Pediatric Otitis Media Research Articles

Up‐Regulation of MUC5AC and MUC5B Mucin Genes in Nasopharyngeal Respiratory Mucosa and Selective Up‐Regulation of MUC5B in Middle Ear in Pediatric Otitis Media with Effusion

Mucins are the major component responsible for the gel-like properties of mucus secretion. Currently, little is known about the regulation of mucins in otitis media with effusion (OME). We investigated the expression of MUC5AC and MUC5B mucin gene messenger (m)RNAs in middle ear effusions as well as in tissue biopsies of the respiratory mucosa of the nasopharynx by means of reverse-transcription polymerase chain reaction (RT-PCR). A prospective, controlled, clinical trial. The study group consisted of 25 children with a diagnosis of OME who were to undergo bilateral ventilation tube insertion with adenoidectomy. A sample of middle ear effusion (n = 50) as well as tissue biopsy from nasopharyngeal respiratory mucosa (n = 25) were obtained from each patient. For the nasopharyngeal mucosal biopsies, two control groups were made up from 30 children with healthy ears who underwent tonsillectomy +/- adenoidectomy operation; control A, 15 children with adenoid hypertrophy, and control B, 15 children with healthy nasopharynx. RNAs were extracted from effusion and tissue samples, and semiquantitative RT-PCR was performed for MUC5AC and MUC5B to investigate their expression. In the middle ear effusions, MUC5B mRNA expression was detected in 48 (96%), whereas MUC5AC mRNA was detected in 8 (16%). On semiquantitative analysis, MUC5AC/glyceraldehyde 3-phosphate dehydrogenase (GAPDH) and MUC5B/GAPDH mRNA ratios in the study group were significantly increased compared with those in both control groups (P < .05). The results suggest that the middle ear has a unique mucin gene expression pattern when compared with that of the nasopharynx. Up-regulation of MUC5B in the ear may play an important role in the pathogenesis of middle ear effusions.

Wait-and-see strategy applicable in paediatric otitis media

Wait-and-see strategy applicable in paediatric otitis media

Middle Ear Fluid Streptococcus pneumoniae Serotype Distribution in Costa Rican Children with Otitis Media

Streptococcus pneumoniae conjugate vaccine became available in Costa Rica in 2004. Previous S. pneumoniae middle ear fluid (MEF) data obtained during the period 1999-2001 from Costa Rican children indicated that serotype 19F was the most common type (75%), but more recently other serotypes have become more prevalent. To establish the most common S. pneumoniae serotypes present in the MEF of Costa Rican children with otitis media (OM) and to analyze serotype distribution by demographic factors, disease distribution and antimicrobial susceptibility patterns and assess the potential protection provided by the new conjugated heptavalent S. pneumoniae vaccine in Costa Rican children with OM. During 2002 and 2003, 69 S. pneumoniae isolates were obtained from the MEF of Costa Rican children, ages 3-49 months, with OM. Serotyping was performed by the quellung reaction with antisera from Statens Serum Institute, Copenhagen, Denmark. The most common S. pneumoniae serotypes isolated were 19F (26.1%), 6B (14.5%), 9V (8.7%), 16F (8.7%), 14 (5.8%), 23F (5.8%), 3 (5.8%) and 6A (5.8%). Serotype distribution was similar among children younger than 24 months of age or 24 months of age or older and by disease distribution. There was a tendency towards more penicillin- and trimethoprim-sulfamethoxazole-nonsusceptible isolates among vaccine-type strains than among non-vaccine type strains. The serotype distribution of S. pneumoniae causing pediatric OM in Costa Rica is similar to those reported from developed countries. The current heptavalent pneumococcal conjugate vaccine covers 74% of OM episodes in Costa Rican children.

Guideline for managing paediatric otitis media with effusion released

Guideline for managing paediatric otitis media with effusion released

Expression of mast cell tryptase in pediatric otitis media with effusion

Objective: To evaluate the possible relationship between allergy and otitis media with effusion (OME), we investigated the presence and level of tryptase, which reflect mast cell activity. Materials and methods: Twenty-five children with intractable OME were studied. Thirteen patients were confirmed allergy positive by multiallergosorbent test. Twelve patients were allergy negative. Evidence for mast cell tryptase presence and degree of activation in the middle ear effusion (MEE) were measured by using Western blotting and radioimmunoassay (RIA). Results: The typical single band of 32 kDa tryptase was found in the MEE. And it was more strongly expressed in the MEE with allergy positive than negative. RIA demonstrated that mean tryptase level was significantly higher in the MEE with allergy positive than negative. Conclusion: These results suggest that allergy may be one of the contributing factors in the persistence of intractable OME.

