Recurrence Of Otitis Media Research Articles

Prevalence of Otitis Media in Children and Pattern of Antibiotic Prescription at a Tertiary Hospital in Makkah

Background: Otitis media (OM) is a common inflammatory disease of the middle ear and mostly affects children less than 5 years. It is divided into several disease subcategories: acute otitis media (AOM), recurrent AOM, OM with effusion (OME), and chronic otitis media (COM). This study aims to determine the otitis media and identify the manner of prescribing antibiotics used for the treatment of OM cases in children from 3 months to 5 years old in Hera General hospital in Makkah city. Methods: The samples were retrospectively conducted at a tertiary General Hospital in the western region of Saudi Arabia. 113 records met the inclusion criteria for the study. Data were analyzed using descriptive statistics (percent and frequency). For quantitative data, the chi-square test and mean were used. Results: The number of OM cases was higher in patients aged 3 years old and less among age categories. The percentage of males (54.6%) was higher than females (45.4%). Amoxicillin-clavulanate was the most used treatment of OM in the inpatient ward, outpatient, emergency, and after discharge. The protocol of treatment was mostly by prescribing both antibiotics and analgesics without requesting any further samples to investigate the type of pathogen related to this infection. Cases presented to the emergency department were discharged with an antibiotic prescription without further investigation of the records for previous infection or recurrence. Conclusions: Due to increasing the antibiotics resistance alert around the globe, we believe that OM recurrence could be one of the community-acquired infections that affect the pediatric population and lower the quality of life and need specific attention from a physician who prescribes antibiotics for OM without further investigation.

Association of e-Cigarette Exposure with Pediatric Otitis Media Recurrence.

Otitis media (OM) is a common inflammatory disease spectrum in children and a leading cause of pediatric physician visits, antibiotic prescriptions and surgery. Tobacco exposure is associated with increased risk of OM recurrence, chronicity and surgeries. Tobacco products have changed dramatically in recent years with the advent of electronic cigarettes (e-cigarettes). While users frequently perceive vape as less harmful than traditional cigarettes, burgeoning evidence supports its contribution to respiratory pathologies. The consequences of secondhand exposure, particularly among children, are understudied. The aim of this study was to examine the association of e-cigarette emissions (EE) with OM recurrence and surgeries in the US. Questionnaire data regarding ear infections and tobacco exposure was gathered for all pediatric respondents of the National Health and Nutrition Examination Survey (NHANES) 2017 to 2018. Weighted analyzes and logistic regression models were used to assess associations. Data was available for 2022 participants (aged 6-17); all were included for analyzes. Tobacco exposure was observed in 42%; 9% were exposed to EE. EE contributed to risk of ≥3 ear infections (OR = 1.61, 95% CI 1.01-2.58, P = .047). After adjustment for significant covariates (race and asthma), the association fell below significance (P = .081). No other significant associations were observed between ear infections, or tympanostomy tube insertion and exposure variables (EE, gestational or other household exposure). Exposure to EE may confer greater risk of pediatric OM than previously identified factors such as household smoke, or gestational exposure. Further investigation of EE and its health implications in children is warranted. IV.

Balloon dilation with stent implantation for the treatment of Eustachian tube obstruction

When the Eustachian tube is dysfunctional, the external air cannot enter the middle ear, resulting in a negative pressure state in the middle ear, which can cause a series of pathological changes in the middle ear. In this paper, 13 patients with recurrence of otitis media after balloon dilatation of the Eustachian tube were treated with stenting in the Eustachian tube for Eustachian tube dysfunction with satisfactory results, and this method can provide a reference for the clinical treatment of Eustachian tube dysfunction.

