Otitis Media In Infants Research Articles

Otitis Media in Infants and Children

Otitis Media in Infants and Children

Pharmacokinetics and pharmacodynamics of gatifloxacin in children with recurrent otitis media: application of sparse sampling in clinical development

Gatifloxacin is a 4th-generation fluoroquinolone previously under investigation for the treatment of otitis media in infants and children. These analyses were designed to evaluate the extent of drug exposure relative to adult populations and to examine the relationship between drug exposure and response to therapy in children with recurrent otitis media or early treatment failures of acute otitis media. The patient population included 187 patients from an open-label, multicenter, noncomparative study using gatifloxacin 10 mg/kg once daily. Gatifloxacin exposure was estimated using a single steady-state blood sample in conjunction with a pharmacostatistical model developed using a separate pediatric data set. Gatifloxacin exposure was equivalent to that in adults given 400 mg daily. Of the 41 patients who had Streptococcus pneumoniae from middle ear culture, there were only 3 bacteriologic failures; there was no relationship between plasma fu AUC 0–24:MIC ratio and outcome. In conclusion, population pharmacokinetic/pharmacodynamic methods allowed estimation of drug exposure using one sample per patient.

Association of surfactant protein A polymorphisms with otitis media in infants at risk for asthma

BackgroundOtitis media is one of the most common infections of early childhood. Surfactant protein A functions as part of the innate immune response, which plays an important role in preventing infections early in life. This prospective study utilized a candidate gene approach to evaluate the association between polymorphisms in loci encoding SP-A and risk of otitis media during the first year of life among a cohort of infants at risk for developing asthma.MethodsBetween September 1996 and December 1998, women were invited to participate if they had at least one other child with physician-diagnosed asthma. Each mother was given a standardized questionnaire within 4 months of her infant's birth. Infant respiratory symptoms were collected during quarterly telephone interviews at 6, 9 and 12 months of age. Genotyping was done on 355 infants for whom whole blood and complete otitis media data were available.ResultsPolymorphisms at codons 19, 62, and 133 in SP-A1, and 223 in SP-A2 were associated with race/ethnicity. In logistic regression models incorporating estimates of uncertainty in haplotype assignment, the 6A4/1A5haplotype was protective for otitis media among white infants in our study population (OR 0.23; 95% CI 0.07,0.73).ConclusionThese results indicate that polymorphisms within SP-A loci may be associated with otitis media in white infants. Larger confirmatory studies in all ethnic groups are warranted.

Meconium contaminated amniotic fluid and infant otitis media: Is it a risk factor in children surviving aspiration and initial distress of respiration?

Histological studies show that amniotic fluid cellular content (AFCC) causes in the middle ear a foreign body reaction, the extent and severity of which depends upon the massiveness of contamination. We studied how factors related to birth and environment affect proneness to acute otitis media (AOM) in infants born through meconium contaminated amniotic fluid. From the birth records of infants born from 1996 to 2000 a list was made of those born through meconium contaminated amniotic fluid with pulmonary aspiration and tracheal suctioning, followed by treatment in a neonatal intensive care unit. Thirty-seven such children formed the study group, 43 children matching the study cases but born through clear fluids formed the control group. Birth and environmental factors together with the frequency and number of episodes of AOM were analyzed in all, based on a verified questionnaire. In addition, 27 children in the study group and 21 in the control group received a specialist ENT examination, hearing tests and tympanometry. The events at delivery were highly significantly different between the two groups, manifested by the lower Apgar points in the study group (p<0.001) while other birth and environmental factors appeared equalized. The first episode of AOM in the study group came earlier than in the control group and their frequency was significantly higher during the 1st and 2nd year of life and during the entire observation period (p<0.001). Tympanostomy was performed more often in the study group. Tympanometry showed more cases of reduced static admittance and negative pressure than in the control group and hearing was poorer. Cases with compromised delivery through meconium contaminated fluids, resulting in pulmonary aspiration and in need of intensive care treatment, form a risk group, which should be closely followed. Early nasopharyngeal suctioning of AFCC may reduce its entry into the middle ear. A prolonged episode of AOM suggests mucosal involvement of several middle ear compartments, shown by histological studies to occur in all cases of massive contamination. Placement of a ventilation tube after the first prolonged AOM allows regression of the granulation tissue in the air spaces together with the secretory elements in the mucosa.

