Prevention Of Acute Otitis Media Research Articles

Streptococcus salivarius Probiotics to Prevent Acute Otitis Media in Children

New approaches for the prevention of acute otitis media (AOM), the most common reason for antibiotic use in children, are needed. To assess the efficacy of the Streptococcus salivarius K12 oral probiotics in the primary prevention of AOM. This double-blind, randomized placebo-controlled clinical trial was conducted from August 1, 2020, to May 31, 2021, at 50 day care centers in the Oulu region of Finland. A total of 827 children aged 1 to 6 years attending day care were included. The exclusion criteria consisted of ongoing antimicrobial prophylaxis or immunodeficiency. The follow-up time was 6 months and was completed on May 31, 2021. Data were analyzed from October 24, 2022, to September 16, 2023, based on intention to treat. Eligible participants were randomly allocated to receive 1 daily dose of a S salivarius K12 product or placebo every evening for 6 months. A daily dose was defined as 1 sachet of soluble oral powder for children younger than 3 years or 1 chewable tablet for children 3 years or older containing 1 × 109 colony-forming units of S salivarius K12. The primary outcome was the proportion of children with at least 1 episode of AOM requiring antimicrobial therapy within 6 months of randomization. All physician visits and purchases of antimicrobial drugs were retrieved from the electronic national medical record and prescription register. The primary outcome was met if the legal guardian had purchased an antimicrobial prescription for AOM. A total of 827 children with a mean (SD) age of 4.1 (1.6) years (433 boys [52.4%]) were randomized to S salivarius K12 oral products (n = 413) or placebo (n = 414). Thirty-four children (8.2%) in the S salivarius group and 24 children (5.8%) in the placebo group experienced at least 1 episode of AOM requiring antimicrobial therapy during the 6-month follow-up period (relative risk, 1.42 [95% CI, 0.86-2.34]; proportion difference, -2.44% [95% CI, -5.94% to 1.09%]; P = .17). Time to first AOM episode did not differ between the groups (174 [95% CI, 171-177] days in the S salivarius group vs 176 [95% CI, 173-179] days in the placebo group; P = .18). In this randomized placebo-controlled clinical trial, the daily use of the S salivarius K12 products for 6 months did not reduce the occurrence of AOM. New approaches for primary prevention of AOM among children are needed. ClinicalTrialsRegister.eu Identifier: 2020-001076-14.

Prevalence of acute otitis media in a tertiary care center of Assam

Background: Otitis media is infection of the middle ear cleft, which comprises acute and chronic otitis media and otitis media with effusion. Acute otitis media (AOM) is the second most prevalent pediatric emergency. Aims and Objectives: The aim of the study was to assess the epidemiology and clinical manifestations of AOM cases reported to the ENT OPD. Materials and Methods: A retrospective study was conducted in a tertiary care center of Assam from January 2021 to December 2022. A total of 840 patients from a wide range of socioeconomic strata were included in the study who belong to Upper Assam, parts of Arunachal Pradesh and Nagaland region. Results: Majority (25.8%) of the patients were below the age of 10 years. The age group of 31–40 years (25.2%) was next in line. In the age range of 71–80 years, the least number of patients (0.3%) were observed. The majority (53.09%) of the patients were from Dibrugarh district of Assam. Conclusion: This study has brought to light the prevalence of AOM in this region and the need for the health department to raise public understanding of the significance of a healthy lifestyle in the prevention of AOM, early diagnosis, and treatment.

Acute otitis media in the first two months of life and the impact of pneumococcal conjugate vaccines: A retrospective cohort study.