Role of functional MRI images in differentiation between Cholesteatoma and recurrent otitis media with granulations

Background: The use of diffusion-weighted (DW) sequences to distinguish recurrent cholesteatoma from chronic otitis media with granulations has shown to be quite effective. The differential in water molecule diffusion in various biological tissues is used in DW MRI. Objectives: The goal of this research was to evaluate the analytic exactness of DWI and the change in ADCs of the middle ear cleft cholesteatoma and non-cholesteatomatous tissue, particularly recurrent otitis media single-shot multi echo planar DW images. In the event of cholesteatoma , intraoperative findings and histological data would be used to validate the outcomes. In the event of otitis media, we will either follow up with the patients clinically to see whether their symptoms improve or if they need a CT scan. Patients and methods: At South Valley University Hospitals, this research was performed on patients with supposed cholesteatoma (supposed clinically or by CT scan) or branded those, as well as patients with suspected recurrence of otitis media who had previously had operation or were preparing for surgery. Results: Range of Mean ADC values of cases enrolled in this study which calculated by 3D synapse, even cholesteatoma or otitis media varies from 0.4 to 2.35 with mean average 1.028 Conclusion: DWI is a useful technique in the assessment of cholesteatoma because it distinguishes it from otitis media with high specificity, reducing needing next stare procedures in many instances.

Assessment of Mothers care Hindering Successful Tympanostomy Tube for Children with Otitis Media with Effusion

Background: Tympanostomy Tube is the best modality of management of otitis media with effusion which needs mothers care for helping on maintenance the functions of tympanostomy tube and prevent recurrence of otitis media with effusion. Aim: this study aimed to assess maternal care hindering successful tympanostomy tube for children with otitis media with effusion. Design: Descriptive design was used to conduct this study Settings: This study was conducted at Out-Patient Otolaryngology-Head and Neck Surgery clinic affiliated to Tanta university hospitals and Ain shams university hospitals. Sampling: A purposive sample consisted of 100 mothers and their accompanied children with otitis media with effusion and tympanostomy tube. Tools of data collection: Two tools were used which included: An interviewing questionnaire sheet and Attitudinal rating scale. Results: nearly two third of the studied mothers had poor knowledge about otitis media with effusion with tympanostomy tube. While, less than quarter of them had fair knowledge and less than quarter of them had good knowledge. Conclusion: The current study concluded that more than half of the studied mothers had incorrect knowledge about the best way to clean the child's ear while keeping the Tympanostomy tube and the best position for a baby while breastfeeding or eating to keep the tube, respectively. Recommendations: Conducting educational programs for preschoolers and their mothers about early detections and aspects of care related to OME to minimize the negative consequence of OME

Role of DWI in differentiation between cholestatoma and recurrent otitis media

Abstract Background Cholesteatoma and otitis media are common middle ear pathologies. They may cause serious complication such as hearing loss, facial nerve paralysis or intra-cranial complications in advanced cases. They are mainly diagnosed by otoscope yet CT examination is essential to confirm the diagnosis in some cases as well as assess its extensions for proper surgical excision. However, CT is poor in differentiation of cholesteatoma from other middle ear pathologies. Between the two diseases, there are a grey zone. Depending on CT images in differentiation between cholestatoma and otitis media, radiologist will be susptable for misdiagnosis. Objective To determine the diagnostic accuracy of DWI and the difference between the ADCs of middle ear cleft cholestatoma and those of non-cholesteatomatous tissue especially recurrent otitis media on single-shot echo planar DW images. In a case of cholestatoma, the results will be confirmed by intra-operative findings and histopathological data. In a case of otitis media, we will follow up the patients clinically if signs and symptoms resolve or not; or follow up by CT examination. Methods This study was conducted on patient with suspected cholesteatoma suspected clinically or by CT examination or known patients and patient also with suspected otitis media recurrence who underwent already surgery or preparing to that; at Ain Shams university hospitals. The patients referred from the otolaryngology department at Ain Shams university hospitals and from other private clinics. The patients was investigated using magnetic resonance imaging (MRI). Results MRI examination was advocated to differentiate between cholesteatoma from other middle ear pathologies. Delayed post contrast T1 images were used but showed low sensitivity for smaller lesions as well as patient inconvenience due to delayed imaging after 30-45 minutes. In recent years, diffusion weighted sequences have been used in diagnosis of cholesteatoma due to its bright signal on DWIs. In our study we used thin cut multi-shot EPI diffusion weighted images in the assessment of cholesteatoma and otitis media suspected clinically or by CT examination or known patients. It showed very good sensitivity and excellent specificity in detection of diffusion restriction of cholestatoma compared to chronic otits media which appear as a facilitated diffusion. The use of multi-shot techniques improved its sensitivity compared to single shot images yet it is still relatively less than non-EPI techniques. Conclusion DWI is a beneficial tool in the evaluation of cholesteatoma and differentiate between it and otitis media with excellent specificity that reduces the need of second look surgeries in multiple cases. The use of multi-shot diffusion weighted techniques improved its sensitivity significantly compared to single shot techniques. It still could not detect lesions smaller than 4 mm.

