a current and multi-etiological challenge that requires attention and expert knowledge of a paediatrician. The active parental involvement in ear pathology prevention in their child will help their children to grow physically healthy.

Air pollutants, seasonal influenza, and acute otitis media in children: a population-based analysis using 22-year hospitalization data

BackgroundAcute otitis media (AOM) is a prevalent childhood acute illness, with 13.6 million pediatric office visits annually, often stemming from upper respiratory tract infections (URI) and affected by environmental factors like air pollution and cold seasons.MethodsHerein, we made use of territory-wide hospitalization data to investigate the relationships between meteorological factors, air pollutants, influenza infection, and AOM for children observed from 1998 to 2019 in Hong Kong. Quasi-Poisson generalized additive model, combined with a distributed-lag non-linear model, was employed to examine the relationship between weekly AOM admissions in children and weekly influenza-like illness-positive (ILI +) rates, as well as air pollutants (i.e., oxidant gases, sulfur dioxide, and fine particulate matter), while accounting for meteorological variations.ResultsThere were 21,224 hospital admissions due to AOM for children aged ≤ 15 years throughout a 22-year period. The cumulative adjusted relative risks (ARR) of AOM were 1.15 (95% CI, 1.04–1.28) and 1.07 (95% CI, 0.97–1.18) at the 95th percentile concentration of oxidant gases (65.9 ppm) and fine particulate matter (62.2 μg/m3) respectively, with reference set to their medians of concentration. The ARRs exhibited a monotone increasing trend for all-type and type-specific ILI + rates. Setting the reference to zero, the cumulative ARRs of AOM rose to 1.42 (95% CI, 1.29–1.56) at the 95th percentile of ILI + Total rate, and to 1.07 (95% CI, 1.01–1.14), 1.19 (95% CI, 1.11–1.27), and 1.22 (95% CI, 1.13–1.32) for ILI + A/H1N1, A/H3N2, and B, respectively.ConclusionsOur findings suggested that policy on air pollution control and influenza vaccination for children need to be implemented, which might have significant implications for preventing AOM in children.

Is there an increased risk of otitis media in children with obstructive sleep apnea?

IntroductionThe purpose of this study was to investigate the prevalence of otitis media and other otolaryngologic disorders in children with Obstructive Sleep Apnea (OSA) compared to those without OSA in a large cohort. MethodsA retrospective cohort study was carried within the US Collaborative Network within TriNetX. The OSA group was defined by ICD-10 code G47.33 and non-OSA group excluded patients with OSA. Both groups were required to have a CPT code for an outpatient visit to act as a control: 99202–99215. Propensity score matching for age, sex, and race was performed. Prevalence of otitis media (ICD-10H65, H66), chronic otitis media (ICD-10H66.1, H66.2, H66.3, H65.2, H65.3, and H65.4), tympanostomy (CPT 69433, 69436), adenoidectomy (CPT 42830, 42831), tonsillectomy (CPT 42825, 42826), adenotonsillectomy (CPT 42820, 42821), and allergic rhinitis (ICD-10 J30.9) were compared in this cohort. ResultsPropensity score matching yielded 165,665 (M = 95949, F = 69901) patients with a mean age of 10.7 (SD = 4.07) for each cohort. Children with OSA were 1.27x and 3.86x more likely to be diagnosed with otitis media and chronic otitis media, respectively (P<.0001). They were 3.81x more likely to undergo a tympanostomy (P<.0001). Children with OSA were 4.1x, 18.2x, and 24.7x more likely undergo an adenoidectomy, tonsillectomy, and adenotonsillectomy, respectively (P<.0001). Children with OSA were also 2.03x as likely to have a diagnosis of allergic rhinitis (P<.0001). ConclusionChildren with OSA experience otitis media and related surgical intervention more than children without OSA. Since allergic rhinitis and adenoid hypertrophy are contributors to both OSA and AOM, their increased prevalence in children with OSA may explain their increased frequency of AOM.

Second opinions: Do otolaryngologist demographics matter?