Information on pneumococcal vaccination's impact on the prevention of acute otitis media (AOM) at very young ages is limited. To define the trends in tympanocentesis-proven AOM incidence, clinical characteristics, microbiology, and antibiotic resistance in infants <2 months of age in southern Israel, before and after the sequential introduction of 7- and 13-valent PCVs. A retrospective population-based cohort study including children <2 months of age diagnosed with AOM at the pediatric emergency room between January 2005-Decmber 2009 (pre-vaccination group, group 1) and January 2013-July 2021 (post-PCV13 introduction, group 2). 160 patients were enrolled, 89 (55.6%) in group 1 and 71 (44.4%) in group 2. The mean incidence of AOM decreased from 1.2 cases/1000 live births for group 1 to 0.45 cases/1000 live births for group 2, P<0.001.130 (81.25%) patients were hospitalized, with higher hospitalization rates in group 1 vs. group 2 (84/89, 94% vs. 46/71, 65%, P<0.001). Hospitalization length was longer in group 1 vs. group 2 (4.07±4.09 days vs. 2.70±1.82 days, P=0.021). Positive MEF cultures were reported in 94/160 (58.75%) patients, with a decrease in positivity rates between the 2 groups (71/89, 80% vs. 23/71, 32%, P<0.001). S. pneumoniae was the most common pathogen (55/94, 58.5%); it was the most frequent pathogen isolated in group 1 (46/71, 65%), and the second most common pathogen in group 2 (9/23, 39%), P=0.03. A significant increase was recorded in the percentages of patients with negative MEF cultures (from 21% to 68%, P<0.001). The introduction and implementation of PCV13 in southern Israel was associated with a decrease in AOM in children <2 months of age and of S. pneumoniae recovery in these patients and was accompanied by less admissions and shorter hospitalizations. An increase in the proportions of negative bacterial cultures from MEF was recorded during the study period.

Recurrent Acute Otitis Media Environmental Risk Factors: A Literature Review from the Microbiota Point of View

Acute otitis media (AOM) constitutes a multifactorial disease, as several host and environmental factors contribute to its occurrence. Prevention of AOM represents one of the most important goals in pediatrics, both in developing countries, in which complications, mortality, and deafness remain possible consequences of the disease, compared to in developed countries, in which this condition has an important burden in terms of medical, social, and economical implications. The strategies for AOM prevention are based on reducing the burden of risk factors, through the application of behavioral, environmental, and therapeutic interventions. The introduction of culture-independent techniques has allowed high-throughput investigation of entire bacterial communities, providing novel insights into the pathogenesis of middle ear diseases through the identification of potential protective bacteria. The upper respiratory tract (URT) is a pivotal region in AOM pathogenesis, as it could act as a source of pathogens than of protective microorganisms for the middle ear (ME). Due to its direct connection with the external ambient, the URT is particularly exposed to the influence of environmental agents. The aim of this review was to evaluate AOM environmental risk factors and their impact on URT microbial communities, and to investigate AOM pathogenesis from the microbiota perspective.

Serum antibody levels to pneumococcal polysaccharides 22F, 33F, 19A and 6A that correlate with protection from colonization and acute otitis media in children

BackgroundSerotypes 22F and 33F have been added to a new pneumococcal-conjugate vaccine (PCV-15) because of their prevalence in causing invasive pneumococcal diseases (IPD). MethodWe measured anti-polysaccharide 22F, 33F, 19A and 6A antibodies in children before and after pneumococcal colonization and acute otitis media (AOM) episodes caused by these specific-serotypes. A two-step method for construction of correlate of protection (COP) models included using a generalized estimating equation for the relationship between antibody level, age and colonization history followed by logistic-regression modelling that included colonization or AOM episodes as independent variables, and age adjusted antibody level as the predictor. ResultsA vaccine-induced serum antibody level of 0.45 μg/ml for 22F, 0.51 μg/ml for 6A and 4.1 μg/ml for 19A correlated with prevention of pneumococcal colonization by respective serotypes (insufficient number of cases for 33F to find COP against colonization). Antibody levels of 0.25 μg/ml for 22F, 33F and 6A and 2 μg/ml for 19A correlated with prevention of AOM by the respective serotypes. ConclusionsA COP threshold of anti-22F, 33F, 19A and 6A serum antibodies for NP colonization and AOM in young children can be derived using GEE and logistic regression modelling.