Diagnostic value of tympanometry using subject-specific normative values

Tympanometry has proven valuable in the diagnosis of otitis media in infants. The classification used in the Finnish otitis media studies has resulted in high specificity yet only moderate sensitivity. We aimed to explore the benefit of using each subject's individual previous test results (obtained at previous visits of the children when diagnosed healthy) as normative values. Specific aim was to assess this approach in increasing sensitivity in the diagnosis of otitis media. We used tympanometric (GrasonStadler GSI 38) results of children in the Finnish otitis media vaccine trial obtained at pre-scheduled 7-month visits (if ears found healthy) and at the first subsequent sick visit with respiratory infections and potential otitis media within a 90-day period after the 7-month visit. Children with recent otitis media within the previous month and tympanometric tests with documented interfering factors were excluded. Pneumatic otoscopy was used as the reference method for the diagnosis of otitis media. Altogether 2476 children at the 7-month visits were examined; after exclusions data on 1759 children were available for analysis. Of these children, 630 were brought to at least one sick visit defined above. Finally, data on 906 ears were available for analysis. Entirely flat type B tympanograms predicted otitis media accurately; also high-peaked tympanograms were accurate in predicting normal middle ear status. For the moderate-peaked curves in-between, absolute and relative changes in the tympanometric variables from the 7-month visit to the sick visit were explored for accurate prediction of otitis media; decrease in curve height by at least 2/3 was found most valuable. Sensitivity of the type B tympanogram was 61% and specificity 99% at the sick visit. The sensitivity increased to 67% with a specificity of 98%, if results with the ratio of static acoustic admittance (height of the curve) at the sick visit compared to the previous healthy visit <0.35 were also considered abnormal together with type B curve in indicating otitis media. The subject-specific normative values were not found especially useful, although a slight increase in sensitivity was achieved without compromizing specificity.

Association of early‐onset otitis media in infants and exposure to household mould

Otitis media is one of the most common infections of early childhood. Children who first experience acute otitis media at an early age (before 6 months) are at increased risk for recurrent otitis media. This prospective study investigated exposure to measured levels of airborne household mould and the risk of early otitis media in the first 6 months of life among a cohort of infants at high risk for asthma. Between September 1996 and December 1998, women were invited to participate if they had at least one other child with physician-diagnosed asthma. Mothers were given a standardised questionnaire within 4 months of their infant's birth. Airborne mould samples were also taken at this time, and culturable fungi were categorised into four levels according to the report of the Commission of European Communities: 0 (undetectable), 1-499 colony forming units (CFU)/m(3) (low), 500-999 CFU/m(3) (medium), > or =1000 CFU/m(3) (high). Infant respiratory symptoms were collected during quarterly telephone interviews at 6, 9 and 12 months of age. Of the 806 children in the study, 27.8% experienced otitis media before six months of age. Household levels of Penicillium and Cladosporium were modestly associated with the number of otitis media episodes (P = 0.056 and 0.081 respectively). After controlling for potential confounders, Penicillium and Cladosporium were not associated with early otitis media. High levels of 'other' mould (defined as total spore count minus counts for Penicillium, Cladosporium, and yeast) were associated with early otitis media (OR 3.49; 95% CI [1.38, 8.79]). We also found associations between day-care outside of the home and birth during the summer or fall season with early otitis media. This study is suggestive of a relationship between otitis media and mould that warrants further study.

Survey of parenting books for advice on the common cold, diarrhea, and otitis media in infants and toddlers.