Compare two surgical interventions for otitis media with effusion in young children

To prospectively evaluate the effect of tympanostomy tubes combined with adenoidectomy and tube insertion on treatment for otitis media with effusion in young children, and to analyze the related factors of prognosis and recurrence of the disease. The clinical and follow-up data of 184 children with otitis media with effusion who were treated in the department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University from September 2013 to January 2015, were reviewed systematically. According to different surgical methods, they were randomly divided into the observation group in which patients were treated with tube insertion combined with adenoidectomy, and control group in which the rest underwent simple tube insertion. The curative effect, changes of air conduction hearing threshold before and after surgery, the healing time of tympanic membrane and recurrence of middle ear effusion were compared between the two groups. Influencing factors of recurrence of otitis media with effusion were analyzed, and the effect of healing time on tympanic membrane after tube removal was observed. The total effective rate of treatment in the observation group was higher than that in the control group (91.84% vs 80.23%, P < 0.05), and the air conduction hearing thresholds in two groups were decreased significantly at 3months and 6months after surgery, respectively (P < 0.05). The total effective rate of children under 4years old in the observation group was also higher than that in the control group. The duration of middle ear effusion and the recurrence rate in the observation group were shorter/lower than those in the control group (P < 0.05). Analysis showed that recurrent respiratory tract infection before surgery and retention time of ventilating tube shorter than 12months were risk factors for recurrence of otitis media with effusion, while adenoidectomy was a protective factor. Besides, the tympanic membrane healing time of the tympanic membrane tube for 1years was shorter than that of the tympanic membrane tube for more than one year (P < 0.05). The persisted perforation rate is 3.57% in less 12months of tube, as opposed to it was 12% in more 12months of tube (P < 0.05). Tube insertion combined with adenoidectomy is more effective than tympanostomy tubes in the treatment of young children with OME, and the same results were found for children under four years of age. It can significantly shorten the duration of middle ear effusion and reduce the recurrence rate after surgery. For 3-6year-old children, the upper respiratory tract infection and short ventilation tube indwelling time increase the possibility of OME recurrence, it is recommended that the ventilation tube should be retained for at least 12months.

Analysis of factors associated with multiple ventilation tube insertions in children with otitis media with effusion.

To determine the factors related to multiple ventilation tube insertions in children with otitis media with effusion. A retrospective review was performed of 126 ears of 81 children aged less than 12 years who had undergone insertion of a Paparella type 1 ventilation tube for the first time between August 2012 and March 2018. Mean age at the first operation was 4.0 ± 2.2 years, and the mean duration of otitis media with effusion before the first ventilation tube insertion was 5.4 ± 4.5 months. Among 126 ears, 80 (63.5 per cent) had a single ventilation tube insertion and 46 (36.5 per cent) had multiple insertions. On multivariate logistic regression, tympanic membrane retraction, serous middle-ear discharge, and early recurrence of otitis media with effusion were independent predictive factors of multiple ventilation tube insertions. Tympanic membrane retraction, serous middle-ear discharge, and early recurrence of otitis media with effusion after the first tube extrusion are associated with multiple ventilation tube insertions.

Risk of occurrence and recurrence of otitis media with effusion in children suffering from cleft palate

Risk of occurrence and recurrence of otitis media with effusion in children suffering from cleft palate

THE IMPACT OF AN EDUCATIONAL PROGRAM FOR MOTHERS OF CHILDREN WITH OTITIS MEDIA ON THE PREVENTION OF ITS RECURRENCE AT ZAGAZIG UNIVERSITY HOSPITAL

