Recurrent Acute Otitis Media Research Articles

Bacterial Reservoirs in the Middle Ear of Otitis-prone Children Are Associated With Repeat Ventilation Tube Insertion.

Repeat ventilation tube insertion (VTI) is common in children with recurrent acute otitis media (rAOM). Identifying risk factors associated with repeat surgery will improve clinical management and prevent repeat VTI. Surgical records were assessed at 8 years following VTI surgery for rAOM in children 6-36 months of age. Children were grouped according to detection of bacterial otopathogen in their middle ear effusion (MEE) at the time of VTI, and outcomes for future otorhinolaryngology surgery compared. Age, gender, pneumococcal vaccination status, antibiotic usage, day-care attendance, number of siblings and number of AOM episodes were similar between groups. Of the 63 children who had PCR +ve MEE, 58.7% required repeat VTI compared with 31.4% of the 51 children with no otopathogen detected in their MEE (odds ratio = 3.1, 95% confidence interval [1.4-6.8]; P = 0.004). Nontypeable Haemophilus influenzae (NTHi) was the predominant otopathogen in MEE (79% of all PCR +ve MEE). Respiratory virus detection was not associated with repeat VTI. Presence of bacterial otopathogen, specifically nontypeable H. influenzae, in the middle ear during VTI was a predictor of children at-risk of repeat VTI. Here, we identify a modifiable microbiologic factor for repeat VTI that can be targeted to improve clinical management of rAOM.

Grommets - an update on common indications for tympanostomy tube placement

Children younger than 7 years are at increased risk of otitis media because of their immature immune systems and poorly functioning eustachian tubes that normally ventilate the middle ear space and equalise pressure with the external environment. More than 80% of children have at least one episode of acute otitis media (AOM) before the age of 3 years and 40% experience six or more recurrences by the time they are 7 years old. By the age of 3 years, approximately 7% of children undergo surgery for tympanostomy tube insertion for a range of otitis media issues, most commonly for chronic otitis media with effusion (OME), recurrent AOM, and acute otitis media that persists despite antibiotic therapy. However, tympanostomy tube insertion is associated with risks and remains a controversial practice especially in children with OME of less than three months’ duration and in children with recurrent AOM. Adverse effects associated with tympanostomy tube insertion include those associated with anaesthesia and its complications (laryngospasm, bronchospasm), as well as tube related sequelae such as recurrent (7%) or persistent (16–26%) otorrhoea, blockage of the tube lumen (7%), granulation tissue (4%), premature extrusion of the tube (4%), tympanostomy tube displacement into the middle ear (0.5%) and persistent perforation of the tympanic membrane (1–6%). This article offers guidance for family practitioners wishing to optimise health outcomes in children potentially requiring tympanostomy tube placement.

Turbinate hypertrophy in children with allergic rhinitis: clinical relevance.

Allergic rhinitis (AR) is the most common immune-mediated disorder in childhood as it may affect up to 40% of children. Turbinate hypertrophy (TH) is an important sign as reliably predicts AR both in children and adults. Consistently, nasal obstruction is a very common symptom in AR patients and is closely linked with turbinate hypertrophy. This study investigated 544 (304 males) children with AR to define factors associated with TH. TH was diagnosed in 438 (80.81%) AR children. The multivariate analysis demonstrated a significant association between age, male gender, and recurrent acute otitis media (RAOM), and TH (p-values: 0.0219, <0.0001, and 0.0003, respectively; OR 0.87, 3.97, and 0.22 respectively). In conclusion, this real-life study showed that TH was very frequent in children with AR and age, male gender, and RAOM were significantly associated with TH. (www.actabiomedica.it)

Prevalence, risk factors and management strategies for otological problems in girls with Turner syndrome.