Characterization of cytokines present in pediatric otitis media with effusion: comparison of allergy positive and negative

To investigate the possible relationship between allergy and otitis media with effusion (OME), we investigated the cytokine level in the middle ear effusion (MEE)s of children with persistent OME. Interleukin (IL)-2, IL-4, IL-6 and tumor necrosis factor (TNF)-α in the MEEs were measured by devised sensitive sandwich enzyme-linked immunosorbent assay (ELISA) and compared allergy positive group with allergy negative group. The mean levels of IL-4, IL-6 and TNF-α in MEE were significantly higher in allergy positive group than allergy negative group ( P<0.05). Elevation of Th-2-driven cytokines (IL-4, IL-6) and TNF-α in MEEs may be a contributing factor in the persistence of OME with allergy.

Paediatric otitis media: who to treat with antibacterials?

Paediatric otitis media: who to treat with antibacterials?

Practice patterns versus practice guidelines in pediatric otitis media

Objective: To study the practice patterns of physicians and their adherence to an evidence-based practice guideline (PG) on pediatric otitis media with effusion. We hypothesized that overall knowledge of the recommendations from the guidelines would be less than 75%, and that specialist physicians would have better knowledge of the recommendations than generalist physicians. Methods: We performed a survey study of 1167 otolaryngologists, pediatricians, and pediatric otolaryngologists. Each physician was sent a 6-item survey asking about their practice patterns and treatment preferences for young children with otitis media with effusion. We compared responses between different specialties. Results: The overall response rate was 48%. Only 8 (1.4%) of the 558 responding physicians answered all 6 items congruent with the PG. Overall, pediatricians, otolaryngologists, and pediatric otolaryngologists had similar total scores, but different scores on individual items. Conclusions: These results indicate that the practice patterns of pediatricians, otolaryngologists, and pediatric otolaryngologists differ from the recommendations of an evidence-based PG. In particular, 2 items covering key treatment recommendations were answered in agreement with the PG by fewer than half of the physicians. It is not clear from this study whether these discrepancies were due to poor dissemination or knowledge concerning the PG, or disagreement with its recommendations. (Otolaryngol Head Neck Surg 2001;124:489-95.)

A feasibility study of chiropractic spinal manipulation versus sham spinal manipulation for chronic otitis media with effusion in children

Background: Pediatric otitis media with effusion is a common and costly condition. Although chiropractors have anecdotally claimed success in treating otitis media, there is little research to support their claims. Objective: A pilot study was undertaken for the purpose of assessing the feasibility of conducting a full-scale randomized clinical trial investigating the efficacy of chiropractic spinal manipulative therapy (SMT) for children with chronic otitis media with effusion. Methods: This study was a prospective, parallel-group, observer-blinded, randomized feasibility study. Twenty-two patients, ages 6 months to 6 years, received either active chiropractic SMT or placebo chiropractic SMT. Otoscopy and tympanometry were used to create a middle ear status profile, and daily diaries were collected. Results: Five newspaper advertisements over 6 months generated 105 responses. Twenty patients subsequently qualified and were randomized into the study. Collection of tympanometric and otoscopic data proved to be challenging. Compliance with the treatment and evaluation protocols and daily diaries was excellent. There were no reports of serious side effects as a result of either the active or placebo chiropractic treatments. Conclusion: Recruitment for a randomized controlled trial is feasible and could be enhanced by medical collaboration. Patients and parents are able and willing to participate in a study comparing active SMT and placebo SMT. Parents were extremely compliant with the daily diaries, suggesting that similar quality-of-life and functional status measures can be successfully used in a larger trial. We found the objective outcomes assessment involving tympanometry and otoscopy extremely challenging and should be performed by experienced examiners in future studies. (J Manipulative Physiol Ther 1999; 22:292–8)