Acute viral otitis media: etiology, diagnosis, treatment

Acute otitis media (OSA) is one of the most common diseases in children and adults and the most common cause of antibiotic therapy, often unreasonable. 20–70% of respiratory infections in adults and children is complicated by the development of CCA. Despite the fact that only 10% of CCA has a viral etiology, the vast majority of CCA are also viral-bacterial co-infection. The article presents the main pathogenetic mechanisms of the development of CCA, such as viral and virus-induced. The term “heat-generating” microorganisms is introduced. A review of the most common pathogens of CCA viral and bacterial. An otomicroscopic picture is described based on the generally accepted domestic classification of CCA. The main tympanometric curves and their types during CCA are presented. Much attention is paid to the modern principles of pathogenetic and symptomatic therapy. In particular, local anti-inflammatory and analgesic therapy using ear drops containing lidocaine. Some progress in the prevention of acute otitis media is discussed, which has led to a decrease in the frequency of visits to doctors about otitis media and the appointment of antibiotics. This is due to the widespread use of vaccines, as well as the introduction of “wait-and-see” tactics in mild and moderate cases of CCA without initial antibiotic treatment. Success in reducing the incidence of CCA will depend mainly on preventing the colonization of the nasopharynx by otopathogens, as well as reducing the incidence of viral infections. According to international and domestic recommendations, the basis for the prevention of acute otitis media is vaccination against pneumococcus, hemophilus bacillus and influenza virus.

Italian primary care paediatricians’ adherence to the 2019 National Guideline for the management of acute otitis media in children: A cross-sectional study

IntroductionThe Italian Guideline for the management of acute otitis media (AOM) in children has been recently updated. We conducted a cross-sectional survey to investigate the adherence of Italian primary care paediatricians to the guideline recommendations. MethodsA questionnaire including 13 closed-ended questions was administered to the paediatricians participating in the 24th National Congress of Practical Pediatrics, held in Florence in November 2019. The answers were collected and analyzed. ResultsEight hundred fifty-four out of 1000 questionnaires were collected (85.4%). Most of the participants declared that they did not remove the cerumen (63.9%). Pneumatic otoscope and tympanometry were routinely used by a minority of paediatricians (9.6% and 3.9%, respectively); all the participants declared to routinely prescribe oral analgesic drugs and 97.6% of them considered amoxicillin or amoxicillin/clavulanic acid as the first-choice antibiotic. In an uncomplicated unilateral AOM case, the preferred strategy was immediate antibiotic therapy in children under two years of age (83.1%) and watchful waiting in those >2 years (77.3%). Oral amoxicillin was most commonly prescribed at the 80–100 mg/kg/day (56.6%), in 3 daily doses (87.7%), while amoxicillin/clavulanic acid was equally prescribed at 80–100 or 50 mg/kg/day (47.1%–48.5%), mainly in 2 doses (58.6%). However, both drugs are recommended at a dosage of 80–90 mg/kg/day (calculated on amoxicillin), in 3 daily doses. Although the Guideline recommends ten days of therapy, both drugs were most commonly prescribed for 7–8 days (55.5%–57.7%). Pneumococcal and flu vaccines were recommended only by 41.6% and 31.6% of participants, respectively. ConclusionsOur data suggest adequate adherence of the guideline recommendations considering the preferred antibiotic drug, pain management and the choice between immediate antibiotic therapy and watchful waiting. Conversely, targeted training programs are needed to improve adherence to recommendations on cerumen removal, use of pneumatic otoscopy, correct use of antibiotics in terms of optimal dosage, duration and number of daily administrations, and to implement proper AOM prevention strategies.

No evidence from a systematic review for the use of probiotics to prevent otitis media.

This systematic review evaluates the current evidence for the use of probiotics in the prevention of acute otitis media (AOM) in children. This study is registered with PROSPERO prior to commencement. PubMed, MEDLINE, EMBASE and Cochrane database were searched using relating keywords. All literature was screened to determine relatability to the topic. Review articles were also screened for additional literature. Thirteen studies were found on probiotics and their role in preventing AOM in children. They ranged in quality from poor to moderate. Half (2/4) of the studies that used nasal probiotic formulations showed a significant difference in reducing otitis media, while only a third (3/9) of the studies using oral formulations suggest benefit in reducing AOM. None of the studies demonstrated significant adverse effects from probiotics. The evidence for any effect of probiotics on the prevention of AOM is limited, and the overall low quality of studies makes it difficult to draw definitive conclusions. No serious adverse events were noted, and there is some evidence to suggest possible benefit with nasal probiotic administration.

Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Prevention.

In recent years, new information has been acquired regarding the diagnosis, treatment and prevention of acute otitis media (AOM). The Italian Pediatric Society, therefore, decided to issue an update to the Italian Pediatric Society guidelines published in 2010. The search was conducted on Pubmed, and only those studies regarding the pediatric age alone, in English or Italian, published between January 1, 2010 and December 31, 2018, were included. Each study included in the review was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. The quality of the systematic reviews was evaluated using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 appraisal tool. The guidelines were formulated using the GRADE methodology by a multidisciplinary panel of experts. The importance of eliminating risk factors (passive smoking, environmental pollution, use of pacifier, obesity, limitation of day-care center attendance) and the promotion of breastfeeding and hygiene practices (nasal lavages) was confirmed. The importance of pneumococcal vaccination in the prevention of AOM was reiterated with regard to the prevention of both the first episode of AOM and recurrences. Grommets can be inserted in selected cases of recurrent AOM that did not respond to all other prevention strategies. Antibiotic prophylaxis is not recommended for the prevention of recurrent AOM, except in certain carefully selected cases. The use of complementary therapies, probiotics, xylitol and vitamin D is not recommended. The prevention of episodes of AOM requires the elimination of risk factors and pneumococcal and influenza vaccination. The use of other products such as probiotics and vitamin D is not supported by adequate evidence.

Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Treatment.

New insights into the diagnosis, treatment and prevention of acute otitis media (AOM) have been gained in recent years. For this reason, the Italian Paediatric Society has updated its 2010 guidelines. A literature search was carried out on PubMed. Only pediatric studies published between January 1, 2010 and December 31, 2018 in English or Italian were included. Each included study was assessed according to the GRADE methodology. The quality of the systematic reviews was assessed using AMSTAR 2. The recommendations were formulated by a multidisciplinary panel of experts. Prompt antibiotic treatment is recommended for children with otorrhea, intracranial complications and/or a history of recurrence and for children under the age of 6 months. For children 6 months to 2 years of age, prompt antibiotic treatment is recommended for all forms of unilateral and bilateral AOM, whether mild or severe. Prompt antibiotic treatment is also recommended for children over 2 years with severe bilateral AOM. A watchful-waiting approach can be applied to children over 2 years with mild or severe unilateral AOM or mild bilateral AOM. High doses of amoxicillin, or amoxicillin-clavulanic acid for patients with a high risk of infection by Beta-lactamase producing strains, remain the first-line antibiotics. AOM should be managed on a case-by-case basis that takes account of the child's age, the severity of the episode and whether it is unilateral or bilateral. In patients under 2 years, prompt antibiotic treatment is always recommended.

Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Diagnosis.

In recent years, new progress has been made regarding the diagnosis, treatment and prevention of acute otitis media (AOM). The Italian Pediatric Society therefore decided to issue an update to the previous guidelines published in 2010. Literature searches were conducted on MEDLINE by Pubmed, including studies in children, in English or Italian, published between January 1, 2010, and December 31, 2018. The quality of the included studies was assessed using the grading of recommendations, assessment, development and evaluations (GRADE) methodology. In particular, the quality of the systematic reviews was evaluated using the AMSTAR 2 appraisal tool. The guidelines were formulated using the GRADE methodology by a multidisciplinary panel of experts. The diagnosis of AOM is based on acute clinical symptoms and otoscopic evidence; alternatively, the presence of otorrhea associated with spontaneous tympanic membrane perforation allows the AOM diagnosis. The diagnosis of AOM must be certain and the use of a pneumatic otoscope is of fundamental importance. As an alternative to the pneumatic otoscope, pediatricians can use a static otoscope and a tympanometer. To objectively establish the severity of the episode for the formulation of a correct treatment program, an AOM severity scoring system taking into account clinical signs and otoscopic findings was developed. The diagnosis of AOM is clinical and requires the introduction of specific medical training programs. The use of pneumatic otoscopes must be promoted, as they are not sufficiently commonly used in routine practice in Italy.