Background: Otitis media is a common pediatric condition that affects most children by their second birthday and untreated cases of otitis media can possibly cause long term complications. This study aimed to evaluate the impact of implementing educational program for mothers about preventing of the recurrent otitis media. Design: Quasi- experimental design was conducted at pediatric ENT outpatient clinic at Zagazig University Hospital on a sample of 118 mothers who had children suffering from otitis media and attending the previously mentioned setting to manage their children. Tools of data collection: Data were collected by using child assessment sheet and structured interview questionnaire for mothers. Results: About one quarter of the studied children had recurrent otitis media once or twice episode per year and less than two thirds their recurrence were four episodes or more per year before program. After implementation of the educational program the children improved as the majority of children had recurrent otitis media once or twice episode per year. Conclusion: There was a positive impact of the educational program in improving mothers' knowledge as well as their reported practices about otitis media as well as on the recurrence of otitis media. Recommendations: Regular and continuous health educational programs are essential for improving the mothers' knowledge and their reported practices regarding their children having otitis media

THE IMPACT OF AN EDUCATIONAL PROGRAM FOR MOTHERS OF CHILDREN WITH OTITIS MEDIA ON THE PREVENTION OF ITS RECURRENCE AT ZAGAZIG UNIVERSITY HOSPITAL

Background: Otitis media is a common pediatric condition that affects most children by their second birthday and untreated cases of otitis media can possibly cause long term complications. This study aimed to evaluate the impact of implementing educational program for mothers about preventing of the recurrent otitis media. Design: Quasi- experimental design was conducted at pediatric ENT outpatient clinic at Zagazig University Hospital on a sample of 118 mothers who had children suffering from otitis media and attending the previously mentioned setting to manage their children. Tools of data collection: Data were collected by using child assessment sheet and structured interview questionnaire for mothers. Results: About one quarter of the studied children had recurrent otitis media once or twice episode per year and less than two thirds their recurrence were four episodes or more per year before program. After implementation of the educational program the children improved as the majority of children had recurrent otitis media once or twice episode per year. Conclusion: There was a positive impact of the educational program in improving mothers' knowledge as well as their reported practices about otitis media as well as on the recurrence of otitis media. Recommendations: Regular and continuous health educational programs are essential for improving the mothers' knowledge and their reported practices regarding their children having otitis media

Anti-confocal assessment of middle ear inflammation.

To improve the diagnostic prediction of recurrence of otitis media with effusion after surgery, an anti-confocal system combined with spectroscopic measurements is proposed to reject unwanted signals from the eardrum and assess the blood content. The anti-confocal system was experimentally evaluated on both optical middle ear phantom and human skin. Results showed effective rejection of signals from the eardrum using a central stop replacing the confocal pinhole, while still detecting signals from the middle ear mucosa. The system is sensitive to changes in blood content, but scattering and absorption characteristics of the eardrum can distort the measurement. Confocal detection of eardrum properties was shown to be a promising approach to correct measurements.

Therapeutic outcomes of canal wall up mastoidectomy in combination with Type I tympanoplasty in otitis media.

Objective:To evaluate the therapeutic effects in terms of disease clearance and hearing improvement of canal wall up mastoidectomy in combination with Type I tympanoplasty in otitis media.Methods:A total of 78 patients (81 ears) with otitis media were treated by canal wall up mastoidectomy in combination with Type I tympanoplasty. The postoperative tympanic membrane morphology, average of pure-tone hearing thresholds and average air-bone gap were used as the indices for evaluating therapeutic effects.Results:The patients were followed up for two years in average. All the tympanic membranes recovered, with the ear canals being dry. There were five cases (5 ears) of tympanic membrane retraction and one case of otitis media recurrence. Hearing was effectively recovered by 76.54% (62/81) after surgery.Conclusion:Combining canal wall up mastoidectomy with Type I tympanoplasty can treat otitis media safely and effectively due to high postoperative dry ear canal rate, satisfactory reconstruction of hearing and maintenance of ear morphology.