Early-response cytokine expression in adult middle ear effusions

Various cytokines are presently known to be associated with the regulation of inflammatory responses. In pediatric otitis media, cytokines that correlate with various degrees of inflammation are present in middle ear effusions as inflammatory mediators. The present study was undertaken to examine the potential role of the early-response cytokines, interleukin-1β and tumor necrosis factor-α, in adult otitis media. Fifty-nine adults with otitis media underwent tympanocentesis, and the effusion specimens were analyzed for the presence of both cytokines by enzyme-linked immunosorbent assay methods. Eighty-eight percent of the effusions were serous in nature. Sixty-seven percent of the patients had a known history of head and neck malignancy and radiation to the temporal bone. Twelve percent of the effusions were positive for interleukin-1β expression, compared with 85% of effusions in children with otitis media. Eight percent of the effusions contained tumor necrosis factor-α, compared with 85% of those collected in pediatric otitis media. All of the specimens that contained tumor necrosis factor-α also contained interleukin-1β. In the present study, there was no correlation with head and neck malignancy/radiation or the clinical degree of inflammation with the presence of either cytokine. We conclude that adult otitis media is associated with lower expression of an acute inflammatory response, as judged by the levels of interleukin-1β and tumor necrosis factor-α in the effusions. Additionally, adult otitis probably represents a less severe and more chronic inflammatory state in comparison with pediatric otitis media. Further analysis of inflammatory mediators in adult otitis media is necessary to evaluate the contribution of cytokines in relation to various etiologic factors. (Otolaryngol Head Neck Surg 1998;119:342-5.)

Don??t use expensive antibacterials in paediatric otitis media

Don??t use expensive antibacterials in paediatric otitis media

ANTIBIOTICS QUESTIONABLE FOR ACUTE OTITIS MEDIA.

Otitis media is common in children, but whether it should be treated with antibiotics isn't clear. These investigators reviewed six randomized trials (conducted in several countries between 1958 and 1994) of antibiotics vs. placebo for acute pediatric otitis media. Sixty percent of …

Effects of air pollution on the upper respiratory tract of children.

The impact of the environment on the upper respiratory tract of children has become an issue of recent interest. Sulfur dioxide causes nasal congestion in children as well as an increase in both mast cells and lymphocytes in nasal lavage fluids. Chlorpheniramine blocks the effect of sulfur dioxide on the nasal mucosa. Ozone exposure results in nasal congestion, increased levels of histamine, neutrophils, eosinophils, and mononuclear cells in nasal lavage fluid. No data are available on the effects of nitrogen dioxide or wood-burning stoves on the upper respiratory tracts of children. Formaldehyde in sufficient concentrations causes upper airway irritation; however, no data are available on its long-term effects. Detriments in air quality cause adverse changes in the lower respiratory tracts of susceptible individuals. The effects on the upper respiratory tract are more difficult to document. There may be a causal relationship, but definitive proof of whether air pollution results in significant increases in pediatric otitis media, sinusitis, rhinitis, and pharyngitis has yet to be demonstrated.

Twice-daily cefprozil ???suitable??? for paediatric otitis media

Twice-daily cefprozil ???suitable??? for paediatric otitis media

Comparative safety and efficacy of clarithromycin and amoxicillin/clavulanate in the treatment of acute otitis media in children

Clarithromycin is a new macrolide antibiotic with a wide spectrum of activity that includes the pathogens commonly causing pediatric otitis media. This randomized, investigator-blinded, multicenter trial compared the safety and efficacy of clarithromycin and amoxicillin/clavulanate in the treatment of acute otitis media in patients ages 6 months to 12 years. A total of 338 patients with acute otitis media diagnosed by otoscopy were randomized to receive clarithromycin 7.5 mg/kg twice daily, maximum 500 mg twice daily (n = 161), or amoxicillin/clavulanate 13.3 mg/kg three times daily, maximum 500 mg three times daily (n = 177), for 10 days. Treatment groups were comparable with respect to demographics, severity of infection and number of previous episodes. Efficacy was assessed by clinical examination performed within 48 hours of finishing study medication. A successful clinical response was seen in 90% (121 of 135) of evaluable clarithromycin patients vs. 92% (133 of 145) of evaluable amoxicillin/clavulanate patients (P = 0.681). Clinical failure or relapse (Posttreatment Days 0 to 4) occurred in 10% (14 of 135) of clarithromycin-treated patients vs. 8% (12 of 145) of amoxicillin/clavulanate-treated patients. Gastrointestinal adverse events were the most commonly reported in both groups. Of these events diarrhea was the most frequent, occurring in 12% (19 of 161) of clarithromycin and 32% (57 of 177) of amoxicillin/clavulanate-treated patients (P < 0.001). These results indicate that the efficacy of clarithromycin oral suspension was comparable with amoxicillin/clavulanate oral suspension in the treatment of acute otitis media in children. Clarithromycin was better tolerated than amoxicillin/clavulanate with a lower incidence of gastrointestinal side effects.