Xylitol for the prevention of acute otitis media episodes in children aged 2–4 years: protocol for a pragmatic randomised controlled trial

IntroductionXylitol (or ‘birch sugar’) is a naturally occurring sugar with antibacterial properties that has been used as a natural non-sugar sweetener in chewing gums, confectionery, toothpaste and medicines. In this...

Prospects for vitamin d in prevention of acute otitis media in children

The article presents an overview of the role of vitamin D in prevention of acute otitis media in children. It provides brief pathogenetic justification of the action of vitamin D on the human immune system. The reasons for the urgency of the use of vitamin D supplements in prevention of acute otitis media in children are analysed. Topical issues to further study the problem in paediatric practice are presented.

Acute Otitis Media During Infancy: Parent-reported Incidence and Modifiable Risk Factors.

Age at exposure to acute otitis media (AOM) risk factors such as day care attendance, lack of breastfeeding and tobacco smoke is little studied but important for targeting AOM prevention strategies. Moreover, studies are typically restricted to clinically diagnosed AOM, while a significant subset can occur outside the health care system, depending on the country setting. This study aims to determine risk factor exposure and effect of its timing within the first year of life on parent-reported AOM symptom episodes. In the WHeezing and Illnesses STudy LEidsche Rijn birth-cohort study, 1056 children were prospectively followed during their first year of life. Group day care attendance, breastfeeding and tobacco smoke exposure were recorded monthly and parent-reported AOM symptoms daily. Generalized estimating equations were used to estimate the association between the time-varying risk factors and AOM symptom episodes, while correcting for confounding by indication. The first-year incidence rate of parent-reported AOM was 569/1000 child-years [95% confidence interval (CI): 523-618]. Children who attended day care had higher odds of developing AOM symptom episodes compared with those not attending (odds ratio: 5.0; 95% CI: 2.6-9.6). Tobacco smoke exposure and (a history of) breastfeeding were not associated with AOM. Test for interaction revealed that the effect of day care increased with each month younger in age. First-year day care attendance is a major risk factor for AOM symptom episodes among infants in the community. This adjusted effect estimate is higher than previously reported and is age-dependent. AOM prevention strategies in day care facilities should therefore focus in particular on the youngest age groups.

Acute otitis media in the children: etiology and the problems of antibacterial therapy

The objective of the present review was to summarize the currently available literature data on etiology of acute otitis media in the children, the role of biofilms in the development of this pathology, and sensitivity of its principal causative factors to various antibiotic medications. The secondary objective was to elaborate the practical guidelines for the prevention of acute otitis media in the children.

Randomized controlled trial of juzen-taiho-to in children with recurrent acute otitis media

ObjectiveRecurrent acute otitis media (AOM) in young children is rapidly increasing worldwide. Repeated antibiotic use leads to antibiotic-resistant pathogen development. Complementary and alternative medicine approaches have been suggested as a supplemental treatment option to conventional antimicrobial medicine. This randomized, parallel-group, open-label, non-herbal medicine controlled trial assessed the efficacy of a traditional Japanese herbal medicine, juzen-taiho-to (JTT) for AOM prevention in otitis-prone children. MethodsChildren prone to recurrent AOM aged 6–48 months were recruited from 26 otolaryngology clinics in Japan and received conventional AOM treatment based on Japanese guidelines with or without 2 daily oral doses of JTT (0.10–0.25g/kg/day). The mean number of AOM episodes, coryza episodes, and duration of total antibiotic administration per month were compared during 3-month intervention. ResultsAt least one episode of AOM was diagnosed in 71% of JTT-group and 92% of control participants during follow-up. JTT administration reduced the frequency of AOM episodes by 57% compared with children who received conventional treatment alone (0.61±0.54 vs. 1.07±0.72 AOM instances/month; P=0.005) and also significantly decreased number of coryza episodes (P=0.015) and total antibiotic administration (P=0.024). ConclusionsThis is the first report of recurrent AOM prevention by herbal medication. JTT appears to effectively prevent recurrent AOM in children. Subsequent double-blind studies are needed to confirm the beneficial effects of JTT on recurrent AOM and upper respiratory tract infections.