Surgical Treatments for Otitis Media With Effusion: A Systematic Review

The near universality of otitis media with effusion (OME) in children makes a comparative review of treatment modalities important. This study's objective was to compare the effectiveness of surgical strategies currently used for managing OME. We identified 3 recent systematic reviews and searched 4 major electronic databases. Eligible studies included randomized controlled trials, nonrandomized trials, and cohort studies that compared myringotomy, adenoidectomy, tympanostomy tubes (tubes), and watchful waiting. Using established criteria, pairs of reviewers independently selected, extracted data, rated risk of bias, and graded strength of evidence of relevant studies. We incorporated meta-analyses from the earlier reviews and synthesized additional evidence qualitatively. We identified 41 unique studies through the earlier reviews and our independent searches. In comparison with watchful waiting or myringotomy (or both), tubes decreased time with OME and improved hearing; no specific tube type was superior. Adenoidectomy alone, as an adjunct to myringotomy, or combined with tubes, reduced OME and improved hearing in comparison with either myringotomy or watchful waiting. Tubes and watchful waiting did not differ in language, cognitive, or academic outcomes. Otorrhea and tympanosclerosis were more common in ears with tubes. Adenoidectomy increased the risk of postsurgical hemorrhage. Tubes and adenoidectomy reduce time with OME and improve hearing in the short-term. Both treatments have associated harms. Large, well-controlled studies could help resolve the risk-benefit ratio by measuring acute otitis media recurrence, functional outcomes, quality of life, and long-term outcomes. Research is needed to support treatment decisions in subpopulations, particularly in patients with comorbidities.

Osteopathic evaluation and manipulative treatment in reducing the morbidity of otitis media: a pilot study.

To study the effects of osteopathic manipulative treatment in routine pediatric care for children with recurrent acute otitis media. Pilot cohort study with 1-year posttreatment follow-up. At follow-up, subjects' parents or legal guardians and their referring and/or family physicians were contacted to determine recurrence of otitis media since intervention. A referred and volunteer sample of pediatric patients ranging in age from 7 months to 35 months with a history of recurrent otitis media (N=8). For 3 weeks, all subjects received weekly osteopathic structural examinations and osteopathic manipulative treatment. This intervention was performed concurrently with traditional medical management. Five (62.5%) subjects had no recurrence of symptoms. Of the three remaining subjects in this cohort, one had a bulging tympanic membrane, another had four episodes of otitis media, and the last underwent surgery after recurrence at 6 weeks posttreatment. Closer analysis of the posttreatment course of the last two subjects indicates that there may have been a clinically significant decrease in morbidity for a period of time after intervention. The present study indicates that osteopathic manipulative treatment may change the progression of recurrent otitis media, a finding that supports the need for additional research in this area.

Are Homeopathic Remedies Effective?

Are Homeopathic Remedies Effective?

Management of recurrent acute otitis media in children: systematic review of the effect of different interventions on otitis media recurrence, recurrence frequency and total recurrence time

To conduct a systematic review comparing the effect of three interventions (prophylactic antibiotics, tympanostomy tube insertion and adenoidectomy) on otitis media recurrence, recurrence frequency and total recurrence time. Literature on recurrent otitis media was identified using the PubMed and Scopus search engines for the period January 1990 to March 2011. A hand search of the reference lists of relevant articles and textbooks was conducted to identify additional studies. Randomised, controlled trials with a minimum of 40 children and follow up of at least 12 months were included. Eighteen publications were identified. Each was assessed using preset inclusion criteria; seven publications met these criteria. Prophylactic antibiotics are effective in reducing otitis media recurrence, recurrence frequency and total recurrence time. Tympanostomy tube insertion failed to reduce the prevalence of otitis media recurrence, but reduced the recurrence frequency and total recurrence time. Adenoidectomy reduced otitis media recurrence; results on otitis media recurrence frequency differed but on average there was a reduction; however, the two studies with relevant data on total recurrence time had contradictory results.

Clinical manifestation and risk factors of children with cleft palate receiving repeated ventilating tube insertions for treatment of recurrent otitis media with effusion