Parenting books often provide advice for common medical ailments of infants and toddlers. However, the accuracy of such advice has never been evaluated. The purpose of this study is to survey the informational content of a sample of parenting books. Fifty general parenting books were identified and reviewed for the informational content on the following topics: common colds, diarrhea, and otitis media. When covered by the book, accurate and consistent information was generally provided in the following topic areas: non-medicated nose drops for nasal congestion, upright positioning for children with colds, breastfeeding infants with diarrhea, electrolyte solutions for diarrhea, and feeding practices as they relate to otitis media. The following topic areas displayed significant inconsistency: the use of decongestants, antihistamines, expectorants, cough suppressants, and decongestant nose drops for colds; antidiarrheal medications; soft drinks and juice for diarrhea; home recipes for oral hydration solutions; and the usefulness of pressure equalization tubes for refractory otitis media. Practitioners should be aware that parents may be misinformed by some parenting books and take measures to educate parents.

Racial/ethnic disparities in the diagnosis of otitis media in infancy

Objective: Otitis media (OM) is an extremely common pediatric diagnosis. Several risk factors have been associated with OM, but the relationship between OM and race/ethnicity remains controversial. We sought to define the relationship between OM diagnosis and race/ethnicity in infants. Methods: By multivariable logistic regression, we evaluated the association between OM diagnosis and race/ethnicity in 11,349 non-low-birthweight infants who were participants in a prospective cohort study of infant care practices. Results: As in previous studies, breastfeeding was associated with a decreased risk of OM diagnosis while other factors were independently associated with a substantially increased risk of OM diagnosis: out-of-home daycare, multiple children living in the home, and mother’s multiparity. Daycare was associated with a “dose effect” in that the risk of OM diagnosis increased with an increasing number of children in the daycare. While the crude analysis suggested little relation of OM diagnosis and race/ethnicity, the association was confounded by several covariates including maternal marital status, number of children living in the home, breastfeeding status, and maternal age. After adjustment for relevant confounders, Black (OR 0.74; 95% CI 0.61–0.89) and Asian infants (OR 0.77; 95% CI 0.57–1.0]) were less likely to be diagnosed with OM than White infants. Conclusions: This large prospective study confirms previous risk factors for OM and demonstrates a strong “dose effect” of the size of daycare centers on OM. The study also demonstrates that the association between race/ethnicity and OM diagnosis is confounded by social factors. After adjusting for such factors, Black and Asian infants are less likely to be diagnosed with OM than White infants. The reason for this racial disparity remains unknown.

Infant otitis media and the use of secondary heating sources.

This prospective study investigated the association of exposure to indoor secondary heating sources with otitis media and recurrent otitis media risk in infants. We enrolled mothers living in nonsmoking households and delivering babies between 1993 and 1996 in 12 Connecticut and Virginia hospitals. Biweekly telephone interviews during the first year of life assessed diagnoses from doctors' office visits and use of secondary home heating sources, air conditioner use, and day care. Otitis media episodes separated by more than 21 days were considered to be unique episodes. Recurrent otitis media was defined as 4 or more episodes of otitis media. Repeated-measures logistic regression modeling evaluated the association of kerosene heater, fireplace, or wood stove use with otitis media episodes while controlling for potential confounders. Logistic regression evaluated the relation of these secondary heating sources with recurrent otitis media. None of the secondary heating sources were associated with otitis media or with recurrent otitis media. Otitis media was associated with day care, the winter heating season, birth in the fall, white race, additional children in the home, and a maternal history of allergies in multivariate models. Recurrent otitis media was associated with day care, birth in the fall, white race, and a maternal history of allergies or asthma. We found no evidence that the intermittent use of secondary home heating sources increases the risk of otitis media or recurrent otitis media. This study confirms earlier findings regarding the importance of day care with respect to otitis media risk.

Airway infections in infancy and the presence of allergy and asthma in school age children

Aim: To investigate the association between a history of otitis media and respiratory tract infections in infancy and allergic sensitisation and asthma in school age children of atopic and non-atopic...