To determine the prevalence and risk factors of ear disease in Turner syndrome (TS), propose an algorithm for future surveillance and recommend preventative strategies. Review of TS patients seen in the West of Scotland between 1989 and 2015, with questionnaire follow-up in 2015. Of 168 girls, median age 27.3 (3.8-47.2) years, ear problems occurred more frequently with 45,X and 45,X/46,XiXq than other karyotypes: 71/103 (69%) versus 23/65 (35%). Recurrent acute otitis media (AOM) first developed at 0-5years in 23 (40%) girls, persisting in 16 (10%) at 5-10years; and first developing at 5-10years in 11 (7%). Persistent otitis media with effusion (OME) first developed at 0-5 and 5-10years in 23 (40%) and 14 (8%) girls. Recurrent AOM was significantly linked with cholesteatoma in 8 (4.9%) girls (7 aged >10years). Permanent hearing loss was documented in 28 girls (16.7%), with 16 (9.5%) receiving hearing aids (bone-anchored in 3). Acute otitis media and OME occur commonly in preschool TS girls and may persist or newly develop in later childhood. Recurrent AOM predisposes to cholesteatoma. Strategies to reduce otological morbidity include: intensive patient education, annual audiology, vaccinations and a randomised trial of antibiotic prophylaxis in high-risk groups.

High concentrations of middle ear antimicrobial peptides and proteins and proinflammatory cytokines are associated with detection of middle ear pathogens in children with recurrent acute otitis media.

Recurrent and chronic otitis media (OM) are often refractory to antibiotics due to bacterial persistence in biofilm within the middle ear. In vitro and in vivo studies have demonstrated that antimicrobial proteins and peptides (AMPs) are bactericidal against otopathogens, indicating potential therapeutic value for recalcitrant OM. We measured concentrations of 6 AMPs and 14 cytokines in middle ear effusion (MEE) from 67 children undergoing ventilation tube insertion for recurrent acute OM. Sixty one percent of children had bacterial otopathogens detected in their MEE, 39% by PCR and 22% by PCR and culture. Groups were defined as: PCR-negative/culture-negative (absence of bacterial otopathogen), n = 26; PCR-positive/culture-negative (presence of nonculturable bacterial otopathogen), n = 26; PCR-positive/culture-positive (presence of culturable bacterial otopathogen), n = 15. Age, antibiotic usage, day-care attendance, presence of respiratory viruses in MEE and number of AOM episodes were similar between groups. AMP and cytokine concentrations were higher in children with bacterial otopathogens in their MEE compared to those with no bacterial otopathogens. Median concentrations of AMPs (except HBD2) were 3 to 56-fold higher in MEE from children with bacterial otopathogens detected in their MEE (P ≤ 0.01). Similarly, median cytokine concentrations (except TGFβ) were >16-fold higher in MEE with bacterial otopathogens detected (P ≤ 0.001). This is the first study to measure AMPs in MEE and together with the cytokine data, results suggest that elevated AMPs and cytokines in MEE are a marker of inflammation and bacterial persistence. AMPs may play an important role in OM pathogenesis.

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.

Impact of the 13-valent pneumococcal conjugate vaccine on the incidences of acute otitis media, recurrent otitis media and tympanostomy tube insertion in children after its implementation into the national immunization program in Turkey

ABSTRACTThe aim of this study was to investigate changes in the incidences of acute otitis media (AOM), recurrent AOM (rAOM) and tympanostomy tube (TT) insertion in children following the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) into the national immunization program (NIP) of Turkey in April 2011. National coverage for the PCV7 was 97% in 2009, 93% in 2010, 96% in 2011 and for the PVC13 was 97% in 2012, 97% in 2013, 96% in 2014, 97% in 2015, 98% in 2016, and 96% in 2017 for Turkish children younger than 12 months of age. A total of 499932 pediatric visits were recorded, and AOM was diagnosed in 23005 (4.6%) children. The incidence of AOM in children ≤5 years of age decreased from 10700/100000 (2011) to 4712/100000 (2017), with a significant decreasing trend (p < .001, r = −0.965). When the mean annual incidences of AOM between the transition period of PCV13 (years 2011/2012) were compared with those of a post-PCV13 period (years 2016/2017) for children ≤5 years of age, the incidence of AOM was found to be decreased by 54% (p = 0.013). The mean incidence of TT insertion was found to be decreased by 65% (p = 0.003) between the transition period of PCV13 and a post-PCV13 period for children ≤5 years of age. On the other hand, rAOM incidence was found to be increased in whole pediatric age groups. Our study showed a significant decrease in the incidences of AOM and TT insertion in children ≤5 years old after implementation of PCV13 in the NIP in Turkey.