ObjectivePediatric patients and their caregivers may receive information from their primary care physician (PCP) that does not match current American Academy of Otolaryngology (AAO) guidelines. The purpose of this study is to evaluate the frequency of parents deciding to seek a second opinion based on the demographics of pediatric otolaryngologists who deliver guideline supported advice, contrary to advice from their child's PCP. MethodsA survey was distributed to parents in a pediatric otolaryngology clinic between June 2021 and July 2023. Demographics included parent age category, gender, race, and age of youngest child. The survey included a scenario depicting recurrent otitis media with clear ears and a suggestion to defer tympanostomy tube insertion per AAO guidelines after their child's PCP recommended tubes. Thirteen variations of otolaryngologist photos were used in the case, including a control case with no picture. ResultsOf the 658 participants, 460 (69.9 %) were female. 551 (83.7 %) were aged 30–49 years, 70 (10.7 %) were younger, and 37 (5.6 %) were older. 545 (82.8 %) were White, 30 (4.6 %) were Black, 20 (3.0 %) were Asian, and 31 (4.7 %) were Hispanic. 39.9 % of parents would seek a second opinion if an otolaryngologist recommended watchful waiting following evaluation of their child's otitis media. Participants given the control case were 2.23 times more likely to listen to the otolaryngologist's advice (p = .025). If a picture was provided, respondents were more likely to follow advice given if the pictured otolaryngologist was female (p = .025, OR = 1.47) or Asian (p = .042, OR = 1.53). ConclusionIn this group, there is evidence that physician race and gender may influence decision making when considering action versus monitoring in the context of recurrent otitis media.

An infant mouse model of influenza-driven nontypeable Haemophilus influenzae colonization and acute otitis media suitable for preclinical testing of novel therapies.

Nontypeable Haemophilus influenzae (NTHi) is a major otitis media (OM) pathogen, with colonization a prerequisite for disease development. Most acute OM is in children <5 years old, with recurrent and chronic OM impacting hearing and learning. Therapies to prevent NTHi colonization and/or disease are needed, especially for young children. Respiratory viruses are implicated in driving the development of bacterial OM in children. We have developed an infant mouse model of influenza-driven NTHi OM, as a preclinical tool for the evaluation of safety and efficacy of clinical therapies to prevent NTHi colonization and the development of OM. In this model, 100% of infant BALB/cARC mice were colonized with NTHi, and all developed NTHi OM. Influenza A virus (IAV) facilitated the establishment of dense (1 × 105 CFU/mL) and long-lasting (6 days) NTHi colonization. IAV was essential for the development of NTHi OM, with 100% of mice in the IAV/NTHi group developing NTHi OM compared with 8% of mice in the NTHi only group. Histological analysis and cytokine measurements revealed that the inflammation observed in the middle ear of the infant mice with OM reflected inflammation observed in children with OM. We have developed the first infant mouse model of NTHi colonization and OM. This ascension model uses influenza-driven establishment of OM and reflects the clinical pathology of bacterial OM developing after a respiratory virus infection. This model provides a valuable tool for testing therapies to prevent or treat NTHi colonization and disease in young children.

Temporal Swelling Following Cochlear Implantation: Frequency, Treatment, and Outcomes.

To investigate the frequency, treatment, and outcomes of postoperative delayed-onset swelling around cochlear implants. Retrospective, observational, nonrandomized group study. Academic medical center. Among 354 patients (516 ears) who underwent cochlear implantation (CI) at our hospital between May 2009 and October 2022, 329 (472 ears: 138 children [246 ears] and 191 adults [226 ears]) with a follow-up period of >3 months were included. Physical examination and computed tomography of the head were performed. In total, 5.5% (26/472 ears) had a history of delayed-onset swelling around the implant. This complication occurred in 9.8% (24/246 ears) of children and 0.9% (2/226 ears) of adults. The mean time to onset of swelling was 50 (range, 5.5-147) months following CI. In 60% (21/35) of the cases, the cause was unknown, whereas in 25.7% (9/35) and 11.5% (4/35) of cases, it was head trauma and acute inflammation, respectively. Conservative treatment (observation, antibiotics, and/or strong magnetic compression) was adapted in 91.4% (32/35) of cases. After conservative treatment, revision CI surgery was performed in one ear. Additionally, recurrent swelling was observed in 23.1% (6/26 ears) of swelling cases. The results suggest that delayed-onset swelling around implants occurs more frequently in children than in adults because of the higher incidence rates of head trauma and acute otitis media in children. In most cases, conservative treatment was adequate; however, careful follow-up is necessary. Our findings can serve as a reference for optimizing care and intervention options after CI.