Clarithromycin - new agent for otitis media/M. avium complex

Clarithromycin is an acid-stable erythromycin derivative that was developed by the Japanese company Taisho and has subsequently been licensed to Abbott on a worldwide basis. It has already received approval for upper and lower respiratory tract infections and for skin and soft tissue infections. The next indication for which Abbott hopes to receive approval from the FDA is paediatric otitis media. For this condition, antibacterial treatment is indicated to relieve symptoms, and hasten resolution of the infection. However, studies performed during the 1980s demonstrated the emergence of resistance to standard therapeutic agents such as amoxicillin amongst bacteria which commonly cause otitis media. Thus, the quest for alternative therapies began.

The effect of middle ear effusions from children on in vitro ciliary activity

In an attempt to clarify the effect of middle ear effusions (MEEs) on ciliary activity, the ciliary beat frequency (CBF) of nasal epithelium from normal subjects was determined following incubation in Hanks' solution containing effusions from pediatric otitis media with effusion. Both serous and mucoid types of effusions increased CBF 15 min after incubation. The mucoid type of effusion was then found to decrease CBF 6 h after incubation. Since the pH and osmotic pressure of the solution containing the effusions were within the physiological ranges for normal ciliary beating, our findings show that MEEs can influence CBF in vitro.

Viscoelastic properties of middle ear effusions from pediatric otitis media with effusion and their relation to gross appearance

The viscosity and the elasticity were measured in 146 individual middle ear effusions (MEEs) from 93 children with otitis media with effusion (OME). The effusions were classified into serous or mucoid type by their macroscopic appearance. The distribution of elasticity showed two peaks, corresponding to the peaks of serous and mucoid types of effusions. There were a small number of effusions in the intermediate range of elasticity, where the effusions were most effectively transported by the cilia. These findings suggests that the MEEs of pediatric OME are accumulations of rheologically suboptimal fluid in the middle ear cavity.

Two Alternatives to Ampicillin for Paediatric Otitis Media

Two Alternatives to Ampicillin for Paediatric Otitis Media

Evaluation of cefaclor

The chemistry, pharmacology, pharmacokinetics, bacterial spectrum, clinical use, dosage, adverse reactions, and dosage forms and cost of cefaclor are reviewed. Cefaclor, a congener of cephalexin monohydrate, is a new semisynthetic cephalosporin antibiotic. It is well absorbed when given orally on an empty stomach; absorption is delayed by the presence of food. Although metabolism may play a role in the disposition of cefaclor, elimination is primarily renal. Cefaclor's spectrum of activity is similar to that of cefalexin, including a wide range of gram-negative and gram-positive bacteria; in particular, Escherichia coli, Klebsiella spp., Proteus mirabilis, Salmonella spp., and Haemophilus influenzae are more susceptible to clinically achievable concentrations of cefaclor than cephalexin. Cefaclor has been demonstrated to be effective against beta-lactamase-producing H. influenzae resistant to ampicillin, but further studies are needed to establish the clinical significance of this activity. Efficacy of cefaclor has been demonstrated in urinary tract, upper and lower respiratory tract, and skin and soft tissue infections in adults and children as well as in pediatric otitis media. Adverse reactions, mostly gastrointestinal, are generally mild and occur in few patients. Usual doses are 250-500 mg every eight hours in adults and 20--40 mg/kg/day in children, although this pediatric dose may be two low for otitis media. Clinical superiority of cefaclor over less expensive antibiotics has not been demonstrated.