Respiratory infections caused by non-typeable Haemophilus influenzae.

This review will consider recent developments in the clinical aspects of infections due to non-typeable Haemophilus influenzae. In addition, newer developments in the areas of mechanisms of pathogenesis, host pathogen interaction, immune responses and efforts toward vaccine development will be reviewed briefly. Non-typeable H. influenzae continues to be a common cause of otitis media in infants and children, sinusitis in children and adults, pneumonia in adults, and lower respiratory tract infection in adults with chronic obstructive pulmonary disease. While the rate of beta-lactamase production by isolates of H. influenzae varies geographically, most regions show a rate of 20-35% of isolates producing beta-lactamase. Recent studies have highlighted the possible role of bacterial biofilms formed by H. influenzae as a cause of otitis media. Several lines of evidence indicate that H. influenzae causes intracellular infection in the lower respiratory tract in chronic obstructive pulmonary disease and this observation has important implications in understanding the human immune response to the bacterium. Lipooligosaccharide is an important virulence factor for H. influenzae and research is generating new information on the complex role of this molecule in colonization and infection of the respiratory tract. Several surface molecules are under active evaluation as vaccine antigens. Non-typeable H. influenzae is an important cause of respiratory tract infections in children and adults. Most strains are susceptible to amoxicillin/clavulanate, fluoroquinolones and the newer macrolides. Research in the next decade promises substantial progress in the challenge of developing vaccines for nontypeable H. influenzae.

Book Review: Otitis Media in Infants and Children

Book Review: Otitis Media in Infants and Children

Otitis Media in Infants and Children

Otitis Media in Infants and Children

Book Review: Otitis Media in Infants and Children

Book Review: Otitis Media in Infants and Children

Short-term penicillin-V prophylaxis did not prevent acute otitis media in infants

Objective: To determine whether prophylactic, short-term penicillin V treatment during upper respiratory tract infections can prevent the occurrence of recurrent acute otitis media in young children. Methods: Seventy children were studied in a prospective, double-blind, placebo-controlled study. All children had suffered their first episode of acute otitis media before the age of 6 months. After inclusion in the study group, administration of penicillin V or placebo was initiated by the parents at subsequent upper respiratory tract infections. The children were examined by otomicroscopy within 3 days after treatment was initiated. The children were scheduled for a total follow-up period of 12 months, including bimonthly visits for check-up irrespective of treatment periods. Results: There were 304 treated episodes of upper respiratory tract infection. There was no significant difference in the number of acute otitis episodes between groups. Conclusion: Initiation of penicillin V prophylaxis at upper respiratory tract infection in small children did not prevent recurrent acute otitis media in this study.

Therapy for otitis-prone children in Tenshi hospital

With the recent emergence and increases of multiple-drugs-resistant Streptococcus pneumoniae, we have been seeing an increasing number of infants with intractable recurrent otitis media which is resistant to the general conservative out-patient treatments such as oral administration of medicines or tympanotomy. In this study, we investigated the inflammation-causing bacteria in the infants with otitis media which were treated in our hospital from January to December in 1997, and in six serious cases among them, we measured IgG subclass and specific IgG2 antibody to S. pneumoniae to examine them. As a result, S. pneumoniae was found to be the cause in 45% of the cases of initial development of otitis media, and in 88% of them the S. pneumoniae was penicillin-resistant. The level of specific IgG2 antibody to S. pneumoniae was low in all the cases, whereas IgG2 subclass was deficient only in one out of the six cases; from these findings, the selectively low level of immune status was thought to be the cause of the recurrences of otitis media. In two cases, clinical condition was markedly improved by immunoglobulin substitute therapy, which demonstrates that immunoglobulin is effective for the intractable recurrent otitis media in infants.