Health technology assessment of video otoscopy for the diagnosis of otitis media in children in comparison to conventional otoscopy in primary healthcare settings in India

ObjectiveThis Health Technology Assessment (HTA) was undertaken to assess the clinical-effectiveness, cost-effectiveness, and operational feasibility of using otoscopes in primary healthcare settings in India, for diagnosing otitis media in children. MethodsWe undertook a three-step process sequentially determining (i) clinical effectiveness of video as well as conventional otoscopy (compared to otic microscope as the reference standard); (ii)cost-effectiveness analysis of the video otoscope; and (iii)operational feasibility and health equity considerations. The systematic review for clinical effectiveness involved literature search across five databases, screening and inclusion of relevant studies, and data synthesis. Cost-effectiveness analysis was performed using data from published literature, specialist interviews, and cost assumptions if neither was available. The Progress Plus tool was used to explore health equity and operational feasibility was taken into account. ResultsThe systematic review on clinical effectiveness include three relevant studies from a total of 1361 identified. The pooled sensitivity and specificity of video otoscope were 0.70 (95%CI 0.60, 0.84) and 0.92 (CI95% 0.89, 0.95) to be 0.88 (95% CI, 0.84 to 0.91). The cost-effectiveness analysis identified the incremental cost-effectiveness ratio (compared to conventional otoscope) as INR 1008.4 per QALY, with an overall gain of 413 QALYs per year. This was well below the willingness-to-pay threshold for India. There was potential of enhancing health equity and no insurmountable operational barriers, to the use of video otoscope in primary healthcare settings. ConclusionThis HTA concluded that video otoscope is clinically effective, cost-effective, and operationally feasible in Indian primary health settings, for diagnosing otitis media in children.

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.

Comorbidities of exudative otitis media in children: focus on cough

Introduction. Otitis media with effusion (OME) is the most common and asymptomatic form of otitis in preschool children, accompanied by the accumulation of exudate in the middle ear with the development of conductive and mixed hearing loss. The article discusses data on the nature of comorbid diseases in exudative otitis media and modern ideas about the effectiveness of a combination drug for concomitant bronchopulmonary pathology in children.Aim. To study the nature of comorbid diseases in OME and evaluate the effectiveness of a combined expectorant drug in the treatment of upper and lower respiratory tract infections.Materials and methods. 104 children diagnosed with acute and chronic otitis media with effusion were examined. All children were divided into 2 groups: Group I (50 people) with acute otitis media with effusion, Group II (54 people) with chronic otitis media with effusion. The average age of children in group I was 5.02 ± 0.48 years with the highest prevalence in the younger group (70%), the average age of children in group II was 5.87 ± 0.47 years with the highest prevalence in the preschool and primary school groups (88%). Group I children with tracheitis and bronchitis received a combined expectorant.Results and discussions. The recurrent course of otitis media with effusion is supported by allergies in 43%, and by pathology of the upper and lower respiratory tract in 34%. The development of hearing loss leads to dysarthria in 26% of cases, which can undoubtedly negatively affect the further social adaptation of the child. Complex therapy of cough with a combined expectorant gave a positive clinical effect in 95% of cases, reduced the need for systemic antibiotics by 2.5 times, shortened the duration of the disease by 1.7 times.Conclusions. Early diagnosis of comorbid diseases in AOME at a young age, timely complex treatment of bronchopulmonary pathology will prevent the development of COME with impaired speech development in older children.