Cornelia de lange manifestations in otolaryngology: A systematic review and meta-analysis.

Cornelia de Lange syndrome (CdLS) is a rare genetic disorder. Our goal was to systematically review the literature regarding otolaryngology manifestations of CdLS. We systematically reviewed the PubMed, Embase, CINAHL, Scopus, and Google Scholar databases for original articles of otolaryngology manifestations for patients with CdLS. These articles were analyzed, and pooled prevalence was calculated. We analyzed 1,310 patients included in 35 case series and 34 case reports. Hearing loss was present for many patients (27 studies), with sensorineural hearing loss affecting 40.3% (95% confidence interval [CI]: 17.3-63.4) and conductive affecting 22.7% (95% CI: 5.7-39.7). Recurrent acute otitis media was the most frequent infectious manifestation, with 56.5% (95% CI: 34.1-78.4) in seven studies, followed by recurrent airway infections with 44.1% (95% CI: 11.0-87.1) in five studies. Forty-nine (49.7%) percent of patients (95% CI: 25.9-73.6) in nine studies had dysphagia, and 76.6% (95% CI: 59.8-93.3) in four studies had some degree of dysphonia. Craniofacial anomalies were reported in 30 studies, with micrognathia (53.1%; 95% CI: 34.1-72.1) and high arched palate (70.6%; 95% CI: 56.5-84.8) commonly reported. Additional physical exam abnormalities reported included those involving: lips (76.8%; 95% CI: 65.3-88.4), dentition (65.1%; 95% CI: 27.2-100), mouth (85.5%; 95% CI: 76.2-93.8), and eyelashes (87.1%; 95% CI: 77.2-96.9). Sleep-disordered breathing or obstructive sleep apnea affected 25.8% (95% CI: 11.4-40.2) of patients (7 studies). Airway anomalies were reported in 11 case reports. This is the first comprehensive evaluation of otolaryngologic manifestations in the CdLS literature. Most reported hearing loss and craniofacial anomalies. Sleep disorders occurred in a minority of patients, whereas airway disorders were primarily reported in case reports. These conditions should be further examined given their potential life-threatening implications. 3a Laryngoscope, 130:E122-E133, 2020.

EFFECT OF PASSIVE SMOKING ON OTITIS MEDIA IN CHILDREN- AN OBSERVATIONAL STUDY

Background: Otitis media is a common infection in young children. Multiple studies have looked at the impact of environmental tobacco smoke(passive smoking) on children and the incidence of otitis media infection.&#x0D; Objectives: This study was conducted to evaluate the correlation of environmental and parental smoking on otitis media in children of age range brtween 0-12age.&#x0D; Methods: This was an observational study conducted on 320 clinically diagnosed otitis media in 0-12 year age children. The study was performed in five year period from March 2009 to March 2014. All the patients were observed in routine OPD check up by a single observer. A pre designed Performa was used to record relevent information like patient data, history, clinical findings and investigation report from individual pregnancy.&#x0D; Results: The male predominance was observed. Forth group wass of 9-12 year age with most prevalent patients having either from of disease; this was because of more than three years of exposure to passive smoking. The most Prevalent disease was observed in under proverty line people. Patients were having perental smoking at home were more prevalent to AOM and CSOM. &#x0D; Conclution: The results support a relationship between the exposure of passive smoking abd prevalence of recurrent AOM and CSOM in children.