Honey and beehive products in otorhinolaryngology: a narrative review

Honey and beehive products were rediscovered as an alternative treatment in wounds. The medicinal properties also raised interest of their use in Otorhinolaryngology. To give an overview of the effectiveness of beehive products in Otorhinolaryngology. Narrative. A literature search of the databases PubMed, EMBASE and Cochrane was performed from the last two decades till December 2014. The search terms 'honey', 'propolis' or 'royal jelly' were used. Articles, which evaluated the effectiveness of beehive products in Otorhinolaryngology, were included. The quality assessment of included studies was performed using the Cochrane Collaboration's risk of bias tool. A total of 36 studies were identified and evaluated. Eighteen studies investigated their effect in oral infections, seven in infection of the respiratory tract, six in rhino-sinusal diseases, four investigated the use in tonsillectomy and head and neck surgery and one study explored the preventive effect in otitis media. Honey can be considered as effective (additional) treatment in mucositis, childhood cough, persistent post-infectious cough and after tonsillectomy. Propolis may have a role in the treatment of (aphthous) stomatitis, mouth ulcer and prevention of acute otitis media. Royal jelly showed to reduce mucositis. In the presented studies, beehive products proved to be safe, with only minor adverse reactions. Studies showed to be diverse and had some methodological limitations.

Streptococcus salivarius 24SMB administered by nasal spray for the prevention of acute otitis media in otitis-prone children.

This paper reports the results of the first study in which Streptococcus salivarius 24SMB, a safe α-haemolytic strain capable of producing bacteriocin-like substances with significant activity against acute otitis media (AOM) pathogens, was intranasally administered in an attempt to reduce the risk of new episodes of AOM in otitis-prone children. In this prospective, randomized, double-blind, placebo-controlled study, 100 children aged 1-5 years with histories of recurrent AOM were randomized 1:1 to receive an intranasal S. salivarius 24SMB or placebo twice daily for 5 days each month for 3 consecutive months. Fifty treated children and 47 who received placebo who were compliant with study protocol were followed monthly for 6 months. The number of children who did not experience any AOM was higher among the children treated with the S. salivarius 24SMB preparation than among those in the placebo group (30.0 vs 14.9%; p = 0.076). Moreover, the number of children who received antibiotics during the study period was lower among the children treated with S. salivarius 24 SMB than among those who received placebo (70 vs 83.0%; p = 0.13). Compared with the children who were not colonized by S. salivarius 24SMB after treatment, the number of colonized children who experienced any AOM was significantly lower (42.8 vs 13.6%; p = 0.03). Similar results were observed when the children treated with antibiotics for AOM were analysed (67.8 vs 95.5%; p = 0.029). This study revealed the ability of intranasally administered S. salivarius 24SMB to reduce the risk of AOM in otitis-prone children.

Acute otitis media in children-current treatment and prevention.

Acute otitis media (AOM) is the most common bacterial infection in children and has a very varied clinical spectrum, ranging from spontaneous resolutions to serious complications. The effect of antibiotics in AOM depends on the chosen outcome, but has been shown to reduce pain somewhat, and have a greater beneficial effect in severe cases of AOM. Today, not all episodes of AOM are treated with antibiotics, but most countries have issued guidelines that include an option of watchful waiting in many cases. Prevention of AOM reaches from modification of environmental risk factors to vaccinations and surgery. Conjugate pneumococcal vaccines and influenza vaccines have been shown to somewhat reduce the number of AOM episodes in different groups of children. Grommets, with or without adenoidectomy, are effective at least during the first 6months after surgery.

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

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