Clinical Outcomes Associated with Amoxicillin Treatment for Acute Otitis Media in Children.

Acute otitis media (AOM) is the most common reason children are prescribed antibiotics. Bacteria that produce beta-lactamase are an increasingly frequent cause of AOM and may be resistant to amoxicillin, the currently recommended treatment for AOM. We aimed to evaluate the clinical outcomes of children treated with amoxicillin for AOM and assessed whether outcomes vary by infecting pathogen or beta-lactamase production. 205 children 6-35 months old diagnosed with AOM and prescribed amoxicillin were included. Bacterial culture and qualitative multiplex real-time polymerase chain reaction were performed on nasopharyngeal swabs collected at enrollment. Parents completed surveys assessing symptoms, antibiotic adherence, and potential adverse events. The primary outcome was treatment failure with amoxicillin. Secondary outcomes included recurrence, symptom improvement, resolution, and adverse drug events (ADE). 8 children (5.4%) experienced treatment failure and 14 (6.8%) had recurrence. By day 5, 152 (74.1%) children had symptom improvement and 97 (47.3%) had resolution. Parents reported ADE for 56 (27.3%) children. Among 149 children who did not take any amoxicillin before enrollment, 98 (65.8%) had one or more beta-lactamase-producing bacteria. Common bacterial otopathogens were Moraxella catarrhalis (79, 53.0%), Streptococcus pneumoniae (51, 34.2%), Haemophilus influenzae (30, 20.1%), and Staphylococcus aureus (21, 14.1%). Treatment failure did not differ between children that did (5, 5.1%) and did not (3, 5.9%) have beta-lactamase-producing otopathogens (p = .05). Among children diagnosed with AOM treated with amoxicillin, treatment failure was uncommon and did not differ by pathogen or beta-lactamase production. These data support guidance recommending amoxicillin despite an increasing prevalence of beta-lactamase-producing bacteria.

Protective Characteristics of Human Breast Milk on Early Childhood Otitis Media: A Narrative Review.

Introduction: Human breast milk (HBM) contains a complex and dynamically changing variety of factors that contribute to the infant's developing immune system's ability to fight upper respiratory tract infections, including otitis media (OM). We sought to summarize the current evidence on the protective characteristics of HBM, through direct or donated feeding, toward early childhood OM. Methods: For this narrative review, we performed a literature search on OM in the context of HBM feeding in the PubMed, Embase, and Google Scholar databases, between January 1, 2008, and July 1, 2023. Results: Immunoglobulin A (IgA) provides a short-term immunity of 2-3 days against otopathogens causing OM. IgA-mediated immunity is effective against OM up to 7 months of age if breastfeeding continues. The role of transferred IgM and IgG in HBM is unclear. Although there is a potential protective value of microRNA, hormones, oligosaccharides, stem cells, and interleukins present in HBM, their role is unclear. Any duration of breastfeeding is superior to no breastfeeding in OM risk reduction, with a big variability among studies (odds ratio 0.23-0.81, depending on the duration). Duration of breastfeeding ≥6 months was found to be the most effective in OM risk reduction, but there was no evidence of continued benefits after 2 years of age. Expressed breastfeeding was not shown to be more beneficial. The protective values of donor HBM against OM are still undetermined. Conclusion: HBM has numerous components that contribute to protection against early childhood OM.