Otitis Media in Infants and Children

Otitis Media in Infants and Children

Étude de l'épidémiologie bactérienne de l'otite moyenne aiguë de l'enfant observée en ville dans la région Nord Pas-de-Calais

Background – The aim of this work is the study of the bacteriologic epidemiology of acute otitis media in infants observed at home in Nord Pas-de-Calais area, and the analysis of bacteria associated to recurrent otitis and clinical failure.Observations – A total of 295 specimens of ear pus specimens were collected from children (mean age: 18 months; average: one month–12 years). Pneumococcus strains were isolated from 52% of samples and 80% of these showed resistance to penicillin. H. influenzae was found in 35% of specimens and the half produced a β lactamase. Pneumococcus is the predominant pathogen isolated in prolonged otitis media, while H. influenzae is preferentialy found during recurrent otitis media. The main bacteriologic cause of failure traitement was penicillin-intermediate or -resistant pneumococci. The therapy administred 48 to 72 hours before collection of ear pus sample in therapeutic failure was ineffective (oral cephalosporins or macrolides), or administred to low dosage (50 mg/kg/j).Conclusion – Our results demonstrate, in opposition to other studies, Streptococcus pneumoniae as the most frequent pathogen in acute otitis media. They also show the excellent correlation between antibiotic therapy and clinical failures.

Antibiotics for Acute Otitis Media in Infancy: Based on Fear or on Facts?

Antibiotics for Acute Otitis Media in Infancy: Based on Fear or on Facts?

Otitis Media in Infants and Children

Dr. Klein is Professor of Pediatrics at Boston University School of Medicine and Vice Chairman for Academic Affairs of the Department of Pediatrics, Boston Medical Center. He completed his undergraduate studies at Union College in Schenectady, New York in 1952. His career has been notable for fortunate choices and valued role models and mentors. He was admitted to Yale School of Medicine, where he thrived in the Yale system of personal responsibility (absence of examinations). He completed a pediatric internship at the University of Minnesota Hospitals, where he was influenced by the extraordinary presence of Robert Good. Obligatory military service was still in effect in 1957, and the best opportunity for a young physician interested in infectious diseases was to be accepted by Alexander Langmuir into the elite corps of the Epidemic Intelligence Service at the Centers for Disease Control. Dr. Langmuir impressed on “his boys” disciplines of public health and “shoe leather” epidemiology. Dr. Klein was stationed in the New York State Health Department in Albany, where he investigated outbreaks of enteroviral infections, Asian Flu, and antibiotic resistant staphylococcal disease. Although it was Dr. Klein's intent to return to Minneapolis to complete his residency and practice pediatrics, his wife Linda Klein suggested that a year or two in Boston would be a worthwhile family experience. Again, good fortune came his way with a pediatric residency under the most esteemed pediatric clinician of those years, Sydney Gellis, and a Research Fellowship in Infectious Diseases at the Thorndike Memorial Laboratory directed by Maxwell Finland. Dr. Finland was professional father to more than 100 infectious disease fellows who now strive to emulate his research ethic and productivity. Dr. Klein has remained at the Boston City Hospital (now Boston Medical Center) first on the Harvard Medical Service and now on the Boston University faculty. He is the author of more than 400 publications, including the textbooks Infectious Diseases of the Fetus and Newborn Infant 5th edition, co-edited with Jack S. Remington (Philadelphia: Saunders, 2001) and Otitis Media in Infants and Children cowritten with Charles D. Bluestone (Philadelphia: Saunders 3rd ed 2001). He is the recipient of the Bristol Award of the Infectious Diseases Society of America, the Distinguished Physician Award of the Pediatric Infectious Diseases Society and Clinician of the Year Award of the Massachusetts Infectious Diseases Society. Dr. Klein is a highly competitive tennis player, an emotionally labile Boston Red Sox fan, and a devotee of big band music. Address correspondence: Jerome O. Klein, M.D., Pediatric Infectious Diseases, Boston Medical Center/BUSM, Maxwell Finland Laboratory for Infectious Diseases, 774 Albany Street, 5th Floor, Boston, MA