The effect of adenoid hypertrophy on hearing thresholds in children with otitis media with effusion

IntroductionOtitis media with effusion is common middle ear mucosa disease that can cause hearing loss in children. Adenoid hypertrophy can cause recurrent acute otitis media in addition to otitis media with effusion as a result of eustachian tube dysfunction and primary infection focus. The aim of this study was to investigate the effect of adenoid hypertrophy on the hearing threshold in children suffering from otitis media with effusion. MethodsChildren of school age with otitis media with effusion were included in the study. The size and location of the adenoid tissue were determined by examination with a flexible endoscope. Four adenoid size groups were determined according to the percentage of choanal closure. The coverage was 0–25% in the first group, 26–50% in the second group, 51–75% in the third group and 76–100% in the 4th group. The location of the adenoid tissue in the nasopharynx was divided into three groups. In group A, the adenoid tissue was not in contact with torus tubarius. In group B, the adenoid tissue was in contact with the torus tubarius but did not cover it. In group C, the adenoid tissue covered the torus tubarius completely. Bone and air conduction thresholds were determined using standard procedures. The statistical relationship between the size and location of adenoid tissue and the hearing thresholds was investigated. ResultsThe study was conducted with the 88 ears of 50 children aged 5–15 years. The median values of mean air conduction thresholds at 500 Hz, 1000 Hz, and 2000 Hz in the adenoid tissue size groups 1–4 were 22 dB HL, 20 dB HL, 15 dB HL, and 20 dB HL respectively. The median values of the mean air conduction thresholds were 20 dB HL, 20 dBHL and 18 dB HL in the adenoid location group A-C, respectively. No significant correlation was found between the groups (p:0.213) and the relevant hearing values (p:0.670). Type B tympanogram was identified in 46 ears and type C tympanogram in 42 ears. The mean hearing thresholds were significantly higher in the ears with a type B tympanogram in the otitis media with effusion cases. (P < 0.001).There was no significant correlation between the duration of effusion and the adenoid size (p:0.931), adenoid location (p:0.626) and hearing threshold (p:0.815). ConclusionWe concluded that adenoid tissue size and location have no effect on hearing thresholds and the duration of effusion in otitis media with effusion. We suggest caution before deciding on adenoidectomy in otitis media with effusion cases. Adenoidectomy should not be performed in children over 4 years of age unless there is a definite indication such as nasal obstruction or chronic adenitis.

Supervised Nasal Saline Irrigations in Otitis-Prone Children.

Objectives: To retrospectively investigate the impact of supervised daily nasal saline irrigations (NSI) with 0. 9% saline solution in children with a history of recurrent acute otitis media (RAOM).Methods: A retrospective pilot study was planned to evaluate the possible effect of supervised NSI in reducing the number of acute otitis media (AOM) episodes in otitis-prone children aged 1–5 years, compared to children not instructed to correct NSI performance.Results: Analysis was based on the data contained in 173 charts (57.3% males, mean age of 30.9 ± 7.3 months). 52.0% of children had not been instructed to perform NSI, while the remaining (48.0%) patients had received supervised NSI. At the 4-months follow-up visit a significant reduced number of AOM episodes (1.03 ± 0.14 vs. 2.08 ± 0.16; p < 0.001) as well as antibiotic treatments (1.48 ± 0.17 vs. 2.59 ± 0.18; p < 0.001) was documented in children receiving supervised NSI compared to those not instructed for NSI performance.Conclusions: These data suggest that NSI should be considered in the therapeutic management of children with RAOM, and should be routinely prescribed as a daily adjunctive treatment to reduce acute infectious exacerbations in otitis-prone patients. Accurate parents training is crucial in order to improve children compliance and treatment effectiveness.

Pneumococcal conjugate vaccines for preventing acute otitis media in children.

Pneumococcal conjugate vaccines for preventing acute otitis media in children.

Role of Biofilms in Children with Chronic Adenoiditis and Middle Ear Disease.

Chronic adenoiditis occurs frequently in children, and it is complicated by the subsequent development of recurrent or chronic middle ear diseases, such as recurrent acute otitis media, persistent otitis media with effusion and chronic otitis media, which may predispose a child to long-term functional sequalae and auditory impairment. Children with chronic adenoidal disease who fail to respond to traditional antibiotic therapy are usually candidates for surgery under general anaesthesia. It has been suggested that the ineffectiveness of antibiotic therapy in children with chronic adenoiditis is partially related to nasopharyngeal bacterial biofilms, which play a role in the development of chronic nasopharyngeal inflammation due to chronic adenoiditis, which is possibly associated with chronic or recurrent middle ear disease. This paper reviews the current evidence concerning the involvement of bacterial biofilms in the development of chronic adenoiditis and related middle ear infections in children.