Conclusion: From this study, we suggest that male gender and complete type of cleft palate contribute to the recurrence of otitis media with effusion (OME) in the patients with cleft palate. Objectives: It is well known that children with cleft palate have a high prevalence of OME due to anatomic dysfunction of the eustachian tube. Our goal was to determine clinical manifestations and risk factors for children with cleft palate who received additional ventilating tube insertions after initial tube insertion during palatoplasty. Methods: We retrospectively reviewed the medical and operation records of 213 patients who received ventilating tube insertion during palatoplasty from January 1993 to June 2006. The single-VT group (n = 140) included patients who had one ventilating tube insertion only, and the repeated-VT group (n = 73) included patients who received ventilating tube insertion repeatedly because of recurring chronic OME. We analyzed age, sex, types of cleft palate, preoperative tympanogram, characteristics of discharge during myringotomy, and duration of first ventilating tube in situ. Results: There were significant differences between the single- and repeated-VT groups in the rate of male patients (43.6 vs 72.6%), the rate of complete cleft palate (30.0 vs 61.6%) and incomplete cleft palate (61.4 vs 26.0%), the rate of preoperative type A tympanogram (30.0 vs 13.7%) and type B tympanogram (57.1 vs 75.3%), the proportion of discharge during myringotomy (72.1 vs 86.3%), and the mean indwelling period of the first ventilating tube (12.7 ± 9.6 vs 10.5 ± 6.5 months). In addition, sex and type of cleft palate were proved to affect the repetition of VT independently. However, when we performed multivariate analysis, only complete type of cleft palate and male gender showed significant differences between single- and repeated-VT groups.

Antioxidant Role of Selenium in Rats with Experimental Acute Otitis Media

The aim of this prospective experimental animal study was to determine whether selenium had a protective effect on oxidative stress in rats with acute otitis media, by measuring the alterations of antioxidant parameters and lipid peroxidation on days 4 and 10 after inoculation into the middle ear. Streptococcus pneumoniae was inoculated into the middle ear cavities of 32 rats in animal laboratory of a tertiary medical center. Group 1 served as the control group and the animals were administered 1.5ml/day saline. Group 2 received 0.2mg/kg/day oral selenium for 10days. The blood samples of each group were obtained on post-inoculation days 4 and 10. The levels of thiobarbituric acid reactive substances, albumin, total sulphydryl, superoxide dismutase and glutathione peroxidase were investigated. Day 10 level of thiobarbituric acid reactive substance in group 2 was lower than the day 4 level of the same substance in the control group. Although glutathione peroxidase and superoxide dismutase levels significantly decreased starting from 4th day until 10th day in group 1, their levels increased in group 2. Day 10 levels of albumin and total sulphydryl in group 1 were significantly higher than day 4 levels in group 2. We found that selenium supplementation for 10days decreased thiobarbituric acid reactive substances and increased glutathione peroxidase and superoxide dismutase levels when compared to the control group. We believe that selenium supplementation may be beneficial to prevent the clinical sequelae and recurrence of otitis media.

Otitis media with effusion: Recurrence after tympanostomy tube extrusion

Objective The incidence rate of recurrence of otitis media with effusion (OME) in children after tympanostomy tube extrusion and the relationship between recurrence and tube retention time was investigated. Also relationship between recurrence rate and initial age of tube insertion was analysed. Study Design A retrospective case series of patients who had tympanostomy tube insertion. Methods A total of 91 children (169 ears) were reviewed. Ears of children divided into three groups according to retention time of tympanostomy tubes. Group I: tympanostomy tube retention time less than 6 months. Group II: tympanostomy tube retention time 6 months to 12 months. Group III: tympanostomy tube retention time 12 months or more. Results OME recurrence rate after tube extrusion was 20.7% in the study. The longer the tympanostomy tube retention time was the lower was the recurrence rate of OME. The comparison of the three groups indicated that recurrence rates were higher in group I (36.54%), than in group II (17.74%) and in group III (9.1%). There were statistically significant differences in recurrence rates between group I and group III, and between group I and II ( p < 0.05, p < 0.05). However, the difference in recurrence rates between group II and group III was statistically not significant ( p > 0.05). In the preschool age group and school age group, the recurrence rates were 5.5% and 15.4%, respectively. There was no significant difference between these two groups ( p > 0.05). OME recurrence was observed in 9.9% of males and in 11% of females. There was no significant difference in recurrence rates between males and females ( p > 0.05). Conclusion After extrusion of tympanostomy tube, children should be followed-up regularly for recurrence of OME. The shorter the retention time of tympanostomy tubes was the higher was the recurrence rate. For the treatment of OME the ideal type of tubes should have the lowest complication and recurrence rates. Further studies are needed to ascertain the relationship between the incidence of OME and optimal tympanostomy tubes duration of tube stay in tympanic membrane. Therefore, new studies with larger series are necessary to investigate the correlation between the recurrence rates and different tympanostomy tubes after extrusion of tubes.