Recurrent Acute Otitis Media In Children Research Articles

Postero-superior tube in a grooved bone vs. transtympanic tube for middle ear ventilation: a retrospective study comparing outcomes in the Lebanese pediatric population

Background Myringotomy with trans-tympanic T-tube (TTT) placement is the most common surgical procedure performed in children. Finding a technique that provides longer aeration periods, lower complications rates, and less need for subsequent interventions will help the healthcare system from preventable events. Objectives To compare the efficiency and complications rates of the traditional TTT to those of the novel postero-superior tubes in a grooved bone (TGB) for long-term middle ear ventilation in children suffering from recurrent acute otitis media (RAOM), or chronic otitis media with effusion (COME). Methods A total of 200 pretreated ears (96 by TGB and 104 by TTT), were examined after at least 3 years. Data concerning tube condition, and ear outcomes were collected. Pre- and post-operative audiograms were also performed. Results TGB remained in place for longer periods, and it resulted in significantly lower rates of persistent tympanic membrane (TM) perforation (0% vs. 30.8%), TM retraction (14.6% vs. 32.7%), myringosclerosis (12.5% vs. 38.4%), otorrhea (29.2% vs. 52.9%), and need for topical antibiotics (31.3% vs. 51%). It has also resulted in more significant reduction in the air–bone gap on audiograms. Conclusions and significance TGB could be an effective and safe option for middle ear ventilation following COME or RAOM in children.

Current views on the treatment and prevention of recurrent acute otitis media in children (review of clinical recommendations)

Recurrent acute otitis media (RAOM) represents at least 3 or more separate episodes of acute otitis media within 6 months or four or more episodes over a 12-month period. The incidence of recurrent otitis media varies from 5 to 30% and does not tend to decrease. Until now, the questions of conservative and surgical treatment of patients remain unsolved. One of the main methods of treatment is antimicrobial therapy. Recently, the treatment of recurrent otitis media is complicated by the increasing acquired resistance of bacteria to antimicrobial drugs. There is also no consensus on the need for and scope of surgical interventions for children with RAOM. The authors in their article cite existing modern approaches to the prevention and treatment of RAOM in 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.

The modern possibilities of diagnostics and treatment of recurrent otitis media in children

The incidence of recurrent acute otitis media (RAOM) is between 5-30% of the population and has no tendency to decrease. The purpose of this study was to improve the efficiency of diagnosis and treatment of RAOM in children. In carrying out this work were as follows: to establish the incidence of herpes simplex virus, Epstein-Barr virus, cytomegalovirus in children with recurrent otitis media, define the clinical features of RAOM in children with identified markers of active herpes infection and develop an algorithm for the diagnosis and treatment children with recurrent otitis media and markers of active herpes infection. According to the survey markers of herpes infections in children with RAOM identified in 63,8% of cases, mainly active EBV infection is diagnosed – 46,7%. The clinical picture of RAOM in children with markers of active herpes infection characterized by a prolonged course of the disease for more than 7 days – 96,7% (p < 0,05), intoxication more than 3 days – 93,3% (p < 0,05) , obstruction of nasal breathing – in 80,0% (p < 0,05), regional lymphadenitis – in 76.7% of cases (p <0,05), the reaction temperature 38–39 ° C – in 63,3% of cases (p < 0,05). We have developed an algorithm of diagnosis and treatment of children with recurrent otitis media with identified markers of active herpes infection allows to conduct the anti-viral therapy and prevent complications.

Efficacy of ceftibuten in 5 versus 10 days treatment of recurrent acute otitis media in children

Objective: in recurrent acute otitis media (AOM) several alternative treatments are suggested, e.g. cephalosporins. Information about the optimal duration of treatment in recurrent AOM is sparse. The aim of the present study was to compare the efficacy of ceftibuten in 5 versus 10 days treatment in recurrent AOM in children. Methods: this was a single-blind (doctor blinded), randomized, multicentre study with two parallel groups. Eleven investigators at six centres in the west of Sweden enrolled a total of 180 patients. Outpatients with a new clinical AOM within 1 month were randomized to 5 or 10 days treatment with ceftibuten, 9 mg/kg/day, as a single dose. Results: the mean age of the patients was 1.2 years (range 6 months–8 years). The patients had on average had three antibiotic treatments during the preceding 12 months. The recurrence rates in the 5- and 10-day groups were 21.4 and 4.5%, respectively, at first follow-up visit day 12 ( P=0.001). The total recurrence rates between the two groups during the whole follow-up period of 40 days, 35 and 30%, respectively, did not differ significantly. The rate of recurrence did not correlate to nasopharyngeal findings of Streptococcus pneumoniae or Haemophilus influenzae. Pneumococci with decreased susceptibility to penicillin were found in 5% of all pneumococci, and beta-lactamase producing H. influenzae in 8%. Adverse events were reported less frequently in the 5- compared with the 10-day treatment group. Conclusion: this study on young children with recurrent otitis media has shown no statistical difference between ceftibuten given once daily for 5 and 10 days as determined on day 40. The 10-day treatment was significantly better at early follow-up.

Exposure to environmental tobacco smoke as a risk factor for recurrent acute otitis media in children under the age of five years

Exposure to environmental tobacco smoke (ETS) has remained a controversial risk factor for otitis media in children. This study evaluates the association between exposure to ETS and recurrent acute otitis media (RAOM) in 85 cases and 85 age and gender matched controls under the age of 5 years. Cases and controls were obtained from outpatient otolaryngology and ophthalmology clinics, respectively, at the Children's Hospital of Eastern Ontario. Cases were defined as having four or more physician documented AOM episodes in the preceding 12 months and controls were otitis free in the prior 12 months. Exposure status was assessed via parental questionnaire. Controlling for other risk factors (via conditional logistic regression), such as daycare attendance, socioeconomic status, prematurity and family history of otitis media, a significant association between ETS and RAOM was evident (odds ratio = 2.68, 95% CI = 1.27–5.65). When categorized, a significant exposure response relationship between increasing level of exposure to ETS and increased risk of RAOM was evident. The population etiologic fraction indicated that up to 34% of RAOM cases may be accounted for by ETS exposure. We conclude that exposure to ETS is an important and modifiable risk factor for RAOM in children under the age of 5 years.

Prophylaxis for recurrent acute otitis media: a Brazilian study

We enrolled 60 children with recurrent acute otitis media (AOM) in a study of the effectiveness of antimicrobial prophylaxis. All children were entered into the study following an acute episode of infection treated with amoxacillin (AMX) for 10 days. Following therapy, the children were re-examined, and then randomly assigned to receive either trimethoprim-sulfamethoxazole (TMP-SMX), amoxacillin (AMX) or a placebo (PLA). Twenty children were included in each group. Each drug was administered once a day at bedtime, at 1/3 the therapeutic dose, for 3 months. Children were re-evaluated with pneumootoscopy during episodes of acute illness and with pneumootoscopy and impedance tympanometry (TYMP) at monthly intervals. We observed a significantly increased rate of recurrent AOM in children receiving placebo compared with those who received antibiotics (50% vs. 17% P < 0.005). Both prophylactic antibiotics were equally effective in preventing recurrent AOM (recurrence rate 20% TMP-SMX, 15% AMX). We also observed that recurrences in children receiving placebo occurred earlier in the study period than in those receiving antibiotics. These results suggest that antimicrobial prophylaxis in children with recurrent acute otitis media is effective in reducing subsequent disease. The similar efficacy of both antibiotics tested suggests that the less expensive agent should be used.