Rituximab-induced IgG hypogammaglobulinemia in children with nephrotic syndrome and normal pre-treatment IgG values.

BACKGROUNDIn paediatric patients with complicated nephrotic syndrome (NS), rituximab (RTX) administration can induce persistent IgG hypogammaglobulinemia among subjects showing low basal immunoglobulin G (IgG) levels.AIMTo evaluate the effect of RTX on IgG levels and infections in patients with complicated NS and normal basal IgG levels.METHODSWe consecutively enrolled all patients with complicated NS and normal basal IgG levels undergoing the first RTX infusion from January 2008 to January 2016. Basal IgG levels were dosed after 6 wk of absent proteinuria and with a maximal interval of 3 mo before RTX infusion. The primary outcome was the onset of IgG hypogammaglobulinemia during the follow-up according to the IgG normal values for age [mean ± standard deviation (SD)].RESULTSWe enrolled 20 patients with mean age at NS diagnosis of 4.2 ± 3.3 years. The mean age at the first RTX infusion was 10.9 ± 3.5 years. Eleven out of twenty patients (55%) developed IgG hypogammaglobulinemia. None of these patients showed severe or recurrent infections. Only one patient suffered from recurrent acute otitis media and underwent substitutive IgG infusion. Three patients undergoing only the two “starting doses” experienced normalization of IgG levels. Using Kaplan-Meier analysis, the cumulative proportion of patients free of IgG hypogammaglobulinemia was 57.8% after the first RTX dose, 51.5% after the third dose, 44.1% after the fourth dose, and 35.5% after the fifth dose.CONCLUSIONRTX can induce IgG hypogammaglobulinemia in patients with pre-RTX IgG normal values. None of the treated patients showed severe infections.

SAT-217 A Spontaneous and Uneventful Pregnancy in a Turner Syndrome Patient with 45,X[22]/46,X,+Mar[2]/46,Xx[1] Mosaicism: Case Report and Literature Review

Case report: Our patient was first evaluated at 5 years old (yo) because of short stature (height standard deviation score (SDS) -2.4) and recurrent acute otitis media. Her karyotype was 45,X and she did not have cardiac or renal malformations. She was treated with oxandrolone 0.0625 mg/kg/d for 20 months starting at chronological age (CA) 9y 8mo and then with growth hormone (GH) 50 µg/kg/d for 3 years starting at 12 yo, reaching an adult height of 146 cm. She had spontaneous thelarche with CA 11y 11mo and spontaneous menarche at 14y 6mo of age. Her menstrual periods, which were initially regular, became irregular and at 19 yo she started to use contraceptive pills to regulate them. She got married at 25 yo and adopted her first daughter when she was 29 yo. Since her LH and FSH had always been normal before anticonceptional use and became suppressed after its start, we discontinued it when she was 29 yo to reevaluate her ovarian function and asked for a new karyotype. Her LH, FSH and her menstrual periods went back to normal and she decided to try for a spontaneous pregnancy. Cardiac /aortic MRI was normal and pregnancy was allowed. Her new karyotype was 45,X[22]/46,X,+mar[2]/46,XX[1] and Y chromosomal material was not detected. At 32 yo she became pregnant. Standard blood examination and first trimester ultrasonography were performed without abnormal findings. She was then monitored by a high-risk pregnancy team and cardiologist. At 38 weeks of gestation, a cesarean section was performed because of cephalopelvic disproportion. She delivered a healthy female infant with a 46,XX karyotype. Literature review: More than a 100 cases of spontaneous pregnancies in patients with Turner syndrome (TS) were reported in literature. These patients had spontaneous thelarche and menarche and most of them had mosaicisms involving a 46,XX lineage, although there are reports of spontaneous pregnancies in patients with 45,X monosomy, isochromosome or ring X and mosaicisms for other cell lineages. Most newborns have a normal 46,XX or 46,XY karyotype and no abnormalities in physical examination. However, there is a higher risk of miscarriage especially during the first trimester of gestation (between 30 and 45%) and a higher prevalence of Turner syndrome in the offspring. Furthermore, other unfavorable outcomes apparently unexplained by the presence of Turner syndrome in the mother were described such as Down syndrome, atypical genitalia, cerebral palsy, hydrocephalus, cleft lift and palate and congenital tumors. There are also risks for the mother, especially involving pregnancy-induced hypertensive disorders, which can increase the risk of aortic dissection, but also a higher risk of gestational diabetes. Conclusion: Spontaneous pregnancies in TS patients occur mainly in patients with mosaicisms and should be monitored by obstetricians and cardiologists with experience in dealing with these patients.