THE EFFECT OF CEFIXIME IN TREATING RESPIRATORY TRACT AND URINARY TRACT INFECTIONS IN CHILDREN

Third generation cephalosporins are commonly used for the treatment of diverse infections in children. Cefixime is an oral third-generation cephalosporin with a broad-spectrumantibacterial activity and a relatively long elimination half-life. It is available in oral, intravenous, and intramuscular forms. It is effective against certain bacteria, such as Streptococci, Neisseria gonorrhoeae, Moraxella catarrhalis, Haemophiles influenzae, and Gram-negative bacilli. However, it is poorly active against Staphylococcus aureus, Coagulase-negative Staphylococci, and Enterococci. Clinical trials have shown that cefixime is comparable to amoxicillin and cefaclor in treating acute otitis media in children caused by various organisms, including Streptococcus pneumoniae. It is more potent than other cephalosporins against Enterobacteriaceae but less activeagainst ciprofloxacin. The recommended dosage for children is 8 mg/kg/day orally, once daily or in two divided doses and the most prominent side effect is diarrhea, which occurs in up to16% of children. Cefixime is a safe and effective for treating upper respiratory tract infections and acute otitis media. However, there is insufficient evidence regarding its efficacy in treating sinusitis and lower respiratory tract infections in children as its antimicrobial spectrum does cover the bacteria commonly associated with these infections. Due to its partial excretion through the kidneys, cefixime is frequently used to treat urinary tract infections in children.

The role of non-typable Haemophilus influenza in recurrent otitis media in children

BackgroundWhen reaching their first birthday, kids in poor nations and about 62% of children in wealthier countries experience their initial occurrence of otitis media. The primary culprits for these bacterial ear infections in infants are the non-typeable Haemophilus influenzae (NTHI) strains, known for causing both acute and recurring episodes of otitis media. This study aimed to isolate and identify the non-typable Haemophilus influenzae isolates in children with recurrent otitis media and to evaluate the antibiotic sensitivity of the isolated Haemophilus influenzae strains.MethodsThis cross-sectional study was conducted on 60 children (38 males and 22 females) who suffered from recurrent acute otitis media, ranging in age from 6 months to 5 years, and presented at the outpatient clinic between June 2022 and March 2023. Swabs were collected from ear discharge and examined using the Vitek system and PCR.ResultsMicrobiological examination of ear swabs revealed that H. influenzae was the most commonly isolated species (38.3%), followed by S. pneumoniae (26.7%). The current study found that 82.6% of Haemophilus influenzae isolates were non-typeable, whereas only 17.4% were typeable based on PCR results. The results were considered highly significant (Hs) as the P value was < 0.001. High-level resistance of H. influenzae isolates was observed against ampicillin (78.3%), while high-level sensitivity was noted with Amoxicillin-clavulanate (73.9%). NTHi was significantly associated with the presence of complications compared to other organisms (78.3%).ConclusionsThis study concluded that NTHi plays a significant role in recurrent acute otitis media (rAOM). Therefore, we hope that significant advancements will be made in developing an efficient vaccine against NTHi in the near future.

Watchful Waiting Strategy in the Treatment of Acute Otitis Media in Children

Background: Acute otitis media (AOM) is a common issue among children, often requiring antibiotic treatment. It is crucial to explore methods for the rational use of antibiotics. This study aimed to assess the effectiveness of the watchful waiting approach in treating children aged 6 months to 18 years with mild to moderate AOM. Methods: This prospective quasi-experimental study was conducted on 100 children with mild to moderate AOM. All patients, except those in severe or critical conditions, were placed on the watchful waiting strategy. A follow-up was conducted after 48 - 72 hours. If symptoms had improved, the watchful waiting approach continued. If medication was necessary for various reasons, these reasons were documented. Subsequently, children who completed the watchful waiting strategy were compared to those who received antibiotics. The collected data were analyzed using chi-square and t-tests in SPSS Statistics for Windows (version 16.0). Results: In this study, 59 patients (59%) were treated with the watchful waiting approach; nevertheless, 41 patients (41%) received antibiotics. The presence or absence of postnasal discharge showed a significant difference between the two groups (P = 0.001). No significant differences were observed between the two groups regarding fever (P = 0.066), enlarged tonsils (P = 0.740), snoring (P = 0.252), and bilateral involvement of the tympanic membrane (P = 0.313). Conclusions: Based on the results, the watchful waiting strategy is a cost-effective method for children aged over 6 months with mild to moderate symptoms, provided that parents cooperate fully. Clinicians should be cautious and consider alternative treatments if postnasal discharge is present, as it might indicate a higher likelihood of treatment failure with the watchful waiting approach.