Correlation between Subjective and Linear Measurements of The Palatal Airway on Lateral Cephalometric Radiography

Introduction: hypertrophied adenoid tissue is one of the most common health problems that occurs in childhood that results in many symptoms including 1. Nasal obstruction. 2. Mucoid, mucopurulent nasal discharge and postnasal discharge 3. Snoring and obstructive sleep apnea. 4. Recurrent acute otitis media (A.O.M). Objective: to evaluate the correlation between subjective and linear measurements of palatal airway on lateral cephalographs. Patients and Methods: Diagnostic lateral cephalometric imaging study that took place from March 2017, to July 2018. 200 Children with chronic mouth breathing (116 boys and 84 girls), with age range from 2 to 14 years, were enrolled in this study. Patients were grouped into three groups according to age: a- 2 - <6 years were 84 patients (42%). b- 6 - <10 years were 76 patients (38%). c- 10 – 14 years were 40 patients (20 %). Results: The age was inversely correlated with the grade of airway obstruction. The correlations between the palatal airway grading with the shortest adenoid distance (SAD) and the most convex adenoid distance (CAD) were r= -0.826 and r= -0.424, respectively, which is statistically significant. The relation between SAD and CAD was directly proportional to each other accounting for correspondence of evaluation in more than 50% of the population which is statistically significant. Conclusion: subjective grading of palatal airway obstruction correlates with the objective measurements of SAD and CAD. Although both methods are reliable in measurement particularly the more severe obstructions, SAD is a more favorable objective tool.

Preventing unnecessary tympanostomy tube placement in children

ObjectiveIn 2013 the American Academy of Otolaryngology published tympanostomy tube guidelines for children; Action Statement 6 recommends against tube placement without middle ear effusion (MEE) at time of assessment. To date, little research has directly evaluated this recommendation in reducing the need for ear tubes. We evaluated the effectiveness of this recommendation and potential risk factors that influence the success of watchful waiting. MethodsRetrospective chart review collecting demographics, daycare status, smoking exposure, and time of year of visit. Children aged 6 months to 12 years without MEE on presentation, but with 3 or more episodes of acute otitis media (AOM) in 6 months or 4 or more episodes in 12 months, were assigned to watchful waiting (WW) treatment. These patients were followed every 4 months or returned sooner with additional infections. Any continued AOM, or MEE on follow up leading to tube placement, defined WW failure. Results123 patients met criteria, with 81 still in WW to date (66% success rate). 42 children failed WW and received tympanostomy tubes (34% failure rate). There were no statistically significant associations between age, race, gender, smoking exposure, daycare, or month of presentation between children who failed WW compared to children receiving tubes. ConclusionsTympanostomy tube guidelines mitigate unnecessary tube placement in a majority of children with recurrent AOM without MEE. To our knowledge, this is the first study supporting the 2013 recommendations, with a 66% success rate. Additionally, no significant associations between modifying risk factors in those who failed watchful waiting were identified.

A study on the efficacy of prophylactic antibiotics in recurrent acute otitis media

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; To study the efficacy of broad spectrum antibiotics in the prophylaxis of recurrent acute otitis media.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 86 patients of age group between 2 and 15 years with history of recurrent otitis media were enrolled to study the efficacy of the prophylactic antibiotics used in this condition. The children were treated with amoxicillin or azithromycin during the acute episode. Then they were divided equally into two groups and assigned to receive amoxicillin in one group and azithromycin in the other group at one third the therapeutic dose as prophylaxis for 6 months. The children were evaluated at the end of every month and recurrent episodes if any, was documented. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; At the end of 6 months it was observed that prophylactic antibiotics were more effective in the younger age group of 2-7 years. Efficacy rates of 87.5% with azithromycin and 77.4% with amoxicillin were noted.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; As azithromycin is given once a week compared to amoxicillin which is given daily and was found to be equally effective as a prophylactic drug in recurrent acute otitis media with a better compliance, it is a good alternative to amoxicillin as a prophylactic antibiotic. Proper dosage goes a long way in bringing down resistance to the therapeutic agents.&lt;/p&gt;

A study protocol on comparative randomised controlled trial of Homoeopathy -vs- allopathy in acute otitis media and its recurrence in Children

Background: Acute otitis media (AOM) is one of the most common acute infections in children, and injudicious prescription of antibiotics may lead to increase of antibiotic-resistant cases. Homoeopathic treatment may provide a safer and more effective treatment. Objective: Earlier, a pilot study conducted by the Central Council for Research in Homoeopathy (CCRH) on eighty patients at a single centre showed non-inferiority results. This study shall be undertaken to substantiate the earlier findings. Methods: This will be an open-label, non-inferiority, randomised controlled (parallel arm) trial to be conducted on children in the age group of 2–12 years, suffering from AOM. The trial will include 240 children; each participant shall be randomly selected to receive either individualised homoeopathic medicine or symptomatic allopathic medicine. In case a child does not have ≥50% improvement with assigned treatment on day 3, he/she shall be given antibiotics. Children shall be treated/followed up for a period of 1 year to check recurrence, if any, in both the groups. The primary outcomes are changes in the Tympanic Membrane Examination Scale and Acute Otitis Media-Severity of Symptoms scale, time to improvement in pain through the Facial Pain Scale-Revised between the groups and recurrence (number of episodes, intensity and duration) of AOM between the groups at 1 year. Discussion: The study will consolidate the findings observed during a pilot study conducted by the CCRH at Jaipur, India. It is proposed to compare the role of individualised homoeopathy over allopathy in the treatment of AOM and to assess its role in controlling the recurrence.

Evaluating short and long term outcomes following pediatric Myringoplasty with Gelfoam graft for tympanic membrane perforation following ventilation tube insertion

BackgroundMyringotomy with ventilation tube (VT) insertion to treat recurrent acute otitis media and chronic secretory otitis media has become one of the most common surgical procedures performed in children. Although contemporary literature has detailed the various patient and perioperative factors that affect successful pediatric myringoplasty, there is still limited evidence surrounding the increasing number of graft material options. In particular, gelfoam patching has arisen as a simple and efficient modality for perforation closure, but has a paucity of evidence particularly in pediatric cohorts. Our study aims to evaluate the clinical and audiometric outcomes following gelfoam myringoplasty for TMP following prolonged VT insertion in an urban pediatric population.MethodsA retrospective review of pediatric patients who underwent myringoplasty between 2013 and 2018 following ventilation tube insertion. Patient demographics, comorbidities, and graft material were correlated with audiometric and clinical outcomes on follow up examination.ResultsOne hundred twenty patients underwent myringoplasty, with 61 (50.8%) males with a mean age of 8.9 years old. 101 (84.2%) of patients eventually underwent successful tympanic membrane (TM) closure, with 93 (77.5%) demonstrating closure at initial follow up. In the gelfoam cohort, 77 (90.6%) of patients demonstrated successful TM closure at initial follow up. Overall mean time to closure was 5.6 (standard error (SE) 0.9) months. A multivariate Cox proportional hazards model demonstrated none of the covariates including graft material significantly affected TM closure. Mean change in air conduction threshold were comparable between graft materials.ConclusionsPediatric myringoplasty with gelfoam graft material is a safe and viable alternative with favorable short and long term clinical and audiometric outcomes.